Dear Curtis

I was thinking about the last time I saw you. You pulled up in front of my hotel in Santa Monica with the Merlin and the Bike Friday in the car. We rode down to Manhattan Beach, then back up to Santa Monica, where we froze while eating at a sidewalk cafe. Los Angelenos have this thing about hanging out outside, even being in a desert where it’s freezing as soon as the sun goes down. Not to mention that we were in sweaty bike clothes. Neither of us knew you would die before we ever saw each other again. It was a good last visit. I remember the ride, but not what we ate.

I was in town for a workshop led by Dr. Roy Meals (see “About Bone” in “blogroll”.) I’m back in touch with him and he makes me remember you. By the way, while I enjoyed the chance to ride the Bike Friday, the Merlin was one of my dream bikes and I secretly wanted to ride it.

I was living in San Francisco during the last great plague. I lost my boss and my job to that one. It was hard to see Jim wasting away. The last time I saw him, he was blotchy with Kaposi’s Sarcoma and barely clinging to life.

So now we have another plague. This one kills a lot faster, but kills a lot fewer of its victims. When the 1980s plague hit, we weren’t sure how it spread and people tended to avoid each other (or at least certain others) until we knew. This one requires that we avoid each other because it spreads so easily. But like that other one, we’re still learning. We were first told it spread only through droplets and not aerosols. Oops, turns out that was wrong and it can hang in the air longer than we thought. Turns out the virus can live on surfaces long after the droplets have dried.

When you got a cellphone and started calling me on Mondays, we stopped writing letters. I missed that. Since I don’t have your phone number in the afterlife (nor do I know that there is an afterlife), I’m back to writing letters to you. In the children’s book “The Mole Family’s Christmas” (by Lillian and Russell Hoban), Delver Mole decides to write a letter to Santa. He doesn’t know where to reach him, but knows that Santa comes from up, so he decides to send the letter up. In the same vein, I don’t know where to send this, so it’s going to the internet, the 2020 version of up. If you want to hear the story, I recorded it on a CD for my nieces, since they were blind and unable to read. (My kids also got copies, even though I could read to them in real life.) I could maybe send it to you via the internet. The CD also contains my all-time favorite read-aloud story, “Little Tricker the Squirrel Meets Big Double the Bear” by Ken Kesey (yes, that Ken Kesey).

This plague has gone viral. It spread worldwide in less than three months. As of April 2, there were only 18 countries not yet reporting confirmed cases. Does that mean they don’t have the disease? Or that they don’t have testing? “Confirmed cases” is an interesting concept. Since we can’t test everybody, and it is cold and flu season as well as allergy season, we don’t know who has this disease. Some people have suspicious symptoms and don’t get tested. Some people have suspicious symptoms and tested negative (but the false negative rate has been reported as increasing with each day after onset, and ~30% on day ten for nasal swabs per Wikramaratna, et al [worse for throat swabs].) Dr Gary Procop of the Cleveland Clinic calls false positives extremely unlikely. We could talk about Sensitivity and Specificity and Odds Ratios and the like, but overall we lack data to draw any strong conclusions about the tests we have.

There is some reluctance to test, as that would show more people with the disease and possibly lead to greater panic. Criteria for testing vary – my PCP said I didn’t meet criteria, my Employee Health Department said I did. So we don’t know a lot. When people die during the pandemic, but have not been tested, they are not identified as having died from COVID-19. We don’t use up test kits on the dead. If people are getting better, we don’t test them. If people are surviving at home we don’t test them, as bringing them in to testing centers risks spreading the disease.

So every day we see charts with logarithmic curves of the increase in cases; and those curves surely underestimate the numbers. We see daily numbers, not rounded, which makes us think there is a level of precision which is not actually there. Despite that, we’ve crossed the ½ million threshold in the US and are approaching the 2 million mark worldwide. We’re over 100,000 deaths. All of these numbers will be higher by the time you see this.

We’ve lost famous people and unknown people. I’ve already written about John Prine and embedded several of his songs. I read this tribute today and it made me cry again. It contains a link to Roger Ebert’s review of Prine from 1970.

Much of the world is in some level of quarantine. We don’t like to use that word, so here it is called “Safer at Home”. Only “essential” businesses are open. That means I go to work (hospitals are essential). Grocery stores are essential; though I used to go to the corner store almost daily and I’ve been there once this month. When I go to the co-op, I drop >$150 at a time so I can minimize the number of shopping trips. Restaurants are not essential, but can sell take out. Most of them have “no contact” pick up methods. They set the food outside and you pick it up. Pizza places have “no contact” delivery. They call to tell you when they are leaving it on your doorstep and you pick it up after they leave – same with Meals on Wheels. In some states, gun shops are considered essential. I don’t even want to comment on that. It is like living in a Twilight Zone episode.

Our only president likes to call this the “Chinese Virus” (and he has this weird way of saying “China” – it almost sounds like he wants to say “vagina”, like Austin Powers talking about his character “Alotta Fagina” (itself a parody of a James Bond character name).

https://ytcropper.com/cropped/7z5e94cf0b09b7c

https://ytcropper.com/cropped/c65e94cfb8cd252

Were you still around and not sheltering in place, you would get to see American racism first hand again. Folks would blame you for this disease, even though you were born and raised in L.A.

I don’t remember if I’ve told you about the president. He inherited a real estate fortune and frittered it away. He may be the only person who managed to lose money running a casino. He has declared bankruptcy for more businesses than most business owners will ever own. He was the star of a reality TV show with the catchphrase “You’re fired!” He likes that phrase so much that he regularly fires cabinet members, press secretaries, and other senior officials. He uses Twitter to do it. Almost all in his administration have the word “Acting” in front of their titles. You can’t make this shit up.

By the way, the rest of you can read this. Curtis was a friend in LA; the last person with whom I kept up a snail mail correspondence. Since he’s not around to read my letters, that falls to the rest of you. Since he’s no longer on earth, I’ve explained a few things that may be obvious to the living. Another letter to him can be found here.

Bicycling First Aid

  • If in doubt, go to Urgent Care
  • If anything is possibly life-threatening, call 9-1-1
  • If somewhere between those two, have someone take you to the nearest Emergency Department
  • Nothing in here is to be construed as a substitute for obtaining professional assistance
  • If your helmet strikes the pavement with your head in it, it is time for a new helmet. A bike helmet is a single-use item in that regard. Before you throw it away, crush it. (It’s not that hard, and can be satisfying in a way. Thank it for its service as you destroy it.) Destroying it ensures that some innocent person won’t come upon it in your trash and say, “Sweet! A free helmet!” and place their self at risk.
  • Road rash is your most likely ailment. That’s what your water bottle is for. Squirt the road rash liberally with clean water right away. It will hurt less then than it will later. Try to get dirt and gravel out as soon as possible. As soon as you can, wash thoroughly with soap and water. Again, the sooner you do it, the less it hurts. Bandaging road rash is tricky – you don’t want a dressing to stick to it and re-injure the area when you pull it off later – and road rash usually appears on bony prominences (joints) so it is hard to get dressings to stay in place. For road rash you want:
    Non-stick gauze
    Roller gauze
    Tape
    Maybe 2×2 or 4×4 gauze pads depending on wound size and drainage
    Band-net
    See photos below. You may also needs gauze pads (not pictured) if particularly leaky. Hot tip: Cut tape first, stick one end where it’s handy, then you have tape ready without having to free up hands to cut it while trying to hold a dressing in place. The non-stick gauze is impregnated with petroleum jelly (Vaseline), which will make it stay in place so your hands are free. It will also make it not stick to the wound when you remove it later. And it keeps the wound bed moist to promote healing. (Sorry Ivy, who hates the word “moist” almost as much as “mouth feel”.) The roller gauze soaks up some fluids and keeps the Vaseline from attracting dust and grit in the air. The band net holds it all in place. It works well over elbows and knees, where it is hard to get dressings to stay. Cut it longer than you think you need.
  • Broken collar bones are the bane of cyclists. See a doctor for that. The treatment advice I have would make this too long and I’d rather do it face-to-face.
  • Broken ribs are likely if you are older or crash hard. Treatment is mostly pain control. In the old detective movies, the hero got kicked in the ribs, stumbled back to his office, and had his secretary wrap yards of adhesive tape around his chest. He’d head right back out to the streets and bring down the bad guy.
    Broken ribs hurt way too much for that. Plus, the old adhesive tape technique increases the risk of pneumonia. You have to breathe and the chest wall has to stay mobile. Ibuprofen is not recommended, as it slows the growth of new bone, so retards healing. Lidocaine patches can help with pain. The bad news is that they only work for 12 hours, then you need 12 hours off before they are effective again. Kinesio-tape can help with the pain and swelling from rib fractures. It can stay in place for several days.
    Apply the tape as shown. Round all corners so it is less likely to peel. Apply the tape as shown in the picture below. The two pieces should cross over the area of greatest pain. There should be no tension on the tape. Rub it to activate the adhesive (which requires mild heat). The photo below is taping over a bruise. Same concept for ribs; the central point of the lattice should be the area of greatest pain.
  • I should probably add that, if you have to provide CPR, Good Samaritan laws prevent you from being sued if you make your best effort. Get trained on CPR and use of AED. Both can be done without training – it beats watching someone die. What is written here is not training. I’m not going to fit a ½ day course into a paragraph; and I’m not qualified to train you. You can do compressions only without breathing. Check for a pulse first. Don’t do CPR on someone whose heart is beating. They won’t like it and it won’t help. CPR requires effort – deep and fast. About 2-2 ½ inches deep and 100-120 times/minute. My trainers taught me to sing “Stayin’ Alive” or “Another One Bites the Dust” to keep the tempo. For most people, the former is probably a better choice; though if I woke up to my rescuer singing the latter to me, I’d be happy. It is not comfortable for the patient. Ribs may be broken. As my friend said after he came back to life, “My chest really hurts. I think she broke my ribs. But don’t tell her anything. She saved my life and I’m not complaining.”
the legs running diagonally up and to the right are a little short…

COVID-19

copyright Jay Ward Productions

On another note, our Fearless Leader told us about the “beautiful” test for COVID-19. I don’t know about his definition of beauty, but that’s a mighty long swab that goes into your nostril. If your nasal passages didn’t curve, it would come out the back of your head. Luckily, it’s a very flexible swab. It tickles but it doesn’t hurt. If you need the test, get tested. If not, save the test for those who do need it, as the supply is limited despite what Fearless Leader says.

After insisting he didn’t need the test, he announced on a Friday night that he’d just been tested. I haven’t been able to determine how long it actually takes to perform the test. The CDC website is vague on this. On the day I was tested I was told it would take 4-5 days to get results. Maybe it’s faster if you’re the President. (And mine came back in 72 hours, per the original estimate.)

If that sounds like a confession, it is.

This reminds me of the HIV/AIDS crisis in San Francisco in the 1980s. Anonymous testing centers were set up throughout the city. Test results only went in your medical record if you volunteered them. Everyone wanted to be tested but no one wanted their results known. To have AIDS as a pre-existing condition meant the end of health insurance for you; not to mention the end of your love life. People didn’t want to come near you. No one would touch you. Treatment was still experimental. Life span was considered limited. When I had a mysterious illness in 1993, my doctor’s first actions were to test for HIV and TB. (I had neither – and I had been monogamous since my first negative test, when my partner insisted we be tested before having sex.)

Now (at least temporarily) insurance is not an issue. At the time I am writing this, I am in “self-quarantine”. Before you read it, my negative result will be back and I will no longer be a pariah. I came down with a cold after visiting an ill family member in Minnesota. Many of my co-workers also had colds and missed some work. That is pretty normal for this time of year. What is not normal is for me to be sick enough to miss work. That hasn’t happened in years. I’m sure my resistance was lowered by my surgery this winter. I lost my voice but didn’t really feel all that sick. I started riding the bus to work instead of riding my bike, in order to save energy, and because my dormant asthma was beginning to raise its ugly head. I was able only to whisper most of the day, which was what convinced me to stop working until I could talk again. I had to sleep sitting up. I was inhaling Albuterol in order to sleep without coughing. On Thursday I was diagnosed with an acute asthma exacerbation secondary to an acute upper respiratory infection (a cold). I was placed on a five day dose of oral prednisone and told to return to work on Saturday. I did not meet criteria for COVID-19 testing.

On Friday evening, Employee Health placed me on paid administrative leave. I was ordered to undergo COVID-19 testing and not return to work until a negative result was posted and they notified my supervisor in writing that I was cleared to return to work. I was to self-quarantine. Note that this was now two weeks after I had gotten sick and the night before I was planning to return to work. I was clearly improving, and was told I would improve greatly after the second day of steroids. They could not yet tell me when a test would be available. Note that this was days after our president claimed that the beautiful test was available to anyone who wanted it. I, as a front-line health care worker, did not yet have access to the test.

On Saturday, I was called and instructed to report for testing. I was greeted by a doctor, RN, and CNA, all dressed in disposable gowns, gloves, and masks. They all placed face shields when we entered the testing room. Swabs were inserted though my nostrils to my nasopharynx (back of the throat, farther down than you’ve ever reached, or maybe thought possible). They were held there for 10 seconds to soak up some goop. That was it. Now go home and wait.

https://www.dailykos.com/stories/2020/3/14/1927440/-Coronavirus-A-Letter-from-Italy?detail=emaildkre (People in Italy singing together, from their balconies, while on lockdown.)

I decided life was not surreal enough so I decided to watch The Twilight Zone. Season one, episode one was called, “Where is Everybody?” A man walks into a town with signs of recent (as in moments ago) life, but there seems to be no one around. The streets here look something like that now. It was the perfect choice. https://ytcropper.com/cropped/FC5e7007b47e54c

My neighborhood library branch was to have a grand re-opening in a new location last weekend. The grand opening was canceled, but the library was to open anyway. Monday it was closed due to staffing shortages. At least I got to see the outside, complete with covered bike parking. And I got to ride my bike for the first time in 2 ½ weeks. It felt great! (And later that day they announced that all libraries were closing effective Tuesday, 3/17.)

Now I know I don’t have COVID-19. I still can’t work because I can’t talk without coughing. The prednisone has not worked its magic. I can’t tell that it did anything of benefit. I can’t very well wear a sign that says “I’m negative!” so as not to scare people when I cough. Sort of the anti-Hester Prynne. While I don’t have it, that does not put me at any less risk of getting it now. While I’m no longer quarantined, that doesn’t make life much different.

The airlines are asking for a federal bailout. The banks and investors are buoyed up by slashed interest rates. Meanwhile, all of my neighborhood restaurants are closed. Some of them allow curbside pick up, but you can’t go inside. Most of those employers don’t provide paid sick leave. Some are doing it voluntarily right now. Who is going to prop them up? They don’t have billions in reserves.

Giro d’Italia

The Giro d’Italia, previously scheduled for May, has been postponed indefinitely.

I could have sworn I had used this clip already, but the WordPress search feature didn’t find it, nor did my manual search. Adrian Monk suddenly looks positively normal.https://ytcropper.com/cropped/FP5e70248033472. As usual, if you only read this in email, you see only my words and miss the good stuff.

As Walter Cronkite used to say: