Dumbells and donairs (weekly recap)

How are you coping with another week of being housebound?

I’d say that I probably need to work on my coping skills. There have been some extremely high-anxiety moments in our household (I have an unflappable husband and no kids, so I don’t need to tell you who the resident stress case is), but also some silver linings. I’ll focus on the silver linings.

I attended two virtual pilates classes hosted by my wonderful gym this week. It’s been many years since I’ve done pilates, and I been wanting to try it again. Enter pandemic. After attending just the two classes, I feel like I’m actually starting to learn how to breathe properly, and loosening up my L-spine and hips. These are both things I’ve been meaning to work on, so I’m grateful to have this unexpected opportunity.

My husband has started baking! He made bread in our breadmaker a couple of weeks ago, and he has another batch baking tonight. It sounds as if yeast is at a premium in North America at the moment (didn’t see that one coming), so our bread experience may be truncated once we run out of our current supply…but this evening I’m eyeing the breadmaker with delicious anticipation.

While we’re discussing food (let’s be honest, when am I not?), my husband and I have established a new ritual of take-out Saturdays. Historically, we usually eat out or order in on Saturdays, but making it into a ritual turns the whole affair into a pleasure to look forward to. After much dissent/discussion, we settled on donairs (and poutine) from a local restaurant last night and they were spot on. I made a kale salad to have on the side, because, well…donairs and poutine.

I also baked these oatmeal ‘scotchie’ cookies (a big hit) last week, and trialed this cornbread muffin recipe, which we paired with chili — it’s definitely going to be my go-to cornbread recipe from now on. Seriously, I haven’t made a single recipe from Once Upon a Chef that hasn’t turned out delicious.

I’ve been going into my clinic two days a week and also had a plethora of Zoom meetings (like everyone else), but the less frequent need to look fully professional has meant not having to use heat every day to wrangle my fine and naturally wavy/curly hair. I’ve been trying to air dry wherever possible and testing out some products that have been hanging out at the back of my bathroom shelves for the past…while. I’ve been trying to follow the tips for my hair-type outlined in this recent article (thanks, Cup of Jo)! Verdict: I’m still not ready to wear my hair down in all its air-dried glory to places like clinic, but I think I’m making progress with letting it do it’s thing, and working with whatever that thing is.

I had an opportunity last night to catch up on some short-form reading that I’d bookmarked last week. This prose poem is like a big hug and a reminder that you aren’t alone if you’re struggling right now. Also, as I’ve been constantly reminding myself in moments of frustration and crushing anxiety, everyone is facing their own set of challenges right now. I have a tendency to get snippety and snarky when I’m anxious, and my brain likes to tell itself that my problems are the biggest in all the world…but, if there was ever a time to put things in perspective and just be kind, then this would be it.

Instead of three things I’m thinking about this week, I wanted to focus on one big thing that seems to be on most of our minds. For exactly how long is the world going to be practicing COVID-19 mitigation strategies (aka social — or perhaps more aptly ‘physical’ –distancing)?

Reports from China indicate that Wuhan is relaxing its lockdown ever so slightly, and while it’s been a bleak week in North America (New York in particular…I found this Atlantic article very moving), a certain president indicated his desire to have his country “…raring to go, by Easter.” (Cough. Good Friday is April 10. Cough.) — Update at 10:00 MST : it appears that the plan to be raring to go at Easter has fortunately been tabled.

So, how long will we be waiting?

The short answer is that nobody is sure.

England’s Deputy Chief Medical Officer, Dr. Jenny Harries, announced today that she anticipated that it might be at least six months before life returns to normal, with a gradual reduction in distancing measures expected over that timeframe.

In their modeling study, published on medRxiv this week, Kissler et al raised the possibility that social/physical distancing may need to be maintained up until 2022, possibly in intermittent ‘pulses’ (i.e. relaxing the distancing for a few weeks/months at a time and then ramping it back up).

The Atlantic also published a detailed article last week, which suggesting four possible timelines, keeping in mind that, in order to stop the SARS-CoV-2 from spreading rapidly from person to person, somewhere between 60-80% of the population need to develop resistance to the virus. There are two ways in which this could happen: development of a vaccine, or spread through that proportion of the population (assuming that we do, in fact, develop immunity after a first infection — it seems likely but not certain that this is the case).

I’ve summarized their timelines very briefly here as follows, but highly recommend reading the article:

  1. The 1-2 month scenario (we fail at flattening the curve) – Most experts think this scenario is unlikely, and I hope it doesn’t happen. The most likely way in which early resolution would occur is through too quick of a lapse in social distancing, leading to a big surge in cases (aka steepening the curb), which would completely overwhelm the health care system and likely increase the case-fatality rate significantly.
  2. The 3-4 month scenario (we outsmart the virus) – If we find that the majority of people actually have mild disease, which would mean that there are many individuals in the community who flew under the radar with undetected cases due to asymptomatic/mildly symptomatic disease, and if we not only start testing aggressively for cases, but also for immunity (provided that infection results in immunity), we may be able to develop strategies that allow us to relax physical distancing measures sooner, at least for people who are known to be immune and/or are likely to have a minimally symptomatic disease course (like children, for example).
  3. The 4-12 month scenario (we get a summer reprieve…or not) – How this scenario would play out depends on whether or not the virus ‘backs off’ in the summer months (akin to other seasonal viruses, like influenza). If this is the case, we’d probably be able to relax mitigation strategies a bit over the summer, but would expect to see another wave of infections (and re-tightening of mitigation strategies). However, if the number of new infections doesn’t start fall by mid-June, this would make it very likely that the virus isn’t seasonal, and mitigation strategies would likely continue throughout the summer. Which brings us to…
  4. The >12 month scenario (we wait patiently for a vaccine) – This is what we’re looking at if we don’t have a big, global curve-steepening surge within the next couple of months, if we’re not able to use testing for infection/immunity status to our advantage, and if SARS-CoV-2 doesn’t exhibit seasonality. We’ll be dependent on either developing a vaccine or slowly allowing 60-80% of the population to get infected (ideally at a rate which doesn’t completely overwhelm the health care system). This could require a year or more of relatively aggressive mitigation strategies. To develop a vaccine that is likely to be safe enough to confidently administer to billions of people, we’re looking at spring 2021…at the earliest.

As a side note, earlier this week, the Canadian Medical Association Journal published a discussion with three Canadian infectious disease doctors. They made the following points regarding how to interpret whether mitigation measures (i.e. social/physical distancing) are working:

  • It’s important to remember that it takes a minimum of two weeks to see effects of mitigation measures on new cases, because the average incubation period is 5-6 days before symptoms arise (if they arise), and then usually another 6-7 days to develop symptoms severe enough to seek medical attention. This means that a positive test in a symptomatic individual usually reflects a transmission event that occurred almost two weeks ago (MW note: this doesn’t necessarily apply in the setting of aggressive contact tracing and testing of asymptomatic individuals)
  • Therefore, an uptick in cases during the first two weeks following the institution of mitigation measures doesn’t necessarily mean the measures are futile – we need to be patient

Please stay home, stay safe, and stay healthy this week!

 

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