Some precise number of days (which I know but will redact) before I turned 18, I know exactly where I was and what I was doing. That is because I could not quite legally gamble, yet I was in a casino in Las Vegas. On Christmas Day. I was doing a family thing for family connections that lived in Las Vegas. Visiting a casino on such a strange day is just something one can do if you don’t take traditional holidays too seriously and you happen to be in town coincidentally.

What single adjective would I use to describe the Las Vegas casinos on Christmas Day? Answer: Chinese. That was a while back, but I doubt things are too much different today. Think about it. Normal Christmas-celebrating Americans wouldn’t usually think to go to Vegas on such an incompatible major holiday. But it would be reasonable for normal Chinese people to happily take up the slack and cheap rates.

In 2019, exactly 8 days after flying and spending the day in airports (SAN, PHX, BUF — LAS on the way out!), I record my first written description of the illness that dominated my life this past winter. What day did I travel? November 28 - Thanksgiving Day. A day I chose because the rates (and I) were cheap — Americans do not like to travel the entirety of Thanksgiving Day. I have no idea if this is truly relevant, but it is certainly interesting to think about.

You know how my blog posts often maddeningly change topics a few paragraphs in? The change often looks like a radical departure, but I do actually try to keep a thematic strand connecting them. So here we go.

The Economist just posted a very interesting article called How SARS-CoV-2 Causes Disease And Death In Covid-19. The article says:

The immune response to a virus starts with infected cells producing a suite of signalling molecules called cytokines. Some of these tell other cells nearby to be on their guard against attack, thus stymying the virus’s ability to replicate itself. Others tell the immune system to come and put some stick about. Thus called to arms, the immune system launches both a prompt all-purpose response—inflammation—and a subsequent targeted counter-attack using antibodies and cells specifically programmed to attack both virus particles and the cells they have infected. Unfortunately SARS-CoV-2 seems able to interfere with the early steps of the immune response. It can apparently counteract the part that dampens replication in nearby cells. It may also enhance inflammation.

When inflammation gets completely out of control the body enters what is called a cytokine storm. Such storms drive the most severe outcomes for covid-19, including multi-organ failure.

Now take a look at this birthday greeting I wrote to a friend and former colleague who is a computational biophysics researcher and professor of pharmacology.


I’m still struggling to get to my next birthday, still under attack by some kind of pathogen. … I’ve never had an illness like this as an adult. My guess is that it is a flu virus but it could be bacterial. I feel like it went from my lungs to my major meat muscles. Each day I’d get a new thing. For example, one day my tibialis anterior was hit with what runners call "shin splints". I’m very familiar with muscle pain from muscle wear and tear but it’s unnerving when there is no sensible cause. I set up a bike inside and riding that helped my leg muscles a lot. I think the main infection is mostly defeated and controlling secondary infections is indeed the important thing. I lost a lot of weight so I’m trying to eat as much as possible. That’s not easy since I have very little appetite. I’m also wondering if maybe my body is doing some silly overreacting, something like a cytokine storm. Of course, as you know, at that level it all becomes overwhelmingly complex.


Reviewing these emails has helped me put together some other pieces of the puzzle. All spring long I’ve been cold. Especially my shins. I moved a down sleeping bag to my office to put on my shins thinking I was blocking a draft or something. I crawled around to see if a fan from a computer on the floor was blowing on my legs. I changed things around with my seating arrangements thinking maybe my circulation was being constrained by my chair making me cold (circulation problems are synonymous to me with being cold — and, yes, I am an expert). Then a few weeks ago the weather went from cool to insanely hot (90F/32C) overnight. My shins were still cold.

That was an "oh shit" moment for sure. My illness has really messed up my shins apparently. I am now aggressively rebuilding my shin muscles. Now that I’m focusing on them it’s clear, they’re not right at all. I’m a little nervous about other lasting damage. I’m sleeping about 30 minutes to an hour longer each day than I did at the same time last year (I always sleep the maximum amount my body will let me).

But I feel mostly ok. I have a near comically healthy lifestyle — if anyone is going to shake off problems that can be shaken off, it will be me. The excellent Ed Yong (whose book I reviewed) has a very interesting article in the Atlantic; it is the first I have seen which has been properly sympathetic to the brutal hardships of symptomatic survivors. The article is very scary because of this and strong hints of long term effects. You can see why I’m taking this all kind of seriously. And even though the infallible apolitical CDC has assured me — by fiat — that I did not suffer covid 19 because they did not notice the infection, I’m going to pay attention to covid 19 data and assume it is relevant for the functionally identical illness I did have.