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WHAT DOES WHO SAY?

For that matter, what does WHO know that we don’t know for sure?  WHO knows, and what do they know, and when did they know it? I don’t know!  Reminds me of the old Abbot and Costello baseball joke, “Who is on first, What is on second, and I don’t know is on third.” Who wears a mask, and what does it do, and why does nobody know? Are you confused about what to do?

WHO (World Health Organization) sticks by its original advice not to wear masks unless you are sick or caring for someone who is sick. The CDC (Centers for Disease Control) has made a 180̊   policy switch from don’t bother with masks, to everyone should wear a mask.

The United Kingdom recommends masks for health care workers but not for the general public. Germany likewise did not feel masks are useful, but just switched to the other side, making masks mandatory.

Our Surgeon General tweeted, “Stop buying masks!”

Fifty countries now require masks in public, including France, Poland, Israel, Austria, the Czech Republic, Slovakia, Bosnia, Cuba, Columbia, Vietnam, Venezuela, Argentina, and another thirty-six. 

So what are we, who do not have a coughing , sneezing, talking, or breathing laboratory, to do? It’s all conflicting advice and conflicting data!  It is interesting that all the other public health measures that are being touted have no controversy around them.  Should I have 6 feet of separation?  Where are the double-blind studies that prove that? Do we really need to wash our hands 20 seconds? Has anybody tried to do it for only 15 seconds? Let me answer that.  Nobody! What about all the studies that made surgeons scrub their hands for a full minute , but in the good old days, it was 10 minutes for the first scrub of the day. Is more than a ten people group proven to be the caldron of bacterial and viral contagion?  Somehow the masks have captured our attention, and the fight is on.  Both Dr. Fauci and Dr. Brix are wearing masks, but President Trump is not.

What do we know?  If you have ever seen the saliva spray from just talking ( the picture above as well as https://bgr.com/2020/04/19/coronavirus-face-mask-spit-particles-video-social-distancing/) they are very impressive.  They demonstrate unequivocally that masks do decrease the droplet spay from those activities.  If you doubt if that spay containing virus would not infect you, I have a bridge in Arizona, the Brooklyn Bridge, I can sell you for a real bargain. 

The recent unintentional experiment in Mount Vernon, Washington, is very telling.  A minister strongly believing in first Amendment rights, did not wish to stop choir practice, and had a two-hour session of singing where social distancing was practiced, and no one was visibly sick. Of the 60 singers, 40 got the virus, and a few even died. But thank God they did not let anyone violate their constitutional rights!

It appears to me that the double-blind controlled study that requires a large number of test subjects with masks, and without masks that proves once and for all that wearing masks reduces the spread of COVID-19 will never be done.  We may have to rely on common sense and anecdotal evidence.   I used to be annoyed by people wearing masks when I was a non-mask wearer.  Now I am annoyed by the non-mask wearer.  Are they arrogant?  Do they know something I don’t know? Are they smarter than me or dumber? Or are they just impolite and socially handicapped?

I take the tack that wearing a mask shows that I care about the people around me whether it helps or not.  It certainly does no harm, and it possibly helps, according to some.  I do not want people to think I am somehow superior to them.  These are uncertain times.  There comes a time when we must accept less than certainty, and the mask is a great social equalizer even if their effect is uncertain!

REMEMBERING MY MOTHER

My mother was born on October 30, 1910, in Czernowitz, Austro-Hungary.  She was born, as they say, with a silver spoon in her mouth.  Her father was among the über-rich with oil wells in Ploiesti north of Bucharest, and large cattle farms which served to export beef to England, in the south of what now is Romania. She had one brother, Polka, who was the heir to the fortune when Stephen Dowhanczuk, her father, died prematurely at age 50 of Diabetes, refusing the second leg amputation due to gangrene.  Polka was not that lucky either.  The Russians shot him execution-style in the street in front of his villa for the sin of being rich. 

My father had humble beginnings, which most likely was the reason the Russians left my mother alone.  His mother was widowed, and supported him going to medical school by cleaning houses for the likes of Stephen Dowhanczuk.  My father’s biological father was long gone, a portrait painter from Moldavia on the way to emigrate to Jerusalem to make his fame and fortune.  So the silver spoon did not last long.  All she had left of her parents’ wealth was the jewelry she had accumulated growing up.  It was a sizable collection.  When my father realized he had to get out of Communist Romania to save his life, he and my mother packed up one suitcase each and started to run, disguised with forged passports. Secret housing changed every night on the way, to special trains that moved refugee populations.  The jewelry was tossed out the train window when the risk of being discovered as a rich bourgeoise became a sudden issue when heavily armed Russian military wandered through the trains looking for the rich parasites escaping the clutches of Stalin’s justice.  

From the frying pan into the fire, my Catholic mother wound up in Nazi Germany, married to a Jew who hid his credentials, and carried documents proving his German ancestry, even converting to my mother’s faith to further prove his Aryan origins.  They lived in a small town in what was Austria, but annexed to Germany in the Anschluss around 1939.  It was an idyllic place in a valley where a sparkling blue-green river full of rainbow trout ran through it.  The Alps cradled the valley, as if to shield it, which in fact it did during the Allied bombing of B 24 runs to decimate the German panzer factories.  Thus I was born in the middle of World War II, 1943. My mother was a self-taught consummate cook.  She knew the Slavic kitchen from her childhood, haluschke, stuffed cabbage rolls, gogoshar charcoaled red peppers in a marinade of oil, vinegar, and onions, Borscht (red beet soup) etc.  But added the Austrian palate of Knödel, Zwetchken Kuchen, Sauerkraut, and the like to her repertoire.  I learned it all from her.  She never measured anything.  It was a pinch of this and a handful of that.  I do wish I would have paid more attention, though, and written it down. 

After the war, my father lost his job as the town doctor because Austrians wanted to put their own doctors to work, and as is common in most wars, doctors survive better than front line soldiers.  Luckily he got a job with the US Army, and through that, we were able to come to the Promised Land.  The trip to La Guardia in New York was exciting.  An emergency landing in Iceland due to one of the four engines of our TWA plane catching fire delayed us a bit, but we made it alive.  To come to this country, you must have a sponsor, at least that is how it was in 1954.  Our sponsor was Anna Tolstoy, the daughter of the famous Russian author of War and Peace fame.  Her motivation was not entirely benevolent.  She had a large farm in upstate New York that she ran with basically slave labor of people she sponsored.  You had to give her a year of labor to repay her services as a sponsor.  She had sent two Ukrainian “thugs” to escort us to our new home.  With great skill and cunning, we managed to escape from them by hiding in toilets and doing a lot of running.

From the Alps to the slums of Chicago, a real culture shock for us.  My father did not make enough income the first year to support my mother, nor me, and my sister.  My mother had to join the labor force.  She got a job making and loading shoelaces in the Florsheim shoe factory.  My sister, age eight, and I, age eleven, were on our own, finding our way, ten blocks or so through the back streets of Northside Chicago.  It was a Polish, Jewish, Puerto Rican neighborhood with the occasional robbery and shooting, even then.  After my father finished his mandatory internship, which he was required to do even though he had been a doctor for a quarter of a century, we moved to Peoria, Illinois where he got a job in the largest insane asylum in the mid-west.  We lived on the grounds of the hospital that had about 200 acres at its disposal with multiple buildings and even a farm where the inmates could grow vegetables and fruits. We lived there for ten years.  

Then luckily, my father got a job working for the Veteran’s Administration in Los Angeles.  Who would not want to live in Southern California?  My parents finally had achieved a level of lifestyle which, although not opulent, was similar to their early life.  I emulated my father and became a doctor while my sister became a teacher.  My mother was happy! Despite a very hectic life, losing all possession twice, once running away from the Russians and the second time leaving Austria, my mother adapted and never complained.  In fact her favorite saying was, “You must adjust!” It certainly was what she did.

When my father retired from the VA at age 70, they lived in Santa Monica.  After I had fulfilled my military obligation, I practiced in Santa Paula, CA, and convinced them to move up with me.  They sold their house and bought a house in Santa Paula, which allowed my father to have an artist’s studio where he painted to his heart’s content and allowed my mother to spend time with her children and her grandchildren.  When my father died at age 80, she moved into a small guest-house on my Citrus and Avocado ranch.  She cooked her favorite dishes and drove her little Ford until age 96.  She was in good health until 86 when she developed a B cell Lymphoma.  With modern treatment, she beat that and remained active for 10 more years.  The last 3 years were not so easy for her though.  I had just come home from a medical meeting in Chicago, our original home in the US.  She asked me if I had visited our 1st home in the US.  I spent several hours with her reminiscing about that time in our lives.  Later that afternoon, her caretaker called me that she had chest pain.  I went to see her and recognized that she had had a heart attack from her thready irregular pulse and low blood pressure.  I have always had a supply of essential medications and found some Morphine that gave her immediate relief of her pain.  Her caretaker was appalled with me that I did not call an ambulance.  She was 99 years old.  She did not wish to go to the hospital.  Knowing that I could get in trouble by being accused of “elder abuse,” I called a friend, an internist, to come and see her for at least a second opinion to appease the caretaker.  He came, and we agreed, no hospital, just comfort measures.  That evening I felt I  should stay the night with her.  I slept in the adjoining bedroom.  It was October, and even though we were in California, it was cold outside.  The house was shut, windows down.  Even the heat was on.  At 2AM, a cold wind woke me.  I got up to check on my mother. She breathed her last breath, then no more.  

“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.

7th book going to the printer

My 7th book went off to the printer today.  It will be available in a few weeks at Amazon.com or directly from me through my website.  It will be under my name and the name of the book, “What I Forgot to Say.”  It follows the format of my previous book, “What I Still Want to Say.” And it is likewise an anthology of essays. Many of the essays have the theme of our current pandemic, COVID-19.  But there are a variety of subjects from the St. Francis Dam disaster that swept through my home valley, the most extensive civil engineering failure in history, to what you have always wanted to know about physics but were ashamed to ask, like what entropy and entanglement are for example, and where we came from and where we are going.  Some essays are strictly historical about men and women who have contributed to why we the way we are, while others are controversial issues about impeaching presidents and conspiracies.  Amazon requires the price to be $38 to cover printing and shipping costs, but through my website, it will be available for $25, including tax and shipping.  On my website under Books, click on the title, which will bring up the Online Store where you can use most credit cards or purchase it through PayPal. I guarantee you will not be bored and will like it or hate it.  Either way, it’s worth 25 bucks.

THE RETROSPECTOSCOPE

It is always easier to look back and find the things we should have done differently but didn’t. In my job as a surgeon, I used an instrument, the sigmoidoscope, that allowed me to look up the rectum to find lethal diseases lurking up there. 

It is that instrument that inspired the development of another scope, the retrospectoscope, that allows one to look back to the past to see what could have been done better. This scope, which is still in research and is not yet fully developed, is also able to predict the future with a small modification, the proper training, and if used correctly.

Just as the Greeks had the Oracle of Delphi, who apparently had an ancient version of this tool, and the Oracle of Omaha, Warren Buffet, who has a newer version that can be turned to the future.  So far, he is the only one who is licensed for that use.

I wish I had the fully developed model of the retrospectoscope and could turn it toward the future also.  I would have done exactly what several of the Senators did and sell my stocks rather than lose 25% of my retirement assets. Although the Senators had insider information which they are apparently vaccinated against and allows them to do so with impunity and immunity to consequences.  I would not want to spend two years in jail, as Martha Steward did for that crime. 

I would have bought more toilet paper.  I would have gotten masks, and worn them much sooner than I did. I would have stocked up on a lot more canned foods, so I would not have to go to the grocery store and stand in line to find out that they are out of dairy products, garlic, hand sanitizer, and wine. Especially wine, since Dr. Anthony Fauci recommended using alcohol to cleanse surfaces, I could have sterilized my gut surface much better than I was able to do. 

I see so many of my friends and acquaintances now criticizing what was done and the flaws in the way things proceeded.  This pandemic is new to us, that is what novel means –it comes from “novo,” Latin for “new.”  The last major world pandemic was in 1918-1919.  None of us were here  101 years ago, or at least very few, and those that were, don’t remember.  We are too harsh on ourselves and those that lead us.  We are learning things we didn’t know just a few weeks ago, and are adjusting accordingly, just like all hominids have learned to do in the last four million years since we came down from the trees and started walking upright in the savannas of Africa. Overall I think we are doing much better than I would have predicted.  The curve is flattening and even turning down in some parts of the country.  It is looking like we have fewer infected people and fewer deaths than predicted, precisely because we have practiced social distancing, hand washing, and wearing masks, although not as much as we should have.  There are still too many people out on the roads, some attending houses of worship looking for answers from heaven.  These answers have been beamed down already, but a few people won’t listen.  This reminds me of the joke about the guy who refused to leave his home as the water was rising in an epic storm. “The Lord will provide!” he said when people tried to get him out of his house.  A boat came by and told him to get in.  He again refused, saying, “The Lord will provide.”  He continued to pray.  Soon he was forced to the roof to avoid drowning.  A helicopter hovered above and sent down a rope.  The man still refused and still was waiting for the Lord to rescue him.  Naturally, he drowned.  Up at the pearly gates, he was angry.  “I prayed and waited for the Lord to save me. What happened?” St. Peter answered, “What more did you want? We sent a boat and then a helicopter, and you refused to take them!” 

Despite the stalwarts who congregate, students who go to spring break beach parties, and those who refuse to wear masks, there are enough people who have listened to God’s message to socially keep distance, which is the only means to slow the spread of this scourge. Even Chicago’s death rate is slowing down, not because of fewer Corona deaths but because of fewer gunshot deaths. Obviously, social distancing works in mysterious ways that are new to us as well.

As soon as the retrospectoscope has been FDA approved, I will be in line to buy mine and turn it to the future, so I will know with certainty what to do!

CORONA CONSPIRACIES

I am not a conspiracy fanatic. I refer you to an essay I wrote six years ago: http://cuttingedgepublishing.net/essays/conspiracy-theories-2/. I generally do not believe in them as they are usually fictitious, not true, made up, and patently false. Also, those theories are generally accusatory towards groups that they, the conspiracy groupies, have already tried and convicted as guilty for their own reasons in their minds, with little concrete evidence. They are not exactly impartial.  I have acquaintances like that! But once in a while, the conspiracists have hit on something.  The problem becomes in sorting out at which conspiracy theories we should take a closer look.

Humans are prone to look for patterns.  This trait has led us to discover some spectacular associations.  It allowed Ernest Rutherford to describe the current model of the atom with a central nucleus and a cloud of electrons orbiting around the nucleus.  A new branch of physics evolved with new laws and new theories and became quantum physics. Dimitri Mendeleev, the Russian physicist, recognized the pattern of the elements.  He created the Periodic Table listing them in relation to each other.  He even left spaces for elements that had not yet been discovered, recognizing the pattern demanded there be an element in a particular spot even though that element had not been found or created. Sure enough, with time, it was.

Looking for patterns has also created some horrendous idiocies.  We looked for and have found unfortunate humans afflicted with diseases of the mind and called them witches, whom we then burned on the stake.    

Here is a conspiracy theory that you at least should take a look at. I am just saying…!

Virology and bacteriology are sciences that can be used for good or evil.  The biological weapons that have been created by man are based on that science.  Anthrax, Smallpox, Measles, Yersinia pestis, Syphilis, Typhoid, Yellow Fever, and others have been used in the past to reduce the enemy in strength and number. Envelopes of the white powdered Anthrax have been sent to members of Congress and the White House.  Saturated blankets with Smallpox pus were distributed to Indians in the 1700 and 1800s as a supposed friendly gesture, but actually to kill. More of the indigenous South and North American population was wiped out by disease than gunpowder.  In the Middle Ages, the bodies of plague victims were catapulted over castle walls to break a siege. Biologic weapons are potentially more lethal than nuclear weapons. 

We have all heard Trump call it “the Chinese Virus,” for which he was roundly criticized as racist.  But the fact is that the Corona Virus did come from China, specifically from a Wuhan wild animal market with bats, turtles, snakes, ferrets, etc.  I have actually been to that market just a few days before 9/11. 

Wuhan “wet market”

Chinese people have eaten wild animals for thousands of years. Supposedly 14,000,000 people are involved in that business, with an annual market value of 76 Billion dollars. China has apparently shut down that business.  Good luck to them, shutting down an activity that has been in existence for several millennia is likely to fail. 

“Gain of Function” research dates back to 2012 with H5N1 Avian flu virus to enhance virulence and transmissibility, allowing a better understanding of transmission and control of the disease. In 1914 Barack Obama shut down the experimental program of GOF (Gain of Function). The aim of these programs has been with benevolent intent, but the opposite could be true. Obama did not stop the program but held their funding. His reasoning presumably was the danger in that pursuit. They were back in business again in 2017.  The purpose is to study and to gain an understanding of disease-causing agents, and develop medical countermeasures on the benefit side or how to weaponize viruses and bacteria on the evil side.  It so happens that 300 yards from the Wuhan wild animal market is a level IV virology lab that studies exactly those issues with guess what, Corona Virus. The level IV lab is approved to deal with the most dangerous pathogens that can be aerosolized.    Their work is freely published in journals of virology and can be accessed in those journals and the internet.

Bat Woman, as she is known, Shi Zhengli, the lead virologist at the Wuhan Institute of Virology, was reported to say, “Could that be our Corona Virus?” when she was urgently recalled from Shanghai to Wuhan at the beginning of the outbreak.

According to the New York Times and The Atlantic monthly, China has now started its own disinformation campaign of conspiracy theories. China now blames the US Army for bringing the epidemic to Wuhan to answer the criticism that they were slow to contain virus in the early days by muzzling physicians and whistleblowers who attempted to warn fellow citizens and us. They are evicting reporters, including the Wall Street Journal, who report on this new tactic. These actions have not been helpful and are reminiscent of old cold war tactics. China, in fact, has a documented history of handling other viruses with less than full protocol to prevent a breach such as the SARS Virus in 2003 where 1814 citzens of Bejing were infected with 79 deaths as a consequence.

Another strange story has emerged.  One of the Chinese scientists was recently tried and convicted to 12 years in jail for selling lab animals to markets for human consumption.  It is rather odd to have the Virus originate just yards from where CoronaVirus research is going on.   It is possible the Virus leaving the confines of the lab, could have occurred accidentally without ill intent. At this point, does it matter how the Virus came to infect humans, as we know it has?  Will it change anything if we know? Or is this all mental self-stimulating cud-chewing of the conspiracists? 

NEW THOUGHTS ON THE SURGICAL MASK

Previous essays I have published take the WHO ( World Health Organization) viewpoint that regular masks are not effective and do not need to be worn by the general public.  A surgeon friend of mine brought up a point that I had not considered.  He has a broader vision that all people ought to wear the regular surgical mask because it would be a social equalizer.  Now, if you see people in the street with a mask on, you have this gut reaction, they must be infectious, and you ought to distance yourself from them.  If everyone wore a mask, regardless of what type, we would all be equal and would be reminded that distance is essential, along with coughing and sneezing.

As pointed out by many previously, the N95 mask is the only mask that protects the wearer as it filters out particles the size of the virus.  These masks are not all that easy to wear.  Firstly, they must be fitted for each individual. They are tight, uncomfortable, and can actually bruise the delicate skin on the face.  Because they filter out very small particles, it is hard to draw air through them, and it makes breathing a real chore.  The common surgical type mask, on the other hand, is easy to wear and easy to breathe through and does prevent larger droplets from contaminating the environment even though it does not filter out incoming air well, especially aerosolized particles. The standard surgical mask, therefore, may protect the environment from broadcasting the larger droplet spray, but to a lesser extent, the wearer of the mask. It is the large droplets that are presumed to be the primary mode of transmission.

The history of that mask goes back to Paul Berger, a French surgeon, who in 1899 published a paper where he said, “For several years I have been worried as to  the part that drops of liquid project from the mouth of the operator, and may cause infections (in the patient on whom the operation is performed)…”.  He started to wear the cloth mask and insisted that his assistants would do likewise.  The response from his fellow surgeons was one of ridicule, just like they ridiculed Ignaz Semmelweis, who suggested we ought to wash our hands after performing an autopsy.  Ignaz postulated that “little plants” from the dead body could get on the hands, and whatever killed that person would then be transmitted to the hands and then to a new victim.  Berger suffered the same kind of insults regarding his new idea of wearing a facemask. Semmelweis, in the interim, became so convinced that handwashing was actually saving lives that he started attacking his surgeon colleagues in the local newspaper, calling them murderers.  They responded by incarcerating him in an insane asylum where he died, knowing he was right. 

Berger seemed headed for the same fate, had it not been for the famous surgeon, Jan Mikulicz. Jan also chimed in with an article that mirrored Berger’s ideas about spraying droplets while talking, coughing, and sneezing.  Jan was the protégé of another famous surgeon, Theodor Billroth. With those names as character references,  the mask became the standard for all surgeons in short order.

Just recently, an interesting experiment proved that talking/singing can spread disease.  A minister in Mount Vernon, Washington, who refused to follow the social distancing order, held choir practice, and 60 members of his choir showed up.  None of them were ill, none of them coughed or sneezed.  They just sang for two hours.  Within a few weeks, 45 of them were sick with COVID-19, and several had died, proving that just talking (or in this case singing) was sufficient to spread the virus. It is thought that the majority of transmission is by larger droplets rather than finer particle spread.  Had these singers all worn masks, it is likely that none, or at least fewer, would have been infected. Of course, that experiment has not yet been done, but it would be interesting if it were.  I would suggest the next minister who wants to break the law, that the choir participants should all wear masks, and perhaps he would kill fewer of them.

I do understand the science behind the difference between the regular face mask and the N-95 mask. Still, I will have to change my opinion and go against the recommendation of the WHO (World Health Organization) and start wearing my homemade double layer mask my wife sewed from old (washed x 3) underwear (I am serious!).

HOW TO DEFEAT COVID-19, LESSONS WE HAVE LEARNED FROM HISTORY

This is a novel experience for the whole world, no pun intended. The last time we saw anything like this was over 100 years ago. “We” may be an exaggeration, as I still had 25 years to go to exist. From historical accounts, we are handling it far better than the country did then, with the possible exception of St. Louis, which in 1918 shut down the entire city, including schools, bars, most businesses except coffin makers and embalmers.  Theater owners and musicians were the most vocal opponents, claiming their livelihood was being destroyed. When all was said and done, and the quarantine lifted several months later, St. Louis had only 31,500 of its inhabitants that contracted the flu, and only 1,703 deaths in a city of 800,000.  The rest of the country did not fare as well, 675,000 Americans died. Many towns had so many deaths they had to stack the bodies on the sidewalks outside the mortuaries.

We are currently, 3/24/2020, in the exponential growth phase, with a doubling of cases every three days in our community, and no obvious blunting of the curve.  I still see a lot of traffic on the road, plus people standing in line very close to the person in front of them, and the young who, out of school, are heading for the beach.  It seems we are not taking this very seriously yet!  Although I am an optimist, we are not following the mandate very strictly. We need to tighten up the transmission rate.  I suppose it will take some law enforcement methods to get people to comply.  The R0 is still above 1. 

The concept of R0 (pronounced R naught) is the number of people a single person with the disease will infect.  If R0= 1, then the disease will stay at its current level.  If it is less than 1, it will eventually burn itself out.  But if it is any number greater than 1, it will grow, the speed of growth dependent on that number.

Author of chart: Kiera Campell

The R0 of COVID-19 is probably around 2 now.  When you are #2 you need to try harder as the saying goes.

The current public health measures include: 

  • Frequent hand washing (for 20 seconds), and clothing especially cover clothing.
  • Keep two yards distance between individuals
  • No more than ten people in one group (that includes going to Houses of Worship)
  • Stay home and work from home
  • Cover coughs and sneezes
  • Disinfect surfaces touched by people (countertops, door nobs, etc.) The virus stays infectious for at least 4 hours on copper, but maybe for three days on stainless or plastic surfaces. A recent report from one of the Princess Cruise Ships had viral particles that were still infectious 17 days after the ship had been evacuated!
  • Don’t touch your face (where the virus gains entrance to your body)
  • Avoid contact with sick people

Notice, masks are not on the recommendation list as the regular surgical masks are not sufficient to filter out the virus when inhaling. However, a sick person who wears such a mask will limit the particulate spray if they cough or sneeze.  It takes a better mask (the N-95) to actually filter out the virus, which is currently recommended for health care workers only.  The general public is discouraged from using them as they are in short supply, thus taking away masks from those that really need it.

These are not all the measures that could be taken.  More confining measures may become necessary.  The shutting down of services could be much more severe. Food sources could be centralized and restricted to one member of a family.    An entire city or region could be shut down with armed military control of egress and ingress—the less contact of people with other people, the less chance to transmit the disease. Testing of the population, as South Korea has done, would identify the people who are at the greatest danger of spreading the virus and emphasizing the isolation of those people. One problem would be identifying those people because individuals start shedding the virus before they develop symptoms, and some remain asymptomatic, which would require largescale testing of everyone. That would require massive testing centers, and special hospitals to relocate large segments of the population and contain them.  The more stringent the measures, the more adverse the effect on our Country’s economy would result.

At this point, opening the economy back up, as suggested by some, would cost lives. What good does “Social Distancing” do? That question was answered 102 years ago. If we compare the 1918 St. Louis death rate of 31 deaths per 100,000 population per week, with strict social distancing, to Philadelphia at 257 deaths per 100,000 population per week, during no public health measures, gives us an over eight times greater mortality. Are we willing to trade loss of lives for fully stocked shelves of toilet paper? Besides, there would still be significant panic, and it would be nowhere near normal.  We have no drugs that will attack the virus, nor do we have vaccines that will prevent infection at this time.  Currently, several medications will be tested, however, to determine if there is any efficacy for them to use either as a treatment or prophylactically to prevent infections. 

Chloroquine and hydroxychloroquine are both drugs that have been around for several decades.  Their original use was for malaria treatment and prevention, as well as rheumatoid arthritis.  The Chinese experience, as well as the French experience, suggests that these drugs reduce the viral load.  This, however, has not been confirmed by rigorous scientific studies, and may just be another toilet paper fairy tale at this point.

Ritonavir/lopinavir, a combination drug for HIV, has been in use since 2000.  It impedes the replication of the virus and has shown efficacy with the MERS virus in animal studies, but when tried in China was not useful.  This drug combination is also being tested in combination with interferon-beta.  No clear results are available from that study yet.

Immunologic treatments with serum from recovered Covid-19 patients has also given hopeful results.   Ultimately making our own antibodies, stimulated by a vaccine, will be the answer.  Several vaccine trials are in Phase 1 trials.

HOW EPIDEMICS HAVE AFFECTED US

Here it is 2020, and we are still battling pandemics.  History records the first recognized pandemic in 165 AD, the Antonine Plague.  Marcus Aurelius Antonius was emperor and gets the credit as it occurred on his watch. It was a virus, probably measles or smallpox, nevertheless devastating. It killed one-third of the empire! 

We have had pandemics at regular intervals that decimated the population, but each time it seems that a smaller percentage of the people had to die. The plague of Justinian took 30 million. It was likely Pasteurella (now renamed Yersinia) Pestis, a gram-negative bacteria that was carried by fleas that infested rats. It occurred during Justinian’s reign, 541-540 AD, and is said to have thwarted Justinian’s efforts to reunite the Eastern and Western Roman Empire. From 1347 to 1351, the “Black Death” as the Plague was called, swept in from Central Asia on the backs of black rats that carried infected fleas.  It came in on the Silk Road, then transferring to merchant ships going to Genoa, Italy.  The world population had been 475 million but shrank down to 350 million.  1631 saw it for a return engagement in Italy, but later in 1665  in London, and yet again in 1885 in China and India with at least 12 million deaths. This was probably the most lethal of the pandemics so far. Europe lost half its population. It had three forms, bubonic, pneumonic, and septicemic.  The bubonic form was named for the enlarged lymph nodes that occurred in the axilla and groin called “Bubos.”  In the pneumonic form, the bacteria directly attack the lungs causing death sooner; therefore, the most lethal. The septicemic plague occurs in the bloodstream and is usually not infectious.

As a child growing up in Austria, I was always fascinated by the “Pest” (the German word for plague) columns. Most  European cities have a memorial erected to commemorate the plague depicting grotesquely posed dying humans often intermixed with devil and angel-like sculptings. Antibiotics were still far off then. Most of the first generation antibiotics, even Sulfa drugs, would have been effective against the “Black Death,” had they been available.

FJ6AKF Austria, Vienna, Graben, Pestsaule, Plague Column, 1693, detail.

In the late 1800s, the Yellow Fever virus decimated 150,000 French and Americans. This was related to the efforts to connect the Atlantic and Pacific Oceans by way of digging the Panama Canal. Yellow Fever is a viral disease transmitted, most often, by the female mosquito, Aedes aegypti. In 1793 there was an outbreak in Philadelphia, the then capital of the US. Nine percent of the population died, and the inhabitants of the city fled, including the President of the United States, George Washington.

Walter Reed, an army doctor, was the most instrumental in finally beating the disease, by control measures of the mosquito’s breeding in bodies of stagnant water and implementing extensive vaccinations. As an aside, it was Dr. Walter Reed, who gave us the procedure consent form.  When he was doing his experiments with yellow fever vaccinations in Cuba, he had the troops sign a paper that indicated there could be ill effects from what he was doing to them.

From 1889 to 1890, it was the Russian Flu that took 1 million people—followed by the Spanish Flu from 1918-1919, courtesy of the H1N1 swine flu, with 50 to 100 million deaths, the second worst pandemic. Later the 1957 H2N2 virus with 1.1 million people.  And then the Hong Kong Flu in 1968-1970 H3N2 virus took another 1,000,000. 

HIV Aids started in Africa, probably another zoonosis, a disease derived from animals. This one was transmitted from chimpanzees and began in 1981.  I remember listening to a lecture that mentioned this strange new disease that affected Haitians, Homosexuals, and Hemophiliacs.  It was something I thought would never have much to do with my career.  How wrong I was! It changed my entire approach to the surgical patient.  It has killed nearly 35 million people, including a physician acquaintance. I had an injury caring for a dying HIV  patient.  The ID doctor that cared for me, suggested I immediately cut off the finger where the injury occurred.  I didn’t follow his advice but did spend the next few anxious months checking my blood tests frequently. The newer antiviral drugs have finally made a dent in this disease, but HIV remains a formidable enemy. 

The more recent epidemics are far less lethal.  The 2009-2010 Swine Flu, another H1N1 virus, was only 200,000 deaths, SARS a mere 770, and MERS 850.  Ebola was more challenging to control and killed 11,000 people. It was named after a river, the Ebola River, which means “Black River,” sufficiently ominous-sounding, for a virus that looks like a worm under an electron microscope and has no known cure, with a mortality rate of 50 to 90%.

Our latest, now declared a pandemic, bat derived, Covid-19 has killed 11,921 as of 3/21/2020   8:43 AM EST. We have brought back an old response to epidemics, the quarantine. The process of isolating sick people was mentioned in Leviticus, and used in the Middle Ages to contain Leprosy.  In 1448 the Venetian bureaucracy imposed a 40 day waiting period before allowing ships to dock, to be sure no one on board had the plague.  The word “Quarantena” means “40 days” in the 15th-century Venetian language. 

There is good news, though.  Several drugs have shown some activity against the virus, including an old anti-malarial medicine, chloroquine. Several antiviral drugs are beneficial, and also serum from recovered Covid-19 patients contains antibodies that seem to help in very sick victims.  Based on that news, the market gained just 300 points, and then quickly plummeted by 900 points; so Wallstreet is not yet all that convinced.   

NEW BOOK

My next book is close to hitting the ranks of published works, which you will be surprised to know is about 300 books a day for the US alone.  This will be my seventh book (eight if you count the first one with the ignominious title that Amazon required me to change and now is the respectable title of Tales of a Country Surgeon. Sadly the sales plummeted with the title change).  This new book is entirely respectable, WHAT I FORGOT TO SAY. This book is a sequel to the book titled, WHAT I STILL WANT TO SAY. Like that book, it is an anthology of essays on a variety of subjects.  I copied the content page of what is written to give you an idea of what is in it.  I have in mind 10 to 15 more chapters.

1 We are all Homo Sapiens1
2 Leonardo da Vinci4
3 The Wall9
4 My Take on the Last Few Days of Evil in SoCal13
5 Area Code 80516
6 Epistemology19
7 The Ibiza Affair23
8 Retirement26
9 Can Feminism be Toxic Too?31
10 Explaining Trump and Why Impeachment is Not a Good Idea35
11 What is the Point of Impeachment?38
12 The Magic of German Compound Words41
13 Doppelgänger45
14 The Green New Deal48
15 Alfred Nobel52
16 The Naked Ape59
17 Medicare for All64
18 Water68
19 Entanglement71
20 The Making of a Surgeons73
21 Two Men, Two Disasters75
22 The American Revolution or Do We Owe It All to a Woman77
23 DNA Does Not Lie80
24 Ancient Genes that still Haunt Us83
25 Origins86
26 A Primer in How to Recognize Neanderthal Genes in Ourselves and Others88
27 Skiing90
28 Entropy93
29 In Defense of Suicide96
30 Anchor Baby98
31 Life101
32 Colon Cancer for Dummies104
33 Who has the Better Vision108
34 Impeachment and Trial of a President111
    

The cover is my favorite flower from my native country, Austria.  It is the Forget-Me-Not flower to serve as a flowery metaphor for the title.