Saturday, March 14, 2020

Forks Over Knives Diet is The Bomb (You've Been Waiting For)

See the source image

I have really been enjoying autonomy over what I eat. Before I left China, I sat the family down and we watched "Forks Over Knives"--the documentary (available on Netflix) that discusses, among other things, the lives and careers of two inspirational doctors, Dr. T. Colin Campbell, a nutritional biochemist from Cornell University and Dr. Caldwell Esselstyn, a former top surgeon at the world-renowned Cleveland Clinic. A spinoff of their website is a fabulous resource, replete with a menu planner that will allow you to choose dishes by category (e.g., dessert!) and then generate a shopping list by aisle. They also provide breaking nutritional news that underlies their philosophy, such as this week's: New Harvard Review Finds Little Evidence to Support U.S. Dairy Recommendations.

When Harry came home from bicycling around the island of Hainan and a couple weeks of living in the countryside with his dad, we also watched “The Game Changers”, a documentary on Netflix that tells incredible stories of how a vegan diet can improve athletic performance in professional athletes.

In my absence, 丫丫 has been reading Dr. Thomas Campbell's book in Chinese. Thomas M. Campbell II, MD, is the Medical Director of the University of Rochester Weight Management and Lifestyle Center at Highland Hospital where he works with individuals and groups to lose weight and prevent and treat illness through diet and lifestyle. He is also the son of T. Colin Campbell, Ph.D., who is the Jacob Gould Schurman Professor Emeritus of Nutritional Biochemistry at Cornell University, project director of the acclaimed China-Oxford-Cornell Diet and Health Project, and coauthor (with his son) of The China Study.

The China Study is the most comprehensive epidemiological study of nutrition ever conducted. More than thirty years ago, nutrition researcher T. Colin Campbell and his team at Cornell, in partnership with teams in China and England, embarked upon the China Study, the most comprehensive study ever undertaken of the relationship between diet and the risk of developing disease.

Here are an assortment of dishes that I’ve made and devoured over the last three weeks. Not all of them meet the Forks Over Knives standard, but they are all vegan. PornHub is free for Italians; Americans will have to settle for my "food porn":

Cranberry sauce, pickled beets, almonds, and toast with red tea and cider.

Summer squash with quinoa, mixed dried fruit and nuts, and hard cider (with thermometer).

Apple. squash, mixed greens and pickled beets with box o' wine and puerh tea. 

Oatmeal with dried currants, chrysanthemum tea, and orange juice.

Curried quinoa, red peppers and squash with a side of salad greens.

Rice pasta with tomato sauce and salad with raspberries.

Seaweed rice cake sprinkled with pickled beets on mixed greens. Homemade dressing.

Friday, March 13, 2020

Preparing to Return: Broken Refrigerator, No Big Deal?

If there was ever any question or any question left about the competence of our gridlocked legislative branch to cope with this emergency, Senator Mitch McConnell has laid that to rest. Senator Lamar Alexander has indicated that they will not take up the COVID-19 bill from the House until after their recess. Meanwhile, the irresponsible language of those in the Grand Old (Wizard) Party is on full display, despite loud and clear objections from the head of the CDC.

Click here to hear the NPR Fresh Air story.

Today, I heard from an American expat living in Italy on lockdown, asking for advice, which I am reticent to dispense. Sadly, my most important piece of advice was not to follow the advice of the Department of State unless she understood the underlying reason for their recommendations. It was, I believe, a mistake for me to come back to the United States. I have no confidence in this Administration or its hyper-political appointees. The advice that I "should depart by commercial means" (Feb. 2) sent to those receiving alerts from the Department's STEP Program seems to be countermanded by most medical and public health experts.

As I prepare for departure and another two weeks of quarantine or isolation (I am asymptomatic now, but a lot can happen by Wednesday at noon, when I expect to land back in my city in China), there is a lot to think about:
  • I may not see the kids for another couple weeks in an abundance of caution, as they go to live with their grandma during my quarantine (or isolation) period. 
  • I will be asking for any guidance from the Chinese government about how to get from the airport to our apartment, what the arrangement should be inside my home (where the refrigerator has just stopped working!), and anything else I may need to know to comply with the government's mandated "concentrated or home isolation."
  • Remaining safe on the flights is my partner's biggest concern and my parents, but I think the chances of getting something on my journey are maybe less than anywhere else I am out in public.
This is the guidance that I received from my travel agent, "According to the Guangdong Provincial Command for Prevention and Control, all outbound flights to Guangdong, airlines or their agents should inform passengers with a history of travel to 23 countries within 14 days at ticket sales and check-in procedures at outbound airports, after arriving in Guangdong, they will be placed in concentrated or home isolation for 14 days. The 23 nations are: South Korea, Japan, Iran, Italy, France, Germany, Spain, Singapore, the United States, Kuwait, Bahrain, Thailand, the United Kingdom, Australia, Switzerland, Malaysia, Norway, Iraq, the United Arab Emirates, Vietnam, Austria, Sweden, and the Netherlands."  The policy was set to go into effect at midnight on the 13th of March or noontime today Boston time. It is excellent that, unlike AirBnB, Dartmouth Coach, and the three rental car agencies with which I have had to deal (Budget, Hertz, and Enterprise), the Chinese government is putting the onus on the ticket sales and check-in agents to inform travelers of their responsibilities.

A visit to the Guangzhou Foreign Affairs Office, yielded little information beyond the reassuring latest figures for COVID-19 cases in Guangdong (as of 24:00, March 10, 2020), which some of my fiercest red-baiting friends will discredit as the propaganda of a totalitarian state, and "How to stay safe from COVID-19 at your workplace?". There is propaganda, of course, but the message sits well with me:
"GDTV World of Guangdong Radio and Television recently invited singer-songwriter Mike from the United States and TV personality Romeo from Italy, two well-known expats living in Guangzhou, to produce an a capella song titled "Let love go viral". The heartwarming tune calls on people from around the world to send love, not hate, to each other amid the COVID-19 epidemic," the site also reports. See the video!
I have been told there may be a five-hour observation period at the airport because people may have been taking masking drugs to avoid showing symptoms. I am not sure if that delay will happen in Beijing or when I get to Guangzhou or not at all, but I do not have sufficient time for that during my currently scheduled layover.  There certainly are reports of airport chaos as China imposes new quarantine rules for returnees.

Wednesday, March 11, 2020

"Be (Better) Prepared": What Alexander Might Have Done Differently

This is a conversation with an EMT about quarantining vehicles, among other thing, and proper travel protocol for newly repatriated Americans who need to quarantine.

Becca is a first responder and a nature lover. When there is a sick bird of prey, she works with NH Fish & Game to deliver it to the vet in a safe way. When someone has contaminated an ambulance or a vehicle, she wipes it down best she can. She worked on Superfund sites in the past and wore hazmat suits to prevent spreading contaminants from those sites to the outside world. She and I have been talking incessantly for the last three weeks about everything from foam soap to what New Hampshire residents would do if Seabrook Nuclear Plant had a release. We knew each other through Project Laundry List, the nonprofit organization that I ran for 15 years.

When she let me know that she was disappointed in me for driving a rental car from JFK International Airport to my quarantine location in Seneca County, NY, I told her that I could do better now, but when I arrived in New York that was the best I knew how to do without breaking the bank. What follows is an edited conversation that we both agreed to publish together as a way to be part of the solution, instead of part of the problem.

This is a wide-ranging conversation about practical considerations for Americans returning from China, Italy, South Korea, and a growing list of nations and the steps they should take to quarantine.

Alexander: Absent any resources from the state, like a van that takes you to designated quarantine quarters--a hotel maybe, what is the best way for an individual or a family returning to the US and facing quarantine to get from an international airport to their expected quarters?

Becca: That depends whether they're symptomatic or asymptomatic. If they're symptomatic, they'll likely be flagged at the airport's CDC checkpoint. I strongly suspect that the CDC has been arranging ambulance transports for the symptomatic to the hospital or the home depending on the severity of the signs or symptoms.

With regard to how the asymptomatic are supposed to travel away from the airport, the CDC has been surprisingly mum. That is my understanding, anyway. For that reason, individuals and families returning to the United States are using rideshares, car rentals, and public transportation. Should the CDC be arranging transportation for the asymptomatic? In my opinion, it should, especially if they're returning from CDC Level 3 travel advisory countries, and the CDC is instructing them to isolate for two weeks after leaving the airport.

Right now many rideshare contractors can't afford to quit although many have and many would if they could afford to do so. In a statement to Business Insider on March 6th, an Uber spokesperson announced that drivers diagnosed with the virus or otherwise affected by coronavirus quarantines would be able to receive compensation for up to 14 days to make up for lost revenue. But rideshare contractors are saying this isn't enough. Many worry that compensation will only be provided to rideshare contractors who have been diagnosed with COVID-19, and many have no health insurance (or limited health insurance) and can't go to see a doctor. Due to the absence of CDC guidance, I'd take a rental car if I was asymptomatic, because I could clean it before driving away from the airport. Not to throw shade at rideshare contractors, but how do I know that I'm stepping into a rideshare that is cleaned properly, especially if someone that may have been symptomatic was riding in it prior to me? A rental car might be the more expensive option however. And a rental car may not be practical for those living in urban or suburban areas near the airport. Now I'm sure you'll ask me how to properly clean a vehicle...

The CDC has also been surprisingly mum with regard to guidance for cleaning personal vehicles, especially those used for commercial purposes. That is my understanding, anyway. That said, the CDC has issued guidance regarding the cleaning of ambulances and aircraft. Ambulances are designed to be cleaned. So are commercial airplanes. Personal vehicles cannot be cleaned as easily, although there may be some takeaways here. And again these takeaways are probably more useful for rentals and rideshares that are used commercially. First of all, we're not really sure how long coronavirus can live on soft surfaces like fabric or carpet, and according Havard Medical School these soft surfaces may be difficult to wash. There is no carpeting and relatively few soft surfaces in the patient compartments of ambulances outside of the cots, and the sheets and blankets on the cots are sent to the laundry immediately after the patients are dropped off at the hospital. CDC recommends routine operating procedures for cleaning aircraft unless potentially symptomatic passengers have been identified.

If potentially symptomatic passengers have been identified, enhanced cleaning procedures are recommended, which include cleaning all porous (soft) and non-porous (hard) surfaces within 6 feet of the symptomatic passengers in all directions with EPA-approved cleaners that are effective against COVID-19 (SARS-CoV-2); additionally, items that cannot be cleaned (i.e. pillows, passenger safety placard, and other similar items) should be disposed of properly. Airlines are expected to ensure that workers are trained on the hazards of the cleaning chemicals in accordance with OSHA's Hazard Commmunication Standard, 29 CFR 1910.1200. Airlines are also expected to properly train cleaning crews to demonstrate an understanding of how to use personal protective equipment (PPE), when PPE is necessary, and how to properly don (put on), use, and doff (take off) the PPE.

Here is a list of EPA's registered antimicrobial products for use against novel coronavirus SARS-CoV-2, the cause of COVID-19. These products are also used regularly on ambulances to clean equipment and surfaces that are porous and non-porous alike after the patients are dropped off at the hospital. They are also frequently used by car rental agencies. One of them, Clorox Healthcare Bleach Germicidal Cleaner Spray, can be purchased on Amazon by anyone including a rideshare contractor. Are Lyft and Uber drivers being taught how and when to use them properly? My best guess is that taxi services are held to a higher level of service in this regard. Legislators might consider looking into this.

Alexander: I decided to isolate myself in an Airbnb away from anybody that I knew in the countryside and return my rental car so that I could not even go for hikes along the gorges nearby. You told me that you were very disappointed that I drove the car and did not keep it for two weeks. This whole five-week trip is likely to cost more than a month's salary for me. What should I have done?

Becca: Initially that was true, yes. However, if you attempted to clean the vehicle before returning it, I couldn't be, could I? I say this because of the position that the CDC has been putting us in. How did you clean the vehicle?

Alexander: I wiped down the steering wheel with a wet wipe and told the rental agency that I had just returned from China.

We are both furious that there were reputedly high school students working at Market Basket in Warner, NH, who just returned from Italy and should be in quarantine.  That is where you do your shopping, right? Healthy young kids and their parents probably have little to fear if they catch COVID-19, right? Why should they quarantine?

Becca: They were observed working at the Market Basket in Warner, and yes, I do my shopping there. They were also observed drinking coffee at Grounds in New London.  Several members of my local community and the surrounding area called the N.H. Department of Health & Human Services (DHHS) hotline for COVID-19 to report them.  On one hand, yeah, I'm furious. On the other? I sympathize. There may have been a communication disconnect between the school district and the students initially over whether the students in question were returning from a CDC level 2 or 3 travel advisory country. As they were returning home from Italy, Italy was considered a CDC level 2. After they arrived home, the CDC upgraded Italy from a level 2 to a level 3. A two-week isolation at home is required for the level 3s. Teenagers pay attention and they generally dislike inconsistency. This was an inconsistency. They've been asking many of the same questions we have some of which center around other inconsistencies. Teenagers are less likely to comply with austere measures, such as the type of isolation required for level 3s, when there are inconsistencies. Above all else, isolation isn't easy for teenagers due to their high energy level. Regardless, isolation works. And I don't think anybody wants to spread the coronavirus.  It doesn't help that we may feel fine and may be capable of spreading before we feel sick. Hopefully rapid-screening tests are in our foreseeable future. And maybe one of these very teenagers will design one. 

Alexander: The state can do nothing, you tell me. But some people have said that it is a misdemeanor. Does that vary state-to-state? What sort of power should and does the state have before declaring a state of emergency?

Becca: I don't believe that the State of New Hampshire has declared a state of emergency yet. Last week, a Dartmouth-Hitchcock Medical Center employee defied instructions from DHHS advising him to stay home after returning from Italy. Concerned members of his community reported him to DHHS, and the State of New Hampshire issued him "an official order" of isolation under RSA Section 141-C:11. He had tested positive for coronavirus though. Another man who had been in close contact with him had also tested positive for coronavirus. Violating RSA Section 141-C is a misdemeanor under RSA 141-C:21. Obviously the State of New Hampshire has the power to issue official orders of isolation and to enforce them. However it would appear as though this power has only been exercised against individuals with positive test results and any individuals who may have closely associated with them. The State of New Hampshire's power may also be limited in other ways. For example, a family in my community runs a daycare out of the family home. Asymptomatic family members who returned from the high school field trip to Italy are isolating at home on a volunteer basis per the DHHS advisory.  Several members of my community want the DHHS to shut the daycare down temporarily. The DHHS claims that it does not necessarily have the power to do so, so long as the asymptomatic family members who are isolating on a volunteer basis are isolating properly. I think that asking the state to issue official orders of isolation for the asymptomatic may be a heavy lift. I'm not sure how I feel about the day care situation though. How do you feel about orders of isolation and the day care situation, having been through isolation yourself?

Alexander: I am very concerned that it is ineffective if not done well and that it is a harrowing mental experience, akin to isolation or solitary, but not as extreme. The insecurity of not knowing when I would be reunited with my girlfriend and kids, the lack of support from some friends and family for my decision to return (which the government said we should do!), and being in the Finger Lakes without a car or a single soul that I know was hard.

New York has recalled all the college students living abroad and declared a state of emergency. When Governor Cuomo made the announcement of the money they would be spending, he said that the people in quarantine need to be visited once a day. Maybe that is true if they are sick with mild symptoms, but that was not my experience. As a healthy individual, I just had to call in my temperature readings from morning and evening once per day, after an initial visit from the county's health workers. How would you recommend the nurses visiting an asymptomatic patient dress for meeting an asymptomatic patient?

Becca: I am not sure what nurses visiting asymptomatic patients are required to wear although the  CDC has issued guidance for public health officials conducting evaluations. The CDC has also issued guidance for first responders. Per the CDC, any patients requiring emergency medical services and who are exhibiting signs or symptoms of a respiratory infection should be given a facemask. If COVID-19 is suspected regardless of whether a patient is symptomatic or asymptomatic, first responders are encouraged to wear a single pair of disposable patient examination gloves, a disposable isolation gown, respiratory protection (i.e., N-95 or higher-level respirator), and eye protection. How did the visiting nurses dress for their visit with you, the asymptomatic patient? Does it match up with the CDC's guidance for public health officials conducting evaluations? If they didn't take your temperature and stayed 6 feet away from you, they may have been dressed appropriately.

Alexander: They were very professional and followed the guidance.

It is important to think of the environmental impact of overkill. I am thinking of the now billions of masks that are headed for the landfill or the incinerators in China. Can you talk a bit about the mask buying frenzy, what are reasonable preparations people should be making, and the sorts of decisions that we as a society need to make to preserve financial and natural resources for their highest and best purpose?

Becca: I am worried that the frenzy may create both unnecessary waste and a shortage. Handwashing and voluntary isolation appear to be the most successful means of reducing the spread. Although facemasks catch droplets, it would appear as though they may not catch tiny particles a/k/a tiny aerosols not to mention that viruses can transmit through the eyes. Most of the folks we see wearing masks to protect themselves are not wearing eye protection. I find that puzzling. It may be an indication of where we're at so far as public health education opportunities go. I really love CDC's hand-washing campaign. I first learned about it through your blog!

Alexander: Do you know what the quarantine agreement looks like in NH? My "gentleman's agreement" in New York only restricted me to the town, but the visiting RNs from the Health Department told me to stay only on the property. I asked for special permission to go on an abandoned graveyard that abutted the place and they granted it. I was unlikely to see any living people there. Do you think I was given too much latitude?

Becca: According to an advisory that DHHS has been distributing to schools in New Hampshire, asymptomatic travelers returning from countries with a Level 3 travel advisory (such as Italy) are to be advised to stay home and monitor their health for 14 days after returning to the United States. Family members including children of quarantined individuals are not required to quarantine and long as they remain asymptomatic, they can leave the home and can go to public places like school and work. If the person being quarantined develops illness, household members must then also stay home on quarantine. Do I think you were given too much latitude? No. And further, I would have less concerns about walking around in the graveyard after you left then I have had about shopping at the Market Basket in Warner for the past week. I know your voluntary quaranitine a/k/a isolation wasn't easy. Quarantine is especially hard on children and teenagers. I would love to know more about this through the eyes of your children and your students, if you were to blog about it in the future. It doesn't surprise me that students in my community have been violating the terms of their quarantine agreement and it raises questions for me with regard to how we as a state might better handle pandemics and quarantines moving forward. There are far too many inconsistencies right now, which is understandable, and there are also the psychological ramifications, which we haven't really begun to look at yet.  I'm glad you were given permission to visit the abandoned graveyard. Not everybody has been that lucky, if you'd call that lucky?

Alexander: Can you tell me something about the ranking of different types of products to clean hands? Am I right in thinking that liquid soap (without anti-bacterial) is king and that foam soap is better than bar soap, but pretty much everything is better than Purell and other alcohol-based hand-sanitizers?

Becca: That is an excellent question and everybody will probably have a different opinion and that's understandable. I will share mine with you, and the reasoning behind it. What's your take? I'm sure during your isolation, you spent a lot of time thinking about soap.

Foam Soaps

Foam soaps (a/k/a aerosolized liquid soaps) are all the rage in New Hampshire where I live. They are fun and often cheaper than the other types of liquid soaps, and until a couple of years ago there were no studies comparing liquid soap with foam soap in regard to the efficacy of reducing hand microbial burden a/k/a "germs."  According to a study published in 2017 by the American Journal of Infection Control, foam soap is not as effective as liquid soap in eliminating hand bacterial load. The study authors indicated this may be due to the fact that one must build up lather with liquid soap, whereas foam soap is already dispensed as lather. In addition, the amount of soap dispensed per pump is less with foam soap compared with liquid soap. For these reasons the study authors suggested that the use of foam soaps for handwashing may give a false sense of hand decontamination and eventually lead to the spread of resistant bacteria. As you may have guessed, the CDC is mum with regard to the efficacy of the various types of liquid soaps. That is my understanding, anyway. In my personal opinion, foam soaps are better than nothing if we're aware of their limitations.

Bar Soaps

Those little lavender soaps are fun for adults and children just love soaps embedded with toys. But are they sanitary? There has been a lot of buzz about that. Dermatologists generally seem to agree that it's not a big deal to deposit microorganisms from your skin onto your soap, and then back onto your skin. There may be a few exception to this general agreement however. One is, if you have an open cut they may allow pathogens to more easily enter your body causing conditions such as athlete's foot. You may also be more likely to pick up some sort of illness or infection if you share your bar soap, because bar soaps may allow germs to transfer from one person to another. For this last reason, I don't personally keep bar soap in my guest bathroom. Also, I change washcloths and towels frequently and absolutely abhor loofahs. Washlcloths and loofahs are porous and may collect skin cells upon which pathogens may feed. They are considered unsanitary if used repeatedly, especially if they remain wet in between uses.


Surprisingly, CDC isn't mum with regard to sanitizers. And I quote the CDC: "Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs." Especially if our hands are really dirty or greasy. According to ProPublica, we may be buying hand sanitizers that won't work for coronavirus, because many made by the Purell and Germ-X brands rely on benzalkonium chloride instead of alcohol as the active ingredient. Non-alcohol antiseptics may not work as well for many types of germs or may just reduce the growth of germs rather than killing them. They may be better than nothing but people are buying them without knowing the difference. The CDC recommends hand sanitizers with at least 60% alcohol when we aren’t able to wash our hands. For that reason, I've always carried a bottle of pure 60%+ rubbing alcohol in my car along with a roll of sturdy paper towel. Since the winter flu season started, I have used both after shopping at the Market Basket. I saw a toddler sitting in a shopping cart a couple of days ago. He had a runny nose, and after rubbing at the rheum a/k/a liquid on his nose, he rubbed his fingers on the shopping cart handle. After I'm done grocery shopping, I douse the paper towel with the rubbing alcohol, and then vigorously scrub my hands with the paper towel. I like scrubbing with paper towel, because doing so creates some friction to help remove the germs. The great thing about rubbing alcohol is that it generally has a freezing point well below 0°C, and won't freeze in the car during the winter flu season.

Alexander: Thank you for taking the time to talk to me today and over the last three weeks since I have been home.

Tuesday, March 10, 2020

Two Quarantine Experiences: East and West Coast

This post is a side-by-side comparison of Alexander Lee and Michael Heister's travel and quarantine experiences. The two know each other from weekly trivia at Tristan's Cal-Mex in Guangzhou, Guangdong Province.

Alexander returned solo to the United States, landing in JFK International Airport in New York City on Monday, February 17. Michael returned with his Chinese wife and their daughter to LAX, in Los Angeles, California on February 5.

Why did you return to the United States?

A: The United States government issued a warning that we should depart by commercial means on Feb. 2. Some subsequent messages did not repeat that verbiage, but by February 10, I had purchased a $1,555 round-trip ticket. My family was safe on the 14th floor of a gated community in a section of the city, an island, on which no diagnoses of COVID-19 had been reported. My partner supported my departure and we planned to reunite in the U.S. as soon as possible. I believed that I could be a better advocate for them outside of China's Great Firewall and that, having recently re-watched The Sand Pebbles (1966) with my girlfriend and her son, it is generally a good idea to depart when your government gives that order--no matter how much you dislike the current Administration or its draconian policies. I was unclear about the level of accurate reporting inside China or the rate at which the disease was going to continue to spread when I bought my ticket on February 10. By my date of departure, it had slowed to a trickle.  Since I left there have been no new reported cases in Guangzhou. 

M: We--American citizen husband, Chinese citizen wife with tourist visa, daughter with American passport--flew out of Guangzhou on February 5, after some hiccups. We'd arrived at the airport in the morning, having booked a cheap one-stop flight through Seoul to McCarran Airport in Las Vegas. We had even received an email from Korean Air that all was well. Literally an hour or less before we got to the counter, the South Korean government had changed its policy, and was not allowing any Chinese citizens to transfer through Seoul without South Korean visas. Our young daughter and I could continue if we chose, but my wife could not. She gallantly offered to stay. I nixed that practically before the words were out of her mouth. She spent a couple of hours on her phone finding the alternative that best suited us. I felt at that moment - emotions running a bit high - like our options were shrinking rapidly, and didn't want to risk any other transfers, especially through airports in mainland China. She booked us a same-day direct flight to LAX. If it was just my wife and me, we'd have toughed it out, but we'd already passed nearly two weeks in our apartment in voluntary let's-avoid-people-and-public-places isolation, and we really felt that if we stayed, we'd be asking a LOT of our six-year-old--especially since we were privileged/blessed with other options. We really felt that if we stayed, we would be asking her to put much of her life on-hold for an indefinite period of time.

When you got off the plane, what happened before you left the airport?

A: I stood in a line to have my temperature taken by an airport employee. When that was complete, we proceeded to immigration and passport control. After passport control, under the supervision of both a major and captain of the uniformed Public Health Service, a row of fold-up tables served as a check-in station with CDC. The workers, in their new khaki CDC vests, appeared to be new employees or even possibly volunteers.

The woman who helped me said, "We are telling people that it is a good idea to quarantine for two weeks." At this point, she was interrupted by a colleague, who said, "You can't tell him it is mandatory. You have to tell him it is optional." I interrupted this worker to say, "I don't want to be part of the spread of an international disease. My friends would never forgive me so I am going to self-quarantine. She did indicate it is optional." The woman helping me then asked for a phone number. I provided my parents' and said, "Please don't call that unless you need to." I was presented with some papers from CDC and the NY Department of Health, mostly in Chinese, that explained what health precautions were recommended (e.g., wash your hands!).

M: We touched down around 6 PM, and had to wait just a few minutes before disembarking. We were greeted at the end of the jetway by CDC personnel who took our temperature and quizzed us about where we'd traveled and how we felt. Our daughter, quite honestly, told the CDC she had trouble breathing through the mask, and didn't like it. We were handed a form suggesting we monitor our temperature for 14 days. We were not placed under any mandatory orders of quarantine or isolation. We experienced a three-hour-plus wait in line at passport control at LAX, as there was an extra processing step there with the CDC as well. At the final window, the customs officer chose to send my wife upstairs for additional processing or whatever benign-sounding bureaucratic term they use. This entailed an additional three-hour wait for our daughter and me downstairs while my wife waited upstairs. Customs interrogated her for just a few minutes about where she was from, what she planned to do in the U.S., and so on. Very friendly. Then the officer asked an assumptive question about my wife being from Wuhan, and she quickly corrected him. He was satisfied with her answer, and she met us downstairs a bit past 1 AM.

What happened after you left the airport?

Isolation and Quarantine Agreement signed on 2/20/2020
A: I went to the AirTrain and took it to Federal Circle, distancing myself from other passengers, but no longer wearing the mask that we had been asked to wear throughout the flight on China Airlines. At Federal Circle, I picked up a reserved rental car from the Budget desk and drove to Upstate New York, stopping along the way in Scranton, PA, to have dinner at a Thai restaurant. I spent two weeks at the same location and, having arrived on February 17th, my parents got a call on February 19th from a very kind RN at the county health department, which is responsible for the address I had given the CDC workers when I gave them the phone number. To this point, nobody had warned me that an initial in-person visit from public health workers would be necessary. They came out on the morning of the 20th with a care package of gloves, surgical masks, Purell, Chlorox wipes, Kleenex, and a very nice quality thermometer. I was told to take my temperature twice per day--once in the morning and once in the evening--then report the readings to them in the morning of each subsequent day of voluntary quarantine. I also recorded these on a sheet provided by them in a folder that had a list of local hospitals with Emergency Rooms. They left me with another paper from the CDC on health precautions.  After the quarantine, I drove to their offices and retrieved a letter from them that certified I had completed my two weeks in quarantine.

M: We rented a car, drove close to an hour, and checked into a motel. The following day, we drove the rest of the way to Las Vegas. We did not wear our masks, but we did keep a reasonable distance from other people.

How was the experience of your quarantine?

A: It was qualitatively different than the January 23 to February 17 period that I had spent mostly home bound, leaving only to sit in the car while my partner bought vegetables and supplies in an open-air market. It was qualitatively different than the two two-week writer's retreats that I did in 1999 and 2009. In fact, it was harrowing. The lack of clarity about when and how my family would be able to join me did not help. The around the clock care and feeding of a wood stove while it snowed, rained, and blew a gale combined with jet-lag and anxiety led to many nights of poor sleep. I spent entirely too much time on the Internet, getting sucked into arguments about politics and meeting half of the mean, brutal trolls on the Internet. I argued with my boss, my board chair, my parents, my girlfriend, and lost a very old friend for being both dismissive of his Democratic Primary candidate-of-choice and also vehemently disagreeing about whether we should be scaremongering about the virulence of COVID-19. I cooked, blogged here, and talked on the phone incessantly. I waged a campaign with my Congressman to get the Department of State to declare whether their language "should depart" actually meant that we should depart. The Department responded that we "should" and that their recommendation had not changed, despite subsequent alerts that did not repeat that verbiage.

M: Our experience was obviously quite different, as we departed almost two weeks before Alexander, and were not required to quarantine or isolate. We chose on our own to turn in the rental car and minimize our time outside my brother's home as much as reasonably possible. After 14 days, we rented a car again, enrolled our daughter in a local elementary school, and were out and about as we pleased. As for our daughter, while being in an American school is a fresh challenge for her, she is enjoying spending time with her older cousin here.

Doxology Handwashing Timer

Thursday, March 5, 2020

Burning Money: My "Fool's Errand" to the Homeland

UPDATE(S): Since this post on Thursday morning of March 5, there have been additional costs associated with the journey, which I have added to this accounting in red. I will continue to update this until I return to China.

I do not feel the need to explain myself, despite the judgmental and horrible things that people have said before and after my arrival on this, my native soil. As my readers know, I have come back because the United States government told Americans living abroad that they "should depart by commercial means." It was not "if you choose to depart, you must use commercial means" because, in fact, the consulates are under-staffed in China and staying there is a bit of a The Sand Pebbles-esque decision. (More on that in a later post.)

Some of you may have seen an article from the Old Grey Lady about being a pariah and the stigma of a Returnee. Today, there is another article about how the rich and super-rich are preparing.

On the other hand, a full accounting of the expenses that I have encountered since my return and some anticipated expenses appears below. I am offering this not so much as a word of caution to my friends in China who might be considering a similar "junket," but more as an explainer to the public of what is involved in such an endeavor. It would be financially devastating for the vast majority of the people with whom I work in China.

This accounting does not include taxi expenses to the airport in Guangzhou or any cash expenses that I may have spent with the cash dollars that I had in my wallet prior to arrival.

It also does not include the ongoing family expense of paying rent in China for the apartment that houses my girlfriend and kids. I am lucky to have a partner who can pay for food and basics for the family without my help during this time, but many people will not have that luxury.

It also does not include the future expenses that I anticipate: food for the next couple weeks until planned return; another rental car or public transportation (will it ever be responsible to sit among others for several hours) to get back to the airport; etc.
  • Airfare to Date  

  • My flight home was 10,900 RMB ($1,555). It is a round-trip ticket set to return in June. The change fee from our travel agent, which I assume is at cost passed on from the airline, is 1,100 RMB (about $158). 
  • If I choose to return on March 18, it will cost me another 1,180 RMB (approx. $170 at today's rates), which I shelled out today because tickets are flying out the door as Chinese people realize that it might be safer to return than weather this in the Land of the Free, Home of the Daring. 

  • Rental Car Fees to Date 

  •  The first car that I kept for 24 hours was picked up at JFK and dropped off at Ithaca Airport. It cost was supposed to cost $234.90 with a base price of $172.20, taxes and fees of 62.70 and I agreed to pay the $10 for the collision damage plan, but I was subsequently charged $268.40 and have not called to find out what the additional costs were. 
  •  But I was charged $14.00 for EZPass tolls based on the license plate of the car. 
  • The second car that I picked up in Horseheads, NY, and dropped off in Hudson, NY, cost $144.00 plus the collision damage plan of $30. 
  • The third car, which I plan to keep through Saturday, was picked up at a different rental car location (not an airport, which saves money) in Hudson and will be dropped off in the Seacoast of New Hampshire. It is expected to cost $257.77 plus a $40 collision damage plan, which is a far sight cheaper than an extending the Hertz rental by the same amount of time.
  • Lodging to Date 

  • AirBNB from Monday, February 17 (the day that I arrived at JFK from Beijing) to Wednesday, March 4 cost me $625.95. 
  • Then another $62.76 for a single night in Leeds, NY, at The Hodepodge Lodge AirBNB. Leeds is across the Hudson River from Town of Hudson, where I needed to return my rental and where I expected to borrow a friend's Subaru; however, I do not drive stick/standard and after about 600 feet of practice, I was not not confident, so decided to rent another car after three hours of calling both Travelocity and Hertz (long hold times and multiple disconnects due to poor cell service or incompetence on their end). By the time I reimburse my friend for sending his key and send it back to him, it will be roughly $60 through the USPS. 
  • I am fortunate to be headed to a farmhouse for the duration of my stay that belongs to a friend in the Seacoast of New Hampshire
  • Public Carrier Transportation to and from Rental Car facilities

  • It was $65 from the Ithaca Airport to my AirBNB on Day Two of Quarantine. That was the drop off point for my Budget rental at Federal Circle, the car rental location associated with JFK.
  •  I gave a Benjamin Franklin ($100) to my Superhost for driving me to the car rental place in Horseheads, about an hour away. A taxi would have cost $165. There was no offer of a shuttle despite multiple calls to the Hertz location, explaining that neither Lyft nor Uber were responding to calls in my rural area. (Not sure about the range of the shuttles that Hertz might offer, but a guy dropping his car off at Enterprise yesterday was shuttled home in it by one of their employees.)
  • $12.43 for a Lyft from Hertz to Enterprise since keeping the car from Hertz for three more days was going to cost
  • Gasoline 

  • $21.45 at Mirabito in Ithaca to return compact car (hybrid) to Airport drop-off with a full tank
  • $30.71 of gas from Stewart's Shops in Catskill, NY to return the Hertz vehicle full in Hudson.
  • $30.84 at Irving in Hartford, VT to add  gas to the not-so-minivan that Enterprise rented to me

  • Healthcare 

  • $401.78 for health coverage from the exchange for the month of March. (Yes, Mom, I was uncovered from Feb. 17 to Leap Day, because my employer's insurance was not portable and HR did not remind me to get travel insurance.)
  • $37.95 for a flu shot at Kinney Drugs in Seneca Falls, NY (yes, home of the 1848 convention!). It will be re-imburseable, but I had not yet received insurance card with number.

  • Food and Meals 

  •  $252.45 for a Forks Over Knives diet (no meat and mostly fresh food) at the Green Star Coop in Ithaca. (I was asymptomatic and wearing a mask. I called in advance to see if they could prepare the order, but they only had a not in-house delivery service that would have cost a lot so I did my own shopping, somewhat irresponsibly.)
  • Lots of free squash and canned goods, as well as a spice cabinet and probably $100 to $200 of other edible supplies from host. 
  • Forgotten amount for restaurant meal in Scranton, PA, but roughly $40.
  • Incidentals 

  •  The SIM card, necessary for getting Apple to call you back when your computer gives you a Service Battery ⚠ warning, but also for getting Uber to verify you, was $20 for the month of calls and texts, plus $10/GB (no charge beyond 6 GB or $60). I have used 0.43 in just two days since leaving my lazaretto. I had to pay $12.95 for expedited shipping to make sure the card would arrive before I departed.
  • Purchase of two washable, re-useable masks for $59.98 that were sent to my sister and have not arrived.
  • $8.99/month for Netflix, planned mental sanity account, but never watched more than the first episode of "The West" by Ken Burns and sixteen minutes of the second one

Tuesday, March 3, 2020

Final Full Day: So Long, My Lazaretto

This is the second post about the Willard Asylum for the Chronic Pauper Insane. 

"Willard Psychiatric Center- 125 Years of Service" says the sign on the back ell.
Site of the first chartered agricultural college in New York, which gets chartered in 1853, opens its doors to promising young farmers in December of 1860, but will basically go defunct as boys marched off to fight for the Union, closes its doors in November 1861. The sprawling campus of what would become the Willard Asylum for the Chronic Pauper Insane includes Hadley House, with a big stage for entertainment, and dozens of buildings--very large and small--that housed the engineer and various other "important" staff, as well as 3,000 or so inmates at a time at its peak. The vast majority of staff lived in the same buildings as the inmates, in case there was any bleating, antics, or need to tie someone to a chair or thrown them in an enclosed metal crib in the middle of the dark, quiet nights here alongside Lake Seneca. This was a humane place compared to what they might have experienced had the New York Legislature, in April 1865, not passed the Willard Act, modeling an institution on the philosophy of Dorothea Dix--some of whose documents used to be part of the collection at this little house museum.

In my earlier post, I speculated that the inmates were a variety of PTSD patients from the Civil and Great Wars, as well as cast-offs from families that could not deal with the syndromes of their children, but it never occurred to me that being gay--a tidbit that my decent docent mentioned in an off-hand way--would have been one qualification for commitment. (An example of my white straight privilege.)

I have shared all of my pictures and my descriptions of what I saw yesterday on a public Facebook post. I have not the time to write a long post today as I must retrieve my letter from Seneca County Department of Health. Also, I have a date with Lucifer and Taughannock Falls, which "is the highest reliable single plunge in the State of New York."

State: New York
Location: Robert H. Treman State Park, 6 miles south west of Ithaca.
Height: 115
Crest: 20?
Water Source: Enfield Creek
Waypoint: 42.40056N 76.58444W
Summary: One of the more impressive falls in the Finger Lakes Region. This one definitely should be part of any waterfall tour of the area. You can hike from the falls through the scenic Enfield Glen to the Lower Falls.