Archives for March 2020

Love in the Time of Coronavirus

Plaza Fernandez de Madrid, Cartagena, Colombia

Photo from Plaza Fernandez de Madrid, where parts of the movie _Love in the Time of Cholera_ were filmed. This square also contained the cisterns for Cartagene’s water supply, fitting since cholera spreads through contaminated water.

Much of the news each day is devoted to describing problems with a new coronavirus, COVID-19, which has been spreading over the world since the beginning of 2020. Typically people try to ignore it, hoping it will go away. Then suddenly it sweeps through in a terrifying manner, and there is panic. Governments are left with an impossible situation, trying to protect their population while at the same time keeping an economy running so that businesses and people don’t go bankrupt. It’s a kind of a love story, where the girl must choose between two suitors she loves, hoping to choose one without hurting the other.

There were six world cholera pandemics in the 19th century. The third pandemic brought the disease to South America in the mid-1800s. In February, when COVID-19 was just starting to spread in China, we were on vacation in Cartagena, Colombia (South America), home of Gabriel García Márquez, the famous Colombian author. He wrote Love in the Time of Cholera, a story spanning the period from about 1880 to 1930 that follows the lives of two main characters, Florentino Ariza and Fermina Daza. Florentino, a passionate, artistic man, is struck by love at his first sight of Fermina. She is swept up by the same longing for him. Fermina’s father won’t allow her to see Florentino, and the family moves away to keep her at a distance from him. Still the couple exchange love letters.

The family eventually returns home. There, a third character, Dr. Juvenal Urbino, meets Fermina when he is called to examine whether she has cholera. The doctor verifies her good health and starts to court her, much to the liking of her father. The doctor has become rich and famous after ridding the town of cholera. He is a logical thinker who is driven to find fame and success.

Dr Urbino proposes to Fermina, and she rationalizes that, as much as she loves Florentino, she really hasn’t spent much time with him. She makes the logical choice is to marry the Doctor. Thus they are wed.

Florentino is disconsolate and swears his undying love for Fermina, despite being rejected as her suitor. In French en colère means angry; Florentino is choleric. He realizes he can somewhat ease his emotional pain by having trysts, so he starts to keep count of the number of his affairs. Sometimes he has fun. Sometimes there are terrible consequences. He never marries.

Meanwhile Fermina and Dr Urbino raise a family, have a comfortable life, and are widely respected in the community. Yet they have disputes, and the doctor is unfaithful. Like in any marriage, life is less than perfect. Years pass by, everyone grows old. One day Dr. Urbino falls off a ladder and dies. As soon as the funeral is over, Florentino appears before Fermina to again court her. She repulses him, but he is persistent. He has become head of a river transport company and is himself successful. She eventually gives in, and they settle together in old age.

This love story is a kind of dance between the three characters, and likewise, treating a pandemic is also a kind of dance until there is a vaccine to protect people from it. The city of Paris has a long history with vaccines, starting with cholera.

Large monument to Louis Pasteur at Place de Breteuil, Paris

Large monument to Louis Pasteur at Place de Breteuil, Paris (click on photos to see larger version)

A cholera vaccine for chickens was first discovered almost by accident in 1879 by Louis Pasteur, a microbiologist here in Paris. He was the first to understand the concept of a vaccine. He also made important discoveries in wine fermentation, inventing the process known today as pasteurization, widely used to preserve milk, wine, and other foods. Pasteur invented the vaccines for rabies and anthrax. I got my last cholera shot at the Pasteur Institute, which he founded and where he is buried. The search for a new vaccine is important to our story.

Love in the time of Coronavirus is perhaps just as intriguing as Love in the Time of Cholera. The government of every country on earth is faced with an impossible situation involving two things it loves. One, the economy, provides the means to live for everyone in the country (as well as for the government), but the economy requires a great deal of interaction between people. The other love, the people themselves, is threatened by a disease that will infect and kill many of them should they work to make the economy successful. Governments faced with this dilemma have chosen so far to protect the people, but it is killing their economies, perhaps promising financial and employment losses greater than any we have seen in our lifetimes.

Paris Marché Saxe

Paris Marché Saxe with police patrols and places marked to indicate where to stand in line.

Here in Paris we are under a pretty strict protocol. We can’t meet with anyone. There is no getting together with other family or friends. This is central to limiting the spread of the disease. No one knows who is infected. We can only go out to the grocery store or the pharmacy or the doctor or for exercise by ourselves (which still allows walking the dog should you have one). Access to stores is controlled to limit the number of people inside. There is a line at the door. At the outdoor markets, there are marks on the ground by the vendor stalls to keep people waiting in line at least one meter apart.

The French have issued a form that you must carry to show the police that you are outside for an authorized purpose. Your actions need to conform to your stated purpose. Parks and monument areas are off limits, even for those who want to exercise. People have been instructed to limit outdoor trips to a 2km radius from home. I was checked for my form and activities by a police patrol on Saturday. They forbid me to cross the Champ de Mars on my way to the grocery store. We wash our hands every time we come back in the apartment. We disinfect reusable bags after getting groceries.

I run alone regularly and go to the store for necessities. Otherwise I am here in the apartment. It’s not really a problem since I have plenty to do, study French, listen to audio books or read (in French and English), work on the Poulsbo Rotary web site, on home office projects I’ve been neglecting, and on keeping up with friends and family via FaceBook, e-mail, etc. Brenda does much the same. She goes to the outdoor markets. She also has a video workout session each week via FaceTime with her fitness trainer, as well as other fitness workouts from the internet. We’ve been scheduling movie rentals to have a date night that we can look forward to. The food in France is still excellent, and Brenda is a fantastic cook. We are not suffering.

I attended a Poulsbo Rotary Club online meeting using Zoom, a teleconferencing Web site and app. The meeting was really quite effective. Applications like Zoom could meet many needs as group congregations continue to be banned in the coming months.

Every night at 8pm, Parisians open their windows and applaud our healthcare workers for their efforts in combatting the virus. In my mind we extend these thanks to the police, rescue workers, sanitation workers, delivery personnel, and everyone else who still goes to work each day to supply the public with life’s essentials.

You can think of COVID-19 as an iceberg – what you see is only a fraction of what there is. When you try to calculate how fast the virus is spreading, you must make assumptions about the huge number of the already infected that you don’t officially know about. Many infected don’t ever have symptoms but can still spread the disease. I made an estimate of the growth of known active cases using assumptions from an article by Thomas Pueyo. Based on what is known now, the true number of active cases must be much greater than the number of known cases. Social distancing is necessary to slow the real (unknown) number of new active cases so that the known active cases, accounting for recoveries and deaths, can remain within the capacity of the medical establishment. If you can make the number of known active cases go down, you can be sure that the number of unknown cases is reducing by an even greater number.

COVID-19 cases in France and US

Known active COVID-19 cases in France and the US vs theoretical exponential rise as of 22 March

I have been plotting the number of known active cases in France and in the US versus the predicted exponential growth of known cases using Pueyo’s original assumptions. As you can see, the curve of active cases in both countries appears to be diverging from the predicted exponential rise if there were no controls. However, the rise in the US is still troubling.

A more recent article from Thomas Pueyo exhorts the US to do more now and outlines some ways to proceed once the initial surge of cases has flattened. Though the time to flatten the initial peak can be as short as a month with strict social distancing, the course of the recovery may be much longer, perhaps 18 months with some lesser social distancing measures still in place. Brace for big changes in how we interact socially.

Social distancing is a temporary strategy to buy time, not a fix, and will be financially devastating if it continues for a long time. Strict social distancing now will shorten the time of economic devastation. How can the government give some attention to her other love, the economy? We need to figure out how to test everyone rapidly and easily. Who has COVID-19, who doesn’t, and who has recovered and is now immune? Once we know this, we can figure out how to get people back to work.

Besides universal testing, we should consider other strategies:

  1. Use of drugs already approved for another purpose, such as hydroxychloroquine, an anti-malarial drug, in combination with azithromycin, to lessen the effects and shorten the recovery time. French doctors are having success when starting treatment before severe effects take hold.
  2. Use of a cell phone app or other means that identifies everyone with the virus and is able to track with whom they have had recent interactions. This method has been used successfully in South Korea and China. There may be privacy concerns with doing this in the west.
  3. Isolating everyone over age 65 and sending everyone else back to work. This could still expose millions of younger people to deadly consequences, and isolating the elderly will be difficult to control.
  4. Development of a vaccine – they say it will take 18 months.

Our leaders should insist that the bureaucracy act urgently to evaluate treatments that mitigate the disease or to evaluate for approval any proposed vaccine. These are tricky processes that require care so as not to do further harm, but stopping the spread and protecting those most vulnerable is urgent. We need a revolution in reviewing and approving solutions or many many will die.

As is apparent, the plot of Love in the time of Coronavirus is still under development. I’m confident that a world working furiously to solve these problems will be able to produce unexpected solutions. I ask you to practice strict social distancing, even if not yet mandated by your local or federal government. Keep your distance from others outside of your home. A lot is at stake here.