From History

Confutatis Maledictis … Voca me

Blondie and Wolfgang Amadeus Mozart

In case you are not fluent in Latin, that is what the title means. Once the accursed have been destroyed… call me.

The last time I worshiped in a church was at age 7, almost three-quarters of a century ago.  That is a long time, but not when comparing it to eternity, which is what I was thinking about at the time.  I had been honored to be selected as an altar boy from amongst my grade school classmates in Austria.  I was chosen probably because my father was the only chess partner with whom the local priest could play an advanced game of chess.  They would spend days literally on one game, often deep into the night.  My father’s religious background was somewhat dubious, although he and the priest had vehement discussions about God and philosophy. Ironically my father had just converted to Catholicism as he needed those credentials to further his claims of Teutonic origins.  The constant risk of being taken off to Auschwitz by the Nazis was ever-present. Although, it would have more likely been Mauthausen, which was only 130 km from our village.  My father, the town doctor, was not all that happy with my recent appointment; he thought it was inappropriate, given our family’s circumstances, something I did not comprehend until I was much older. I, on the other hand, was thrilled! I especially loved the long flowing robes they gave me.  My job was carrying the censer.  Those of you who are not Catholic will likely not know what that is. It is the metal container for burning incense.  My job was to bring it down the aisle of the church already lit and emanating the holy smoke.  I was not to disburse it but hand it to the priest who did that.  But I could not resist, a little unnoticed subtle swinging of the censer on its chains actually produced a lot of smoke (the carcinogenicity of which has never, to this day, been tested) that I could waft through the church. 

My father felt it necessary to talk about philosophy and ethics with me.  As a consequence, my stint as an altar boy did not last very much longer.  And as life progressed through school, college, and medical school, it became increasingly difficult for me to reconcile my earlier philosophy that I learned in altar boy school, with the biblical God who did not, or could not stop the evil of the world.  How was it that God could allow such evil and cruelty to permeate our lives?  It started with the flood which drowned all of humanity, including the unborn save for Noah and family.  God allowed the Holocaust, the Holodomor, the Armenian Genocide, and all those genocides in Africa.  Free will didn’t do it for me, besides it did not consider the free will of all those murdered people who, I am sure, had different visions for themselves, which did not take into account their free will.

Nevertheless, I am not aspiritual.  I consider myself very spiritual, and  I have a fervent belief that there is more to our existence than is apparent, and that our lives have a purpose beyond our comprehension. My journey eventually led me to medicine and a life of service to the sick and injured, in principle, not all that different from priesthood. Even everlasting life is possible in my construct of the universe, although with a different twist involving double helixes of DNA.

There is more of my early years that stayed with me than just the smell of incense, and my secret inner spiritual life.  It was music.  In European churches and cathedrals, music often accompanied the services. In large churches or cathedrals, it was frequently a full orchestra.  This was a good thing because it did make the services, which were all read in Latin in my time, much more tolerable.  The liturgical music was often, if not almost always, composed by Mozart, who, by the way, was Austrian.  One particular piece of music that affected me more than others was the Mozart Requiem in D Minor, particularly the “Confutatis.” It begins in D Minor but modulates to F Major with very rhythmic commanding male voices that have an almost infernal sound.  Confutatis Maledictis  – Once the Accursed have been destroyed – Flammis acribus addictis – and given over to the bitter flames – Voca me con benedictis – call me with the blessed, now sung by a gentle melodic heavenly female choir in hushed angelic tones.  If you have never heard it, you must before you die.  In fact that is what I want for my funeral whenever that happens, hopefully, later than sooner.  It was also what Chopin ordered to be played at his, which was quite an achievement because women were not allowed to sing in the churches of Paris.  It took a special proclamation by the Archbishop to allow it.  It is surprising that Chopin chose the Mozart requiem for his funeral, as Chopin had written the penultimate iconic masterpiece of all funeral marches himself, which you would recognize instantly, as it was played in many movies and served the funerals of many heads of state including JFK, Stalin, Brezhnev, and others. It is universally recognized and linked to death and mourning.  

You will assume that all  I listen to is Classical Music.  That is simply not so!  The Confutatis brings forth the theme of summoning you, in Mozart’s case, to Heaven.   There is another piece of music from my later youth that was not classical, that also is summoning you.  It evokes many pleasant memories from when I was young and much better looking than now. This is another melody you should listen to before you die, this one with a completely different style and meaning. While the Requiem is calling you to Heaven, Blondie is calling you for a much more earthly and earthy activity compared to the Requiem!

Call me (call me) on the line
Call me, call me any, anytime
Call me (call me). I’ll arrive

You can call me any day or night
Call me

Cover me with kisses, baby
Cover me with love
Roll me in designer sheets
I’ll never get enough!

The call is quite transparently a bit more sanguine than the Requiem call. Music is the universal language that can and does evoke all flavors of human emotions.

THE BARD WRITES A MODERN SOLILOQUY

“To open or not to open, that is the question? Whether ‘tis nobler in the mind to suffer the slings and arrows and risk COVOD-19, or to stay at home, to sleep and perchance to dream.  Ay there is the rub.  Should we herd on the beaches toe to elbow, should we hit the malls four abreast, should we take off our masks and crowd into congress and state houses, waving flags and claim our rights of birth? Or grunt and sweat under a weary life?  Should we follow science or the constitution?  There is the respect that makes calamity of so long a life. For who would bear the whips and scorn of ICU care? It is us who would dare?”

How about should we practice common sense? There is no easy answer; both hardcore choices offer death and destruction.  Opening will create the same scenario as in 1918 of Philadelphia vs. St. Louis, double the death rate. Not opening will increase unemployment, increase the suicide rate, increase domestic violence, child abuse, depression, increase poverty, destroy the market, and produce its own set of evils. 

The answer, of course, is to do both with forethought and caution. It all depends on the community. is it urban? Is it rural? What is the population density? What jobs can function well from home?  What jobs require actual physical presence? What jobs are essential? What jobs are optional?  How well can people learn to practice social distancing? Which masks work best?  Are there medications that decrease the risk of infection like Pepcid, Vitamin D, Remdesivir, and who should be taking them?  Certainly, the low-risk drugs should be liberally distributed, where the high-risk drugs (like Hydroxychloroquine) that can cause Torsade de Pointes (freely translated -death), also renal and liver toxicity  could be doled out only to those that are healthy, but at high risk, who have normal Q-T intervals (normal EKG’s for non-doctors).  Testing for both active virus and antibodies would also help in deciding whom to isolate and who is relatively safe to walk among us.  Simple testing such as temperature screening should be practiced widely and regularly.

The message should be crystal clear and delivered not just from the governmental authorities but a consortium of elected officials, law enforcement, scientists, physicians, and spiritual leaders of the community.  This will strengthen the message and allow stringent enforcement of the decisions that are uniformly adopted. Social distancing will be with us for a long time to come.  Just look at the continuing increase in cases and the death rate.  And, yes, uniform enforcement must be dealt out to all.  Just like Typhoid Mary was put behind bars for not obeying the law, and because of that careless act killed people with typhoid fever.  That will not work for us, the jails are already full, but some disincentives for civil disobedience will need to be meted out, a fine, for example, and civic service for repeat offenders. Nowhere in the Constitution does it give anyone the right to infect others at their whim. Just as people wielding weapons need to be constrained to protect society, so do people who would spread disease wantonly. No one is above the law!

What should we do?  We should do what common sense dictates.  Do the best for the most, as the power of the people dictates us to do! 

“STINKO” DE MAYO

Execution by firing squad of Emperor Maximilian I of Mexico

I do not celebrate Cinco de Mayo.  I doubt that many Mexicans know the real story surrounding that date. If they knew what a vicious, murderous, and petty character President Benito Pablo Juarez Garcia really was, they should not either. 

On May 5, 1862, the Mexican Army defeated the French Army in the First Battle of Puebla.  Benito ran the country into the ground financially, as liberals often tend to run out of your money, and Mexico fell heavily into debt to Spain, England, and France.  Britain and Spain were less anxious, but the French sent troops to Mexico to encourage repayment of the debt. A year later, the French defeated the Mexicans in the Second Battle of Puebla and also took Mexico City. The first battle was a morale boost for Mexico, even though it was a minor victory of little military consequence.  The second battle allowed France to install Emperor Maximilian as the leader of the Mexican Government.  Maximilian was appointed by the Emperor of France, Napoleon III, the nephew of Napoleon I.  Maximilian was a Habsburg, the younger brother of Franz Joseph, Emperor of Austria.   Napoleon I had divorced Josephine and moved into the Palace of Schönbrun in Vienna and married an Austrian Princess with whom he had a son. It was this that created the French/Austrian connection from then on.   Maximilian was an enlightened leader.

Maximilian, as Emperor of Mexico, introduced land reform in Mexico, giving property to the people to grow crops and develop.  He took assets from the very wealthy Catholic Church and created religious freedom for everyone. Maximillian brought Austrian culture and even Austrian music to Mexico. The classical “Umpapa” music heard in the usual Mexican folk music is heavily laced with strains of accordion sounds, an instrument popularized in Berlin and  Vienna around 1830.  Maximillian gets no credit for that musical gift to Mexico.

Other than ruining Mexico’s economy, Juarez didn’t do much for the people.  Benito Juarez, President of Mexico, had to escape when Maximilian was crowned.  Juarez, the head of the liberal factions, was in conflict with his own country’s conservative branch, who, in fact, supported Maximilian over him. Maximilian offered Juarez amnesty and even offered him the position of prime minister.  Juarez had conservative members of the Government rounded up and had them murdered without trial, just shot, which was the original  “Black Decree,” according to historians.  He later accused Maximilian of that heinous act and used it as justification for having Maximilian executed.  Although Maximilian did execute some hardcore military, he did so after a military court-martial and pardoned many of them.

Abraham Lincoln refused to support Juarez, nor did the US House and Senate, and it was only because Andrew Johnson, who took over after the Lincoln assassination, could not get Congressional support for Mexico, and pulled the Reagan/ Iran Contra Affair trick, by privately and secretly seeing to it that Juarez got some much needed presumably “lost” weapons of US Army stock near the Mexican border for his fight against Maximilian. After all, he wanted to follow the Monroe Doctrine of no European influence in the Americas.

When the French abandoned Maximilian,  he was arrested.  He had the chance to escape but did not want to leave his supporters, and never assumed that Benito, whom he liked and with whom he had an amicable relationship, would kill him. Every crowned head of Europe including Queen Victoria, the Czar of Russia, the Kaisers of Austria, and Germany, the King of Spain who was a Habsburg, Garibaldi of Italy and the famous author, Victor Hugo of France, as well as Pope Pious IX petitioned Juarez to give amnesty to Maximilian, but Juarez felt he needed to prove himself to the Europeans.  He needed to show his superiority to those aristocrats that he was in charge, and he was more powerful, he was the leader of Mexico now.   But to me, that just proved his small-mindedness and provincial attitude, as well as a loss of respect in Europe!

Maximilian, when facing his executioners, gave each of them a gold coin, asking them not to shoot him in the face so that his mother could recognize his body. On June 19, 1867, Maximilian was executed by a firing squad.  His last words were “Viva Mexico!”

I was born in Austria, and my parents were Austrians.  I have respect for my place of birth and its history.  And I resent the fact that a self-impressed bureaucrat who wanted to call attention to himself by murdering an Austrian Emperor gets any credit at all, instead of condemnation, even if this was over 160 years ago. So I don’t think you will hold it against me if a call it “Stinko de Mayo!” and don’t share my Guacamole or beer with anyone as a celebration of a petty president.   Besides, it wasn’t until the 1980s that the day got more attention because of the American Beer Industry who looked for a date to celebrate, and it now rivals the Super Bowl in beer revenue and avocado sales, except this year because of the Corona pandemic.

WE ARE AT WAR! (This Time with a Virus!)

It pains me to see the bitter divisiveness our country is undergoing, specifically understanding the current ad hominem attacks on President Trump. Ad hominem attacks, rather than attacking the substance of a position, attack the person’s character, his motives, or other personal attributes of the individual, and make the argument that because of these traits, his position is also wrong. It was Aristotle who first pointed out that such arguments are illogical and unsound. These attackers focus on Trump’s stupidity, his narcissism, his self-aggrandizement, his lack of humor, his small hands (and we all know what that is supposed to mean) etc. etc. Is this helpful?  Does this add anything to the discussion? Will this change anything? Almost none of these tirades focus on meaningful critique as to what he should do differently. This makes me think the critics either don’t know what he should do differently or they are afraid to voice any opinion because they very well may be wrong. 

Former Vice-President Biden was very critical of Trump about shutting down travel from China.  He called him hysterical, xenophobic, and fearmongering.  The spinmeisters claim those labels did not specifically relate to him closing travel from China, even though those critical remarks came right after the travel restrictions.  If that is so to what did it refer? Ah! I know. He named the virus “the Chinese virus,” which called forth another straw man, the race card.  Trump is a racist! But is that realistic? The fact that the epidemic started in Wuhan, China, ostensibly from Chinese bat soup, makes it relatively easy to call it a Chinese virus, just as the 1918 pandemic was called the Spanish Flu with much lesser justification. The first case of the 1918 Flu was actually in Kansas. 

Biden’s fearmongering critique demonstrates how being critical too soon can backfire.   The newest Biden critique complains the opposite, that Trump acted too slowly.  Trump tends to be positive about opening up the country, about medications that may help, about the stock market coming back, about fewer deaths than the models predicted.  He often puts the better spin on the message given by his consultant doctors; nevertheless, he does what they say to do. I might add that doctors are trained to hang black crepe.  It is in their nature. I know, I am one. Trump does not want to be the fearmonger that Biden claims him to be.  He wants to be reassuring but has not acted on that positivity, and sticks closely to what Dr. Anthony Fauci recommends. I am sure the President would like to be a cheerleader, and we certainly need one!  

In a few months, we will have the chance to elect a new president.  That will be the time to exercise your opinion, your rights as a citizen, and your wisdom.  The word Democracy comes from two Greek words, Demos (the people) and Cratos (the power). We shall see what our Democracy will do, and then I shall support what the people decide, as our Founding Fathers envisioned, and I hope the rest of the country will also do as I do. In the meantime, I believe for the current COVID war, our Democracy has already spoken twice. For almost 250 years we have had certain rules for electing the President, and those rules have not changed. It is appropriate to go with the lawfully elected President, given our time of uncertainty and combat against an unseen enemy.

Ad hominem attacks lack style and put the attacker into a lesser class.  If you can’t argue intelligently with facts and figures, don’t succumb to name-calling.  It does not make you look classy. Donald Trump is no Ronald Reagan, but he is our President, whether you like it or not. We are in a war, even though this enemy is a virus, and war demands we act on a war mentality that traditionally requires unity and civility.   I plead that we keep our cool and act with style, intelligence, and wisdom, and listen to Aristotle!   

THERE IS NOTHING NEW UNDER THE SUN

It has been a month now that the government edict to stay at home has been proclaimed.  Many have lost jobs, and there is a natural resistance that is evolving among the restless among us.  The question of individual rights and freedoms is raised.  Is it not my right to control where I go and what I do? This philosophy has evolved into a political movement of Libertarianism that emphasizes freedom of choice, voluntary association, and holding the individual’s judgment as the holy grail of how we should live. There are right-leaning and left-leaning Libertarians. But both pit governmental authority against individual opinion. Why should I wear a mask when I am not sick, why should I vaccinate my children when vaccination has some risk and has in some cases shown not to be completely protective?  Why should I stay at home when I need to get back to work?  There are only two certainties, death and taxes. People die all the time, how is that different from this virus?  The country’s and my personal economic condition is deteriorating while I sit at home bored out of my mind.  It is my decision to risk my life if I deem it necessary?  We live in a democracy.  How can the government tell me what to do?

Those are the arguments I hear from friends, the radio, talk show hosts, and sometimes I even have these thoughts myself.  There is, however, an overriding principle.  Humans live in social groups.   Only hermits can act out their fantasies. Our actions impact others. We have social responsibilities that go beyond our personal being.  When our freedom impacts society adversely, society has a right to regulate what we do.  Willie Sutten, when he was caught, was asked why he robs banks?  His answer, “Because that is where the money is.” I have always wanted to be rich, but I can’t go to banks, like Willie, and take what I want.  My right to be rich is infringed upon by other’s rights not to have their wealth stolen. My right to refuse vaccinations interferes with the population’s rights not to have a carrier of disease spread the plague and shorten their life span.

Mary Mallon was born in County Tyrone in Northern Ireland. She came to New York and was a  cook working in restaurants, and also for a number of families that hired her to cook for them.  Everywhere she went, people got sick with fever and diarrhea; some even died.  The disease that caused this illness was determined to be from a bacteria, Salmonella Typhi.  She was not ill and appeared perfectly healthy.  At least 50 deaths from Typhoid fever were attributed to her.   

She was held in quarantine from 1907 to 1910.  But when released, she went back to her old job of cooking.  This time she moved on, when people got sick, to the next cooking job.  Authorities failed to catch her until 1915.  She spent the rest of her life in jail and died in 1938 of pneumonia. History assigned the name “Typhoid Mary” to her.

It was Rudolph Virchow, a German pathologist of the 19th century, who gave us the word “zoonosis,” a disease that originates in animals and then is transmitted to humans.  In its more aggressive form, it can then spread from human to human. There are many zoonoses, Swine Flu, Avian Flu, Ebola, Malaria, Anthrax, Trichinosis, Rabies, Plague, COVID-19, etc. Our close association with animals started with the domestication of animals, going back to the late Pleistocene, beginning 129,000 to 11,700 years ago during the last ice age.  The Middle Ages brought humans and animals together even closer, when farmers brought their animals into their houses for warmth and to guard them.  Because we lived in close proximity to animals, their bacterial, viral, and protozoan diseases could now jump to us quite easily.

When our freedom interferes with the freedom of others, a compromise must be negotiated.  We can only exercise our freedom if it does not take away the freedom of others.  That principle is what allows the imposition of shelter in place dictates, immunization mandates, social distancing rules, and the wearing of face masks. South Dakota resisted implementing social isolation for much too long in the name of freedom of choice, with many unnecessary deaths. This recent pandemic has been a new experience for us, but it is not unprecedented.  1918 gave us the Spanish Flu, named because of a misunderstanding.  Spain was neutral in World War I.  The first case of that Flu was actually March 11, 1918, in Kansas.  Because there was censorship, as not to reduce the morale of the troops, it was not reported.  Spain, on the other hand, was not bound by that censorship and reported all the gory details, including that their king, Alfonso XIII, came down with a severe case of it.  That cinched it.  From then on, it was “The Spanish Flu.”     Quarantine and masks were the order of the day. There is nothing new under the sun!

CORONAVIRUS FOR DUMMIES

My last two essays were, you guessed it, on COVID-19. That is all you hear on the radio or TV these days. In keeping with the trend, I am continuing to stir the pot. It has gone viral.  Coronavirus, true to its name, is a virus that has gone viral! 

Viruses grow exponentially (J-shaped growth curve), the fastest growth rate there is, the larger the growing population, the faster the growth, as long as the food holds out.  When the food runs out, the curve then changes to a logistic curve (S-shaped growth curve).  This curve shows a slowing down of growth. So what makes the curve slow down?  There are only two things that make the curve slow down: #1 fewer in the susceptible herd are available (either through the susceptible making themselves less available or the process makes the susceptibles less available ).  #2 the rate of growth slows down.  This happens when it takes longer to infect the next person.  This could be when people wash their hands more often, don’t go out to spread the virus, or at least sneeze into a napkin. Ultimately when the food supply runs out, both mechanisms are at work, reducing the susceptible and the rate of spread.

The number of new cases will slow down, guaranteed! But will we still be alive to talk about it? I think we will.  There are several reasons I believe this.  We are worried about it, in fact too worried! As evidenced by the stock market!  The virus is not as dangerous as the news media tells us.  The mortality rate is likely not 9% as SARS was, it is closer to 0.1% as the last flu outbreak was. The measures we are taking to reduce the number of people exposed, and the rate of spread will reduce the number of new cases.  It is common sense not to go out and buy cruise trip tickets.  It is common sense to limit your unnecessary exposure to large crowds.  It is common sense to wash your hands often.  It is common sense not to bring the virus close to the places the virus gains entry to your lungs, like your eyes, your nose, and mouth. The virus stays active for a couple of days on any surface, such as a door nob, so washing hands is not only hygienic but important.

I have been in the doctor business over two-thirds of my lifetime, and have washed my hands to the point that I have scrubbed off my fingerprints. 

They always have trouble when I need to give a fingerprint for a passport or other ID, because I obliterated them off over the years. I first learned to scrub for surgery in my third year of medical school at UCLA from one of the icons of surgery. He put soot on our hands, then blindfolded us, gave us a brush and soap, and made us scrub our hands. You would be surprised how much soot stayed on our hands and the places that were most likely to remain black, the back of our hands, the webspace between the fingers, and the space between the wrist and the palm.   For medical students, it was a minimum of ten minutes (first scrub of the day) to get our hands clean. But for our purposes, washing for 20 seconds is generally enough.  I learned a nice little trick from my grandchildren’s primary school teacher, singing the “Happy Birthday” song twice (at regular speed) is precisely 20 seconds. 

You get the virus from another person, either through direct contact or through a surface, the infected person has left some body fluids.  Avoiding other people is one way to decrease contact.  I believe that shaking hands was an ancient, rather strange custom.  It goes back to the Middle Ages when you met someone in the forest. You extended your right hand, as did the other person, to show that they did not have a dagger in it.  It was somewhat awkward standing there with both your and his hands extended, so grabbing and shaking seemed like the right thing to do. As we don’t carry daggers any more, this Middle Age custom has outlived its usefulness and needs to stop.  I vote for the Mr. Spock handshake: right hand raised at your side with the index and middle finger spread form the ring and pinky finger in a V configuration.  This is necessary because if you don’t spread your fingers, it looks like a “Heil Hitler.” And if you leave just your middle finger up, it changes the entire meaning.

Viruses, like white men, can’t jump. Therefore a yard distance between people should be enough although the CDC in an abundance of caution has now revised it to two yards unless they are coughing or sneezing. If they are, you need to get out of that room, because the sneeze generates particles that are as small as 5 microns in diameter that travel over 100 miles per hour, and can stay in the air indefinitely like any pollen sized or smaller particle.

Masks are not very helpful, except for the ill person who coughs and sneezes.  It keeps the particles that are spewed out more confined.  Regular masks, actually, are not very effective in preventing inhalation.  For one thing, the sides allow fine airborne mist to enter the space behind the mask, which is inhaled. To be effective, it has to be a special mask fitted to the individual that allows only air that goes through the mask to get to the person using it.  Those masks do not let fine mist or small particles to go through.  These are called N95 masks.    

Hugging is another one of those human customs that should go away.  I won’t even discuss kissing.  Hugging and kissing ought to go the way of arranged marriages and should be relegated to the XO on the written word.

Good Luck!! Gus Iwasiuk XOXO

LIES, DAMNED LIES, AND STATISTICS

Mark Twain by A.F.Bradley ©       Benjamin Disraeli  Photos.com/Jupiterimages ©

“There are three kinds of lies: Lies, Damned Lies, and Statistics.” The phrase is often claimed to be one of Mark Twain’s quotes, who, in fact, attributed it to Benjamin Disraeli, who served Queen Victoria as Prime Minister of the United Kingdom.  This quote is not found anywhere in Disraeli’s writings, although he may have said those words. Regardless of who said it, the sentence argues that statistics are often the worst kind of misinformation because they have the authority of numbers; the sources are hard to pinpoint and dispute and therefore are believed.

I fell into this trap recently and exposed my ignorance by quoting the Coronavirus mortality statistics, as given in large part, by the Chinese government.  The clue to me should have been “Chinese government.” The number of deaths I saw in the news was 3,132 deaths of a total of 92,303 (the newest numbers 3,886 deaths and 111,650 total cases). Nevertheless, mortality rates remain close to 3.4%.  The number of people that died is probably accurate.  It is hard to fake death, and counting the dead is likely to be reasonably precise. If they don’t move, they are probably dead.  The denominator has grown to 111,650 people that have the disease and are almost certain to be undercounted.  Mild cases are frequently not diagnosed or reported.  A runny nose is a runny nose, not COVID 19, in most people’s judgement, but then again, it could be.  The denominator is likely a much larger number judging from statistical analysis of previous epidemics. This would significantly revise mortality downward.

That, however, is not the essential source of misleading information. To accurately estimate disease mortality, raw numbers give the wrong impression.  In the seasonal flu mortality, we see every year, and the numbers are more accurately reported remaining under 1% because:

  • We are in the USA
  • Our health reporting is mandated by governmental agencies (not necessarily a strong point)
  • We try to be scientifically as honest as we can with checks and balances that report dishonesty or ulterior motives for inflating or deflating numbers
  • The people in charge of reporting don’t have quite the hidden motives or pressures as an autocracy generates, who initially punished reporting physicians
  • Our system has multiple sources of input that act as an automatic control mechanism
  • Our math adds the mild cases and estimates of asymptomatic people to the calculations (although this has to be retrospective)

Almost all comorbidities affect mortality rates: heart disease, chronic lung disease, renal failure, liver failure, obesity, neurologic disease, diabetes, cancer, immune deficiency, pregnancy, age, etc.

Without knowing the demographics of the population under discussion, raw data mortality rates are almost meaningless.  In the 2017-2018 flu season, which was one of the most severe epidemics in the last decade, if you were a healthy person, not pregnant, under 65 years of age, your risk of death was under 1%, but if you had a heart problem and were over 65 your mortality was over 10%.

How can we interpolate all this to the Coronavirus?  The 3.4% mortality rate is a raw number for many (but not all affected people); the mild ones didn’t even get counted.  I hate to use the term “fake news” because of its political overtones, but I think it is justified here.  The news media has “hyped up” this issue with inflated numbers for reasons that are suspicious to me.  To sell more newspapers? To be ahead in reporting doom and gloom? (which seems to be a habit of the news media culture). Or is it to affect elections? To create panic? To develop financial uncertainty? To…?  A recently published editorial in the most prestigious medical journal in the world, The New England Journal of Medicine written by Anthony S. Fauci (the nation’s leading expert on infectious diseases), H. Clifford Lane, and Robert R. Redfield, https://www.nejm.org/doi/full/10.1056/NEJMe2002387 has stated, and I quote, “the case fatality rate (of Covid 19) may be considerably less than 1% (the bold letters are mine). This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%).”  So take everything with a grain of salt!

 

 

 

 

 

 

 

COVID 19

In 2017-2018 45,000,000 people had seasonal influenza in the US and 61,000 people died of it.

“Coronavirus,” the cause of COVID 19 (Corona Virus Disease 2019) at this point has infected 92,303 cases worldwide with 3,132 deaths, which is a 3.4 % risk of dying.  Taking all comers, healthy people have a 0.9% chance of dying, while people with heart disease have a 10.5% chance of dying. The virus has an affinity for lung tissue because the viral surface has little projections that fit precisely into mirror image receptacles on the lung cell surface. If it gets into the lungs, it takes over the lung cell’s DNA by inserting itself into our DNA and starts reproducing, as viruses lack the ability to reproduce without using cells of other organisms like us.  It’s all about reproduction! That process kills the lung cell, and we are left with fewer and fewer lung cells to exchange COfor O2.  When there are not enough lung cells to exchange the gases, we become hypoxic (not enough O2 for the brain) and we die.  97% of us can beat the virus by making antibodies, and we recover. Depending on what kind of other diseases we harbor anywhere from 3% to 10.5% of us can’t.  Coronavirus is more virulent than regular flu, but not as virulent as some.  There are plenty of other viruses that are worse.  Ebola, for example, kills 50% of its victims, and smallpox had a 20% mortality in unvaccinated individuals.  But the 1918 pandemic (Spanish flu)  killed 100,000,000 people, the worst pandemic in human history.

So far, COVID 19 has not been all that impressive in the US, 121 cases with 9 deaths.  Of course, that is not what could happen.  If we don’t take the correct infection control measures, we will be in a world of hurt, so to speak!  The steps that have been made so far exceed anything that has been done in the past. I believe that if we take the common-sense steps we are told to do, we will remain relatively safe. Ultimately a vaccine is the answer. 

We owe vaccination to Edward Jenner, a physician, who noticed that milkmaids who contracted a benign disease called cowpox from the infected udders of cows did not contract deadly smallpox. During Jenner’s time 1/5th of the English population secumbed to smallpox.  In 1796 Jenner took some of the pus from a milkmaid’s hand that had the cowpox variola and scratched the skin of his first patient, the son of his gardener, placing a small amount of the pus on it.  It produced a local infection but never spread to the whole person. It worked, and no one that underwent vaccination got smallpox.  Jenner is credited with saving more lives than any other human being in all of history. The Latin word for cow is vaca.  Hence he called his procedure vaccination. In the early 1970s smallpox vaccination was stopped, and by 1979 WHO (the World Health Organization) declared smallpox eradicated from the face of this earth. The virus is no longer present in our world except in one laboratory that keeps the culture under close guard primarily for the study of this once deadly killer that potentially could be weaponized. Anyone older than age 50 still bears the telltale scars of the vaccination that left two pockmarks, usually on the right upper arm.   Smallpox vaccination is the first vaccine and the only disease that has been eradicated.

Coronavirus, too, will take its place in the history books of vanquished viruses, and it will not be because of avoiding Corona Beer as 30% of the population has done.   Multiple laboratories around the world are furiously working on an effective vaccine.  Apparently, Israel is ahead of most, claiming a vaccine will be available in weeks to months. After that, we should be able to go back to our routine lives.

ENTROPY

Ludwig Boltzmann was probably the most important scientist of the 19th century.  He was an Austrian physicist who introduced the concept of atoms.  He was ridiculed and harassed to the extent that he eventually committed suicide in a desperate depression of what he saw as a rejection of him and his life’s work.  The most prominent scientists of the time stood up during his lectures to declare that atoms are just an imaginary construct to explain mathematical formulations, not reality.  Scientific journals did not even allow him to use the term, “atom,” as it was just not scientific. Besides who has ever seen an atom? He traveled to the attend the World’s Fair in St. Louis in 1904, also to Berkeley and Stanford, where he lectured and discussed his atomic theories with colleagues, but failed to realize that proof of his concepts and theories was just around the corner, and he would be vindicated. But it was not to be. In 1906, while vacationing in Italy he hanged himself while his family was out swimming in the Adriatic.

The picture above is his gravesite in the Zentralfriehof (Central cemetery) of Vienna. The inscription above his bust, S=k.log W is a formula that sums up his interpretation of the second law of thermodynamics.  S is entropy (the level of disorganization), k is the Boltzmann constant, and W is all the possible molecular states.  In 1906 there were four known states of matter: solid, liquid, gas, and plasma. 

But there is a fifth possible molecular state, the Bose-Einstein condensate (BEC) that both men had theorized but was not created until 1995, long after Bose and Einstein had joined the immortals. Satyendra Nath Bose, born in Calcutta India, became a theoretical physicist. While studying a particular molecular relationship of gases under various thermal environments, called the Maxwell-Boltzmann distribution, he theorized that under very cold conditions, the molecules would not behave as the Maxwell-Boltzmann statistics predicted. He presented his thoughts to Albert Einstein who agreed and helped Bose publish his theory. During extremely low temperatures, he showed that atoms lose their individual structure and fuse together into one super-atom at the balmy warm temperature of one billionth of a degree above absolute 0. Matter does not behave the same in this state.  Electrons can sneak through the maze of now motionless fused together atoms, without any loss of heat, it now has become a superconductor. That super cool matter can even explode like a supernova, fondly called “a bosenova.” I never got past college freshman physics, so my level of physics competency would not be able to tell you if Bose-Einstein condensates would also act differently than Boltzmann’s formula on entropy would predict.

The first law of thermodynamics states that energy is constant in the universe.  It can neither be created nor destroyed, although it can transform from one state to another.  For example, fire can heat water which will produce steam which will drive a piston up and down to turn a wheel.  Heat is transformed into mechanical energy. 

The second law was the focus of Boltzmann’s attention.  Entropy, the level of disorganization, increases with time.  He realized that the disorder in the universe must always get more disorganized.  Even if you think you are organizing your house, sweeping, washing, making the beds, straightening the table cloth etc. etc., you are breathing, moving muscles, moving the broom.  In aggregate, you are using up energy, disbursing heat, excreting CO2, using up O2, burning up sugar and degrading the body’s tissues.  You are increasing entropy.   Just as burning a log in the fireplace making a pile of ashes from an organized piece of wood, with bark, fibers, and nutrients that used to course through its tubules.  Entropy is increasing, as it must.  Just as the energy of heat must flow from a higher level of heat to a lower level (colder) and can never be in the opposite direction, things are constantly getting worse.  But as it does so, it peels off energy. Without this energy nothing would work, nothing could grow, nothing could exist. It is this energy we use to live and thrive. In driving a car it burns a very organized, symmetrical, aromatic six carbon organic chemical, that derives from ancient life through complex processes.  As it combusts, it winds up as CO2 and H2O. But it generates the energy to get us from point A to point B. Without this inevitable process called entropy, we would not be able to survive.  Eventually, entropy will reach a level of equilibrium where no further disorganization can happen, where entropy will cease to increase.  This will happen when no more energy is readily available, and the universe will be a dark, empty, and cold place. But don’t worry, this will take billions upon trillions of years. We can still celebrate a few more birthdays.

The third law of thermodynamics deals with when entropy reaches that equilibrium.  Entropy will reach a steady-state, when it is so cold it will be the theoretically lowest temperature that it can get, 0 Kelvin.  If heat is molecular motion, there will be absolutely no motion. In Centigrade that would be – 273.5 ̊C which happens to be absolute zero, calculated correctly by William Thomson, which earned him the title of Lord Kelvin.

At that temperature, the state of matter would all transform into the Bose-Einstein condensate, one super-atom of the universe.   And if S=k.logW does not apply to this form of matter, it would set up for the release of all the nuclear forces,  another “Big Bang” or in this case a “Bosenova” as so eloquently stated by Yogi Berra, “It’s déjà vu all over again!” 

A PRIMER IN HOW TO RECOGNIZE NEANDERTHAL GENES IN OURSELVES AND OTHERS

Now that the human genome has been sequenced, and Neanderthal genes have been found in up to 4% of our DNA, we can no longer deny our ancestral roots.  Some of us have more of it and others less.  Asians and the native people of Oceana have more Denisovan genes than the Neanderthal genes, up to 5% in some of them. Denisovans were not a known hominid species until recently when a discovery in Siberia of hominid skeletal and dental remains was uncovered.  The DNA was neither Homo sapiens or Homo neanderthalensis but a heretofore unknown hominid.

Neanderthal (also written as Neandertal) appeared in the Pleistocene Epoch  (2.6 million years to 11,800 years ago) first found in the Neander Valley (Tal) in Germany.  When first discovered in 1856, they were thought to be deformed H. sapiens, but when they were found all over Europe and the Middle East, the deformed theory was discarded and they got their own species name, even though some paleontologists thought that a bit premature. Strangely, 25,000 years ago Neanderthals disappeared. Charles Darwin published The Origin of Species in 1859. Various theories of their extinction have been postulated.  This was in the midst of the last ice age.  Could that have been their death nail? Did we out-hunt them, competing for every bit of protein in the cold barren land that was overwhelmed with ice?  Did we absorb them as suggested by our own DNA? Or did we kill them?  There is evidence of cannibalism that could have contributed.

Getting back on how to recognize them within and amongst us.  They actually had a larger brain housed in a lower profile cranium. The brows were more prominent, and the nose and eye sockets had bigger openings. The front teeth were larger, spaced farther apart, and the occipital ridges were more prominent, suggesting stronger posterior neck muscles.

The chin was what we would classify as weak. Their hyoid bone in front of where the voice box would be, suggested they had similar linguistic skills to us. Also, they could not have had the stone tool technology and social customs, such as the burial of the dead, decorative arts, and even flute-like musical instruments without language.  They had pale skin and possibly red hair, making them more sensitive to UV light and prone to skin cancers.  Other genetic studies suggest they were prone to depression and eating disorders. 

They did not have the ability to domesticate animals and lacked dogs that could have helped them in hunting larger game.  This lack of skills with taming animals may have contributed to their demise.

Putting it all together.  If you see a red-haired very muscular person, especially the back of the neck, about 5 foot 5 inches tall, a barrel chest with large hands and size 13 shoes, a weak chin, prominent brows and premature aging from sun damage, with possibly a skin lesion or two, who is kind of mean, hates dogs, and is grouchy, you may be meeting one of them.