The Law of Nature

In all my studies about pandemics I would always think about what one would look like today, we have made so many scientific advances since the 1918 flu but it’s now clear one thing hasn’t changed and that’s human behavior.

My dad talks about getting taken to the gymnasium when he was a kid to get his polio vaccine, and how grateful his mom was that there was one available. Polio killed but even more so it maimed in a ferocious way that children were put in iron lungs or if they were lucky only wheel chairs for the rest of their lives. The first big outbreak happened in 1916 in New York City, before that it had circulated but did not strike in the way it did that year. Until a vaccine was created in 1955, theaters and pools would shut down every “polio season” as they were often seen as hot spots in an attempt to prevent the spread. Those who could leave crowded cities often would escape to the country side in an attempt to avoid it and children often had to carry records showing that they were not infected with it. The March of Dimes came out of polio research and really spurred early philanthropy beyond the ultra wealthy. FDR took it upon himself to call on Americans to send dimes to help fund polio research (hence the name). Even when there were no known cures people would seek out remedies, FDR would escape to a bath house down in Georgia believing that the water helped with his rehabilitation (probably an early form of water therapy).

What was once a potential death sentence or a life filled with disability has been almost completely eradicated worldwide, there are less than 200 cases globally but without a vaccine it’s estimated that 17 million people who are otherwise healthy at this moment would be paralyzed. As of 2017, there were three individuals in the US who still depended on an iron lung to survive, which is one of the most inspiring and also heartbreaking medical devices we have. This article does a great job of painting the picture of those three lives. In the peak year of 1952, 60,000 cases of Polio happened in the US with 3,000 people dying, and an additional 21,000 paralyzed as a result. Polio gets into the body through the mouth then grows in the intestines, it can then travel into the blood stream reaching the nervous system where there it will attack the spinal cord or the brain, where it can cause paralysis. The death like most viral infections is not pretty, imagine a 6 year-old gasping for breath as their lungs become paralyzed and they essentially drown in their own secretions, parents only able to offer some comfort as they cradle their head as the rest of the body is in an iron lung working to force them to breath. Devastating. Jonas Salk started trials of a vaccine in 1953 (beginning with his own children) and by 1960s the reoccurring epidemics were 97% gone.

Why am I talking about polio, well with the current pandemic feel like I can finally spew out all this random knowledge about other diseases, and I still have a book due to the Notre Dame Library about it. But because I think a lot about polio right now with the discussion of schools opening up because polio mostly impacted younger children– but also if at it’s peak it killed 3,000/year by today’s measure we would have never focused on a remedy so maybe there is a lesson to learn about how society acted towards life during that time. There aren’t a lot of articles out there about movements during polio that contested the closure of areas; but I’m sure some mothers were exasperated when getting to the pool to realize it’s closed down and all the kids want to do is go for a swim. COVID-19 fortunately does not strike kids in the same way as adults and elders, or at least that is what current studies show but we’re still responding in real time to the virus so we still don’t know everything about it (the polio vaccine did a double blind study with 1.8 million school children). The most recent data shows that kids under 10 aren’t big spreaders of the virus, but with 1/3 of the cases in Florida being children that might change. A study that just came out of South Korea (n=65,000) shows that kids ages 10-19 are just as effective at spreading COVID-19 as adults (still limitations within the study). Those kids who are impacted tend to have preexisting conditions (much like adults) and symptoms are showing up differently with inflammation and rashes, and often triggering Kawasaki Disease (1/3 of kids who were diagnosed with this in NY had preexisting conditions).

Let’s take it back for all of you at home that stopped your science education in high school (and there is nothing wrong with that, that’s where my math career ended and always so grateful I have Heidi to message about math problems– and math is technically different than stats which I have painstakingly taken twice now for two different degrees….). A virus is a collection of genetic code (either DNA or RNA) surrounded by a protein coat that needs host cells to replicate itself, since it can’t replicate on its own. Viruses are different than bacteria–which are single celled organisms that can harm or help support life — think of gut bacteria vs. those that cause an infection. Viruses can’t be treated with antibiotics and instead need anti-viral medication or vaccines to eliminate them, non-pharmaceutical interventions are a way to reduce or mitigate the spread, think of hand washing.

Why does this information matter, well based on quite a few facebook posts I’m convinced that people don’t know how viruses function and behave. Because viruses can’t survive on their own, they need a host, and that host doesn’t necessarily have to be humans but most human infectious diseases are initially transmitted from animals. This is a great video that shows how host jumps happen. One more step that the virus has to take is going from just infecting humans to transmit the virus from human to human. H5N1 causes a severe respiratory disease in birds (avian flu) and human cases do occur with a 60% mortality rate but it’s very difficult to transmit humans to humans so the virus jumps from a bird to a human and there is no additional jump to another human– but if it jumped human-to-human and retained that mortality rate we’d have a problem.

Humans are hosts for COVID-19, it is transmissible from human-to-human which means each one of us is a potential host and potential spreader. How do we stop COVID, we make it hard for it to find a host. This is where all the non-pharmaceutical interventions come in that have been talked about; washing hands, wearing a mask, maintaining physical distance because we don’t have any antivirals or vaccines developed at the moment, and even if we did, a mass vaccine campaign is no small undertaking.

Right now the United States has 142,000 deaths from COVID–in the past two weeks alone cases are up 33%, hospitalizations are up 75%, and deaths are up 101% with 20 states being in the “red zone”. That’s a line of dead bodies that stretches 66 miles, or from my parent’s house to the nearest McDonald’s, pasture upon pasture filled with a person who was somebody to someone. So it’s been extremely frustrating and quite dismaying to see people’s response to this: “It’s not a problem here” “Masks are an infringement of my freedom” and “We just have to live with it” because we’re all potential hosts and we’re all potential spreaders. Even arguably those who have been previously infected because we don’t know how long immunity is lasting for, and it might not mean much if the virus keeps mutating beyond what immunity you had.

“It’s not a problem here”– this is really interesting to me because I think of 9/11, the twin towers didn’t fall in rural South Dakota and yet my community was shell-shocked on the attack. 3,000+ Americans died and it was enough that people felt called into action from around the country. I also think of what our reaction would be now to 9/11, how many would be quick to believe it’s a conspiracy theory, an inside job, a way to control the citizens, how much misinformation would have gotten circulated on facebook. If COVID isn’t a problem at the moment for your community, be grateful, but also work to take steps to prevent it from becoming a problem. We continue to take our shoes off at the airport, even though dying in a terrorist attack is a much lower threat than COVID-19 right now. Viruses don’t respect borders, it doesn’t stop at state lines or county lines.

“Masks are an infringement of my freedom” I’m not sure how this became such a rally cry or such a partisan issue. Masks aren’t an infringement of your freedom. Individual liberty isn’t an absolute. “In every well ordered society charged with the duty of conserving the safety of its members the rights of the individual in respect of his liberty may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand” and that “[r]eal liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.” (Jacobson v. Mass, 197 U.S. 11 (1905)). Basically you’re arguing that everyone should have the freedom to unfettered rights and that rights come with no responsibility.

Cheney and I agreeing 100% on something–not the Patriot Act….

The mask argument just shows how unwilling we are at the moment to take care of one another. I get there was confusion early on with masks, I didn’t start wearing one until end of March when I went out. A lot of the mask data we have is from antecedent studies because it would be unethical to have a control group without masks exposed to COVID-19. We continue to learn new information about this disease, and we’re responding in real time. We know to be infected it’s time + exposure. Because I live in Alaska when I go to a trail I don’t wear a mask (I also don’t go to very busy trails), but will have a face covering around my neck that I can pull up like a bandana or buff. It doesn’t have to be this all or nothing, we know that inside, poor ventilated spaces are great for transmitting the virus, and that masks help if you can’t maintain distance (inside and outside). On a personal note, I would love to see the data of those who supported the Patriot Act passage and those who oppose mask mandates, my guess is that there is a large correlation but I would argue the Patriot Act was a larger infringement on your individual liberty.

“We just have to live with it” Nope, nope, nope. No other country is willing to live with it, if this is your view point, ask how many more Americans is it acceptable to die. I get frustrated because the amount of deaths we have are wholly unnecessary, and I’m quite ashamed of our response. I have spent the past three weeks in the weeds of other countries law and policies related to COVID and I can tell you almost every country is performing better on this test. Are we suppose to be okay that we’re doing better than early model projections, that we don’t have 500,000 Americans dead? What’s the threshold for you to take action? Washing hands, wearing masks, maintaining distance are what should also be part of broader testing and contact tracing. Look and see if you are able to get tested in your area without showing symptoms? It’s not happening in a lot of places and until it does we will be in this constant catch up game.

This past week I was in a pretty dark spot because I can’t believe that this our response and that people are okay with it. Do I think if I got the virus I would die, statistically no, but there are outliers, do I want to have prolonged lung damage or neurological damage, no. Do I think my parents are at a higher risk, absolutely. Do I want members of my community to die or have their lives impacted, no. This virus doesn’t just kill but wrecks havoc on one’s body in a brutal way (and in ways we won’t know for a while), and I know what you’re thinking, but Kate, asymptomatic people, you wouldn’t even know you had it, except that lung damage is shown in those who have shown no symptoms. Imagine going for a hike or a walk with 75% of your current lung capacity. Breathe through a straw if you want a full effect.

As schools talk about re-opening, we’re missing the part of the conversation that talks about what we can do in the next 6-weeks to make that more feasible. I don’t have kids so I’m not writing from a place of needing to get them out of the house so I can focus on my work, but I feel for those parents who are navigating this work space and childcare/school work at home. I think ignoring the disease is not a great approach– and think there are concrete steps we can be taking to ensure our schools are safe for when they do open up.

Viruses don’t care about our families, our work, we can’t negotiate with them. It’s the law of nature, not the law of man that we are battling with. Do you want to be part of the solution or part of the problem? Everybody is a potential host of this virus to replicate in. We don’t have to be in total lock down or completely open, it doesn’t have to be this divisive. We’re all battling the same enemy, we’re all on the same team. Until everyone realizes that the longer this is going to go on. The longer issues go on beyond COVID, immunizations are down, mental health issues, domestic violence. A lot of people had an idea of fissures happening within our society but this has exposed large ruptures in a way that we should no longer be willing to ignore. For me this is the longest I’ve gone without seeing my family. And everything just seems a little harder to deal with most days– as if I was going to graduate from therapy any time soon…

As for Alvin and I’s adventures, we have gone canoeing, hiking, backpacking–oh and he ran away from the boarder’s for two days and ended up 20 miles away, yikes. We just sent out a breed kit to find out what he is. If you haven’t placed your bet yet, you can here.

Congrats, if you made it this far, my next therapy session is about 3 weeks away and the turmoil in my mind was putting me in not a great place personally so welcome to my current therapy session. Happy to discuss anything further or provide references to anything that I have. Hope at least the pictures of Alvin helped you get through it. I’m sure if you’re reading this you’re probably on a similar page with the COVID response.

The Abyss

Last weekend seemed like an indulgent, illicit activity and now a lifetime away. Many people are finding themselves in spaces that don’t allow for them to escape for empty trails (looking at you, CO) and fresh air all while being able to maintain 6 feet of distance apart. I was finding myself with feelings of isolation in Alaska this winter and have found that this might be as good of place as any to weather out the impending storm. As COVID-19 cases have slowly uptick in Anchorage I’m now trying to consciously recreate in a way that would reduce the need for me to access healthcare services or require a backcountry rescue so will in all likelihood find myself on the local trails for the impending future–but fortunate enough to squeak one more weekend in.

We headed out to another glacier, this one was 20 miles one way–the plan being we’d ski out, set up camp, ski back the next day. I did 20 miles total the weekend before but my biggest fault when it comes to mileage is I still operate in cycling miles, 20 miles, psh ain’t no thang. Little different when cross-country skiing and having 30-40 pounds on your back (realistically probably 20 since I didn’t pack my industrial strength hairdryer this time– and if you don’t get that reference guess we know what you’ll be doing in quarantine).

While we escaped from the constant news updates and feelings of impending doom it was hard to completely turn my mind off from the virus. I would float in and out of scenarios and do comparative analyses to past pandemics and outbreaks (fun fact my favorite pandemic to study is the 1918 flu (you never forget your first) but my favorite disease is tuberculosis). I worried about being out of service for 48 hours and the potential notifications that might be awaiting my arrival. I also thought about if we should even be out there– there is a lot of discussion right now about if people should be partaking in these activities (yes, no, responsibly…I’ll default to my favorite lawyer answer, “it depends” (not legal advice).

The first day called for cooler temps than last weekend and snow. Okay going to get my winter camping badge for real this weekend. We drove 2 hours out of Anchorage and pulled off on the side of the road. I know the saying, “be bold, start cold” but I’m always convinced I will stay cold and never get warm so I bundled on layers with the thought I would take them off as needed. I was told that it was a river bed of flatness out to a glacier so was slightly surprised when we started on a slight downhill, followed by a pretty steep uphill, some more downhill, and some fresh tracks. Stopping to go pee I mused that I’d probably just leave my skis on so I don’t sink in the snow to which there was thunderous chorus that exclaimed of course I should keep my skis on just try not to pee on the bindings (still so much to learn). We descended down for about four more miles before the reaching the river bed.

With the clouds still surrounding us we just began skiing towards this white abyss. And in a lot of ways the physical landscaped matched my internal feelings about the pandemic. Right now we can’t see what we’re working towards (all these measures social distancing, quarantine, isolation against an invisible enemy) we have projections of what will happen if it works and if it doesn’t work but we’re in this abyss right now where we have pushed off from one side and have yet to see a safe landing. And yet we kept moving, I would repeat the mantra in my head, “kick, glide, feel the rhythm, feel the ride” (and if you don’t get that reference also prime quarantine opportunity). We would stop and change layers as needed–adding, removing, snacking. Talking about what the view would have given us without the clouds. On an exposed section the wind had picked up and the soft, fleeting snow had turned into fierce pieces of ice striking my face, it reminded me of acupuncture needles and just imagined I was getting a free facial –one guy talked about doing 100 mile ski race (yeah, read that again) and how it was like this the whole way and at one point he remembered thinking he just wished the snow would stop hitting him in the face. We only dealt with it for maybe 15-20 minutes but imagine I would have different thoughts if it was 100 miles…

After skiing for 19 miles with about 6 hours of moving time we talked about setting up camp, we were within range of the glacier (maybe depending on route beta) but could still be 2-3 miles away, it was getting late and dark and still a lot of things that need to be done to set up camp. We found a spot perched out of the riverbed and got to work. I dug out a hole to put the tent in, which at least helped to warm me up, while one of the other guys started the stove to melt snow and boil water for our bottles and dinner.

We got it accomplished and set up without too many mishaps– and even dug out some more snow for cooking and eating.

Even adding on another area for a firepit (as one of the guys packed firewood and we stacked it on shovel to get it going). It was nice to warm up next to and abate my shivering if only for intermittent moments.

After we had gone through all the wood we headed to bed. At this point I took off my damp ski boots, put on wool socks and down slippers, and got into dry clothes which helped to really warm me up (the -20 degree bag also does wonders). I still slept with a puffy vest, jacket and a hat on. I even figured out how to work the sleeping bag this time and only woke up once with a cold face.

Before going to sleep one of the guys thought about checking the weather for the morning, I lamented, that it doesn’t matter what the weather is going to be we have to face whatever shows up so we can just not check and pretend it will be nice. Which again took me back to the pandemic as we don’t know what tomorrow will bring but we’re in it and regardless will have to wake up and face whatever shows up overnight. Luckily, the morning did not disappoint. I stepped out of the tent and was greeted by calm skies and the sun starting to creep over the horizon releasing a nice alpenglow that quickly bathed the valley in sunlight.

We made breakfast, packed up camp, leaving our bags and gear to ski over to the glacier. It was alluring but in a more subdued enchantment than the previous weekend. It wasn’t piercing blue but rather dingy with intricate crystal lattices where water had frozen onto the surface.

We skied around for a bit, I learned that you should just follow in the previous tracks and not put in your own tracks on a glacier–not because anything bad happened, it was just pointed out to me as I was frolicking around.

Here’s me in multiple puffy layers…frolicking

We headed back to our camp spot to pick up our things and I took off about three layers on the top and bottom. We started making our way back along the trail we came in on. The views were pretty spectacular so occasionally I would just stop to turn and take it in.

Skiing out was pretty uneventful, minus the view. I found myself more hungry than the day before and slowly made my way through all my snacks (and a few emergency ones-which made me a little nervous but never got to my emergency, emergency sour patch kid provisions so).

All those downhills became uphills in the later part of our day but saw it as an opportunity to try to get better at going uphill (spoiler alert, I did not) but at least it gave my legs a different position to be in for a while. We crested the last hill and could see the road off in the distance but there remained a false flat to get up to the car. I started on the slight incline that would lead up to the car but had no concept of how long or the distance it would be so pulled out another emergency provision when I saw the snow pile the car was situated behind and put the morsel back in my jacket for another time (because I had left a bag of Hippeas in the car as a post-ski snack, also learned that trick the week before).

We got to the car and my boots were frozen to my bindings so took the whole contraption off. Then got in and ate a bunch of Hippeas.

Putting the fun between the legs (mostly a cycling joke)

The whole time I kept making comparisons to being in the backcountry with the pandemic– feel free to keep reading but stop if this will contribute to your anxiety. I’ll also put some good websites that I follow you can check out at the end.

  1. Have a good leader: Going into the backcountry requires you to be putting your life in others’ hands if something happens. Our trip leader sent out a map, route guidance, and information on what to anticipate and expect. Right now I feel that most administrations are operating out of fear/unknown/uncertainty/poor planning and actively triaging while not doing anything to assuage the public’s anxiety about what we’re facing (don’t believe me, remember the 2009 pandemic, how long were you stuck in your house for that one?).
  2. Only take what you need: skiing 20 miles with a pack means making the conscious effort to really decide if you need an article of clothing or piece of gear. This is also relevant now with people buying insane amounts of toilet paper and hand sanitizer (pro tip: hand soap is better).
  3. But be prepared: It means I carried 4 pairs of socks, extra food, and multiple different layers to meet the potential challenges. Social distancing means reducing your interactions so be prepared to last a week between grocery store runs.
  4. Don’t be a dick: You’re in the backcountry with a long ski out, if you’re attitude goes south it’s going to impact everyone. Again, turn you speakers off at 11:30pm when ya know your next door neighbor has a small child and is also stuck at home all day.
  5. Communicate effectively: Talking about when to eat lunch, letting them know if you’re stopping to change layers or to take a rest. Giving others in the group time to anticipate (I usually announce that I’ll be peeing in 20-30 minutes to get everyone on the same page). Right now we don’t have one unified voice giving us direct messages (thank you federalism for reserving public health powers to the states; apparently the founding fathers did not know how viruses work and that they don’t respect boundaries). During Ebola the US had a Czar (what an amazing job title) right now you have the President saying one thing, State Governors enacting various orders, and Dr. Fauci trying to get a clear and accurate message out, but not one unified message telling you that this is going to be a long haul– are we up to the challenge yes, because we are responding by taking x,y,z steps and this is what the next few weeks/months are going to look like.
  6. Look out for one another: Checking in to make sure everyone is still feeling okay, do we need a break, how about some candy, how are people’s feet. When you’re in the backcountry you’re only as strong as your weakest member (i.e., me– also thank you to all my high school coaches who loved that saying and would occasionally linger their gaze a little too long on me when I had a lackluster performance.) For a pandemic, we’re only as strong as our most vulnerable, our most uninsured, our most elderly. Which means being willing to step up and take care of each other now- the cost of treatment of COVID-19 is estimated to be ~$34,000. Imagine not having insurance, are you going to go to the hospital unless it gets really bad and how many potential people will you be in contact with before it gets to that point. Our institutions are being challenged, health isn’t just the absence of disease but all the social determinants that make it up (access to food, water, housing…) all these things that provide stability so people can seek healthcare. I also don’t think it should take a pandemic for us to realize how broke some of our systems are but that’s a whole another blog post/paper.
  7. Don’t operate out of fear: Things can go wrong but staying calm and making decisions using logic will help you go a long way. My go to mantra for most things is: Facts over fear. The hysteria around contagious diseases is somewhat understandable; and only supports stronger legal regulations so that politicians cannot capitalize on this fear and uncertainty to gain political points. By enacting robust legal framework that safeguard civil liberties while taking into account an unprecedented necessity for quarantine we can avoid the mistakes of the past and abrogate the uncertainty of the future (lolz, this was a section from my conclusion on my paper on quarantine last year where I mostly argued that quarantine should only be used a tool of last resort because we have so many other provisions we can use to safeguard the health of the public– didn’t really factor into my analysis a 2 month lackluster response from the government for a contagious disease outbreak–jokes on me).

I remain angry at the situation because I don’t believe it needed to get to this point. China as the source of outbreak spent a lot of their time triaging and just trying to get ahead of it. They put other countries on notice and I believe our response is criminal because we had plenty of time to prepare and we squandered it away (it’s like getting a 30-day eviction notice and waiting till day 31 to take action). Lives will be lost because of the passive response our government (cutting funding to the CDC, designing their own test, not adequately providing healthworkers with protective equipment) has taken. I remain hopeful that communities are up to the challenge, we are up to the challenge, and just like the storm moving out and the blue sky shinning the next day, we will emerge from this cloud. Research actually shows that when disasters strike people become more pro-social, they cooperate and support each other, they’re better than ever. This storm isn’t going to blow over overnight and we won’t get through it quickly (Easter is highly aspirational– and without more tests to know what we’re really up against, highly unlikely) it definitely won’t be today, not this week, unlikely this month, maybe May we’ll take a breath and reassess. What I’m saying is it’s going to be a long haul at this point and things will probably get worse before they get better but we need to stay strong and do our part– oh yeah and call your congressional reps and demand mandatory testing and while you’re at it suggest that they commandeer private companies to start making PPE, ventilators, and getting respiratory therapists trained (grateful to the companies that have shifted their focus already–but the government should respond like a war effort, this is a war we are waging). Yah know, I love a good government overreach. But really if you think the free market will save us now, there has been a post circulating showing that Tuberculosis remains the number one killer in the world as if that means we should not be taking action with COVID-19. This actually shows why we need a strong government response. Antibiotics have existed for TB for nearly 70 years and yet it remains endemic in parts of the US (no, really, think about the last person you knew with TB in the US and now realize it’s still around circulating in communities– not your community? Maybe ask yourself why that is–happy to pass along a paper). Oh yeah and also tell them that the vaccine and treatment should be covered by federal funding. As much as it’s easy to get consumed with the negative I remain optimistic that this will shift our societal norms for the better. That doesn’t mean I don’t fluctuate between wondering if the tightness in my chest is anxiety or the virus–daily temperature checks and yoga to help assuage my fears. If you feel like this paragraph sounds exasperated with tones of eternally optimistic well welcome to the inside of my brain at the moment.

Unlike the 1918 Flu, I hope that when this is over we will not look backward and inward with fear and shame of our response. COVID-19 has exposed massive fault lines in domestic and global institutions but I remain hopeful that we will come out on the other side willing and ready to work towards a more perfect world. But as my brother would say, ‘hope springs eternal‘ with me.

I feel like I should apologize for how sassy this comes off as but I’m not going to because I don’t like having to counsel young parents who are in high risk categories of what documentation should be in place for their children because they have been informed by their physicians if they catch COVID they will likely die.

For your reading pleasure:

Duck of Minerva– Mostly focused on global politics but all the articles as of recent are focused on COVID-19 responses.

The Washington Post Monkey Cage– Also another political science based platform but mostly for domestic politics.

New England Journal of Medicine: Mostly focused on COVID-19 related science, stats.

And if you’ve made it this far here are some things I’ve combat my anxiety:

Down Dog: Free yoga!

These articles sent by my friend, Vega: The Science of Well-Being and one on the grief you’re feeling. She also shared a host of wellness tips, I won’t put them all here but my favorite was: Remind yourself daily that this is temporary. It seems while we are in the thick of it, it will never end. It is unsettling to think of the road stretching ahead of us. Just remember we will return to feeling free, safe, busy, and connected in the months ahead. You can find more of her stuff, here.

If you’ve made it this far, congratulations, take a breath and remember those blue skies will be back.