“Jason, Jason, Are You Okay?” A Tale of March Illness

My last post prompted some back-channel questions about how I’m doing. Which is touching. So please permit a brief* follow-up post answering that question publicly.

* 1,600 words is “brief,” right?

A Wasted March

The first week in February, I thought I was coming down with a cold. However, by the time I took my buoyancy class on February 6, it cleared — and two days later, I jetted off for a week in sunny, spectacular Bonaire. And I didn’t feel at all sick on the island. However, one day on a dive, I think I might have given myself a mild over-expansion injury. I had a fast ascent (almost 60 feet in two minutes, which is the top end of the recommendation) while maintaining buoyancy solely through breathing and not by playing with my inflator or dumps. Later that evening, I experienced a bit of trouble breathing and some chest tightness, but by the next morning all was well. So I shrugged that experience off as a nod to the age-old diver warning to never hold your breath.

Our return trip routed through Miami International Airport on Saturday, February 15. At MIA, we packed cheek-by-jowl in a petri dish of humanity for two hours, in addition to back-to-back, full, three-hour flights in (alas) coach. 

About 10 days later, I got a cold, but it was an odd one. First, it was remarkably mild. And second, it stayed purely in the upper respiratory tract. No sore throat, no cough. That pattern was unusual; usually my colds always migrate to my lower respiratory tract with a sore throat and a cough. Instead, I just experienced two weeks of occasional sneezing and nose-blowing and mid-grade exhaustion. Not enough to be debilitating, but certainly enough to induce me to do just the minimum.

By the middle of the first week of March, the cold persisted, but the exhaustion got a bit worse. Again, not debilitating, but after I finished work, I was done for the day. No writing, just … existing, watching YouTube videos or staring blankly at my computer screen realizing I intended to write but couldn’t be bothered to move my fingers. And, oddly, I became significantly cold-sensitive. No fever, but just consistently chilled, which is odd because Michigan winter is my jam and my office this time of year typically clocks in somewhere between 52 and 56 degrees Fahrenheit. I actually turned up the furnace and kept a blanket on me and kept my feet on a hot pad.

Two weeks later, on March 18, things turned worse. For the next week, I alternated between feeling okay-ish and not. The pattern was consistent. Between 8p and 10p, a slight fever, somewhere between 99F and 99.6F oral (my baseline oral temp is around 97.5F) with intense chills set in. I’d go to bed and poor Murphy d’Cat couldn’t understand why I couldn’t stop shivering violently despite four blankets. But by morning, I’d be sweaty yet the fever broke. Until the evening. I yo-yo’d like this for roughly a week. I also developed a very slight cough, never productive.

One night — Friday the 20th — I woke up at 3a unable to breathe. Tight chest, labored breathing. I was thiiiiis close to thinking about going to the ER until I remembered I had a pulse-ox monitor. So I took a few measures, saw my sats were 96 or 97 or 98 percent, and figured I was talking myself into a worst-case diagnosis, so I went back to bed. Didn’t sleep much, granted, but I went back to bed nonetheless.

On the 23rd, I called the doctor’s office. Turns out, I needed a new doctor; mine doesn’t accept my new insurance, although the nurse triage line was kind enough to tell me that I should self-quarantine and there was no need or capacity for COVID-19 testing. Later that day, I found a new primary care doc, but because of the COVID crisis, I couldn’t be formally enrolled with a new-patient visit for 90 days. So, I’ve got an appointment … in mid-May.

By the 29th, the cold-like symptoms and the fevers mostly stopped, but it wasn’t until April 1 that I actually felt decent.  

Tips for Staying Virus-Free

My assumption through the long, tired slog through March was that I had the cold and then the flu. However, neither the cold not the flu behaved like normal — the obvious assumption is that I had COVID-19, but even then, my symptom progression didn’t really match a typical COVID-19 case: I never experienced significant shortness of breath, my fevers were mild (and, strictly speaking, didn’t seem to cross the 100.4F mark), and I didn’t develop a persistent cough.

I’m a fan of the Dark Horse Podcast, hosted by Bret Weinstein. He and his wife, Heather Heying, have been “sheltering in place” in Oregon so they’ve been live-streaming on YouTube twice each week. They’re both evolutionary biologists, famous for the kerfuffle a few years ago at Evergreen State College. They’ve shared some fascinating information about COVID-19, including Heather’s likely experience with it much earlier than the general pandemic in the United States. They offered some great information about the disease and its origins in their first and second livestreams. Their third livestream kept up the theme (it covered bats, bio-weapon theories and the social implications of the pandemic). I had asked them a question and, in the separate Q&A livestream they conducted, Bret actually answered my question about masks (by name!), which left me kind of geeked.

After reviewing some CDC materials and seeing how Weinstein and Heying addressed the subject, I think the odds are well above average that I acquired COVID-19 but my case was mild enough that I avoided hospitalization. It’s improbable, giving timing, that I was infected in Miami, but it’s also possible that a sequence of unfortunate events — potential lung over-expansion plus a mild cold — left me a bit more open to a lower respiratory infection than I might otherwise have been. However, without a test, this hypothesis cannot be verified. And in Michigan right now, there’s no capacity for screening for people who aren’t seriously ill.

One interesting educational tidbit that I learned from Weinstein and Heying relates to more advanced infection prevention. Everyone, of course, should follow basic guidelines for minimizing infection risk:

  • Wash your hands for at least 20 seconds with soap and water.
  • Do not touch your eyes, nose or mouth with un-washed hands.
  • For the coronavirus, wear an appropriate mask when you’re in a public space, and practice social distancing of at least 2 meters from everyone else at all times.

Weinstein recommended a few other precautions, to which I’ve added a few of my own:

  • If you don’t own a supply of N95 masks, make due with a doubled-up bandanna. Wear it over your nose and mouth in public, as if you were some sort of Antifa thug. A bandanna (or, as I’ve been wearing, a cotton shemagh) is likely highly effective, if not as good as an N95 mask, given the vector of coronavirus infection. Wash it daily. Clinical evidence from a 2010 study published in Applied Biosafety suggests bandannas are 11 percent effective at blocking 1 micron particles. The coronavirus is 100 to 120 microns and travels in droplets, suggesting that a well-fitted bandanna face covering could be something above 90 percent effective or better in blocking the virus. As they say — good enough for government work. (Weinstein recommends the bandanna in the absence of N95 masks, and my question to him in the livestream addressed this journal article.)
  • When you get home from a trip, strip and shower immediately and do not re-wear clothes. Virus particles could land, e.g., on your hair and then transfer to your pillow or to your eyes/nose/mouth through inadvertent touching. The SARS-CoV-2 virus is believed to live just a few hours on fabric, but that’s all it takes. If you decontaminate yourself after you get home, you substantially cut this risk.
  • Men with epic beards — yeah. You do know that they’re massive infection vectors in any case, right?
  • If you can sanitize your cart handles or basket handles at the store, do so. Sanitize them before you actually use them.
  • Decontaminate your hands with soap or alcohol sanitizer before you enter the store and before you get into your car. It’s not necessary to wear gloves in the store given that coronavirus doesn’t lead to COVID-19 through direct skin contact.
  • After you put your groceries away at home, wash your hands. The coronavirus can live up to a week on hard non-porous surfaces, so assume all the packaging of your groceries are contaminated. As such, wash your hands after touching all this stuff, especially before/during/after meal prep.
  • Safety glasses or sunglasses with side protection limit viral exposure to the eyes.

Lots of people have suffered from COVID-19, but emerging anecdotal evidence suggests it might have passed through parts of the country, especially California, earlier than people assume. Given that those early mild-to-moderate cases were likely misdiagnosed, odds are good that many more people have contracted the virus and either proved asymptomatic or experienced non-acute symptoms that have kept them out of the denominator of public-health stats. Until serology tests hit the market, however, we have no way of knowing who might have encountered the virus but avoided COVID-19 infection, or who encountered it and experienced mild symptoms.

Did I have COVID-19? Hell if I know, but it’s more likely than not. Some of my symptoms are consistent, some aren’t. Then again, my “cold” and “flu” weren’t typical, either. All I know for sure is that I basically lost the entire month of March to a mild, yet real, malaise — one that didn’t break until April 1.

A Pandemic of Opinions About the COVID-19 World Order

What a difference a month makes. Just 30 days ago, the Wuhan Coronavirus seemed like a distraction from the seriousness of the Democratic beauty pageant. Partisans sniped about whether COVID-19 represented an existential threat to the species or a hoax to get Trump. The Dow was looking to crest 30,000 points. Life offered predictability.

In fact, just six weeks ago, I remember sitting on the porch of our rented apartment in Bonaire, overlooking the Caribbean Sea, enjoying rum and a cigar and talking to Dave (who frequently travels to China) about whether he had been to a place called Wuhan, because the news stories out of China were looking scary. He told funny stories about his travel adventures in China and India.

Now? No one’s laughing. No one with working synapses thinks it’s a hoax.

Where to begin?

The Epidemiology

Let’s start with the science. 

The novel coronavirus that originated in Wuhan likely originated with a wet market. That’s a market serving slaughtered animals, many of them exotic. The Chinese government made motions to shut them down after the SARS epidemic but let them persist. 

Some terms: The virus, called SARS-CoV-2, sometimes leads to a disease called COVID-19. People can be infected by the virus and, because they’re asymptomatic, not actually manifest the disease. The math about the dangers of COVID-19 are based on reported cases of people whose infections have morphed into the disease. However, some unknown proportion of the country has acquired and defeated the virus without developing the disease. Keep that distinction top-of-mind when you think about population-prevalence statistics. A good deal of reporting has mixed, willy-nilly, cases of infection and cases of disease.

It’s difficult to get a good sense on how wide the disease has spread, in part because people with very mild cases are likely under-counted in the denominator and in part because some of the worst outbreaks occur in countries with regimes that shade the truth (China, Iran, possibly Russia and Venezuela). For people with mild-to-moderate infections, the disease symptoms are so similar to influenza that only a specific test yields a concrete diagnosis. In general, though, the danger signs of COVID-19 include dry (often extreme) coughing, shortness of breath, and fever.

The CDC offers an online symptom self-checker that helps put your mind at ease about what your best course of action may be. In general, if you experience trouble breathing, become confused or lethargic, show a bluish tint to your face or lips, or feel persistent pain/pressure in your chest, seek immediate medical attention. Those are signs of hypoxemia—low blood oxygen—and is caused by, among other things, acute respiratory distress syndrome, which is a serious complication from COVID-19.  Basically, your lungs fill with fluid, preventing oxygen absorption in your tissues, which is why the number of ventilators is important. (If you’re a worry-wort and you merely think you’re having difficulty breathing and then hyperventilate and then generate the same symptoms of respiratory insufficiency … get yourself a pulse oximeter and learn how to use it.)

However, those big-three symptoms everyone talks about aren’t the only ones that manifest with COVID-19:


When you consider how COVID-19 differs from the cold or the flu, two statistics matter:

  1. The R0. The R-naught of a pathogen marks its replication multiplier. A pathogen with R0 = 1 generally results in one infected person infecting a single other person, in the long-run average. Diseases with an R0 of less than 1 generally self-contain; not enough people get them to cause a pandemic. Diseases with R0 above 2 spread like wildfire. It’s easy to see why: One person infects two. Those two infect four. Those four infect 8, who infect 16, who infect 32. Imperial College London estimates the R0 of COVID-19 to be 2.4. That’s code for “a lot of people will get exposed to this thing in the normal course of business.”
  2. The case fatality rate. The case-fatality rate is the proportion of people infected by a pathogen who will die from the pathogen or complications related to it. A study published 24 February in JAMA suggests a case-fatality rate, as represented by official Chinese statistics, of 2.3 percent. That rate, however, is highly dependent on the age and chronic comorbidities of the afflicted. Relatively few young-and-healthy people die of COVID-19, for example, although they can and do. In Italy, the official case-fatality rate is somewhere above 8 percent, but Italy’s population skews older and they’re classifying any cause of death that looks like COVID-19 to be COVID-19, so that number is almost surely overstated. In the United States, it appears to hover around 1.45 percent with statistics current as of 26 March.

People sometimes ask: Is all this drama worth it? After all, more than 80 percent of infected people experience no or very mild symptoms. In fact, absent clinical testing, doctors can’t tell the difference between COVID-19 and the flu. So why worry?

The best way to answer that question is to look at the interplay between the case-fatality rate and R0. The flu’s case-mortality rate is around 0.05 to 0.1 percent with an R0 of 1.3. Compared to the flu, it appears COVID-19 kills 15 to 75 times more people and infects twice as many people. Although it’s true that for a broad swathe of people, COVID-19 infection proves utterly anticlimactic, the public-health concern isn’t with the 80 percent. It’s with the 20 percent who require hospitalization. Of those, 5 percent will die, and a proportion will only survive acute respiratory distress syndrome through the use of a ventilator—and many those extreme survivors will never regain full pulmonary function.

If we leave the disease unmanaged, the prospect that 1 million or more Americans could die from COVID-19 isn’t scaremongering—it’s science. Given that there’s presently no vaccination or treatment, the only tool in our toolkit becomes an artificial reduction in R0 through tactics like enforced social isolation. Because even though the virus might have an average “natural” case-fatality rate of 1 percent in optimal-care settings, if a large chunk of that 20 percent who require hospitalization can’t get a ventilator, the case-fatality rate increases. Sometimes dramatically. In an overstretched healthcare system with inadequate ventilator supplies and fewer healthcare providers (because they, themselves, are sick!), that death rate climbs. And climbs. And climbs.

Are these broad shutdowns scary? Sure. Unprecedented? Yup. Necessary? Absolutely!

In a perfect world, by mid-summer, we’ll all look at these shutdowns and wonder if it was all a let-down. Much ado about nothing. If that’s the case, then congratulations to us all—these measures worked. And if mid-summer comes and the world feels like Thunderdome—well, then, they didn’t. And may God have mercy on our souls.

Shining Points of Light

Resist the urge to see only the bad and the scary, though. Use this moment as a ready-made excuse to connect with old friends (remotely, of course) and to practice random acts of kindness. Stories abound of people doing good things—like people who organized a drive-by celebrating a 7-year-old’s birthday. Or the teenager who delivered dinner and offered an impromptu trumpet performance for an isolated elderly couple. Or the students who use their 3D printer to help create face masks for healthcare workers. You can be the hero of such a story, too.

I’ve been eating my own dog food. The last few days, I’ve been sending occasional text messages and emails to folks I haven’t seen in a while, or who I know might be struggling, or who happen to live in a hot zone like NYC. We each enjoy our web of networks. Now’s as good of a time as any to make sure the strands connecting each node remain active and strong.

Some institutions are doing their best and thereby demonstrating their resilience. My home parish, for example, has followed the orders of the bishop and the governor to suspend public services, but the church stays open for private prayer and individual confession remains available. Plus, the parish has called every registered parishioner to check in, and the pastor has been releasing daily YouTube videos with Lenten reflections on the readings of the day plus a blessing. (And the bishop live-streams Sunday Mass from the Cathedral.)

Arts institutions have offered creative online performances. Even Sir Patrick Stewart has been tweeting a sonnet a day. Because Shakespeare. And corporations are helping, too—Xfinity/Comcast is, for the next few months, waiving all Internet usage caps to accommodate work-from-home activities.

When you’re part of the solution, you’re not part of the problem. You can be a shining point of light. And when enough points of light glow in the darkness, the darkness shall not overcome it.

The Problem of Information

Speaking of darkness, let’s turn to the media.

The most significant gut-churning lesson from the last 90 days isn’t about the virus or the economic aftereffects of it. Rather, for me, the big story has been the utter failure of the press to be serious about, well, anything. Consider:

  • Reporters have repeatedly asked President Trump if it’s racist to call the disease the “Chinese Coronavirus” or the “Wuhan Coronavirus” despite that it’s common practice to name new diseases after the location they first appeared. Think about that. You’re a reporter. It’s a pandemic. You have access to the President of the United States. And your primary goal is to try to dunk on him about terminology? Seriously?
  • The conservative media went on, and on, and on, about how COVID-19 is just the flu and complaining about it is like impeachment all over again. Then they decided it was serious and Trump’s response has been perfect.
  • The progressive media attacked Trump for not locking the country down, days after attacking him for locking down the borders, despite that the president has no authority to lock down parts of the interior—let alone the entire country—except in specific instances of armed insurrection. No matter what Trump does, it’s too little, too late, too corrupt. Even Governor Cuomo has found nice things to say about Washington’s response, for cryin’ out loud.
  • The centrist pundits tried to prognosticate their way into relevance, only to be proven wrong (in the aggregate) at every step of the way.

For a long time, China lied about the respiratory illness arising from this virus. Chinese authorities at all levels suppressed information. None of this information is in dispute. As recently as this week, China maintained that a U.S. Army athlete brought the virus to China last November. To mention the duplicity of the Chinese Community Party in allowing the disease to spread isn’t racist. It’s truth.

A Gallup poll taken March 13 to March 22 shows that of nine polled entities, the U.S. news media was the only institution underwater in its approval rates. Overall approval for the media stood at just 44 percent, with 55 percent disapproving. Contrast that to the media’s foil, President Trump, whose approval rate for the coronavirus crisis stands at 60 percent. Even Congress is at 59 percent approval

For an excellent case study in the utter lack of self-awareness “infecting” the media, consider Damon Linker’s March 27 column in The Week in which he wrote:

Over and over again, those who report on and analyze politics at close range have documented the president’s lies, exposed his schemes to enrich himself, taken note of his errors and their consequences, and highlighted his incompetence and cruelty — and at every step of the way they have assumed this would make a political difference. But it hasn’t.
Maybe it’s time to recognize that it won’t.
Accepting this is hard. Journalists, academics, and intellectuals tend to be idealists. They went into this line of work not because they wanted to be rich but because they wanted to make the world a better place in some way. This doesn’t mean their ideas on improving things would always have positive outcomes if they were enacted, or that their favored policy proposals deserve to take priority in our public life. Not at all. But it does mean they tend to assume that most people will recoil from outright lies, deception, malice, injustice, sleaze, and thuggish imbecility when it is exposed and demonstrated to them.
But maybe that isn’t true.

It’s isn’t true at all, but it’s a perfect encapsulation of the tendency of the modern commentariat to loathe Trump and the Republicans so much that bumper-sticker slogans substitute for truth and moral catastrophizing reins supreme. Nassim Nicholas Taleb defines the Intellectual Yet Idiot as “the inner circle of no-skin-in-the-game policymaking ‘clerks’ and journalists-insiders, that class of paternalistic semi-intellectual experts with some Ivy league, Oxford-Cambridge, or similar label-driven education who are telling the rest of us 1) what to do, 2) what to eat, 3) how to speak, 4) how to think and 5) who to vote for.” Sounds a lot like the press corps, from top to bottom, and their fellow travelers in Twitter’s Blue Check Mark Brigades.

I think there’s a lot of truth to Taleb’s framework. And—forget the coronavirus a moment—the prevalence of the IYI crowd in the media and in the commanding heights of academic administration and cultural institutions hints at the weakness of the elite worldview that’s part of the current repatrimonalization of Western institutions. Individual people cannot make prudent decisions about life-or-death choices, let alone inform their economic and political beliefs, when the primary gatekeeper of information is across-the-board corrupt. How much of the populist resurgence roots in some way to a reaction against IYI narratives?

Yet that’s where we’re at. I’ve dreaded this conclusion for a while now, but the systemic failure of the press seems inescapable

Preparing for Tomorrow

Pundits churn out prediction stories like the genre’s en fuego. Every single one of these predictions is utter horseshit. No one knows what lies ahead. No one knows how long it’ll take to get Wuhan Coronavirus under control; no one knows the final death toll; no one knows the secondary toll taken from loss of livelihood in the shutdown; no one knows how long the economy will take to return to pre-crisis levels; no one even knows if the economy will ever fully recover given the presently unquantifiable risk of radical social disruption that renders the Washington Consensus moot.

So I’m not going to offer predictions.

Instead, I do two things:

  1. Hope for the future. Humans tend to rally in the face of adversity. I’m generally bullish on the short-term prospects. I wouldn’t be surprised to see a bit of a renaissance in organized religion and in the strengthening of the “little platoons” in hyperlocal contexts. I believe we’ve got it in us to come out ahead. I remain hopeful that human ingenuity will find a way to defeat this virus and that by mid-summer or autumn, we’ll have something like a solution that allows for a significant degree of a return to normalcy. I’m betting that by Thanksgiving, we’ll be giving thanks for the CoronaCrisis receding in the rear-view mirror.
  2. Plan for the apocalypse. I also remain aware that things can always get worse. How much worse? No one knows. But just as the best-case scenario isn’t likely to materialize, neither is the worst-case scenario. That said, if you plan for the worst-case scenario, you’re prepared for everything. So I’ve been slowly working on stocking some non-perishable food items and jugs of water. I’ve made sure all my first-aid kits have been re-stocked and that stuff that’s expired got rotated out. I’ve added recurring tasks to my to-do list to swap and recharge the batteries in my radio and flashlights. I’ve re-inventoried my hiking-and-camping gear. I’ve been making checklists in case I need to get out of Grand Rapids in a hurry—Where will I go? What will I bring? How shall I provision for, and transport, the cats? If I’m traveling by car, what else might I toss in my bags if I’m not sure how long, or ever, it might be before I return home? 

Think about these things. Being prepared for the worst while hoping for the best means that you’ll take whatever happens in stride.

All that said: Stay safe and healthy.