The Structure Of Life

People are born into a family, and they're surrounded by a larger culture (other relatives, neighbors, classmates, coworkers, people on television, people in books, etc.). From their earliest years onward, they're surrounded with those two contexts (the family and the larger culture). They think, talk, make their plans, and so on with those two contexts in mind. Christians should be intervening in people's lives to get them to be more concerned about God, above their concern for family and above their concern for the rest of the culture. God is superior, he deserves to be of more concern to us, and the family and the culture wouldn't exist and wouldn't have hope for the future without him.

Given the nature of life and how so many people err so much in the direction of neglecting God while giving too much attention to the family and the rest of the culture, we should adjust our efforts accordingly. Family issues, career issues, and such should be addressed within the framework of the primacy of God, and the tendency of people to overestimate the former while underestimating the latter needs to constantly be kept in mind.

Often, opposition to a Christian view of the family comes from a minority of the population, even if it's a large minority, an unusually vocal one, or something like that. Even when the opposition represents a majority, that majority often simultaneously overestimates the family in other contexts. I've mentioned before that the Pew Research Center has found that when asked where they find meaning in life, Democrats cite the family more than Republicans do. Just because a group is anti-family in some contexts, that doesn't prove that it isn't overestimating the family in other contexts. And the pro-family response to anti-family movements can go too far in the pro-family direction. There's a reason why Jesus repeatedly addressed the need to love him more than you love your family. There was a lot of fornication, adultery, divorce, homosexuality, abortion, polygamy, etc. in Jesus' day. He addressed those issues while simultaneously recognizing the primacy of God, telling people that loving God is the foremost commandment, and recognizing that the same culture that had so many anti-family characteristics also needed to repeatedly be warned about overestimating their family. And much the same can be said about other issues in life (careers, healthcare, etc.).

One of the reasons why I'm bringing these things up is that a lot of Christians (and Jews and others who should know better) don't seem to be giving these subjects enough thought. I frequently hear people who should know better commenting on how nothing in life is more important than the family (or your health or whatever), how the biggest issue of our day is the family or some kind of anti-family movement in our culture, people saying a lot about their family while saying far less about God than they ought to, etc. A lot of this seems to involve peer pressure, since people know that it's so popular to give a lot of attention to something like your family, your career, or health issues, whereas it's unpopular to say much about God. But we should be going against the peer pressure rather than going along with it. And the peer pressure wouldn't exist if there weren't so many people holding these false ideas and pressuring others to go along with them.

"The seed which fell among the thorns, these are the ones who have heard, and as they go on their way they are choked with worries and riches and pleasures of this life, and bring no fruit to maturity." (Luke 8:14)

Ioannidis on COVID-19

"A Conversation with John Ioannidis"

Social justice matters more than social distance

"Suddenly, Public Health Officials Say Social Justice Matters More Than Social Distance"

Trump and light therapy

Trump:

Supposing we hit the body with a tremendous - whether it’s ultraviolet or just very powerful - light. And I think you said that hasn’t been checked, but you’re going to test it?

And then I said supposing you brought the light inside the body, which you can do either through the skin or in some other way. And I think you said you’re going to test that too? Sounds interesting.

And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning, because you see it gets in the lungs and it does a tremendous number on the lungs? So it would be interesting to check that, so that you're going to have to use medical doctors with, but it sounds interesting to me. So we'll see. But the whole concept of the light, the way it kills in one minute, that's pretty powerful.

It seems to me many people are unfairly criticizing Trump on this:

1. Granted, Trump can speak ignorantly, but that's nothing new. In fact, previous politicians including Obama have made many ignorant statements, but do liberals including the mainstream media ever parse and criticize their own side as much as they criticize Trump and conservatives? Many liberals are acting like Trump is telling people to throw themselves onto a burning pyre in order to kill the coronavirus.

2. It's not as if Trump is suggesting it's definitive treatment. He's not acting like Elon Musk did several days ago. Rather Trump is asking medical experts to investigate.

3. For that matter, light has long been used as treatment for some conditions. For example, UV light treatment (e.g. PUVA therapy) is not uncommonly used in certain cases of psoriasis, eczema, vitiligo, lichen planus, cutaneous lymphoma, etc. Ask any dermatologist.

4. Granted, these aren't infectious diseases. Again, Trump doesn't have a medical background (and in fact he's deferring to medical experts on this), so one wouldn't expect Trump to be able to make the distinction. Maybe the criticism should be that Trump shouldn't make apparently impromptu remarks like this. If so, his critics might as well try to rein in what Trump says on Twitter too. /s

5. At the same time, there's some precedence in the use of phototherapy in other coronaviruses. Take the use of phototherapy in the first SARS-1 coronavirus back in 2003 (e.g. here). (Our pandemic is SARS-2.) Also, phototherapy was used in MERS (e.g. here). And even a prestigious science journal like Nature has published on the use of phototherapy against other pathogens. Granted, these aren't all great studies or anything, but it's not like there's zero precedence for phototherapy. Perhaps this is the kind of thing Trump had in the back of his mind.

6. This isn't to suggest phototherapy is a good idea with regard to the coronavirus. Indeed, phototherapy has distinct disadvantages. Not least of which is increased risk of certain cancers (e.g. BCCs, SCCs, melanoma), especially in certain skin types (e.g. Fitzpatrick scale). And I certainly don't think phototherapy should be pursued if it means less focus or attention is placed on other therapies like drug based antivirals and vaccines.

7. I should be clear: I'm not defending Trump's proposal so much as I'm criticizing his critics.

It's challenging to compare nations over coronavirus response

I think many people simply assume it's a fairly straightforward comparison to compare how the US is doing vs. how other nations are doing in terms of responses to the coronavirus or COVID-19. Many people simply look at the total case numbers and the total deaths between nations without considering other factors involved. However, consider the following variables:

1. Population density

   Nations could have significantly different population densities. Indeed, cities within nations could have significantly different population densities. All things equal, the more dense a population is, the more challenging it is to maintain a certain distance from one another. Not to mention population density may impact a city or nation's access to its health care system as well as delivery of health care to the general population.

2. Health demographics

   Nations could have significantly different population demographics which impact their health. Some nations may have a higher median age than other nations (e.g. China is 37.4, Italy is 45.5, USA is 38.1). Some nations may have "sicker" people at baseline than other nations (e.g. higher rates of obesity, higher rates of hypertension, higher rates of diabetes).

3. Health care systems

   Nations could have significantly different health care systems. Take the quantity and quality of its health care providers and workers (e.g. some nations have more physicians per capita than other nations, some nations have better medical education and training than other nations). Take people's access to health care and a nation's delivery of health care to people. Some nations don't have a primary care system that stands in-between the general population and hospital systems like the US does, but instead the general population goes directly to the hospital, which could more easily overwhelm hospital systems. Some nations have socialized medicine which comes with its own complex sets of challenges.

4. Private enterprise

   Some nations' health care systems allow for better cooperation with private enterprise than other nations. Some nations can better mobilize private industry to help. Some nations are more advanced in prior research and development of medical technologies (e.g. pharmaceutical therapies), though to be fair R&D isn't necessarily primarily a private enterprise. However, at the very least, R&D is often closely tied to private industry in Western-style democratic nations.

5. Testing

   Some nations have done more and/or better testing of their populations than other nations. As Samuel Shem (pseudonym) points out in his satirical novel The House of God: if you don't take a temperature, you can't find a fever!

Of course, this isn't to suggest we can never reliably compare nations. This isn't to suggest we can't learn from other nations when they have failed. This isn't to suggest we can't adopt strategies from other nations when they have succeeded. Rather I'm simply pointing out that comparisons between nations can be more complicated and challenging than at first glance.

Medical dystopia

Economic downturns always lead to increased poverty, and increased poverty necessarily results in more deaths. By "flattening the curve" via turning off the economy, we've now made it where not only do you have to avoid COVID-19 during your quarantine, but you need to avoid that heart attack, accidental fall in the shower, burning yourself at the stove, not tripping over your cat, etc. etc. etc. Because hospitals can't afford to pay doctor's and nurses given the ban on so-called "elective" procedures and the fact that most people who need any medical care are probably furloughed too so they can't pay anyway, they have to cut hours and pay, meaning there's fewer people to see you during your emergency. When you enact the economics of a socialist utopia, you get the standard of living of a socialist utopia. Only now there's no America to flee to.

https://www.facebook.com/peter.pike.75/posts/10158167326508928

Destroy the healthcare system to save the healthcare system

Remember when a major rationale for lockdowns and curfews was to "flatten the exponential growth curve" so that the healthcare system wouldn't be overwhelmed by COVID-19 patients? Only here's the side-effect on the healthcare system:

https://www.live5news.com/2020/04/06/musc-implementing-workforce-realignment-plan-it-works-through-serious-financial-deficits-covid-crisis/

What's the harm?

What's the harm with trying a drug like hydroxychloroquine? For example:

There has been a lot of “what’s the harm” logic for #COVID19 therapeutics going around like @ChrisCarrollMD pointed out.

Let’s talk specifics, here’s the harm that comes from various Rx being evaluated currently. This is why the evidence of benefit is critical 👇🏽👇🏽

— Viren Kaul, MD (@virenkaul) April 7, 2020

Hydroxychloroquine:
🚨Cardiomyopathy and ventricular arrhythmias: ❤️ damage
🚨 Bone marrow suppression: Compromised immunity and bleeding risk
🚨 Hypoglycemia: Low blood glucose

Here’s @US_FDA’s fact sheet: https://t.co/dI40HwZbh4#COVID19

— Viren Kaul, MD (@virenkaul) April 7, 2020

Lopinavir/ritonavir:
🚨QTc prolongation & heart blocks: affects electricity in ❤️
🚨Risk of MI: ie heart attacks esp with previous structural heart diseases
🚨Hepatotoxicity: Liver injury. Critically ill pts can develop liver injury by other mechanisms, so added damage #COVID19

— Viren Kaul, MD (@virenkaul) April 7, 2020

Tocilizumab:
🚨Increased liver enzymes in 20-30%
🚨Liver injury resulting in transplant or death has been reported
🚨Low neutrophil and platelet counts
🚨 Anaphylaxis: Could be life threatening in sick patients
🚨 High TG level’s: makes using propofol (sedative) hard #COVID19

— Viren Kaul, MD (@virenkaul) April 7, 2020

IVIG:
🚨Low BP in 15%
🚨Anaphylactic reactions
🚨Pulmonary edema: fluid in lungs
🚨Aseptic meningitis
🚨Hemolysis: breakdown of 🩸 cells
🚨Kidney failure
🚨Thromboembolism: Increased clotting , which is already an issue with #COVID19

— Viren Kaul, MD (@virenkaul) April 7, 2020

My goal is not to create a scare but provide education on why just using therapies isn’t as simple. The risks need to be weighed against the benefit.

Problem is we don’t have good data to suggest benefit. And we do know the risks.

To deal with this pandemic ...

— Viren Kaul, MD (@virenkaul) April 7, 2020

"Lord Sumption explains national overreaction to coronavirus"

(Credit to Steve from whom I first saw this.)

Chinese Health Organization

BREAKING: Japanese Vice PM says the @WHO should be renamed "Chinese Health Organization, Taro slammed the WHO for reciting the Chinese talking points with regards to #COVID19, and insisted that the Corona virus should be called the Wuhan virus. pic.twitter.com/GuuDmqo0c0

— Reagan Battalion (@ReaganBattalion) April 2, 2020

By the way, in addition to how China has been treating Taiwan, let's not forget how China has been treating Hong Kong, which I've posted about in the past.

Also, I think we should stop funding the WHO.

The course of coronavirus

It doesn't look like the numbers or percentages are entirely accurate. However it's still useful as a generic schema for how the coronavirus seems to be playing out.

Summary of clinical trials for coronavirus

There are several different treatment options that physicians and scientists are looking into for the coronavirus. Such as antivirals and vaccines. These aren't necessarily mutually exclusive.

I've posted on a few of these in the past (e.g. convalescent plasma therapy, remdesivir, hydroxychloroquine/azithromycin).

Here's a more comprehensive list so people can see what's being worked on around the world to combat the coronavirus:

(Source)

Confirmation bias

Coram Deo asks a good question here:

I don't know if either Hawk or steve (or another active T-blogger) would be willing to take up the question, but both here and elsewhere I'm seeing what I perceive as rampant confirmation bias swirling amidst the current coronavirus pandemic and I'm wondering if it's possible to implement guards or filters in our critical thinking to avoid this to some extent.

This assumes of course that folks wish to avoid or mitigate this feature, indeed many seem to rush to pick out this or that expert, model, or theory which bolsters their preconceived notions.

Thanks, CD. That's a good point and a good question! What you've said is important to keep in mind. If I can offer my random thoughts:

We're not shooting in the dark

1. On the one hand, the coronavirus (i.e. SARS-CoV-2/COVID-19 or simply COVID-19) is a novel virus. That poses many challenges for us. For example, take the fact that it's constantly mutating. Indeed, there are at present approximately two different groups of the coronavirus - i.e. L and S haplotypes. As such, its virulence and transmission can shift over time in unpredictable ways. In fairness, the coronavirus seems to be reaching some genetic stability now. Hopefully it won't significantly change before we can find a vaccine. (By the way, if anyone wishes to see the mapping of the various strains of the coronavirus' genomic evolution, this website is a good resource.)

2. On the other hand, the leading disease that's killing people from coronavirus is acute respiratory distress syndrome (ARDS). Yet ARDS is an utterly familiar disease to physicians today. In other words, yes, we have to wait for therapies like antivirals and vaccines for the coronavirus. However, it's not as if we're wildly shooting in the dark. We know how to treat ARDS. We know how to protect the lungs. We know how to intubate patients. We know how to put patients on mechanical ventilation. We know how to prone people early to help increase their survival chances. We know how to use empiric antibiotics. We know how to use inhaled prostacyclins and neuromuscular blockers. We know the seven Ps for the care of ARDS patients. Indeed all these (and other) strategies work very well for ARDS.

3. It's just that, even absent the coronavirus, ARDS has high mortality rates:

ARDS is associated with appreciable mortality, with the best estimates from a multicenter, international cohort study of 3022 patients with ARDS, suggesting an overall rate of death in the hospital of approximately 40 percent [1-4]. Mortality increases with disease severity; unadjusted hospital mortality was reported to be 35 percent among those with mild ARDS, 40 percent for those with moderate disease, and 46 percent for patients with severe ARDS [4].

Self-medicating for coronavirus

"Man dies after ingesting chloroquine in an attempt to prevent coronavirus"

Since liberals are losing their minds over this:

1. No, this is not Trump's fault. Trump did not tell the man to drink "parasite treatment for fish". This is simple stupidity. Don't be stupid. And don't blame Trump if you're stupid. If anything, Trump should honor you with a Darwin award.

2. Neither chloroquine nor hydroxychloroquine are cure or prevention for coronavirus at this stage.

3. Besides, even if it "worked", it would need to be taken under the supervision of a physician. You can't just go and do it yourself. Well, you could, but if you do, see #1.

Is obesity a factor in coronavirus deaths?

As many know, many people are obese. Hence the question has arisen: is obesity a factor in someone dying from the coronavirus?

Yes

On the one hand, I do think obesity is a factor. Obesity alone does decrease respiratory functional capacity and it does increase oxygen consumption.

In addition, someone who is obese likely has diabetes and hyperglycemia (undiagnosed or diagnosed). The hyperglycemic state could serve as a growth medium for microbes.

And the obese are sometimes immunodepressed.

No

On the other hand, I don't think obesity is the primary or sole factor. The leading cause of death in this coronavirus is acute respiratory distress syndrome (ARDS). However there are many obese people who have survived ARDS, heart failure, and hemophagocytic lymphohistiocytosis (HLH) in the context of active infection.

To be fair, modern medicine can work wonders.

Hypothesis

I suspect there might be a genetic issue involved. There have already been a number of deaths in the coronavirus due to a severe or exaggerated cytotoxic response aka cytokine storm (e.g. here, here). A cytokine storm on top of already diminished cardiorespiratory reserve in the obese.

Point being, perhaps different people's immune systems respond differently to the coronavirus. This could be a decisive factor in these deaths from coronavirus. Perhaps that's what makes a more fundamental difference in life or death at least among the obese.

Just a hypothesis. And hypotheses need to be tested.

Not just older people

The following is helpful to keep in mind, though also keep in mind the majority who are infected with the coronavirus don't need hospitalization. Of course, there are exceptions depending on certain groups. Notably health care providers are at higher risk from getting infected with, hospitalized, and even dying from the coronavirus than the general population.

While vast majority of deaths from #COVID19 are age 60+ many young adults and middle aged Americans are becoming seriously ill and surviving only after prolonged hospitalizations and ICU admissions that have long term consequences. This is a dangerous virus for most age groups. pic.twitter.com/jVYWFatTDM

— Scott Gottlieb, MD (@ScottGottliebMD) March 23, 2020

Plasma therapy for SARS-1

1. Recently there's been national news about the use of hydroxychloroquine/azithromycin as an antiviral agent against the coronavirus. For example, see my post here. In the opinion of a nobody like me, I think hydroxychloroquine/azithromycin may be promising - for example there's lots of anecdotal evidence, and there's the now-famous small study out of France - but let's not get out hopes up too much. We need more and better studies, which we can fast track. That's what I'd say anyway.

2. At the same time, I've mentioned convalescent plasma therapy more than once (e.g. this post). Here is a thorough review of the scientific literature regarding the effectiveness of convalescent plasma therapy in the first SARS virus back in 2002-2003: "The Effectiveness of Convalescent Plasma and Hyperimmune Immunoglobulin for the Treatment of Severe Acute Respiratory Infections of Viral Etiology: A Systematic Review and Exploratory Meta-analysis" (2015). It's published by The Journal of Infectious Diseases.

I presume most people likely already know our current coronavirus pandemic was started by the SARS-2 virus (i.e. SARS-CoV-2/COVID-19). But I mention it just in case some don't.

3. Likewise Arturo Casadevall at Johns Hopkins is starting a grassroots organization called the COVID-19 convalescent plasma project.

4. Of course, these aren't mutually exclusive. We can pursue both as well as other viable means to combat the coronavirus (e.g. remdesivir). In fact, we already are pursuing many other viable means to combat the coronavirus (e.g. see this Science article). Ultimately the best solution would be a vaccine. But at this point it looks like a vaccine is at least a year away if not much longer. So we need something in the interim.

Hydroxychloroquine and azithromycin redux

....be put in use IMMEDIATELY. PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE! @US_FDA @SteveFDA @CDCgov @DHSgov

— Donald J. Trump (@realDonaldTrump) March 21, 2020

1. I've recently discussed hydroxychloroquine and azithromycin here.

2. That said, the following 7-minute video says exactly what I've been trying to say but far more clearly, succinctly, and perhaps even objectively (I admit I can get carried away in debate). It's non-partisan and focused on the medical science. His conclusion is like mine: it's promising, but (thus far) based on limited evidence.

Plague attire

It's often hard enough to know what to wear each day, but all the more so in a pandemic! What's de rigueur in a plague?

Certainly one needs a mask to protect from breathing in contagions - or out! Yet a mask could take many different shapes and sizes.

Likewise one needs to have sufficient places on one's person to carry or store basic medical supplies. Would that be best realized in outer pockets or inner linings? Would a utility belt work?

We wouldn't wish to limit our range of motion with too much apparel or too many accessories.

No doubt the spectrum of regalia could range from cloaks and capes to more threadbare options.

I'm sure we could continue to multiply issues to address in one's dress. But theory becomes tedious. Let us move onto substance!

Might I offer some of our finest Spring selections: