purplekow

I must admit I cannot top as often or as diligently as I once did, but have found other ways to top rather than "switching".

Well Monday morning came and while for many who are not working, the weekdays and the weekends are one big blur, for those of us on the hospital schedule, weekends still have some meaning because some of us get the whole weekend off, at least once in a while. I had this weekend off which meant that this morning was like hundreds of other Mondays I have faced. Two days off and the grim realization that I have to go back to work, this time for the next 12 days. I had peeked into the patient records and I knew before I got there that there was about a dozen new patients and that the majority of them were Covid patients. I also knew that, although on Friday I had sent home three or four patients who had been as sick as you can get with this disease, including one man who had been on a ventilator for 14 days, that there were at least a couple of the new ones and at lest three of the already established patients who might be heading in that same direction. My call started at 6 AM, meaning any non-insured patients admitted after that hour would be mine. The first call came in at 6"05 waking me a full half hour before my alarm. Two patients admitted just after 6 AM who had been there overnight but who were awaiting test results before admission. I listened to the ER resident's report, agreed that the patients needed to be in the hospital. I gave some preiminary orders and headed back for that last 15 minutes before the alarm. The alarm lost a close race with the phone. Different ER resident and another admission. Sometimes the extra ten minutes sleep can be a blessing, a bit of a refresher before getting up and into the day and other times, like today, that extra ten minutes makes it feel that you have been on a 25 mile march in full battle gear though you have never left the bed. So by the time I arrived at the hospital an hour and tend minutes or so later, there were the residual number of patients from last weeks lists, the two days of patients which had been admitted to my service over the weekend and the three new patients from the morning. Twelve in total, 9 Covid, three not and then three more in the ICU who were not technically my patients at the moment but who I sent off to the ICU and who would return to my service if they ever left the ICU. I headed to the ICU to check in. One man, a man that I may have mentioned in an early post here, was completing his 20th day on the ventilator. He was a sturdily built Mexian landscaper who had never been in a hospital. He came in on the first day looking sick but not terrible but he got terrible in a few hours and he has been on a ventilator ever since. He needs medication to keep his blood pressure above shock levels and it is only his previous good health that is keeping him alive at this point. Sadly, his family is in Mexico and he is alone here in the US. IF he should pass, there is no one to claim the remains. No one here to mourn except the staff who have spent three weeks urging him to live. I am not a religious man but I said a prayer for him anyway, what could it hurt? The second man has also been in the ICU on a ventilator for two weeks. Also young and fit, 37, he is doing slightly better than the previous patient but his is definitely a touch and go situation. The final patient is a woman I admitted last week and who took a wrong turn and she kept on going, downhill. With the new emphasis on trying to keep patients off ventilators or to limit ventilator use, she was given every medication we have along with high flow oxygen, All to no avail. Friday before I left, I called her husband and took my phone into her room to allow her to speak with him. She does not have a cell phone. After a brief conversation, she said: "Te quiero mi amor". and that was the end. I have no idea if she has spoken with him since. It will definitely be a long time, if at all before she speaks with him again, I will only mention that of the remaining patients on the regular Covid floors, three went home and two went south. Both of the two who failed were offered convalescent serum and both refused. I expect both to be in the ICU, on a ventilator and remdesivir, before I return in the morning, It is unclear what was frightening to these people about the idea of convalescent serum. In at least one case and likely in both, the families had objections which they passed onto the patients. One patient had signed the consent and then when the IV fluid arrived, she refused. Fortunate for another patient who was a borderline candidate who got her dosage rather than wasting it. So it goes. New people, new treatments. Still seeing peaks and valleys. in admissions to the hospital and to the ICU but the number of deaths seems to have leveled off. Tomorrow is another day, Covid care went from being constantly changing to now a routine that the caregivers know by rote. Diagnose. Plaquenyl...probably not but some are still getting it. Zithromax...probably not but some are still getting it. Check the blood inflammation markers, are they going up or going down. Going down, watchful waiting, Going up, hold your breath and when they go too high make sure they have the anticoagulants and the statins and the famotidine (this week's newsmakers has been in use for weeks) the zinc and the vitamin C...what could it hurt. Check the oxygen demand and the respiratory rate. If it is going up give the Tocilizumab and high flow oxygen at 60 liters. Did it turn it around? Yes...breath a sigh of relief. No....convalescent serum, if they will take it. Then wait. Then the step into the abyss. Intubation, ventilation, remdesivir, Levophed, medically induced coma, feeding though a nasal tube and prayer. I read a study a few years back out of Duke I think, that they had patient's in the ICU for whom people prayed and a matched group who did not have a specific prayer group. The prayer group was not on site. The group did not know the patients and yet those patients did statistically better. Anomoly? God only knows. But that is when I started telling my patients that they should be a non=discriminatory, non=denominational acceptor of prayer. I do not believe it works, but I do it for each and every patient because in the words of the orange haired beach ball, "what could it hurt?" Even prayer from non-believers are heard if any are, one would think. So even you cynics and naysayers, if you have a few minutes and care to offer a quick. "Hey god, how about getting the guy in room 509 better" it may be the best spent part of your day in isolation.

I understand 42 is the new 32. Or is it 32 is the new 42. In any case, he is old enough to vote old enough to........ push his head down and have him suck me off.

And who knows more about Electronic Dance Music than librarians?

Would look him up on line and see what became of the one that disappeared. My father had a cousin, Frankie was my father's younger cousin about 40 at the time, who was the black sheep of the family, He was a con man and he was in and out of trouble with the law all the time. At one point, he was living in California with a rich older woman who may have been the attorney general of the state (my memory of this is vague as I was about 9 at the time but whoever she was, she was rich and powerful and he was living with her). He was a notoriously bad driver and he had several car accidents so the woman hired a chauffeur for him. Even though he was visiting NYC and did not have a car, the chauffeur came on the trip. My home at the time was about a 5 minute ride from what was then Idlewild Airport, So Frankie and the chauffeur stayed at our home. I slept in an attic bedroom with a pull out couch and Frankie and the chauffeur slept on the pull out. The chauffeur, Jimmy, his name just came back to me, was in his 20s and I remember being very impressed with his Popeye biceps and lean body and a nautical tattoo he had on the left forearm, During their first night, I awoke during the night and heard heavy breathing and in the moonlight from the window I could see some movement on the pull out couch. The heavy breathing stopped with a big sigh and I went back to sleep. The next day I asked Jimmy if he slept alright because I heard him breathing heavy. He said he was better than fine and that in a few years I would know why he was breathing that way. For the next three days I could not take my eyes off of Jimmy but I was not sure why. He was right, a few years later I knew why he was breathing that way but it took me a bit longer to realize why I could not take my eyes off him. I can still vaguely picture him now, crew cut, sandy hair, angular face, tattoo was an anchor, great guns and his pants were very tight, which may have been the style then, I have not thought about this in decades.

If you can't last long, you can't do porn.

This may look like its about baseball and it may initially sound like it is about baseball, but I don't think its about baseball as "Mike plays hardball....got the leather, got the lumber". "ball with the big boys makes him all cocky, he holds his own cause he's short but he is stocky". "mike doesn't chew cause I asked him not to, he took the hint and spat it out." And the after game singing in the shower and pile on the pitcher's mound". Coincidence that the catcher gets piled on by a bunch of guys on the pitcher's mound? As Artie Johnson used to say..."Very in-ter-esting"

No vaccines are 100% effective. In some years. the flu vaccine is only 20 to 25 % effective. They are designed yearly based on the expected strain to predominate. Some years there are two strains so the vaccine is only partially effective. Sometimes they totally miss the mark in predicting the strain and the vaccine has very limited effect. Others vaccines such as measles and mumps are very highly effective as the virus itself is very stable and the rest of the time, herd immunity protects us. That is why you do hear of only the rare outbreak of measles. Those outbreaks usually start in unvaccinated persons. There was an outbreak of mumps from a Jersey short bar a few years back. I treated two patients who had been vaccinated as children but as hard drinking thirty somethings their immunity did not totally protect them, They had mild cases of mumps and luckily it did not effect their testicles and reproductive capability. So as to a CoVid vaccine, it may be difficult to produce a vaccine if the virus has significant genetic variability over time. The different genetic strains of flu are the reason that there is a flu shot each season and each of them are different than the prior year's. The hope with CoVid is that some would become immune from the vaccine, some would be immune from past exposure, if exposure confers long lasting immunity which is not clear that it does, and many would benefit with herd immunity and the others who get the disease could be quickly diagnosed and treated. It is not to be expected that the disease will be totally eradicated, but as a public health issue, it is hoped that it can be contained and treated. While Sars has not been seen since the early 2000s, MERS (Middle Eastern Respiratory Syndrome) a less reported disease seen in Saudi Arabia, continues to be present mostly in Saudi Arabia with occasional cases elsewhere. This virus has a natural host in camels and so it has been difficult to totally eliminate the disease. It has the potential to be devastating, but it appears to be more easily held locally than SARs which spread worldwide.

If you have video or erotic pictures of yourself, have you ever used it for masturbatory purposes. In other words, have you even gotten yourself off by watching yourself on video, in pictures or in a mirror?

Just as a comparison, recent recommendations for hydroxychloroquine (Plaquenyl) the original trump panacea, are that it should not be used as an outpatient only in hospitalized patients and then with caution. Reported that twice as man deaths with HCQ as without. Again, one report and most recent recommendation. It is still being used. So do not jump off or onto the Remdesivir bandwagon, let it get to the end of the trial before deciding.

We are getting more and more non Covid admissions but only those that cannot be treated at home are staying for any period of time. With so many Covid patients in the hospital, the possibility of contagion is high for those Non Covid patients who are in the hospital, However, patients are still be treated for other things. Right now I have 11 patients, 8 are Covid and 3 not. Of those, tomorrow 4 Coiv and two not will be going home. Admitting today, so will see what the morning brings.

Covid, in some places has overwhelmed the health care system. Some of the first Covid cases we saw at the hospital were doctors and medical office staff. People did not realize that, yes that migraine could be Covid or that diarrhea could be Covid or that sinus congestion could be Covid and that back ache, yep Covid. So the little old lady coming into the office gets Covid in the waiting room or from the staff member taking her blood pressure. We have gotten much smarter about it and I think doctors will be coming back to the office. if a problem can be taken care of with a video visit, that will be the option most providers will take. That method is safer for the patient and for the providers. I do not like it and I think most providers do not like it, but for he near future, Covid rules medical care. The physical can wait. The prescription change can be called into the pharmacy. The swollen, red leg can be done over the video. I would think doctor's offices will start having patients come in for an appointment and have the patients use their car as the waiting room. My cousin wanted an appointment with her doctor and was told she would not be seen until after she had a negative CoVid test. That order was called in, She was looking to be seen for a Gyn problem but as fate would have it, she had Covid. As much admiration I have for nurses and other personnell as well, during this crisis, I have to admit most doctors have not stepped up. Hospitalists, Intensivists, ER docs all working diligently night and day. Backbreaking and dangerous work. Anesthesiologists, some are great, others are absent. Other specialities? it is really hard to get them to come into the hospital to get things done. A lot of things are being put on hold, not just elective surgeries but other non urgent surgeries as well. Try and get a colonoscopy for a patient for bleeding better jump through every hoop they put up even then it is nearly impossible. An elective colonoscopy? You would have more luck finding a dodo in a Blockbuster Video. So to answer your question, just like almost every other field, medicine is now shaped by Covid. Medicine, is for the most part All Covid all the time. Yesterday I have 8 patients admitted to the hospital, 7 were Covid, Three of those had something else but they had Covid too. The other, had a cardiac issue for which he got a stress test and an appointment for a cardiac catheterization next month, Will they be doing them electively next month? who knows. So medical care for now and intervention, if needed, later.

It is PK as I am rarely PC.

We are involved in two Remdesivir trials. One given to very sick patients who are on a ventilator and one given to patient's earlier in the course. It is too early to tell and it is definitely so that the leaked results were either Apocrypha or designed to get a stock bump. That said, we have had a few patients make great improvement in the late use arm of the study. I am not privileged to the actual data but we are a small site so compared to the worldwide nature of this study, a drop in the ocean, We have not used it in the early use arm of the study yet. Early reporting either pro or con has to be taken with a grain of salt, but while this will not be a panacea, it looks to have a role in late use but do not bust out the fireworks until the study is said and done.

He was an answer on Who Wants to Be a Millionaire tonight. Jane Fonda had a question as to which one of the following people did not play Colonel Sanders in a KFC commercial. Norm MacDonald. Rob Lowe George Hamilton David Spade. Jane did not know who Norm MacDonald was but did get the answer of David Spade, who she did not question who he was. So Spade is up one in the Q rating war with Norm MacDonald. Jimmy Kimmel who is hosting this brief reboot dropped that MacDonald was the celebrity who had won the most money on Celebrity Millionaire, which was $500000.. I believe. Jane herself could have had a $500000 question if she trusted her Phone A Friend and answered that it was Lima Peru not Reykjavek Iceland that was in the same time zone as NYC. She decided to walk with 125000 for her charity.

He was an answer on Who Wants to Be a Millionaire tonight. Jane Fonda had a question as to which one of the following people did not play Colonel Sanders in a KFC commercial. Norm MacDonald. Rob Lowe George Hamilton David Spade. Jane did not know who Norm MacDonald was but did get the answer of David Spade, who she did not question who he was. So Spade is up one in the Q rating war with Norm MacDonald. Jimmy Kimmel who is hosting this brief reboot dropped that MacDonald was the celebrity who had won the most money on Celebrity Millionaire, which was $500000.. I believe. Jane herself could have had a $500000 question if she trusted her Phone A Friend and answered that it was Lima Peru not Reykjavek Iceland that was in the same time zone as NYC. She decided to walk with 125000 for her charity.

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane. Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in. However there is one particular episode that I would like to write about today and a group I would like to salute. I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest. I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either. I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it. With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway. I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down. Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day. They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone. I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete. So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

I have been back to work for a few days but I have not had time to report back here. I would think that most of you have Covid fatigue so perhaps a break from my posting here was just the cure you needed for that. That, and not watching any form of information at all. While I was off, I avoided all radio and television except for Netflix and HBO. The world seemed almost sane. Upon my return to work, things seemed under better control. I do not know if we had gotten used to the chaos or if during my time away, the chaos had magnified in my mind and the reality of it did not seem quite so enormous. That feeling lasted for about an hour and then the reality of the situation set in. However there is one particular episode that I would like to write about today and a group I would like to salute. I went into see a patient today who had been taken off a ventilator after 14 days. He was doing surprisingly well and he had been treated with all therapies availbable at this hospital except human plasma which was not available at the time he was his sickest. I gowned up. Gown, two masks, face shield, two sets of gloves and headed into the room. The ambient temperature was about 82 degrees and I later learned it was that way in most of the rooms because the patients tended to be cold and they only have a light sheet to cover themselves. The skimpy hospital gowns do not add much for warmth either. I spoke with the man, a nice guy from Peru who happened to be visiting a friend when he became ill and was brought to another hospital about 50 miles away. He had an endotracheal tube placed and as there were no ventilators available at that hospital, he was sent on an hour ambulance ride with someone or more like two people alternatingly pumping an Ambu bag. Ambu bags, for the uninitiated are rubber football shaped items with a valve to attach to an endotracheal tube and an entry port for oxygen which can be manually squeezed to pump air into the lungs, usually for short periods of time, but it can be done for as long as fresh hand muscles are available for the squeezing. I asked him about his recall of the preceding events and all he could recall was going to the hospital and then waking up here two weeks later. The drug induced coma had done its job effectively. As I was talking, there ws a knock on the door and I went to the door and was asked if I would deliver his tray and take his vital signs while I was in the room. I did so, waiting impatiently for the thermometer to beep once I had place it in the patient's mouth. I walked it back to the door and showed the result to the nurse outside. The machine which took the vital signs was then wheeled to the door so that they could be noted in the patient record. I spoke to the patient further and he told me he needed to urinate. I went to the door and got the nurse to bring me a urinal. She did so promptly and I brought it to him. He had some type of underwear on, I am not sure from whence that came as most patients, at least male patients, go commando, He could not manage to get his equipment out of the briefs nor could he manage the get them down. He asked for an assist. I helped him slide them down. (now those of you who are making a porno movie in your mind from this should know....this was not at all sexy) and gave him the urinal. Unfortunately the prolong time in bed on a ventilator had made it difficult for him to stand and also made it difficult for him to arrange the urinal properly. I helped him up, setting off all sorts of alarms and then took the urinal and found just the right angle to allow him to urinate into the bottle without missing a drop. I then helped him back to bed and tried to turn off the alarms. Even with explicit instructions from the nurses outside, eventually one of them had to come in to show me how to do it. With the patient settled, I was able to leave the room and received a round of applause from the small group of nurses standing around the hallway. I had been in the room 7 minutes or so. My mask was fogged. My arms were sweaty. I was breathing heavily from the heat and the masks. I needed to sit down. One patient. 7 minutes. That was enough to have me needing a long drink of water and a 10 minute sit down. Now to the point. These amazing women and a few men do this for hours at a time. They get into and out of gear more than a dozen times a day. They are taking care of 2 to 4 of these amazingly sick patients and they do it hour later hour and day after day. They rarely get to sit and if they do it is to write a note or talk with a family on the phone. They give medications. They make clinical judgements that have life and death consequences. They make the bed, take the temperature, comfort the patient, talk with them and hear their fears. They listen especially hard because these patients do no have visitors and the only real sustained human contact they have is their nurses. I have seen nurses arrange FaceTime interactions for a family who wanted to see their matriarch one last time before she succumbed to the disease. They relay patient messages sometimes through translation services to patients whose families are hundreds or thousands of miles away. They need to answer the questions, get the medications, arrange the tests and get the patient orders from the doctors. They need to face the possibility of contracting this possibly fatal disease from patients who are unable to avoid coughing on them or who grab them unexpectedly. These are women in their 20s, many mothers of young children who come in to work every day, middle aged women who have seen it all and done it all twice. There are senior nurses, some back from retirement because they could not sit home and allow someone else to do it alone. I cannot express in words the admiration I have for these practitioners. They do not get a round of applause like I did when I managed to take a temperature and helped a man avoid peeing on the floor. They are getting some recognition now but not nearly enough. They are the cornerstones in this battle against this disease. These daughters, mothers and sisters are the front line, down in the trenches soldiers carrying the heavy loads and doing so willingly and without complaint. They deserve any accolade that might be sent their way and a hundred times more for each of the mercies they complete. So If you read this and you know a nurse text her, phone her, send her a card and give her a heartfelt but in these times, a virtual hug and a round of applause. It made me, someone who was only a 7 minute nurse, know that someone was watching and appreciating the effort, I think the 24/7 nurses deserve much more than that.

I am a drinker of Diet Coke but during this crisis I have given it up. I am drinking lots more very cold water and it seems to be doing quite well for me. I do miss the caffeine rush occasionally but I can go to coffee for that if need be. I used to drink four to five cans of Diet Coke per day.

We are using it. It is not a miracle drug but it is the best we have along with Tocilizumab. Notice what is not in that sentence? Plaquenyl (hydroxycloroquine). While still in use it is generally felt to offer little in the overall treatment and so Dr. Fauci appears to have been right when he warned at the WH press conference that the drug's effectiveness was only anecdotal. This drug does have good initial scientific evidence of effectiveness. Hopefully some people will learn that the science matters. Problem with Remdesivir is that manufacturing of it is very limited right now, the chemicals needed to make it are hard to come by and most of them are held in large part by China.

Interesting that since the CoVid pandemic, we have seen a drop in alcohol related admissions to the hospital to almost nil. Usually there would be two to three a day. About 13% of the people in the US have alcohol related problems. So staying home and drinking or not drinking seems to be keeping people out of the hospital. If they are drinking at home, they usually do not get seen, they pass out and wake up and start drinking again so withdrawal is not the problem. Alcohol induced pancreatitis and other toxicities not related to withdrawal are still a problem but those patients have not been showing up. Also people are not going to bars so alcohol consumption on a social basis is probably way down. I would guess police calls about street fights and public intoxication are way down as well. In addition, our usual cadre of drug seeking patients are way down. In order to get to be seen in the ER they have to go through a screening area in a tent outside the ER. Then they need to risk coming into a ER filled with Covid patients. They may be drug seekers but there are apparently barriers they will not climb to feed the habit.

The number of swine flu deaths in the US was about 13000. Worldwide it was much higher due to mostly deaths in China. Deaths being reported out of China with Covid 19 are much less a percentage of the people killed either because China became better adept of controlling the spread or because they are underreporting the number of deaths or because both are true. Clearly US deaths from Covid 19 will be several times higher than the Swine flu and with a much greater effort to control it. Worldwide, it is likely to exceed the number of deaths as well. This will certainly be true if the disease takes a hard toll on Africa which was relatively spared from the swine flu.

Well Lunch is over. We ate outdoors. He was in the house for a very short period of time mostly to use the facilities. All plates and utensils immediately went into the dishwasher and were washed at the hottest settings and will not be used for more than 48 hours. The last load of dishes was in there clean for at least one week. We kept social distances and spoke across the table about 8 to 10 feet apart. I will not be using that outdoor table for quite some time. Last time I used it was more than one month ago. So I feel as though this was a safe and sane encounter.

He was quite coherent when I saw him but not a big conversationalist. His body however spoke volumes. With social isolation who knows what is going on in people's lives. In New Jersey they considered Liquor stores essential and kept them open and gun shops were also deemed essential. . Nice to know that there may be drunk people able to buy a gun in this state. To the point, I have seen Steve on two occasions. One time we both had a few drinks and the next times, though I offered he declined. He was a nice guy but I did not go into a long history of his life. While his responses to you were odd, I would not be quick to attribute them to a chronic drug or alcohol problems. For example, I have made nonsensical responses to texts and phone calls when I was very tired or just woken from sleep or distracted by something else. It seems clear he was not at his best but there is not sufficient reason to assume to worst.

I have a childhood friend coming to visit today. I have an outdoor front porch where we will be sitting across a table from one another to eat. No common utensils. Social distancing and social discourse and then good bye. No touching. He probably will not go in the house unless it is to use the guest bathroom, which I do not use. He has been in virtual quarantine for weeks and I have not because of my job so most of the risk is his. Neither one of us is sick but of course the is not an assured situation. Is this risky behavior? Probably so but I believe the risk is minimal and it is the kind of risk we will all be taking when things open up again.