Responding to
COVID-19

"To conquer frustration, one must remain intensely focused
on the outcome, not the obstacles."

T. F. Hodge
"We were doing so well! What happened?"

This was a friend's lament the other day when we were talking about the surge in cases of COVID-19, as well as that of many others. "What don't people understand?"

They're good questions. And, according to Christina Maxouris with CNN, there are several factors driving the increase in infections. One is the reopening of colleges and schools. Another is the cooling weather. But Tom Inglesby, Director of the Johns Hopkins Center for Health Security, suggests that those aren't the only things. "I think there's some pandemic fatigue, people not really following the public health guidance that's out there - masking, or distancing, or telecommuting. There are more people going back to large gatherings, family gatherings." The latest wave threatens to be the worst yet, we're being advised, as cooler temperatures are forcing people back indoors and as many Americans are feeling exhausted by months of restrictions. "Unlike earlier waves, which were met with shutdown orders and mask mandates, the country has shown little appetite for widespread new restrictions," Dr. Inglesby added.

Health experts have been talking for some time about the possibility of a surge in infections with the colder weather. We heard about it all through the summer. "After a month of warning signs, [the] data make it clear. The third surge of the COVID-19 pandemic in the United States is under way," begins this article from The Atlantic's COVID Tracking Project.

Here at home, the state is seeing record numbers of cases with cases growing rapidly in the southwest and southeast corners of the state. In response, the Governor has modified her public health order, requiring that all stores close by 10:00 PM, and closing all state operated museums and historical sites. The order encourages people to "shop alone" and not bring along family members. If the virus continues to spread exponentially, "New Mexico will not have health care and hospital capacity for every New Mexican who needs care."

Our understanding of what's happening with the coronavirus is still developing. Why, for example, does it seem to spread more quickly in some communities than others? Why does it seem to be more infectious in some settings than others? Why does it have such varied impact on individuals and groups? Zeynep Tufekci, an associate professor at the University of North Carolina and who writes for The Atlantic, commented, "I’ve heard many explanations for these widely differing trajectories over the past nine months - weather, elderly populations, vitamin D, prior immunity, herd immunity - but none of them explains the timing or the scale of these drastic variations. But there is a potential, overlooked way of understanding this pandemic that would help answer these questions, reshuffle many of the current heated arguments, and help us get the spread of COVID-19 under control."

Tufekci explains that researchers are finding COVID-19 incidents in which a single person likely infected 80 percent or more of the people who were in the same room as the infected individual, and in just a few hours. But, at other times, COVID-19 is much less contagious. In fact, multiple studies from the beginning of the pandemic have suggested that as few as 10 to 20 percent of infected people may be responsible for as much as 80 to 90 percent of the virus' transmission, and that many people barely transmit the virus at all.

This kind of behavior, alternating between being super infectious and fairly non-infectious, is what health experts call over-dispersion. And it's what makes COVID-19 so difficult to predict. With some diseases, such as seasonal flu, an outbreak's distribution is relatively linear and predictable. COVID-19 doesn't follow a predictable pattern, making it much more challenging to manage. It also makes it much more difficult for public health folks to provide advice on what people should do. As Tufekci writes, "This has been a huge challenge, especially for health authorities in Western societies, where the pandemic playbook was geared toward the flu."
This also means that contact tracing for COVID-19 is more complicated than for other diseases. Most public health agencies do what is called forward or prospective contact tracing. Once an infected person is identified, they try to find out with whom the individual interacted afterward so that they can test, isolate, and quarantine these potential exposures. But that’s not the only way to trace contacts.

Because of over-dispersion, most people will have been infected by someone who also infected other people. Only a small percentage of people infect many at a time, while most infect zero or maybe one other person. Adam Kucharski, an epidemiologist, explains, "If we use retrospective contact tracing to find the person who infected our patient, and then trace the forward contacts of the infecting person, we are generally going to find more cases compared with forward-tracing the contacts of the infected patient."

Retrospective contact tracing is what helped Japan get its arms around the coronavirus relatively early on and, as this article suggests, it could help in the United States. “So if it is bars, if it is waterparks, if it is hair salons, whatever it might be, that's going to help you direct limited public health resources in a targeted manner to stop transmission,” Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security observes, “If you can direct public health actions towards those high risk activities, you can leave the rest of the people alone to go about their lives. And I think that's what we want to get to - precision-guided public health. The information gleaned from contact tracing both prospective and retrospective helps health departments do that.”

Getting back to my friend's frustration, it's not so much that people don't understand but that they choose to behave a certain way. Paul Krugman offers this thought: "Many things should be matters of choice. The government has no business dictating your cultural tastes, your faith or what you decide to do with other consenting adults. But refusing to wear a face mask during a pandemic, or insisting on mingling indoors with large groups, isn't like following the church of your choice. It's more like dumping raw sewage into a reservoir that supplies other people's drinking water."

We know what we need to do and each of us simply needs to do it. I realize that may seem overly simplistic when faced with daily dire warnings that we may be looking at a winter of high rates of infections and intermittent lockdowns. The emotional and mental fatigue that people are experiencing is extreme.

Nevertheless, our collective experience comes down to individual choice.

Knowing that Kitchen Angels volunteers and staff are doing all that they can, all that the experts and science can offer right now, to keep each other and our clients as safe as possible, will have to suffice . . . for the time being.

We've done an excellent job. We've had no infections. That, in and of itself, is an important measure of our success, at least within our own small community. And as we learn more, we'll do more.

Thank you for your diligence and for all that you are doing to keep yourself and the entire Kitchen Angels family safe and healthy.

In gratitude,
‌
Thank you for all your vigilance. We want you to stay safe,
healthy, and informed.
Can Meditation Help?

With all the noise and chaos surrounding us right now, it's important to find ways to create a bit of peace and quiet in our lives.

As David Gelles suggests, meditation is a simple practice, available to every one, which can reduce stress, increase calmness and clarity, and promote happiness.

Put simply, meditation is a way to train the mind. Most of the time, our minds are wandering (remember the "monkey mind" from several weeks ago?). We’re constantly thinking about the future, dwelling on the past, worrying, fantasizing, fretting or daydreaming. Meditation can help quiet our mind and bring us back to the present moment. It can give us the tools we need to be less stressed, calmer and kinder to ourselves and others.