Monday, March 30, 2020

An Epidemic and The Psyche



Much is being made to night of this photo, and others like it, as the people of New York City gather to watch The USNS Comfort glide into New York Harbor.
Credit: New York Post
I write this because I am dismayed at the responses I've seen in the press--from Reuters to Breitbart to the Post--that these "bone headed" people are ignoring social distancing rules. I don't know how many ordinary people, who aren't internet pundits, feel.

Then I saw this on the evening news tonight, and I have to say I was moved at the spectacle of help on the way to a city that is literally (and perhaps justifiably) freaking out. Can you imagine, living in such a concentrated hub of humanity, thousands of cases, hospitals filling up. And then a white ship of hope arrives.

Hospital Ship USNS Comfort Arrives in New York | National Review
Credit: The National Review
Is it any wonder people broke out of their self-imposed isolation for a moment to welcome the help? I fear it is a peculiar disease of mankind that criticism comes easier than kindness. There has been kindness aplenty, and that feels like something healthy. This collection of masked and fearless New Yorkers is seen looking on, an old man grasping the barrier as if he were looking out of prison bars. 

I don't know. I just couldn't muster up any criticism of these people, clutched in this malignant grasp.
Hospital Ship USNS Comfort Arrives In New York To Ease Coronavirus ...
Credit: WBFO

The Pandemic, So Far

Speaking of malignant forces, how's this virus doing? I have reviewed the statistics from various locales and so far there is a consistent 1 to 1.4% mortality rate. There are outliers like Italy and Louisiana, but most experience run to about 10 to 14 people in 1000 will die. This breaks down to maybe 4 people older than 80, 2 or 3 aged 65-80, maybe 1 or 2 from my age group, and the rest lightly scattered in the remaining groups. 

Of course, we still don't know how many people get the virus and never get sick. They are carriers in many cases, but how would they know when testing is in such short supply? I think once we can estimate the number of people infected but not sick, plus those plausibly afflicted and perhaps tested, the illness rate and death rates will be lower. It's the contagiousness of this thing that got us discombobulated. Contagiousness is thought of as "R-naught"--R0. I've seen R0 rates of 1.4 to 3.7--that is, one person can infect 1.4 to 3.7 people, with the average settling in at about 2.5. Now this can come down if people, don't...um, congregate. But baseline, its R0 is higher than the flu (which we have a vaccine for, so, just sayin'). People who want to bring this thing under control want the rate to be less than 1 (then the number of cases will go down).

Social distancing is an imperfect tool to limit any epidemic. South Korea used a better tool: aggressive testing, selective quarantine, and contact tracing as a means of limiting the damage. Another shortcoming of social distancing and general area lockdowns is the social isolation it can lead to. Just because it is an imperfect tool, doesn't mean it shouldn't be used, especially if the better approaches, well let's just say it's too late for those. 

So one has to wonder: who should we really be pissed at? Our fellow, desperate citizens? Or the people who govern them? It is said that the people rule, but: leaders must lead. Our politics these days doesn't seem to lend itself to that. So the morgues get a little bit fuller, the dying die without family, we grow farther apart in both space and mind, and once again we're humbled by the power of Nature to impose her brand of reconciliation on a careless species. This can be expected to focus our attention.

Maybe the catastrophe is being pinned on the wrong culprits.  
Wash your hands and touch your face :)

Tuesday, March 24, 2020

Coronavirus Update

So it's been a while, because I teach a very intensive course until Spring Break. What better time than now to dive back into the blog?

I won't rehash the usual advice or news, since there's a constant fire hose of these all day long. I'm sure any readers of this blog are up to speed on hygiene, and of course what coronavirus is, and why people are worried about it. There's a lot of speculation out there: When will it peak? When will it decline? How many people may die of COVID-19? When can we go back to back to "normal" (whatever that ends up looking like)? But speculation is mostly a waste of time. Most experts will be wrong, either by a lot of a little. A few will say they "called it," but mostly they'll have just gotten lucky.

If it sounds like I'm a bit jaded by this experience, I am. In the middle of the chaos, there's no time to ask the deeper questions that need to be asked. Those deeper questions are what interest me the most, though, perhaps because I am only mildly inconvenienced by this catastrophe. There are many folks who are a lot worse off than just "inconvenienced," so I've mostly kept my thoughts to myself.

So, in no particular order, I'll go ahead. Perhaps it's time to share.

The Silence of an Early Spring
This was the parking lot at Target. On a Tuesday. At 11 AM.
Credit: Author
My spouse desperately need a new computer in order to teach from home, so we went forth. Nothing available. Here's what we found inside, at the Starbucks entrance inside Target.

Credit: Author
This is certainly the most closed down we've been since 9-11. Maybe more so. So far it's been difficult for people, but I haven't heard about any adverse health effects, such as suicides, homicides, relapse of depression, violence, or health problems directly attributable to the closing down of America. Perhaps my readers have, and perhaps I'm not paying enough attention. I am hearing about a lot of people turned away from hospitals, ERs, and doctors' offices because of the perception--I think--that it's just too risky to do your job in a time like this. 

The counter-argument: It is too risky to see anyone but the sickest COVID-19 patients right now!

But it isn't.

According to NPR, a Dutch researcher found that many health care workers were already infected with the novel coronavirus. So a lot us may already have had it--and not known it. No symptoms. Yet it's changing how we work. Just today a colleague of mine had to take her husband back to the hospital for readmission, because he was discharged--just days ago--"too soon" with a major kidney problem, because of the collective organizational worry about what's coming. 

I get it: How bad can it get? is the question that troubles hospitals, who are trying to create capacity for anticipated thousands of very sick patients, even though these acute shortages are only being really being seen in major cities. In the rest of Pennsylvania, the numbers suggest that while growth is geometric, some of this owes to increased testing. Deaths remain modest, with 6 out of 644 cases as of 2 PM Monday (most in the Philadelphia area), 1%, twice the rate death from the flu, but the flu has caused 128,000 cases and 100 deaths in Pennsylvania so far, and the season isn't over yet

So one question that I look forward to answering after we all head back to the Starbucks, when this is over, will be: What was it about this thing made it seem like a coming apocalypse? We don't take flu, or tuberculosis, or HIV seriously enough to devote efforts to limit their spread (or we'd already have enough masks and gloves in a stockpile somewhere). Why this?

Hydroxychloroquine

This is an antimalarial drug, but it's also used for autoimmune diseases like lupus and rheumatoid arthritis. A nationwide shortage of the drug now exists because prescribers are hoarding the drug for themselves and their families. I have a family member with lupus who is on this drug, and although I haven't heard from her yet, I have heard about numerous cases in which people with these serious diseases cannot get it, because it's been hoarded by the very people charged with helping the sick.

Perhaps the shortage of personal protective equipment has led to this behavior. Maybe not. Perhaps it's just self-centeredness, a doppleganger of the "self-ism" of many of our societies  in the West, in which individual "freedom" is believed to eclipse the common good.

Anyway, I found it interesting that in just a few days of this behavior, several people have died from taking this drug. (The link is just a couple of the cases reported so far--maybe this will cause people to rethink taking medical advice from a real estate developer.)

If you are considering, I would not recommend it. I myself would use a homeopathic remedy--at least the cure won't kill me.

Panic Buying

Or is it something else, maybe boredom? After all, we're pretty much left with just the grocery stores for outside entertainment in the presence of others of our kind. Here's an example:

Credit: Julie Moffitt
The pasta aisle at a local supermarket. I do hope none of this ends up in a landfill when it's too stale to eat. Maybe people will donate to food banks, especially with all the unemployed now coming online.

I understand. We're freaking out. But why? Should seem obvious, one could say. Deaths, lockdowns, mysterious, invisible invaders among us (sound familiar?), and all sorts of disruption with no clear end date. If I examine the real data so far, I can conclude that we have a serious health problem on our hands that mostly afflicts people 50 and older, that it seems alarmingly contagious but modestly fatal--the vast majority live when circumstances allow, such as healthy food supplies, clean water, avoidance of well-known bad habits (In China 52% of men smoke), and exercise some healthy behaviors, the fatality rate seems a modest 1%--and will probably be lower once we have a real denominator. We don't actually know how many people even are infected with the novel coronavirus.

Today I began to wonder Did we need something to happen? Were things too easy? Were we somehow bored? Did we need "a kick in our complacency," as Jean-Luc Picard put in Star Trek?
Things were not great for a lot of people, but we were tolerating it. This communal freak out accomplishes laying bare the inequities and poverties of many parts of the world, thus to inspire better discussions about how to fix those inequities. 

I mean, people are gettin' an education about their "health insurance". Am I right?

I'm not sure that I would say that people are somehow "causing" this. But this epidemic was probably influenced by the growing power of Chinese agribusiness, which like America's, forces the less wealthy to find other means of support, when they see a market to over-exploit.

In other words: systems move as an interconnected wave. It's not possible for me to imagine that this is objective decision-making in the face of limited data; rather it is the collective psychic seizure that for a moment frames everything into such relief, it can no longer be ignored. So...
  • We should have been better prepared for this.
  • Politicians politicizing catastrophe should be publicly flogged.
  • Individuals should have been better prepared, both by equitable wealth-structures and personal effort.
  • We need to have a real conversation about what's possible and what's desirable, real soon.
So that's going to mean new discussions. I kinda hope it upends the current political stalemate. That's what I'm thinkin' about. How about you?

Special Thanks: to Julie Moffitt. I love bouncing ideas around with you. Inspiration.

UPDATE 3/25/20: COVID-19 cases in U.S. 55,000; deaths, 801. From the CDC: "CDC estimates that so far this season there have been at least 38 million flu illnesses, 390,000 hospitalizations and 23,000 deaths from flu." Context.

Tuesday, January 28, 2020

What is Dementia?

I ran across this on Facebook:

"One man turned nursing home design on its head when he created this stunning facility."*

It unsettled me. It's sad, it's hopeful. Mostly it endeared me. I have worked with many people living with dementia. Many times they seem blank, distant, unreachable. Occasionally they are irascible, combative, silly, or rude. They can be hilarious and good-natured. They can grope, throw food, or repeat the same word for hours.

They can stare at you like you are the last real person they will ever remember, just because you were there at a particular time.

I have often observed such people to display hallucinations, or speak as if to spirits, or describe the world in detail as it was 50 years ago, but to them it feels like today. I've wondered, "Is she just lucky to have such a pleasant hallucination?" when one has seen many appear to be having pretty frightening delusional experiences.

But then what is "delusional"?

Is it delusional to attempt escape of a fragile and painful body, immobile, perhaps fetid, through the agency of a flight of fancy that seems so real? Or perhaps it's an unsurprising that such a person could find themselves in a fearsome funhouse full of unfamiliar sights and sounds and strangers.

So I read this and found myself really liking the concept. Give in to the delusion. Why fight it? Too often we fight against Nature. There is no winner inasmuch as we all will die. Some believe they will go on to another life...but...why the rush? So much are we tuned into our embodiment of ourselves--our actual bodies--that it becomes hard to imagine actually leaving this mortal life. I feel that way. I like this life. This causes me to wonder if others, whose lives perhaps weren't so lucky, would actually be served by a magical delusion that seems so real.

Except when we interrupt it. Suppress its expression.

There's been a movement in geriatrics that aims at not trying to reorient our memory-challenged elders when they are having a delusion. I've seen this begin to spread in health care, and in fact our own students benefit from this research. So it's getting around. A good idea.

This gives me hope that we are really beginning to put aside our assumptions and lean into Nature. Without that lean we're just regarding things at a distance, struggling with our ignorance, and perhaps robbing people of a sort of restorative humanity they may need in their final days.

Peace.

* Although I did not verify this story, it's plausible, and seems like a pretty good idea in any case.

Sunday, January 26, 2020

Is The End Of Homeopathy Near?

The short answer is "no."

Over the past couple of years the US Food and Drug Administration has been reviewing the regulations governing homeopathic medicines. Mostly they have been trying to get at the issue of new medicines marketed over-the-counter for consumers.

In general I have been supportive of these regulations, since there is evidence that homeopathic remedies, used improperly, can cause harm. It's like I tell my students:

If it's strong enough to cure you, it's strong enough to kill you.

Well, "kill" might be an overstatement. I've never seen a remedy kill anyone! But I have seen some harms, such as when people repeatedly take high potency remedies that were not carefully prescribed. Dr. Hahnemann himself wrote in the Organon of Medicine that strong remedies in high potency leave their mark on a patient. I have referred earlier to an FDA recall of Zicam because of such problems.

Lately, I've been getting a lot of hysterical email blasts from various homeopathic advocacy groups, and a few emails from patients who are alarmed by these reports, which claim the FDA is trying to gain the authority to recall homeopathic single remedies, which are used in classical homeopathy for complex, constitutional cases, acute problems, and other maladies.

This is not true. For support I'll share this very well written report from the American Association of Homeopathic Pharmacists, here in its entirety in the link. But I'll direct the reader's attention to the crux of the report, as I see it:

"AAHP also believes that the greatest existential threat to the industry today is not FDA but rather manufacturers and distributors marketing products not in compliance with current Good Manufacturing Practices [emphasis mine]."

People who access "natural medicine" are often unaware that the manufacturers of such products still live and work in a capitalist world where the object is to make money. It may be many believe they're also doing good...but, they still have to make payroll! I've talked here many times about Big Pharma and how allopathic drug makers are often corrupt, greedy, and frequently develop drugs that are expensive yet have marginal effectiveness. One must not assume that because a product is herbal or nutritional and outside of the pharmaceutical regulation system, it's "okay." In fact it is because these products are lightly regulated that nefarious intentions can lead to economic opportunism. 

If one wishes to contact the FDA about these draft regulations, one of the best things you can tell them is about the benefits of homeopathic single remedies to your health, and the importance of their continued availability. Expressing support about existing homeopathic medical practice reinforces with them that there's a constituency that values access to homeopathic single remedies.

Be well & stay warm!