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Stochastic Surrender

Dear Everyone:

"Stochastic Surrender."


A friend and colleague reached out last night and asked me for the “two words of my past week.” Stochastic Surrender was my reflexive response.


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Photo Credit: Emmanuel Coupe


I’ve been struggling to write this week. Some of it is that I simply haven’t had time to get physically and emotionally *still* enough to begin sorting through the infodemic and avalanche of emotions of the last 7 days. Some of it is that I’ve been attempting to respond to many of your questions by penning another Q&A (with humor).


Some of it is that this week has. Been. INSANE.


But with that little prompt from Ann, I realized that my week has been an exercise in leaning into the randomness, of trying to find patterns in the seemingly endless tragedy and pain and nonsense and noise, and of being ok when the picture – the future and even the present – remained blurry, despite my efforts.


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By now I trust there’s no need to check in on you: everyone is hydrated and breathing, right? Some of you may have even chocolated today, and I know at least one of you had opportunity to kitten this week. If, however, you have (like so many of us) had a *day* or a *week* and haven’t done – and maybe don’t even WANNA do – the things you need to in order to take care of you, let me give you this gentlest nudge.


Nudge.


Go get a drink. (No, NOT wine. It’s not even 5 o’clo…oh fine. Whatever. I’m not arguing. Just get a water while you’re at it). Now stretch. Breathe deeply as long as you’re standing up – all the way to your toes and out.


Again.


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Let’s face it: None of us are doing ALL the things we need to do. Its ok. I haven’t had a walk in 3 days. My sleep has been spotty some nights. Many of us are chocolating more than we’d like to admit (yep, we verbed it. Move on).


On the other hand, I also had a week filled with connections and gratitude and meaningful work and surprising amounts of laughter.


Laughter is resilience.


Laughter. IS. Resilience.


I don’t know of any emotion as instantly transformative as laughter. Connected moments of joy in the midst of pain or fear or sorrow lifts our souls.


The day of Joseph’s leukemia diagnosis was fueled with all the “to dos” – ICU admission, labs, chemo, procedures, endless calls and, of course, terror – but by the time evening rolled around Joseph and I were already cracking jokes. CANCER jokes (‘cause we’re dark and twisty like that. His dad, for the record, did *not* find us humorous which only served to increase the tenor of our laughter and jokes). In the week that followed, my sister and cousin joined us and ICU staff eventually requested we keep the door closed because we were “having too much fun…”


Anyone who knows me knows my default is to reach for humor; to diffuse, to lighten, to heal, and to bring perspective. Nothing, I’ve learned, brings perspective when I’m 47 ft deep down the rabbit hole of my darkest-paranoid-terror than poking a little fun at myself (The Husband has learned this works, too). Humor restores rational thought, putting me back into my prefrontal cortex.


If you’ve fallen into that “this is an unending horror show and NOTHING WILL EVER BE FUNNY AGAIN!” pit of despair, send up a bat signal. Be brave and ask someone in your life to send you a box of toilet paper and sarcastic card…


Humor won’t cure the ‘Rona, but laughter will break it’s spell.


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I feel like we should do some kind of wrap up of the avalanche of information that came at us this last week, but the truth is there was SO MUCH I’m not even sure where to begin.


Oh wait, yes I do.


PLANDEMIC IS GARBAGE


Please don’t share it. And please gently push back at those who do.


Those of us in the medical community have known of its “star,” Dr. Mikovitz, for decades. We know of her because she is a shining example of WHAT NOT TO DO: of lying, of cheating, of cooking the data and of doing harm to public trust in the scientific process. She isn’t a respected scientist who did groundbreaking work – she’s a disgraced professional who lied and cheated and is trying to reclaim a moment in the sun, once again at the expense of others.


Anytime anyone – ANYONE – attempts to manipulate us emotionally in order to make claims that they have an exclusive “corner on the truth” in science, we should immediately become skeptical of their motivations, and of the truth in their claims. Science stands on its own, regardless of who says it. New data may cause us to UPDATE or REFINE our models -- we are all watching happen real-time with our#COVID19epidemiological modelling. But those new findings are built on the foundations of existing knowledge. True scientists never claim the corner on truth, and they always want and encourage their work to be scrutinized and improved upon.


I’m putting several links in the comments section that I think are important for us to read and understand. The proliferation of harmful – and I mean really, really, lethally harmful – conspiracy theories that are making the rounds is something all of us need to have the ability to counter in the weeks and months to come.


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Let’s talk modelling.


The IHME model has again been revised (and please understand that when I say this I mean, “updated because we have new, more comprehensive data”). This is the model out of University of Washington that so many of us used and relied on through the months of March and April to help form policies and predictions.


It now is clear that the original model was overly optimistic. Modelling always is built on assumptions, and the flaw in their early modelling appears to have been, in part, the assumption that Americans would – wholescale – adhere to more strict social distancing than we did. They have revised (again) the total death count to be somewhere around 134,000 Americans, with the assumption that deaths will slow/stop somewhere towards the end of June.


I don’t have the mathematical skill to refute their modelling, but when we look at countries that have started to recover, it is not a bell-shaped curve with a quick up and down. It is a quick uptick, with a long, slow decline in the daily number of cases and death. There is no reason to believe our trajectory is going to be dramatically different. Furthermore, there’s no reason to believe we are more than halfway done with this pandemic.


THAT said, I'm putting an article in the links that looks across several new models that have come out in the last couple of weeks suggesting our decline may be more rapid than we've seen other places. Again, I'm going to remind us all that there are factors that have and are going to continue to play out that make it difficult to predict ANYTHING with certainty.


I like optimism. But it has to be tempered by realistic expectations.


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Now let’s talk reopening.


This week I co-authored an op-ed with my friend Dave Kimsey, Chatham Village President entitled The Yes/And of Reopening: Striking a Mindful Balance (link in the comments - Chatham Clarion 5/7/2020)


Our willingness to tolerate uncertainty is going to be a key component of successfully reopening our communities. Let me remind everyone: The public health policy of#FlattenTheCurvewas NOT that we all remain sheltered and closed until the virus was gone. That ship sailed in January when we began to have community transmission in the U.S. in the absence of a federal pandemic response plan.


The point of flattening the curve – of the closures and distancing and stay home orders – was to allow our healthcare systems to come online with enough of the 4 S’s: Staff, Stuff, Space and Systems that we could handle the number of people who would be infected and need critical care. It also buys time for physicians to learn from each other’s experiences and improve treatment, and for scientists to study potential therapies and antivirals.


Keeping the rate of transmission down is key, not because this virus won't be with us forever (it will) but because we don't want everyone getting sick all at once and overwhelming hospital capacity. That happens much faster than people think. It is a highly infectious virus with a long lead time before symptoms (5.1 days) develop during which time we can be asymptomatically infected and unknowingly infecting others.


Does physical distancing and universal masking work 100%? No. We don't have anything right now that works 100%. We need a vaccine or a cure (and even these are rarely 100% effective). In the meantime, all we have is the sum total of several different public health strategies which, when taken together, start to add up to something meaningful. Reducing rate of transmission matters, and everything we as citizens do that add to that reduction (damn, that’s a backassward way of saying it) is helpful to the collective.


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The enemy in this situation is invisible, and that is proving to be one of the more difficult challenges in this pandemic. American individualism is as central to our identity as our patriotism—we like an enemy we can take to the streets and beat in a fair fight. The idea that this virus requires us to do nothing? It is anathema to our sense of who we are as Americans.


Creating a new sense of normal is a constant challenge these days. As we move through May, we already see isolation fatigue amp up as the weather improves. And as politics start playing a more prominent role than public health in managing this pandemic, we are quickly approaching the time when we, as a community, will have to make decisions about how we intend to proceed.


The White House published a plan for reopening America. It is a tiered, risk-stratified approach that leaves much of the decision-making to state governors. It does lay out a series of provisions that must be met when moving from one tier to the next, including testing, contact tracing and trends in new cases. Unfortunately, we are still probably many weeks away from meeting the testing provisions laid out in this plan (we need, at a minimum, to be conducting 500,000 to 1 million tests per day nationally) and even further away from having an adequate number of trained contact tracers (nationally, we have about 1,500, but estimates say we may need more than 100,000).


The question, then, is do we move forward without the ability to identify and quickly tamp down new flares?


The answer is Yes/And.


Yes, we need to reopen, AND we may need to reopen more slowly than many of us want. We need to remember that every day we delay, we increase our ability to test and trace (and treat).


Yes, we need to reopen, AND we need to accept there will continue to be necessary limits on the size of gatherings to slow the spread and mitigate unnecessary risks. Every one of us is going to have to make decisions in the weeks and months to come regarding our own risk tolerance. That said, we also need to remain mindful that we aren’t just risking ourselves but our neighbors, too.


Yes, we need to reopen, AND we need to commit to protecting each other through universal masking when indoors. Remember: Masks protect the other person. When I wear a mask, I am protecting you. When you wear a mask, you are protecting me. There is nothing more American than looking out for our neighbors—this is how we do that in the time of COVID-19. Universal masking indoors reduces transmission by more than 50% and is one of the best tools in our toolbox for protecting each other as we reopen and decreasing a risk of resurgence that would mean more rounds of closures.


Yes, we need to reopen, AND we must accept that it won’t be an immediate return to normal. Physical distancing will allow us to continue to keep that curve flat by slowing the spread of the illness.


Yes, we need to reopen, AND we need to work together to chart a new normal until we have a vaccine because there are inevitabilities:


1. By traditional measures, we are at least 9 to 24 months away from having a vaccine.

2. We don’t yet have reliable medication for treatment, though it is advancing daily.

3. As we reopen, there will be flares of new COVID-19 cases. We can reduce the number and severity of them by doing our best to take care of each other.

4. This is a tricky virus. The average time of symptom onset is about five days. During that time, each one of us can be walking around unknowingly infected and unknowingly infecting others. Universal masking when indoors coupled with rigorous, frequent handwashing and physical distancing of six feet can reduce that risk significantly.

5. Living in rural America is no protection from this virus. Tracking by Johns Hopkins University breaks down instances by county and shows we do have significant flares in many very rural parts of the U.S.

6. Despite the extraordinary measures taken thus far, more than 72,000 Americans died in 6 weeks. Our vigilance going forward will help keep additional numbers as low as possible.

7. Fear doesn’t help in a pandemic. Caution and respect for others does.

8. Disdain doesn’t help in a pandemic. Care and respect for others does.


#NeitherFearNorDisdain


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We humans aren’t practiced in tolerating uncertainty - we seek the binary solution. But in the time of Covid19, that desire for easy certainty isn’t just dangerous, it can be deadly.


Stochastic Surrender (you knew I’d circle back, eventually) therefore suggests a willingness to lean into the uncertainty. To recognize – and even begin to trust – that patterns will start to emerge from the seeming randomness of it all. To accept the notion that while we are unable to make precise predictions, we are learning as quickly as we can, that “best practices” and policies will change as new information becomes available.


Meanwhile, I’m trying to be mindful about noticing and honoring the collateral beauty of this time. It doesn’t diminish the pain, and it in no way compensates for the loss of life and livelihood. But mindful recognition of the collateral beauty – not just the collateral damage – reminds me that we DO have choice in how we respond to what is happening.


In the end, we *are* our choices.


“Sometimes bravery is nothing more than gritting your teeth through pain, and the work of every day, the slow walk toward a better life.” ~Veronica Roth~


Keep being brave, generous and kind, always.


More soon,


K


#CareInTheTimeOfCovid

#America

#PatrioticIntroversion

#WeCanFixAnythingButDead

#ResponsibleReopening

#Testing

#ContactTracing

#NeitherFearNorDisdain







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