Aghast: the brazen murder of George Floyd

I have no doubt what my late daughter Danielle would have said about this latest travesty.

I am not normally at a loss for words (just ask my wife), but this is one of those times. I will try to have something honest and constructive to say ASAP. It's all a bit overwhelming (says the comfy "woke" retired white guy).

PRESIDENT OBAMA

I want to share parts of the conversations I've had with friends over the past couple days about the footage of George Floyd dying face down on the street under the knee of a police officer in Minnesota.

The first is an email from a middle-aged African American businessman.

"Dude I gotta tell you the George Floyd incident in Minnesota hurt. I cried when I saw that video. It broke me down. The 'knee on the neck' is a metaphor for how the system so cavalierly holds black folks down, ignoring the cries for help. People don't care. Truly tragic."

Another friend of mine used the powerful song that went viral from 12-year-old Keedron Bryant to describe the frustrations he was feeling.

The circumstances of my friend and Keedron may be different, but their anguish is the same. It's shared by me and millions of others.

It's natural to wish for life "to just get back to normal" as a pandemic and economic crisis upend everything around us. But we have to remember that for millions of Americans, being treated differently on account of race is tragically, painfully, maddeningly "normal" — whether it's while dealing with the health care system, or interacting with the criminal justice system, or jogging down the street, or just watching birds in a park.

This shouldn't be "normal" in 2020 America. It can't be "normal." If we want our children to grow up in a nation that lives up to its highest ideals, we can and must be better.

It will fall mainly on the officials of Minnesota to ensure that the circumstances surrounding George Floyd's death are investigated thoroughly and that justice is ultimately done. But it falls on all of us, regardless of our race or station — including the majority of men and women in law enforcement who take pride in doing their tough job the right way, every day — to work together to create a "new normal" in which the legacy of bigotry and unequal treatment no longer infects our institutions or our hearts.

REVEREND KRISTEN HARPER

When you go to create a post, Facebook asks, "What’s on your mind?"

What is on my mind is the deaths of Breonna Taylor, Ahmad Aubery and George Floyd. While Minneapolis burns, most of the rest of the country remains sheltered; sheltered by COVID-19 because it's a great excuse to do nothing; sheltered by Whiteness because it's not your problem; sheltered by apathy because its just another news story.

I am not sheltered. I am afraid. Breonna Taylor was an EMT working to help and save people afflicted by the corona virus and was murdered in her home-a home that wasn't even the house the police were looking for. I have always been afraid of some of my neighbors with their huge American Flags and pickup trucks with gun racks but now I don't even like to take a walk around my neighborhood. 

This virus has only revealed how deeply rooted racism is within this country and how little Black lives truly matter.  Banners mean so little when people allow their Governments and Law Enforcement officers to impoverish and kill Black lives. We live under this constant fear and constant pain that so many pretend to sympathize with and yet do so little to change.

How can we look at our Black and Brown ministers, our Black and Brown co-workers, our Black and Brown teachers, nurses and nurses aids, companions and caregivers, our Black and Brown friends; and think reading a book will make the difference? How can we think that simply saying, "it's horrible" will really change our lives? How can we be paid less, treated with paternalism or condescension, allowed to clean your homes or keep up your property and expect us to be grateful for your "friendship."

Where are you when the brothers and sisters of my bones are being murdered? Where are you in my fear? No friends. I am not angry. I am just soul shattered.

Kristen was one of my late daughter Danielle's closest friends, and a fellow UU Minister. She posted this on Facebook. I asked her permission to post it here.

Kristen officiated at my grandson's wedding after his Momma died.

Keebo and KJ are soon to grace us with a baby boy great-grandson.

JULY 18TH UPDATE

Our Great-Grandson Kai, born 7 weeks preemie, now a month old. Baby and Momma doing fine.

A CLOSE FRIEND AND 1964 HIGH SCHOOL CLASSMATE

I can’t imagine having brown skin. I can’t imagine being treated as less than whole because I have brown skin. I can’t imagine being the momma of a little brown-skinned boy that grows up to be a brown-skinned young man that I have to be scared to death, every day, about what might happen to him when he goes out into this bigoted, racist America, to just live his God-given life.

I’m so sad, and so sorry.

Me too.

THE BIGOTRY OF MY CHILDHOOD

"Coons, 'Boons, Baboons, Jigs, Jigaboos, Jungle Bunnies, Spear-Chuckers, Porch Monkeys, Spooks..."

And, of course, the now-radioactive "N-word."

I was born a first-wave Baby Boomer WASP kid (Irish/English/German) to middle class parents in western Long Island NY in 1946, not far from the Queens borough, and then grew up in northern NJ where my Dad worked for Bell Labs in semiconductor R&D. I would hear those racial epithets all across my childhood years, carelessly spewed by relatives, friends' parents, and random proximate adults generally. Those kinds of slurs inevitably got assimilated into our own budding vernaculars.

My own parents' bigotry was relatively subdued and passive (polite suburban "plausible deniability"). e.g., in Hillsborough, during my 7th grade through high school years, according to my Ma, our black mailman, Herbie, was "one of those nice negroes" (as opposed to those Uppity "N" troublemakers in Newark, etc).

Prejudice was by no means restricted to African-Americans. Italians were "Ginnies" or "Wops," Puerto Ricans (eventually extending to all Hispanics) were "Spics," Asians were "Chinks," and Jews (irrespective of ethnicity) were "Kikes." Gays? Need I elaborate?

Eventually, I would hear Native Americans referred to as "Timber Niggers."

These days we can add "Ragheads," "Camel Jockeys," and "Sand Niggers."

Fall 1960: I began high school (Somerville NJ) and went out for the freshman football team (on which I would absurdly become the starting Center, given that no one else wanted the position). We picked classmate Bill Dorsey (then 17 yrs old, and black) to be our starting QB. It was scandalous; QB was a white kid's position. Blacks could be linemen or fullbacks, period.

Times have indeed changed, but, the NBA Boston Celtics joke is not all that old: "How many blacks can be on the court at the same time? Two at home, three on the road, five when you're behind." And, black NHL hockey players still get bananas thrown at them on the rink.

After we ran roughshod over our entire schedule and went handily undefeated, most of the bigoted football fanatic parents pretty much just grudgingly STFU. "State Champs in 4 years? OK." (It would not happen.) Us kids were just having fun, without a shred of racial hostility. (I am often reminded of the hilarious movie "Varsity Blues.")

By the time I was a senior (and still starting Center [#50 above] for the now-21 yr old Bill Dorsey [#16 above] ), the U.S. was increasingly deep into the heated struggle for black civil rights. Me, my football Jones was fast waning. I was only 5'10" and 165 lbs and was tired of getting the crap knocked out of me week after week by dudes outweighing me by 40-60 lbs or more (we went 6-3 that year, and nowhere close to a state title). I just wanted to be a guitar player.

Playing black R&B music, in particular. Which some viewed as "cultural appropriation" (and not without some merit). We'd sneak into blues and jazz clubs in Newark and Manhattan on fake IDs, usually the only white faces in the crowds. We may have been playing the likes of Chuck Berry, but we were diggin' on the likes of Jack MacDuff, Maynard, Sonny Stitt, and the Oscar Peterson Trio.

My parents were not amused, to put it mildly. Neither were my coaches ("hanging with the wrong crowd"). I'd been accepted to Kent State, with a partial football scholarship. Right.

Nonetheless, straight out of high school, I headed out on the road in a bar band, commencing a mostly hardscrabble "living" of 21 years, guitar in hand.

By 1967 I'd wound my way to California. In 1968, I joined a local San Francisco start-up band: Italian-American drummer Fred Abruzzo, Mexican-American bass player and standup comic Jose Simon, black lead singer Rick Stevens, and me, the "Irishman." We called our band "Four of a Kind,"--or, jokingly, "the Spic, the Spook, the Wop, and the Mick."

Only Fred and I survive. We remain steadfast friends. He quips, "well, Bobby, we're down to Two of a Kind now."

I moved on to Seattle. On July 27th, 1970 my second daughter was born. And, racially speaking, as they say, Shit Got Real.

Danielle, ~ age 3

FAST FORWARD TO 2018

April 27th, 2018: Holding my daughter's hand the day she died.

2018

Were my Danielle still alive, there's no doubt she'd be all up in my grill over the George Floyd murder and its aggregate upshot.

While we frequently lamented and laughed SMH about racial bigotry, Danielle and I would sometimes heatedly disagree over what I often viewed as her over-the-top paranoia about Keenan (my grandson) during her repetitive admonitions while iteratively having "The Talk" with him from early on.

She was right; I was wrong. It does not suffice for Cheryl and I to be "post-racial non-bigoted white progressives." Her concerns were real, they were warranted, as we yet again unhappily see. We discussed it again shortly before she died. I apologized. Benign intentions are not enough. And, while I had no say in being born white, I have a subsequent say when it comes to actively promoting justice. I vow to Keenan and KJ (and our soon-to-arrive great-grandson and our extended multiracial tribe) to henceforth do better.

IMMANUEL ACHO: UNCOMFORTABLE CONVERSATIONS...

Yeah.

JUNE 6TH UPDATE

Washington DC, blocks from the fenced-off White House, on the newly-named "Black Lives Matter Plaza."

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More to come...

Annie Duke ROCKS!

One mitigative personal upside of our continuing "all-covid19-all-the-time" period for this Parkinson's-addled non-essential non-worker and life-long unlearner has been the recent volume of compelling books I've consumed while getting "three weeks to the gallon of gas" (and Netflix binge-watching) here in the Homeland "shire."    

No read more fun and illuminating than Annie Duke's delightful "Thinking in Bets."

I'd gotten one of my routine Amazon email book pitches. Intrigued, I clicked on the book cover link. It was offered up as a Kindle edition special, which, with my always-accruing credits (I continue to buy a ton of books), would only set me back 59 cents.

"What have you got to lose?" Nonetheless, after reading the Amazon blurb, I went, as is my custom, to first reading the negative one-star reviews, which can often be show-stoppers (afterward, I would muse "did we read the same book?").

Never before having heard of Annie Duke, I recall also having had the fleeting, snarky thought: "Oh, will the yummie Jessica Chastain play her too in The Movie" (successor to Molly's Game).

LOL.

ANNIE IN THE NEW YORKER

Annie Duke Will Beat You at Your Own Game
    
Late last year, I wrote to Annie Duke, a former professional poker player, about the possibility of profiling her. Duke, who for years was the leading female money winner in the World Series of Poker, retired from the game six years ago and has since refashioned herself as a corporate speaker and strategic consultant. She struck me as someone with a potentially unique and strange set of perspectives on gender, celebrity, and money. We spent the next few weeks engaged in a polite game of psychological warfare. I became attuned, moment by moment, to infinitesimal shifts in power and grew obsessed with the notion that she might be playing our negotiations like a card game. I’m still not sure how much of it was in my head.

At first, Duke enthusiastically agreed to be profiled, and often responded to my e-mails with smiley faces and exclamation points. She invited me to accompany her to a charity event and suggested that I come along to her brother-in-law’s birthday party. When I asked her to recommend friends and colleagues who might have insight into her career, she responded eighteen minutes later with an annotated list of twenty-seven names. It included all living members of her immediate family, her ex-husband, various professional poker players, and celebrities she has taught to play the game. Duke seemed to understand instinctively that affording a journalist access can actually be a form of self-protection: her avid participation would decrease my need to ferret out potentially unflattering material elsewhere.

Since retiring, Duke, who has four children and lives near Philadelphia, has travelled across the country delivering keynote speeches to conferences held by the likes of Citibank, Pandora, and Marriott. She has co-authored multiple gaming guides, and her first general-interest book, “Thinking in Bets: Making Smarter Decisions When You Don’t Have All the Facts,” came out in February. The book’s premise is that poker players live in a world in which “risk is made explicit” and are therefore trained to assess incoming information logically and judiciously in a way that other people are not. “A hand of poker takes about two minutes,” she writes. “Over the course of that hand, I could be involved in up to twenty decisions. And each hand ends with a concrete result: I win money or I lose money. The result of each hand provides immediate feedback on how your decisions are faring.”

Duke argues that we bet all the time: on parenting, home buying, restaurant orders. Betting is merely “a decision about an uncertain future,” and our opponents are not other people but, rather, hypothetical versions of ourselves who have chosen differently than we have. Her most urgent message is that we should all be more comfortable living with self-doubt—not for ethical reasons but for intellectual ones. Embracing uncertainty, she argues, makes you a better thinker. “Real life consists of bluffing, of little tactics of deception, of asking yourself what is the other man going to think I mean to do,” she writes, quoting John von Neumann, the father of game theory…

Read all of it.

Also buy and carefully study all of "Thinking in Bets." Not kidding.

INTRODUCTION:  Why This Isn’t a Poker Book

CHAPTER 1:  Life Is Poker, Not Chess
Pete Carroll and the Monday Morning Quarterbacks
The hazards of resulting
Quick or dead: our brains weren’t built for rationality
Two-minute warning
Dr. Strangelove
Poker vs. chess
A lethal battle of wits
“I’m not sure”: using uncertainty to our advantage
Redefining wrong

CHAPTER 2:  Wanna Bet?
Thirty days in Des Moines
We’ve all been to Des Moines
All decisions are bets
Most bets are bets against ourselves
Our bets are only as good as our beliefs
Hearing is believing
“They saw a game”
The stubbornness of beliefs
Being smart makes it worse
Wanna bet?
Redefining confidence

CHAPTER 3:  Bet to Learn: Fielding the Unfolding Future
Nick the Greek, and other lessons from the Crystal Lounge
Outcomes are feedback
Luck vs. skill: fielding outcomes
Working backward is hard: the SnackWell’s Phenomenon
“If it weren’t for luck, I’d win every one”
All-or-nothing thinking rears its head again
People watching
Other people’s outcomes reflect on us
Reshaping habit
“Wanna bet?” redux
The hard way

CHAPTER 4:  The Buddy System
“Maybe you’re the problem, do you think?”
The red pill or the blue pill?
Not all groups are created equal
The group rewards focus on accuracy
“One Hundred White Castles…and a large chocolate shake”: how accountability improves decision-making
The group ideally exposes us to a diversity of viewpoints
Federal judges: drift happens
Social psychologists: confirmatory drift and Heterodox Academy
Wanna bet (on science)?

CHAPTER 5:  Dissent to Win
CUDOS to a magician
Mertonian communism: more is more
Universalism: don’t shoot the message
Disinterestedness: we all have a conflict of interest, and it’s contagious
Organized skepticism: real skeptics make arguments and friends
Communicating with the world beyond our group

CHAPTER 6:  Adventures in Mental Time Travel
Let Marty McFly run into Marty McFly
Night Jerry
Moving regret in front of our decisions
A flat tire, the ticker, and a zoom lens
“Yeah, but what have you done for me lately?”
Tilt Ulysses contracts: time traveling to precommit
Decision swear jar
Reconnaissance: mapping the future
Scenario planning in practice
Backcasting: working backward from a positive future
Premortems: working backward from a negative future
Dendrology and hindsight bias (or, Give the chainsaw a rest)

ACKNOWLEDGMENTS
NOTES
SELECTED BIBLIOGRAPHY AND RECOMMENDATIONS FOR FURTHER READING

I was gratified to see that a lot of the books she cites are ones I own and have read. Were I still teaching "Critical Thinking" her book would be a required text.

Once something occurs, we no longer think of it as probabilistic—or as ever having been probabilistic. This is how we get into the frame of mind where we say, “I should have known” or “I told you so.” This is where unproductive regret comes from.

By keeping an accurate representation of what could have happened (and not a version edited by hindsight), memorializing the scenario plans and decision trees we create through good planning process, we can be better calibrators going forward. We can also be happier by recognizing and getting comfortable with the uncertainty of the world. Instead of living at extremes, we can find contentment with doing our best under uncertain circumstances, and being committed to improving from our experience…

One of the things poker teaches is that we have to take satisfaction in assessing the probabilities of different outcomes given the decisions under consideration and in executing the bet we think is best. With the constant stream of decisions and outcomes under uncertain conditions, you get used to losing a lot. To some degree, we’re all outcome junkies, but the more we wean ourselves from that addiction, the happier we’ll be. None of us is guaranteed a favorable outcome, and we’re all going to experience plenty of unfavorable ones. We can always, however, make a good bet. And even when we make a bad bet, we usually get a second chance because we can learn from the experience and make a better bet the next time.

Life, like poker, is one long game, and there are going to be a lot of losses, even after making the best possible bets. We are going to do better, and be happier, if we start by recognizing that we’ll never be sure of the future. That changes our task from trying to be right every time, an impossible job, to navigating our way through the uncertainty by calibrating our beliefs to move toward, little by little, a more accurate and objective representation of the world. With strategic foresight and perspective, that’s manageable work. If we keep learning and calibrating, we might even get good at it.

Duke, Annie. Thinking in Bets (pp. 230-232). Penguin Publishing Group. Kindle Edition.

Very smart woman. Lots to ponder. You will do well to watch all of it.

THE CRUX

"Once something occurs, we no longer think of it as probabilistic—or as ever having been probabilistic. This is how we get into the frame of mind where we say, “I should have known” or “I told you so.”

Annie says poker players call this "resulting." An interesting chronic problem in this time of being fashionably "data driven," and the tendency to spuriously correlate the quality of individual decisions with their singular outcomes. "Hindsight bias," in brief.

So, how does this stuff cohere with the so-called "Science of Deliberation," scientific thinking directed at accurate decisionmaking?

UPDATE: ANNIE DUKE BOOK RECOMMENDATION

She touted this one on Twitter.

I'm a couple of chapters in thus far. Very good. I can see why she recommended it.

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More to come...

"A malevolent holiday"

From Harper's Magazine, Easy Chair column (paywalled):

“Everybody knows that pestilences have a way of recurring in the world, yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky,” writes Camus in his 1947 novel The Plague, as translated by Stuart Gilbert. He continues: “There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.” A masterpiece of European postwar fiction, The Plague offers a uniquely clear, forceful, and meticulous account of the states and stages of inertia, ignorance, denial, learned helplessness, and—when we’re at our best—resistance that we pass through as we’re confronted with an evil as efficient as it is incomprehensible…

…For Camus, the question of sickness, of life’s two irreducible teams—pestilences and victims—and of the Sisyphean struggle for meaning in a godless, absurdly indifferent universe, was always quite literal. He worked on the book for six eventful years: first in Oran, then in the French Alpine village of Le Chambon-sur-Lignon, where he went to treat his tuberculosis, and afterward in Paris, during the Resistance, distilling into fiction his painstaking research on the history of plagues in Europe and Asia. Taken at face value as a work of extraordinary and exhaustive insight into the fundamental conditions of living under biological pestilence—and in this way contrary to Judt—The Plague does in fact offer a considerable number of lessons.

A pandemic, if you are fortunate enough not to be hospitalized or killed by it, wears you down by other, more subtle measures. It administers, by a thousand cuts, a kind of spiritual and psychological incapacitation. It sends you away on a malevolent holiday, open-ended, enough to make you crave the rhythms and ardors of labor. By stripping you of the most basic knowledge that the world will remain predictable, stable in the morning, it makes you all too aware of just how good you once had it—and that no such assurance was ever promised to you in the first place. Indeed, one of the key insights of The Plague is its emphasis on the fundamental fragility of all human arrangements, and the concomitant inability of most people to acknowledge this tenuousness until it is far too late for meaningful collective action. (Beyond the particular menace of the coronavirus, this is ultimately what is so terrifying about the climate crisis.) It is our great strength as well as our terrible weakness to live most fully in the past and in the future. But pestilences rob us of the sanctuary of both of these states, forcing us into the totalizing uncertainty and silence of the present. A pandemic, then, is an opportunity, at last, to see ourselves and our condition more clearly. If there is one, this is the virus’s silver lining…

'eh?

Among my decades-long hardcopy periodicals subscriptions are The Atlantic, The New Yorker, and Harper's. The latter remains primus inter pares.

COVID19 FREEDUMB UPDATE

"Let's say you woke up with a terrible cough, a fever, and severe body aches. Immediately, you rush to the doctor and unfortunately, you’re diagnosed with COVID-19. For the last two weeks, you’ve been unaware that you were infected and you’ve ignored "the rules." You've gotten together with some close friends for pizza, had a few people over, even visited a park and a beach. You figured, 'I don’t feel sick. I have the right to keep living my normal life. No one can tell me what to do.'

With your diagnosis, you spend the next few days at home on the couch, feeling pretty crappy; but then you’re well again because you’re young, healthy and strong. Lucky you.

But your best friend caught it from you during a visit to your house, and because she didn't know she was contagious, she visited her 82-year-old grandfather, who uses oxygen tanks daily to help him breathe because he has COPD and heart failure. Now, he’s dead.

Your co-worker, who has asthma, caught it too, during your little pizza get-together. Now, he’s in the ICU, and he's spread it to a few others in his family, too--but they won't know that for another couple of weeks yet.

The cashier at the restaurant where you picked up the pizza carried the infection home to his wife, who has MS, which makes her immunosuppressed. She’s not as lucky as you, so she’s admitted to the hospital because she’s having trouble breathing. She may need to be placed in a medically-induced coma and intubated; she may not get to say goodbye to her loved ones. She may die surrounded by machines, with no family at her bedside.

All because you couldn't stand the inconvenience of a mask; of staying home; of changing your familiar routines for just a little while. Because you have the right, above all others’ rights, to continue living your normal life and no one, I mean no one, has the right to tell you what to do.”

     — Anonymous

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More to come...

ASQ webinar on Covid19 assay QA

Better late than never. These new coronavirus tests have been rife with error.

PROGRAM OVERVIEW

Testing is dominating our conversation during the current Covid-19 crisis as we think about reopening our economy. FDA has rapidly authorized nearly 100 different tests for emergency use to help detect, diagnose, and treat the infection caused by the novel coronavirus. There is widespread concern about the quality and reliability of these tests because of the perception that the FDA has relaxed the normally stringent requirements for performance validation.

In this webinar, the focus will be on recently authorized serology tests for the detection of antibodies and review their reported performance. The presenter will discuss how we can assess the level of uncertainty and risk when these tests are used for population serological surveys. Finally, the presenter will share thoughts on current misconceptions about testing and how Quality professionals can help facilitate a more informed public conversation and awareness.

Free, but name and email address registration required. I signed up to attend. From the email notice, it's obviously available to all ASQ members, but whether registration extends to the public at large is not clear.

I've been harping on the testing validation issues for more than two months. See here as well. My ASQ (in particular the BioMed Division) has been MIA up to now.

UPDATE FROM SCIENCE-BASED MEDICINE

COVID-19 Testing
Currently available tests for COVID-19 are imperfect but useful if used properly, with rapidly evolving research on new tests underway.

As states are beginning to phase out total lockdown in the US, there is much discussion about how best to do it, minimizing the chance of causing a resurgence in COVID-19 cases. Just about every expert questioned about this topic focuses on testing – we have to do lots of testing in order to track people who have the disease, trace their contacts, and isolate them. At its core the idea is simple – instead of isolated everyone, we isolate those who have the virus, but in order to do that we have to know who has it and who doesn’t. Symptoms are one guide, but you can have the virus and pass it on without displaying symptoms. Therefore testing is critical. Some experts estimate we will need to do millions of tests per day to safely open up.

What is the state of our testing technology, and how reliable is it? There is a lot of work in this area, so this is a rapidly moving target, but some recent reviews help put things into perspective…

BTW, the Wiki has a nice, detailed entry on Covid-19 assay technologies, methodologies, and issues.

POST-WEBINAR UPDATE

It was good, notwithanding the CusterFluck Webex interface login and recurrent bandwidth issues.

Niec presentation deck.

I would say, in deference to his Copyright, contact the author for the slide deck. He has lots of good stuff on his site. Attendees all got pdf access to it, but I don't want to usurp his show.

All good information, but nothing much I'd not already addressed in detail. I was looking for useful particulars on assay tech/methodology R&D QA and SARS-CoV-2 screening deployment workflow QA. They remain substantive concerns.

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More to come...

95 days of tracking #COVID19

I first mounted a screen shot of the Johns Hopkins Covid-19 tracking site on February 11th.

This morning:

Yeah, "we're all (however begrudgingly) in this together." Widespread continuing willful denial in the U.S. notwithstanding.

Screening assay availability at scale and accuracy remain glaringly unresolved concerns.

But...

Is it too early to start drinking?

91 DAYS SINCE CALVIN WAS BORN

Four days after my first Covid19 post, our new grandson Calvin arrived.

Frustrating to not be with him more. Going on months old now. Fabulous.

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More to come...

"During these challenging times,

we're all in this together."

Right.

Don't know about you, but I'm getting sick of that banal ad copywriter blather. "Let them eat clichés."

And, yeah, I know it's lexically true.

ERRATUM

The Day in Stupid.

FROM THE NEW YORKER:

"Zoonotic, Vector-borne Diseases"

In 2006, the idea that an unknown virus might spill out of some wild animal into humans, achieving person-to-person transmission and causing a global pandemic, seemed a distant prospect to most people. As an engaging science-fiction scare, it ranked somewhere beneath “Alien: Resurrection.” But Ali S. Khan, of the National Center for Zoonotic, Vector-Borne, and Enteric Diseases, was tasked with dreaming that nightmare by daylight.

NCVED (pronounced “N. C. Zved,” according to Khan), part of the Centers for Disease Control and Prevention, resided in an unobtrusive gray brick building, behind locked gates and locked doors in the C.D.C.’s compound on Clifton Road, six miles northeast of downtown Atlanta. During a two-day visit that year, I worked my way along the NCVED corridors, interviewing scientists who knew all about Ebola viruses (yes, there are more than one) and their lethal cousin Marburg; about West Nile virus in the Bronx and Sin Nombre virus in Arizona; about simian foamy virus in Bali, which is carried by temple monkeys that crawl over tourists, and monkeypox, which reached Illinois in giant Gambian rats sold as pets; about Junin virus in Argentina and Machupo virus in Bolivia; about Lassa virus in West Africa, Nipah virus in Malaysia, Hendra virus in Australia, and rabies everywhere. All these viruses are zoonotic, meaning that they can pass from animals to people. Most of them, once in a human body, cause mayhem. Some of them also transmit well among people, bursting into local outbreaks that may kill hundreds. They are new to science and to human immune systems; they emerge unpredictably and are difficult to treat; and they can be especially dangerous, as reflected in the name of the branch within NCVED that studied them—Special Pathogens. For these reasons, some scientists and public-health experts, including Ali Khan, find the viruses an irresistible challenge. “It’s because they keep you on your toes,” he told me…

About a 40 minute read (has audio embed also). Excellent.

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More to come...

#SocialDistancing: alone together

Just saw this reviewed in my current hardcopy Science Magazine (paywalled).

The other public health crisis

As a fledgling physician, Vivek Murthy considered social issues such as loneliness to be outside the domain of doctoring. That all changed when he met a patient named James, whose health concerns appeared to stem from social isolation that started after winning the lottery. In restructuring his life to his new economic standing, James had inadvertently cut himself off from his existing support network, sending his health into a downward spiral. In his book Together, Murthy—who served as the 19th surgeon general of the United States—draws from decades of scientific research and his own experiences with patients like James to show just how damaging loneliness can be.

The timing of the book's release coincides with a global public health crisis, as people around the world adapt to the ongoing COVID-19 pandemic. Murthy's account of the factors driving loneliness and his suggestions to combat isolation are particularly poignant now, as many abide by recommendations to stay home and avoid social contact with others…

Had to buy the Kindle edition. Glad to have done so.

Author’s Note
This is a book about the importance of human connection, the hidden impact of loneliness on our health, and the social power of community. As a physician, I felt compelled to address these issues because of the rising physical and emotional toll of social disconnection that I’ve watched throughout society over the past few decades. What I could not anticipate, however, was the unprecedented test that our global community would face just as this book was going to press.

In the first weeks of 2020, the COVID-19 pandemic turned physical human contact into a potentially mortal threat. The novel coronavirus was on the loose, like an invisible stalker, and any of our fellow human beings could have been its carrier. Almost overnight, it seemed, getting close enough to breathe on another person became synonymous with danger. The public health imperative was clear: to save lives, we’d need to radically increase the space between us.

As I write these words, we are still in the middle of this pandemic. With health workers at risk, hospital equipment in short supply, and death rates from the coronavirus spiking by the day, governments the world over have mandated “social distancing,” closed schools and most businesses, and ordered everyone but essential service workers to stay home. Those first responders, health-care and food-supply workers, and others who must stay on the job to protect us are now putting their lives on the line. They remind us just how much we depend on each other…

This pandemic isn’t the first and won’t be the last time our social connections are tested, but it is rare for the whole world to face such a grave challenge simultaneously. For all our differences, our shared experience is itself a bond. We will have this memory in common for the rest of our lives. And if we learn from this moment to be better together, we won’t just endure this crisis. We will thrive.

March 2020

AMONG THE NUMEROUS ACCOLADES

“This powerful and important book looks at loneliness as a public health issue. Vivek Murthy shows why loneliness evolved in our species, how it can be harmful, why it’s on the rise today, and what we can do about it. By creating better connections with our friends and our communities, we can lead healthier lives and help our friends be healthier.” 

   —Walter Isaacson, New York Times bestselling author 

“Murthy’s book makes a powerful case for the role of community and human connection in medicine. He provides cogent and compassionate insights about how to heal the art of healing.”

   —Siddhartha Mukherjee, the Pulitzer Prize–winning, New York Times bestselling author of The Emperor of All Maladies

We shall see. Amazon reviews were all lauditory. A timely read. Just getting started, stay tuned. I am reminded of another fine book I cited on this blog some time back.

6: SOCIAL FACTORS
Life with people

Philosopher Jean-Paul Sartre famously wrote, “L’enfer, c’est les autres”—hell is other people. No. Not if you want to live long. One of the keys to a long health span and a long life is social connectedness.

Loneliness is associated with early mortality. It has been implicated in just about every medical problem you can think of, including cardiovascular incidents, personality disorders, psychoses, and cognitive decline. Loneliness can double the likelihood of developing Alzheimer’s disease. It increases the production of stress hormones, which in turn lead to arthritis and diabetes, dementia, and increased suicide attempts. It leads to inflammation, increasing proinflammatory cytokines such as interleukin-6 (IL-6), and it negates the beneficial effects of exercise on neurogenesis, the growth of new neurons. Loneliness is worse for your health than smoking fifteen cigarettes a day. If you are chronically lonely, the risk that you will die in the next seven years goes up by 30 percent.

Loneliness and social isolation are not the same thing. Social isolation refers to having few interactions with people and can be evaluated objectively (for example, how many people you interact with in a week and for how long). Loneliness is entirely subjective—it’s your emotional state. Social isolation can be calculated. Loneliness is felt.

People can feel lonely even when surrounded by others, such as in the middle of a party or inside a large family. Loneliness is a feeling of being detached from meaningful relationships, and that may arise from feeling unacknowledged, from feeling misunderstood, or from a lack of intimacy. Having a spouse sometimes helps, and sometimes not. There are certainly people who enjoy being alone and who do not feel lonely, just as there are people who are constantly in the presence of others, perhaps making small talk, but feeling completely alone. Being unmarried raises the risk of loneliness and a host of health-related problems, but being married doesn’t help in all cases—not all marriages are happy ones.

Social isolation can lead to loneliness, of course, and both can increase in old age owing to a variety of factors. People retire and swiftly lose the social contact they had with co-workers. Friends die. Health and mobility problems make it more difficult to leave home. Ageism, present in many modern societies, leaves older adults feeling devalued, unwanted, or invisible. Younger friends and family members become caught up in their own lives and might not take time to visit older people. Government research in the UK found that two hundred thousand older adults had not had a conversation with a friend or relative in more than a month. Clearly that kind of extreme social isolation can lead to loneliness.

Levitin, Daniel J. Successful Aging (pp. 179-180). Penguin Publishing Group. Kindle Edition.

ANTISOCIAL DISTANCING AT THE MICHIGAN STATEHOUSE

Angrily protesting the governor's emergency stay-at-home order. Just out of photo range above, the requisite "patriotic" Confederate flags, crude swastika placards, and assault weapons replete with playtriot army surplus store garb.

#COVIDIOTS
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The latest from Hopkins.

Speaking of Hopkins, and "public health" more broadly. From NPR:

Opinion: Always The Bridesmaid, Public Health Rarely Spotlighted Until It's Too Late

The U.S. is in the midst of both a public health crisis and a health care crisis. Yet most people aren't aware these are two distinct things. And the response for each is going to be crucial.

If you're not a health professional of some stripe, you might not realize that the nation's public health system operates, in large part, separately from the system that provides most people's medical care.

Dr. Joshua Sharfstein, a former deputy commissioner for the Food and Drug Administration and now vice dean at the school of public health at Johns Hopkins in Baltimore, distinguishes the health care system from the public health system as "the difference between taking care     of patients with COVID and preventing people from getting COVID in the first place."

In general, the health care system cares for patients individually, while public health is about caring for an entire population. Public health includes many things a population takes for granted, like clean air, clean water, effective sanitation, food that is safe to eat, as well as injury prevention, vaccines and other methods of ensuring the control of contagious and environmental diseases.

In fact, it is public health, not advances in medical care, that has accounted for most of the increases in life expectancy during the past two centuries. Well before the advent of antibiotics and other 20th Century medical interventions, public-health activities around clean water, food safety and safer housing led to enormous gains.

"It's pretty invisible" if the public health system is working well, said Sharfstein, who also once served as Maryland's state health secretary. "It's the dog-that-doesn't-bark agency."

But while public health isn't as flashy as a new drug or medical device or surgical procedure, it can simultaneously affect many more lives at once…

Still, because the public-health system mostly operates in the background, it rarely gets the attention — or funding — it deserves, until there's a crisis.

Public health is "a victim of its own success," said Jonathan Oberlander, a health policy researcher and professor at the University of North Carolina-Chapel Hill.

"People can enjoy clean water and clean air but don't always attribute it to public health," he said. "We pay attention to public health when things go awry. But we tend to pay not a lot of attention in the normal course of events.”

Public health as a scientific field was created largely to address the sort of problem the world is facing today. Sharfstein noted that Baltimore established the nation's first public health department in 1793 to address a yellow fever epidemic. But between emergencies, the public health domain is largely ignored.

"In the U.S., 97 cents of every health dollar goes to medical care," he said. "Three cents goes to public health.”…

Read all of it. Very good.

UPDATE

Finished Dr. Murthy's book. Very enjoyable read. The Science Magazine review sums it up nicely:

…Collectivistic communities—those that emphasize the needs of the group over the needs of individuals—can foster connectedness by providing social institutions that bind people together. But oppressive social norms inherent in many such communities can cause undue stress, and those who do not conform to these norms can be ostracized and left even more isolated than those from individualistic communities. Understanding the profound necessity of connectedness and how we can protect ourselves from isolation in modern society can help us to take deliberate action to cultivate our relationships with others.

For those who are fortunate, the practice of social distancing during the COVID-19 pandemic may provide valuable opportunities to reconnect with family and loved ones quarantined at home. For many others, the situation will be dire. Those living alone will experience increased isolation, and those most at risk, such as the elderly and ill, may be kept in isolation from their loved ones. On a societal level, the public health implications of this widespread disconnect may be severe.

By showcasing research on the impact of loneliness and its social and environmental antecedents, Murthy presents a road map of the various pathways that lead to connection or isolation. Although the path to connectedness may be long and arduous, particularly while social distancing, the direction in which we must head is clear.

Well worth your time.

AS IS THIS

My current read, just started.

Fun stuff. Clear thinker.

apropos of last year's riff on "Deliberation Science."
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More to come...

#COVID19 May Day, lockdown protests, and Remdesivir

From the Editor of Science Magazine.

Pandemics are international. A virus doesn't respect borders between countries—or between states, as we are seeing with severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) in the United States. Unfortunately, too many world leaders want to treat the situation as a problem for their nation alone and not the world.

Science will rise to the challenge of coronavirus disease 2019 (COVID-19) and is doing so. The structures of the most important SARS-CoV-2 proteins are now known. Although we are still in the early stages of understanding human immunity to the virus, neutralizing antibodies are being identified. Clinical trials have begun on vaccines and drugs. There's no shortcut, but there's reason to think we can conquer this if we can get enough time and collaboration. Most world leaders don't seem focused on giving the scientific and biomedical communities these two things…

Nobody wants to continue social distancing forever (or thinks they can). Even the most pessimistic modelers of COVID-19 spread agree that this degree of behavioral change can't be sustained for many months. But the tools needed to get to the next phase in the United States are still not showing up: increased testing, staffing and gear for the hospitals with the greatest needs, and masks for everyone.

Courageous and confident world leaders believe that nations work best together through international institutions; this process has benefited the world for decades. Weak leaders believe in this but only if it benefits their country alone or even themselves. The WHO is not perfect, but it has helped put out many fires around the world for a long time. - H. Holden Thorp

More editorial content from the same issue of Science Magazine:

LOST IN TRANSLATION

Coronavirus disease 2019 (COVID-19) has been the greatest disruption to the movement of people since World War II. Many who had plans—and permission—to move permanently from one country to another have seen their transition put on hold. Worldwide, the flows of tourists, business and professional travelers, and students are all affected. But those most vulnerable to the virus and virus-related policies are low-paid migrant workers who have lost their jobs, and refugees or displaced people. Their lives were precarious even before the pandemic spread.

Migrant workers suffer as they struggle to return home with little or no money, often in the face of travel restrictions and suspension of transport links. In India, after Prime Minister Modi imposed a country-wide lockdown on 24 March, hundreds of thousands of internal migrants crowded the roads on foot, creating the very conditions that the lockdown was meant to prevent. Many foreigners are being summarily expelled, such as in India and Saudi Arabia. Others are stranded in foreign countries. Losing jobs creates a cascade of other losses for migrant workers—of legal status and access to health care and other public services. Only a few places, including Portugal and New York state, have opened their health care systems to migrants regardless of legal status (as Thailand has done since 2013 in response to the AIDS epidemic and other infectious diseases brought to the country by migrant workers). These migrants' families back home will suffer too, from the loss of remittances that fund health care, housing, education, and better nutrition. The departure of temporary migrant workers also creates risks for the native population. Agricultural producers in Europe, for example, are predicting crippling labor shortages this spring and summer.
   
Refugee camps are densely packed—the largest one in the world, in the Cox's Bazar District of Bangladesh, has three times the population density of New York City, without a single high-rise building. Social distancing is impossible in such a setting. Clean water for handwashing is scarce. Medical resources are thin, although humanitarian agencies are ramping up hand-washing stations, protective gear, isolation units, and ambulance services. Conditions in European “reception centers” for refugees and asylum seekers, like that near Moria village on the Greek island of Lesvos, are worse than in many refugee camps in poor countries. Moria holds about 22,000 people in a site built for 3000. There are 1300 residents per water tap... - Kathleen Newland

Ugh.

Meanwhile in the U.S., armed Branch Covidian Playtriots are storming a number of state capitols to protest their relatively comfy stay-at-home inconveniences.

Manly stuff, 'eh?

REMDESIVIR?

Just got emergency FDA clearance. Good idea?

Early tentative efficacy findings, via WIRED.

MAY 4TH UPDATE

From Science Based Medicine.

COVID-19: Out-of-control science and bypassing science-based medicine
During the COVID-19 pandemic, there hasn’t just been a pandemic of coronavirus-caused disease. There’s also a pandemic of misinformation and bad science. It turns out that doctors today are just as prone as doctors 100 years ago during the 1918-19 influenza pandemic to bypass science-based medicine in their desperation to treat patients…

Important reading.
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More to come...