Old Mesilla

 Mesilla's San Albino has a design very similar to San Felipe de Neri in Albuquerque, but of more modest proportions.  The Plaza in front of the church was a little crowded with vendors, but it still seemed a calm and inviting place to visit on a sunny Sunday morning.  When we arrived in the Plaza the morning service was being broadcast to the neighborhood, and then the large number of parishioners in their Sunday-best began to file out, pausing to shake hands with the clergy.

  That is Margaret walking into the coffee shop across the street from the church.  The building is a thick walled adobe which was the residence of a lady named Josephine, and the shop was first known as Josephine's Gate until it got its current name recently.

The coffee and pastries are good, the large outdoor seating area is nicely shaded and the accomplished guitarist provided some nice sound as we killed an hour prior to meeting up with our daughters for lunch in Las Cruces.

Mesilla and the surrounding area was still a part of Mexico until well into  the 19th Century. Today it is about an hour north of the border.

On the previous evening we had enjoyed a family reunion dinner at Mesilla's biggest restaurant, La Posta. 

 

 

Politics Endangers Health

 I doubt the title will provoke an argument, particularly this year.  

A couple of things have brought the issue into sharper focus for me.  Trump is scheduled to visit Albuquerque on Thursday and will hold a rally at the Albuquerque Sunport.  As it happens, there is a high probability that the airport was where I contracted Covid during our recent five-day trip to Boston.

There were many opportunities for contagion at the stops along the way, but the long and densely packed security lines at our trip's beginning should have been a red flag.  Covid booster shots shortly before traveling seemed worthwhile, but did not stop the disease this time. A guide from New Mexico's Department of Health illustrates the possible precautions in addition to vaccination:

 

The first safety practice is likely the most important: Avoid large gatherings.  The next, Social Distance, is not available in airport security lines.

In relation to two of  the specifics applicable to the upcoming Trump rally, mask wearing and vaccinations, there can be little hope of compliance in the Trump crowd.

Public health tracking of Covid is very sporadic at present.  If you google "political rallies covid" all the links refer to a study from around the time of the last election four years ago:

(from a CNBC article)

  Researchers looked at 18 Trump rallies held between June 20 and Sept. 22 (2020) and analyzed Covid-19 data the weeks following each event.

   The researchers found that the rallies ultimately resulted in more than 30,000 confirmed cases of Covid-19.

   They also concluded that the rallies likely led to more than 700 deaths, though not necessarily among attendees.

 That study was conducted near the height of the pandemic, so the results are likely not accurately predictive of what will be produced by the Sunport rally.  It is also unlikely that the poor level of monitoring now in force will give a true picture of the public health outcome.

Update:

It turns out that Trump could have staged his rally in Albuquerque's Convention Center if he had paid the $440,000 he still owes the City for the last time he was here.  Just as well for public health as it  now looks like Thursday's event will take place on the tarmac near CSI Aviation, so a better ventilated venue.

Automating Health Care Provision

 Dealing with COVID has stimulated some thoughts about the current state of health care and where it is likely heading under the influence of Artificial Intelligence and Large Language Models.

The day after we arrived home from our Portland adventure I started an effort to see what treatment options were available.  I found out that COVID emergency procedures had been shut down and the only option which seemed available was my regular doctor at the Presbyterian Health Services clinic.  

The phone listed under my doctor's name did not work, so I dialed the main clinic number and got put on endless holding music.  I then sent the following message to the care team:

I tested positive on Tuesday evening for COVID.  I have some congestion and fatigue.  My temperature is normal.  I would like a recommendation for treatment.  

Mike Connealy

Two days later I got a reply:

Hello Mr. Connealy,  

 We received your MyChart message and due to the symptoms you have reported, your message has been sent to a Team Registered Nurse (RN). 

 We will make our best efforts to address your concerns and determine the next steps in your care within 4 business hours...

Fortunately, in the meantime I had come across another option on the Presbyterian web portal called Online Visits.  I clicked the link, and up popped a questionnaire asking for symptoms and health history which I completed in about ten minutes.  An hour later I got a thorough emailed summary of the "online visit":

Good morning— I’m prescribing Paxlovid for you, but I wanted discuss the interaction that it will have with your levothyroxine... 

Diagnosis - COVID-19 infection

My name is ALEXANDRA CARTER, MD, and I'm a healthcare provider at Presbyterian Healthcare Services. I've reviewed your interview. Based on your responses and recent positive COVID-19 test, I see that your symptoms are caused by a COVID-19 infection.

Since you tested positive on a self-test, you don't need another test. A positive self-test means that the COVID-19 virus was detected, and you very likely have a COVID-19 infection.

Most people with COVID-19 have mild to moderate symptoms and can rest at home until they get better...

As it turned out, my regular nearby Walgreens Pharmacy did not have Paxlovid in stock, but they sent me to another branch up the road where I got the prescription at no cost.

Margaret went through a similar process with her doctor, so we also used the online visit feature to get her an immediate response and prescription.  Both her doctor and my doctor's care team expressed irritation that we had sped up the diagnosis and prescription process by doing an end-run around their usual bureaucratic procedure.

So, it seems most primary care physicians are going to have to up their game with the regular inclusion of an automated process of diagnosis and treatment.  Not every condition will be as simple to deal with as our COVID experience, but progress in AI medical care provision  will surely make it relevant to treatment on a broad scale.  

The Online Visit process in this case is perhaps best characterized as AI-lite, but it was quick and effective.  While a lot of the content in the visit summary was boiler plate, it clearly took into account my responses in terms of symptoms and health history, and it was reviewed by "ALEXANDRA CARTER, MD".  (I'm assuming she is a real person.)  I wonder if reviewing AI-generated diagnoses and treatments is a full-time job and how Dr. Carter feels about doing it.

I am also wondering about how the big health care corporations like Presbyterian are going to assimilate AI, and to what ends. While speed and accuracy are likely targets, quite a lot of motivation is also likely to involve profit maintenance and enhancement. There is no guarantee that patient benefits will be on a par with bottom line considerations.

The doctor will see you now.

Travel

Our trip to Portland went mostly as planned, with a surprise ending.  Changing planes in Oakland provided  a welcome glance at San Francisco including the Bay Bridge, the downtown and San Bruno Mountain where I had spent many hours hawk watching.

(Right click image to open in a separate tab to view full-size image.)

In Portland we stayed in an elegant apartment on the bank of the Clackamas, surrounded by the huge trees that are everywhere.

The Clackamas has about the same flow as the  Rio Grande, being only waist deep in the middle.

Lots of wildflowers and birds, including a majority of vultures.  My daughter was lucky enough to see some aerial combat between a pair of Osprey and a Bald Eagle.

My best find along the river bank was wild blackberries,  which evoke my best memories of both San Francisco and the Pacific Northwest.

The wedding which brought us to Portland included an hour's boat trip on the Willamette.  Portland is a marvelous city; I think it may have doubled in size since my last visit.  The bridges were familiar; I was impressed with the number of modern-looking skyscrapers and the endless public open spaces.

(I only got a few shots on film on this trip.  I did better on earlier trips to Portland in 2008 and 2011.)

Our visit was brought to an abrupt end when -- on the day before the wedding ceremony -- the groom tested positive for COVID.  So we moved our departure up a day, which resulted in a complicated flight home.  A day after our return to Albuquerque we both tested positive.

Travel Prep (Google Bard)

 Which type of locations or environments are at highest risk for COVID contagion?

The highest risk locations or environments for COVID contagion are:

Indoor locations with poor ventilation. This is because the virus can spread through respiratory droplets that linger in the air for hours. Examples of indoor locations with poor ventilation include:

Bars and restaurants

Gyms and fitness centers

Churches and other places of worship

Schools and universities

Offices

Nursing homes and other long-term care facilities

Locations where people are crowded together. This is because the virus can spread more easily when people are in close proximity to each other. Examples of crowded locations include:

Concerts and sporting events

Festivals and fairs

Public transportation

Grocery stores and other essential businesses

Locations where people are singing or shouting. This is because singing and shouting produce more respiratory droplets, which can spread the virus more easily. Examples of locations where people sing or shout include:

Choirs

Karaoke bars

Sports stadiums

Protests

Healthcare settings. This is because people who are sick with COVID-19 are more likely to be shedding the virus. Examples of healthcare settings include:

Hospitals

Urgent care clinics

Doctor's offices

Pharmacies

It is important to note that the risk of COVID contagion can vary depending on the specific location or environment. For example, a crowded indoor location with poor ventilation is likely to be riskier than a sparsely populated outdoor location with good ventilation. It is also important to consider the specific activities that are taking place in a location. For example, a choir rehearsal is likely to be riskier than a grocery store run.

Here are some tips for reducing your risk of COVID contagion in any location:

Wear a mask that fits well and covers your nose and mouth.

Stay at least 6 feet away from other people.

Avoid crowded indoor spaces.

Open windows and doors to improve ventilation.

Get vaccinated and boosted against COVID-19.

Wash your hands often with soap and water.

Avoid touching your face.

If you are sick, stay home and get tested for COVID-19.

By following these tips, you can help protect yourself and others from COVID-19.

What precautions are most effective for individuals at reducing exposure to COVID?

The most effective precautions for individuals at reducing exposure to COVID are:

Getting vaccinated and boosted against COVID-19. Vaccination and boosters are the best way to protect yourself from getting sick with COVID-19. They can also help reduce the severity of illness if you do get sick.

Wearing a mask that fits well and covers your nose and mouth. Masks can help block respiratory droplets that may contain the virus. It is important to wear a mask that fits well and covers your nose and mouth to get the most protection.

Staying at least 6 feet away from other people. The virus can spread through respiratory droplets produced when an infected person coughs, sneezes, or talks. Staying at least 6 feet away from others can help reduce your exposure to these droplets.

Avoiding crowded indoor spaces. Crowded indoor spaces are where the virus can spread more easily. If you must go to a crowded indoor space, wear a mask and stay at least 6 feet away from others.

Opening windows and doors to improve ventilation. Good ventilation can help reduce the spread of the virus. If you are in an indoor space, open windows and doors to let fresh air in.

Washing your hands often with soap and water. Washing your hands can help remove the virus from your hands. Be sure to wash your hands for at least 20 seconds.

Avoid touching your face. The virus can enter your body through your eyes, nose, and mouth. Avoid touching your face with unwashed hands.

If you are sick, stay home and get tested for COVID-19. If you are sick with symptoms of COVID-19, stay home and get tested. This will help prevent you from spreading the virus to others.

By following these precautions, you can help protect yourself and others from COVID-19.

How significant is the risk of COVID during air travel in the U.S.?

The risk of COVID during air travel in the U.S. is relatively low. This is because of the following factors:

Airplanes have very good ventilation systems. The air in an airplane cabin is constantly being circulated and filtered, which helps to remove any respiratory droplets that may contain the virus.

Passengers are required to wear masks on airplanes. This helps to block the spread of respiratory droplets.

Airlines are taking additional precautions to prevent the spread of COVID. These precautions may include requiring passengers to show proof of vaccination or a negative COVID test, and conducting temperature checks at the airport.

According to a study by the Harvard T.H. Chan School of Public Health, the risk of getting COVID on a plane is about 1 in 2,000. This is much lower than the risk of getting COVID in other indoor settings, such as bars and restaurants (1 in 100) or gyms (1 in 50).

Of course, there is no such thing as zero risk. If you are concerned about the risk of COVID during air travel, you can take additional precautions, such as:

Booking a window seat. This will help to reduce your exposure to other passengers.

Bringing your own food and drinks. This will help you to avoid contact with surfaces that may be contaminated with the virus.

Washing your hands often with soap and water. This will help to remove any virus that may be on your hands.

Avoid touching your face. The virus can enter your body through your eyes, nose, and mouth. Avoid touching your face with unwashed hands.

If you are sick with symptoms of COVID-19, you should not travel by plane. Stay home and get tested for COVID-19.

(?)

Are any major U.S. airlines currently requiring passengers to wear masks in flight?

As of August 8, 2023, no major U.S. airlines are currently requiring passengers to wear masks in flight. The Transportation Security Administration (TSA) lifted the federal mask mandate for public transportation, including airplanes, on April 18, 2022. This means that passengers are free to choose whether or not to wear a mask on airplanes.

However, some airlines may still require masks in certain circumstances. For example, JetBlue requires masks for passengers who are not fully vaccinated. And Alaska Airlines requires masks for passengers who are traveling to or from certain international destinations.

It is always a good idea to check with your airline before your flight to see if they have any specific mask requirements.