Monday, November 23, 2020

Why I want to be first in line for the Covid-19 Vaccine

I was talking to some educated reasonable people in the last few days, after Pfizer released the basic results of it's phase 3 Covid-19 vaccine trial and Moderna released the interim results of it's phase 3 trial. Both had efficacy of about 95% against the virus with no major side effects. For people in the know, that's a slam dunk, a hole in one, an 80 yard touchdown pass, a sub 2 hour marathon. So I want the vaccine, either one, as soon as possible, and I'll try to explain why in laymen's terms for you doubters.

First, there are two sides to a vaccine, how effective it is, and how dangerous the side effects might be. There is also the option to not get the vaccine. I made the table below to summarize the available data as simply as possible for the two options.

Not Getting a Vaccine and Getting the Disease

Getting the Vaccine

How Effective at Preventing Covid-19



Chance of Dying after Two Months



So, obviously the discussion is more nuanced than that, if you don't get the vaccine, maybe you won't get the disease either. For starters, what are the long term possible health implications of the vaccine? Before I answer that, we need to answer at the same time what the long term possible health implications of getting the disease are. So first, we don't know for the vaccine. We really have no idea if there are any negative effects from either the Pfizer or Moderna Covid-19 vaccines that show up more than 2 months after getting the second shot of the vaccine. Who knows, maybe people will keel over dead exactly six months after the second shot. Highly unlikely, that sentence was sarcasm, but the point is, we really do not know. To answer the second part of that, what are the long term consequences of not getting the vaccine and instead getting Covid-19, well for starters there is about a 2% chance of death, and that's an average, if you are over 60 or have any comorbidities like obesity, your risk of death is much higher. To give an anecdote, one person I know that contracted Covid-19 in July still has not fully gotten back her sense of taste like she had four months ago. There are no reports of that with the vaccine. In other words, we know that getting the disease you could die or have months long health problems, but getting the vaccine seems to have no immediate negative health effects. Again, this is a hole in one.

Second, still on the risk side, what are the short term risks to getting the vaccine or not getting the vaccine? For the Pfizer vaccine, you have a 2-4% chance of a fever or a headache... boohoo. Get over it. For Covid-19, again the average in the USA across all populations is about 2% chance of dying. Personally, I'll take the headache and a fever for the day or a few days. I would enjoy the extra day working from home... and being alive.

Finally, there is the efficacy aspect. Quick clarification, efficacy is basically how effective the vaccine is under lab controlled administration of the vaccine, in the real world, the effectiveness will be a little lower because some people will not get the second dose of the vaccine and others will get them spaced much farther apart than the prescribed 21 days or 28 days. So 95% effective is about as good as it gets. Frankly to definitively raise the official effective percentage higher than 95% there needs to be many more sick people than just the 170 that Pfizer had get Covid-19 (of those 162 were in the placebo group). Also, we don't know the circumstances of the eight people who had the vaccine and then got sick. Maybe some of them got Covid-19 between the first and second shot. Maybe some of them are healthcare workers who were working in Covid-19 wards and on accident received a high dose of the virus. 

Additionally, for those that still don't know how vaccine trials work here is a summary. First there is a pre-clinical phase where the vaccine is basically tested in animals to make sure it creates antibodies and does not kill the animal. If you watched the movie I Am Legend with Will Smith, that's the phase he's injecting the vaccine in rats. Phase 1 is a small group 10-80 people and the purpose is to make sure that it does not harm humans. A vaccine that crippled or killed humans would hopefully be obvious at this stage. Phase 2 trials are something like 100-2000 people to determine what the appropriate dose is to produce the desired antibodies while minimizing side effects. Finally phase 3 vaccine trials are 20,000-60,000 people where the statistics become real. Half are given a placebo and half are given the actual vaccine. Then, we all wait for a predetermined number of people to get sick from that particular disease, in the case of Pfizer and Covid-19 it was about 150 people that needed to get sick to determine how effective the vaccine is. 

This all comforts me because I'm not confident enough to sign up for a phase 3 vaccine trial, although I thought about it, but given the data that is currently available, count me in for either one of these. 15,000+ people have each had these two new vaccines and they seem to be working without major side effects. Long term, I'd much rather take my chances with one of these vaccines than with an actual case of Covid-19.

With all of this said, I'm bullish on these two vaccines for the above reasons and I'm also optimistic that in the future mRNA might be a key to making dozens of other vaccines for diseases that have confounded scientists for decades.  The US government has thrown billions of dollars through Operation Warp Speed at vaccine manufacturers, and let's be honest, it looks to be a huge success! 

Sunday, November 15, 2020

How to Run the Grand Canyon Rim to Rim to Rim

I'm going to write this partly as a trip report, and partly as a how to. I love doing new things, new mountain adventures like this, and I also really enjoy doing routes that I've done many times. There is a comfort in doing a route I've done before, mentally it's easier, and for big routes like this, all of the unknowns on the first trip, like water stops, knowing which sections are difficult and which are easy, are now knowns. So it's possible to go faster too. This was my first R2R2R, but I am already planning an April trip to do it again with a different friend.

Some very basic information, expect to run and walk 43 miles, ascend and descend 11,000 vertical feet, and experience temperature swings of 45 degrees Fahrenheit from coldest to warmest point during the day, with a maximum elevation just over 8,000 feet and lowest elevation of about 2,800 feet above sea level. While definitely a difficult "run" that is NOT for amateurs, it's much easier and safer than Nolan's 14 or running the three Chicago Basin 14ers from Purgatory ski resort, both of which I tried earlier in 2020.

Rim to Rim to Rim Route
Strava Activity:

First, camping and logistics. You're going to want to start early in the morning, we woke up at 5 AM with the temperature in the 30s on October 24th. Being in Covid-19 times we camped on forest service road 328 to avoid people in hotels to the west of the south entrance to the park. You can see it at the bottom of the map below. The dirt road actually goes for 20+ miles with dozens of free camping spots. They are primitive, so no bathrooms or running water. You could also get a hotel in Tusayan a few more miles south, there are at least four large hotels there.

Free camping on road 328 just south of the park.

We woke up, had breakfast, broke camp down, drove into the park, and then drove toward the start of the South Kaibab Trail, on Yaki Point Road. You can't actually drive down the road, they had a ranger stationed at the entrance and only park busses could drive down it, but there are pull offs just 200 yards from the road, so our one person support crew parked and M and I jogged a quarter of a mile up to the start of the trail. We took a quick bathroom break to let the coffee do it's work, and then at 6:45 AM started our watches as we plunged down the canyon. We ran down it too fast. The first mile was a 7:26, and we made it the seven miles to the bridge over the Colorado River in just under 58 minutes, that's too fast for my fitness. It gave me a little muscular tiredness that was unnecessary. When I do it again I'm going to ease off on the first 1/6th of the route, maybe 1:05 or so, and hopefully be in better shape too. 

Interestingly, I found the Grand Canyon to be disorienting, that's really the best word for it in my mind. M at one point said he had vertigo as he looked around on our run. To give an example, 2-3 miles into the canyon, I had of course been focusing on the trail and my foot placement, but we were at an easy stretch so I looked up and around to enjoy the view. I almost fell over! For a second I wasn't sure what was up and what was down. Mountains are like cones. On the way up they are in front of you and generally to the right and left with essentially nothing directly behind you, and behind you to the right and left. On the way down it's the opposite, the mountain is behind you with miles of empty space in front of you and to your right and left. But in the Grand Canyon, as you descend and look out straight ahead, there are cliffs in front of you and to your sides. It's just a strange feeling for people that spend lots of time on mountains.

There are multiple running potable water stops at Phantom Ranch, we stopped at the one closest to the bridge at 1:02 elapsed time for an average pace of 9:22. Of course, at this point everyone is feeling pretty great, and you really should because you're only getting started. 

The route is rather nicely divided into 1/6th sections of about 7 miles each. The next 7 miles are up a 3.9% grade to Cottonwood Campground. We ran it with cool temperatures probably in the 50s, and honestly, I think smoothly running this section is key to having a fast day. We covered these seven miles in 1:30 for a 12:22 pace. Apparently the running potable water was turned off on Friday, October 23rd, and we brought a filter and tablet to purify water, but it was still running so we filled our bottles and headed up to the North Rim. 

After two miles we passed the Manzanita camp, which also had running potable water. It is the last of the three potable water sources in the canyon going from south to north. We continued up to the North Rim, mostly walking with some running, and for those 7 miles my time of 2:31 had an average pace of 20:48. 

I thought the North Rim was closed, and I was not sure there was any water, but when we topped out there was a water spicket 30 feet from the top, and two full parking lots on paved roads within 200 yards of the trail! M beat me up the trail by running much more of the uphill. When I got there we only stayed maybe 10 minutes so I could eat a little and drink some water, cold water from the spicket which was great! At this point we were already in trouble. I reached the top right at 5:00, although we had been aiming for 4:45. Neither one of us had been eating enough. I think M was at 600 calories, and I was very similar. I brought 1400 for the day, and I definitely had not had enough at that point. The problem was while my stomach wasn't revolting, it was craving mostly fat and a little protein, not the carbohydrate Shot Bloks and Jelly Beans that I had brought. So I could still eat, but my stomach was only desiring eating a single 33 calorie Shot Blok in a mile, instead of three of them in that mile. In other words, I still felt good on the North Rim at half way, but I knew that sub 10 hours wasn't going to happen and I needed to keep eating and drinking to avoid a bonk, but still thought sub 11 hours was possible.

We ran down from the North Rim, briefly stopping at Manzanita for a few minutes to enjoy having run a mountainous marathon and then we made a rather significant mistake. The potable water was flowing, and both of us had about 3/4 of a liter left, but instead of refilling our bottles, we decided, per the original plan, to refill back at Cottonwood Campground, where there had been water in the morning. Unfortunately two miles later at Cottonwood Campground, having covered those seven miles downhill in 1:37, the water spicket was dry, there was maybe 1 ounce that came out, and by that point we each had less than half a liter. We decided it was "only" 7 miles down a 4% grade, let's just go run it, and filter water if we need. Running 7 miles down 1,300 feet seems like the kind of thing you could easily do on a half liter of water. Well, the problem was it was now into the 80s and mostly sunny. Thank God there was a thin cloud for a good portion of this run because we quickly became dehydrated. (I was doing a fair bit of praying at the time, it's pretty common for me on these sort of adventures.)

This section from mile 28 to 35, while not technically the crux or the hardest part, is in my mind now, the key to the whole adventure. M and I both wore short sleeve shirts and shorts, and we didn't bring any long sleeve or jackets. So while the start had been freezing, it was perfect for this section, we were going as light as we could, which again helped us move quickly in the afternoon heat. However, because we were both dehydrated, our bodies were not craving the carbohydrate food we had brought either, which slowed us down even more. And once you dig yourself in a hole on an ultra run, even if it's not that deep, it's awfully hard to get out of it. Eventually, about three miles in, as I was having to sit for a minute every half mile or so in patches of shade we made the call to stop the next time the trail and river were close and in the shade. That happened about a mile later, when I was down to a few ounces of water. M had the filter and stepped over to the creek and filled one of my bottles. As I sat on a rock and gulped the half liter, my body immediately started sweating profusely. I had been sweating a little, but it just poured out of me as my body realized it was no longer in dehydration mode. I filled up another liter of water and we ran the three miles to Phantom Ranch. Along the way I had to pee, and there was not much that came out and it was not at all the color you want to see. 

I did a lot of mountain traverses and link ups this summer involving 8+ hour days. However, a mountain is quite different than the Grand Canyon. When you start in the morning on a mountain it is cold, and often stays a similar temperature as you ascend to the summit. With the cooler temperatures you might not need to drink as much or eat as much. However when you turn around and go down, the day has usually warmed up so you can shed layers, and drink a lot more, and eat any food you have left. When you reach a stream crossing between two mountains, it's often the warmest time of a traverse or link up, so purifying water and drinking it feels right. Rim to Rim to Rim is different. It starts out the coldest it will be for the day and immediately gets warmer as you descend. As you do the bottom section and go back up the other side, the temperature is relatively consistent for hours. When you are on top of one of the rims, it's cool and so you don't feel the need to drink as much. However, the second time you drop down into the canyon, it's afternoon in a lower altitude desert, and you need to drink a lot, and you really have to plan the water stops.

At Phantom Ranch we took a solid 20 minute break to drink and eat and sit down. Both of us were craving fat, like a milk or cheese at this point.  At this point 35 miles in with the crux of the route remaining, we both knew it was basically going to be a hike out, between the dehydration and eating less than 1000 calories each, we were not getting out of the canyon quickly. It took 3:41 from the time we stopped for water until reaching the parking lot at the top, a section we had run down in 1:01. Had we had better hydration and nutrition earlier in the day, we could have easily trimmed an hour off of that.

With 1.5 miles to go M carried the empty backpack of a woman who had twisted her ankle and who's husband was trying to carry her out. The two of them seemed pretty competent and self sufficient, apparently she had already limped something like 8 miles since twisting her ankle, and was almost at the top. With a half mile to go the sunset was dark enough I turned my headlamp that I had carried all day and not used so far. I turned around to see the people we had passed on the way up and there was a string of more than a dozen headlamps heading up to the South Rim in the dark. Lesson learned, definitely bring a headlamp to the Grand Canyon, I almost left mine behind.

I finished in a total time of 11:52, and moving time of about 10:31. I definitely want to do it again, in under 10 hours, I know I can do that. The April 2021 trip might be a more measured effort in the 12-14 hour range. At the top we had enough cell service for a text message to our support crew who drove up the road and picked us up. We drove into Tusayan and had drive through McDonalds, I devoured a milkshake and spicy chicken sandwich with extra mayonnaise, which I had also been craving. That was a first, craving mayonnaise They were delicious! We were all caked with dirt from the canyon, and spending another night sleeping in the dirt didn't sound appealing, so we booked a hotel in Flagstaff and drove there before showering and collapsing. The next day we drove the 11 or so hours back to Denver with many stops to stretch and walk a little.

What will I do differently next time?

  • Start earlier. M and I are both somewhat fast, so aiming for sub 10 hours and a leisurely 6:45 AM start to running was very reasonable, and with him I'd do again. But with a slightly slower or less experienced group, I think leaving the South Rim at 5 or 5:30 AM is probably a good idea. For two reasons, one, it will help most people slow down on the descent because you would be running in the dark, and two, when night falls it's demoralizing, and so finishing in the daylight is highly preferred.
  • Bring some fat and protein to eat. Specifically there are some one ounce cheese slices that are individually packed and bringing 2-4 of those would be a huge boost. Also, I'll probably bring some Mini Moo's half and half shots, they are only 10 calories each, but my body was craving them on this run.
  • Drink more in general, and specifically refill my water bottles when I have the chance, like at Manzanita. 
What did we do right, that really worked?
  • Short sleeves and running shorts with no backup clothing. Yes, I realize this is a huge risk to not bring more clothing, but for people who are really planning to do this 43 mile adventure, sub 4 hour marathon types, carrying an extra 8 ounces of spare clothing or even more will slow you down a little and you don't really need it.
  • We brought headlamps, even if you only use it for 15 minutes like I did, it's worth it.
  • Each of us had two liters of water capacity. Most of the time I only had one liter of water on me because many of the sections take 90 minutes or less, which again helped us move faster, but having the extra capacity of a second liter was used, especially hiking up both sides of the canyon on 2.5+ hour sections.
  • Navigating is easy. Most of the trail is 4 feet wide, it feels a little like you have to try to get off the trail, but every year there are rescues of people that get off the trail and quickly get lost, which I would understand if you get off the trail because it can be disorienting.
  • Living at altitude before attempting this. I've started to take for granted the last two years that I can just show up almost anywhere in North America and not worry about the altitude, where as people who live near sea level would struggle with hard exertion at 8,000 feet elevation.
Thanks for reading!

Saturday, November 14, 2020

A New, Positive, Perspective

 The last few weeks have been rough. #understatement 

Work has been eventful... and I mean stressful for me. After not shipping one of our products since September 2019, we shipped five in eight days. Shipping is stressful as it's letting our works of art out into public to be judged. I took a new role in September, and whew it's been difficult! I took it, because the last two people in that role quit and who else was going to do it? Yet I quickly learned why it's so difficult. It's a nexus for both information, and physical hardware, and when any aspect of those two things don't get done a certain way by a certain time, it falls to this role. In my previous role I was responsible on the digital and information side, which is a strong suit for me, now I'm getting into the actual hardware too, which contains more data. I'll get back to that. Plus, not sure you've seen, but the USA had an election recently and Covid-19 cases are skyrocketing around the country.

Add it all up and I felt overwhelmed. 

My boss, who I am very open about with my struggles, offered to go to lunch, and as we were heading out the door, another coworker, and very good friend of my boss, who I'll call A, asked to come with us. I was planning to tell my manager the struggles of the day, but A beat me to it, by going on a ten minute description of the issues he was working on. It blew my mind! I was aware of two issues he brought up, but a few others were new to me. I also realized, 'wait, I can help here.' I have the skills to maybe not help with these immediate issues, but I can make sure that in three weeks, he won't have to deal with these issues again, at least for the next 9+ months... until we have another ground up redesign effort, but possibly never again, if we can front load some existing software tools we use.

Ten minutes later when we were eating and I was then asked about what was up in my world, I said with a small laugh, "I think A about covered it." My first thought about what I was feeling in that moment was, 'misery loves company' but that's not exactly the feeling or perspective change I had. My mind shift was more, 'the things that are stressing me out are stressing me out because I'm currently responsible for them in a way that I have not been before. So I kind of don't know what I'm doing. But! We are nearing the end of this surge and it is a great time to reevaluate HOW we do things so that a person does not get put in my position, or for that matter A's position during the next surge.' In other words, exactly what I came to a startup to do, build a company by building the processes and roles to systematically create a physical product where there previously was none. In the depths of the trenches I've been in the last few weeks, I've only seen the mud, not the whole battlefield. However, I've now been at the company through three product kickoffs and two product launches, in addition to the kickoffs and launches that I saw at my previous company. I have the experience.

Point being, it's easiest to map a process when you've done every step of it, or at least witnessed them all. And once you have a map, you can get from start to finish more reliably without getting lost, which makes the stress levels go down. You can onboard people and describe to them how to do it. Ultimately you can optimize the process. And my manager actually suggested to me this week, I should write all this down, so that we don't forget it, so that we don't have things fall through the cracks. Honestly, I'm delighted to go spend some time working on that. It's great when you have a thought about going to do something that needs to be done, and then your boss has the same thought and gives you the assignment. 

To step out more broadly, my family and closest friends are taking Covid-19 super seriously. As a competitive runner, I don't want any lasting lung or heart damage from getting the disease. I'm only socializing with a single person in this current wave. She's the only person in my Covid-19 bubble. And seeing all of these people I care about take it so seriously, I have a lot of hope that through Zoom calls, phone calls, texts and some socially distanced outdoor adventures we'll make it through this winter just fine. Oh we'll drink too much alcohol, and have lots of negative depressing thoughts, and anxiety when we have to interact with strangers, but ultimately we won't be dying. I read in an article today, "If you're not dead, you're winning."

So I'm optimistic. We're going to get through this. I'm going to get through this. 2020 is a learning experience that we will all pass on to future generations. As my blog is titled, we are learning to do, and in this case the doing is very difficult right now, and many will suffer mental health effects for a long time, let alone the hundreds of thousands of dead Americans. Many people have been humbled this year, which is often a hard experience, but I'm optimistic that will allow us to help each other heal in years to come.