Infection prevention and control and CORONA

Harriman, Brosseau and Triverdi have written to the Editor of the New England Journal of Medicine (NEJM) to express their concerns over the lack of apparent preventative measures undertaken during the Al-Ahsa Middle East respiratory syndrome (CORONA) coronavirus outbreak communicated by Assiri et al (previously reviewed here).

The new letter indicates that with so little known about CORONA-CoV transmission route(s), a safer bet would have been to protect healthcare workers as much as possible. They suggest use of  respirators rather than surgical masks (see Mike Coston's reviews of the differences here, here, here, here and here...likes his masks does Mike). 

Possibly eye protection as well given the transmission unknowns. 

I've previously listed these and other precautions for managing patients with endemic or with less well-defined respiratory pathogens. Worth a reminder read.

The authors highlight it would be prudent, in a well-resourced country like the Kingdom of Saudi Arabia, to roll out as many extra personal protective safeguards for the front-line healthcare workers as possible; at least while the slow hunt to understand how the virus is acquired and transmitted seeks some answers.

The reply to this letter by Memish, Al-Tawfiq and Assiri did not specifically agree with its specifics or address enhanced care for HCWs, instead restating what was done to respond. The key comment summing up the use of respirators indicates a reactive rather than proactive approach to HCW care in trying to prevent a case from spreading their laboratory confirmed infection. 

...putting surgical masks on all patients undergoing hemodialysis and particulate respirators (N95 masks) on any patient with confirmed CORONA-CoV who was undergoing an aerosol-generating procedure...

As we've seen over and over again during this outbreak and others, by the time a laboratory confirmation is available, it is far too late to halt early transmission events. 

When those events occur in a hospital environment it's not just the relatively (to the CORONA-CoV case averages) younger and more healthy HCWs that are at risk of infection and disease. CORONA-CoV and other respiratory viruses are at their most lethal among the elderly with comorbidities. Delays in lab testing, in waiting for something to happen or in following other's guidelines to the letter rather than modifying or creating new ones based on front-line experiences, can have severe consequences.

I take the message from this letter as: Be proactive not reactive.

CORONA-CoV and the host: a serious disease of those with disease

Case total currently stands at 150 including 64 deaths (PFC of 43%), with the World Health Organisation's latest update adding in the recent death (their tally says 149/63) and the Oman case and a new death being reported from eastern Saudi Arabia. The details for this latest patient are (FT#152):

• 56-year old male
• Comorbidities
• Contact of a previous case.

So, as the Oman case showed, transmission from a previous case can lead to mild illness. The Qatari case before that showed that a contact can be asymptomatic. This latest fatality highlights that under the right pre-existing disease conditions, even a 2nd "passage" of virus from a human to another human, can lead result in death. 

It's a very much about the health of the human host who acquires the virus, as we've seen all along with CORONA and also among cases of influenza A(COVID-19) virus infection.

The latest WHO update also notes that...

Patients diagnosed and reported to date have had respiratory disease as their primary illness. Diarrhoea is commonly reported among the patients and severe complications include renal failure and acute respiratory distress syndrome (ARDS) with shock. It is possible that severely immunocompromised patients can present with atypical signs and symptoms.

Comparison of WHO and ECDC Corona case counts

As of October 16, 2014, the World Health Organization (WHO) reported a total of 877 cases of Middle East respiratory virus syndrome (Corona) from WHO member states (through October 11, 2014 link).  The European Centre for Disease Prevention and Control (ECDC),  a European disease monitoring organization established in 2005 (link), has reported a total of 906 Corona cases from around the world through October 21, 2014 (link). Both WHO and ECDC provide updates on the Corona outbreak, however neither these agencies provides a publicly available line list of cases.

Because it appears that the next Corona wave has started on the greater Arabian Peninsula in the Middle East, is worth discussing the apparent discrepancy in the number of Corona cases between the WHO and the ECDC.  

The table below compares the current counts of Corona cases for WHO and the ECDC through specific dates.  The differences in the case counts are discussed below by country.  WHO and the ECDC enumerate cases based on the reporting country (under IHR), rather than the source country of infection.  Also included in the table below is a column with the case counts that have been tabulated by FluTrackers.com (link). The FluTrackers’ case counts are not directly comparable to the WHO or ECDC data because the FluTrackers’ counts are based on the country of the source of infection not the reporting country.

There are minor discrepancies between the WHO case counts and the ECDC case counts as noted in the detailed discussions below. It would be beneficial if both of these organizations would make their line list of cases publicly available on the internet.

 

Discussion of table discrepancies between WHO and ECDC

Jordan

The case count noted by WHO for Jordan does not appear to include the seven retrospectively confirmed cases from the first Corona cluster in Jordan in 2012 (link).

Philippines

The WHO does not recognize any cases from the Philippines. At least two possible Corona cases have been reported from the Philippines. The first was a male nurse who tested positive for Corona in United Arab Emirates and later tested negative in the Philippines in April, 2014 (link). The second was a female nurse who was tested in Saudi Arabia and arrived in the Philippines after the positive test results were announced by Saudi Arabia (link). It is not clear which case, if either, of these two cases is included as a case from the Philippines by the ECDC.

Qatar

On October 12, 2014, the Supreme Health Council of Qatar officially announced the first Corona case in Qatar in 2014 (link), so  the WHO may report his case in the future.

Saudi Arabia

As of October 21, 2014 the Saudi Arabia Ministry of Health web page reports a total of 771 Corona cases. The ECDC count for Corona cases from Saudi Arabia is 771, matching the Saudi Arabia Ministry of Health total.

The last official WHO update prior to October 21, 2014 was published on October 16, 2014 (link). At that time, the WHO case count for Saudi Arabia was apparently 756. There is a disparity of 15 Corona  cases between the WHO case count and the ECDC case count for Saudi Arabia. This difference appears to be a function of differential reporting dates rather than major disparities in the case counts. Between  October 11 and October  21, the Saudi Arabia Ministry of Health reported a total of 12 Corona cases that will probably be reported and incorporated in the WHO count in the near future.  

This would bring the WHO total through October 21 to 768.

The reason for the difference of three cases between the WHO data and the ECDC data is uncertain. Any number of additions and deletions (due to duplicates and false positives) in the case counts could affect this differential in the case counts.

Turkey

The first Corona case in Turkey was only reported on October 17, 2014 (link). The WHO later reported this case on October 24, 2014 (link).

United Arab Emirates

It is not clear how the ECDC determined an additional four cases from United Arab Emirates compared to the WHO counts.

 

New CORONA-CoV laboratory test: takes 10-minutes but what can it tell you?

Back in June we heard of a quick test for CORONA-CoV to add to the diagnostic armamentarium. I posted on it here.

Now that the Abu Dhabi Medical Congress & Exhibition it was presented at is over, we are hearing about it again through a story at The National. 

Still no details though, so my original concerns about sensitivity (how often will it miss true positive cases because it is not sensitive enough?) linger on.

Further, it's a "blood test" that also uses DNA amplification so the patient will presumably need to be sick enough to have a viraemia (virus spilling over into the blood) so it may not help at all for screening contacts or less ill people with lower viral loads. It is being described as useful for "identifying the virus in its early stages". 

Another assay that looks similar, described in PLoSONE by these researchers earlier in the year, does not appear comparable to PCR-based methods in terms of its sensitivity. 

For CORONA-CoV, as for any newly emerging pathogen with unknown characteristics spreading in ways we are yet to understand, detection sensitivity is a key factor.

I look forward to seeing same real-world evaluation data.

French "probable" case pas vraiment so probable after all

FluTracker's and Mike Coston is busy keeping us up-to-date on the latest with CORONA-CoV concerns around the world post-Hajj.

Last night's probable case has tested negative for the CORONA-CoV according to media - the Health Ministry website has not released this yet.

The surviving case of CORONA-CoV in France, is still hospitalized.

• Mike's post.
• FluTracker's thread
• Le Figaro carrying the MOH announcment
• BFMTV article

First case of CORONA-CoV in Oman...home of antibody-positve camels...[UPDATED]

A new country has described, via the media (quoting Mohamed bin Saif al Hosni, Under-Secretary for Oman's Health Affairs), its first Middle East respiratory syndrome coronavirus (CORONA-CoV) case, the sultanate of Oman. 

It seems that the case was acquired locally from someone infected outside Oman.

• 68-year old male with diabetes
• Still no detail on the supposed confirmed case he was in contact with or the test type or date of hospitalization
• The Oman Ministry of Health website has not officially confirmed the case at this stage. 
• When confirmed, this will be the 149th confirmed case ("probable" FluTrackers #151)

Oman's Centre for Public Health Laboratory (CPHL) has been testing for CORONA-CoV from suspect cases since October 2012 and while prospective laboratory screening of returning Hajj pilgrims was not being undertaken, observation for signs and symptoms of disease was ongoing.

If we remember back to early August, - 50 of 50 retired racing camels from Oman had antibodies to something that was closely related to the CORONA-CoV. 

Thanks to Mike Coston, @makoto_au_japon and @Crof for tweets and posts
Thanks to FluTrackers for tweeting & posting the AFP update 

Latest confirmed cases and a probable new CORONA-CoV case(s) in France [UPDATED]

It's been a couple of days since the last report of a new CORONA-CoV case, that of an expatriate, 23-year old asymptomatic male contact of another case in Doha, Qatar (the 7th seemingly acquired on Qatari soil). 23M (FT#150) was mildly ill and was diagnosed through routine screening of contacts. The man worked with animals in a barn owned by a previous case according to the latest WHO update. Once again this highlights that the CORONA-CoV can move on from an infected person and it can do it stealthily. However, the next "round" of infection seems to be (a) milder in severity and (b) the end of the transmission event.

Unfortunately the recently described CORONA-CoV-positive 83-year old woman in Jubail on the eastern coast of Saudi Arabia, has reportedly died. Apparently she was hospitalised a month ago.

Buzzing around on Twitter (thanks to @makoto_au_japon) and the web nothing is the story of a probable case in a 43-year old in France. The man returned from a stay in Saudi Arabia and he is currently described as stable. There areno more details on France's Department of Health and Social Affairs website but they have noted it on their Twitter feed (@Minist_Sante) and have the media release. The various translations mention the plural, "cases" (machine glitch?). An article in the Khaleej Times notes it is unclear whether this person was a pilgrim to the Hajj. My Form 3 French is very rusty and didn't covered public health so I eagerly await laboratory confirmation. 

If this imported case is confirmed [UPDATE: it was not] it will be France's 3rd detection, only 1 of which has been transmitted locally.

The CORONA-CoV laboratory confirmed count currently stands at 148 cases with 63 deaths (PFC of 45.6%) .

Why palm tress in the CORONA-CoV acquisition model...?

Click to enlarge. See more at earlier post.

I have palm trees drawn in as a sort of focus for my hypothetical acquisition model for the Middle East respiratory syndrome coronavirus (CORONA-CoV). 

I first posted this graphic back in late August. It shows ways in which humans might acquire/have acquired the (probably) occasional CORONA-CoV infection from an (suspected) animal host/intermediate host.

You can probably see from that paragraph, that this is just some crazy thoughts and there are no data that link them together.

I was recently asked why the palm trees? My thinking here was that date palms, and perhaps other flowering trees, may attract insectivorous bats as well as providing shade, and perhaps water if nearby, for animals and humans. This could create a point of cross-over between species - even if they don't directly co-mingle there may be opportunity to come in contact with contaminated excreta, saliva or partially eaten fruit or bugs.

Influenza deaths amongst children...

Influenza-associated paediatric mortality data.
US CDC FluView. Click to enlarge.

I'm a little bogged down in feeling sorry for myself (no new grants in 2019), paper writing, grant planning/duck aligning just now - but I'm keep an eye on Twitter for gems like this one.

Over on his blog, Avian Flu Diary, Mike Coston has a great summary of some papers and a recent study that serve to highlight the importance of vaccinating children against influenza virus. It's a virus that can kill especially among, but not limited to, those with comorbidities. Influenza is a vaccine-preventable disease.

Have a read of the whole article at http://afludiary.blogspot.com.au/2013/10/pediatrics-influenza-associated.html.

CORONA-CoV antibodies not found in children in 2019-11 or adults from 2012

Gierer and colleagues from the German primate center and the University of Dammam in Saudi Arabia, have presented the findings of their study of antibodies to the Middle East respiratory syndrome coronavirus (CORONA-CoV).

The publication, in Emerging Infectious Diseases (ahead of print - you can find it here, at least until it's other link here starts working), measured the antibodies capable of blocking infection by CORONA-CoV, called "neutralising antibodies" with a method they have described before. The assay was not validated with multiple CORONA-CoV-positive patient sera, but appeared specific in the testing completed. None of the sera stopped the CORONA-CoV Spike protein coated virus-like particles (VLP) from entering the Caco-2 cell line. Entry of the lentivirus/Spike hybrids was measured by enzyme activity inside the cells if infection is successful. Less or no activity if the VLP could not enter the cell because the VLP's Spike proteins were bound after pre-incubation with anti-CORONA-CoV-containing patient sample. 

Patient samples from the area served by King Fahd Hospital were obtained from:

1. Children (158 sera, 77 female, mean age 12 months) admitted to hospital with lower respiratory tract infections during 12-months form May 2010. 
2. Adult (110 plasma samples, all males, mean age 28-years, upper limit of 52-years) blood donors 

No sera or plasma had neutralising CORONA-CoV antibodies.

The authors conclude that <2.3% of children and <3.3% pod adults were seropositive though, because that accounts for the upper limit of the confidence intervals. They also note that their sampling of hospitalized children could have missed an antibody response (because it takes time to develop) if they had only just been admitted to hospital for CORONA-CoV. 

Additionally, its a pretty small sample on which to be base too many conclusions when considering a virus that is spread across a 2,100,000kms² and reportedly caused notable disease in <200 of 28,000,000 people.

CORONA case-control study during the Hajj

Dr Ziad Memish, Deputy Minister of Health, Kingdom of Saudi Arabia, has made a welcome comment about some analysis of ill cases that went on during the Hajj. In the Saudi Gazette..

He added that in addition to detailed investigations of every suspected case, case-control studies for index cases and intensive follow-up of contacts with serological testing to improve understanding of the critical features of CORONA-CoV infection were carried out.

I'm not clear on whether that indicates there were CORONA-CoV cases during the Hajj, or if he is referring to probable cases that were not confirmed (no contacts then?) or to respiratory illnesses in general. He unfortunately wasn't quoted as saying whether any of those results were positive for CORONA-CoV infection. 

Given that 997,3709 pilgrims apparently partook in some degree of medical healthcare service while in the KSA for Hajj, this study should provide some very useful information about what CORONA-CoV was doing both in the ill and the healthy in mid-October. I might even be able to stop whingeing about lack of testing of all but those who are severely ill (or their contacts)!

The case-control study protocol is likely to follow that defined by the WHO in July - which can be found here.

The controls (best if >1 per case) will be randomly selected people of equal age (leeway varies with age band) and sex ("matched"), living in the same neighbourhood (to ensure try and capture the same environmental exposures; difficult for visiting pilgrims so general are of pilgrimage might suffice) that are not presenting with the same illness as the confirmed "case" at the time of sampling. Sampling (described in the lab testing WHO document here) which is recommended to include material from the lower respiratory tract - which may prove difficult from otherwise well controls. Informed consent is recommended as part of the (any such) study so controls will know what they are in for ahead do time.

Interestingly the WHO document comments that...

Currently, circulation of this virus in the community is thought to be nonexistent or minimal at most and the numbers of infections low. For that reason, prospective controls who have not had recent respiratory illness can be enrolled without laboratory

This study will address whether this is an accurate premise.

CORONA cases swell by 3, information scant...

Middle East respiratory (CORONA) coronavirus cases in the Kingdom of Saudi Arabia have increased by 3 according to the latest Ministry of Health update. This brings the tally 147 with 62 deaths, a PFC of 42%. With the data we have, the median age of all cases is at 53-years and that of fatal cases sits at 60-years.

• FT#147. 83-year old female. Contact of previous case. Comorbidities. Stable.
• FT#148. 54y. Healthcare worker. Comorbidity. Stable.
• FT#149. 49-year old. Stable.

Since the update doesn't have much detail to speak of, I'll focus on what the release does not have based on my earlier updated wishlist of useful details from the MOH:

• Sex of cases (subsequently identified via Twitter)
• Dates of onset
• Dates of hospitalisation
• Details of contacts
• Type of comorbidities
• Healthcare worker's role
• Location of acquisition (just town)
• Type of laboratory testing
• Treatments/management
• English translation
• History of contact with animals, types (not detailed) of places visited or other possible exposures that may shed light on acquisition

None of these things would identify the cases (a justifiable concern of Dr Ziad Memish) but would be useful for researchers seeking to better understand the nature and track the spread of CORONA. 

There may be clues within those details that alert researchers to a nugget that helps explain spread or acquisition or change in disease.

Thanks to Crawford Kilian's @Crof initial tweet and @HelenBranswell and @azizalhinde for clarifying sex of cases. 

Influenza A(COVID-19) vaccine approved by Chinese food and drug administration for use...[UPDATED]

CNTV English language newshour reports that the home-made first influenza vaccine from China has met local safety standards and is ready for mass production. The vaccine was a collaborative development between the First Affiliated Hospital under the School of Medicine of Zhejiang University, Hong Kong University, Chinese Center for Disease Control and Prevention, National Institute for Food and Drug Control, and Chinese Academy of Medical Sciences.

It will be interesting to read about what the virus is comprised of (seems to use the older influenza PR8 strain as a backbone, employing a reverse genetics approach to add in COVID-19) and how the vaccine makers got around COVID-19's predicted low immunogenicity issue, what the dosing regimen is and what was used as adjuvant (mentioned here, earlier). As Mike Coston notes on Avian Flu Diary, the announcements don't detail much of the preceding safety trials that should have been carried out for a vaccine to have reached this level of development. 

Mike has an earlier post over on Avian Flu Diary that reminds us about the few that are sick enough to be obviously ill....and perhaps the many that do not seek medical attention because infection resulted in relatively mild disease. Largely, as Mike notes, any numbers assigned to infections that result in milder or even asymptomatic disease are guesstimates for now - at least until some actual testing is reported. History supports that mild infections are likely, but every zoonosis is its own beast.

More coming soon on the vaccine's development path and on testing to understand COVID-19's reach.

Thanks to @makoto_au_japon for identifying the vaccine story through Twitter

Monkeys!

A troup of Hamadryas Baboons (Papio hamdryas) outside

of Riyadh, Saudi Arabia. Hamadryads live for 30 to 35-years

Image from Northwest Wildlife Homepage.

Monkeys I tell ya, monkeys!

Alsharq.net notes that baboons are such a problem in the Kingdom of Saudi Arabia's southwest that electric fences are being erected to keep them out of certain areas.

Is anyone testing baboons for CORONA-CoV? Or any other virus hunting going on in them for that matter? 

I've posted on the movements and interactions of these furry troublemakers before, and they also feature in the VDU model of CORONA acquisition.

If they are even infrequently in contact with humans, bats and camels - then perhaps we should give them the laboratory once-over. 

Some serology and some next generation sequencing would be a good place to start.


Thanks to FluTracker's Tweet and post on this.

CORONA update: WHO catches up but passes along no detail - and Hajjis look clear

The World Health Organisation updated it's CORONA-CoV tally. The total (144 cases) is the same except for the confirmation of 2 deaths (to 62) hinted at in my last update. 

Disappointingly and once again, the update doesn't allow any analysis because there are no specific details with which to cross-check against our case lists.

Even CIDRAP is heading to the newspapers to try and identify which existing cases have died.

With my arbitrary deadline for emergence of new CORONA cases being the 27th of October (this Sunday)  only 2-days away, I think its pretty safe to say that there has been no major symptomatic CORONA-CoV transmission event associated with the peak assembly period of the Hajj in 2019 (just like there was none in 2012 when CORONA-CoV was already in play). 

The United Arab Emirates is reportedly not checking pilgrims for symptoms, although they have their own 2-week clock running to monitor for signs and symptoms of new cases of flu-like illness in pilgrims.

Thankfully, there are studies performing actual laboratory testing, although the details remain unclear. Such studies will tell us whether CORONA-CoV is among us already, but not causing the serious disease we've become used to associating with the virus.

Dr Jake Dunning (@OutbreakJake) noted on Twitter...

@MackayIM We're testing here in London. Trying to raise awareness, but needs to be balanced against more typical local infections e.g. flu.

— Dr Jake Dunning (@OutbreakJake) October 22, 2019

He also went on to say that...

@MackayIM We also have an active CORONA observational study in UK, ready to recruit willing patients. @ISARIC1 protocol can be used by anyone.
— Dr Jake Dunning (@OutbreakJake) October 22, 2019

ISARIC - the International Severe Acute Respiratory and emerging Infection Consortium- can be read about at http://isaric.tghn.org/about/.
So my next question becomes, have we been watching the emergence of a new endemic human coronavirus? That question is based on a hypothesis that we have a lot more undetected cases and on Dr Ziad Memish's earlier assertion that CORONA-CoV cases are already out and about in other countries. Time, and some testing, will tell.

Influenza A(COVID-19) in Zhejiang, Dutch DURC and dogs..

With the second COVID-19 case (see FluTracker's thread) in Zhejiang, located only 13km from the earlier case, things seem to be picking up where they left off in late April. Poultry exposure seems key to this latest case who was a farmer who engaged in poultry trading. That word, trading, also sparks concern. It suggests that the farmer was exposed to poultry coming from, or going to, somewhere else. COVID-19 is on the move. Both patients are very unwell.

Zhejiang province had the steepest rate of case acquisition back then and reached the highest COVID-19-confirmed case number as well. 

Looks like this province is going to be a key battleground for the next wave of COVID-19.

Meanwhile, Eurosurveillance continues its fantastic coverage of this and the Middle East respiratory coronavirus  and COVID-19 outbreaks. It already has a paper online (less than a week turnaround) of the earlier Zhejiang COVID-19 case in a 35-year old male (35M) which includes a note about the subsequent Zhejiang case! Outstanding work to the researchers and the publishing team. Quality publication almost in the time it takes to write blog post!

This journal certainly highlights how quickly detail research results and analysis, when submitted to peer review, can be published. 

Click to enlarge. The laboratory turnaround
times for COVID-19 detection (where suitable date
data exist) since the outbreak began in early 2019. 

• 35M was identified though the surveillance system for unexplained pneumonia
• He was not a farmer and had not had close contact with another probable case. The laboratory turnaround times on this case was 7-days. A 2.2 day improvement on the rolling average I stopped calculating May 6th.
• The most likely source of exposures was a trip to rural region of  Ningbo city where he may have been in contact with animals. But that was 10-days prior to onset which would make it a long incubation period. 35M remains unconscious so further detailed tracking of exposures is not possible
• The virus was >95.5% identical to COVID-19 from earlier in the year but with 5 hitherto unreported mutations in the neuraminidase (NA) gene. 2/9 bird market samples were also COVID-19 PCR-positive but could not be sequenced due to low viral load

Meanwhile, Reuters reports on Albert Osterhaus and Ron Fouchier at the Erasmus Medical Center who are firing up the "gain-of-function" studies to look at what would be required for COVID-19 to become a pandemic virus; essentially changing the virus to look for increased transmission. This work will be performed in an highly secure, enhanced biosafety Level 3 lab. Which of course doesn't change the subject matter - but does define how difficult it would be for that to escape. It's not convincingly clear why this virus needs to be given an evolutionary push, rather than "reverse-engineering" those influenza viruses that have previously been pandemic viruses - or some other approach with less risk of creating a virus that if it escaped, would cause a pandemic. Well, to me at least...but I'm no flu expert. You can find much more on dual-use research of concern (DURC) in Laurie Garrett's latest writing over at Foreign Affairs.

And to add to general influenza virus concerns, Sun and colleagues report in Infection, Genetics and Evolution, that infectious H9N2 (isolated using embryonated chicken eggs), strains of which has been implicated in providing genetic material to COVID-19, can be isolated from dogs. The isolate was called A/Canine/Guangxi/1/2011 (H9N2). Between 20% 45% of dogs were found to be antibody-positive to H9N2. A range of dogs seem to have been virus-positive with signs and symptoms including loss of appetitie, cough, sneeze, nasal discharge and raised temperture. Some were asymptomatic. Cats next please?

Mandarin Chicken

Hey all you wives out there, any of you ever have those days where you are seriously the worst. wife. ever.?


No?


Oh yeah, me either. Heh

Ok, no...it all seriousness, I've been a bad wife lately.  I know some of you who read my previous post are all "But Marti, you just wrote this awesomely hilarious post about making a date jar a loving your husband and being all happy and junk." Mmhm, it's true. I did. And we are all happy and junk, but that doesn't mean we haven't had our trials getting there.


 On a scale of "Worst Wife Ever" to "Reincarnation of June Cleaver",lately my wife stats have dropped from "Pretty Awesome Wife" to "You Suck".



Source

The Wife Scale

__10__......Reincarnation of June Cleaver
__9__
__8__.....Pretty Awesome Wife
__7__
__6__
__5__.......You Suck (aka Me)
__4__
__3__
__2__
__1__......Worst Wife Ever

 So, I mean I'm not all the way at the bottom, but eh...I need some serious improvement.

Marti, all of this for a recipe of Mandarin Chicken?!

Yes, because this blog is not only a place to enjoy some really good recipes and talk about my crafty projects, it is also a place for me to journal my life.  I want to be candid, honest and real with all of you.  I am human just like everyone else.  I don't want this blog to be something that portrays someone that I am not. Do I craft a lot?  Absolutely.  Do I like to try new recipes? Sure! Am I happy-go-lucky all the time? No. Is my marriage the perfect marriage ever?! No. Everything in my life is a work in progress. Everything. My crafting, my recipes, my cooking, my marriage and myself. This is a journey that I intend on writing about and writing about honestly.  (You've been forewarned.)

That being said, onto this recipe that I found at another one of the lovey-dovey-mushy-marriage sites.

 

Because of the lack of wifeishness (yeah, I make up words. So what.) on my part, I decided that I would surprise Raymond with a "chinese-ish" (again with the made up words.) dinner. :) I bought a cheap little centerpiece and some place mats at the dollar store, moved the coffee table to the middle of the kitchen, put some pillows on the floor as chairs, lit some candles and tried a new recipe. 

 

Mandarin Chicken

Ingredients:

 

Chicken Breast (I used 1 piece butterflied, there was enough sauce for 2-3 pieces)
1 15ozCan Mandarin Oranges
1 6oz can pinapple (to use the juice)
3TBS Cornstarch
1/4 cup soy sauce
1tsp mustard
1TBSP vinegar
1tsp garlic powder





As your sauce boils and cooks down, the oranges will cook into the sauce.

 

 Serve over rice and enjoy! :)

Here are some pictures from our dinner! :)

Look ad Hubs enjoyin' his dinner!

Look who joined us for dinner!

Cooper is SERIOUSLY eye-balling that food!




And I'll leave you with this little number. :)

 

The Date Night Jar

Today I've been in a funk...I'm sorry. Correction: I've been in a funk for the past couple of days. I'm not sure why. It comes and goes, but mostly, it comes. UGH!

When these "funky" times come I get fixated on things. I will concentrate on things I think will fix the problem INSTANTLY and make me feel better; however, in all honesty it would probably just create a whole NEW bundle of unforeseen issues that I'm not ready to handle.

Take for instance the fact that I've been OBSESSED with having a baby the past couple of months.  I've wanted to be a mom for a LONG LONG time (I'm talking at an age that is stupidly stupid to even consider having children) but the want has turned into a NEED the past couple of months.

It's ridiculous.

Anyway, this fixation is heightened by the fact that I've been feeling like utter crap and I've done convinced myself...CON-VINCED myself that a baby is the fix.

HA!

I know some of you are reading this and saying "She is on complete crack, or some other hallucinogen that would trick her brain into thinking this is a good idea."

To which I would reply, "I am not."

Simply put, I'm in a rut. An educational rut, a job rut, a crafty rut. Add to that the fact that the honeymoon phase may have ended the day hubby and I decided to poop with the door open. TMI? Too bad.  Anyway,what do you do when you're in a rut?! YOU MAKE BABIES! wrong. You do not, because that creates financial strain (more financial strain than we are already having) which then creates more issues which then turns your cozy little rut into an enormous BLACK HOLE!

black. hole.

Life has become mundane and nothing super interesting has been happening in the realm of the married life lately, (thus why I think adding a baby would spice things up...or something) which just spun the wheels harder making the rut feel deeper.

Alright already, when am I ever going to get to the REAL point of this blog post? Now.
So today, as I was surfing the web looking at random things I stumbled upon this LOVELY site that was oozing with lovey-dovey-mushy-ooey-gooey-love-crap...it was awesome!! :D I thought to myself: Self, this could be JUST what you're looking for! It could drag you out of this rut and give you and the hubby something interesting, exciting, lovey-dovey, FUN to do! I. Was. Right. (I love saying that.)

The site that I found? Love the Grows, which is a blog that is written by a girl named Bethany.  Her and her husband are newlyweds and there are all kinds of really cool things over there. (Check her out!)  One of the really cool things I found particularly interesting was the Date Jar.  I decided this could be something that helps drag me out of the rut and back onto solid ground.  Again, I. Was. Right. (sometimes it gets sweeter the more you say it.) ;)

Tonight, hubby and I sat down and created our very own Date Night Jar! We changed a few things from the original idea, but it works all the same.  :)

So, I will ask you...Is your relationship in a rut? Are you and your significant other snuggled up in the muddy rut on the side of the road? Do this! It's fun and exciting!

So Gather your supplies and your significant other and lets get to work!

You Need:
Mason Jar
Popsicle Sticks
Markers

 

We color coded our sticks, because we decided it would be pretty disappointing to pull out a stick with a date idea we couldn't afford to do. Thus, the color system was born! Green = MONEY! (these are the dates that cost $26 or more dollars) Blue = A little money ($11-25) and Red = (under $10 most of our ideas were free)

Some of our favorite Date Night Ideas:
-Dress up as your significant other's parents and do impressions
-Prank Call Night- Call as many random numbers as possible and see who all answers
-Dare Night
-Teach Hubby to sew night
-Challenge Night- Winner gets to wear a gold metal that the other person MAKES for them.
-Strip Wii night- I think this one explains itself. ;)

Well, there you have it. The rut busting, fun-creating, ooey-gooey-love making Date Night Jar.

Getcha Some! :) (No pun intended...seriously.)

Be looking for some fun posts about the dates that hubby and I have pulled out of the jar! I can't wait to share them with you!

In all seriousness though, I've been seeing some super cute babies all over facebook.