Dilbert says "facemasks don't help" is a lie. LINK
it may have been a "little white lie" to prevent a toilet paper type run on facemasks, meaning none will be available for ordinary folks.
The dirty little secret: protection depends on what facemask does what.
when I was in medical school, we were told surgical masks (which back then were cloth... yes, I'm that old) only keep the surgeon from spitting into the patient's wound.
here in Asia, people wear masks all the time.
Ordinary masks that keep you from spreading your germs to others (e.g. in TB it keeps the spray that emits with ordinary talking/coughing/sneezine from spreading germs.
But they won't protect you from tiny virual (or even bacterial) particles that float in the air from going into your lung.
However, they also keep you from touching your face.
For viral etc. protection you need a heavier, tight fitting mask (which I had when I was a doc, since we treated TB cases).
And full protection requires not only a mask but a facial screen.
FINEST KIND CLINIC AND FISHMARKET.... Discussing medicine, culture, and the joys of cooking Pansit.
Monday, March 30, 2020
Advice for helping difficult elders
.............
having stubborn or abusive elders is hard at the best time but now trying to keep an eye on them during an epidemic is worse.
advice on how to help them without going crazy yourself.
Normal people care for each other.
Narcissists prefer to complain and abuse others.
Conservative Treehouse notes that the real VIPs are the ones who are helping, often by just doing their usual job.
and remember: This is a worldwide problem.
update: NYTimes: How to know when you can reopen the country: By testing who is immune to the virus and won't spread it.
I discussed earlier the types of tests available and that not all tested the same thing.
the only problem: He assumes a uniform federal policy is needed, one that ignores the differences in states but would push his idea of a one payer medical system. *
(he was involved in Obama care, meaning he wasnts the government to tell docs how to treat patients, and of course never mentions in his article in Atlantic magazine a while back says people over 75 should die, or to that effect, since their lives are useless.... hmmm...given this report out of the UK, it looks like he is not the only one with that idea._)
the state health departments are supposed to have the policies in place for local outbreaks; his plan would require the gov't to establish a brand new red tape filled bureaucracy from the bottom up, and take months if not years to put into place... that would slow things down. But never mind.
I agree everyone should have accesss to medicine, but after working for the feds for years, I know how that results in ratioining and making following the rules more important than actual patient care...
one reason that it took so long for the viral tests to get approved and distributed was the bureaucracy, and nearly every day one sees red tape standing in the way of medical care or getting needed equipment: and then they blame Trumpieboy of course, not the system, because politics.
as for the fact that some states seem to be a bit slow following the rules reminds me of John Ringo's description of the plague that started in a Chinese town and spread...in his book the Last Centurion... start reading HERE and ignore the bad language and black humor.
Sigh.
having stubborn or abusive elders is hard at the best time but now trying to keep an eye on them during an epidemic is worse.
advice on how to help them without going crazy yourself.
Normal people care for each other.
Narcissists prefer to complain and abuse others.
Conservative Treehouse notes that the real VIPs are the ones who are helping, often by just doing their usual job.
If you feel comfortable sitting in your socially distant box and bitching about all things that are not right, or might be not be right….
Or, if you prefer to allow yourself to be overcome with dark imaginings simply because what cannot be done is more comfortable than the effort to oversee what needs to be done…. well, that’s okay. You can do that. And when you’re done doing that you’ll still be in the same place.
Or, you can check on older neighbors to make sure they are OK and make sure they have necessities. If older neighbors need something at the store, get it for them. Friends and neighbors who are anxious, send them a card or note with positive comments on it. Give people hope. If you don’t want to send a card, send an e-mail checking up on people. Order an extra lunch or dinner from a local restaurant just so you can give an tip to the delivery person who shows up at your door. Then stick the extra in the fridge and eat it tomorrow.
We can do this. No-one is saying this doesn’t suck; but some people know that standing around bitching about the comparative values of current life in suckdom doesn’t actually accomplish anything.-------------------------------------
and remember: This is a worldwide problem.
update: NYTimes: How to know when you can reopen the country: By testing who is immune to the virus and won't spread it.
I discussed earlier the types of tests available and that not all tested the same thing.
the only problem: He assumes a uniform federal policy is needed, one that ignores the differences in states but would push his idea of a one payer medical system. *
(he was involved in Obama care, meaning he wasnts the government to tell docs how to treat patients, and of course never mentions in his article in Atlantic magazine a while back says people over 75 should die, or to that effect, since their lives are useless.... hmmm...given this report out of the UK, it looks like he is not the only one with that idea._)
the state health departments are supposed to have the policies in place for local outbreaks; his plan would require the gov't to establish a brand new red tape filled bureaucracy from the bottom up, and take months if not years to put into place... that would slow things down. But never mind.
I agree everyone should have accesss to medicine, but after working for the feds for years, I know how that results in ratioining and making following the rules more important than actual patient care...
one reason that it took so long for the viral tests to get approved and distributed was the bureaucracy, and nearly every day one sees red tape standing in the way of medical care or getting needed equipment: and then they blame Trumpieboy of course, not the system, because politics.
as for the fact that some states seem to be a bit slow following the rules reminds me of John Ringo's description of the plague that started in a Chinese town and spread...in his book the Last Centurion... start reading HERE and ignore the bad language and black humor.
Sigh.
Why it spread
I have been a bit angry how China ignored the implications of a new pneumonia/viral infection of unknown causes when it was first seen in Wuhan because China should have known better, since they had been through this type of outbreak in SARS, which also spread because China tried to cover it up.
this is basic public health, fellahs: Even in Africa, when a dangerous disease pops up, usually the public health people, including experts from other countries, are called in right away to try to stop it's spread.
In China, however, no one seemed to recognize that a new, highly fatal pneumonia was seen in their sophisticated hospitals might become a danger.
DUH.
and they punished the doctor in Wuhan who put a notice on the social media about seeing such cases in his hospital.
Ironically, he was not a hospitalist or infectious disease specialist, but a lowly opththalmologist who saw the cases and wondered why no one was talking about them.
He put a comment warning his fellow docs on their social media the end of December and was forced to apologize for doing this.
If China had recognized this might be a new "SARS" and isolated Wuhan while tracing contacts, it might have localized the epidemic.
Instead, they let a couple million folks go home to celebrate Chinese New Year, spreading the disease all over China. And since there was no contact trace or warning, many went overseas to spread the disese.
And China was saying it did not spread person to person through the end of January and the WHO agreed with China that closing the borders was not warranted, and so China, the WHO and many of the US MSM condemned Trumpieboy for closing the US from Chinese flights the end of January.
Now, of course, all of the ordinary slowness and spread and normal chaos is being blamed on Trumpieboy: because politics. And because politics, one simply can't rely on much of the MSM news.
There are a lot of rewriting of history on this: Just look at the comments on any of the discussions on Youtube.
Korea did a good job in stopping the spread of the latest coronavirus. But what I didn't recognize is that they went through this type of threat during a previous outbreak of a more lethal corona virus, MERS. A camel coronavirus from the Middle East that we were starting to prepare for back then, but luckily even though a few of our health care workers came back with it, it did not spread.
Report on how one person with MERS caused a local epidemic in Korea can be found HERE
this patient went to three hospitals before he was diagnosed, and spread it to people in the first two hospitals before someone recognized what he had.
this was mentioned in this audiobook that I am listening to right now:
I posted this interview with the author a few weeks ago from Joe Rogan's podcast:
-------------------
in the meanwhile, here in the Philippines, the problem with hunger in unemployed workers and their families is becoming a problem.
LINK LINK2
and now the DOH is backpeddling on the claim about inaccurate tests provided by China after the Chinese embassy protestedPressured the government to withdraw the claim or else.
The embassy claimed the bad batch from China was donated from a private donor and originated from an unlicensed company in China so don't blame China, and that the new batches were as good as the WHO test.
presumably the fact that someone is making and selling fake tests in China does not mean China is responsible for allowing these companies to defraud people in the midst of an epidemic.
(sort of like how the Chinese government is not responsible for those dying from counterfeit or fake medicines, or for people dying from opioids that originated in China).
and the Chinese trolls are there condemning the DOH for insulting China (in so many words).
Sigh.
Finally, even though China is claiming the new tests are fine, ABSCBN notes that the tests donated by Jack Ma are being used haven't been checked yet.
this is basic public health, fellahs: Even in Africa, when a dangerous disease pops up, usually the public health people, including experts from other countries, are called in right away to try to stop it's spread.
In China, however, no one seemed to recognize that a new, highly fatal pneumonia was seen in their sophisticated hospitals might become a danger.
DUH.
and they punished the doctor in Wuhan who put a notice on the social media about seeing such cases in his hospital.
Ironically, he was not a hospitalist or infectious disease specialist, but a lowly opththalmologist who saw the cases and wondered why no one was talking about them.
He put a comment warning his fellow docs on their social media the end of December and was forced to apologize for doing this.
If China had recognized this might be a new "SARS" and isolated Wuhan while tracing contacts, it might have localized the epidemic.
Instead, they let a couple million folks go home to celebrate Chinese New Year, spreading the disease all over China. And since there was no contact trace or warning, many went overseas to spread the disese.
And China was saying it did not spread person to person through the end of January and the WHO agreed with China that closing the borders was not warranted, and so China, the WHO and many of the US MSM condemned Trumpieboy for closing the US from Chinese flights the end of January.
Now, of course, all of the ordinary slowness and spread and normal chaos is being blamed on Trumpieboy: because politics. And because politics, one simply can't rely on much of the MSM news.
There are a lot of rewriting of history on this: Just look at the comments on any of the discussions on Youtube.
Korea did a good job in stopping the spread of the latest coronavirus. But what I didn't recognize is that they went through this type of threat during a previous outbreak of a more lethal corona virus, MERS. A camel coronavirus from the Middle East that we were starting to prepare for back then, but luckily even though a few of our health care workers came back with it, it did not spread.
Report on how one person with MERS caused a local epidemic in Korea can be found HERE
The index case was a returning traveler from the Middle East. The infection had spread within the hospital, and subsequently to other hospitals because of patient movement, resulting in nosocomial transmission at 16 clinics and hospitals. The epidemic lasted for 2 months, with the government declaring a “virtual” end to the epidemic on July 6, 2015. In order to control the outbreak, the government quarantined 16,993 individuals for 14 days, and the economic loss was estimated at 9.311 trillion Korean won (8.5 billion US dollars) [8].
this patient went to three hospitals before he was diagnosed, and spread it to people in the first two hospitals before someone recognized what he had.
this was mentioned in this audiobook that I am listening to right now:
I posted this interview with the author a few weeks ago from Joe Rogan's podcast:
-------------------
in the meanwhile, here in the Philippines, the problem with hunger in unemployed workers and their families is becoming a problem.
LINK LINK2
and now the DOH is backpeddling on the claim about inaccurate tests provided by China after the Chinese embassy protested
The embassy claimed the bad batch from China was donated from a private donor and originated from an unlicensed company in China so don't blame China, and that the new batches were as good as the WHO test.
presumably the fact that someone is making and selling fake tests in China does not mean China is responsible for allowing these companies to defraud people in the midst of an epidemic.
(sort of like how the Chinese government is not responsible for those dying from counterfeit or fake medicines, or for people dying from opioids that originated in China).
and the Chinese trolls are there condemning the DOH for insulting China (in so many words).
Sigh.
Finally, even though China is claiming the new tests are fine, ABSCBN notes that the tests donated by Jack Ma are being used haven't been checked yet.
Sunday, March 29, 2020
Only 40 percent of test kits are accurate
China sent the coronavirus test kits to the Philippines.
Now the Inquirer has an article saying they don't work very well :
so which donated tests are inaccurate? those sent by the Chinese Government or the ones sent by Jack Ma?
we are not the only country seeing problems with China's donations: LINK
Well, Singapore is sending 40 thousand test kits so that will help.
we are still in lockdown, with about 1000 cases in the entire Philippines and about 100 deaths. One case in our town was sent to the big city nearby.
the death rate in the elderly is about the same so far...but a lot of kids sick with bronchitis, probably RSV...
but a lot of people coming to the door asking for rice since they are out of work (and we sell organic rice and often donate it to the poor).
Now the Inquirer has an article saying they don't work very well :
Some COVID-19 test kits from China yield inaccurate results, DOH admits
DOH Undersecretary Maria Rosario Vergeire said the testing kits only showed 40 percent accuracy compared to the testing kits from the World Health Organization (WHO)...
(The first test kits China only showed 40 percent of accuracy. We did not use this.) The Chinese government earlier donated 100,000 testing kits to the Philippines. Vergeire, however, did not specify how many of the said testing kits showed inaccurate results.
so which donated tests are inaccurate? those sent by the Chinese Government or the ones sent by Jack Ma?
we are not the only country seeing problems with China's donations: LINK
Well, Singapore is sending 40 thousand test kits so that will help.
we are still in lockdown, with about 1000 cases in the entire Philippines and about 100 deaths. One case in our town was sent to the big city nearby.
the death rate in the elderly is about the same so far...but a lot of kids sick with bronchitis, probably RSV...
but a lot of people coming to the door asking for rice since they are out of work (and we sell organic rice and often donate it to the poor).
Saturday, March 28, 2020
Questions, I haz them
I have a lot of questions about covid virus, partly because there is too much information out there so the important questions are often hidden like the purloined letter in the midst of a bunch of superfluous information that you already know.
So here are a few thing I am wondering about (and might have missed in my reading).
This is the NEJM article on how one is supposed to investigate a new infectious disease. (aka epidemiology) Published Feb 18
emphasizes the need to check families and contacts to see if people with few symptoms are infectious. Meaning you need to do a lot of tests on low risk folks to figure out what is going on.
ah, but where are the studies here? Slowly dripping out from the CDC, so we should know more as days go by.
which brings me to another question: What test is being used by whom?
and the acute test for the acute virus is a PCR test for the actual genetic material of the virus: this checks if you are infected and can spread the disease.
but this might not check if the person is immune or not: for that you need to check the anti body titer (IgM for early period, IGG for full immunity, positive after ten days).
the problem with antibody tests is that they won't pick up early infections, only turning positive after a few days, when the person hasn't had time to develop immunity. So in early infections, you can spread the disease with a negative antibody test.
the reports say this was the test used by China early in the epidemic.
Since these tests do detect if a person has had the infection, but this means the test will pick up those who have recovered and won't spread it.
the delay in diagnosis in antibody tests, which miss early infections, was why in the past, we docs in Oklahoma, where Rocky Mountain Spotted fever was common, just treated all fevers with tetracycline: Because the rash and the blood test for Rocky Mountain spotted fever didn't turn positive right away, and by then the disease could kill you.
... so I am never quite sure which test the lay press is talking about when they say test results.
and of course, another problem with all of these sophisticated tests is that they have to be accurate:
Instapundit notes:
CHINA SYNDROME: China Supplied Faulty Coronavirus Test Kits to Spain, Czech Republic.
if these highly publicized tests were faulty, can we trust the test data from China, where maybe their tests were similarly flawed?
This is one reason the US FDA was slow in approving a test, by the way: you need to get the test right or it's useless.
So stop your complaining about Trumpieboy (and implying that the hard working bureaucrats at the FDA were incompetent) for not having thousands of tests immediately as if someone had a magic wand and poof suddenly they appeared. The FDA/CDC were making sure that the damn things actually worked.
and now that the USA has tests that actually work, all and sundry are getting tested, so we see huge numbers of cases reported.
Not in the reports: Which test?
which is why I noted different tests measure different things: acute ongoing infections that can spread, or old infections of immune recovered folks just show who used to have it and now they can't spread the disease.
another question about those reports that USA has more reported cases than China... Is this because the USA is doing more tests and their tests are more accurate. Or maybe it's because China isn't doing a lot of tests anymore, or isn't reporting them...
And if you believe China's claim that they only have a few cases now, mostly in folks entering that country, well, as the saying goes, If you believe that I have a bridge in Brooklyn that I'd like to sell you.
===============
some of these questions are being answered by the meticulous investigations of the CDC, but you have to read the technical details at their website.
LINK discusses that Washington state nursing home.
LINK2 discusses severe cases.
----------------------
what is the demographics of the US cases? Someone pointed out that younger cases in New Orleans and NYCity might have HIV (diagnosed or undiagnosed) from MSM or drug use.
If so, then the spread of Wuhanflu in the homeless, who are drug users and often have chronic health problems (hep C, TB malnutrition) could be terrible.
Are the cities forcing these people into hotel rooms?
Some wag suggested they should put them in Trump Tower,. Well, yes, hotels and even college dormatories could be forced to house such people, but those empty cruise ships could also be used for emergency housing or even emergency hospitals.
another question: Now, with Mexico closing the border to the USA, I am reading about fresh produce that is being destroyed due to the long lines (a problem here in Manila also).
Is the virus slowing down the importation of illicit drugs (e.g. opioids from China trafficked via the Mexican drug cartels)? A similar question could be asked here in the Philippines: some of our Shabu (aka meth) is made locally, but a lot of it is from Burma etc. via Chinese cartels, and of course Manila is a distribution center to distribute these drugs all over the world... but the airports are essentially closed right now....
-----------------
taboo question: Is there a racial difference in the severity of the disease? if so, which races?
====================
Some cases have relapse, according to early reports.
but will having a mild case give you immunity? This is important, since if it does, then herd immunity will stop the spread of the disease. (unless, like influenza, or the common cold, a new strain pops out so you could catch the new strain again.) And of course, it would mean a better hope that a vaccine would work.
So far, however, no one knows if having the disease will make you immune.
Early in March there were reports that there were two variations of the Wuhan flu: one mild and one lethal.
Have studies since then confirmed this? And if so, are the viruses similar so that there is cross immunity?
But unless the mild case brings you resistance to future infections, it suggests the 1918 Spanish flu redux, when the flu broke out in multiple places and was much more lethal in 1919...because of the cytokine storm.
this brings up all sorts of questions about vaccines: if you get partial immunity, immunity to a different strain of virus from being infected or from a vaccine, could this result in inducing a cytokine storm in a small percentage of people who come down with a slightly different strain of the virus...but alas I'm not an expert: but here in the Philippines we were harmed by the Dengue vaccine, which probably saved a lot of lives but killed some kids (partly because there are four variations of the germ and usually you get the severe disease in your second infection)..., so if they do get a covid vaccine, expect the anti vaxxers to come out in force.
------------
update: In the Philippines, up to recently anyone could pick up antibiotics without a prescription (now they are getting stricter about this). So now the authorities said: no chloroquin without a prescription.
------------------------
Lancet article on using Chloroquin for viral infections from 2003 and why it works. For later reading.
historically, the ancient Inca used it to treat "fevers" (maybe malaria or maybe not), and later many people often gave "jesuit bark" aka quinine for "fevers".
This broad anti viral activity might be why it worked when the fever didn't come from malaria.
and one reason that it works in early cases but not in severe cases might be because it stops replication of the virus: once you are sick it won't stop the cytokine storm.
So here are a few thing I am wondering about (and might have missed in my reading).
This is the NEJM article on how one is supposed to investigate a new infectious disease. (aka epidemiology) Published Feb 18
emphasizes the need to check families and contacts to see if people with few symptoms are infectious. Meaning you need to do a lot of tests on low risk folks to figure out what is going on.
Starting these epidemiologic and surveillance activities promptly will enable us to choose the most efficient ways of controlling the epidemic and help us avoid interventions that may be unnecessarily costly or unduly restrictive of normal activity.even given that there is usually a two week lag in publishing "urgent" articles, one wonders why this wasn't done in China a lot earlier: say in late Dec or early January. True some of these investigations require the ability to test, but hey, you can also do clinical questionaires to give you a bit of an idea to figure out if maybe it is spread from person to person, so maybe you shouldn't let everyone go home for the New Years celebration.
ah, but where are the studies here? Slowly dripping out from the CDC, so we should know more as days go by.
which brings me to another question: What test is being used by whom?
and the acute test for the acute virus is a PCR test for the actual genetic material of the virus: this checks if you are infected and can spread the disease.
but this might not check if the person is immune or not: for that you need to check the anti body titer (IgM for early period, IGG for full immunity, positive after ten days).
the problem with antibody tests is that they won't pick up early infections, only turning positive after a few days, when the person hasn't had time to develop immunity. So in early infections, you can spread the disease with a negative antibody test.
the reports say this was the test used by China early in the epidemic.
Since these tests do detect if a person has had the infection, but this means the test will pick up those who have recovered and won't spread it.
the delay in diagnosis in antibody tests, which miss early infections, was why in the past, we docs in Oklahoma, where Rocky Mountain Spotted fever was common, just treated all fevers with tetracycline: Because the rash and the blood test for Rocky Mountain spotted fever didn't turn positive right away, and by then the disease could kill you.
... so I am never quite sure which test the lay press is talking about when they say test results.
and of course, another problem with all of these sophisticated tests is that they have to be accurate:
Instapundit notes:
CHINA SYNDROME: China Supplied Faulty Coronavirus Test Kits to Spain, Czech Republic.
if these highly publicized tests were faulty, can we trust the test data from China, where maybe their tests were similarly flawed?
This is one reason the US FDA was slow in approving a test, by the way: you need to get the test right or it's useless.
So stop your complaining about Trumpieboy (and implying that the hard working bureaucrats at the FDA were incompetent) for not having thousands of tests immediately as if someone had a magic wand and poof suddenly they appeared. The FDA/CDC were making sure that the damn things actually worked.
and now that the USA has tests that actually work, all and sundry are getting tested, so we see huge numbers of cases reported.
Not in the reports: Which test?
which is why I noted different tests measure different things: acute ongoing infections that can spread, or old infections of immune recovered folks just show who used to have it and now they can't spread the disease.
another question about those reports that USA has more reported cases than China... Is this because the USA is doing more tests and their tests are more accurate. Or maybe it's because China isn't doing a lot of tests anymore, or isn't reporting them...
And if you believe China's claim that they only have a few cases now, mostly in folks entering that country, well, as the saying goes, If you believe that I have a bridge in Brooklyn that I'd like to sell you.
===============
some of these questions are being answered by the meticulous investigations of the CDC, but you have to read the technical details at their website.
LINK discusses that Washington state nursing home.
LINK2 discusses severe cases.
what is the demographics of the US cases? Someone pointed out that younger cases in New Orleans and NYCity might have HIV (diagnosed or undiagnosed) from MSM or drug use.
If so, then the spread of Wuhanflu in the homeless, who are drug users and often have chronic health problems (hep C, TB malnutrition) could be terrible.
Are the cities forcing these people into hotel rooms?
Some wag suggested they should put them in Trump Tower,. Well, yes, hotels and even college dormatories could be forced to house such people, but those empty cruise ships could also be used for emergency housing or even emergency hospitals.
another question: Now, with Mexico closing the border to the USA, I am reading about fresh produce that is being destroyed due to the long lines (a problem here in Manila also).
Is the virus slowing down the importation of illicit drugs (e.g. opioids from China trafficked via the Mexican drug cartels)? A similar question could be asked here in the Philippines: some of our Shabu (aka meth) is made locally, but a lot of it is from Burma etc. via Chinese cartels, and of course Manila is a distribution center to distribute these drugs all over the world... but the airports are essentially closed right now....
-----------------
taboo question: Is there a racial difference in the severity of the disease? if so, which races?
====================
Some cases have relapse, according to early reports.
but will having a mild case give you immunity? This is important, since if it does, then herd immunity will stop the spread of the disease. (unless, like influenza, or the common cold, a new strain pops out so you could catch the new strain again.) And of course, it would mean a better hope that a vaccine would work.
So far, however, no one knows if having the disease will make you immune.
Early in March there were reports that there were two variations of the Wuhan flu: one mild and one lethal.
Have studies since then confirmed this? And if so, are the viruses similar so that there is cross immunity?
But unless the mild case brings you resistance to future infections, it suggests the 1918 Spanish flu redux, when the flu broke out in multiple places and was much more lethal in 1919...because of the cytokine storm.
this brings up all sorts of questions about vaccines: if you get partial immunity, immunity to a different strain of virus from being infected or from a vaccine, could this result in inducing a cytokine storm in a small percentage of people who come down with a slightly different strain of the virus...but alas I'm not an expert: but here in the Philippines we were harmed by the Dengue vaccine, which probably saved a lot of lives but killed some kids (partly because there are four variations of the germ and usually you get the severe disease in your second infection)..., so if they do get a covid vaccine, expect the anti vaxxers to come out in force.
------------
update: In the Philippines, up to recently anyone could pick up antibiotics without a prescription (now they are getting stricter about this). So now the authorities said: no chloroquin without a prescription.
------------------------
Lancet article on using Chloroquin for viral infections from 2003 and why it works. For later reading.
historically, the ancient Inca used it to treat "fevers" (maybe malaria or maybe not), and later many people often gave "jesuit bark" aka quinine for "fevers".
This broad anti viral activity might be why it worked when the fever didn't come from malaria.
and one reason that it works in early cases but not in severe cases might be because it stops replication of the virus: once you are sick it won't stop the cytokine storm.
Friday, March 27, 2020
Emma: A poorly acted classic remake
Historian/novelist MariaElenaVidal loved the latest version of Emma.
However, I turned it off after about 15 minutes.
The main character is played with a flat affect (no emotions in her face) and not very believable. Asperger's syndrome is in fashion, of course, but here it doesn't work: she comes off merely as unlikable.
and I can't abide movies about unlikable people.
Mr Knightly might be interesting, for unlike most of the other characters he at least acts like a normal human being, but why did the movie introduce him by a longish nude scene showing him dressing (trying to attract the gay audience was my take on this).
The actor who played the minister seems to be smirking all the time, as if he were mocking his role.
Even Emma's father seems to be grimacing at her all the time as if he had a headache. Another waste of a good actor.
Unless you know the book, you have no idea of what is going on, or that Emma had manipulated that couple to marry (did anyone mention it?) and went on to try to manipulate a lot of other people into marriage. I was watching with my son in law, and was trying to explain the plot to him when I gave up and turned it off.
Unlikable protagonists might be tolerated, as might nude scenes that have nothing to do with the plot, but a bad screenplay/plot on top of this is just too much for me to waste my time. (I felt the same way about The Favorite by the way, but that's another story).
The whole point of Jane Austen is that people kept their emotions inside: a lot of the "action" has to be portrayed or explained by hints and facial expressions. But a movie or film has to show they are real people underneath: and from my limited viewing of the film, I really didn't believe the characters (except for Mr Knightly when he finally got his clothing on) were real human beings.
previous versions were better: Why remake a classic like this when the 1996 version is much better:
or better yet, watch the 2009 BBC miniseries that is now on Amazon Prime.
Or stick with Belgravia if you want to watch a period piece (done by the guy who was behind Downton Abbey).
-----------------
the heck with kinky remakes of classic stories: K drama rule.
Right now we're watching Strong woman
with english subtitles on youtube. Some episodes missing from youtube, so you'll have to google for asia streaming sites.one two
However, I turned it off after about 15 minutes.
The main character is played with a flat affect (no emotions in her face) and not very believable. Asperger's syndrome is in fashion, of course, but here it doesn't work: she comes off merely as unlikable.
and I can't abide movies about unlikable people.
Mr Knightly might be interesting, for unlike most of the other characters he at least acts like a normal human being, but why did the movie introduce him by a longish nude scene showing him dressing (trying to attract the gay audience was my take on this).
The actor who played the minister seems to be smirking all the time, as if he were mocking his role.
Even Emma's father seems to be grimacing at her all the time as if he had a headache. Another waste of a good actor.
Unless you know the book, you have no idea of what is going on, or that Emma had manipulated that couple to marry (did anyone mention it?) and went on to try to manipulate a lot of other people into marriage. I was watching with my son in law, and was trying to explain the plot to him when I gave up and turned it off.
Unlikable protagonists might be tolerated, as might nude scenes that have nothing to do with the plot, but a bad screenplay/plot on top of this is just too much for me to waste my time. (I felt the same way about The Favorite by the way, but that's another story).
The whole point of Jane Austen is that people kept their emotions inside: a lot of the "action" has to be portrayed or explained by hints and facial expressions. But a movie or film has to show they are real people underneath: and from my limited viewing of the film, I really didn't believe the characters (except for Mr Knightly when he finally got his clothing on) were real human beings.
previous versions were better: Why remake a classic like this when the 1996 version is much better:
or better yet, watch the 2009 BBC miniseries that is now on Amazon Prime.
Or stick with Belgravia if you want to watch a period piece (done by the guy who was behind Downton Abbey).
-----------------
the heck with kinky remakes of classic stories: K drama rule.
Right now we're watching Strong woman
with english subtitles on youtube. Some episodes missing from youtube, so you'll have to google for asia streaming sites.one two
Thursday, March 26, 2020
Family news harvest time and flu
Things remain quiet.
Only a few hundred cases of wuhanflu here in the Philippines, I suspect numbers are still low, probably because so few people have been tested: Which explains why we are seeing headlines of the celebrities and politicians who are testing positive (they are the only ones getting the tests before they get really really sick).
from PhInquirer:
remember: Manila has 10 million plus folks, many living in crowded slums. There is first class medical care, and (usually crowded) public hospitals for the poor, but if there is a large number of cases that need ICU, there will be chaos and a lot of folks will die because I doubt there are enough respirators.
Manila, like our area, has been on strict lockdown: indeed, one of the worries is the delay in passing screening sites to get food to customers.
here, in our neighborhood, the maid reports one child died of pneumonia and one old lady died at home in the past 2 days (I often get asked for a donation to help the family with burial expenses). Neither of them appear to be from Wuhan flu: because their symptoms didn't fit the clinical picture.
I ran across this post at an Aggie website, from an ER doc in Texas that describes the clinical pattern of the disease... It's quite well written, but frightening. (headsup FR).
Essentially five days after you get sick you get shortness of breath etc...
and the severe cases "crash" on day ten with a cytokine storm and go into acute ARDS and multi organ failure over a matter of hours and might need to get on a respirator or you'll die...., Lancet article on cytokine storm here.
and he said he hasn't had much luck with Hydroxychloroquin (many other docs report it works, but it might not work on severely ill patients, or even cause cardiac toxicity, and note that there have been no well done controlled studies yet). And he notes some have cardiomyopathy etc as a complication.
Read only if you are in the medical field since both articles are technical.
we remain in lockdown. I stay indoors except to walk the dogs: I do need exercize and hate to use Lolo's exercize bike which I got out of storage so that I could exercize at home...
Joy is going to the farm where they have harvested and are drying the rice in the sun. (traditional drying is on a tarp or a clean surface, even a roadway, under the hot sun...and you have to move it around now and then to make sure it dries evenly. There are electric driers for when it rains but this increases the farmer's expenses and lowers their profit).
She is most happy they now have a harvester/thresher for the farmers to use, since when she was young, they had to cut and gather all the rice by hand before they put it in a thresher to separate.
one of the side streets near us has a barrier saying no one is to pass there because of quarantine. Does that mean there is a case in one of the homes? Maybe, but actually I suspect tricycles and cars have been using the street to avoid getting checked by the police who stop cars on the main streets and they are tired of all the traffic noise.
----------------
update: One case in a local hospital was transferred to the larger city nearby.
And the maid's niece's twins are sick with a chest infection and were admitted to the hospital in the next town where there is specialty care(I suspect RSV, which is pretty bad in kids, because we've been asked for money to have other neighbor's children seen at the hospital,... so probably not Wuhan Flu)
Only a few hundred cases of wuhanflu here in the Philippines, I suspect numbers are still low, probably because so few people have been tested: Which explains why we are seeing headlines of the celebrities and politicians who are testing positive (they are the only ones getting the tests before they get really really sick).
from PhInquirer:
COVID-19 CASES BREAKDOWN (PH)MANILA, Philippines —
The Department of Health (DOH) has recorded three more deaths due to the coronavirus disease 2019 (COVID-19) and 84 new cases of infection in the country.
This brings the number of deaths due to COVID-19 to 38. The total number of confirmed COVID-19 cases in the country is now recorded at 636. The DOH also reported six new recoveries, taking the total number of persons who have recovered from the illness to 26 as of 4 pm Wednesday.government website LINK
remember: Manila has 10 million plus folks, many living in crowded slums. There is first class medical care, and (usually crowded) public hospitals for the poor, but if there is a large number of cases that need ICU, there will be chaos and a lot of folks will die because I doubt there are enough respirators.
Manila, like our area, has been on strict lockdown: indeed, one of the worries is the delay in passing screening sites to get food to customers.
here, in our neighborhood, the maid reports one child died of pneumonia and one old lady died at home in the past 2 days (I often get asked for a donation to help the family with burial expenses). Neither of them appear to be from Wuhan flu: because their symptoms didn't fit the clinical picture.
I ran across this post at an Aggie website, from an ER doc in Texas that describes the clinical pattern of the disease... It's quite well written, but frightening. (headsup FR).
Essentially five days after you get sick you get shortness of breath etc...
and the severe cases "crash" on day ten with a cytokine storm and go into acute ARDS and multi organ failure over a matter of hours and might need to get on a respirator or you'll die...., Lancet article on cytokine storm here.
and he said he hasn't had much luck with Hydroxychloroquin (many other docs report it works, but it might not work on severely ill patients, or even cause cardiac toxicity, and note that there have been no well done controlled studies yet). And he notes some have cardiomyopathy etc as a complication.
Read only if you are in the medical field since both articles are technical.
we remain in lockdown. I stay indoors except to walk the dogs: I do need exercize and hate to use Lolo's exercize bike which I got out of storage so that I could exercize at home...
Joy is going to the farm where they have harvested and are drying the rice in the sun. (traditional drying is on a tarp or a clean surface, even a roadway, under the hot sun...and you have to move it around now and then to make sure it dries evenly. There are electric driers for when it rains but this increases the farmer's expenses and lowers their profit).
She is most happy they now have a harvester/thresher for the farmers to use, since when she was young, they had to cut and gather all the rice by hand before they put it in a thresher to separate.
one of the side streets near us has a barrier saying no one is to pass there because of quarantine. Does that mean there is a case in one of the homes? Maybe, but actually I suspect tricycles and cars have been using the street to avoid getting checked by the police who stop cars on the main streets and they are tired of all the traffic noise.
----------------
update: One case in a local hospital was transferred to the larger city nearby.
And the maid's niece's twins are sick with a chest infection and were admitted to the hospital in the next town where there is specialty care(I suspect RSV, which is pretty bad in kids, because we've been asked for money to have other neighbor's children seen at the hospital,... so probably not Wuhan Flu)
Revenge of magical thinking
EcclesIsSaved Blog say the Pope has discovered the real reason for the Wuhan virus epidemic:
No, not bat soup, but Mother Gaia, aka Pachimama, is having a temper tantrum:
ha.
I'm so old that I remember when epidemics and natural disasters were called the "wrath of God" and a punishment for our sins.
now however, sins of "the flesh" (and spending money supposed to go to charities on orgies) get you a "who am I to judge" from the Pope, whereas using a plastic straw will result in Pachimama getting a temper tantrum and killing you.
However,there are still some who continue to recognize the spiritual realm in the disease.
For example, Xi, said on Jan 29:
"The epidemic is a demon, and we cannot let this demon hide,"he adds that he would release information about the demon "in a timely manner", and the WHO bowed down to the supreme leader and said fine, no epidemic here, folks, just move along and don't stop travelers because it might hurt the feelings of the Great Leader.
the logic behind this seems to be: if you pretend the demon isn't there, maybe he will go away.
What's wrong with this picture?
but Trumpieboy did it anyway and China condemned them for doing that,
China criticized the U.S. controls, which it said contradicted the WHO’s appeal to avoid travel bans, and “unfriendly comments” that Beijing was failing to cooperate. “Just as the WHO recommended against travel restrictions, the U.S. rushed to go in the opposite way. Certainly not a gesture of goodwill,” said foreign ministry spokeswoman Hua Chunying.things are not getting better: it's now not PC to notice China's laxness was behind the disease epidemic, and the twittertrolls will get you if you say "China Virus" or Wuhan Flu.
update: Wayback machine article from the NYTimes:
ah, but the whistleblower posted his observations on Weibo (a Chinese social media site) to fellow physicians on Dec 30 , warning them they needed to wear protective clothing when treating these patients, and got a warning from the Government about spreading fake news.
Austin Bay points out that that little bit of political correctness in the US MSM is merely China's "useful idiots" helping them to coverup their incompetence.
A lot of people don't recognize that when doctors find an outbreak of a brand new infectious disease, usually they call for help, and plans are made to find it's cause and stop it's spread quickly.
In late December 2019, doctors and other medical practitioners in Wuhan identified the pathogen and warned that it presented a threat to human life....So CCP apparatchik police treated Wuhan's conscientious doctors as criminals and suppressed their warnings. CCP thuggery and brutality halted local efforts to confine the virus and prevented responsible medical efforts from disseminating information that might help global researchers find cures and vaccines.
This is especially important if it might be a new disease that has been put on a list of "watch out for this because it might become bad"
2013 article on newly emerging diseases.
Instead, China covered it up for a month, (and maybe longer: early cases date back to early December, and the world only found out about it when a Wuhan doctor posted his concerns on a discussion board.
Was the basic public health investigations done? without checking where people caught the virus, it was not "known" that it could spread person to person, or that people with few symptoms could spread it. Part of this is blamed on the lack of tests, but that doesn't explain why when doctors and nurses were getting sick and dying at a high rate it didn't make someone do a "duh" and figure out that this was infectious person to person and stop people from traveling from the epicenter.
date to remember: Whistleblower posted concern on Dec 29.
LINK to timeline: Jan 8 the WHO said there were 50 cases but it was still being denied it was transmitted person to person. That fact wasn't admitted until Jan 20 (but notice the AFP photo accompanying the article from Jan 17 shows medical personnel in protective suits, meaning someone was aware it could spread from person to person).
The best way to understand their mindset is to watch the miniseries Chernobyl, where the regime worried more about bad publicity about the nuclear accident than they did about the local people.
one is reminded of what Richard Feynman wrote about the Challenger disaster:
"For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.
------------------
update: I checked my "wayback" machine for the English Weibo feed, and found this.
January 23, they are still discussing the infection came from animals
Tuesday, March 24, 2020
Shopping in the shutdown
I went to the bank, accompanied by my daughter in law Joy, to deposit a check and get money (I do this every week because I tend to spend money if I have it, so I keep to a strict schedule to budget money).
Our branch was closed, but another branch was open with a skeleton staff. They don't know me so I had to show ID (no problem) but with the shutdown, they said the courier might not be picking up the checks to send to the Manila branch that sends it to their US branch to transfer the money, so they don't know when the check will clear (usually it takes 21 working days).
Luckily I have enough savings here for now, if we don't have any emergencies.
I might have to arrange for my bank in the USA to wire money from my pension to here if the lockdown continues. Sigh.
On the way in, the security guard sprayed our hands with alcohol/hand sanitizer and checked our temperature.
I also went to get dog food at the agri store, and dropped Joy at the pharmacy to pick up my medicines (anti histamines for allergies and ibuprofen for my arthritis) because the pharmacy had long lines and I am at higher risk than her.
Few people are on the street, and the cops and security guards are all wearing masks.
I have a cloth mask: I guess the disposable ones are being kept for those who need to change them all the time.
The cook buys our daily food (mainly fish or meat and fresh veggies, since we eat our own rice), and I guess the local bakery is closed since she is buying pre packaged pandesal (Bread rolls).
Usually I buy the laundry detergent and things like whole wheat bread, peanut butter, cheese, snacks, coffee (3 in 1 for the staff) etc. at a local grocery store, but again I didn't want to go into the crowded store, so I sent the maid, who said they wouldn't let her in without a mask (which they of course sold her).
Alas, the small local grocery store didn't have the loaf bread, or some other commodities that come from outside the area. Presumably they still have stock that has a longer shelf life, at least until they run out.
I worry that soon the distribution of commodities is going to be a problem: Joy is still trying to figure out how to get our rice delivered due to long lines and limitations on how many can go with the trip (i.e. it means the driver will have to help move the heavy sacks of rice with only one helper).
by the way: you do need a permit from the Barangay office (neighborhood office) to shop, and it only allows shopping for groceries and medicine. The staff went there to get one a few days ago, but our cousin who works there brought mine to the house to spare me the trip and long lines.
-------------------
the city lockdown is affecting the dead: the poor lady and her baby who died a few days ago is scheduled to be buried but only with a blessing to the grave, not with a mass.
Lolo's five year anniversary is tomorrow: Usually we should attend mass and visit the grave and buy a lot of flowers to decorate it, and then stay at the grave for awhile to pray and eat.
But of course, I won't be doing this. Lolo was a FilAm and even though family might be upset, I doubt he'd want us to endanger ourselves.
-----------------------
Duterte is asking for more powers: it is approaching the level of martial law in some areas at present. Since many remember Marcos, martial law is a "no-no", but most of the opposition recognizes this might be needed in some areas.
and while the US and Philippines are busy trying to prevent their people from dying from the China virus, China has been busy expanding their military bases and aggression in the West Philippine sea. China claims the expansion is a "civilian effort" (meaning they only are doing this to steal the resources of the Philippines and VietNam) but they aren't really fooling anyone.
Our branch was closed, but another branch was open with a skeleton staff. They don't know me so I had to show ID (no problem) but with the shutdown, they said the courier might not be picking up the checks to send to the Manila branch that sends it to their US branch to transfer the money, so they don't know when the check will clear (usually it takes 21 working days).
Luckily I have enough savings here for now, if we don't have any emergencies.
I might have to arrange for my bank in the USA to wire money from my pension to here if the lockdown continues. Sigh.
On the way in, the security guard sprayed our hands with alcohol/hand sanitizer and checked our temperature.
I also went to get dog food at the agri store, and dropped Joy at the pharmacy to pick up my medicines (anti histamines for allergies and ibuprofen for my arthritis) because the pharmacy had long lines and I am at higher risk than her.
Few people are on the street, and the cops and security guards are all wearing masks.
I have a cloth mask: I guess the disposable ones are being kept for those who need to change them all the time.
The cook buys our daily food (mainly fish or meat and fresh veggies, since we eat our own rice), and I guess the local bakery is closed since she is buying pre packaged pandesal (Bread rolls).
Usually I buy the laundry detergent and things like whole wheat bread, peanut butter, cheese, snacks, coffee (3 in 1 for the staff) etc. at a local grocery store, but again I didn't want to go into the crowded store, so I sent the maid, who said they wouldn't let her in without a mask (which they of course sold her).
Alas, the small local grocery store didn't have the loaf bread, or some other commodities that come from outside the area. Presumably they still have stock that has a longer shelf life, at least until they run out.
I worry that soon the distribution of commodities is going to be a problem: Joy is still trying to figure out how to get our rice delivered due to long lines and limitations on how many can go with the trip (i.e. it means the driver will have to help move the heavy sacks of rice with only one helper).
by the way: you do need a permit from the Barangay office (neighborhood office) to shop, and it only allows shopping for groceries and medicine. The staff went there to get one a few days ago, but our cousin who works there brought mine to the house to spare me the trip and long lines.
-------------------
the city lockdown is affecting the dead: the poor lady and her baby who died a few days ago is scheduled to be buried but only with a blessing to the grave, not with a mass.
Lolo's five year anniversary is tomorrow: Usually we should attend mass and visit the grave and buy a lot of flowers to decorate it, and then stay at the grave for awhile to pray and eat.
But of course, I won't be doing this. Lolo was a FilAm and even though family might be upset, I doubt he'd want us to endanger ourselves.
-----------------------
Duterte is asking for more powers: it is approaching the level of martial law in some areas at present. Since many remember Marcos, martial law is a "no-no", but most of the opposition recognizes this might be needed in some areas.
and while the US and Philippines are busy trying to prevent their people from dying from the China virus, China has been busy expanding their military bases and aggression in the West Philippine sea. China claims the expansion is a "civilian effort" (meaning they only are doing this to steal the resources of the Philippines and VietNam) but they aren't really fooling anyone.
Genetic puzzle behind the virus
I had read a couple articles that mentioned Africans having fewer Corona virus cases and deaths, and I assumed that this was because of the sunlight/living outdoors instead of inside houses in the winter as in China and the USA/Europe, or maybe because a lot of Africans take anti malarial medicine to prevent getting that disease, or maybe just that they haven't done enough tests and people are sick without going to hospitals and getting counted.
But StrategyPage notes:
this doesn't mean they can't get sick or die, but merely that the disease might be less fatal in certain populations.
One wonders if this observation is seen in the African diaspora on other continents.
------------
globalvoices has a report on the cases in DRC, which were imported from Europe.
that makes sense, since a lot of reports are that people who came in from Europe are the ones who are bringing the disease to their African homes.
But StrategyPage notes:
...Chinese researchers found that Africans are less likely to catch covid19 because they have one fifth as many cellular receptors in their lungs than Chinese. That difference enables covid19 to cause breathing problems more, or less, readily. ...
Lung damage is the most frequent cause of death among covid19 victims. So far Africa, with 18 percent of the world population has only suffered about 0.3 percent of the covid19 infections. Africans are not immune, just less likely to get in infected or suffer the breathing problems that cause most covid10 related death
this doesn't mean they can't get sick or die, but merely that the disease might be less fatal in certain populations.
One wonders if this observation is seen in the African diaspora on other continents.
------------
globalvoices has a report on the cases in DRC, which were imported from Europe.
DR Congo has banned large gatherings, ordered school and university closures for four weeks and closed its border with Rwanda, all measures taken to stem the spread of the virus. The government also suspended all international flights from countries with a high number of cases of COVID-19.
that makes sense, since a lot of reports are that people who came in from Europe are the ones who are bringing the disease to their African homes.
Monday, March 23, 2020
A course on infectious disease
the Teaching company puts out excellent lecture courses on various subjects: well worth the cost.
Today, they put their course on infectious disease on line for free.
Today, they put their course on infectious disease on line for free.
Vikings, disease, and globalization
No, not the football team, but the old style Vikings.
SagaThing has a podcast and photos discussing the 18th century claim that Vineland was actually in the Boston Area.
this is probably an urban legend, but there is a lot of speculation about what would have happened if the settlement had succeeded: think Colombian exchange of disease and crops that would have changed history on both sides of the ocean. If the Indians had become resistant to smallpox, could they have stopped European settlement of North America? And could syphilis have decimated armies in Europe and changed that continent's history also?
see also: the Emigma of Dighton Rock
A trivial fact about Cotton Mather: He helped popularize small pox prevention in the 1720s by inoculating people with a small amount of actual smallpox: a practice he had learned about from African slaves and one that was being used in the Ottoman Empire and popularized in England by Lady Montague, who lived there with her ambassador husband.
this was risky, of course, but the morality was much lower than getting the actual disease, especially since most Americans (either Europeans who were born in the colonies or the Native Americans) had no resistance to the disease, the morality was quite high.
And when George Washington was fighting near Boston which was having a minor small pox epidemic, and knew most of his men had never been exposed to the disease, he first tried quarantine/isolation, but later mandated that all recruits who had never had smallpox receive smallpox vareolation in areas separate from the main camp, and only join the army after recovery.
That probably saved the American revolution.
In contrast, the black slaves who joined the British to fight because they were promised their freedom caught the disease because the British were clueless about the need for this preventitive treatment.
--------------------
There is a concept about "communities of memory": that churches, clubs and other institutions remember the lessons of human experience in the past and codify these lessons into laws and customs.
In medicine, the US military (and it's close relation, the US Public Health Service) has one such memory.
For example, our National Guard unit had a "headsup" about the potential for HIV to become a major epidemic before it hit the news, and I did the HIV counseling for screening our National Guard units at a time when the MSM was pushing the fake news that "everyone" was at risk for the disease. Uh, no: but it was taboo to mention behaviors that spread the disease.
Fast forward to the Coronavirus:
So maybe allowing Mardi Gras in New Orleans, Spring Break in Florida, and the New York City celebration of the Chinese New year were a bad decision, especially since the President had already closed the airports to stop the possible spread of the disease.... and when you read about stuff like this, where people who should have known better encouraged such parties, it does make one wonder if maybe one should heed the lessons of the past.
headsup instapundit
 |
| https://duxbury.wickedlocal.com/news/20180627/draken-viking-longship-visits-plymouth |
this is probably an urban legend, but there is a lot of speculation about what would have happened if the settlement had succeeded: think Colombian exchange of disease and crops that would have changed history on both sides of the ocean. If the Indians had become resistant to smallpox, could they have stopped European settlement of North America? And could syphilis have decimated armies in Europe and changed that continent's history also?
see also: the Emigma of Dighton Rock
the rock has been a focus of marvel and speculation ever since the year A.D. 1690, when the Reverend Cotton Mather, of witchcraft and brimstone fame, described it and the curious message engraved on its weathered, red-brown sandstone face.-------------------
A trivial fact about Cotton Mather: He helped popularize small pox prevention in the 1720s by inoculating people with a small amount of actual smallpox: a practice he had learned about from African slaves and one that was being used in the Ottoman Empire and popularized in England by Lady Montague, who lived there with her ambassador husband.
this was risky, of course, but the morality was much lower than getting the actual disease, especially since most Americans (either Europeans who were born in the colonies or the Native Americans) had no resistance to the disease, the morality was quite high.
And when George Washington was fighting near Boston which was having a minor small pox epidemic, and knew most of his men had never been exposed to the disease, he first tried quarantine/isolation, but later mandated that all recruits who had never had smallpox receive smallpox vareolation in areas separate from the main camp, and only join the army after recovery.
That probably saved the American revolution.
In contrast, the black slaves who joined the British to fight because they were promised their freedom caught the disease because the British were clueless about the need for this preventitive treatment.
--------------------
There is a concept about "communities of memory": that churches, clubs and other institutions remember the lessons of human experience in the past and codify these lessons into laws and customs.
In medicine, the US military (and it's close relation, the US Public Health Service) has one such memory.
For example, our National Guard unit had a "headsup" about the potential for HIV to become a major epidemic before it hit the news, and I did the HIV counseling for screening our National Guard units at a time when the MSM was pushing the fake news that "everyone" was at risk for the disease. Uh, no: but it was taboo to mention behaviors that spread the disease.
Fast forward to the Coronavirus:
So maybe allowing Mardi Gras in New Orleans, Spring Break in Florida, and the New York City celebration of the Chinese New year were a bad decision, especially since the President had already closed the airports to stop the possible spread of the disease.... and when you read about stuff like this, where people who should have known better encouraged such parties, it does make one wonder if maybe one should heed the lessons of the past.
headsup instapundit
virus news: fake news and onion poultices
We are still in complete lockdown here, including police who stop you on the street to check if you have the paper giving you permission to shop etc.
So I am in effect isolated with my dogs (and family, including the cook, the maid and the secretary and her family) in the house, with of course, a TV and internet connection.
I keep seeing these lies posted on my facebook page, and what makes me angry is that the MSM fact-checkers didn't stop them from being published.
Are they ignorant, or twisting things for political purposes? Trumpieboy speaks in his usual vulgar manner which is easy to understand but may exaggerate on the side of hope, and we read he is lying: One wonders how FDR's phrase "we have nothing to fear but fear itself" would be spun in today's toxic press environment. Probably they would be ridiculing him for lying about the Nazi threat, I guess.
At a time when people need to understand what is going on, and to have hope, I am aghast at this behavior.
LINK is conservative PJMedia list of the press' accusations that Trumpieboy is lying, along with the explanation that any 13 year old with access to google could have fact checked, but apparently no editor bothered to do so.
A lot of them are so obviously political spin and bad reporting.
But some of the "spin" is merely a difference of opinion by two different experts.
But some of the Spin is a misunderstanding how bureaucracy works (and a mis-understanding of how American government works, since much of this is controlled at the state, not federal level). No, the president does not micromanage everything: often this is done at a lower level of government.
as a doc who worked for years in the federal (and state) jobs, I am aware of how bureaucracy works: and the dirty little secret is that alas too often regulations are more important than common sense, alas.
For example, it's not really a the lie that the slowness of getting tests available was a government problem. It was true. But part of it was because of "red tape" that emphasized that the tests be evaluated to make sure they were accurate, never mind that the need to test was urgent.
So of course, the tests had to pass quality control and a maze of paper work to be approved before the laboratory could use them.
actually don't blame President Obama: the problem started long before his time in office.
Another problem in the media is all those fake experts who go around saying huge numbers of people will die.
True, a lot of people will die, but unless one analyzes the data, it will sound worse than it is.
one, you need to know the percentage of the population who die: 30 die in a nursing home sounds different than 30 out of 120 people in a nursing home died.
Then there is the problem of "x number people have the disease have died" numbers. Out of how many people?
This sounds terrible (and it is):
left out of the article: That Wuhan had 11 million people.
1.4% of people in Wuhan with symptoms died:
but this ignored that most people never never got sick so weren't tested. So the actual death rate in the population was much lower (less than one percent).
Another lie is that this is no worse than influenza, usually written by someone who never worked at a hospital or clinic in the middle of a major influenza epidemic.
The difference being that, unlike the 2009 "swine flu" epidemic (where both Lolo and I were immune since we had antibodies from a previous influenza epidemic in 1974), in this case everyone can get sick at the same time: including a lot of the nurses and caregivers, leading to the hospitals being overwhelmed with sick patients and not enough staff to care for them (which is what happened in Wuhan).
One is happy that the phrase "lower the curve" is finally being noticed by the clueless and picked up by the MSM in recent days.
As for treatment: see previous posts on that data and how the MSM is so busy spinning their web of political bias that one cannot rely on them for straight new (and no, I don't watch CNN: CNN Phil is off line for some reason and I can't stand Fox, so my news is from the internet, or from local news outlets on TV)
FYI: approval of medicine takes time, but if a medicine might work doctors will use it because they dislike patients dying when something might work and the "approved" treatments aren't working.
Finally, there are a lot of crazy stories out there: Grandmom says her potato soup cured her. Yup and probably Grandpa's whiskey helped him avoid the virus too (but only if he used it to clean surfaces), and no, a gin and tonic won't cure you either.
And it gets crazier if you check out Facebook: Vitamin C, Silver nitrate, miracles veggies...
well in medical school we were told a story about onion poultices.
During the Spanish Flu, there was a very high mortality among pregnant women.
One doctor was called to see a pregnant woman who was very sick and he know would probably die, and advised the latest scientific treatment that he knew was probably useless, but hey, he had to try.
The family's grandmother however, insisted that "all she needed was an onion poultice" and she'd be cured. The doctor forbad that useless treatment to be used in his hospital, of course. And of course, the woman died as he anticipated.
But for years, the family members would rebuke him saying: if only we had used an onion poultice, she would have lived.
sigh.
The problem of course is when people use folk remedies in the place of a treatment that would actually cure the disease.
But gentle folk remedies are not a problem if it helps the patient feel better (placebo effect) if you add them on top of the treatment that works.
So I am in effect isolated with my dogs (and family, including the cook, the maid and the secretary and her family) in the house, with of course, a TV and internet connection.
I keep seeing these lies posted on my facebook page, and what makes me angry is that the MSM fact-checkers didn't stop them from being published.
Are they ignorant, or twisting things for political purposes? Trumpieboy speaks in his usual vulgar manner which is easy to understand but may exaggerate on the side of hope, and we read he is lying: One wonders how FDR's phrase "we have nothing to fear but fear itself" would be spun in today's toxic press environment. Probably they would be ridiculing him for lying about the Nazi threat, I guess.
At a time when people need to understand what is going on, and to have hope, I am aghast at this behavior.
LINK is conservative PJMedia list of the press' accusations that Trumpieboy is lying, along with the explanation that any 13 year old with access to google could have fact checked, but apparently no editor bothered to do so.
A lot of them are so obviously political spin and bad reporting.
But some of the "spin" is merely a difference of opinion by two different experts.
But some of the Spin is a misunderstanding how bureaucracy works (and a mis-understanding of how American government works, since much of this is controlled at the state, not federal level). No, the president does not micromanage everything: often this is done at a lower level of government.
as a doc who worked for years in the federal (and state) jobs, I am aware of how bureaucracy works: and the dirty little secret is that alas too often regulations are more important than common sense, alas.
For example, it's not really a the lie that the slowness of getting tests available was a government problem. It was true. But part of it was because of "red tape" that emphasized that the tests be evaluated to make sure they were accurate, never mind that the need to test was urgent.
So of course, the tests had to pass quality control and a maze of paper work to be approved before the laboratory could use them.
Townhall noted that “Testing in the United States was fraught with difficulty in large part due to the slow approval by the Food and Drug Administration to allow testing kits developed by private companies outside of the government controlled CDC to be used at a local or national level. Those FDA policies are consistent with the Obama Administration's response to H1N1 and Ebola in 2009 and 2014 respectively.”
actually don't blame President Obama: the problem started long before his time in office.
Another problem in the media is all those fake experts who go around saying huge numbers of people will die.
True, a lot of people will die, but unless one analyzes the data, it will sound worse than it is.
one, you need to know the percentage of the population who die: 30 die in a nursing home sounds different than 30 out of 120 people in a nursing home died.
Then there is the problem of "x number people have the disease have died" numbers. Out of how many people?
This sounds terrible (and it is):
As of Feb. 29, there were 48,557 cases of the coronavirus and 2,169 deaths in Wuhan, according to the study.
left out of the article: That Wuhan had 11 million people.
1.4% of people in Wuhan with symptoms died:
but this ignored that most people never never got sick so weren't tested. So the actual death rate in the population was much lower (less than one percent).
Another lie is that this is no worse than influenza, usually written by someone who never worked at a hospital or clinic in the middle of a major influenza epidemic.
The difference being that, unlike the 2009 "swine flu" epidemic (where both Lolo and I were immune since we had antibodies from a previous influenza epidemic in 1974), in this case everyone can get sick at the same time: including a lot of the nurses and caregivers, leading to the hospitals being overwhelmed with sick patients and not enough staff to care for them (which is what happened in Wuhan).
One is happy that the phrase "lower the curve" is finally being noticed by the clueless and picked up by the MSM in recent days.
As for treatment: see previous posts on that data and how the MSM is so busy spinning their web of political bias that one cannot rely on them for straight new (and no, I don't watch CNN: CNN Phil is off line for some reason and I can't stand Fox, so my news is from the internet, or from local news outlets on TV)
FYI: approval of medicine takes time, but if a medicine might work doctors will use it because they dislike patients dying when something might work and the "approved" treatments aren't working.
Finally, there are a lot of crazy stories out there: Grandmom says her potato soup cured her. Yup and probably Grandpa's whiskey helped him avoid the virus too (but only if he used it to clean surfaces), and no, a gin and tonic won't cure you either.
And it gets crazier if you check out Facebook: Vitamin C, Silver nitrate, miracles veggies...
well in medical school we were told a story about onion poultices.
During the Spanish Flu, there was a very high mortality among pregnant women.
One doctor was called to see a pregnant woman who was very sick and he know would probably die, and advised the latest scientific treatment that he knew was probably useless, but hey, he had to try.
The family's grandmother however, insisted that "all she needed was an onion poultice" and she'd be cured. The doctor forbad that useless treatment to be used in his hospital, of course. And of course, the woman died as he anticipated.
But for years, the family members would rebuke him saying: if only we had used an onion poultice, she would have lived.
sigh.
The problem of course is when people use folk remedies in the place of a treatment that would actually cure the disease.
But gentle folk remedies are not a problem if it helps the patient feel better (placebo effect) if you add them on top of the treatment that works.
Sunday, March 22, 2020
huh? deliver, no return
we got the permits to do a delivery of rice to our customers in Manila, but if the drivers go there to do a delivery, they won't be allowed back into our town due to a strict quarantine order.
Sigh.
We are waiting to figure out a solution. In the "good old days' (/s) you would just give a small gift to the cop, but alas both Duterte and our mayor have been cleaning up the bad cops as part of the war on drugs and corruption, so that's no longer a solution.
however, I should point out that we sell gourmet organic brown rice.
The good news is that the government has enough ordinary rice stored in the capital region for ordinary folks to eat.
and the number of cases in the Philippines is still low, but then, I suspect a lot of cases were never seen or tested.
Or maybe the hot, dry sunny air partly destroys the virus and keeps down the spread.
----------------------------
Dilbert points out a lot of the "panic" stories with criticism are the norm in business: There is always a lot of people complaining that the boss is an idiot.
Sounds about right
-----------------------------
Sigh.
We are waiting to figure out a solution. In the "good old days' (/s) you would just give a small gift to the cop, but alas both Duterte and our mayor have been cleaning up the bad cops as part of the war on drugs and corruption, so that's no longer a solution.
however, I should point out that we sell gourmet organic brown rice.
The good news is that the government has enough ordinary rice stored in the capital region for ordinary folks to eat.
and the number of cases in the Philippines is still low, but then, I suspect a lot of cases were never seen or tested.
Or maybe the hot, dry sunny air partly destroys the virus and keeps down the spread.
----------------------------
Dilbert points out a lot of the "panic" stories with criticism are the norm in business: There is always a lot of people complaining that the boss is an idiot.
Sounds about right
-----------------------------
Dangerous childbirth
A woman in our neighborhood just died in childbirth of eclampsia (aka Toxemia of pregnancy)... they did a CSection but the baby died too. Sigh.
She was in her 30s and had high blood pressure, so was at high risk for this.
There was a delay in getting an ambulance and in sending her to the hospital in the next town due to the coronavirus blockades and discouragement of going outside.
Sigh.
This is the third death from Toxemia/Eclampsia in the last ten years in our neighborhood: another one in an older ladies who had a history of high blood pressure ( with twins) and one a teenager pregnant out of wedlock who was too ashamed to see a physician or midwife for prenatal care. In both of those cases, however, the babies were saved.
Article on the problem LINK
more here about childbirth in the Philippines by a western midwife, although things are improving since when that midwife wrote this in 2010.
one of the problems here in the Philippines is the lack of prenatal care for the poor: Many deliver with midwives or even with poorly trained "hilots", and many more just don't go for prenatal care because they don't realize why then need to get care. But even with prenatal care, this problem can appear suddenly or be missed.
When a person develops signs of pre eclampsia (swelling, headache, etc) the treatment is bedrest, anti seizure and anti high blood pressure medicine, and deliver the baby as soon as possible.
Here, this means going to the larger public hospital in the next town that has specialty services. If you can afford it, you can get a C Section in the local private hospital (but no ICU for the baby).
The next town is only 10 miles away, and the roads are paved, but still it may take 30 to 69 minutes for transfer, or more if you live in the rural areas.
When one of our farmer's wives developed edema/tremors, it took 3 hours to arrange an ambulance and get it to her house, and another hour to transfer her to the hospital, and she too died on the operating table.
Dr. Angi said frustratedly: Why didn't you just put her in a car and send her to me (she is an OB/Gyn who does a lot of charity work at the private hospital here)? But of course, that assumes the mother wouldn't have gone into convulsions in the car, and the transfer would still have taken time no matter what.
Few American doctors have cared for a complicated case of eclampsia: We did see it in the IHS, but a prompt C section usually prevented the mom from going into the seizures that are often fatal.
Ironically, in Africa, the women did not develop the typical signs of edema/swollen legs and high blood pressure: I'm not sure why: Maybe due to the low salt diet in the area where I worked.
They would come in without problems and then suddenly start having brisk reflexes, then tremor, and usually a prompt injection of medicine would stabilize them so they could deliver safely, but not always...So some would still go into a seizure. Sometimes too the seizures happened after the delivery (one third of cases).
The argument about a C section vs waiting a short time to let her deliver normally was a sub plot in Downton Abbey... Back then, in the days before antibiotics and blood transfusions, there was a high death rate from the surgery, and if it had been done, the mother might have died anyway.
She was in her 30s and had high blood pressure, so was at high risk for this.
There was a delay in getting an ambulance and in sending her to the hospital in the next town due to the coronavirus blockades and discouragement of going outside.
Sigh.
This is the third death from Toxemia/Eclampsia in the last ten years in our neighborhood: another one in an older ladies who had a history of high blood pressure ( with twins) and one a teenager pregnant out of wedlock who was too ashamed to see a physician or midwife for prenatal care. In both of those cases, however, the babies were saved.
Article on the problem LINK
more here about childbirth in the Philippines by a western midwife, although things are improving since when that midwife wrote this in 2010.
one of the problems here in the Philippines is the lack of prenatal care for the poor: Many deliver with midwives or even with poorly trained "hilots", and many more just don't go for prenatal care because they don't realize why then need to get care. But even with prenatal care, this problem can appear suddenly or be missed.
When a person develops signs of pre eclampsia (swelling, headache, etc) the treatment is bedrest, anti seizure and anti high blood pressure medicine, and deliver the baby as soon as possible.
Here, this means going to the larger public hospital in the next town that has specialty services. If you can afford it, you can get a C Section in the local private hospital (but no ICU for the baby).
The next town is only 10 miles away, and the roads are paved, but still it may take 30 to 69 minutes for transfer, or more if you live in the rural areas.
When one of our farmer's wives developed edema/tremors, it took 3 hours to arrange an ambulance and get it to her house, and another hour to transfer her to the hospital, and she too died on the operating table.
Dr. Angi said frustratedly: Why didn't you just put her in a car and send her to me (she is an OB/Gyn who does a lot of charity work at the private hospital here)? But of course, that assumes the mother wouldn't have gone into convulsions in the car, and the transfer would still have taken time no matter what.
Few American doctors have cared for a complicated case of eclampsia: We did see it in the IHS, but a prompt C section usually prevented the mom from going into the seizures that are often fatal.
Ironically, in Africa, the women did not develop the typical signs of edema/swollen legs and high blood pressure: I'm not sure why: Maybe due to the low salt diet in the area where I worked.
They would come in without problems and then suddenly start having brisk reflexes, then tremor, and usually a prompt injection of medicine would stabilize them so they could deliver safely, but not always...So some would still go into a seizure. Sometimes too the seizures happened after the delivery (one third of cases).
The argument about a C section vs waiting a short time to let her deliver normally was a sub plot in Downton Abbey... Back then, in the days before antibiotics and blood transfusions, there was a high death rate from the surgery, and if it had been done, the mother might have died anyway.
Saturday, March 21, 2020
Happy Norwuz
the Persian Spring Festival starts on Feb 20.
a pre Islamic Zorastrian festival celebrated in the Middle East, Central and South Asia.
BBC video (from 2019)
link: white House press release:
the sanctions against Iran do not include medicine or food, but nevertheless are hurting the civilian population by wrecking their economy, so many are urging that the US lift them, especially since Iran is in the midst of a major Coronavirus epidemic.
On the other hand, like North Korea, one sees a regime that will take aid supposed to go to their civilian population and use it to build weapons and pay their terrorist proxies fighting in other countries.
I worked in Rhodesia when world sanctions were trying to overthrow the evil apartheid regime: And sometimes our hospital would have to substitute older cheaper but more dangerous medicines to treat diseases, and we had to re-sterilize things like gloves and bandages because supplies were limited (we were allowed 20 pairs of gloves per month at one point).
but eventually it worked, but maybe because the leaders were not crazy believers in a rigid (communist/religious) dogma, just greedy.
I have no easy answer to this.
Lifting sanctions might save lives, but result in more deaths from Iran's proxy wars in Yemen and Syria (not to mention the deaths if one of the crazy Mullahs act on their threats to nuke Israel and start World War 3).
a pre Islamic Zorastrian festival celebrated in the Middle East, Central and South Asia.
BBC video (from 2019)
link: white House press release:
Nowruz is a time of renewal that encourages those observing the holiday to embrace a refreshed spirit of optimism.... As they begin this season of renewed hope, we join our partners and allies around the world in praying for a brighter, freer future for Iran. On behalf of the United States, I extend my warmest greetings for a joyous and peace-filled Nowruz.uh, Mr President: tear down that wall (of sanctions).
the sanctions against Iran do not include medicine or food, but nevertheless are hurting the civilian population by wrecking their economy, so many are urging that the US lift them, especially since Iran is in the midst of a major Coronavirus epidemic.
On the other hand, like North Korea, one sees a regime that will take aid supposed to go to their civilian population and use it to build weapons and pay their terrorist proxies fighting in other countries.
I worked in Rhodesia when world sanctions were trying to overthrow the evil apartheid regime: And sometimes our hospital would have to substitute older cheaper but more dangerous medicines to treat diseases, and we had to re-sterilize things like gloves and bandages because supplies were limited (we were allowed 20 pairs of gloves per month at one point).
but eventually it worked, but maybe because the leaders were not crazy believers in a rigid (communist/religious) dogma, just greedy.
I have no easy answer to this.
Lifting sanctions might save lives, but result in more deaths from Iran's proxy wars in Yemen and Syria (not to mention the deaths if one of the crazy Mullahs act on their threats to nuke Israel and start World War 3).
Sigh.
Kung Flu Fighting: the Musical
from 2013.
this might be the origin of the "kung flu" joke that upset a couple of PC journalists in the US: a video about getting flu shots.
headsup EvilBloggerLady
related item:
----------------
here is an example of press bias: Not the facts, which is to be cautious about unproven cures, but the way it is written to demonize Trumpieboy.
I italicized the biased part of the report: and added my suggested rewrite.
the rest of the article isn't much better.
Historical note:
a lot of people die in the USA because drugs available overseas haven't passed the long complicated studies for approval.
the pressure to "fast track" medicines in cancer or HIV, or to use already approved medicines for "off label" situations is common.
on the other hand, it was this "safety first" idea that prevented a thalidomide disaster.
Of course, thalidomide was pushed as an anti nausea pill (by the way, we still use it for leprosy and multiple myeloma, with strict controls to keep it from pregnant ladies).
Medicine has a long history of using "unproven therapies": some of them work, some don't work, and sometimes the problem is that they are used when the cause of the symptoms might be different, so work sometimes (bloodletting for shortness of breath doesn't work for pneumonia but does work for congestive heart failure complicating a fever, which has similar symptoms).
Remember the story of the 1925 dog sled delivery run from Anchorage to Nome, commemorating the heroic dog sled delivery of diphtheria anti toxin there? The Diphtheria anti serum was first used in the 1890s
LINK
the dirty little secret is that diphtheria anti serum was medical breakthrough never had a "double blind" study until the 1920s and a second one later in the 1940s:
Because the doctors, seeing children dying in front of them, just were not able to watch children die when there was a possible treatment that might save them.
one additional note: anecdotal reports say that China is using serum from recovered Coronavirus patients. If this works, presumably the next step might be "manufacturing" the serum, either via horses/animals which are still used to make anti rabies serum, or by more modern methods.
this might be the origin of the "kung flu" joke that upset a couple of PC journalists in the US: a video about getting flu shots.
headsup EvilBloggerLady
related item:
here is an example of press bias: Not the facts, which is to be cautious about unproven cures, but the way it is written to demonize Trumpieboy.
I italicized the biased part of the report: and added my suggested rewrite.
NYTimes:rewrite: Trump hopes experimental treatments will cure corona virus.
Trump’s Embrace of Unproven Drugs to Treat Coronavirus Defies Science
At a long-winded White House briefing on Friday, President Trump enthusiastically and repeatedly promoted the promise of two long-used malaria drugs that are still unproven against the coronavirus, but being tested in clinical trials.rewrite: At the White House Briefing on Friday, President Trump noted early studies suggested anti malaria drugs might cure corona virus.
“I’m a smart guy,” he said, while acknowledging he couldn’t predict the drugs would work. “I feel good about it. And we’re going to see. You’re going to see soon enough.” 'So that is accurate.
But the nation’s leading infectious disease expert, Dr. Anthony S. Fauci, delicately — yet forcefully — pushed back from the same stage, explaining that there was only anecdotal evidence that the drugs, chloroquine and hydroxychloroquine, may be effective.rewrite: leave out the implication that Dr. Fauci was criticizing the president instead of cautioning people that it might not work because studies haven't been done.
the rest of the article isn't much better.
Historical note:
a lot of people die in the USA because drugs available overseas haven't passed the long complicated studies for approval.
the pressure to "fast track" medicines in cancer or HIV, or to use already approved medicines for "off label" situations is common.
on the other hand, it was this "safety first" idea that prevented a thalidomide disaster.
Of course, thalidomide was pushed as an anti nausea pill (by the way, we still use it for leprosy and multiple myeloma, with strict controls to keep it from pregnant ladies).
Medicine has a long history of using "unproven therapies": some of them work, some don't work, and sometimes the problem is that they are used when the cause of the symptoms might be different, so work sometimes (bloodletting for shortness of breath doesn't work for pneumonia but does work for congestive heart failure complicating a fever, which has similar symptoms).
Remember the story of the 1925 dog sled delivery run from Anchorage to Nome, commemorating the heroic dog sled delivery of diphtheria anti toxin there? The Diphtheria anti serum was first used in the 1890s
LINK
After Roux’s signal paper, the use of diphtheria antitoxin spread throughout the developed world. Wherever it was used there occurred a reduction in case mortality. Although there was nothing akin to a double-blind clinical trial (case mortalities were compared to those prior to the adoption of the antitoxin) the circumstantial evidence was compelling.
the dirty little secret is that diphtheria anti serum was medical breakthrough never had a "double blind" study until the 1920s and a second one later in the 1940s:
Because the doctors, seeing children dying in front of them, just were not able to watch children die when there was a possible treatment that might save them.
one additional note: anecdotal reports say that China is using serum from recovered Coronavirus patients. If this works, presumably the next step might be "manufacturing" the serum, either via horses/animals which are still used to make anti rabies serum, or by more modern methods.
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