We arrive in Banff 3/24 and head straight to the grocery store, having heard from our AirBnB host that things were pretty well stocked. Indeed they were! They were out of beans, sugar, flour, hand sanitizer, and were low on eggs, had just one pint of Haagen-Daz left (ours now!). But generally they were well stocked with fresh items and wht we needed. So far, we have continued to eat well. The AirBnb itself was smaller than it looked in the pictures, but bright and has a great view of the mountains.
Reports from New York are worsening and there is a concern that the system will be overrun. John Mandrola re-tweets this from one of the NY hospitals:
The next day, Peter Rice texts us that Dr. Cabeza, who commutes all the way from Peru, has to quit to take care of her elderly mother, and of course there may be travel restrictions. That left a total of three weeks without coverage; Seong decides to pitch in but we have major concerns about logistics, quarantine, PPE, and personal safety. She responds the next day that she will take a week beginning June 30, and we wait to see if any of the other two weeks get filled by others. Presumably, we would know a lot more about this pandemic by then, PPE would be available, and so forth. In any case this could represent a major change in plans. We were sort of prepared for this anyway, but I’m clearly a lot more concerned than Seong is.
On the same day, Seong’s mom calls feeling poorly, with GI symptoms, shortness of breath, and fatigue; she tells Seong that she will be going to bed at 6pm. She rarely calls Seong with symptoms like this and it’s pretty concerning; could symptoms represent a small heart attack?
But by the next morning she’s feeling much better, so Seong is too. Mom decides to wake us up early to sing her Happy Birthday – all the other family members had beat us to it.
By March 25, Italy is really having trouble, with over 600 new deaths per day, and an overall mortality rate of 10%.
Our days are mostly the same – breakfast, lazy start, skiing at the Canmore Nordic Center, then back home for some snacks, dinner, wine. We had bought six wines fro a local wine merchant, all of which were fine but the best by far was a 2008 Maison Blanche Bordeaux. Overall we continue to eat just fine.
On March 28 they start shutting down the parking lots to the Nordic Center, so we have to park down the road and ski in. The next day they close even that lot and we had to park at the dog park, then walk nearly 30 minutes to go skiing. It was pretty warm and sticky so we used the liquid wax, but it was still pretty slow.
I had been having a pretty civil exchange with Sheasby up until now, but we differed on the data for azithromycin and hydroxychloroquine, which the media have taken up as some sort of cure-all; I send him a few minutes of a podcast by John Mandrola about the weaknesses of the French publication that prompted the entire thing; I maintained that the evidence was good enough recommend an RCT. This was the last straw though; he responded with:
“No actionable data” …Hilarious You remind of the judge who said the 8 or so irrefutable facts I cited were irrelevant – he made his decision in favor of Teri for one reason, my “demeanor”. Another judge in response to a question about the date of a deadline refused to answer it and told me to hire an attorney – after not letting me explain a delay (eg Kayla was sick). Another judge suggested why I hired my attorney – like he could read my mind – which was completely wrong. All 4 of you can Fuck Off. You all are either stupid, ignorant and/or so biased you’re functionally operating at diminished capacity FYI in the last month or so I have not heard one person say it is “just” like the flu – and anything to that effect was only drawing one parallel – typically net annual deaths or the like. when I hear conservatives comment about liberal news I go to the source to verify – it smells like you get your info about conservative viewpoints from liberal sources – which if true, is at the best ill-advises and probably just fucking stupid
I didn’t quite know how to respond, so I didn’t, which perhaps means that’s the end of our relationship? Hard to say. We certainly never convinced one another of a single thing so ultimately it probably wasn’t too advantageous for either of us.
Finally, on 3/30, we decide to take a day off from exercise. By then US cases had increased dramatically and both Italy and Spain have mortality rates in the 10% range.
On our last day in Banff, we were able to score locally made hand sanitizer from O’ Canada Soapworks – 99% ethyl alcohol, they tell us. It smells like alcohol. We are pretty happy about it and buy two pints for $35/pint Canadian.
March 21: Today we headed toward Lake Louise and stopped at the Ross Lake trailhead, put on the backcountry skis and went about 45 minutes each way there. We were on a groomed forest service road for part of it, then saw tracks heading off to the left and we followed those.
Today, March 22, after another late start due to mulling coronavirus, we put on the backcountry skis and skied toward Lake Ohara. Because of the late start, and a burgeoning blister, we turned back but got nearly three hours in.
Once home, I learned that Jack McAnulty had close contact, through his choir, with someone who had tested positive; the contact had been ten days prior. He’d been working in the clinic that entire time. So starting today, he’ll be self-quarantining for the next four days. I suggested that he let the younger folks take the shifts, as the data currently available indicates that they do a lot better – the average age at mortality in Italy is 79.5 recently, and many had co-morbidities.
We also heard that New York surpassed Washington State in deaths today, with 114 compared to 95. 96% of the tests done in the state – about 31,000 so far – come back negative. People are comparing the great results in South Korea with those in Italy. It turns out that we are still quite early and though South Korea does well, the system fails in Italy, with mortality rates as high as 10% there.
As we are leaving, we hear that cases in Whatcom County have increased dramatically. Two days ago, there were just three cases associated with this center, but yesterday 29 new cases were confirmed at the Shuksan Healthcare Center, a skilled nursing facility; 23 in residents, and six in healthcare workers. The second patient in Whatcom County to die of COVID-19 had been a resident here; he was in his 80’s and had been discharged on March 10; he had become ill and died on March 20; his test had become positive only the day after he died, March 21. This is a very worrisome development.
We arrived at our first AirBnB late at night. We weren’t sure what to expect at the border, but they didn’t ask us about the case of wine we had packed. They did seem interested that Seong was a doctor and they asked when she had last seen patients – which was just three days prior. Ketchikan had not yet had a case. They waved us through. Rather frightening statistics were being released from China by this point, and not long after, from Italy.
What’s becoming apparent is that the lack of testing means that we are flying blind – it determines the denominator, hence pretty much everything else, such as prevalence and case fatality rate
As recently as February 23 we were corresponding with Kathryn Roe and the Andersons, excited about planning a trip to Ghana and and Southern Italy. But the coronavirus was on the radar screen already, and by February 29 Governor Inslee had declared a state of emergency, and the State Department recommended against non-essential travel to Italy (level 3 warning, their most severe). At that point the trip was off.
We had been planning that trip for April 10 to June 15, but on March 11 one of Seong’s co-workers asked to take her mid March shifts, so suddenly we had an extra month of time off, starting immediately. Bellingham had no cases of COVID-19 yet, but we were pretty near the epicenter of Seattle, and Vancouver BC, just to the north of us, had reported cases as well. I picked Seong up at the Seattle airport on March 12 and we elected to pack up the car with ski gear and head for the border the following day, Friday the 13th. Auspicious!
Here, we put together a timeline (in retrospect, on March 22, by going through our emails and texts to friends and family):
Retrospective Covid Timeline:
In China: 4 odd pneumonia cases identified on 12/26; reported to their health authorities on the next day; market closure 1/1, virus genome is fully sequenced bu 1/7, test kits available by 1/13, 15 cities shut down by Jan 24. In retrospect, this was amazingly fast
1/15. The man who would become the first US case arrives from Wuhan, where, at that time, there were 41 people identified with the disease. The CDC issued a notice to US travelers from Wuhan who felt sick to seek care.
1/17. The US began checks of passengers from Wuhan at airports in NY, LA and SF.
1/30 The WHO issues a public health emergency declaration and the US State department issues a Level 4 (the highest) warning about travel to China; US citizens should not go. On the following day, all three US carriers (American, Delta, United) cancel all flight so mainland China and Trump restricts return of foreign nationals into the US, and institutes mandatory quarantine of US citizens returning.
2/1 On February 1, a Hong Kong hospital confirmed a patient tested positive of the Wuhan coronavirus. The said man was on board the Diamond Princess where he did not drop by the ship’s medical center for symptom-checking.
According to the statement on Princess Cruises’ official website, the ship was scheduled to return from a two-week itinerary on February 4 but the case of the patient previously on board the ship prompted the Japanese authorities to run tests on passengers, delaying the ship’s Yokohama turnaround. The cruise ship was quarantined and the first 10 cases testing positive transported to Japanese health facilities.
2/24. Still planning southern Italy trip in discussions with the Andersons; emails to Kathryn show no hesitation
2/25. The CDC issues its first major warning that the outbreak could cause “severe disruption” to the lives of ordinary Americans, and urged families and communities to start making preparations. Federal health officials starkly warned that the new coronavirus will almost certainly spread in the United States, and that hospitals, businesses and schools should begin making preparations. “It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said in a news briefing. She said that cities and towns should plan for “social distancing measures,” like dividing school classes into smaller groups of students or closing schools altogether. Meetings and conferences may have to be canceled, she said. Businesses should arrange for employees to work from home.
The extent of the spread of the virus in the US is uncertain, as the CDC stopped the distribution of coronavirus testing kits after they were found to be flawed. Working testing kits are now available in only a handful of states, and it is not clear when new kits will be ready. Donald Trump tells journalists in India that coronavirus is “very well under control in our country” and “is going to go away”.
2/29. CDC level three alert, no nonessential travel to Italy; we tell the Andersons that we will “probably” stay in the US this spring
3/2. Four more die in Seattle for a total of six. The tone in our emails to the Andersons is still rather casual.
3/3 Breakfast with Mark Knittel at Whole Foods. No big deal. A chart comes out showing that the US is not testing at all yet.
3/4. The outbreak in Italy surpassed 3,000 infections and 100 deaths, and officials there ordered all schools closed. Cruise ship Grand Princess is held off the coast. I listen to a podcast by Emily Landon, ID prof and head of infection control at Univ of Chicago, and later send links to it to Seong, Mark Knittel, others. This is one of the first of the really alarming podcasts that I listen to from heads of epidemiology and ID, and coordinators of previous outbreaks such as Ebola etc.
3/5. In an email to Kathryn, we are keeping options open but “pretty strongly suspect that trip to Ghana is not in the cards”. Everyone is talking about canceling international travel now, including Mark Knittle and Joe. We had pretty much decided by this time though that international travel was not wise.
3/7. I go to a boating seminar; people are touching elbows and an announcement is made about hand washing; they have handwashing available but we are still in a big crowded room and there are snacks. I text this to Seong: Class is good. One of the speakers is a retired family physician and says coronavirus is in the community and is recommending here hand washing, no touching our faces, etc!
3/8. I text Seong that I am much more concerned about CV than most, and text to her “I think I’m more concerned about coronavirus than others are. I think about how interconnected everything is, and a disruption anywhere will have a lot of consequences. For instance, imagine a elementary school that decides to close down for a month. If there is a working single parent, he or she will probably have to stay home from work. Imagine if that’s a healthcare worker, police or fire. And I expect people will greatly reduce their travel, eating out, events of any kind where there are lots of people. So a lot of small businesses will have a lot of trouble. But more importantly- ICUs are usually near capacity all the time. Won’t they easily get overwhelmed, then those who need ventilation not get it?”
Later that day, the Italy death toll soars.
3/9. There is no hand sanitizer or isopropyl alcohol available, but the hardware store has some wipes plus denatured alcohol and acetone
Texted Neil with concern about the healthcare system and no wiggle room with ICUs, and a series of nine tweets from Italy where they healthcare system was breaking down.
Frances wondered if we were still coming to Arizona; we hadn’t really talked about it yet, but the next day we cancel the Phoenix trip. The NYT is making daily maps of where the hotspots are, and as of 3/9, Seattle is still the most active. But not for long.
3/10. First case is confirmed in Whatcom County. Trump is still describing it as “a lot like seasonal flu”, and I text to Sheasby: “Do you understand the republican media strategy around coronavirus? It doesn’t make sense to me. The risk/reward equation for under v overplaying the risks is so asymmetric that I see no scenario in which their approach is sensible. Do you?” His response: “? “Media strategy” … ? … the media is a veritable joke and what I see and hear from Trump et al is simply a “prepare for the worse and hope for the best” strategy that they are simply sharing with the public – the “May seem media” will spin it as negatively as possible – almost all the Dems want open borders and prioritized impeachment when this problem was percolating and casted “you’re a racist” stones for limiting travel to/from China early on which appears to have been most prudent. Those were great strategies!! I suspect Trump et al’s first priority is dealing with this in the best ways possible and getting the word out is way down on the list. Meanwhile Schumer is largely about pushing social programs tangentially related to the real problem. And I’ve even seen in the MSM that it’s racist to tie this to “China” and it should be called the TrumpVirus – what do you think about those media strategies?”
3/12. I pick up Seong at the airport after her last set of shifts in Ketchikan rather than have her be in a shuttle bus with so many other people who had just been in Seattle or possibly traveling internationally.
David Greenspan texting me from Morocco, wondering if he sill get home; Lisa and the kids terrified; Moroccan health care total crapshoot. One way would be to fly from Marrachech to Dakar then home. But the flight to Dakar is $9800! Later that same day his travel planners get him on a direct flight from Casablanca to NYC. We discuss the difference between Italy, with more than 1000 deaths at that point, and South Korea, with 67.
3/13. We had decided to head to Canada tomorrow, Saturday, with all of ours ski equipment, when it occurred to us that the border could close. So we packed up and headed off today, advancing our airbnb reservation in 108 mile by one day.
3/16. Peacehealth recommends that their surgical department heads make a plan to cancel elective procedures; Trump press conference in which he changes tone dramatically and the “no big deal, it’s a lot like flu” narrative is over.
It’s hard to understand. My view – even *talking* about hydroxychloroquine, much less staking out some strong position, means that your attention has already been stolen, and the President has already achieved his goal: controlling the narrative. His strategy – as Steve Bannon put it, to “flood the zone with sh*t” – has worked, as it always does. It also occurs to me that there is nothing inherently conservative, Republican, or Trump-like in the position that it should be administered outside of controlled trials; he could have just as easily taken the other position and he would *still* control the conversation, and liberals and conservatives would simply be taking their designated positions. Anyway, it seems to me that Sheasby is so caught up in this preposterous back and forth that it was too much.
