omenti

aerosol transmission

minipost

 

The American Physical Society had a webinar on aerosol covid transmission.   Jose Jimenez of the University of Colorado at Boulder is an aerosol physics expert.    It’s not terribly technical, but the first 45 minutes is probably mostly for public health and medical types. Much  is making the case for about 80% of covid transmission being aerosol rather than droplet.  This was an issue until a few months ago as the WHO and CDC believed it was mostly droplet.  It turns out that was based on a flawed study that is almost 50 years old!  They’ve since recanted.

 

 

Starting around 45m he goes into recommendations.   As always the best bet is to avoid them if people you don’t live with are present or have recently been inside.  With aerosols stagnant air is a problem so you want good ventilation if others are involved.  It turns out CO₂ level in a room is a good enough proxy for aerosol concentration.  Sit in a car with three other people, windows up, and after a short amount of time you’re breathing each other’s air and the CO₂ levels are sky high. Open a window and turn on the ventilation and the levels come down.  He wants to see CO₂ meters in all enclosed public spaces so you can decide what might be safe or not or how long you can be inside.  He’s not a virologist, but some are recommending 700 ppm as a guideline (I've seen 600 mentioned).

 

 

Good enough detectors based on NDIR are in the $100 to $200 range.  It's a very simple technology that uses the fact that carbon dioxide strongly absorbs a specific frequency of  infrared light.  They’re only good +/-50 ppm, but that’s good enough.   Of course all of this has to be balanced with the infection levels in your community.  

 

postscript

 

Several readers asked for CO₂ meter recommendations. I can make a few recommendations, but have only used a few.  Stay away from sub $100 units is the only rule of thumb I can offer.  Schools should have them in each room as well as stores, offices and so on.   You probably don't need one in your home unless you’re curious or want to see how well your windows and HVAC system are working (that can be a big issue).

 

The seminar talks about airplanes. Air exchanges per hour are very high when the ventilation system is on so airborne infection risk is low inside the cabin.  The rest of the trip is questionable - very high levels were found in jetways for example. New York subway trains have good air exchange rates, but I haven’t seen any work on the platforms. Buses vary and I’d be suspicious when the heaters are on in the Winter. I’ve measured a variety of cars. With windows up and two occupants CO₂ levels were over 3500 ppm in twenty minutes. That’s extremely dangerous if one of the occupants is contagious. Opening windows helps, but cars vary. The effect isn’t big on very streamlined cars like Teslas. On aerodynamically dirtier cars opening rear windows canincrease air exchange more than front windows as the outside air pressure on a moving car increases towards the rear of the vehicle. You should also turn on air circulation. With just circulation I got readings around 900 ppm and the best readings with windows were in the 700s.  I’d stay away from any car if someone outside of your bubble is in it.

 

An interesting note is some measurements have been done on cognitive ability and alertness. Over 1500 ppm and people become less alert.  That can have an impact on the quality of work as well as high attention activities like driving. The few studies that have looked at cognitive ability show declines with increasing CO₂ levels.  One study saw the decline start around 800 ppm and another around 1500 ppm.  Neither study was gold standard robust, but I suspect the effect is real - certainly alertness is real.  Many school rooms, offices and homes are normally over those levels so your may want to make changes even after the pandemic.

 

 

scribbler moon

Margaret Atwood

David Mitchell

Elif Shafak

Han Kang

Karl Ove Knausgaard

Ocean Vuong

 

Each of these authors has taken a walk through Nordmarka Forest in Norway to place a their manuscript in a special room in the Deichman Library.  Ninety four more will follow.  The authors are specially chosen for their imagination and the stories are to based on the themes of imagination and time.  No one other than the authors will see their words until 2114.   In that year someone who doesn't exist now will take each of the 100 manuscripts from their containers and prepare them for printing on paper made from 1,000 one hundred year old Norwegian spruces that were planted just before the Margret Atwood took the first walk through the forest. 

 

The Future Library project was created to stir the imagination and give hope.  A century is a good time period - just outside an average human lifespan, but not so long as to be unimaginable. What will be around? Will people care?  

Our greatest responsibility is to be good ancestors - Jonas Salk

 

We live with a number of legacies - a written language, medicine, science, religion, weapons, slavery, pollution. ... some good and some bad. Mostly we live in the present and don't think much about the leverage we have in creating future legacies. Some legacies happen by default.  Humans are one of the few species with a sense of the future.  Projects like the Future Library spark wonder and perhaps give us hope that maybe we can make a difference.  Perhaps a trick is to think about time scales and what we might accomplish.

 

You can do something for yourself on a smaller scale. Here's one of mine:   My thesis advisor gave me his favorite slide rule when I received my Ph.D. It had been given to him by his advisor when he received his.  It became my favorite.  I used it regularly and wondered about the legacy of calculations that were used to build conjectures and hypothesis through their careers.  Every now and again I wondered what I'd do with it.  About twenty years ago a very unusual Summer student came along.  Art and computer science, she ended up at an animation company.  In slide rule had been used for a certain type of story telling..  small corners of the fundamentals of Nature.  I gave it to her some time ago so I could enjoy the link between the past and the future.  One type of story telling changing into another.  She says it's very special to her and gets use for calculations used in making films that tell stories.  Wondering who she gives it to and what path and stories it might inspire gives me pleasure and hope.

 

In my work I have to think of a variety of time scales.  Some events at the subatomic level take place in a under a billionth of a billionth of a second.  At the scale of the Universe some things have been around for billions of years and will be around much much longer.  These times so foreign as to be abstract.  A few weeks ago one of you sent a note from the Grand Canyon that was filled with wonder inspired by that slow geological process that created it.  Wonderful experiences to stir the imagination.  We should seek out these experiences, but I find staying in human time scales and thinking about and building legacies lets me live in a slightly better future and gives me hope.    Set your mind some distance in the future and think of something good you'd like to see there or something bad you'd like to change.  With a target maybe you can imagine a path and help work towards it.  It gives us a way to not discount future people and their world.

 

Scribbler Moon?  That's the title of Margaret Atwood's book you won't read, but maybe your great great grandkid will..

 

how big is switzerland?

Rey-k-javík

The big test was would come at the end of May.  Sixth grade and we had to identify countries and their capitals on a world map.  That meant spelling everything correctly and adding some countries not on the list for extra credit.   I wasn't good at spelling then and it seems to have gone downhill since, but the unit was fun as our teacher had been around Europe and was a good story teller.  She also wanted to make the point that maps lie - that various projections color our impressions and even doing something simple like measuring an area on a Mercator projection was difficult.  A few weeks later the question came that I kept visiting for a few decades. 

 

How is the area of a country measured?  Is it considered a flat surface, or do you measure it on a sphere (I didn't know about the shape of the Earth then), or what about uneven ground?  What do you do about tides?  Shared lakes (like some of the Great Lakes)?  How do you measure a coastline? 

 

My parents tolerated this for awhile and then it was off to the library.  There wasn't much on this, but visits to libraries are never wasted. 

 

Over the years bits and pieces came when I wasn't looking. I first encountered fractals in Scientific American and followed up with Mandelbrot's paper . The measure of a coastline became finally became clear. There was an inherent fuzziness and you had to choose a scale.  And he had developed some beautiful mathematics that got at the heart of the matter - what is a fractional dimension?

 

A countries area is usually defined as the outline of the country projected onto the Earth's geoid or ellipsoid (there isn't standardization, but using the ellipsoid is probably good enough). In other words the so-of spherical nature of the Earth is used.  High tide marks boundaries, interior bodies of water are included in the area, but uneven terrain isn't accounted for.  The terrain bit made me want to see what the impact would be.   About ten years ago I found a dataset of terrain altitudes for the planet on a 100 meter grid. I used these with some detailed country outline data and looked at a few countries.  The Netherlands only gains a tiny bit of area.  The US grows by almost two percent, but Switzerland was slightly more than seven percent larger.  That's big enough to make Switzerland larger than Denmark and the Netherlands.   I didn't have good data for places like Nepal and Bhutan - they'd be spectacular.  And imagine looking at Manhattan with a one meter grid...  Its area would grow enormously.  

 

One of those questions a kid can wonder about that gets quite involved and requires standards be set. 

 

_________

 

Simple Summer Pasta and Tomatoes

For many of us this is peak tomato season.  In late August years ago I had a very simple tomato and pasta dish. The tomatoes were in chucks and not really cooked. It would only work if they were perfect so I gave it a try. Here is about what I did. This would be enough for two hungry people or four people if served as a side course.  It's more of a narration than a conventional recipe. 

Two really amazingly blimpishly ripe tomatoes that are going to have great flavor. If you can, go with heirloom tomatoes as the new ones have so much goodness bred out of them. My guess is I had maybe about one and a half pounds of tomato. Chop these into half inch pieces and scape them into a bowl making sure to recover some of the juice left on the cutting board.

Pour to glugs of a good extra virgin olive oil over the tomatoes.  Sprinkle on a good finishing salt (Malden is great) and freshly ground pepper before gently stirring to mix.  Set the bowl aside. 

Start some water boiling for the pasta and throw some salt in. Cheap salt of course

Now chop a strong red onion into slivers. Maybe about a quarter cup

Chop a handful of good arugula

Cook about a half pound of pasta (I like a quality thick spaghetti for this, but pick your favorite) and try to stay away from the marinating tomatoes

Layer the onions on top of the tomatoes and then make a layer of arugula choppings

Dump the cooked pasta onto the layered mixture in the bowl and give it two or three minutes to heat up a bit. To deal with the frustration grate some parmesan for a topping. (I prefer it cheeseless, but most people probably want it). The heat from the pasta is slightly cooking the ingredients beneath, just barely, but perfectly enough.

Gently mix and serve.

 

companies that care

Recently a heard a podcast on what it means for a company, or employee, to be a steward.  It could be any number of things - relationships, society, the environment. All good, but not many large companies seem to exemplify this beyond PR efforts.  But some smaller organizations are good at this.  I'll mention one - you can probably think of a few on your own. 

 

I'm not athletic but enjoy rowing as an exercise.  In the early 90s I found myself with a used Concept 2 model B rowing ergometer. It had been abused and needed a serious clearing and a few replacement parts.  Calling the company I found myself talking to the product engineer responsible for its design.  He asked some questions and said he'd send a parts list.  A few days later a box arrived with very clear repair sheets and the parts.  The bill of sale said $0.00.  I started the repair, but one of the old parts was bent and I was afraid of damaging the unit.  Another call and he talked me through the repair.  I asked what the parts cost and was told that wasn't a big deal, he was just happy to see one of his old machines being used. 

 

The old model B still works well.  It was made in 1986 and has seen more or less daily use since the repair in  1995.  I've had to buy some parts for standard wear and tear over the years.  They aren't expensive and the company stocks parts for every machine they've made.  The phone support is always friendly and free. 

 

Their ergs work well and I've probably generated a half dozen sales - word of mouth and gym experience are their big referrals. They're the standard erg in college rowing programs and the sport of competitive erg rowing has grown organically within the user base.  They also make most of the oars used in Olympic class competitions.  A combination of design, execution, support and general friendliness makes them one of my favorite companies.   Here's a piece about them from twenty years ago.

 

(the image is of an ancient model B like mine - newer ones look different, but are functionally about the same)

 

Feel free to write about your favorite in the comments section.  Are there any that will be making people happy and the world a better place fifty years down the road?  How about any that are publicly traded?  Is there a size ceiling? 

 

 

 

the small things that make you happy

Pip Coburn and his circle have a practice of sharing "anti pet peeves" - those little things that bring a smile and a bit of happiness. It's a good practice these days.  I had one today and sent it to him and Om Malik.  Om suggested I post it.   Feel free to add your own reason to smile in the comment section.

 

We live next to a large piece of undeveloped swampland. It’s full of deer paths and a mixture of heavily wooded and open areas. For about seventeen years I’ve taken a ninety minute walk around noon when I’m working from home. Today is worth writing about - my vulture returned!

About six years ago a female turkey vulture began to accompany me. She’d wait on a telephone pole where the woods cleared or sometimes she’d spiral down from the sky. For nearly a kilometer I’d walk through a large open area and she’d follow along, making short flights from telephone pole to telephone pole. . Then I’d disappear into a heavily wooded around for about thirty minutes before coming back to the clearing. She’d be waiting and together we’d make our way through the open space - regular partners for nearly four seasons.

Then nothing…

I kept looking and even got in touch with the Raptor Trust in case they had taken in an injured vulture, but after a month assumed she had left the area. Hopefully by her own choice.

Today - mirabile dictu - she reappeared. She only followed me one way, but it was so nice to see an old friend.

 

 

lightning in a bottle

Last week I had my first face to face group meeting since early March. Seven of us set up lawn chairs in a distanced circle on a beautiful lawn.  Apart from not being able to hear each other without speaking up and needing something better to draw on, it was wonderful.  I could talk about the out of band signals that face ot face conversation has, but something else struck me.  Our group tells stories and listens.  We have a real dialog - our group is smarter than the smartest individual. 

 

Dialog was one of the terms the social science group I was associated with banned.  Many people equate dialog with debate.  My favorite way to communicate with small groups (often one other person) is to have a dialog.  We tell stories and listen to each other discovering and learning about each other and ourselves along the way. Both of us can be smarter than each of us as individuals.   Debate - where one person says something and the other challenges  - is the opposite of dialog.  It attempts to convince.  When people with different strongly held opinions engage in debate both parties are dragged into the mud.  Debate fuels emotion and happens to be easy to jump into and highly addictive.   It's a form of communication that is easily weaponized with the aid of machine learning to promote engagement and sell advertising. 

 

Social media platforms focus on social comparison, competition, competition, unsupervised debate and so on. Some allow isolated groups where learning and dialog can place, but tools rarely support that and these groups depend on excellent moderation to survive. 

 

Zoom and other conversation tools have a lot of warts, but allow open conversation that can be turned into dialog. They tend to use subscription models.  People have speculated on the design of real dialog platforms, but I suspect much of the magic is in the same category of picking the perfect members of a team.  My friends tend to be those I can have interesting dialogs with - those who I can learn from.  i only hope our conversations are half as useful to them.

 

There's a special kind of dialog.  The face to face meeting I mentioned had little breadth in educational background.  We get things done, but I've found a lot of creativity seems to happen after talking to or working with someone who is smart, but in a very different field.  The process of learning from them seems to populate and connect parts of your mind that had never connected. Two weeks ago I had a long conversation - a dialog - with someone who is very different.  Over the next week new thoughts came almost daily and one gave me insight into something I've been thinking about for over a decade.  Lightning in a bottle dialogs.  Are there ways to support them?  I suspect the answer won't come from technology.

 

 

 

 

 

take it outside

a minipost

 

Other than the new graduate student, most of us have worked together for a few years.  This morning we carried our folding chairs across the large lawn struck by the novelty of seeing each other without glass, silicon and coordinated electrical signals getting in the way. It was our first face to face meeting since late February.

 

It would have happened earlier if we didn't believe the SARS-CoV-2 coronavirus couldn't be effectively carried by aerosols, but there's too much evidence to the contrary.  Aerosol clouds move and disperse quickly outdoors, so here we were with our face masks and some distance from each other.  Someone brought an easel with large sheets of paper and a few markers and we were off.  

 

A few things cropped up right away.   It gets hot sitting in the Sun for any length of time (you'd think we'd have more sense, but my type generally lacks it).  It was difficult hearing each other.  I can imagine a smartphone app that could take care of that - a local audio conference cloud.  (Gregg - this would be a good student project - I can think of several ways to do it).  One could also imagine iPad screen sharing, but I don't think it would work as well for our discussions - your mileage may vary.

 

We did manage to get a lot done - much more than the Zoom calls we've had.  There's a lot of "out of band" communication that takes place when you're face to face. 

 

I doubt that many would do this on a regular basis, but it raises an interesting point.  Indoors plus an aerosol transmission vector are a bad combination.  To make indoors work you need good fresh air exchange - perhaps a room volume every few minutes.  (Exactly how thoroughly and quickly isn't well-known yet.  This isn't anywhere as bad as measles for example.) Opening windows and doors using fans can do it.  The same with a properly balanced HVAC system .. but that can be difficult and expensive.  Most building systems recirculate air.  You can pass the air through a high-spec HEPA filter (note - HEPA is not a type of filter, but rather a standard).  Unfortunately they restrict airflow and it takes a lot of power to push air enough through.  I'd bet a fair amount of money most classrooms and offices aren't up to the task.

 

I jokingly suggested perfume, cigarette smoke, or incense smoke as a test to someone who studies aerosol physics.  They said it was a good idea.  You shouldn't be able to smell these kind of sources in a properly ventilated room unless you're very close.  Another test is CO₂ level.  A classroom full of people shouldn't register over 800ppm after an hour has gone by.  Building managers are often equipped to test CO₂ and volatile gas levels (you shouldn't be able to smell the carpet either). 

 

In many countries this won't be a big deal.  They've managed to get a handle on the situation with the ability to find and isolate hotspots.  How safe it is to have k-12 kids in schoolrooms is likely to be an experiment we'll see played out.  Colleges, restaurants and bars are probably a clearer call. Such decisions are well beyond my pay grade. 

 

 

rewiring your tardis

In the past few days three friends have been through a lot of stress.  Times like these make me think about where I've been and the paths I've taken.  I recognize too few people have had the freedom and privilege to make choices like I have.  At times like these I wonder about certain turning points that have been important - points that often seemed unimportant from others at the time.  More and more I'm drawn to thinking about events in space-time rather than in just time or space.

 

Studied closely neither time or space hold up on their own.  They seem to, but it's just an illusion that comes from the fact we move around on the Earth at tiny fractions of the speed of light. Space-time, with it’s four dimensions, gives a deeper way to sort out reality.

 

Since it's difficult thinking about anything with more than three dimensions it’s convenient to think of a three shadow of space-time with space as a two dimensioned plane and time running off at a right angle. If you think of the Earth’s orbit around the Sun as a 2d circle in space, we don’t come back to the spot every year in space-time.¹ Instead it's more like a helical slinky with about  four and a half billion equally spaced turns growing by another turn every year. Your birthdays are a long distance from each other.  A minute ago is a huge distance away too .. there's no way you can get back to it. 

 

Not going into detail, but the realization that paths are much more important than destinations was one that escaped me until I was about thirty.  Friendship, curiosity, serendipity ..  there are many things that turned out to be much more important to me than goals.  I like to think about these paths we take through space-time.  From a distance they look like spirals that ultimately might make eighty or ninety turns.  Zoom in on a short section and you realize there's a lot of jagged movement perpendicular to the flow of time. Other people and animals have their own jagged spirals sometimes coming very close or even touching yours.  Those times we're in the presence of each other.  At the scale of that expanding slinky we travel on around the Sun they're such rare events.

 

I've been having more intense dreams during the pandemic.  These ephemeral "realities" sometimes create alternate space-times that never could exist. Places and times that could never exist in the same real space-time.  During her final years my mother spend a lot of time in this place - even when she was awake.

 

For her last four years my mother had dementia.  It came in the form of small strokes.  She'd have one and then find herself with parts of her memory missing.  Between then and the next stroke her mind tried to make sense of the world.  How do you make reality square with what your mind can now connect to.  The brain does as much as it can and the mind now has a new reality to deal with.  

 

She never seemed to realize she had dementia and was usually very happy. Some memories - smell and music - seemed very robust.  But now her best friends might be someone from when she was fourteen and someone else from her forties.  One from Brigham City, Utah and the other from Great Falls, Montana.  She'd have conversations with them and sometimes complained that they didn't quite seem to see eye-to-eye.  The conversations must have been very real to her and overlapped directly into the world the rest of us perceived as real.  It was like watching someone walking along hearing half of their cellphone conversation.  

 

All of this was powerful to watch. Her mind, as it rewired itself, became a TARDIS of sorts that granted her a dream-like freedom from the rigid constraints of space-time.²  She was bringing some of those jagged microsections of the big helix of her life together.  And she seemed to love it.  It made me ask "who am I to judge the happiness of others."

__________
¹ it’s really an ellipse, but to make the argument a bit clearer I use a circle.

² On basic principles I won't define what a TARDIS is.

 

 

making obsolete tech sing and beyond

Over the past few weeks I've been playing around trying to repurpose old hardware. Mostly CD and DVD drives and they're chock full of useful parts - lasers, motors, lenses and so on...  That and a bit of Arduino prototyping to come come up with a bag of junk that could be sent to undergrads next year.   Motivation came from the COVID-19 teaching experience.  At least in physics online classes proved difficult and labs unworkable.  Some folks at Caltech suggested a different lab experience where the student assembles or even invents a piece of  experimental apparatus to use to make some measurements.   The fact that most students have smartphones - basically computers with a number of interesting sensors and a network connection - makes this even more appealing.  It probably isn't appropriate for 101 non-major courses, but it may make a better lab experience for more advanced physics and engineering students.  The potential for real learning rather mechanically following directions is great - assuming you have good instruction to go along with it.  There's also the possibility of creating inexpensive lab kits for high schools.  High school lab experiments are ridiculously expensive and inflexible.  There are a number of interesting directions.  It's been fun and several of us are in exploration mode.

 

I need to add I'm a privileged white male with the ability to take a bit of time and focus on this kind of craziness during an epidemic.  Too many people aren't in that position.  

 

The project reminded me of some attempts to help my mother when she was dealing with dementia.  She became forgetful, so we'd make lists.  Then she lost the ability to read so picturegrams.  All along the way glasses, remote controls, almost anything that wasn't nailed down managed to get misplaced.  And then there was medication.  She went into a managed care facility. Life was less stressful, but she was constantly misplacing things and forgetting how to operate the style telephone and TV remote.  I started building gadgets to help out, but by the time one sort of worked, she had lost more capability.  

 

I've thought about it a fair amount since. The facilities are expensive - at least $80,000 a year and usually more.  What could you change to allow someone stay at home a few years longer?  Even if it cost ten or twenty thousand dollars, it could save a lot of money and be better psychologically.  (Greg Vesonder has done thinking along these lines)

 

Om and I were talking about where the local and personal application of "intelligence" is a big thing, perhaps the biggest thing, for Apple going forward.   With their sensors and local connectivity outside of the cloud, the iPhone and Apple watch have great senior citizen potential. The iPhone has machine learning hardware.  Combine this with ultrawideband location and a dozen applications immediately leap to mind.¹   Fertile ground indeed.

 

Of course the trick is to stay healthy and sharp as you get older.  It turns out there's a wonder drug which, taken regularly, doesn't have negative side effects.  The AMA now considers physical exercise a powerful drug -  often with superior results than conventional drugs. It has been shown effective in lowering the probability of several types of cancer, heart diseases, many forms of dementia, and is even associated with "happiness". You don't need a lot. Walking enough counts and you get it for free if you use a bicycle.  But you have to do it. 

 

Many people use smartphones , watches or dedicated fitbit type devices for motivation.It turns devices aren't universally motivating over time, but if they work for you it's money well-spent.  The sensors and processing can be useful for athletes training at the amateur level, but not at the elite level. That's a separate and fascinating story at the frontier of sports science these days.

 

Finally it's becoming clar that certain types of mental stimulation help push back the onset of dementia.  Forget the memory games marketed for the purpose - they've been shown to be ineffective.  What you want is something that challenges you - something you've never done that you have really work at.  Anecdotally creatives who constantly push boundaries are in good shape.  I suspect it doesn't matter how creative you are - just the fact that you're forcing a lot of new neural connections.  The brain stays plastic for a long time.

_________

¹ Current generation iPhones have the U1 ultrawideband chip.  They haven't done much with it, but it makes a lot of sense for augmented reality, ID verification and object location.  I wrote a bit on UWB a few months ago.

 

a covid-19 recovery story and psa

A departure from the norm - something worth the read and potentially useful.

 

This is from an old Bell Labs colleague .. the story of how they helped his 89yr old stepfather in Brooklyn. This is no substitute for real medical advise, but might give a sense of reasonable supporting steps. Pulse oximeters are cheap ($25 to $50) and a good way to check your blood oxygenation level. Finding an oxygen concentrator would be a big challenge these days. If you see low reading early on it may be possible to take early steps and this may be increasingly useful information as more is learned about treatment.

_______

Sharing a miracle! My 89 year old stepfather Richard, was saved by love, science, creativity, and courage. He tested COVID-19 positive on March 19, with fever, fatigue, and a cough, followed by weeks of extreme exhaustion, spiking fever, and bacterial pneumonia. Now he’s been fever free for ten+ days and is gaining strength daily.

This was a miracle not only because COVID-19 can be so dangerous for any of us but even more so based on his age (he is almost 90!) combined with multiple underlying conditions. We are so grateful to see Richard on a path to recovery now; our goal for this post is to share what we did and what we learned with a goal to help others battling COVID-19.

Below are more than a dozen actions that were taken as an extended family to help Richard fight the virus at home, avoiding the need to go to hospital:

1. Pulse oximeter: we purchased an inexpensive ($25) but essential device in the home to measure blood oxygen levels. Levels need to stay above 90 otherwise a doctor should be consulted; measurements are taken multiple times a day, in tandem with temperature checks.

2. Oxygen concentrator: Richard’s doctor prescribed an oxygen concentrator because his blood oxygen levels were in the 80s. A portable, lightweight, battery powered, multi flow oxygen concentrator (Inogen device) was acquired for him as a result. Think of this as an practical in-home option between normal breathing and a hospital ventilator; it can be used in conjunction with the oximeter for measurement and can be covered by insurance/Medicare, if prescribed by a doctor.

3. Respiratory therapist: A respiratory therapist came to the home to demonstrate how to use the oxygen concentrator; this visit was included as part of receiving the oxygen device.

4. Crowd sourced masks, gloves, and hand sanitizer: hitting roadblocks at pharmacies and online sites, we received a heartwarming response from family, friends, and extended networks sending home made masks, gloves, and hand sanitizer from all over the country.

5. Simulated hospital environment: knowing the severe challenges at NYC hospitals in COVID-19 wards, we did everything we could to keep Richard at home, effectively creating a simulated hospital environment but with the comfort and care of being at home with a loved one.

6. CDC home protocol: my mother followed CDC home protocols for disinfecting and mask usage, ensuring her own safety and physical health, critical for a sustained role operating 24 x 7.

7. Virus warrior mindset: the battle at times was as much psychological as it was physical, and my Mom and Richard were champs of the highest order, mustering extraordinary emotional strength at times to keep going when darkness was pervasive.

8. Breathing and movement exercises: Richard’s doctors recommended a set of breathing, stretching, and walking exercises which he did three times a day. In the beginning it was daunting; over time, he was able to steadily increase the number of repetitions.

9. Virtual Urgent Care: we arranged for my mother to have a virtual urgent care visit, using an iPhone app with video streaming to consult with a doctor on her own health.

10. Real World Urgent Care: we finally found an Urgent Care facility in Brooklyn that would treat COVID-19 patients and had an x-ray machine, after trying more than ten different options at the time; many facilities were closed or refused any one with COVID-19. They did a blood test and a chest x-ray using remote radiologists to read the scans, confirming the bacterial pneumonia diagnosis and prescribing antibiotics (see below); this was much easier than visiting an emergency room at a hospital and a key bridge towards recovery.

11. Nurse/home health aide: we worked with a firm that specializes in home care for COVID-19 patients to bring in an experienced nurse/home health aide at a critical time, to help out for three days in a row.

12. Food and pharmacy delivery, and car services: Family members brought chicken soup to the front door. Delivery services brought food to make it practical to stay in. We had to try more than a dozen car services until one was found that agreed to take COVID-19 patients. A local pharmacy delivered supplies to the home.

13. Hydration and electrolytes: Throughout the height of the virus, Richard had little to no appetite. The doctor impressed upon us how critical it was to drink lots of fluids complemented by drinks with electrolytes such as Gatorade and Pedialyte. For nourishment, a drink such as Ensure can be helpful; for those with diabetes, Glucerna is an easy way to support nourishment.

14. Dual track antibiotics: A combination of Azithromycin and Cefdinir, running for ten days, was effective to battle his bacterial pneumonia. The use of these antibiotics was a key turning point in his recovery. However with viral pneumonia this approach may not be applicable. Note that early on hydroxychloroquine was ruled out due to cardiac risks and limited testing.

We hope that this summary of the approach that we took was useful and can help others battle COVID-19 in the broader war to fight this powerful virus and return to normalcy over time. It’s worth noting that love and care from immediate and extended family, along with friends and colleagues, played a critical role to aid recovery; although this can only go so far with respect to the real world ravages and harsh statistics of this disease, don’t underestimate the role love and care can play in this type of miracle, complemented by the application of science, creativity, and courage.