Bacteria, viruses and the human mind

The following is a quote that I read in the June issue of Harper’s magazine.  It is from the forthcoming book, The Unreality of Memory by Elisa Gilbert.

Viruses and bacteria hijack our minds and make us act weirdly.

For example, Toxoplasma gondii, a parasite found in cat feces, makes mice less afraid of cats; this is an evolutionary strategy, making it easier for the parasite to get from the mouse to the cat.

When it spreads to humans, it may increase their risk-taking.  One study found that people with toxoplasmosis, the infection caused by the parasite, “are more likely to major in business.”  An NBC News story suggested optimistically that the parasite “may give people the courage they need to become entrepreneurs.”

That would be an extreme case of a microscopic parasite altering the course of our lives.  But viruses and bacteria influence our everyday behavior as well.

A 2010 study, for example, found that people become more sociable in the forty-eight hours after exposure to the flu virus, a period in which one is contagious but asymptomatic.  The infected hosts, researchers found, were significantly more likely to head out to bars and parties.

I know of no evidence that coronavirus infection influences human behavior.  None whatsoever.  I am not hinting or implying that it does.

But, as a thought experiment, suppose it did.  How would the virus influence its hosts’ feelings, thoughts and behavior?  What changes would it induce to help itself survive, reproduce and spread?

Looking back on the influenza pandemic of 1918

Click to enlarge. Source: Our World in Data.

I managed to acquire a copy of THE GREAT INFLUENZA: The Story of the Deadliest Pandemic in History by John M. Barry before the libraries and bookstores closed.

It tells the story of the 1918 influenza pandemic, the deadliest in history in terms of absolute numbers.

Nobody knows for sure how many died.  The old consensus estimate was 20 million; the new one is 50 million.  Barry believes that the virus killed at least 35 million and probably between 50 and 100 million people.

In the USA, the estimated pandemic death toll was 675,000—more Americans that were killed in battle or died of wounds in all the wars of the 20th century..

One of the worst things about the pandemic is that its highest death rate was among people in their 20s and 30s, the young and healthy whose immune systems over-reacted to the ‘flu virus.

If the highest estimate of the death toll is correct, from one in 10 to one in 12 of the world’s young adults may have died, according to Barry.

The influenza pandemic arose in a world at war, and spread because of the war, just as the coronavirus pandemic spread because of a globalized world economy.

Barry said the first cases of the new influenza were reported rural Haskell County, Kansas, and then in Camp Funston at Fort Riley, Kansas, in March, 1918, where draftees were being trained and readied to be shipped overseas.

A short time later it appeared in Camps Forrest and Greenleaf in Georgia, and rhino in 24 of the 36 U.S. Army camps.  It was reported in Brest, France, a short time after American troops arrived there.  Soon it spread to all the nations and colonies that participated in the war. and then over the whole world.

At first, it was no worse than ordinary influenza—the “grippe,” as people called it.  But a second, deadlier wave arose during the summer, a mutant form of the first.

It killed in frightening ways.  Some turned blue or black, because of lack of oxygen in the blood.  Some spurted blood from their noses and even eyes and ears, for reasons nobody yet understands.

There were some who had air migrate from congested lungs to air pockets under the skin, which made a crackling sound when bodies were turned over.  One nurse said she could never eat Rice Krispies again.

The United States in which the influenza arose was more of a police state that it has ever been, before or since.  When war was declared on April 6, 1917, every American and every American institution was expected to be fully committed to the war effort.

There was a spy network, a propaganda network and a war bond-selling network, all reaching into every American town and neighborhood.

A Food Administration, Fuel Administration, Railroad Administration and War Industries Board had absolute power to carry out their missions.

But there was no Health Administration, only a relatively powerless U.S. Public Health Service.  No federal or state agency had responsibility for fighting the pandemic.  A volunteer organization, the American Red Cross, filled that vacuum, along with municipal health departments, private physicians and a few dedicated scientists.

What federal authority did do was try to protect civilian morale by suppressing news of how bad the pandemic was.

The seriousness of the pandemic was only acknowledged in the last month or two of the war, and that was in the context of charging Germany with waging germ warfare.

Censorship also suppressed news of the pandemic in Britain, France and Germany.  The first news accounts came from Spain, a neutral country.  From this people got the idea that the ‘flu originated in Spain

Can Russia cope with the coronavirus?

Russia’s growing coronavirus outbreak and its challenge to Putin by Alex Ward for Vox.

A hero of the pandemic

Dr. Sara Cody

Nassim Nicholas Taleb once observed that we all honor heroes who save the day in emergencies, but the greater heroes—usually unknown and unsung—are those who prevent an emergency from arising in the first place.

In the coronavirus pandemic, the heroes of foresight are the public officials who take action before the virus becomes established, instead of waiting for the crisis to develop.

With infections doubling every few days, a delay of a week would mean the number  would be at least five times greater, or probably much more, because hospitals would be overwhelmed.

Ron Unz, editor of the online Unz Review, pointed out that one such hero is Dr. Sara Cody, public health officer for Santa Clara County.   She and other public health officers in the San Francisco Bay area issued a “shelter in place” order on March 16, as soon as the virus made its first appearance.

Los Angeles County followed a few days later, and Gov. Gavin Newsome extended the order to the whole state a few days after that.  Public health officials warned him that if he failed to act, 25 million Californiana could have become infected, resulting in up to 1 million deaths.

There was no precedent for the first lockdown.  Somebody had to have the courage to go first.

LINK

The Government Employee Who May Have Saved a Million American Lives by Ron Unz for The Unz Review.

Neoliberalism’s failure in a time of pandemic

Rev. Dr. William J. Barber II on Twitter

The United States is unprepared to deal with the coronavirus pandemic—short of hospital beds, short of test kits, short of ventilators and other medical supplies.

This is not merely because of the negligence of a few individuals.  It is the result of acceptance of the philosophy of neoliberalism.

Neoliberalism teaches that business corporations should be structured so as to keep costs as low as possible and revenues as high as possible, and that all institutions should be like business corporations.

It also teaches that accumulation of wealth by individuals and corporations is a good thing because private investment is the source of progress and economic growth.

What’s wrong with that? you may ask.

What’s wrong is what we see now—national needs neglected and the whole society put at risk.

Hospitals and other health care providers are told they must operate with maximum efficiency.  All resources must be fully utilized all the time—no empty beds, no unused equipment, no moments to relax for nurses and other staff.

This means there is no slack in the system.  It is hard to provide for the ebb and flow of illness and injury even in normal times.  In an emergency, such as this one, the health care system is overwhelmed.

Also, hospitals and other health care providers must obtain their supplies from the lowest priced source, even if that source is a sweatshop on the other side of the planet.

This means that the United States depends on China and other foreign countries for medical supplies.  If the leaders of these countries decide to limit shipments to the U.S. in order to guarantee supplies for their own people, what can we Americans do about it?

China to reopen its filthy live-animal markets

Wet market in Guilin, China in 2014. Business Insider.

The coronavirus pandemic is believed to have originated in filthy live-animal meat markets in Wuhan, China.  Now the Chinese government plans to allow these sources of infection to re-open.

A would-be totalitarian government can’t or won’t enforce basic public health measures.

This endangers not only the Chinese people, but the whole world.

Maybe this is a reflection on human nature.  It is easier to make people give up basic rights as citizens than give up cherished habits.

The point is not whether the Chinese government is mainly to blame for the pandemic.  That is a question for a later time.  The point is to demand that China change its policy once again and safeguard itself and the world.

Although the Chinese authorities originally suppressed news of the coronavirus outbreak, they then responded in a way I thought was magnificent.

Dan Wang, a business researcher, and Don McNeil, a New York Times reporter, described China’s effective quarantine and testing.

The Chinese built new hospitals in a matter of days, sequenced the virus genome and shared the information with the world, and provided needed medical supplies to other nations.

They’re getting a lot of credit for their achievements, which they deserve, but they also deserve condemnation for leaving the causes of the virus outbreak untouched and for spreading propaganda about U.S. biowarfare in order to distract attention from their own failures.

I know my own country’s leaders do not have great credibility.  China’s leaders see an opportunity to enhance their country’s power and prestige and I do not blame them for taking advantage of it.

But they’ll have greater prestige in the long run if they face facts and stop lying.

LINK

China’s Assault on the World by Rod Dreher for The American Conservative.  This is a good roundup of all the things the Chinese government is doing wrong.  Dreher advocates severance of all ties with China.  This is easier said than done.

Witnessing Wuhan by Tracy Wen Lui for Project Syndicate [Added 4/3/2020]

Note; I made minor rewrites a few hours after posting this.

Coronavirus: a tale of two states

Click to enlarge

Added 4/24/2020.  The Guardian reported that, as of Wednesday, Kentucky had 185 confirmed deaths from COVID-19 and Tennessee had only 161.  We don’t know the full story yet.

Stephanie Jolly of Lexington, Kentucky, created this chart and posted it on her Facebook page, where it quickly became viral.

It shows that Kentucky Gov. Andy Beshear (D) acted more quickly on the coronavirus emergency than did Tennessee Gov. Bill Lee (R) and that the disease has not spread as fast in Kentucky as it has in Tennessee.

Added 3/27/2020:  But even though Kentuckians are better off than Tennesseans, thanks to Gov. Beshear’s prompt action, the number of new cases in Kentucky is still doubling every four days or so.

LINKS

Social Distancing to Fight Coronavirus: A Strategy That Is Working and Must Continue by Maura Caslyn, Emily Gee, Thomas Waldrop and Nicole Rapfogel for the Center for American Progress.

Graph comparing Ky. and Tenn. virus responses goes viral by David Mattingly for WAVE3 News in Lexington, Kentucky.

Two states, one Democrat, one Republican – two very different outcomes by Josh Wood for The Guardian.  [Added 4/24/2020]  The writer praises Kentucky, but also says that the higher number of confirmed cases in Tennessee may reflect that state’s larger population and also more testing—presumably in April, since the Jolly graph shows less testing in March.

Human nature in a time of pestilence

I recently read an old paperback copy of Albert Camus’ novel, The Plague, which I’ve had on the shelf for decades.  If I ever read it before, I don’t remember..

The novel tells the story of a plague sweeping the French Algerian city of Oran.  It was published in 1947, but Camus wrote it during the German occupation of France during World War Two.

The novel’s real topic is not so much plague specifically as how people react to catastrophe.  Camus’ view is surprisingly comforting and reassuring.  The novel’s principal characters all rise to the occasion, and the political and social order, although under strain, functions as it should.

The novel begins with mysterious deaths of rats in the city, a sign of plague, but which Oran’s physicians and municipal authorities refuse to take seriously until people start dying.  The public can’t imagine something could happen that would prevent them from living their accustomed lives.

At first the public seeks to maintain a semblance of normal life while the plague rages.  As the death rate increases, the people forget what normal life was like and just deal with the ever-present threat.  Just as they’ve given up hope, the plague fades away, and people try to pick up where they left off, as if it never happened.

The novel’s six main characters show different ways of thinking and coping with catastrophe—what Camus called the Absurd, meaning things and events that have no purpose or meaning in human terms.

∞

Dr. Bernard Rieux is a physician who at first finds it hard to believe the plague is real, but calls on the authorities to take action.  He heads an auxiliary hospital for plague victims and also helps enforce quarantine regulations.

He works long, exhausting hours.  He finds he has to harden his heart in order to do his duty.  When he visits a patient at home and finds the person is infected, he calls for an ambulance to take the person away, despite the pleas of relatives, who understand that they may never see the victim again.  In the later stages, he has to go to patients’ homes accompanied by police

He does not believe in God and denies having any overarching philosophical belief.  He does his job simply because he is a physician and that is his role.  When asked what he believes in, he replies, “human decency.”

∞

Jean Tarroux is a mysterious character who seems to have nothing to do but hang out around town and observe life.  But then he takes the initiative to form volunteer auxiliaries to help fight the plague—for example, by disinfecting houses.

He reveals that he is a former revolutionary—a Communist, if you read between the lines, although this is never spelled out.  He joined the revolutionary cause because of his horror of capital punishment; he left it because the revolutionaries are killers themselves.

He speaks about how human beings carry plague within themselves, which I take to mean most human beings are willing to see other people die in order to save themselves or achieve their goals.

He says the great sin is refusing to speak the truth in plain language.  He says his desire is to find out whether you can be a saint without believing in God.

He is one of the last to die, hanging on to life as long as he can,  but rejecting comforting illusions.

∞

Click to enlarge.

Father Paneloux is a Catholic priest who preaches a sermon about how the plague is God’s judgment on the sins of the people of Oran. Camus, although an atheist, took religious faith seriously and a lot of his philosophy, including this book, is a kind of dialogue with Christianity.

The priest says people ignore God’s commandments and reject his love because they confidently expect to be forgiven, but sometimes God’s patience is exhausted and he lets people suffer what they deserve.

He says God figuratively is standing over the city with a giant flail, which is used to thresh wheat and separate the  nourishing grain from useless chaff.  I find this a powerful image.

I think of the flail in terms of the coronavirus emergency, in which we are see who are the wheat (not just health workers, but grocery clerks, trash collectors, janitors and cleaners, truck drivers) and who are the chaff (hedge fund managers, corporate lobbyists, diversity trainers).

The priest joins the volunteer auxiliary and witnesses the slow, painful death of a child from the plague.  He later preaches another sermon on whether a child’s painful death can be God’s will.

He said that a Christian must believe that everything that happens is God’s will, even if you can’t understand the reason.  This includes the death of a child.  Otherwise you don’t really believe in God.

But he adds that if you accept human suffering and death as God’s will, you must be willing to suffer and die yourself.  Later Father Paneloux himself falls sick and dies painfully, but not from symptoms of the plague.

Doubling rates of coronavirus deaths

Click to enlarge

This chart shows that even in Japan and South Korea, the number of deaths from COVID-19 has been doubling every week.  For many nations, the doubling rate is every three days.  It is nearly that much in the United States.  So we shouldn’t be complacent about the relatively small number of people who have died so far.

The USA, China and the coronavirus pandemic

We Americans have long liked to think of our ideals of freedom and democracy as models for the world.  But China, whose leaders reject those ideals, seems to be doing a better job that we are of protecting its citizens and the world from COVID-19.

Advocates of democracy claim that our system is better because it provides a reality check.  When the government fails to do its job, the loyal opposition and free press are there to point it out.

Click to enlarge

China’s initial response to the coronavirus showed the truth of this.  The first physicians to detect the coronavirus were threatened by police for spreading false rumors.

But once China’s rulers realized the truth, they drew upon the strength of a totalitarian system, which is to be able to focus all a nation’s resources on a single objective.

By the way, I greatly admire the courageous Chinese doctors and nurses who risked their lives to stop the spread of the disease,  Not only the Chinese, but the whole world, owe them a debt.

The Chinese appear to have succeeded in stopping the spread of the disease in a relatively short time.  The number of cases in Hubei province, the center of the outbreak, seems to be leveling off at about 70,000.  This is cases, not fatalities.  Hubei has a population of 58 million, almost as great at italy, with 60 million.

Dan Wang, an American living in Beijing, reported on the effectiveness of quarantine measures there.

Click to enlarge. Source: Forbes

The problem with the Chinese system of government is: How can we be sure?  In any large, hierarchical organization, whether corporate, military or something else, those in the lower ranks will tell those in the lower ranks what they want to hear, and those in the higher ranks will tell those in the lower ranks what they want them to believe.

I think there will be a natural tendency of those on the lower levels of the Chinese hierarchy to report everything is under control, whether or not it is.  I know a college professor with a great many Chinese students.  She tells me they are all cynical about reports of success in China, and whether all Chinese cities will get the same protection as Beijing.

Under Deng Xiaopeng, there was enough of a limited free press and civil society to point out the problems.  Will this be true of Xi Jinping?

Based on what little I know, I think the Chinese have responded magnificently and the world owes them a debt.  But if the opposite were true, it would be a long time before I had any way to know it.

Here in the United States, we have Donald Trump, a totally incompetent, but democratically-elected leader who denies reality as blatantly and obviously as any Communist ruler of old.

The saving grace of our system is that his failure to lead is not hidden.  it is obvious to anyone who has eyes to see and a willingness to face facts.

And the other saving grace is that we the people can take constructive action without waiting for orders from the federal government.  State and local governments, universities, research centers, commercial corporations and civic groups are all taking corrective action.

Still, we should ask ourselves.  How is it that we are so completely unprepared?  Why do we have so few hospital beds?  Why is it that China and other countries are able to test for COVID-19 on a large scale and we are not?

The coronavirus and exponential growth

Hat tip to kottke.org.

This video provides a good explanation of the concept of exponential growth, and particularly why there is so much concern about a pandemic that so far has claimed relatively few lives.

The reason, as explained in the video, is the rate of growth of the disease and not the absolute numbers.  Right now there is no cure for the disease and no way to prevent some spread of the disease.

But if the rate of growth can be controlled in the early stages of the disease’s spread, it can be kept under control.

One point made in the video is that there is no such things as exponential growth continuing indefinitely.  At some point the hockey-stick pattern on the growth chart becomes an S-curve and then a bell curve.  But with the spread of an infectious disease, the leveling off may not start until half or more of the vulnerable population is infected, and millions of people are doomed to die.

The coronavirus: challenge and response

I have liberal Democratic friends who are gleeful that President Trump is responding so badly to the COVID-19 crisis.  It will show his inadequacy as a leader in a way that is unmistakable to his followers, they think.

I agree with this assessment.  By fall, the United States is likely to be facing a public health crisis and probably an economic crisis and possibly a weather-related or climate-related emergency, all together.  The nation will need a strong leader, and our current President isn’t it.

I would be happy to seem Trump rise to the occasion and prove me wrong about this.  I don’t want a million of my fellow citizens to die, even if I am not one of them, just to show that I was right.  But I don’t think Trump has it in him to be a true leader.

This would be a great political opportunity for the Democrats.  They could nominate Chance the Gardener and he might still win.  But being glad about it is the kind of extreme partisanship that liberals and progressives attribute to Trump supporters.

Also, few if any of these friends plan to make changes in their own personal lives to avoid being infected and infecting others.  How, then, are they different from Trump?

[Update 3/15/2020.  Actually, the individuals I was thinking of have in fact changed their habits in response to the emergency.  I misjudged them.  I apologize.]

No doubt President Hillary Clinton or President Jeb Bush would not have been so blind to reality..  But the United States would be unprepared to meet the crisis.  The United States has been hollowing out it ability to respond to crises for years.  Look at the responses to Hurricane Katrina, Superstorm Sandy and Hurricane Maria.  As Matt Stoller put it—

The reason America can’t handle the Coronavirus is the same reason we can’t do anything else right.  We don’t let the people who do the work have any say over how or whether the work is done.  That’s why America has mishandled various wars, the response to Katrina, the financial crisis, big tech monopolies, Boeing, the Iowa caucuses, and the crisis with Hurricane Maria in Puerto Rico.  American institutions are organized entirely around the short-term horizon of financiers, and these financiers seek to create monopolies and to grab cash by thinning out supply lines and generating hidden risk.

Source: BIG by Matt Stoller

It is not just CEOs who can’t look beyond the next quarterly report.  It also is politicians who can’t look beyond the next election. But the dynamic is the same.  The reason we Americans have hollowed out our ability to respond to emergencies is the same as the reason we have hollowed out our manufacturing capability..

U.S. Health Care: High Cost and Mediocre Results on An Economic Sense.

I hope we can learn and change.

WHO makes it official: COVID-19 is a pandemic

T. A. Ghebreyesus

Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, officially declared the spread of COVID-19 to be a pandemic, which means it is a worldwide problem, not a number of epidemics limited to  a few countries.

His remarks to the press were partly reassuring and partly alarming.  The reassuring part is that China and South Korea apparently are bringing their epidemics under control, so it can be done.  The alarming part is that not all countries are able or willing to do what’s necessary.

Here are the highlights of what he  said.

In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled.

There are now more than 118,000 cases in 114 countries, and 4,291 people have lost their lives.

Thousands more are fighting for their lives in hospitals.  In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher.

WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterized as a pandemic.  Pandemic is not a word to use lightly or carelessly.  [snip]

 We have never before seen a pandemic sparked by a coronavirus.  This is the first pandemic caused by a coronavirus.

And we have never before seen a pandemic that can be controlled, at the same time. [snip]

Of the 118,000 cases reported globally in 114 countries, more than 90 percent of cases are in just four countries, and two of those – China and the Republic of Korea – have significantly declining epidemics.

81 countries have not reported any cases, and 57 countries have reported 10 cases or less.

We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic. [snip]

Several countries have demonstrated that this virus can be suppressed and controlled.  The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same – it’s whether they will.  

Some countries are struggling with a lack of capacity.  Some countries are struggling with a lack of resources.  Some countries are struggling with a lack of resolve.

We are grateful for the measures being taken in Iran, Italy and the Republic of Korea to slow the virus and control their epidemics.

We know that these measures are taking a heavy toll on societies and economies, just as they did in China.

All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights. [snip]

LINK

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020

Photo: FABRICE COFFRINI/AFP/Getty Images

Taking the coronavirus seriously 2

Source: Ajai Dandekar on Twitter.

America’s Coronavirus Response Has Started Slow, But Will Improve by Tyler Cowen for Bloomberg Opinion.

COVID-19 May Be a Public Health Crisis … But Not for the Reason You Think by Isis the Scientist for Skepchick.  [Hat tip to Mike the Mad Biologist.]

White House overrules CDC push for seniors to avoid flights amid coronavirus outbreak by the Associated Press.

Why Can’t America Handle the Coronavirus Crisis? by Matt Stoller for BIG.

Bern Researchers Produce New Coronavirus Fatality Estimate by Kevin Drum for Mother Jones.

Taking the coronavirus seriously

Congress, thank goodness, is starting to take the coronavirus seriously.  I’m not sure that most of my fellow Americans are.

Matt Stoller reported—

This week, Congress passed an $8.3 billion supplemental spending bill to address the coronavirus crisis.  The bill has a number of parts, including aid for cities and states, pandemic response and vaccine research, and $7 billion in loans for small businesses hit by the disaster.  At first blush, it seems like the legislation is not that big a deal, a narrowly written bill directly responding to a crisis.  But I’ve spent some time calling around Congressional contacts, and I think this legislation is the start of a couple of important political trends.

First, Congress has just taken the lead over the executive branch on governing. Trump initially asked for just $2.5 billion to address the crisis, and Congress rejected that immediately and put in a larger number.  Just for a frame of reference, Singapore has spent $4.5 billion on its response, and Singapore has one seventieth the number of people.  Getting something in the right ballpark would be $300-400 billion, so the amount Congress passed isn’t sufficient.  Even so, it is still the case that Congress is taking the lead on setting policy and governing during a crisis.  That’s a shift in institutional power.

Second, while the Trump administration is floundering, it is not the Democrats, but a younger generation of Republicans, led in this case by Josh Hawley and Marco Rubio, who are actually the most radical in terms of seeking public political action to address the economic fallout from the disease.  Hawley just introduced legislation to give authority to the FDA to investigate drug and device shortages, a basic anti-monopoly tool.  This is necessary, because pharma is using trade secret laws to hide where their factories are located.  And Rubio …  is trying to expand government lending to businesses working on supply chain problems.

Source: BIG by Matt Stoller

President Trump’s response to the coronavirus threat has been to deny the threat is serious.  But there are administrative and institutional problems that have nothing to due with Trump.

The government has forbid the use of COVID-19 tests that haven’t been approved by the Food and Drug Administration, except for those developed by the Centers for Disease Control.  But the initial test kits developed by the CDC were faulty, and had to be recalled.  Surely it is better to have an imperfect test than no test at all.

The other problem is in the basic attitude that health care is an individual benefit, which the individual should pay for or somehow they deserve, rather than a social need.

I suppose you could make this argument for treatment of chronic diseases, such as cancer.  Infectious diseases are another issue.  Priority for COVID-19 testing should go to physicians and nurses and, after that, those whose jobs require contact with the public at large, regardless of income or “merit.”

The health system and the profit system

Coronavirus and Systems Fragility by Rod Dreher for The American Conservative

The coronavirus and the Trump administration

The failure of the Trump administration to prepare for an epidemic is greater than I thought, as indicated by this Jan. 31 article by Laurie Garrett in Foreign Policy magazine.

The epidemic control efforts unfolding today in China—including placing some 100 million citizens on lockdown, shutting down a national holiday, building enormous quarantine hospitals in days’ time, and ramping up 24-hour manufacturing of medical equipment—are indeed gargantuan.

It’s impossible to watch them without wondering, “What would we do? How would my government respond if this virus spread across my country?”

For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable.

In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure.

In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion.

If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is—not just for the public but for the government itself, which largely finds itself in the dark.  [snip]

In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea.

Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later.  

But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.  

In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency.  

The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team.  Neither the NSC nor DHS epidemic teams have been replaced.

The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10.  [snip]

And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent, the disease-fighting cadres have steadily eroded as retiring officers go unreplaced.  [snip]

… State-level health leaders told me that they have been sharing information with one another and deciding how best to prepare their medical and public health workers without waiting for instructions from federal leadership. 

The most important federal program for  local medical worker and hospital epidemic training, however, will run out of money in May, as Congress has failed to vote on its funding.

The HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) is the bulwark between hospitals and health departments versus pandemic threats; last year HHS requested $2.58 billion, but Congress did not act.

Source: Foreign Policy.

The failure isn’t just Trump’s.  Congress has responsibility for oversight of the federal government.  The Democrats with their new majority in the House of Representatives could have prioritized investigating the functioning of governmental departments instead of impeachment.

For that matter, Republicans in the Senate and House could have exercised their oversight functions.  The Washington press corps could have investigated.  But if they had, would we the people have paid attention?  Or would we have found President Trump’s tweets more interesting?

But the main question now is not: Who is to blame?  It is: What do we—we Americans as a nation—do next?

The coronavirus and the test of reality

Passengers disembark from virus-hit Diamond Princess cruise ship

Photo via New York Post.

The first duty of any government is to assure the survival of its people.  The COVID-19 strain of the coronavirus is a test of how well the world’s different governments can perform this basic duty, and they will be judged on how well they perform that duty.

It doesn’t matter whether leaders call themselves conservatives, socialists or something else.  Are they able to act effectively and without panic to meet a threat?  Are they able to face facts or do they punish truth tellers?

Here in the USA, our President and Congress have mainly been fighting over problems generated by governmental policy and a couple of things that don’t really exist—the alleged Trump-Putin collusion and the imaginary Iranian nuclear weapons program.

Now, along with the rest of the world, we face a real external threat—one that can’t be made to go away by means of public relations or changing the subject.

The Trump administration’s budget priorities are its nuclear weapons modernization program and the new Space Force.  In contrast, as Nicole Wetsman of The Verge reported—

The administration’s proposed 2021 budget for the Department of Health and Human Services (HHS) cuts $25 million from the Office of Public Health Preparedness and Response and $18 million from the Hospital Preparedness Program. The administration also asked for over $85 million in cuts to the Emerging and Zoonotic Infectious Diseases program.  [snip]

Housed at the Centers for Disease Control and Prevention (CDC), the Office of Public Health Preparedness and Response is charged with responding to public health emergencies.  It also coordinates public health responses with local and international partners and manages the Strategic National Stockpile, which squirrels away critical medical supplies for use in emergencies.

The Hospital Preparedness Program aims to ready hospitals for emergency surges of patients, and it’s already under-equipped to handle situations like the ones currently seen in China.  Right now in the US, hospitals are already swamped by the flu and are counting their supplies of protective equipment.

Cuts to the Emerging and Zoonotic Infectious Diseases program would further hamstring the CDCs ability to do research on diseases like coronavirus and to gather the scientific information that lets it prepare for outbreaks like this one. [snip]

The 2021 budget request did ask for an additional $50 million for the CDC’s Infectious Diseases Rapid Response Reserve Fund.  That fund, which was established in fiscal year 2019, is currently being used in the ongoing coronavirus response.  That money, though, is activated only after a public health threat appears.

==The Verge.

The coronavirus has not yet reached our shores.  There is still time for the U.S. to rally.  There is still time for President Trump to assume leadership.  There is still time for Democrats in Congress and on the Presidential campaign trail to make an issue of this.  Will they?

It is not just an American issue, of course.  All the world’s leaders—Xi Jinping, Narendra Modi, Vladimir Putin, Angela Merkel, Emanuel Macron, Boris Johnson and the rest—will be weighed in the same balance.

∞∞∞

The coronavirus threat makes two other things clear—the need for internationalism and the perils of globalization. Let me explain what I mean.

How to wash your hands

 

The most important thing you can do to prevent the spread of infectious disease to yourself and others is to wash your hands frequently.

Disease germs are spread when multiple people touch doorknobs, elevator buttons, currency and coins or the like.

I wouldn’t have thought I didn’t know how to do a simple thing like hand washing properly, but i learn from a post on kottke.org that evidently I don’t.  Here are directions from the Centers for Disease Control.

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
2. Lather your hands by rubbing them together with the soap.
3. Lather the backs of your hands, between your fingers, and under your nails.
4. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
5. Rinse your hands well under clean, running water.
6. Dry your hands using a clean towel or air dry them.

LINKS

Map of Areas Most Often Missed During Hand Washing by Jason Kottke for kottke.org.

When and How to Wash Your Hands by the Centers for Disease Control.

The passing scene: Links & comments 11/20/14

Gandhi vs. the Mafia by Jesse Walker for Reason.

More than 900 Sicilian business owners, most of them in Palermo, have successfully defied the Sicilian Mafia and refuse to pay protection money.  It is an example of the success of the tactic of mass defiance, as pioneered by Mohandas K. Gandhi and explained by Gene Sharp.

The power of a small organization such as the Mafia to compel the obedience of large numbers of people is based on the fact that the masses of people are divided and the Mafia is united by powerful bonds of loyalty.  But if great masses of people decide together, all at once, that they will not submit, no matter what, their oppressors cannot kill them all.

I’m reminded of the words of Alexander Solzhenitsyn, the great Russian novelist and dissident.  “Don’t believe them, don’t fear them, don’t obey them.”  And the words of Solidarity Forever.  “The union makes us strong.”

Why the US has the most powerful currency on the planet by Matt Phillips for Quartz.

The American dollar replaced the British pound as the world’s currency of choice after World War One, when the United Kingdom became a debtor nation and the USA became the world’s greatest creditor nation.   Now the USA is a debtor nation, but the world’s business is still done in dollars.

Matt Phillips wrote that the dollar maintains its position because of the inconvenience of shifting to another currency.  I would add that if nations start to sell off dollar-denominated holdings, such as U.S. Treasury bonds, in large amounts, this will cause the exchange value of the dollar to fall against other currencies.

Holders of dollars wouldn’t want the value of the dollar to fall.  But once it starts to fall, they wouldn’t want to be caught at the last ones holding dollars.  If and when the world abandons the dollar, the fall could come very quickly.

The Norovirus Demagoguery Starts Here by Mike the Mad Biologist.

The Norovirus causes gastroenteritis and kills an estimated 570 to 800 Americans a year, as well as causing 56,000 to 71,000 hospitalizations, 400,000 emergency room visits and 1.7 million to 1.9 million visits to physicians.

One of the main ways it spreads is by infected and obviously sick people working in restaurants.  As Mike the Mad Biologist notes, mandatory sick leave for restaurant workers would be a good public health measure.

Ebola’s rank among deadly contagious diseases

Click to enlarge

Source: Information Is Beautiful.

This chart shows the contagiousness and deadliness of infectious diseases.  The higher on the chart, the more deadly.  The further to the right, the more contagious.  Ebola can be found in the upper left part of the chart, just below untreated HIV and rabies.

It is deadly, but not extremely contagious.

The passing scene: November 8, 2014

What the Election Means for the Republican Brand by Daniel McCarthy for The American Conservative.

Can a party philosophically defined by Fox News win millennial voters and the electorate of the future?  Daniel McCarthy wrote that they can win only if there’s no-one well organized enough to complete with them.

The well-oiled machinery of movement conservatism remains in the hands of those who think the only trouble with George W. Bush is that he didn’t go far enough, McCarthy wrote.

Lame duck Obama’s brave new world by Pepe Escobar for Asia Times.

Election of a Republican majority in the Senate means no possibility of agreement with Iran on nuclear weapons and fighting ISIS, no possibility of agreement with Russia on Ukraine and Middle East issues, and no possibility of action of climate change.

On the brighter side, Republicans, out of spite, will probably the Trans Pacific Partnership agreement, with its investor-state provisions to block environmental and financial regulation.  The one thing the GOP and Obama administration will agree on is the so-called global war on terror.

As US and China meet at APEC summit, a drama involving billions in trade by Peter Ford for Christian Science Monitor.

China, which is excluded from the proposed Trans Pacific Partnership agreement, will launch a Free Trade Area of the Asia Pacific agreement as an alternative.  All 21 members of the Asia Pacific Economic Cooperation group will be eligible to join.

The New York Times doesn’t want you to understand this Vladimir Putin speech by Patrick L. Smith for Salon.

The Hidden Author of Putinism by Peter Pomerantsev for The Atlantic.

Vladimir Putin is right to insist on the rule of law in international affairs for everyone, including the United States.  The fact that the rule of law is not observed in Russia’s internal affairs is a separate question.

The Hospital’s Duty of Care by Greg Pond for MRSA Topic, a blog devoted to infectious disease.  (Hat tip to Mike the Mad Biologist)

About 8,000 Canadians die every year of hospital-acquired infections.  That’s because physicians and nurses are too under-staffed and over-worked to have time to wash their hands after every interaction with patients.   I’m sure that U.S. hospitals are no better.  This is a much more serious public health threat to North Americans, at this point, than Ebola.

How Ebola came to be a global problem

Click to enlarge.

My local newspaper, the Democrat and Chronicle, from time to time runs a article on local history.  Some time back the topic was how the Rochester, N.Y., public water system came to be built.

The article said the construction of the water system was controversial, because the affluent section of the Rochester community already had plenty of clean water, and opposed having to pay to provide a public water supply for poor people.

But then it was pointed out to them that infectious diseases that originate from contaminated water did not stay in the slums.  They affected everybody, rich and poor.

I think many of us Americans thought the same way about lack of sanitation, good health care and nutritious food in West Africa.  It was sad, but not our problem.

Well, guess again.  Those conditions are the equivalent of a Petri dish for breeding infectious disease.  And disease, as we’re now learning once again, does not respect national boundaries.

Click to enlarge.

I’ve heard Americans say it is the Africans’ own fault they are so poor, but, as Ian Welsh pointed out on his web log, many of the problems of Africa stems from the 1970s and 1980s when International Monetary Fund and international banks insisted that African governments cut back on education and health care in order to give priority to paying back their debts in full.

Southern Europe is a destination for unauthorized African immigrants, and Spain, Italy and Greece also are cutting back on spending for health care in order to give priority for debt service.

Here in the USA, there are still 40 million people without medical insurance, Welsh pointed out.  How many of them are going to go to a clinic for a diagnosis of an illness whose symptoms are the same as plain ‘flu.

The other day, a friend of mine asked me which I feared most, ISIS or the Ebola plague?  I replied that I’m not afraid of either one of them, but I think that in the long run, the world’s people are at greater risk from mutant killer diseases than they are from international terrorism.   And we’re all in Lifeboat Earth together.

LINK

 Why Africa Can’t Handle Ebola: the Destruction of the 3rd World by Ian Welsh.  [subsituted 10/11/14]

Pigs, antibiotics and the risk of deadly infections

A century ago childbirth, surgery and even minor scratches were deadly risks because of the possibility of infection.  We Americans have no living memory of this because of the miracle of antibiotics.  But our margin of safety is disappearing because of the rise of antibiotics-resistant bacteria.

Drug company research on antibiotics is diminishing for this very reason.  As the drugs become less effective, they become less profitable.  This is a good reason to step up research by the National Institutes of Health on antibiotics and on alternatives to antibiotics (such as phages, viruses that attack bacteria).

Pigs in a factory farm. Credit: Farm Sanctuary

An estimated 80 percent of antibiotics administered in the United States are to animals rather than human beings, most of them to healthy animals to promote growth and as a precaution.  It would be possible to slow down evolution of drug-resistant bacteria by using alternative methods of protecting meat animals from disease, such as raising them in less crowded conditions and weaning them at a later date when they’ve built up natural immunities.

The National Pork Producers Council estimated in 2002 that such practices applied to pigs would increase the cost of pork production by $4.50 a pig.  This is trivial in terms of what I pay for a pork barbecue sandwich, but it might be decisive in terms of a farmer’s profit margins, because processors would not offer a farmer who shunned antibiotics a better price than one who used them.

It is interesting to me that Denmark has addressed this problem more decisively and effectively than we Americans have.  What gives Denmark such a good political culture when compared to the United States?

One reason I’m glad I’ve lived when I have

Death rates per 1 million Americans.   Click to enlarge.  Source: CDC

I came across the top chart when I was looking for something else.  It reminded of my childhood in the 1940s, when it was common for children to be laid up with measles, whooping cough, chicken pox and other “childhood diseases.”  I was lucky.  The only one I got was measles.  I also was lucky in that these diseases were rarely fatal, which was not the case everywhere, either then or now.

The chart shows the death rate from infectious diseases starting to creep back up a little after 1980.  I couldn’t find charts of infectious disease death rates in the 21st century, but my guess is that the death rate has continued to rise, because of natural selection producing disease germs that resist antibiotics and because of new forms of infectious disease such as AIDS.  This doesn’t mean that progress is an illusion, only that it requires a continuing effort.

I still feel lucky to have lived when I have.

Click to enlarge.   Source: New England Journal of Medicine

One reason for the lowering of the American death rate during the last century is that public health has been regarded as a public responsibility.  If availability of vaccination and sanitation had been limited to those who could afford to pay for it, the improvements shown on these charts would not have taken place.  It also is a fact that the big breakthroughs in medicine, such as Alexander Fleming’s discovery that penicillin is an antibiotic or Jonas Salk’s development of the Salk vaccine for polio,  came from researchers working in the public sector.

Hat tip for the top chart to Ezra Klein.