I have been thinking about how we will live in this new world…a world where a deadly disease is lurking.  So I did what I usually do, I started researching it.  I wanted to learn about our immune system in an effort to understand my risk with COVID-19.

We live with risk.  We drive cars, we take medicines, we eat certain foods, we drink. Over time these risks have become integrated into our world and we recognize that they exist, but for most of us they do not rule our worlds.  Since a vaccine for COVID 19 is probably years away, we will have to add this virus to our risk list.

So the question that I researched: what precisely is this risk?  More about this later, first a trip down “immunity lane.”

Caveat: I have no scientific knowledge, I have been using Internet sources at NIH, CDC, Yale, Cornell, Scientific Journals and University websites for my information.  Since I don’t have the background, I could be easily misguided.  Also, I am a big, big believer in NOT using jargon or complex scientific language so I may oversimplify when I describe everything in layman’s terms.  

I have come to the conclusion that Immunology is Rocket Science.  Our immune system is unbelievably complex and variable.  We have only scratched the surface of our immune system, fantastic discoveries await.

Our immune system is filled with redundancies, complex communications, pathogen consumers, janitors, killing machines, construction crew, “generals” and soldiers…all working through our tissue, white blood cells and the limbic system.  To describe what I have learned would take volumes.  Suffice to say that there are hundreds of different cells (not including the millions of B cells with antibodies) and configurations.  So here is a VERY simple overview of the most relevant pieces of our immune system as it relates to COVID 19.

Immunologists categorize immune cells as either Innate or Adaptive.  Innate immune cells are the first to rush to an infection, they are “generalists” whose goals is to find any foreign cell and destroy it. They emerge from our tissue and the bloodstream. The second type are the Adaptive Cells, which arrive days later.  The most well-known are the T Cells and B cells, which are configured to destroy the actual villain or pathogen.  (Of course, it is not that simple, some cells are both Innate and Adaptive and our Adaptive cells also perform innate functions at the beginning of an infection…I told you this was complicated.)  There are a bunch of other types of proteins and enzymes, especially communication enzymes and proteins that notify our immune system that we have an invader and provide feedback about what is happening at the “site.”

So what happens with a rhinovirus (the common cold)?  Since viruses are small, they replicate by taking over our cells.  A rhinovirus starts invading our cells in the nose.  Our innate defenses rush to the site and start battling the pathogen: they kill, they clean dead cells, they rebuild and some consume a portion of the antigen and take it back to the T cells through limbic system. The Adaptive cells use that specific information to create T and B cells specially targeted for that pathogen.  To add to the complexity, B cells as well as dying and invaded cells may send signals to the immune system using cytokines (this is important).  Some communication is sent to the brain and other organs to help us to fight off the invader.  Then the Adaptive cells start heading to the battle.  From the beginning of the infection, T cell “generals” direct the invasion.  Based on the antigen data received, B cells with the specific antibody proteins start duplicating (antibodies are actually B cells with a certain protein configuration on their surface) and head to the site (a significant oversimplification, of course).  T cells serve as both generals and soldiers, some attacking the cells while others coordinate the immune attack.  The B cells and T cells now make a targeted attack on the specific antigen.  They “remember” this attack and store B cells (which contain the antibodies) to defend against future invaders.

Back to our rhinovirus.  During this battle, our nose swells and the cells become more porous to allow the immune cells to attack (hence the stuffy and runny nose).  That’s right, the immune response is the cause of the unpleasant symptoms (this is important for understanding COVID 19) including fever.  After the virus is eliminated, the repair crew generates new cells and gets us back to speed (another oversimplification).

Impressive, huh?  And this is only a tiny fraction of what actually happens.  But there is a problem.  First, the immune system must distinguish between our good cells and “infected” cells, which it does using mostly Toll receptors. (Auto-immune diseases occur when the immune system attack our “good” cells.) Second, the immune system must also “stand down,” or “commit suicide” when the attack is completed.  

Back to COVID-19; the first problem is that there are no B cells with the antibody proteins for a SARS virus. When the T cells and B cells are shown the antigen, the B cells must develop the antibody protein that will kill the COVID 19 antigen (takes about 7 days). For many healthy people, the Innate cells stave off the virus before it gets to the lungs until the B cells with targeted antibodies arrive.  

For those who experience mild symptoms, scientists believe is likely that their immune system is attacking it effectively before it moves to the lungs. 

But, even when it moves to the lungs, our immune cells can keep fighting it effectively.  For most of us, the system functions as it should and after the new antibodies have been developed, we are “cured.” We now have antibodies to ward off a future attack.  

But in severe cases, most scientists believe that a cytokine storm is created.  A cytokine storm occurs when the immune system gets an overwhelming signal and rushes to the site, furiously attacking all cells, even the “good cells”.  Fluid from the battle builds up and causes pneumonia.  The immune system now becomes the attacker. 

Scientists are searching for medications to prevent the storm or stop it once it starts. At Yale, scientists are searching for a bio marker to identify individuals who would be susceptible to these storms.

How bad are cytokine storms?  Very bad.  They cause sepsis. It is believed that most of the 1918 flu deaths were from these storms. 

But messing with the immune system can be dangerous.  In 2006, six healthy young men experienced a cytokine storm within 90 minutes of being injected with an experimental immune suppressant drug; five died.

So, back to risk, we need to be able to adequately assess our risk, what are the chances that we will get a cytokine storm from the COVID-19 virus?  

Now we are back in my wheelhouse.  

CDC guidelines and other guidelines are designed to prevent infection. Obviously, that is most important.  But we also need to know our risk of hospitalization and death if we get infected.

Let me repeat, most people do not develop a severe reaction from this virus.  But for those who do, it can be deadly.  So, the risk question is, “what is the likelihood that if I get a COVID-19 infection that it will become deadly?”

Cornell identified the following risk factors:  age, gender (more men die than women), underlying health conditions (kidneys, diabetes, hypertension, obesity, asthma, or COPD), immune suppression medications (including cancer treatments), race (but this may have more to do with access to health care than genetics), smoking (duh!) and viral dose (amount of exposure). In addition, stress has been found to be a significant immune suppressant.

Given the number of people infected, hospitalized and deceased from COVID 19, there is enough data to build a model that will allow us to assess our individual risk assessment for COVID 19.  We need to know our individual actual risk, especially if we have comorbidities.  (A comorbidity is the simultaneous presence of two chronic conditions, e.g., age & diabetes.) 

Epidemiologists need to create a model from which they can create a “risk assessment app” to give us a risk factor.  For example, I have asthma and I am over 65, so I have 2 comorbidities. A risk assessment app would allow me to enter my risk factors including chronic conditions, relevant medications, treatments, number of “colds or flus” per year, and psychological factors. The result would be the probability of getting the deadly reaction if I become infected with the COVID 19 virus. 

This is especially helpful for people who are healthy but have underlying illnesses. For example, diabetes is recognized as a risk, but diabetics frequently present other comorbidities (e.g., obesity, poor circulation).  What is the risk for someone who has diabetes, but keeps her A1C down, exercises and maintains a healthy weight?

The work that is being done for treatments and vaccines is most important, obviously.  But in the interim, we need to live and work in a COVID-19 world.  

To do so, we need: (a) a reliable antibody test to allow us to know if we have immunity and (b) an individual risk assessment.

Until then, we are walking in this new world without a map.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

I recently re-read Doris Kearns Goodwin’s book Leadership in Turbulent Times. She profiled four Presidents who successfully led America through a crisis: Lincoln, Teddy Roosevelt, Franklin Roosevelt and Lyndon Johnson (Civil Rights).

Lincoln chose his rivals for his cabinet because he felt that the country needed its strongest leaders during this crisis.  When formulating the Emancipation Proclamation, he spoke with politicians and experts from all sides of the political debate. He spent time with soldiers, learning their thoughts on a war that impacted them the most.  While the public wasn’t yet ready for emancipation, he believed that he could convince them. He listened to all positions and opinions for when and how to deliver his message.  His thoughtful analysis worked, by the time he delivered the Proclamation, it was generally accepted despite its radical position.

For Theodore Roosevelt, it was the coal strike of 1902.  The miners struck in the spring of 1902 and the owners were content to allow the strike to continue.  As fall approached with no movement, Roosevelt recognized that many Americans, now dependent almost exclusively on coal for heat, would freeze to death. He knew that he had to find a solution.  He commissioned an expert to study the issue and worked with all parties to reach a solution in time for winter.

For Franklin Roosevelt, it was the first 100 days of his presidency. After he was elected, he immediately closed the banks to prevent their collapse.  He worked with experts from all sides, convened an emergency session of Congress and passed legislation to preserve the banks.  Despite his opposition, he allowed Congress to add an amendment to create the FDIC. (He later acknowledged that this amendment was one of the best parts of the legislation.) Then he convened his first “fireside chat” where he explained to the American public in simple terms what had happened, what would happen and what he needed from them.  The first day the banks reopened, there were lines of people, not to withdraw, but to deposit their money.  

For Lyndon, it was passage of the Civil Rights bill and crucial provisions of the Great Society (e.g., Medicare).  After Kennedy’s assassination, Johnson recognized that the country needed to address civil rights. He manipulated, bullied and cajoled Congress to pass the first significant civil rights legislation.

These were quite different leaders.  Lincoln was reflective. Teddy Roosevelt was a man of action. Franklin Roosevelt was charismatic, and Johnson was a master of working with Congress. While they approached the issue from their own strengths, they all used the following blueprint:

Become an Expert.  They solicited experts and listened to every viewpoint, including the American people. (Lincoln met with soldiers, Teddy met with the miners, Franklin used Eleanor as his “eyes and ears.” Lyndon had firsthand experience.)  By the time they acted, each had a thorough understanding of the crisis from all perspectives.   

Accept Moral Responsibility. These leaders felt they had a moral imperative to solve the crisis.  Unconcerned with popularity or approval, they recognized that they had to lead America through its crisis.  Nowhere was this more evident than the Emancipation Proclamation.

Empathize.  Each leader empathized with the American people; especially the poor and the dispossessed.  Johnson never forgot the devastating poverty that he confronted when he was a school principal in a poor, immigrant district in Texas.  

Treat Adversaries with Respect. Teddy Roosevelt had to deal with coal owners who were arrogant, dismissive, and disrespectful to everyone, including the President of the United States. Time and again, they refused to negotiate and remained unconcerned about the fate of Americans as winter approached.  Nevertheless, Roosevelt refused to give up and kept trying to find a way to work with them, despite their refusal to allow the union to come to the bargaining table.

Use a Strong Team. Lincoln utilized his adversaries, Lyndon cultivated Congressional leaders.  Lincoln was not afraid of strong leaders (who often disagreed with them) to help implement the solution. Franklin Roosevelt cultivated dedicated experts, who sometimes disagreed, but worked tirelessly to implement novel solutions.

Communicate Effectively.  No one did this better than Franklin Roosevelt, who was able to lead and educate the nation with his fireside chats. He made the issues and his initiatives understandable without talking down to his audience.

Recognize Mistakes and Pivot Quickly. Teddy Roosevelt wanted to impose a solution, but his Attorney General advised him that it was unconstitutional; so, Teddy Roosevelt had to craft a different solution.  Several of Franklin Roosevelt’s initiatives were not successful.  Both quickly took responsibility and changed tactics. 

Do Not Take It Personally.  Lincoln and Franklin Roosevelt especially were able to seek advice and counsel from people who disagreed with them. In Lincoln’s case, one of his cabinet members had publicly humiliated him. Yet, they were never vindictive, recognizing that the solving the crisis was more important than their egos.

Keep your Word.  While each allowed debate, once they made their decision, they kept their promise. Lyndon Johnson promised civil rights leaders that he would deliver legislation and refused to give up, despite a prolonged, and heretofore unbroken, Senate filibuster. 

Share Credit.  Each President took responsibility for mistakes, but shared credit for successes.  Even Lyndon Johnson, who was known for having a huge ego, shared credit for the Civil Rights legislation with Congress. 

We can use this scorecard to judge our current leadership in the COVID 19 crisis.  But we can also use it as a blueprint for leadership in a crisis.  Especially since this one isn’t over yet.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

I have returned from Key West, a 22 ½ hour marathon.  With the help of my nephew, we drove straight through, stopping only for hygiene breaks (for us and the dogs) and food.  

Here is our story.

Due to COVID 19; I was reluctant to stay at hotels.  But the rigorous drive and my health precluded me from driving straight through.  My nephew graciously offered to fly down and share the drive with me.  He is a college student from Michigan and has experience in long drives.  I will always be grateful for his help…I couldn’t have done it without him.

We agreed that I would leave from Key West and pick him up at the Fort Lauderdale airport (about 4 hours).

First, the airport.  Ft. Lauderdale is a large, spacious airport, yet I was the only person at the entire arrivals pickup.  Remember how difficult it is to find a place to stop and pick up an arriving passenger? Not during a pandemic. It was eerie, there were no cars, no taxis, no attendants, no law enforcement.

I entered the terminal wearing my mask and gloves.  The clicking of my dogs’ toenails and my footsteps were the only sounds echoing through the cavernous terminal.  During my 35-minute wait, I saw a single cleaning attendant.  

My nephew was one of seven passengers on the jumbo jet.  Each passenger got his own row; except for the absence of food service, it was like a private jet arriving at a private airport.

We embarked on the driving part of our journey, stopping at rest stops that were spotlessly maintained.  We were the only travelers wearing masks or gloves; even in Florida, which has a mandatory mask rule.  Many travelers were elderly, yet they wore no protective gear.

Despite my focus on the environment, we used disposable gloves and masks for safety.  As we traveled through Georgia, the Carolinas and Virginia, we remained the only people wearing either masks or gloves.  Some residents and fellow travelers eyed us suspiciously.

The Interstate had less traffic than usual, but the drive was daunting and after a while, my nephew, not content with my nut and fruit diet; needed to stop at a McDonalds for some “real food.”  In one of the Carolinas, we ordered from the drive-up window, only to discover that the McDonalds was open.  The customers were observing social distance to some extent; but only the employees were wearing masks.

We finally arrived in St Michaels at 2:30 in the morning exhausted and confused. It was as if there were two worlds, one with COVID 19 and one without.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

One of the great things about writing a column is what I learn from readers.

This week, the Spy got a call from Bob Aswell, a resident of Somerset County, who wanted to share a little known story about the devastating impact from the 1918 flu.

His grandmother, Lillian Sterling, was widowed in World War I, when her husband, Milton Byrd died from gas poisoning. To support her three children, she worked at the seafood processing plan, Handy & Sterling in Crisfield.

Times were unimaginably difficult then, and the hardy people of that era looked forward, never backward. But she wanted to make sure that her grandson never forgot the devastation from the 1918 pandemic.  To stop the spread of the disease in Crisfield, its dead were transported and buried on James Island, next to the plant. She quit counting at 383, but others counted over 500 nameless souls buried on that island, their lives marked by simple wooden crosses.

The crosses are gone now, washed away by storms and decay; but the smokestack from the plant remains, a hallowed memory of the loss and destruction that a pandemic can cause.

I have found that there are two types of people in this world—animal lovers and animal agnostics. 

It is obvious that I am an animal lover. But most of my family and some of my friends are animal agnostics.  So, what makes someone an animal lover and another person an animal agnostic?

I researched this question and I found some pretty self-serving research on animal lover websites. These websites claim that people who love animals are more empathetic, have a strong affinity to the natural world and are more environmentally friendly.  

But most animal agnostics that I know are equally generous and empathic as well as environmentally conscientious. And, let’s face it, Hitler was a vegetarian animal lover.

On the other hand, the animal agnostic researchers find that animal people are attracted to animals as something that they can dominate and to fill a deep need to be loved unconditionally. They claim that animal lovers are in search of something to protect, nurture and care for because these relationships are less complex than human relationships.

But animal agnostic researchers have not met my dogs. They rule my world more than I rule theirs. Sometimes they do make a half-hearted attempt to protect me.

I could find no empirical data to support the notion that self-appointed therapy animals (NOT those trained for specific purposes) provide a benefit.  

When I was in graduate school, attributing characteristics, such as love, and affection were considered pejoratively to be anthropomorphic. Scientists believed that animals did not have the same capabilities as humans for love and affection and were merely instinctual. Jane Goodall’s research with the apes, elephant research and many European dog lover researchers have demonstrated that to be a fallacy.  Animals are capable of great affection and, yes, love. Animals grieve, and recent research has shown that dogs prefer human affection to food (probably not my dogs).  

Dogs are one of few the species that can successfully cultivate cross species relationships. Dogs adapt to us, they modify their instinctive behavior to please us (again, not my dogs.)

So, we know that animals connect to us, but not all of us connect to them.

What makes us different?  There is a new scientific field of study that is looking into the differences, but they have been able to gain little insight.

My dogs will approach an animal agnostic, try to stare into their eyes and give them their best affectionate wiggle or smile.  But my animal agnostic friends perceive them as dirty, furry, slobbery beings that are an impediment to a conversation.

(My personal favorite is my 3-year-old nephew.  When one of my dogs snuggled up to him I asked my nephew if he wanted to pet my dog. He looked at my dog, then at me and replied, “No, I want better one.”)

To me, the ability to love animals is simply a gift.  When I look into their dark brown eyes, I can see love. During these times, I enjoy their companionship, their antics and their affection.

I am very grateful for this gift.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

One of the most frustrating aspects of this pandemic is the contradictory, confusing and frightening information that we receive daily. To get accurate information, we need accurate and valid tests.

In an effort to give us broader access to COVID-19 testing, the FDA provided Emergency Use Authorization (EUA) which only requires validation from 20 to 30 test samples. If you read my columns, you know that these are small samples; and some of the confusing data is due to the speed with which these tests have been created. But in a crisis, we must move quickly.

There are basically two types of tests for COVID-19 (although the FDA classifies 3.)  The first test, sometimes called an antigen test, looks for copies of the virus via nasal and throat swabs in patients who show symptoms of the virus. (As a recipient of this test, I can assure you it is very unpleasant.)  Fortunately, the FDA has approved a saliva test.  

The other test is an antibody test, designed to test antibodies generated after the symptoms of COVID 19 have passed.

The only way to assess the accuracy of the first test is to compare it to the results from the second type of test, the antibody test, using a nonparametric test for statistical significance.  Simply put, if you tested positive for the virus in the antigen test, and have the antibodies, the antigen test was accurate.  If you tested negative but have the antibodies it could be a false negative.  

The critical test to get us back to “normalcy” will be the antibody test. Despite wide-spread availability of antibody tests, only four have met the minimal EUA standards.  Some of the unapproved tests, often from Chinese manufacturers, have reliabilities as low as 20%.  (In psychological testing, we reject any reliability less than 95%.)

We know that an accurate antibody test is needed to enable us to “get back to normal.”  Some scientific modelers accept that 40% of the population with antibodies can create “herd immunity” thus making it safe for us to resume our normal routine. But most prefer 90-95%.  In addition, some experts predict that the antibody test will demonstrate that many more have recovered from the virus than our current statistics suggest.

Here is what appears to be true from data that has been gathered.  Approximately 10% (in Florida) to 13% (in Iceland) of those who are symptomatic test positive for the disease.  According to the article in the New England Journal of Medicine, Icelandic researchers found that .8% of the population who are asymptomatic test positive for the disease.  

I am a numbers person, and given everything that I have read, it is obvious that we will not have a herd immunity in the near future. Our current infection rate across the United States is less than 1%. With only 10%-13% of those being tested with symptoms having the virus, and only .8% of a percent without symptoms having the virus, it is unlikely that more than 2% of the population will be “immune”. Even the most optimistic projections predict that only 5% population will have antibodies.  In Wuhan, it is 3%.  New York City, currently writhing from the illness, only a little over 1% of its population has tested positive.  You can do the math.

So what next?  For now, it will be a balancing act between our flailing economy and our health.  I leave it to the experts to make those decisions.

But what is critical is that this is the time to think longer term:  VACCINE and TREATMENT.

According to the New York Times, 35 startups, Universities and smaller medical companies are working on COVID-19 vaccines. Three vaccines are currently being tested in human trials.  However, the scientific community warns us this virus may be resistant to a vaccine.  

Sadly, vaccines are not profitable enough for our largest resources, big Pharma, because vaccines have a low profit margin.  

Since this and other viruses will be with us for some time, we need to focus on developing treatments. Vanderbilt University Medical Center is testing a new antiviral drug, Remdesivir. But there is little in the drug pipeline.

So, how can we prioritize both treatment and prevention?  I leave it up to the experts, but here are some of my “top of the mind” thoughts.

1. First and foremost, we must make vaccine and medications to address pandemics profitable. It could include tax breaks, research funding, extended patent protections.  
2. How about creating a prestigious award, with a significant revenue attached, for collaborative efforts that yield products for COVID-19 and future pandemic viruses?  Let’s face it, the best products come from collaboration.
3. Finally, funding, I personally would be happy to pay a dollar for a “pandemic tax”. Of course, only if the revenues were awarded by independent Federal agencies (e.g., CDC, FDA, NIH) to US medical companies and “out of reach” of politics.

Rather than believing that this is something that we need to get past; it looks like we must recognize that this is part of our future.    Some infectious-disease experts believe the scientific tools already exist to develop vaccines and drugs that work against a wide range of pathogens. We need to create a global monitoring system to identify and monitor potential high-risk viruses. 

Our scientists and medical professionals are racing to find the answers, but in this crisis, it is hard to give them what they need the most.

Data, patience, funding and leadership.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

COVID 19 has arrived, trailing debris and confusion in its wake. In February who would have imagined schools closed, empty restaurants, cancelled travel and events? 

We did not see this coming. Sure, there have been movies and books about this possibility, and we heard about the 1918 flu. We assumed that this would happen at some point. We just didn’t see it happening to us.

All we know is that we don’t know. Hindsight will teach us the best strategies. If hindsight is used to learn, we will be prepared for the next one. If it is used to punish, we will merely be a blame-oriented society.

Those of us who fled the cold weather are flummoxed. If we had anticipated this, we would have returned sooner.  But here we are.

Apprehension is a constant companion.

I can’t speak for other “snowbirds”, but I can tell you about Key West.  Key West was “ahead of the curve” in closing restaurants, theaters, hotels, beaches, bocce ball courts, tennis courts, watersports, boating, piers.  Famous Duvall street, home of countless bars, restaurants, theaters, quickly became a ghost street. Unlike some parts of Florida our infection rates remain very low, less than ½%.

We have been practicing social distancing for weeks now, beaches and piers are barricaded like crime scenes. The Key West that we flocked to is filled with masked people walking aimlessly to fill their days.

Our daily question is when and if we should return. It is safe, but boring, here.

The return trip is treacherous.  For me, it is a long stretch of interstate with stops for sleep, food, and gas. For those who fly, there are the airports and taxis. All chances to get infected.  

Then there is the need to self-quarantine for 14 days to prevent others from being impacted by my choices.  

Still, I yearn for Spring, the fragrances that change with each flower, the brightly colored bushes and flowers, the rain, the bright green grass and newborn leaves, the cool, moist soil.  I deeply miss my family and friends. I miss my neighbors; I miss the St. Michaels community.

So, I wonder, when should I return?  How can I return? Should I return? The daily question.  

There are no guidelines, hindsight will be the only teacher.  All that we snowbirds can do is guess and hope.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.