Monday, April 6, 2020

In Veneto, Keeping People out of the Hospital

From the Financial Times, a comparison of coronavirus treatment in two of Italy's most populous regions, Lombardy and the Veneto:
Struck by a human catastrophe unseen in Europe outside of war, with military trucks taking away corpses from the city of Bergamo, Lombardy has a death rate of 17.6 per cent.

Nearby Veneto’s stands at 5.6 per cent. While virologists caution that the percentage death rate is closely tied to the level of testing, they also attribute the gap to other factors, such as Veneto’s reluctance to hospitalise compared with its neighbour.

“Veneto has a very low mortality compared to the rest of Italy,” said Professor Andrea Crisanti, a leading virologist from the University of Padua, in charge of a mass testing programme across Veneto. “This shows that our approach has worked well so far.”

As of Saturday Lombardy, which has a population of 10m people, accounts for 8,656, or 56.3 per cent, of Italy’s total declared deaths from the virus of 15,362. Meanwhile Veneto, which has a population of 4.9m, has suffered 607 official deaths out of 10,824 diagnosed cases.

Higher levels of testing and tracing in Veneto is the most widely cited explanation for why the region has managed to control its outbreak more effectively than its neighbours.  . . .  Yet experts say testing is not the only reason for the lower death rate.

Venetian doctors also cite the region’s expertise in infectious disease, something they trace back to its pioneering history dealing with viruses arriving in its port from the east. The word quarantine derives from quarantena, the Venetian word for “40 days”, or the amount of time ships arriving from plague-ridden destinations were isolated.

For Giorgio Palù, one of Europe’s leading virologists, and scientific adviser to the governor of Veneto, a critical factor has been the number of diagnosed patients taken into hospital.

The number of diagnosed patients who were taken in hospitals for clinical treatment at the start of the outbreak was about 65 per cent in Lombardy, Prof Palù said.
This compares with 20 per cent in Veneto, where the majority were told to stay at home unless urgent care was required.

“There were different instructions given to the sick by the different regional health authorities,” he said. “Yes, there has been more testing in Veneto but people were kept at home and not taken into hospitals. The more patients you admit to the hospital, the more cases you get. You create the outbreak as at the start nobody was taking care of sampling the doctors or nurses, [so] you were taking home the infection.”

His observation comes as more than 60 Italian doctors and health workers have died, the majority of these in Lombardy. A group of doctors from the Papa Giovanni XXIII hospital in Bergamo warned last month that hospitals had become the main source of transmission of Covid-19 infections, and urged more patients to be treated at home.

“We are learning that hospitals might be the main Covid-19 carriers,” they wrote in the New England Journal of Medicine. “They are rapidly populated by infected patients, facilitating transmission to uninfected patients.”

South Philippine Dwarf Kingfisher

This is the first good photograph ever taken of a juvenile, by eye surgeon Dr. Miguel David De Leon. I suppose this must be a very elusive bird. Below. the adult. Lovely.

Sunday, April 5, 2020

Today's Place to Daydream about: Olympic National Park

Olympic National Park is a vast area of mountains, forests, and coast, much of it wilderness.  In all it measures 922,000 acres, or 3,700 square kilometers.

Yet it sits on the Olympic Peninsula between Puget Sound and the Pacific Ocean, within easy reach of the Seattle metropolis.

There are two parts to the park: the main area surrounding Mt. Olympus, and a strip of undeveloped coastline 60 miles (97 kilometers) long.


Along the beach are amazing sea stacks and hidden beaches, and tidepools full of marine life.

Mount Olympus (no credit for original naming there) is only 7,980 feet (2400 m) tall, but because it gets so much snow the peak remains snow covered year round, and it has several glaciers.



Most pictures of the mountain you can find online are taken from a place called Hurricane Ridge, one of the main jumping off points for high-altitude hiking in the park.

There are lakes.


Because of the isolated location the park holds many unique species or subspecies of animals and plants, including the blue grouse and the Roosevelt Elk.


The park is probably most famous for the temperate rain forest on its western slopes, the rainiest place in the continental US, with 150 inches (380 cm) a year. There are trails laid out so you can explore dense rain forests on moderate day hikes.



Of course between the rain and the mountains there are many waterfalls.


The creation of the park was the end result of a long struggle between preservationists and others that still goes on in various forms. The timber of the Olympic Peninsula is extremely valuable, including giant cedar trees and spruces, and very convenient to shipping. Loggers were itching to get onto the mountain, and behind them were lined up miners and developers. Local Indians were divided against each other and were sometimes against development, sometimes for it. In the 1890s leading environmentalists like Judge James Wickersham led expeditions up the mountain to publicize its wonders. This led to the creation of the Olympic Forest Reserve by Grover Cleveland in 1897; but the Forest Reserve allowed limited logging, provided it would not do too much damage, and the struggle continued. In 1909 Teddy Roosevelt created Mount Olympus National Monument, largely to protect the calving grounds of the elk subspecies that was later named after him. Congress created the National Park in 1938, which protected a vast area. But as I said the fights over development and logging on the peninsula continue to this day.

I have an old friend from Washington who once promised to take me backpacking in Olympic, but that was many years and several children ago, so now I wonder if we will ever get there.

Crisis Socialism

From the Trump Administration, a really great idea:
The Trump administration will use a federal stimulus package to pay hospitals that treat uninsured people with the new coronavirus as long as they agree not to bill the patients or issue unexpected charges.

….A 1918-like pandemic would cause U.S. hospitals to absorb a net loss of $3.9 billion, or an average $784,592 per hospital, according to a 2007 report in the Journal of Health Care Finance that called on policy makers to consider contingencies to ensure hospitals don’t become insolvent as a result of a severe pandemic.
Here we have, in a crisis, the germ of a national health care system: the government paying hospitals a fixed price for services and requiring them to jettison all the tricks they use to raise revenue. This is absolutely essential for any national health care scheme; lots of countries have private insurance, but almost all have prices fixed by the government. And usually those prices are not detailed at the level of so much for a test or an aspirin but a simple flat fee for treatment of a disease, or for days in a hospital. Another key thing in getting people to support such schemes is that they are easy for the patient, just like this will be.

All it took to get the US there was a pandemic that may kill a million people.

Friday, April 3, 2020

Does Hospitalization Fight Covid-19?

While everybody worries about hospital space and states of emergency are invoked to demand more respirators, I keep wondering: does hospitalization help?

The short answer is that nobody knows yet. The numbers I have seen for the survival of people on respirators are all over the place, from 33 out of 98 surviving in one British study to 3 of 22 in Wuhan. (And that's just in the short term; for ventilator patients in general, many who survive to be discharged from the hospital don't live out the year.) And of course we have no idea how many of them would have survived without intervention. Perhaps we will find out when we run out of ventilators.

Patients not on ventilators seem mostly to be getting IV fluids and supplemental oxygen, and again we have no idea how much either of these things helps.

It was not until years after the SARS epidemic that we had any good data on the benefits of care, which turned out to be unimpressive. Of course this is bigger and more people in more places are getting sick, so results are coming in faster, but on the other hand the panic atmosphere means few people have time to keep good records.

When you consider that hospitals have become loci of infection, spreading it to health care workers, their families, and other patients, you have to wonder how many lives are saved by hospitalization.

Our medical system is just not nearly as wonderful as we like to imagine. Social distancing, hand-washing and so on are much, much more important than hospital space, and it looks to me like medicine won't really help us that much until we have a vaccine.

Albert Dros in Madeira's Ancient Laurel Forest

Photographs of the Fanal laurel grove on Madeira, where some trees are 500 years old. Via My Modern Met.





Profound Uncertainty about Suicide

Rachel Aviv:
In the past two decades, the suicide rate in America has increased by thirty-three percent, but there have been few advances in understanding how to prevent this sort of death. A review of forty years of studies in the journal PLOS One, in 2016, concluded that a reliable method of identifying who might commit suicide "remains elusive." Ninety-five percent of people who had been identified in studies as most likely to kill themselves did not do so. Half of the people who committed suicide had been classified as low risk. The authors wrote, "The extent of this uncertainty is profound." In The Savage God, a book about suicide, the English writer A. Alvarez observed that explanations for suicide are almost never sufficient. They are "like a trivial border incident which triggers a major war. The real motives which impel a man to take his own life are elsewhere; they belong to the internal world, devious, contradictory, labyrinthine."
This is from an interesting article in the April 6 New Yorker about a Buddhist teacher who was accused of wrongful death when one of his students committed suicide, on the theory that the destruction of self she achieved in her meditative practice led her not to enlightenment, but to despair.

Links 3 April 2020

George Orwell statue outside the BBC in London by Twocoms

Spitalfields Life visits St. Olave's, which was Samuel Pepys church.

Michael Sorkin's list of 250 Things an Architect Should Know

France's never-ending anti-terrorism mission in Africa's Sahel

Something pleasant: new David Hockney drawings from a recent stay in Normandy

Video of modern people trying to play the ancient Maya ball game

A topic I enjoy: writers' houses

Ross Douthat on the ideology of responses to the pandemic

The new science of necroplanetology

Why have Trump's approval ratings risen during the pandemic? And Matt Yglesias notes that Andrew Cuomo's poll bump has been much bigger

Stranded in his Dorset country house, Ben Pentreath has been taking lots of walks through the English countryside.

Homo erectus

News comes from South African of what are claimed to be the oldest fossils of Homo erectus, dated to between 1.95 and 2.04 million years ago. They were found in the same stratum as fossils of an older Australopithecus species, so the two species may have shared that landscape, but given that the time span on the dates is 100,000 years, that is far from certain. Anyway this gives us a chance to think for a moment about our first really successful ancestors.

Homo erectus survived for around 1.5 million years, fading from the scene around 500,000 years ago. They are almost certainly the ancestors of us and all our close relatives (Neanderthals, Denisovans). They were first discovered in East Asia (Java Man, Peking Man) and only later in Africa, and while most anthropologists think they evolved in Africa that is not certain. They roamed very widely, from France to Indonesia to South Africa. They were not tied to any particular environment but could, like modern humans (or crows) adapt themselves to whatever place they found themselves in: jungles, plains, mountains, cold, hot, inland, on the shore. This was surely due to the vastly greater size of their brains, compared to hominins before them: the biggest Homo erectus brains measured around 1100 cc, about the same size as the smallest brains of normal modern humans. Their brains seem to have grown slowly over time, the average size increasing from around 850 in early specimens to 1000 in the later ones.

They walked much as we walk, leaving their hands free to carry tools. They shaped crude tools from stone, and presumably from other materials, although nothing but stone survives.

And they endured for 1.5 million years. Compared to the span of our civilizations it is a vast stretch of time, 60,000 generations when beings something like us slowly, slowly developed the ways of life that still survive among hunter gatherers. All that time they were changing physically and surely in other ways as well. The crazy nomenclature that surrounds them (Homo ergaster, Homo georgicus, Homo yuanmaoensis) springs from attempts to understand the diversity of their kind, and some splitters still think we should be talking about several different species.

Shell from Java with incised lines, sometimes claimed to be the oldest work of art

We do not know if they had language, but some anthropologists think their skulls show they could make a range of sounds as wide as ours. Recently genetic studies have suggested that the FOXP2 gene, which we know to be essential for language in us, probably evolved by a million years ago. So the early stirrings of our kind's astonishing invention probably took place among them. Since the bones of large animals have been found around their camps, they probably hunted in coordinated groups, and language would come in handy for that. After all they were not bigger or stronger than us, but on the contrary a little smaller and weaker, less able to strong-arm their way through life. Another advantage they may have had: studies of their shoulders suggest they were first species that could throw a spear with deadly effect.

We also do not know if they could control fire, but there is pretty good evidence that they were doing so by 750,000 years ago. That would make them pioneers of another great human advance.

They developed the way of life that defines us, using their big brains and clever hands to negotiate the world. They were smart and adaptable enough to survive through Ice Ages and hot times, across vast areas populated by beasts much larger and stronger than themselves.

Unfortunately their imaginations are closed to us, so we do not know, and probably never will, if they had stories and names. They lived too long ago for us to ever really understand them. We can only look at their bones, and wonder.

Thursday, April 2, 2020

Putinism

In the 6 December 2019 TLS, Owen Matthews reviews a stack of books about Vladimir Putin. He is unimpressed by those that attribute to Putin any ideology or long-range plan and prefers those that see him as reacting to events and responding to opportunities:
Putin, Mark Galeotti points out, is not a chess player; he is a judoka. Chess is a contest with rules and transparency; everyone starts with the same pieces. But Putin doesn't want to limit his options like that. His skill lies in turning his opponent's strength against him at just the right time. "In this respect, in politics as in judo, Putin is an opportunist," Galeotti writes. "He has a sense of what constitutes a win, but no predetermined path towards it. He relies on quickly seizing any advantage he sees, rather on a careful strategy."

This rings profoundly true. There is no Putin core, no ideology of Putinism – just ideologies and strategies to be used and discarded as the moment dictates. Putin is a "gut-level patriot who believes that Russia should be considered as a great power not because of its military strength, its economy or for another specific index, but because it's Russia." Beyond that everything is a tool to be used in the game of staying in power and increasing the country's prestige. Orthodoxy, nationalist philosophy, military intervention in Syria, the festering, low-level war in Donbas – all these policies can be switched on or off as expediency dictates. The result is that "many apparent short-term successes prove to be long-term liabilities, having been neither thought through beforehand nor followed through afterwards." But so far, Galeotti writes, Putin has managed to bluff Russia's poor hand into two decades of surprising wins.
I especially liked this comment on corruption, reviewing a book by opposition politician Gregory Yavlinsky:
Yavlinsky makes a similar argument. Corruption is at once the bond that unites the elite like a criminal clan and, perversely, a took of social control. The Kremlin is not bothered by corruption because, he writes, "it works to their advantage. Government compels a society to be its accomplice in crime, as everyone gets involved in it". And when everyone is guilty – from parents who bribe university admissions tutors to Putin cronies who trade billions in oil wealth through their Swiss offshore companies – the selective application of the law becomes an arbitrary tool of power. This allows Putin and his allies to keep the elite in a "state of uncertainty and fear . . . by suddenly paying to or, to the contrary, turning away from evidence."

Americans Work Too Much Anyway

Business Insider:
If the US stayed completely shut down for two months, the typical US worker would work about the same number of hours this year as a pre-pandemic German worker.

Wednesday, April 1, 2020

Romare Bearden's Black Odyssey

Collages by African American artist Romare Bearden (1911-1988), dated 1979. The Fall of Troy.

Odysseus Leaves Nausicaa

Cattle of the Sun

The Sirens' Song

Battle with the Cicones

Circe

Tuesday, March 31, 2020

The Roman Theater at Aspendos, Turkey

Aspendos is an old Greek city on the south coast of Turkey. The theater was built in 155 AD by the  architect Zenon, a native of the town. With a diameter of 96 metres (315 ft), it provided seating for 12,000.




What an amazing thing, another spectacular remnant of the classical past that I never heard of. Below other images of the town, the aqueduct and then the basilica.



And a coin of Aspendos, c. 377-333 BC, showing scenes from the Olympic games and a delightful little triskelion.