Report from the Front Line: 15 Days, Self-Quarantine

I was also hidden away from home for six days following my prostate biopsy (here). But there was a three-day period starting Tuesday, March 3^rd, when I foraged in public: Albertsons and Costco. Three days of freedom before the self-imposed lockdown started on Friday, March 6^th.

Why Did I Self-Quarantine?

The results of my biopsy weren’t available until March 13^th. Until then, I believed I had prostate cancer. If you’re 70 and have an underlying health issue, like cancer, you’re advised (here and here) to withdraw from life. Don’t go on long trips. Avoid air travel. Have your groceries and meals delivered. Since my biopsy results were negative, I’m only at risk due to my age. Who says going to the gym three to seven days a week for 53 years doesn’t produce benefits?

Our Planned Trip to Princeville in Kuai, HI

We were supposed to travel by air from Las Vegas to Lihue on Kauai this past Saturday, March 21^st. United recently revised its travel policy and I was able to rebook our tickets—to September 22^nd.

Our hotel arrangements were part of a timeshare we once had. Originally, that reservation could not be rescheduled. However, the good folk at the clearing house handling these matters are telling us we may yet be able to reschedule our lodging as well. I even updated our rental car reservation. Now that Hawaii is placing visitors from outside their state to a mandatory two-week quarantine (here) upon arrival, reservation cancellations are on the rise. 

Will all of this be over by then?

Our Planned Trip to Wales, UK

At the end of June, we’re supposed to fly to Manchester, England, drive our rental car west to Wales, and check-in to the Cliff Hotel in Gwbert. We have a week of hiking the Pembroke trail north and south of Gwbert. And, we had also planned to spend a day or so on the return to Manchester at Liverpool.

Our air carrier, Virgin Atlantic has previously announced they will park 85% of their fleet by April 2020 (here). It’s unlikely service between Las Vegas and Manchester is a high priority for Virgin Atlantic. They are more likely to continue flying out of Heathrow and Gatwick, however. At some point, they will undoubtedly contact us to reschedule our flights or refund our tickets. The Cliff Hotel is already closed for non-essential travel (here). We can cancel/reschedule the lodging and the car rental. 

Hiking the Pembroke during the summer sounds great, inviting even. The same hike in late fall, winter, and early spring? Yeah, not so much.

Will all of this be over by then?

Groceries and Food

We’ve mastered the fine art of ordering groceries and deliveries from Walmart. Trust me, it is a bit of an art, since the app isn’t perfect, Walmart’s supply chain isn’t keeping up with demand, and the slots for delivery can be more difficult to secure than, dare I say it, toilet paper. We are coping, however.

There are some funny lessons along the way. For example, our condo building’s entrance is sandwiched between a law office and a chiropractor’s office. Entering requires a building code, an elevator ride, and a bit of a circuitous walk to find our unit at the other end of the complex. So, it’s easier to wait for delivery in the parking lot.

On Saturday, a husband and wife team looked to be our delivery. The man leaned out his window and yelled, “March,” in my direction. March like hell, I thought. Smaller tip, I said to myself. Then I realized they were (recently) from France. Marche is a shorthand for a popular grocery chain in France. It helps to be a world traveler.

On my birthday, we celebrated by ordering Five Guys hamburgers and fries for a lunch delivery. Five Guys is half a mile away. But, hey, us high riskers must pass up the in-store free peanuts and the wild soda machine that mixes flavors for slightly colder burgers and soggier fries. It was great!

We even managed to score a Costco shopping spree and delivery with Instacart. We stocked up on the carbohydrate necessities: butter croissant, two types of huge muffins, unsalted cashews, and biscotti. No luck since, however.

Senior Shopping Hours

Grocery stores and Costco are offering reserved shopping hours for seniors (here). This is either the best or worst of ideas. From all reports, selections are thin. So, count on wins, losses, and the occasional (sometimes bizarre) substitutions. A rotisserie chicken from Costco is sounding better every day. Will it be enough to temp us out of our self-imposed quarantine?

We’re in a city and an area with lots of seniors. Competition will be keen. And no one knows how to gain a competitive advantage in a grocery sweepstakes tour of the store than an older person with a lifetime of practice and finely-honed skills. Give me young parents with unruly children in tow. They’re distracted and off their game to be sure.

I can’t decide if my odds of contracting the corona virus are better, or worse, in a cohort of…cohorts. Arguments can be made either way.

Wine Delivery

Costco in our area won’t permit delivery of wine. Walmart’s app doesn’t provide the option, although they will deliver all wine accoutrement.

Out of desperation, Wendy joined a wine club. She filled out the survey asking all her likes and dislikes—about everything but wine, of course. The club is sending us their starter pack based on their analysis of the survey. I’m certain the analysis reported: If it’s in a bottle, looks like wine, and almost tastes like wine, they’ll take it.

Hand Hygiene

Oh, just shoot me now.

I’ll wash my hands after exiting the bathroom. The doorbell rings with a delivery. I’ll wash again after I’ve sanitized the delivery box and its contents. Then I’ll have to remove the cardboard and packing materials to the communal trash room—and wash my hands, yet again.

Typically, I wash, or sanitize, my hands fourteen to seventeen times a day. And no matter what “they” say, hand lotion does almost nothing to restore abused skin to its original state. My hands are chapped and greasy.

State of Mind

Today, it was reported that Senator Rand Paul, Republican from Kentucky is now in quarantine with a positive test result (here). Okay, that’s bad enough. Yet, Paul, a physician by education and training (here) availed himself of trips to the senate gym, pool, and business lunches after he was tested but before he knew the results. Did I mention Paul is a physician?

My initial reaction was to inflict bodily harm on this idiot. I’m beginning to understand why Paul’s neighbor in Kentucky (here) opened a big can of whoopass on the good senator a while back. Okay, violence is never the answer. Still, the thought warmed my heart.

When Does All of this End?

The White House (?!) released a study out of the UK modeling outcomes for the novel corona virus (here). To save you the trouble, I’ve included the two introductory pages of the study below. I’ve highlighted and underscored the important parts.

It isn’t promising.

All humor aside, this “stuff” could last much longer than any of us would like or prefer. Of course, every family has its own idiot—sometimes more than one. They aren’t shy of telling us this is a hoax, it will all be over soon, the regular flu is more deadly, fewer people will die than forecast ad nauseum.

Let me be clear: I hope this particular idiot is correct. Unfortunately, it is more likely the happy talk will prove to be incorrect—really incorrect.

_____________________________________________

16 March 2020 Imperial College COVID-19 Response Team 

Impact of non-pharmaceutical interventions (NPIs) to reduce COVID- 19 mortality and healthcare demand 

Neil M Ferguson, Daniel Laydon, Gemma Nedjati-Gilani, Natsuko Imai, Kylie Ainslie, Marc Baguelin, Sangeeta Bhatia, Adhiratha Boonyasiri, Zulma Cucunubá, Gina Cuomo-Dannenburg, Amy Dighe, Ilaria Dorigatti, Han Fu, Katy Gaythorpe, Will Green, Arran Hamlet, Wes Hinsley, Lucy C Okell, Sabine van Elsland, Hayley Thompson, Robert Verity, Erik Volz, Haowei Wang, Yuanrong Wang, Patrick GT Walker, Caroline Walters, Peter Winskill, Charles Whittaker, Christl A Donnelly, Steven Riley, Azra C Ghani. 

On behalf of the Imperial College COVID-19 Response Team 

WHO Collaborating Centre for Infectious Disease Modelling MRC Centre for Global Infectious Disease Analysis
Abdul Latif Jameel Institute for Disease and Emergency Analytics Imperial College London 

Correspondence: neil.ferguson@imperial.ac.uk 

Summary

The global impact of COVID-19 has been profound, and the public health threat it represents is the most serious seen in a respiratory virus since the 1918 H1N1 influenza pandemic. Here we present the results of epidemiological modelling which has informed policymaking in the UK and other countries in recent weeks. In the absence of a COVID-19 vaccine, we assess the potential role of a number of public health measures – so-called non-pharmaceutical interventions (NPIs) – aimed at reducing contact rates in the population and thereby reducing transmission of the virus. In the results presented here, we apply a previously published microsimulation model to two countries: the UK (Great Britain specifically) and the US. We conclude that the effectiveness of any one intervention in isolation is likely to be limited, requiring multiple interventions to be combined to have a substantial impact on transmission.

Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely. Each policy has major challenges. We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option. 

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased 

DOI: https://doi.org/10.25561/77482 Page 1 of 20 

16 March 2020 Imperial College COVID-19 Response Team 

absenteeism. The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing – triggered by trends in disease surveillance – may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound.Last, while experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced. 

DOI: https://doi.org/10.25561/77482 Page 2 of 20 

Copyright 2020, Howard D. Weiner