Year: 2025

Commentary, COVID-19

Why I care about the flu too

This is part of an ongoing series exploring how to live with compassion in our world of infectious diseases, which tend to recur in waves.  It started with me trying to figure out how to avoid getting and passing on COVID-19, but I pretty soon realized that it applied to influenza and respiratory syncytial virus (RSV).  In fact, it applies to any disease that can cause major damage or kill, and travels through the population in these wave formations.

When I express concern about COVID-19, I have some friends who say, “Well, isn’t it just like the flu now?”  Some COVID-cautious people respond by saying, “No, it’s nothing like the flu!”  I’m not an epidemiologist, but from everything I’ve heard, a better response is, “Well, it is kind of like the flu, but we should care about the flu too!”

I tend to suffer from recurring sinus infections, but in 2018 they started affecting my lungs as well.  From September 2019 through March of 2020 I had four distinct episodes of nasal congestion, sore throat and coughing.  In January and March of 2020 I had fevers.  In between those episodes I almost felt well.

Of course, even in January 2020 people were talking about this new virus, which came to be called COVID-19.  My infection in January or March might have been COVID, but we didn’t have tests available then.  As I’ve written, I went into the COVID pandemic thinking that it would be necessary and unavoidable for large numbers of people to die, and over those first few months came to understand that mass mortality was neither necessary nor unavoidable, and also that it was massively unjust.

Contrary to what a lot of people have claimed, I found that the sacrifices I was being asked to make as a middle class technology worker – work from home, shop online, socialize without physical closeness,  wear a mask in enclosed space, even avoiding live vocal performance – were relatively minor and felt like the least I could do to avoid endangering people in more vulnerable positions.  I also found that they put a stop to my own respiratory infections.  And when eating outdoors became more available, I found that I enjoyed it even more than I had before.

As I was making these changes to my lifestyle, I kept thinking back to my respiratory infections in the fall and winter of 2019-2020.  I tried to stay home, especially when my symptoms were at their worst, and even give myself a day of added recuperation.  But I got bored and missed social contact, so I kept going out as soon as I felt better, and sometimes when I didn’t feel better.

One time in particular I keep coming back to, when I attended a karaoke meetup in late 2019.  I sang “Total Eclipse of the Heart” with a friend, and I had practiced the Bonnie Tyler part before, so I told my friend I wanted to sing it.  But my lungs were so messed up, I wound up singing some kind of screechy death metal version.  My friend and the rest of the group seemed to enjoy it, but months later, after COVID had arrived, all I could think of was how I might have been spewing whatever virus or bacterium throughout that fairly large karaoke room, infecting the whole group.  If one of them went home and passed it on to an immunocompromised relative, that could have really hurt them, or even killed them.

This is not idle speculation.  While it appears that current strains of influenza aren’t very lethal by themselves, and RSV mostly kills small children, they both can weaken an adult’s immune system to the point where they catch bacterial pneumonia.  As I wrote this past February, my 86-year-old mother was hospitalized with both RSV and a case of pneumonia that appears to have been caused by the RSV.  She was released from the hospital with a diagnosis of congestive heart failure that may well have been caused by the pneumonia.  She died last month after collapsing due to shortness of breath.  We don’t have definitive proof, but the RSV she caught in November 2024 may well have snowballed into the conditions that killed her a year later.

Influenza and RSV are not exactly like COVID-19, but they have similar serious effects that can kill or seriously disable people, and they are especially dangerous to those of us who are vulnerable for other reasons, like age, disability or other health conditions.

Back in 2019 I was vaccinated against the flu, but I didn’t have a lot of guidance telling me not to go out and sing.  Unlike the worst period of the COVID pandemic, in the flu seasons I remember before 2020 we didn’t get detailed updates on the progress of the virus.  At best we got a news report saying something like, “Epidemiologists are predicting that this flu season will be particularly severe,” but no real discussion of asymptomatic transmission, and no monitoring to tell us when to ramp up our protective measures, and when to dial them back.

This is why I started talking about Outbreak Mode, and setting thresholds for going into and exiting from Outbreak Mode, and why I created my Contagion dashboard to compare the reported indicators against those thresholds.  It’s why I decided to to pay attention to the flu and RSV, not just COVID, because the flu and RSV kill people too, and they don’t have to kill as many people as they currently do.

by grvsmth
Commentary

Why eliminating the Department of Education is racist

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On March 20, Donald Trump issued an executive order promising to “dismantle the Department of Education,” something he promised to do in his campaign.  I saw a wide range of reactions from centrists, liberals and leftists, but for some reason none of them came out and said it: this is a deliberately racist action.  Racists understand it, because it’s something they’ve wanted for decades, and Trump is happy to do it.

Many years ago I spent a year in North Carolina and worked in an IT job.  I was taking an independent study on research methods in grad school, so I asked some of my co-workers, twentysomething white guys, if they’d be willing to participate in a sociolinguistic interview.  I asked them all what high school they went to, and none of them responded with any of the local public high schools.

All these white guys said they attended the local Christian Academy.  I thought that was a bit odd, because none of them seemed particularly religious, just a few years out of high school, and filed it away in my mind.  Years later I found the answer: most towns in the South have these “Christian Academies” and they’re also called segregation academies.

When the civil rights fighters of the sixties won several victories against official segregation policies, racists didn’t just fight back using the Ku Klux Klan.  They turned their private, religious schools into instruments of segregation.

I think it’s important here to pause and point out why racists hate integrated schools.  It’s partly because they want to make sure that white kids always have more education than kids who aren’t white.  It’s partly because they want to control the messages that kids are taught.  But it’s also because kids in schools tend to get to know their classmates as peers, and that can lead to equal interracial relationships.  And those can undermine the racial hierarchy.

Of course, there have been interracial relationships for all of human history, and there are structures enforcing segregation and racial hierarchies within schools.  But the fact that children of different races are likely to spend time together in class, in the cafeteria, in libraries, teams and clubs means that they’re more likely to develop friendships and romantic relationships than if they just encounter each other in work and service situations, which are often explicitly structured to reinforce hierarchies.

Here in New York we use municipal and neighborhood boundaries for segregation, especially in suburbs like Levittown and Bronxville, but even, as Nikole Hannah-Jones and others have documented, in places like Brooklyn Heights and the Upper West Side.  It took me years to realize that “good schools” was usually code for schools without too many nonwhite children.  And this is practiced in the South as well.

In New York we also use religious schools for segregation, and that’s obvious for Orthodox Jewish schools, but it’s a bit more subtle for Christian schools, since many of the Catholic orders who run schools view their missions as including nonwhite students.  Catholic schools here often have a similar racial mix to the public schools, but significantly whiter.  They also are not required to take any student, so they can use the threat of expulsion to enforce all kinds of “traditional” hierarchies.

Municipal and neighborhood segregation results in segregated schools funded by public taxes, but under current law, segregation by religious schools requires them to be funded through church tithes and other contributions, or through private tuition.  Meanwhile, parents who are paying tithes and tuition for religious schools are more or less required to fund the education of other kids, many of whom are likely to not be white.

This is why racists care so much about school vouchers, an issue that mystified me for years.  Vouchers put public tax money back in the control of people who run private schools, especially the racists who run the segregation academies.

But what the racists would like even better is to completely dismantle the whole apparatus that was set up in the mid-twentieth century to enforce laws against segregation, to promote integration, and to fund education for all.  They want to return to a system where the highest priority for school taxes was educating white kids, and the nonwhite kids got whatever was left over, if anything.  A system where white kids were kept away from any nonwhite kids who might have a chance to earn their respect and admiration.  And where the local racists were empowered to control the curriculum.

This is why they want to destroy the federal Department of Education.  It’s a goal that Donald Trump, who was educated at a (non-sectarian) private school here in Queens, sympathizes with, and is happy to deliver for them.

by grvsmth
Commentary, COVID-19

What infectious disease hospitalization looks like

Selfie wearing a KN95 mask in a hospital emergency room. On the wall in the background is a small sign reading A-25.

Two weeks ago as I was relaxing before bed, I got a call I dreaded.  The EMTs were in my mother’s apartment; she had fallen and hit her head.  I got dressed, rushed over and joined them in the ambulance, and we set off for the trauma center at Elmhurst Hospital.

A CT scan and some X-rays determined that my mom didn’t have a concussion or broken bones, so the hospital released her the following morning.  They had done some blood and urine tests and discovered that she had a urinary tract infection.  I didn’t know that you could get a UTI from pneumococcal bacteria.  I had noticed her coughing for several weeks, and wondered if there might be a connection. PCR tests for COVID and the flu were negative.

We still didn’t know why she fell, so after her Medicaid-supplied home health aides went off their six-hour shifts, my wife and kid would spend the next eight evenings with her, and I stayed overnight on an air mattress.  Our family doctor listened to Mom’s lungs with a stethoscope and said she didn’t hear anything.  Later that day Mom fell again, caught by her home health aide.

Selfie of me and mom sitting at a table in her apartment. In the background are paintings she's done, including paintings of me and my stepfather.
Mom and me last week, when we thought she could recover at home

Elmhurst Hospital recommended a follow-up visit eight days after they released my mom.  She seemed to be doing better for a few days, but the night before the follow-up her breathing was much worse.  I had a hard time sleeping.  The doctor heard her cough and ordered a chest X-ray.

The following day, last Friday, after the X-ray, I checked the radiology website and saw the images, but the radiologist’s report wasn’t available, only a message saying it was under review.  I kept refreshing the website.  Finally the doctor called me: the X-ray showed my mom had pneumonia, and the doctor recommended I take her to the hospital.

I decided to go to Mount Sinai Queens instead, where they have a bit more room.  They looked at the radiologist’s report and put my mom in an “upgrade” observation room, hooked up to oxygen through a “nasal canula” – the little plastic tube that goes under your nose.  We waited.  I tried to get some sleep.

In the middle of the night, the doctors told me they had done a PCR test: my mom had RSV.  Shortly after that, she started breathing very heavily.  The doctors brought her over to the respiratory area of the emergency room and started preparing some tubes.  I was a bit concerned: “You know she has a DNR?”

The staff stopped work immediately.  “DNR and DNI?”  I wasn’t familiar with the difference, but it turns out that DNR is Do Not Resuscitate, while DNI is Do Not Intubate.  I showed them the scan of my mom’s signed order on my phone.  The doctor spoke with her briefly to clarify that she didn’t want to be resuscitated or intubated – no CPR, no life support.  She had discussed this with me several times: she had seen relatives on life support and didn’t want to “be a vegetable.”

What the staff used next was a BIPAP machine.  It doesn’t have a tube that goes down your throat, but it forces the air down with air pressure, on a rhythm that gives you time to exhale.  My mom was uncomfortable with it in general, but she was able to tell me that one of the straps was pressing against the remaining staple on her head wound, so I relayed that to the nurses and technicians, and they were able to adjust it.

After a couple of hours, the staff judged that my mom was stabilized enough to take it off and bring her upstairs to a ward called the Step-down Unit.  I stayed with her until the daytime shift came on at 9am Saturday, and then went home and slept for most of the day and the night.  

I woke up with a cough and a sore throat on Sunday morning.  I’m pretty sure it’s the same RSV that she had;  I was really frustrated because I knew how important it was to be there for my mom, but I also knew that I would get sicker if I went.  My wife, who was getting over some mild sniffles herself, agreed to go instead.

While my wife was still on the train, I got a call from the hospital.  I don’t want to go into more detail, but there was a situation that they couldn’t handle.  My wife called me, and she couldn’t really handle it either, so I got on the train.  I stayed in that hospital for five hours in my KN95, going out for a short break, trying to rest as much as I could, and when things seemed under control at 9:30pm I went home.  

I woke up on Monday with pain every time I coughed.  Fortunately, my mom has gotten a little bit better starting Tuesday, without me there.  My kid went to visit on Tuesday and my wife visited Wednesday.  Today (Thursday) I finally felt well enough to go visit her. She’s now been moved out of the Step-down unit to a regular hospital ward, but these six days have taken a lot out of her, and I’m afraid it’ll take her a while to recover.

As I was home Tuesday, in between naps, I made a connection: I’ve been doing analysis and reporting of hospitalization statistics for over a year, on Mastodon, on my blog and on a new dashboard I created this winter.  I’m not an expert in any of this, but our leaders haven’t been giving the experts the support they need to make things clear to us, so I’ve been doing what I can, in an effort to avoid situations just like this one.

I’ve been tracking the government statistics on hospitalizations, cases and wastewater traces of RSV, as well as COVID-19 and influenza, trying to prevent myself and my family from winding up in the hospital.  I’ve been wearing KN95 masks in crowded spaces (trains, buses, elevators) and where there are vulnerable people (hospitals, doctors’ offices, pharmacies and grocery stores).  When the case counts for these diseases went up, I stopped singing in-person karaoke.  The city’s restrictions on outdoor dining have made it difficult, but I’ve tried to find uncrowded, well-ventilated restaurants.

My mom got RSV and pneumonia because we live in a society with lots of people interacting, and it’s not enough just for me to take precautions.  This is why I post about these things here on my blog, and on social media.  And I recognize that we have a lot of work to do, especially given the current political climate.

The statistics can be a little dry; I found myself wondering what it means to be hospitalized for one of these respiratory diseases.  I hope that hearing about my mom’s experience – and about my experience struggling to advocate and care for her because I’m fighting the same disease – helps you understand why it’s important to pay attention to warnings about infectious disease outbreaks and help limit the spread of these diseases.

This story also helps highlight some of the limitations of these statistics.  My mother was admitted to the hospital last Friday, and that hospitalization will probably be reported as either RSV or pneumonia, maybe both.  But she visited the emergency room two weeks before, for a fall.  She probably fell because she fainted due to pneumonia, but that visit won’t get reported in the counts of emergency room visits for pneumonia or influenza-like illness.

by grvsmth