testing negative and being non-infected with Covid - slight comment

I wasn't planning on doing this but after a few days of hearing news from all over the place (thanks to being involved with someone who listens to Fox and "christian radio", I've gotten a view from there as well as the European sector that I cover on a regular daily basis and then the NPR and "liberal media" we both listen to....).

Anyhooo..... since part of what I'll be writing here shouldn't be an issue on anyone - regards republican or democrat - since it is fact.

The facts are as follows:

SARS-CoV-2 replicates in upper lung or lower lung, but most often is detected in respiratory part of the back of the nose (nasopharyngeal part). 

The PCR tests are designed to find the RNA in the swabs that are put in our noses - or sometimes the back of the throat - and will pick up virus and parts of the virus to show detection when run through the test.

The quick test - is having a high degree of certainty when positive (that means there is presence of virus in you) but the degree of false negatives is pretty high. This means that the Limit of Detection (LOD) as I previously wrote about, will be higher than 0. There's also a pure biological reason that the rapid test is having a low detection level of people "who might be infected but test negative" since there virus need to replicate to a point of detection. None of the test on market - understandably so - can say that they know you are infected the same day or day after (or even up to day "before you have symptoms") - since there LOD is not as sensitive as that.

Short explanation is this: you meet your friend and hug them. They are infected with SARS-CoV-2 and breathe when they say "Happy to see you". You get some of that breath, and viral particles, in your breath that you take into your lungs/upper respiratory tract (back of the nose/throat). The virus is all happy getting cells to infect and starts getting to work.... that means multiplying.

Depending on how well the virus is multiplying inside your cells, the number of cells and number of viral particles and RNA in your system (cells in the nose/lungs, bloodstream or stool) will vary. That's why some people show "positive" on the testing after 2 days after exposure, or others don't show it until 10 days. Either of them could be sick, have symptoms, and get others sick - it's all individual. That's why the guidelines say 5-14 days for quarantine.

As I explained to my parents - both over 70 - when I went to see them. I had a high risk event when flying, and I said "I want to wait 10 days before meeting you outside" (I'd still wear a mask since I'm the potential spreader at that point). The key facts for me are the scientific articles that say "after 11 days of quarantine without symptoms from a high risk/positive covid19 encounter, 97% are non-positive") .

When I re-entered USA to go to home to my house, I lived in my guest room for 9 days  - monitoring my temperature and symptoms - since it was important to me not getting anyone else potentially infected, and then I got a PCR test on day 8 since if my flight was the potential spreader moment. The test would pick up me as infected after 8 days even if I was symptomatic due to the viral replication rate as reported.

I feel like this aspect has been lost in the discussion. The test will NOT pick up on you being exposed today, yesterday, day before yesterday and maybe not day before that. Why? Because there isn't enough virus in you to get a positive in the test. the Swab is only so good. The swab doesn't go everywhere where the virus might be. The amount of virus is not what the Swab need it to be to pick it up.

This is what's mentioned in the discussion as "wait to test until 4 days after exposure" and quarantine until then. It's also why "going to work every day without social distancing even if you test every day will keep you safe from potential infections" (since you don't know who met someone infected the night before since the test will show up as negative that morning after....). 

Everyone with a basic biology degree should know this. 

Anyone having an infectious disease degree or knowledge knows this. Anyone with a pandemic preparedness knows this.

That's why I'm so confused seeing the "Rose Garden Event" from last Saturday since people are not only kissing and huggin (outdoors), they are also gathering indoors without any social distancing. It's confusing on a Risk level, and on a "protection level"

The only conclusion I can draw from this is that; people in the WH really didn't think Covid19 was an issue from the President, not any of the people surrounding him, since otherwise they would've taken precautions like social distancing, mask wearing indoors and no people cheek kissing and then talking to the president.  

Again, I feel like repeating - "What do I know? I'm just a PhD in microbiology with a speciality of virology and pandemic".....

World Childless Week Sep 14th-20th

From the website: 
"World Childless Week aims to raise awareness of the childless not by choice (cnbc) community. To help the community to find support groups that understand their grief and can help them move forwards to acceptance. It's for anyone who is childless despite their longing to be a parent because they have never been pregnant (for any reason), not carried full term or have suffered the sadness of a baby born sleeping. All our Champions and founder Steph, represent our audience. 

We are here for you through the year, we get louder in September"

Starting Monday is "World Childless Week" and I recommend anyone interested to click on the link here and go explore the community. There will be daily different topics and posts on the subject, and daily webinars.

Overall, the numbers of people who are childless might surprise you - depending on where you are in your life and who you are friends with. At the moment, on average 1 in 5 women reach midlife (45 years old) without any children. In Germany it's as much as 1 in 3. There's a choice of words when it comes to talking about "being without children" and that I like to bring up since it gives a little more nuance to the concept.

• Some are childless by choice (childfree) - implying that it is voluntary and by choice
• Some are childless by infertility - tried to have children but didn't succeed either on their own with a partner or with IVF/fertility treatment
• Some are childless by circumstance - the group that is considered to be the biggest one, and for which there is no "explanation" or rather a quite long list of potential options ranging from "never met someone with whom to have children" to "being with someone who didn't want children and then break off that relationship and then being too old" or other options. If you are interested, there is a list "50 ways not to be a Mother" in the book "Living the life unexpected" by Jody Day found here

For many of us who aren't in the childless by choice category I would say that there are a lot of times when it feels like you are the one who needs to put on a brave face and a smile - and often ignore all the "oh so private commentary regarding my choice or not" that comes along after the question; "do you have children?" has been uttered. 

(I usually say "No, unfortunately not" as I'm tired of hearing "oh, you decided to go have a career instead" or other rationalizations that have been thrown in my face too many times.)

Personally, I would say that some of the comments that I find the most demeaning have to do with parents stating - and often times this happens in work settings, leadership classes or other discussion groups - that "once you have children you realize how important it is to care for others" or "once you have children you become a an adult since you have to take care of someone else" and other short phrases that are thrown around to stated that "they didn't become an adult until they became a parent - however that might not be the universal truth"....

Anyway, I am not going into the Four Yorkshiremen territory (Monty Python) but if something, I would like all you parents and couples who haven't started trying for a baby yet - please consider that not everything in life plays out as one would've wished. And that there might not be a "simple explanation". Or even an explanation at all. That "just have a baby" might not be as straight forward as "boy meets girl, boy and girl have sex, girl gets pregnant, boy and girl have a healthy baby".

It's more talked about today, and maybe even within some sports communities like NHL where a few hockey players the last couple of years have been very honest and vocal about their miscarriages and baby tragedies. If nothing else, the sheer number of how common it is for a detected pregnancy to not proceed and reach week 22 or even later (miscarriage/still birth), is one of the things I wish I would've known earlier and would have been discussed in sex ed in high school. 

Or that it isn't a "simple as something wrong with the woman leading to issues" or other old stories from historic times where fertility is very much linked with male success and female definition of being a real woman = motherhood. That dinner party with my close women friends where it turned out that 75% had had one miscarriage....

As always, it's easy to see the world through one's own lens. All we can do is hope that a lot of us remember that everyone is embarked on a different journey through life, and that with humbleness, friendship and caring for others - we can find friends we didn't knew we had or learn new views from. And communities that support us through different times and obstacles that we might not have thought we would encounter when we started out life journey.

Be kind to each other.

(my post from last year can be found here)

TLDR; remember situation today was intentionally created

TLRD (too long, didn't read) is a great acronym for when things get carried away in explanations and then in the end of a long rant you want to make it easier to grasp "what is it I wanted to say".

I really had planned writing about #covid19 and how international travel has made me be very tired lately.

However, as with best laid plans, they aren't where you end up. I'll write about the covid19 things later. For tonight I feel that I want to clarify something that's been eating me up when listening and being asked to comment on current situation in the USA.

As an immigrant in the USA, living for over 13 years in the South of USA, I feel that I have gathered a lot of information and insight into things that I barely grasped when moving.

I grew up in an intellectual family in Sweden. Lots of reading, lots of politics, lots of knowledge of history. My formative years were times discussing South Africa (apartheid), the Palestine-Israel conflict, USA in Vietnam, colonial powers in general (France and Algeria for example) and Chilean (really several South American countries) dictatorship. I thought I had grasped quite a lot as a protected white native Swede. As one does when reading and meeting a lot of people and discussing on a theoretical level.

However, as usual, when living in the place where things happen - you grasp a different angle. You are forced to encounter situations that you never thought would happen (especially not when you perceive yourself as "knowing"). And most of all, you learn to be humble to a degree that is leaving you with only a few choices. One of them is "I will listen to and accept the reality that these people describe to me is their reality".

And that's what happened when I moved to the South.

I realized after half a year living in the South that something was off. What? Well, at starters I didn't - at the time - feel that my reality was that different from living in Sweden. (In hindsight, which is as we all know 20/20, that's a given red flag that something is strange..... ) My city where I lived was demographically very different from the Sweden city I grew up in.

To make it easy; my home city was easily 90% white, my new city was over 60% African-American. Despite this, the bars and restaurants (and church and work) where I hung out were probably at least 80% white. Or at least "as similar to my home town that I didn't feel that it was too different".

This gave me pause and made me question a few things. Mainly where I was hanging out, why this was and if there was something else on how this was happening.

(side note; it was like this partly because at the time I hung out with other white immigrants at the places they showed me, and then some other places where "middle-class/affluent" people frequented.)

After a few more years in the South I had gathered anecdotal evidence that I'm "passing as an American, specifically a white American woman" and that this fact opened a lot of doors for me. Note, the doors that opened were also where people greeted me as "you're not a real immigrant" since it was perception I spoke English as a native language in my home country Sweden (we speak Swedish), and I am a Christian, and - of course - being white.

However, that's not the point of this blog post. The points of this blog post are to link to a few articles that explain fundamental historical facts that has made the situation we are in today. Where African-Americans and People of Colour (PoC) are more likely to get shot, get arrested, get non-invited for interviews, get looked upon with distrust etc.

It's too long (as I mentioned in the beginning, it's a long story) for me to be succinct.

I mainly want you to know one fact I've learned after all this time living in the South.

It's intentional politics that have gotten us where we are. It's intentional to hinder non-whites and non-wanted people from voting. From owning their own homes. From having the thriving neighborhoods that once were. From excluding a lot of the history about this from schools and public education. (Like the fact that schools in Oklahoma didn't include the Tulsa Massacre in 1921 in the public school curriculum until this fall in 2020 (and who knows how that will happen now with covid).)

The reconstruction after the civil war, the backlash, the Jim Crow laws and the Civil Rights Movement and voting rights. And that are the voting rights that are hot contested in the USA today. It's not like in Sweden, and other EU countries, where you are automatically registered to vote on your 18th birthday - no action required. Nope, there is a process to get registered to vote, and on top of that the voting day is a regular work day with complications to get time off if you aren't a salaried worker.

And the fact that USA system, while it is a lot based on income and that there are a lot of poor white people as well, is based on a right that was for a very long time classifying a non-white African-American as 3/5 of a person. And that the District of Columbia being classified a district and not a state, therefore not having representation in the House of Representatives, is stemming from the fact that there was only "State representatives from real States, and slaves and servants" living there, and since the State representatives and their aides had voting in their home states - there was no need for the other people to have voting/representation rights.

To me, there is no way to see all these historical facts and not draw the conclusion - this is not "natural" this is a "created, systematical way of excluding people that are not wanted".

At the bottom are some links for further reading. There are many many more. And if you ever come by Memphis - the National Civil Rights Museum is a must. It'll take you more than 3 hours to go through it and you will still learn more things afterwards. There is a lot to take in. And it will not be easy. It is difficult things to see and understand.

Final comment; "If not now, when?" There is no waiting. It will be painful to acknowledge that regardless of your own intention or wanting, if you are white - there is a huge burden to take on and work on making things right and just. Nothing else to say or make excuses. It's something we just have to do. And it starts by listening to other peoples' experiences and acknowledging that there are a lot of things we have to change. Now.

Links to read:
Segregation myth - Richard Rothstein This is a GREAT explanation and video interview of the systematic idea behind suburbs among other things
NY Times 1619 project 
Role of Highways in America - The Atlantic
Highway protests - Facing South
Reconstruction era - black congress members
Breaking up slave families

Safe back to school? as a swede and microbiologist in USA

There's a few times more that others when I get more attention. I remember the last pandemic - swine flu 2008 - when a bunch of friends (and not so close friends) from high school and uni contacted me to ask "should we give our kids the new vaccine?". My answer, starting with a disclaimer asking what their pediatrician said and why/if they trusted the MD whom they went to consult about their children with, was that I am pro-vaccines in general - against virus especially - and that I would take the swine flu vaccine when it was offered since I deemed it safe.*

In general, that's what I do; I defer to the experts and then I offer my point of view and what I will do and what I recommend my family to do. All in the same idea as the saying when I was a child "do as I do, not only what I say".

So, last week was a flutter of emails, texts and phone calls from a number of coworkers and friends asking "what do you think about going back to school? Is it safe? In Sweden they had school all through spring!".

I think the answer requires a multipoint explanation. I had a twitter thread the other day where I worked through some of the key points. (That thread started with a reaction of how some data is presenting as comparison between days and that there is no thought on having consistency between groups when comparing them. I'll write a separate post of stats, need to be consistent and attention to detail.)

Anyway, the thread can be found here


The relevant tweets for my this blog post start with number 5. It has to do with statistics ( percentage, likelihood, distribution) and then actual numbers.
In short, a lot of epidemiology concerns population based research, trends and breaking down distribution in larger cohorts. It doesn't really say much about one singular case. It is about distribution and likelihood, percentages and other general numbers that for many people is hard to understand when drawn to a single case.

I mean some of this is almost like explaining the likelihood of winning the powerball... (1 in 292,201,338) which is quite ridiculous and people still play it since "there's a chance to win". Yet same people might have a hard time accepting they have a 1:2.5(41%) of getting cancer after age 60 and not worry too much about that. Let's not get into the likelihood of getting SARS-CoV-2 virus in community spread without any mitigation technique like mask or physical distancing (like sports practicing like normal, indoors in teams).

To get back to point. A lot of these questions last week were directed at me since I am a Swede. My family is in Sweden, a lot of my friends are there and I live in the USA so I have "knowledge from both worlds". In this pandemic there's been a lot of polarizing news (some true, some not) and one of them has been the constant comment about "Sweden's experiment" (let's not get caught up in the fact that the whole world are doing some kind of experiment here and there, or the "United States of America's experiment"). Two parts that have been reported pretty heavily were that Sweden didn't close their schools in the spring, and that the country didn't have a lock down.Let's start with facts:

• Sweden moved high school and universites to online only in March/April.

• Sweden kept elementary and middle schoold open the whole time before summer break.

• Sweden kept daycare open the whole time, and kept it during summer break.

• While Sweden didn't have a mandatory lock down - there is no provision in the law during peace time to do this from congress - a lot of people worked from home, didn't travel, kept children at home, didn't visit grand parents and so on. (side note; Swedes are pretty good at following so called "governmental recommendations" as well as having a relatively big amount of single households in the country -world leading)

However, it's part of this fact checking that Sweden didn't see vast community spread outside of specific suburbs of Stockholm. And that the majority of people who have died so far have been people over 70 who lived in nursing homes/elder cares. It's a tragedy in itself, and should have been prevented.

Why am I mentioning this? Well, simply because I would say that the evidence in April looking at the metrics on who was infected, hospitalized and in ICU pointed at that there was a large group of "people over 60, definitely over 70" who were mainly affected of the virus. Other groups were showing low incidences.

However, like all epidemiologists (and some microbiologists) know there is that thing of "incidence bias". In short terms; as you look, you shall find. (how you test will bias the results you look at)

How many young adults were tested in the spring? How many people were really infected? How many people who had no symptoms were tested? (I bring this up since that's another group that has been shifting in interest the longer the pandemic and data gathering have been going on.)

There is this thing with incidence and drawing conclusions. It's fairly safe to presume that if a large group ends up in hospital during an outbreak - it's a high likelihood that that group is more susceptible than the rest of the population. It is sometimes "simple things" as "the people who have eaten at one restaurant", sometimes "an overabundance of people who are older".

However, it doesn't mean that the groups that aren't found in the hospital are safe. It means that they are either safe OR the outbreak hasn't touched them in large enough numbers for them to get sick. Depending on the numbers, the distribution of sick people might change, and the numbers of sick will people will change.

These details, as well as knowing the difference between an isolated outbreak, an ongoing epidemic and a move to a raging pandemic.... that's why I listen to experts. It's complex to break down all these parameters into bite size morsels of information that people can and want to digest. It requires trust with diseases specialists who work with this everyday. And most of all, it requires an understanding that whatever the data shows in the beginning of an outbreak/pandemic will most likely change with time and amount of people getting infected and that it is crucial to stay nimble, gather more information and reanalyze the results.

Anyway, to make a long story short. Looking at the facts of infection rate and age groups in the USA today it's pretty clear that
a) there's ongoing community spread in a lot of counties (% positive of tested over 10% in a conservative view)
b) actual numbers of infected children, youth and younger age groups are going up
c) there's been fatalities in the groups "under 25", even in "under 17" - which wasn't the case in EU
d) the situation in USA today (in various counties/states or as a nation) is not comparative to the situation in Sweden in the spring
e) the situation in USA today (in various counties/states or as a nation) is not comparative to the situation in EU at the moment where countries are opening up and preparing for school

I don't feel that this complex conversation is taking place - at least not in a bigger context as "the situation in the USA right now is completely different from the EU situation". (I know, northeast are looking more like EU and keeping the numbers pretty good with their continuing partial lock down and limited openness.) I have had a lot of various emotions about this, especially since there are so many things that could be done to mitigate and stop the spread.

Alas, I ended up writing this blog post to put words to my frustration. 

The final point. There is still time to do things to stop this virus from spreading. To be inconvenienced for another time in order to mitigate the spread and give us less infected, less in hospital, less lingering effects from people who have been infected. 

Why is this so important? Because if there is something that drives me completely bonkers right now is the statement "the virus will go away someday [so we don't need to do anything extra]".

(I am sorry about the caps lock) 
THERE IS NOTHING STATING THAT THIS VIRUS WILL GO AWAY ANYMORE. 

The ONLY way we would've eradicated it would've been to quell it completely before it spread into an endemic virus. If it was a "truth" that viruses go away "after awhile" we wouldn't have as many diseases, rare and all, that pop up every so often. 

There's been documented two viruses that have "gone away"; SARS-1 and Small Pox. (First because of effective lock downs and controls, with a virus that was highly deadly. Second because of a world wide joint effort of mass vaccinations and travel bans without showing proof of vaccinations.)

We haven't even eradicated measles even though we have a vaccine since 1970 (and a better one since 1986), and it affects and kills children. Just asking a simple question; if we haven't been able to eradicate a disease that is that deadly and horrible to children - what makes you think that SARS-Cov-2 "will just go away"? There's got to be a solid plan (including distribution of a made efficacious vaccine - this is for another post)

I'll stop since this post is too long, too upset and touching on a lot of different things. Let me know in the comments if there is something I should elaborate or remove. Thanks for reading and being there. 




*there were a number of younger Swedes and Finns who got bad side effects from the swine flu vaccine. It was, over all in hindsight, impossible to have anticipated these side effects. It was about 200 children in Sweden and about 100 in Finland if I remember correctly. Out of a combined population of 13 million at the time. It's difficult to know how this part would've been discovered in the way "we" establish vaccines to be safe in this day and age. Most safety trials require relatively few, and then in the Phase III part of the trials - the more rare side effects are gathered as informational. Still though, it was a huge break in trust and it effected them in a life altering way.

dealing with accidental death

It's been a weird couple of days. Well, to be honest - maybe it's more about it's been a weird couple of weeks and months where the "normal" has been exchanged to something new and uncertain, a lot of new experiences that aren't what we all are  used to, or even know what they mean.

I'm grateful that I'm part of a team at my place of worship where we contact and talk to people who are terminal and their relatives.
I'm grateful to work in a place where we experience death and have people around who help with the process and help support the acceptance of the grieving process.
I'm grateful to use my experience with unexpected death, and suicide, in my circle of friends and acquaintances for something good as in at least I don't shy away of talking about it, or being there when someone else experience it.
I'm grateful that I have friends and acquaintances who have explained their experience with virtual funerals and memorials, especially in this covid time (it's such an odd, new concept that turns a lot of the old traditional ways upside down)

This is all to say that I'm grateful that I have been thinking about death and what I would like my relatives and friends to deal with, and that I think and hope I'm doing something good for people who are in this situation.

However, as everyone who knows, it's a different situation when you know the person in question. And it's never easy to deal with a friend taken away too soon, too fast, who has her whole life ahead of her.

It's one of those things though, so typical me, that when it happened - and people around me who didn't know her - said "I'm so sorry for your loss". I didn't know what to say. It's part of that I don't feel that it is my loss per se. It's her parent's loss. It's her partner's loss. It's the best friends' loss. It's the universe's loss. But it's not mine as a personal only loss. Only when I have unpackaged this I've realized that it's partly a language thing, partly a need to de-personal the loss. I want to answer them "It's all of our loss, cause she was a fantastic force and would do may great things".

I heard from a friend in the morning, she is dead. I was startled and I cried. I started with the negotiation with grief steps and got a fair bit on them. My issue? (As always) it's when you have to vocalize it to others. That's when it becomes real. That's when you have to handle the fall out and the others' feelings. And your own. When you have to tell others; "they are dead". There is no negotiation of that. And there is emotion from the other person. And you get to face that. For good or bad, you have to face your own feelings in that moment.

And yes. It is my loss. I will miss her. I will miss her laugh, stories, shared happy times with me and with others. She was such a joy and a great scientist. And such a wonderful person. She had a huge heart. And she wanted to make it possible for others to succeed in science, regardless of where you came from. She was a member of SACNAS and her friends there told wonderful memories of her. And she made the work day a brighter place with her laughter and her voice.

And in this covid times, I will have to get over the fact that we hadn't been in the same space since midMarch when campus closed down. It will be difficult understanding she is really gone, I will not see her when going to her lab space, the cell culture hood she used, or that she will pick up the phone - they way we have communicated the last couple of months.

I wish this was a better written post - a well written one to her memory. Maybe in the future I will be able to do her justice in an eloquent post with her wisdoms. Or I'll amplify her eulogy when it happens. But for now, I would like to simply say -

I miss you. You were such a great person to have around and you made life just a little brighter. You were brave and loud and so caring for people around you and for people you didn't even know when you went to the US-Mexican border to interpret for the people needing help. And that you were compassionate enough to allow me to feel that I helped, even if it was only with money and not physically being there since I don't know Spanish and I'm not a physician. You gave me courage and heart to keep on trying to help people around me. And you told me you wanted to be like me when you grew up. I joked it off since I didn't know how to deal with it - but I pulled up the texts and you said it several times. I will never forget you. And I will be an even better person in the future, the person you wanted to be, making you proud. Thank you for letting me getting to know you and being touched by your being.