Advice about Covid-19 from a pulmonary critical-care doctor

March 29, 2020 • 11:15 am

Reader Rick sent me this video, which I’ve listened to in its entirety (57 minutes). It’s made by Dr. David Price, a critical pulmonary-care specialist at Weill Cornell Hospital in New York City. Usually he deals with all kinds of respiratory ailments, but, as he says, now he’s dealing only with COVID-19 patients. Here Price offers advice, and it’s somewhat reassuring, as the precautions you need are not onerous but are IMPORTANT. Reader Rick added this information.

I found this encouraging.

Dr. David Price is a critical care pulmonologist. He does a conference call describing  his experience.  It’s a long video, but quite valuable.

Bottom line: COVID-19 is becoming well understood.  If you practice good hand cleanliness procedures and distancing, you have nothing to worry about.

  1. Hand to face is the critical path. Spray, rarely.
  2. Get into the habit of knowing where your hands are and be sure they are clean. (sanitizer)
  3. Wear a mask, not to protect you, but simply to avoid hand to face contact.
  4. You don’t need an N-95 mask. Anything will do.  Give N-95 to your local hospital.
  5. Carry sanitizer with you when you go out.
  6. Be friendly and social, just stay 6′ away.
  7. Shrink your social circle.  You don’t want to be in large groups.
  8. Go to the hospital only if you are short of breath. Headache, fever, muscle ache, cough – stay home.
  9. Course of the disease is 7 -14 days. Immunity then follows.

If  you follow the simple rules, you will not get COVID-19.  This should be liberating.

Again, I’m not a doctor and so you must make your own judgment about this doctor’s advice.  The first 20 minutes of the video are recommendations for general behavior (i.e., wear a mask in public, but only to keep you from touching your face. Price doesn’t mention gloves).  From 20-30 minutes in, Price discusses what you should do if you think your’e infected, or if you have a family member who is infected. From 30 minutes to the end, Price deals with general questions.

Coronavirus updates: three easy pieces

March 22, 2020 • 9:15 am

Today we have an article by Nick Cohen to read, a panegyric by Andrew Sullivan, and an epidemiological website to peruse and fret about. Cohen and Sullivan worry that, although Trump’s response to the viral pandemic has been erratic, hamhanded, and even duplicitous, the Prez could come out of this even stronger. (I predicted the opposite, but what do I know?)

First, a piece by Nick Cohen in the Guardian (is there an American equivalent of this liberal journalist who doesn’t fall prey to wokeness?). Click on the screenshot to read (h/t Jeremy):

Cohen argues, correctly, that both Boris Johnson and Donald Trump, the former described as a “clown in a morgue” and the latter as a “cornered conman,” have grossly mishandled the pandemic, with Trump’s behavior being describe as “close to criminal.” I, for one, have never seen such an blatant display of ignorance, waffling, and lying from a President (including Nixon), and I’m counting on the fact that even benighted Americans can see through Trump’s woeful performance. When they start losing their jobs and the stock market tanks, then Trump loses the only substantial card he had: the economy was doing well. That’s why I bet $100 that he’d lose in November, though most readers seemed to think that was a bad bet.

Cohen goes on to claim that Trump might save his popularity via populism: blaming the virus on the Chinese and thus arousing “America first” sentiments and intensifying the culture wars. A few excerpts:

Instead, an escape attempt began with the right-wing deploying the language policing it so often deplores on the politically correct left. Trump is now insisting that coronavirus should not be called coronavirus but “Chinese virus”.

The side benefits he could expect to bank ought to be obvious. Trump could count on US liberals playing his game by accusing him of being an anti-Chinese racist. Liberals duly walked into the trap and Trump’s supporters were transported from the fear of living in an unprepared country with a demonstrably inadequate leader to the familiar ground of culture war. They could mutter: “Oh, these people call everything they don’t like racist; they’ll be saying it’s racist to call Chinese food ‘Chinese’ next.”

. . . However much critics may want to say Trump is a semi-senile fool – and I do – it is worth remembering that he remains a brilliant political operator, who has destroyed all opponents within and without the Republican party who made the mistake of underestimating him. In this instance his cleverness, and the major benefit he expects to enjoy, lies in shifting the blame for his folly on to the Chinese.

And this is unbelievable:

It does not stop there. If the virus is China’s fault, then domestic critics of his administration are traitors aiding the Chinese communists. You think I’m exaggerating? On 16 March, Trump tweeted a link to an article on the paranoid Federalist site. The author, one Madeline Osburn, was explicit. The Atlantic, a serious American magazine, had joined “China’s anti-American disinformation efforts”, she said. Osburn, who would have had a glittering career on the People’s Daily if she had been born Chinese, cited the work of The Atlantic’s Anne Applebaum, without appearing to know that Applebaum has written two devastating histories of the atrocities of communism. Describing how the pandemic has exposed America’s weaknesses in general, and its president’s weaknesses in particular, made Applebaum a useful idiot at best and traitor at worst, Osburn said.

Well, the “Trump tweeted a link” goes not to Trump but to a tweet by Mark Levin, a conservative commenter, but the article in the Federalist takes us back to the days of McCarthy-ite Red-baiting. Cohen goes on to somewhat extol Trump’s cleverness in deflecting his own incompetence onto the Chinese, and criticizing journalists for “siding with China.” In the end, Cohen is less certain than I about the effect of Trump’s competence on his electability come November. But I’m hoping that America’s pocketbook will outweigh its jingoism.

Cohen:

The hope that events will justify your beliefs is an ineradicable delusion. Surely, now the British will see through Johnson, liberals say, rather than blindly rally to his government in a time of crisis. Surely, the Americans will toss Trump on the scrap heap in November. But political battles do not win themselves. Democrats still have to unseat a sitting president – a feat they have not managed since 1992. Labour still has to turn itself from a serial election-loser into an election-winning machine. As the US shows, coronavirus can become the “China virus”. And what seems an irrefutable argument for a comprehensive welfare state can become an excuse for nationalist tricksters to wrap themselves in their tattered flags.

My own reading of the press, both right and left, doesn’t show this kind of “Chinese excuse”, at least in the U.S., but readers here aren’t so sanguine. My bet is that as the pandemic continues, lasting longer than our public officials are telling us, Trump’s popularity rating will fall, and come November we’ll have Biden in the White House. You may not be elated at that prospect (I’m not), but it sure beats the hamburger-fed tuchas now sitting there.

************

Every Friday, reader Simon sends me a link to Andrew Sullivan’s weekly column, and every Friday I read it, for Sullivan, however you feel about him, is a man worth reading. His latest, replacing his usual tripartite column, is a meditation on the pandemic—especially poignant because Sullivan (who is HIV positive) lived through the AIDS epidemic of the Eighties. Click on the screenshot to read:

According to Sullivan, the “plague of AIDS” changed people in many ways: making some fearful, others resolute and compassionate, and showing “whom you can trust and whom you can’t, and also reveals what matters.” It also brought gay rights, for which we have no equivalent with coronavirus—except, perhaps, a fix of the healthcare system and greater readiness to deal with these emergencies.

Mourning the lose of closeness (Sullivan says it’s been two weeks since he got a hug), he also tries to find the silver lining, which isn’t all that convincing to me, much as I want to find good in the bad. But there’s no law of nature—only the feel-good homilies of faith—that says that tragedy will be compensated with joy. Perhaps it’s because of Andrew’s Catholicism that he feels this way, and indeed, he gives a shout-out to religion:

Good will happen too. Surely it will. The silence in the streets portends something new. The other day, I realized I’d been texting a lot less and calling a lot more. I wanted to make sure my friends and family were okay, and I needed to see their faces and hear their voices to be reassured. As we withdraw from each other in the flesh, we may begin to appreciate better what we had until so recently: friendship and love made manifest by being together, simple gifts like a shared joint, a head resting on your shoulder, a hand squeezed, a toast raised. And in this sudden stop, we will also hear the sounds of nature — as our economic machine pauses for a moment and the contest for status or fame or money is canceled for just a while. “All of humanity’s problems stem from man’s inability to sit quietly in a room alone,” Pascal said. Well, we’ll be able to test that now, won’t we?

These weeks of confinement can be seen also, it seems to me, as weeks of a national retreat, a chance to reset and rethink our lives, to ponder their fragility. I learned one thing in my 20s and 30s in the AIDS epidemic: Living in a plague is just an intensified way of living. It merely unveils the radical uncertainty of life that is already here, and puts it into far sharper focus. We will all die one day, and we will almost all get sick at some point in our lives; none of this makes sense on its own (especially the dying part). The trick, as the great religions teach us, is counterintuitive: not to seize control, but to gain some balance and even serenity in absorbing what you can’t. [JAC: That, by the way, is taught not just by religions but also by philosophies like Stoicism. “Don’t sweat the small stuff” is not a religious homily.]

All fine and good, but if we were God and could have stopped the plague (clearly an issue for theologians who must explain why he didn’t), we would have. The loss of lives cannot be outweighed by a slight increase in the quality of lives that remain. And the lessons learned about life’s fragility, as when you survive a medical crisis, are often forgotten quickly, and it’s back to business as usual.

Finally, Andrew doesn’t see Trump’s incompetence during this time as having doomed his political prospects, but for reasons different from those given by Cohen:

 But a lot is at stake, and I suspect that those who think COVID-19 all but kills Donald Trump’s reelection prospects are being, as usual, too optimistic. National crises, even when handled at this level of incompetence and deceit, can, over time, galvanize public support for a national leader. As Trump instinctually finds a way to identify the virus as “foreign,” he will draw on these lizard-brain impulses, and in a time of fear, offer the balm of certainty to his cult and beyond. It’s the final bonding: blind support for the leader even at the risk of your own sickness and death. And in emergencies, quibbling, persistent political opposition is always on the defense, and often unpopular. It requires pointing out bad news in desperate times; and that, though essential, is rarely popular.

Watching Fox News operate in real time in ways Orwell described so brilliantly in Nineteen Eighty-Four — compare “We had always been at war with Eastasia” with “I’ve felt that it was a pandemic long before it was called a pandemic” —  you’d be a fool not to see the potential for the Republican right to use this plague for whatever end they want. If Trump moves to the left of the Democrats in handing out big non-means-tested cash payments, and provides a stimulus far bigger than Obama’s, no Republican will cavil. And since no sane person wants the war on COVID-19 to fail, we will have to wish that the president succeed. Pulling this off as an opposition party, while winning back the White House, will require a political deftness I don’t exactly see in abundance among today’s Democrats.

*************

Finally, as if you need another reason to be depressed (I’m watching the evening news through my palms, but my hands are clean), reader Charles sent me this ProPublica guide to the readiness of American hospitals to deal with coronavirus.

As Charles wrote, the source seems reputable: “The infection rate scenarios are based on estimates from leading epidemiologist Dr. Marc Lipsitch, head of the Harvard T.H. Chan School of Public Health’s Center for Communicable Disease Dynamics, who made the projections of how many people globally would be infected.”

Read and weep:

The metric is what percentage of hospital beds would be filled (from 0% to over 200%) under all nine permutations of infection rate and time: 20%, 40%, and 60% of American infected, combined with those infection rates occurring over 6 months, 12 months, and 18 months. Here’s the scenario for 18 months; you don’t want to look at the others! Anything that is yellow is bad, indicating 100% hospital-bed occupancy. And it’s almost certain that at least 20% of Americans will become infected.

 

You can also enter your locality and see how ready the hospitals around you are. This is for Chicago. Only under the most optimistic scenario will we not fill more than 100% of the hospital beds. The red line is full capacity.

Oy!

VICE claims that coronavirus is transphobic

March 21, 2020 • 11:00 am

I heard about this article in a tweet from Titania (below), and while the issue she mentions is concerning to some, it’s not sufficiently serious to be immune from mockery. At any rate, you can read the article on VICE by clicking on the link in Titania’s tweet or on the screenshot of the VICE headline below that.

 

On the news last night, I watched a report on how people with serious medical conditions were having their treatment delayed by the coronavirus pandemic. One woman with inoperable cancer was scheduled for treatment with an experimental drug, but it was delayed for several months. She was distraught (she had a young child) because she hoped the drug might help her, but now she’s forced to abandon her last hope.. Another woman with breast cancer (or so I recall) had her X-ray treatment delayed by a considerable period, and was upset because she didn’t want the disease to progress without treatment.

These are heartbreaking matters of ethics, as are the decisions by doctors in Italy about which serious Covid-19 cases to treat and which to allow to die with palliative care.  All this puts into perspective VICE’s kvetchy piece about how “life-saving” trans surgeries are being put off because of the virus. (I tried without success to find any article in VICE about the general delay of medical treatment to people who are seriously ill.)

Let’s have some perspective here. While people awaiting transsexual surgery will naturally be distressed when that surgery is postponed, those surgeries are “life-saving” only in the sense that if some patients doesn’t get them in a timely manner, they may commit suicide. But although statistics show that the suicide rate is higher for transgender people than cisgender people, it’s just as high for non-binary people; and I can’t find hard data on whether delays in transsexual surgery increase the suicide rate—or even if the surgery itself reduces the suicide rate.  Here’s some stats from Human Rights Campaign:

More than half of transgender male teens who participated in the survey reported attempting suicide in their lifetime, while 29.9 percent of transgender female teens said they attempted suicide. Among non-binary youth, 41.8 percent of respondents stated that they had attempted suicide at some point in their lives.

So when we say that the delay in trans surgeries is life-threatening, we have to assume that surgery itself reduces the risk of suicide, and that the delays in surgery (which the article notes could be a few weeks or months) also increase that risk. As far as the first point goes, the article says “research has suggested that gender-affirming surgery. . . has a notable and long-term impact on mental health.”  It adds that “. . . but far too often, trans people already wait far longer than is safe or healthy for this care. Further delays can be dangerous and even life-threatening.”

TVO, in the first link, adds this:

“Trans people are at the highest risk of suicide and self-harm between the period that they’ve mentally decided to transition and when they complete their medical transition,” said N. Nicole Nussbaum, former president of Canadian Professional Association for Transgender Health and staff lawyer at Legal Aid Ontario.

But in the absence of actual data on relative risks and their connection with temporal delay, we can’t assess this claim. (Nonbinary people differ in not having elective surgery—or not having it as frequently—and the risk to them can be mitigated only by therapy.)

But you’ll have noticed an important difference between this risk and the risk of people with advanced cancer: the latter group will certainly die without treatment, and will almost surely have a much higher risk of mortality due to delays. More important, seriously ill patients with Covid-19 have a huge risk of death, which is why they are taking precedence over “elective” surgery like gender reassignment procedures.

The VICE article gives the impression—despite admitting that hospitals are doing their best to insure “continuity of treatment” of patients scheduled for or having already had gender-reassignment surgery, and the explanation by concerned doctors that the delay is necessary to allow hospitals to care for seriously ill Covid-19 patients and protect transgender patients from infection—that this delay is causing discrimination and unnecessary harm to those scheduled for gender-reassignment surgery. There’s a serious undercurrent in the piece of accused bigotry against transsexuals, which isn’t at all justified by the article. Here’s some of what I take to be implications of mistreatment of the transsexual patients:

But in the midst of the COVID-19 pandemic, trans communities on Reddit and Twitter are being flooded with reports of postponed and canceled surgeries in the U.S., U.K., SpainThailand, and elsewhere, leading to enormous stress and disappointment on top of a global health crisis.

. . . Riley Cooper, a 23-year-old trans man in St. Louis, had his top surgerypostponed, with no reschedule date. He says COVID-19 was the reason behind this cancellation, but it isn’t the first time. “This is the third time it’s been postponed. It’s getting more and more heartbreaking to keep getting so close to something that will make me feel better and feel like I’m in the right body for once,” he said. “Every time I feel like I’ve gotten close, something has to come along to take it away.”

. . .Violet Jones, a 29-year-old trans woman and assistant professor in New York, has a procedure scheduled for May that hasn’t been cancelled yet, but she feels it’s imminent. NYC is a national leader in transgender care, but Mayor Bill de Blasio has issued an executive order delaying all non-emergency surgery for the next few weeks.

Jones said she’s doing everything possible to prevent illness, which would force postponing her procedure. “A change to the date would pretty radically alter my plans and overall security around the procedure. The surgery was scheduled to allow recovery during [my school’s] summer months without a gap in pay.” She said that rescheduling may result in lost pay, as her recovery from surgery would conflict with the school year.

Let me be clear. I sympathize with these people, and don’t feel that their distress is unwarranted, or should be dismissed. But, like all of us, and especially those who, as in Italy, can’t get respirators, or who are on the brink of death in intensive care, or those cancer patients whose treatment is delayed—the delay of gender-reassignment surgery is a much smaller problem.

And it’s not as ethically pressing, or as medically serious, as how to triage seriously ill Covid-19 patients or how to delay the treatment of cancer patients. Why, then, did VICE choose to focus on the woes of the relatively few gender-reassignment patients and neglect on their site those whose deaths are surely more probable when delays happen? Why? Because VICE, like many other liberal media, is becoming so woke that it’s losing perspective.  In their view, I suspect, the delays for transgender patients are somehow more wrong than the delays for cancer patients.

Maybe Titania’s post wasn’t that mean-spirited after all. In the end, mockery may be one way to dispel such distorted perspective.

Viability of Covid-19 virus on various surfaces (hint: use gloves when handling Amazon packages and don’t open them for 24 hours)

March 20, 2020 • 10:30 am

Reader Charles sent me a linking to a publicly-available article from the New England Journal of Medicine that measured the viability of the Cov-19 virus (they call it SARS-CoV-2, or “severe acute respiratory syndrome coronavirus-2”) on various surfaces, comparing it to the viability of a closely related coronavirus, SARS-CoV-1.  You’ll remember the second virus from a while back since it was the cause of SARS. As the NIH notes:

SARS-CoV-1, like its successor now circulating across the globe, emerged from China and infected more than 8,000 people in 2002 and 2003. SARS-CoV-1 was eradicated by intensive contact tracing and case isolation measures and no cases have been detected since 2004.

The very short article is intelligible to laypeople, and you can see it here or by clicking on the screenshot below. The full reference is at the bottom:

To measure the viability in aerosols, the virus was nebulized (put into an aerosol form of small droplets), and squirted into a “Goldberg drum,” which rotates and keeps the nebulized material in the air for a long time.  Here’s one of those drums from ResearchGate:

At various intervals, the infected material was sampled and tested for virus viability (aerosol from the drum or virus sprayed on surfaces of copper, cardboard, plastic, and stainless steel). The remaining amount of virus capable of causing infection was measured as the TCID50, or the amount of sampled material required to cause infection in 50% of tissue-cultured material. This figure drops over time as the virus dies.

The main lesson comes from the figure below, which gives, in the three rows, the decay of viable virus over time, the regression plots (on a log scale) predicting the decay over time, and the estimates of the half-life of the virus in aerosols and on various surfaces based on assuming an exponential decay rate of the virus quantity.  The virus of interest, SARS-CoV-2, is shown in red, and its relative the SARS virus (SARS-CoV-1) is in blue.

Have a gander. I’ve put the journal’s caption below the figure for mavens, but summarize the results below that:

Figure 1. Viability of SARS-CoV-1 and SARS-CoV-2 in Aerosols and on Various Surfaces. As shown in Panel A, the titer of aerosolized viable virus is expressed in 50% tissue-culture infectious dose (TCID50) per liter of air. Viruses were applied to copper, cardboard, stainless steel, and plastic maintained at 21 to 23°C and 40% relative humidity over 7 days. The titer of viable virus is expressed as TCID50 per milliliter of collection medium. All samples were quantified by end-point titration on Vero E6 cells. Plots show the means and standard errors ( bars) across three replicates. As shown in Panel B, regression plots indicate the predicted decay of virus titer over time; the titer is plotted on a logarithmic scale. Points show measured titers and are slightly jittered (i.e., they show small rapid variations in the amplitude or timing of a waveform arising from fluctuations) along the time axis to avoid overplotting. Lines are random draws from the joint posterior distribution of the exponential decay rate (negative of the slope) and intercept (initial virus titer) to show the range of possible decay patterns for each experimental condition. There were 150 lines per panel, including 50 lines from each plotted replicate. As shown in Panel C, violin plots indicate posterior distribution for the half-life of viable virus based on the estimated exponential decay rates of the virus titer. The dots indicate the posterior median estimates, and the black lines indicate a 95% credible interval. Experimental conditions are ordered according to the posterior median half-life of SARS-CoV-2. The dashed lines indicate the limit of detection, which was 3.33×100.5 TCID50 per liter of air for aerosols, 100.5 TCID50 per milliliter of medium for plastic, steel, and cardboard, and 101.5 TCID50 per milliliter of medium for copper.

The lessons:

1.) The new virus has a decay rate about the same as the old SARS virus—except on cardboard. The new Covid-19 virus decays completely on cardboard after 24 hours, but the earlier virus is pretty much gone after only eight. What this means is that if you get a cardboard package in the mail from a place like Amazon, either have it left outside your door or, if you’re worried, handle it with gloves and then don’t open it for at least a day.

2.) On stainless steel and plastic, the new virus will be almost completely gone after four days, and on copper in about 8 hours. This means that if you’re holding onto stainless steel or plastic, as in subway straps or poles, or steel banisters, you could be infected even several days after an infected person touched those surfaces.

3.) The new virus in aerosols was even less viable than on cardboard, with both old and new viruses having a half life of one hour (i.e., after 8 hours the infectability has been reduced by 256-fold). But still this means that if you walk through a space in which an infected person has sneezed or coughed an hour or two beforehand, you could get infected.

The main lesson is to avoid being near people sneezing and especially coughing, and wash your hands ASAP if you’ve touched anything suspicious. And, of course, DO NOT TOUCH YOUR FACE. I’ve been practicing that and, I think, have gotten pretty good, though we all touch our faces unconsciously.

Here’s a photo from the NIH, showing the virus erupting from cells. The caption: “This scanning electron microscope image shows SARS-CoV-2 (yellow)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (blue/pink) cultured in the lab.NIAID-RML.”

_______________

van Doremalen N. et al. 2020. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England J. Med. March 17, 2020; DOI: 10.1056/NEJMc2004973.

Camus on the plague, and de Botton gets the vector wrong

March 19, 2020 • 12:30 pm

Ah, we have’t heard from Alain de Botton for a while, and I haven’t missed him (see all my posts on him here). He was always a faitheist, an atheist-butter, and an arduous advocate for atheist churches, which I don’t particularly object to but also don’t feel we need. de Botton is also patronizing: the kind of guy who thinks he sees some great truths about the universe that others have missed—and lets us know that (see here).  Now, after a six-year hiatus from the man, he’s back on my site, not because his new New York Times op-ed has anything particularly interesting to say, but because, when writing about Camus’s great Novel The Plague, seems to get the infectious microbe wrong.

La Peste is in vogue again these days because of the coronavirus pandemic, as people read it trying to discern if there any lessons for the present peril.

And so de Botton tries to give us some lessons. His point appears to be that the “absurdity of life” on view in the novel is not that our lives are intrinsically absurd, but that we are susceptible to the vagaries of fate, which supposedly makes our lives meaningless. Here, I think, is de Botton’s gist:

For Camus, when it comes to dying, there is no progress in history, there is no escape from our frailty. Being alive always was and will always remain an emergency; it is truly an inescapable “underlying condition.” Plague or no plague, there is always, as it were, the plague, if what we mean by that is a susceptibility to sudden death, an event that can render our lives instantaneously meaningless.

This is what Camus meant when he talked about the “absurdity” of life. Recognizing this absurdity should lead us not to despair but to a tragicomic redemption, a softening of the heart, a turning away from judgment and moralizing to joy and gratitude.

“The Plague” isn’t trying to panic us, because panic suggests a response to a dangerous but short-term condition from which we can eventually find safety. But there can never be safety — and that is why, for Camus, we need to love our fellow damned humans and work without hope or despair for the amelioration of suffering. Life is a hospice, never a hospital.

At the height of the contagion, when 500 people a week are dying, a Catholic priest called Paneloux gives a sermon that explains the plague as God’s punishment for depravity. But Dr. Rieux has watched a child die and knows better: Suffering is randomly distributed, it makes no sense, it is simply absurd, and that is the kindest thing one can say of it.

Well, I am not a Camus expert, though I have read the novel, but I can’t speak to whether Camus’s view of life’s absurdity is simply that we all die and can never know when.  Whether that makes our lives “instantaneously meaningless” is debatable, because, in the long view, life can be seen as meaningless regardless of whether it ends instantly or in a drawn-out process.  Yes, Camus is right that there’s no sign of God in the depredations of infectious disease, but that’s Camus’s point, not de Botton’s.

In fact, after reading de Botton’s piece twice, I still can’t see why he felt it worth writing, or why the NYT found it worth publishing. I suppose that if you’re out of bogroll in these parlous times, you could use his essay.

What interested me, though, was de Botton’s first paragraph (my emphasis):

In January 1941, Albert Camus began work on a story about a virus that spreads uncontrollably from animals to humans and ends up destroying half the population of “an ordinary town” called Oran, on the Algerian coast. “The Plague,” published in 1947, is frequently described as the greatest European novel of the postwar period.

VIRUS???? If you remember the story, the vector is carried by rats, and although I don’t know if the disease is named as bubonic plague, it’s very clear that Camus was writing about bubonic plague. And bubonic plague is carried not by a virus, but by a bacterium, Yersina pestis. Indeed, in the quote below, Camus explicitly refers to the cause as a bacillus (bacterium).

Some judicious fact-checking by both the author and the NYT would have been useful here. But that’s not the Times‘s forte these days, what with their claim that the American Revolution was fought to defend slavery.

In the meantime, here’s the great ending of Camus’s novel (originally written in French, of course):

And, indeed, as he listened to the cries of joy rising from the town, Rieux remembered that such joy is always imperiled.

He knew what those jubilant crowds did no know but could have learned from books: that the plague bacillus never dies or disappears for good; that it can lie dormant for years and years in furniture and linen chests; that it bides its time in bedrooms, cellars, trunks, and bookshelves; and that perhaps the day would come when, for the bane and enlightening of men, it would rouse up its rats again and send them forth to die in a happy city.

I don’t know who the translator was, but he rendered Camus’s words into wonderful English: I love the alliteration of “rouse up its rats” and “bide”, “bedrooms”, “bookshelves” and “bane”, and the bittersweet last sentence. This is great writing and great translating. de Botton is not great writing.

What are you doing during the quarantine?

March 16, 2020 • 8:15 am

Many places, including Illinois, are still pretending that the coronavirus pandemic will significantly abate in the next two weeks, a possibility I consider, well, very unlikely. (For example, they’ve closed all restaurants and bars in our state, but only till March 31.) But until it does abate, we’re all pretty much confined and restricted, with many people urged to not go out at all. And because of my age, I count as a member of the “susceptible” group.

I couldn’t tolerate squatting for months, if for no reason other than that my ducks need feeding several times a day, and it’s okay to be outside anyway. However, I had planned to travel during this period: a brief trip to Florida to lecture and also a two-week lecturing gig on a mid-April alumni cruise to Gibraltar, the Canary Islands, Morocco, and Portugal. The Florida gig is canceled, and I’m sure that the cruise will be, too, though they haven’t yet given us any information.

In the meantime, I have sufficient food, tons of toilet paper, and a stock of books. (Right now I’m on a Richard Wright kick, reading Native Son with Black Boy on tap.) But I still feel I need to go somewhere, and I am weighing my options. One thought was to rent a car and drive South to the Mississippi Delta. If restaurants remain open, that’s something I might try to do, as I love Southern food. However, many of the civil rights attractions I hoped to see are closed. (PLEASE don’t warn me about risks; I know them.) I’m pretty sure I’ll go stir-crazy if I have to stay put for a long time.

Others, however, are perfectly happy having time off and chilling at home, particularly if they accrue paid sick leave or their emoluments continue due to a kind employer.

I thought I’d post this to ask readers what they’re planning on doing during the Time of Coronavirus.  As I said, we don’t know how long this will last, but I have a strong feeling that our movements will be restricted for a long time to come.

Since most countries are on some sort of lockdown, this thread is directed at everyone.

From GEN [fotoliaxrender/Fotolia]

Poll results, and a question about healthcare

February 28, 2020 • 8:00 am

On February 26, the night after the Democratic debate in Charleston, South Carolina, I urged readers to discuss the debate in the comments. And so you did, to the tune of—as of today—193 comments.  While nothing is ever settled in these discussion, nor do opinions ever coalesce around a single one (we are, of course, diverse and largely irreligious, which means cat-herding), it’s fun to sound off.

Here are the results of the two polls, both about The Bern. In the first one, a bare majority of readers felt that Bernie would wind up as the Democratic nominee. Many were undecided.

In the second poll, most people (the figures are almost identical to those above) felt that Bernie could NOT defeat Donald Trump. I was surprised, as I thought most people would think that Sanders could beat Trump. In fact, that’s my own view, but I’m not a pundit.

I still have no favorite candidate in the race, and no idea for whom I’ll vote in the primary. (I’m voting by mail).  Nobody inspires me with as much enthusiasm as I had for Obama in the 2012 and 2008 elections (or George McGovern in 1972, which was a complete Democratic disaster). So be it; I’ll still go with whom the convention chooses to run against Trump.

Here is a question for foreign readers who live in countries with single-payer health care. My own view until now has been for the government to pass a single-payer option like Medicare, so that everyone is covered, and must be covered, but also to allow coexisting private insurance.

One reason I feel this way is that almost everybody I know who lives in countries with universal government health care—and those include Canada, the UK, New Zealand, and Poland—has resorted to going to private doctors some of the time because of a) their higher quality and, more important, b) the speed: you seem to have to wait long times under government systems. Often government doctors are very good, but the waiting times, to my friends, seem intolerable.

An example: I had an inguinal hernia last year, and a friend in New Zealand had one at roughly the same time. His was painful; mine was not. I could have gone without treatment, as it wasn’t immediately dangerous, but as I was going to Antarctica, my doctor advised me to have the repair operation beforehand, for if the hernia became strangulated when I was on a boat in Antarctica, I would probably die. (Strangulated hernias must be operated on within a day or so.) Strangulations are rare, but do happen. I called the belly doctor and he said he could operate on me in three weeks. And so I got operated on and completely fixed.

My friend in New Zealand is, as far as I know, still waiting, and says he is in pain. He may wait two years, as I recall, because the government healthcare system can’t fit him in before then.

This is also the case for friends in some of the other countries I’ve mentioned: long waiting times for non-life-threatening operations, even when you’re in pain or debilitated during the waiting period. This is, in fact, why private healthcare coexists alongside government healthcare in those countries.

When readers say they favor a single-payer procedure, do they want the complete elimination of private healthcare and private insurance? Based on my experience, and that of other people I know, that does not seem optimal. Even those people who tout and are proud of their government healthcare seem to resort to private doctors when the crunch comes. Sander, however, seems to favor the complete elimination of private medical insurance and non-government healthcare.

Weigh in below. If you live in a “single-payer” country, have you ever gone to a private doctor? If so, why?

 

Peter Singer deplatformed in New Zealand for his stand on euthanasia of newborns

February 19, 2020 • 9:30 am

It seems to me that an enlightened philosophy would allow people to be able to end their lives in a humane way if they’ve undergone proper medical and psychiatric vetting. Some form of this “assisted suicide” is already legal in Canada, Belgium, the Netherlands, Luxembourg, Colombia, Switzerland, Victoria in Australia, and and in some states of the U.S. (California, Colorado, Washington state, Oregon, and—by court order—in Montana).

I further believe—and I’ve gotten into trouble for this—that we should also allow newborns afflicted with incurable conditions—conditions from which they will suffer and die young—to be euthanized humanely. The conditions under which I think this is not only allowable, but ethical, were first laid out in this post of mine.  I was aware at the time that philosopher Peter Singer had agreed with and defended this view, but I can’t remember whether I arrived at it independently or read it in some of his writings. No matter, for it’s a view that people need to consider, and of course Singer has defended this view far more extensively and ably than I.

For his views, Singer has undergone considerable pushback, and has been not only deplatformed, but subject to calls for his resignation from Princeton (he splits his time between Princeton and the University of Melbourne). I, too, was subject to a surprising amount of publicity, nearly all negative, for my one website post about this. On her own website Heather’s Homilies, Heather Hastie defended my views, summarizing and answering some of the pushback I got (thanks, Heather!),  I also wrote about the surprising opposition to my views here and here.

The opposition, of course, comes largely from believers, who see euthanasia of any sort as “playing God.” I swear that some of these people are Mother-Teresa-like in preferring horrible suffering to a merciful end. After all, Jesus suffered! (That was Mother Teresa’s excuse.)

But others object because they see the euthanasia argument as a slippery slope, leading to scenarios in which we can do away with Grandma in the nursing home simply by signing a paper. It doesn’t work like that, of course, as the states and countries who allow adult euthanasia have strict regulations. And euthanizing newborns with horrible and fatal conditions, like anencephaly, is even more unacceptable. Even though such infants are doomed, there’s something about them having been born that makes the prospect of euthanasia especially appalling to people. Of course I agree that strict procedures, including the agreement of doctors and parents, are essential here, but since these infants will die I see no credible objection to letting them have a peaceful death.

Against the strong negative publicity and many emails I got saying I’m a latter-day Satan (I also got emails from some handicapped people accusing me of wanting to deprive them of life), I received several letters from nurses and doctors who, having seen infants suffer and die, agreed with me. But these people, understandably, don’t want their views made public. I stand by what I said, and Singer stands by what he said. The man is clearly no monster, as his books and papers on ethics are extremely humane. And he walks the walk, giving away lots of his own income to the poor. (I should add that Singer is a recipient of the honor of Companion of the Order of Australia, that country’s highest civilian honor.)

Singer has been deplatformed for his views on infant euthanasia (see here, for instance). And, according to the Newshub article below (click on screenshot, and see a similar piece in Think, Inc.), now a country that’s supposed to be extremely liberal and enlightened, New Zealand, has deplatformed him as well. Singer had a contract to speak at SkyCity in Auckland in June, but the venue canceled his contract.  And this was also due to his views on euthanasia.

Although Think, Inc. says that the Auckand incident shows that Singer “has been de-platformed for the first time in his 50-year career”, that’s not really true. Singer was disinvited from a philosophy meeting in Germany and also effectively deplatformed at the University of Victoria in British Columbia when shouting students made his talk inaudible. Those disruptions were also for his views on euthanasia of newborns, although Singer’s talk in Canada was about effective altruism, not euthanasia.

Anyway, the New Zealand story is here:

 

A quote from the piece above:

Singer, a philosopher who has been recognised both as the Australian Humanist of the Year and the most dangerous person in the world, was scheduled to appear at the Auckland central venue on June 14 for ‘An Evening with Peter Singer’.

However, the figure now says the event had been cancelled by SkyCity after a “news article attacking” his view that it may be ethical for parents to choose euthanasia for severely disabled newborn infants.

“We decided that yes it was a reasonable decision for parents and doctors to make that it was better that infants with this condition should not live,” he has said.

On Saturday, Newshub reported that the New Zealand disabled community was frustrated by his appearance. Dr Huhana Hickey, who has used a wheelchair since 1996 and was diagnosed with multiple sclerosis in 2010, said he wasn’t an expert in disability.

Do you have to be an expert in disability to know when a childhood condition or deformity is invariably fatal and causes suffering

Even Singer says it was the first time he was deplatformed, which mystifies me. But never mind. His contract was canceled because of a “free speech but. . ” argument (my emphasis below):

A statement from Singer on Wednesday said that this was the first time he had been “de-platformed” in his 50-year career.

“It’s extraordinary that Skycity should cancel my speaking engagement on the basis of a newspaper article without contacting either me or the organiser of my speaking tour to check the facts on which it appears to be basing the cancellation,” Singer said.

“I have been welcomed as a speaker in New Zealand on many occasions and spent an enjoyable month as an Erskine Fellow at the University of Canterbury more than 20 years ago. If New Zealand has become less tolerant of controversial views since then, that’s a matter for deep regret.”

A SkyCity spokesperson told Newshub: “Following concerns raised by the public and local media, SkyCity has cancelled the venue hire agreement for ‘An Evening with Peter Singer’.

“Whilst SkyCity supports the right of free speech, some of the themes promoted by this speaker do not reflect our values of diversity and inclusivity.”

Is it “inclusive” to allow children born with only part of a brain, or a brain outside the skull—children doomed to die within days or weeks—to suffer before their deaths? For that is what this is all about. In fact, in September Kiwi citizens will have a referendum on the legalization of voluntary euthanasia for adults with less than six months to live.  At a time when they’re debating this, it is not only proper but essential to discuss the euthanasia of doomed newborns, who suffer but cannot give consent. As Wikipedia notes, “A poll in July 2019 found that 72% of the [New Zealand] public supported some kind of assisted dying for the terminally ill. Support over the past 20 years has averaged around 68%.” Why must the “terminally ill” include only adults?

In such a climate, it’s unconscionable to deplatform somebody for his views, especially when it’s not even clear that his “evening with Peter Singer” was going to touch on this subject. As the report notes above, nobody checked with Singer before canceling his contect.

Promoters of the talk are looking for a new venue, and I’ll report back if they find one.

Finally, here’s cartoon from Heather’s post, underscoring the futility of religion when it comes to helping the afflicted:

h/t: Paul

Why Grania died

September 14, 2019 • 11:00 am

Every day I feel keenly the loss of Grania from my life—and from this site. She wasn’t quite 50 when she collapsed in front of the clinic in Ireland and died; CPR didn’t help. Several days before that, she had passed out in her apartment after vomiting, but didn’t remember the vomiting. Then, for several days thereafter, she was in terrific pain, but wouldn’t go to the doctor. When she finally did, it was too late. I was in communication with her right until she took the cab to the clinic.

The initial autopsy yielded no definite cause of death, but now Grania’s sister Gisela reports the final diagnosis:

“haemopericardium, rupture of a dissecting thoracic aneurysm”.

You can read the medical explanation of this condition here; it is, my doctor tells me, consistent with her symptoms. The dissection must have began several days before when she got ill, and the aorta must have ruptured when she was at the clinic, filling her pericardium (the membrane around her heart) with blood. She bled to death internally, and the only mercy is that it was quick.

Could she have been saved had she gone to the doctor when she first had pain? It’s not clear: arterial dissections are hard to diagnose, and even so, can persist for months or even years without progressing. She might have been scheduled for surgery, but that might have required a long waiting period, and she would have died anyway.

There’s no use pondering the “what ifs” now, as what happened was fated to happen. But I suppose the diagnosis does help give us some closure, though for me there will never be “closure” (whatever that may be) with respect to Grania.

Robotic surgery!

August 24, 2019 • 12:30 pm

Since I had robotic surgery yesterday, I’ve become fascinated with this marvelous innovation in medicine. I’ve looked at a bunch of videos, and found two to post: one with a general introduction to the machines and their use, from the BBC, and the other showing how dextrous the robot is.

When I was wheeled into the operating theater, I asked to see the robot, and I’m pretty sure it was one of the da Vinci machines. It was all covered with plastic, for it had been sterilized, and it was on the other side of the room. (I don’t know whether the surgeon was next to me when he wielded it.)

I can see now why they told me I couldn’t have local anesthesia, as I had requested, to observe my operation: imagine how freaked out you’d be to see those big metal arms descending on your belly! But I wish they’d at least made a video of my surgery.

So here’s a general introduction to robotic surgery from the BBC. Note that this is a general news report, so watch only up to 9:23.

And this shows how good the machine is: a surgery robot sutures a grape. I see now that they put plastic “ports” into the small incisions, and that two arms can operate through a single port.

In many ways this is the future of surgery. I can’t imagine any other way to get an appendectomy.