Dear David,

On behalf of everyone at easyJet, I hope you and your loved ones are healthy and safe at this time.

I wanted to write to you to let you know what’s been happening at easyJet.

Dearest Johan,

I cannot express the relief that swept over me when I saw your message in my inbox. And how like you to worry about me and my family above all else. My dear, dear Johan.

It instantly reminded me of the time four years ago when I took my only trip on easyJet and the very kind flight attendant stood up in front of all the passengers and assured us in the very sweetest of words that everyone at easyJet cares most about our safety… and then proved it by showing us how to operate the safety belts provided to each and every one of us, for free.

I knew then that EZJet, under your stewardship, was a member of our family.

And our family is doing well, given the circumstances.

As luck would have it, the call for self-isolation came when we were visiting Jack and Lucy and their five little ones in Worchester. (Mindy, bless her heart, insists on calling it Wor-chest-er because, as she says — maybe once too often, to tell the truth — would you call someone named Chester “Er”?)

It’s great to get to spend so much time with the grandkids 24/7 and weekends don’t exist anymore. We feel like we’ve really gotten to know them, especially Lilly, the middle child. Seven can be a tough age when you’re an energetic little tyke with no real interests other than dominance, locked in a house with a mother whose patience wore thin about six hours into the whole ordeal. Not that Lucy is a bad mother. She’s wonderful a good amount of the time and Jack still seems to love her.

For the past five weeks Mindy and I have only gone out three times to bring in some items that Jack and Lucy have forgotten to pick up for us on their grocery runs. You would have laughed to see the look on the face of the clerk at the liquor store when Mindy walked in dressed for a blizzard, with a full roll of toilet paper wrapped around her face. By the time she got home with her haul — Jack won’t let us use their car because of an article he read on the Internet — she had soaked through most of the TP and it took forever to comb it out of her hair. At least she combed her hair — it took three of us — for the first time in three weeks. When one door closes, a window opens, as they say. Everything has its positive side.

Although we’re struggling to find one in the passing of Mindy’s beloved Uncle Luke from the virus. Did you know that he landed at Normandy when he was just 17? Sorry to spring this on you, but I knew you’d want to know.

We have comforted ourselves by recalling that easyJet flight. We remember the conversations we had about whether the low cost of the flight was worth the trip to an airport an hour and a half away, which meant getting up at 2AM for a 5:30AM flight. And then Mindy and I laugh remembering learning all the things the ticket price didn’t cover. Not even a choice of seats! It was a wondrous journey of discovery for which we will always be grateful, dearest Johan.

The flight itself was a once-in-al-lifetime adventure. You took us literally miles above our beautiful blue pearl, as someone on TV once said. (I think it was Kermit the Frog but Mindy says it was a human impersonating him.) Anyway, you gave us the gift of flight, Johan, and we shall treasure it forever. Compared to that, Mindy’s lost suitcase is just earth-bound baggage. Literally, actually.

But enough about us, Johan. We appreciate all of the travails you yourself are suffering and tell us about in such a strong, calm voice: the long hold times that must frustrate your phone support people terribly, the suspension of flights that keep you from soaring like the eagle that is you spirit animal. Eagles don’t give us free snacks or carry our baggage without ever dropping a piece or two!

Please give our love and best wishes to every member of the easyJet family. We don’t know how you fit them all into your flat — that’s English for “apartment” — but we are sure that spirits are high, and we hope that you managed to grab enough snacks and those little bottles of liquor to keep everyone going as long as their credit cards keep working.

God bless you, sweet Johan. We miss you!

Your passengers forever,

Hal and Mindy

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Circulating on the Internemets is some timely Passover pandemic humor. It will just be mysterious unless you’re familiar with the part of the Haggadah (the book read during the seder) that talks about the four children. (Hat tip to my sister-in-law, Maria Benet for passing it along.)

The Torah Speaks of Four Kinds of People Who Use Zoom:

• The Wise
• The Wicked
• The Simple
• The One Who Does Not Know How to “Mute”

The Wise Person says: “I’ll handle the Admin Feature Controls and Chat Rooms, and forward the Cloud Recording Transcript after the call.”

The Wicked Person says: “Since I have unlimited duration, I scheduled the meeting for six hours—as it says in the Haggadah, whoever prolongs the telling of the story, harei zeh ‘shubach, is praiseworthy.”

The Simple Person says: “Hello? Am I on? I can hear you but I can’t see you.”or: “I can see you, but I can’t hear you.”

The One Who Does Not Know How to Mute says: “How should I know where you put the keys? I’m stuck on this stupid Zoom call with these idiots.”

* * * * *

To the Wise Person you should offer all of the Zoom Pro Optional Add-On Plans.

To the Wicked Person you should say: “Had you been in charge, we would still be in Egypt.”

To the Simple Person you should say: “Try the call-in number instead.”

To the One Who Does Not Know How to Mute you should say: “Why should this night be different from all other nights?”

                                                — Rabbi Richard Hirsch, Pesach 2020

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I spend a lot of time listening to podcasts – maybe a little less than back in Normal Times when I was commuting 1.5-2.0 hours a day, but if I’m putterin’, I’m pod-listenin’.

I find it wearying to envelope myself in coronavirus or political podcasts these days. I’m not sure why. Maybe you have some ideas. In any case, I’ve been turning to comedy more and more.

Here’s a list, in alphabetical order. I am not necessarily proud of any of these.

• Alchemy This. Kevin Pollack – yes, that Kevin Pollack – has assembled a troupe of improvisers who do three scenes in each hour. At their best, they find an absurd narrative coherence that is mindblowing and reminiscent of Firesign Theatre’s scripted pieces. At their worst, I can’t make sense of the flow of the scene – too many of their voices sound the same to me – but still find the moments of it funny.
• Behind the Bastards. Each episode tells the story of some despicable person, often someone I have never heard of. It’s not flatout comedy, but the tone is comedic. Often excellent.
• The Dollop. Much like Behind the Bastards, but not focused purely on bastards. One of the two comedians who put it together reads an essay about some odd incident in history while the other reacts while hearing it for the first time. Ranges from hilarious to never quite getting up to comedic speed. And it’s entirely possible that the comic style is not exactly to your taste. It’s not exactly to mine.
• Good One. This is one of my favorites. Each episode interviews a comedian for an hour about one single joke of theirs. The interviewer is a total comedy nerd, and the interviews can be very revealing about the comic process.
• How did this get made? Usually recorded live at a theatre, three funny people riff about some terrible movie. Funny bad taste all around.
• Improv4Humans. Matt Besser’s improv troupe improvs scenes, much like Alchemy This. I personally find it less consistent, but it came be very good. For example, the archival show with Zach Woods, recently re-released, has some very funny stuff on it.
• Mike and Tom Eat Snacks. This ended a couple of years ago, but its hundred episodes of Michael Ian Black and Tom Cavanagh are still available. The two of them, unscripted, review snack foods, a timeless topic. (Spoiler: The snack reviews are just a pretense.)
• Wait Wait Don’t Tell Me. As a tote-bag carrying NPR supporter (and once time serial All Things Considered commentator), this one is obvious. It’s also consistently funny.
• WTF. Marc Maron’s podcast used to focus on comedians but has expanded wildly. Which is good, because he is an excellent interviewer. The recent interview with Dan Ackroyd, for example, is great. It turns out that the real Dan Ackroyd is like a Dan Ackroyd character.

I also listen to many other podcasts that don’t talk about current events but are not comedic. Some are fantastic. But it’s comedy tonight!

What would you add to this list?

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NOTE: I edited the title of this post on March 29, 2020 to reflect the increasing evidence that HCQ is not useful in the prevention or treatment of COVID19. I also removed a few paragraphs from the Wall Street Journal reporting on a French  study, since the body of research since then runs contrary to its hopeful findings. As this post states, the rheumatologist I asked about this was not stating an opinion about whether HCQ works against COVID19, and is worried that the supply needed by their patients and by people with lupus might be diminished by a pointless run on the market. The information in this post about HCQ as a commonly used drug remains.

A highly reputable rheumatologist responded to my request for comment about a column by  Jeff Colyer and Daniel Hinthorn in the WSJ that holds out hope for using hydroxychloroquine to fight the Coronavirus.

The rheumatologist, who is highly respected, asked me not to use their name because they don’t want to be perceived as giving out medical advice — which this is not — and doesn’t have the time to go through their email message carefully enough to present it as a polished response. But they gave me permission to run it anonymously with those caveats. Here it is:

I give hydroxychloroquine to almost everybody who has rheumatoid arthritis and some of my patients have been on it for 20 years or more.  Of course, if patients have side effects from it I stop it and if they have improved to the point of appearing to be in full remission, I taper it down and may stop it.  There are people for whom it is not helpful by itself and is often used by me and others in conjunction with our other medicines for rheumatoid arthritis.  It is used similarly in psoriatic arthritis. I have a number of patients who have no swelling and no symptoms after treatment with hydroxychloroquine as the only “disease modifying drug.”

It is recommended to be given to virtually every patient with systemic lupus erythematosus as it is been found to improve their course, even when other medications are needed to get better control.  We also use it in other rheumatic diseases, sometimes with less evidence than for RA and SLE.

I have not used chloroquine, which is a closely related compound but one with somewhat more side effects and it is more powerful.

The side effects of hydroxychloroquine in the short term, which is what would be contemplated in treating COVID-19, are minimal to nonexistent, other than nausea and related problems, which I have almost never had patients report.  Ulcers are not caused by this.  There is a fear that people who are deficient in G6PD, an enzyme, will get hemolysis from this medication shortly after starting it;   people deficient in the enzyme G6PD could have a bad reaction to chloroquine but that is not reported now with hydroxychloroquine.  Hemolysis is destruction of red blood cells in the bloodstream and organs which could be a source of illness, however rumors that hydroxychloroquine causes this appear to be unfounded.  Several (5-10 years ago) years ago, I emailed a rheumatologist who is a world’s expert on hydroxychloroquine and asked him this question and he said that he has never seen this happen; most of us do not test for the presence of this enzyme anymore before starting hydroxychloroquine, as we feel it is not an issue.  This may not be true of chloroquine, but I have a feeling it is also not a problem.  Having to test everyone before getting this drug for COVID-19 would be a logistical difficulty given the time constraints and cost of the testing.

The rare side effects of hydroxychloroquine that might occur in the short term in my experience had been so rare as to be negligible. I have had one patient that I recall in recent years who had more vivid dreams while on this and she found that disturbing.

The vision problems that people refer to occur only after long-term use and the dangerous one is exceedingly rare.  The latter is some permanent loss of visual acuity due to retinal damage.  There was a recent study by ophthalmologists that reported that the upper dose level that we used was too high and they found evidence on new and specific testing of retinal damage at doses lower than we recommended, but these only occurred in people taking it for a long period of time, not a few weeks. Most of us in the rheumatology field have never seen damage at the frequency they report and are very disturbed by those findings.  We have been forced to lower our recommended dosages which undoubtedly has worsened some people.  In my recollection, which could be very faulty, I have had two or three people in over forty years who have had permanent visual changes after many years on the medication.  My associates have had similar experiences.

There are two other ocular problems both of which are reversible and rarely occur. One is a change in the eyeglass prescription (or requiring glasses) and the other is sparkling of lights at night. I have rarely seen either one and they are theoretically reversible by stopping the medication.  They also occur only after long term use, not a few weeks.

There is the possibility of skin pigment changing with long-term use but I do not believe I have ever had this happen to a patient.

I am sure when you review the possible side effects you will find many other side effects, however these are not common and are usually typical of any medication given to anybody for any reason.

The question of whether it is useful in COVID-19 is a separate issue about which I claim little or no expertise.  The initial trial was very small in number, but encouraging.  A real trial will be helpful but by the time it is completed, analyzed and available, we may be well past the pandemic phase, but still useful for the future.

An important study that I have thought of probably will not be done for logistical reasons.  That would be to study our patients with rheumatoid arthritis and systemic lupus who are on hydroxychloroquine to see their incidence of COVID-19 compared to a similar group of patients who are not on hydroxychloroquine.  The logistics are timing, finding a large enough sample size of patients on the drug and off the drug who are comparable, being sure the doses used are appropriate and knowing the exposures of the patient populations.

There is some concern that overuse of hydroxychloroquine by people who do not need it will deplete the supply of this important drug for our patients who are already on it and depending on it.  In fact, today I had a call from a patient who has been taking it for years and could not get it as her pharmacy was out of it.

Another medicine that rheumatologists use to treat rheumatoid arthritis and other conditions has been found in a small study to be successful in treating COVID-19.  That medicine is tocilizumab with the brand name of Actemra.  It interferes with IL-6.

The study the rheumatologist is proposing sounds ultra-interesting and possibly consequential.

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Given this:

Do I at long last get to post this?

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