Physician Assistant With COVID-19 Speaks Out

Christina Fiore in MedPageToday:

A New Jersey physician assistant who was the state’s first COVID-19 patient is speaking out from his hospital bed, calling his illness “severe” and raising concerns about his treatment. James Cai, a 32-year-old non-smoker with no other health conditions, has been at Hackensack University Medical Center for about a week and says his illness has worsened significantly over that time. “In the beginning, they just treat me like normal flu. They say I’m young, I’m not going to die, but they don’t know the truth about corona[virus],” Cai said during an interview posted to Twitter over the weekend.

…Hackensack University Medical Center confirmed Cai is a patient there, but would not comment further. Gilead, which makes remdesivir, told MedPage Today it couldn’t comment on individual patient cases. During the interview, Cai appeared at times to be struggling to breathe, and Pulte halted the interview at one point to give him time to catch his breath. “For the last one week, it’s been hell,” Cai said during the broadcast. His symptoms have included dyspnea, chest pain, high fever, watery eyes, and diarrhea. A repeat CT scan performed over the weekend showed evidence of disease worsening, he said. At one point, he said his oxygen saturation dipped below 80%.

“I don’t think they really understand what’s going on here,” he said. “My brother at Mount Sinai main campus, he understands. He can advocate for me.”

More here.



Q&A with Thomas Piketty, author of Capital and Ideology

From the Harvard University Press Blog:

Capital in the Twenty-First Century was an unusually ambitious book. What prompted you to write another major book so soon?

I’ve learned a lot since the release of Capital in the Twenty-First Century. I was invited to countries about which I knew little, met new researchers, and participated in hundreds of debates. All these exchanges pushed me to renew my reflections. To summarize Capital briefly, it showed how, in the twentieth century, the two world wars led to a very strong reduction in the inequalities inherited from the nineteenth century. I also pointed to the disturbing ascent of inequalities since the 1980s. But the book had two main limitations. The first is that it was very Western centered. In this new book, I widen my scope: I examine the history of “ternary societies” [organized into three classes: nobility, clergy, and workers] and societies of owners or proprietors, but I also study slavery societies, colonial regimes, communism, post-communism, social democracy, the case of castes in India, and inequality regimes in Brazil, China, and Russia. The second limitation is that Capital only scratched the surface of the deep question of the ideologies that support inequalities. It was a black box that I decided to open.

More here.

Why India’s Muslims Are in Grave Danger

Ravi Agrawal in Foreign Policy:

Ashutosh Varshney, a Brown University professor and author of the prize-winning Ethnic Conflict and Civic Life: Hindus and Muslims in India, believes last week’s riots in Delhi bear some of the hallmarks of an organized pogrom. India has been there before: In 2002, in Gujarat, when Modi was the state’s chief minister, more than 1,000 people were killed in religious riots. Most were Muslims. While Modi was later cleared of wrongdoing by the country’s judiciary, critics say that he could have done much more to prevent the attacks. And in 1984, again in Delhi, an estimated 3,000 Sikhs were targeted and killed after Prime Minister Indira Gandhi was assassinated by her Sikh bodyguards. In both cases, experts say, riots could not have been conducted without some complicity on the part of the police.

Varshney believes last week’s deadly clashes could be repeated in other parts of the country—and that Muslims are particularly vulnerable. Here is a transcript of Foreign Policy’s interview with Varshney, lightly edited for clarity.

More here.

Scientists Use Online Game to Research COVID-19 Treatment

Emma Yasinski in The Scientist:

Researchers are calling on citizen scientists to play a free online game called Foldit, in which they help design and identify proteins that may be able to bind to and neutralize the SARS-CoV-2 spike protein that it uses to invade host cells. The scientists hope that players’ creations will yield insights that will allow them to create an effective antiviral therapy for COVID-19. Other researchers are asking citizens for help in a more passive way. The Scientist spoke with Brian Koepnick, who works on Foldit at the University of Washington Institute for Protein Design, about this project.

The Scientist: What is Foldit? How does it work?

Brian Koepnick: Foldit is a free, online game that anyone in the world can download and run on their Mac, Linux, or Windows PC. The main drive of Foldit is our science puzzles. These are weekly challenges that we refresh every week . . . that are directly related to research we’re doing here in the lab at the Institute for Protein Design or in our other labs. Foldit players can participate in the science puzzles. . .  [which] are constructed in such a way that competing players who develop high-scoring solutions make meaningful research contributions.

More here.

Wednesday Poem

The Skin Inside

Out there past the last old windmill
and the last stagnant canal—
the no-man’s land of western Dithmarschen—
cabbage and horseradish in rows of staggering accuracy
stretching all the way out to the frigid
gray-brown waters of the North Sea—
hard-hatted Day-Glo-vested workers perched high
in the new steel pylons rigging cables to connect
off-shore wind parks with the ant-hills of civilization—
I’ve got one hand on the steering wheel,
the other on the dial cranking up King Tubby’s
“A Better Version” nice and loud while waiting
most likely in vain in some kind of cerebral limbo
for the old symbolism to morph into
an entirely new vernacular—an idiom of sheer imagery
in which the images themselves have
no significance whatsoever but struggle nonetheless
to articulate the meaning of meaning—
a hall of mirrors where purity reigns
and the algorithm of death can no longer find you—
and if it’s a truth to be realized that your body is not
your own, then it must be a delegated image of heaven,
while the skin inside has a luster all its own,
reflecting back the warm glow from within.

by Mark Terrill
from
Empty Mirror

Interview with the disease expert who warned us: Michael Osterholm

Peter Bergen at CNN:

Michael Osterholm, the infectious disease expert who has been warning for a decade and a half that the world will face a pandemic, says the US is ill-prepared to combat the coronavirus due to a shortage of equipment and supplies.

Osterholm, of the University of Minnesota, wrote in Foreign Affairs magazine in 2005 that, “This is a critical point in our history. Time is running out to prepare for the next pandemic. We must act now with decisiveness and purpose.” He reiterated this point in his 2017 book, “Deadliest Enemy: Our War Against Killer Germs.”

Osterholm discussed the coronavirus at a recent Washington, DC event at the New America think tank with Peter Bergen, CNN national security analyst and New America vice president.

More here.  And here he is on the Joe Rogan podcast [Thanks to Georg Hofer]:

Tuesday, March 10, 2020

David Cutler: Can the U.S. Healthcare System Be Fixed?

Interview from Harvard Magazine:

Marina Bolotnikova: First, why does healthcare cost so much in the United States? Nearly 50% more per capita than in Switzerland, which spends the second most among wealthy nations.

David Cutler: Yeah, one of the continual vexing points about U.S. healthcare is why it’s so expensive. There are a few reasons why the U.S. spends more than other rich countries. Obviously, in poor countries, there’s an enormous difference in the nature of medical care. Relative to other rich countries, I would say there are three principle reasons why the U.S. spends more. The first is that it’s administratively much more costly. So we have lots of people involved in submitting bills, and adjudicating claims and figuring out what services someone is allowed to receive and not allowed to receive and what you need to do in order to receive those services. And all of that involves people, and people are very expensive. And so probably the biggest contributor to the higher spending in the U.S. is that.

More here.

Sean Carroll’s Mindscape Podcast: Karl Friston on Brains, Predictions, and Free Energy

Sean Carroll in Preposterous Universe:

If you tell me that one of the world’s leading neuroscientists has developed a theory of how the brain works that also has implications for the origin and nature of life more broadly, and uses concepts of entropy and information in a central way — well, you know I’m going to be all over that. So it’s my great pleasure to present this conversation with Karl Friston, who has done exactly that. One of the most highly-cited neuroscientists now living, Friston has proposed that we understand the brain in terms of a free energy principle, according to which our brains are attempting to model the world in such a way as to minimize the amount of surprise we experience. It’s a bit more complicated than that, but I think we made great headway in explicating some very profound ideas in a way that should be generally understandable.

More here.

Why Civility Fails

Robert B. Talisse in at ARC Digital:

More here.

Writing The Latinx Bildungsroman

Lyn Di Iorio at Public Books:

Before our eyes, US Latinx writers are inventing a new form of the novel. The classic bildungsroman, or novel of education and development, typically shows how a protagonist grows up and adapts to her world. Today, Latinx writers are writing their own versions of the bildungsroman, but with a twist. In novels like Angie Cruz’s Dominicana and Ernesto Quiñonez’s Taína, protagonists are educated not once, but twice: first, in mostly Spanish-speaking families and neighborhoods; and later, in the English-speaking society outside the home.

These two bildungsromans take place mostly in New York City, with Cruz’s Dominicana set in Washington Heights in the 1960s, and Quiñonez’s Taína set in Spanish Harlem in the 2000s.

more here.

Is Peter Saul’s Gross-Out Painting Political?

Jackson Arn at Art in America:

One of the earliest mature works in the exhibition, Sex Deviate Being Executed (1964), is also one of Saul’s best. Completed around the same time that Andy Warhol was obsessing over similar material, it shows a gay man smoking a cigarette as he sits in an electric chair. Simple moralistic interpretations get lost in the scene’s queasy virtuosity: the man’s stark profile; his thick, almost monumental arm, which resembles the haunch of an Egyptian sphinx; the decaying blue of his skin against the chair’s lilac. Here and throughout the galleries, the wall texts insist on simple moralistic interpretations anyway—apparently, this painting is about how homophobia, nationalism, and capital punishment are bad, and how a victim “maintains his dignity” in the face of death. The choice of words is unintentionally hilarious, since they appear just a few paces away from a decidedly undignified painting by the name of Human Dignity (1966), in which the title is scrawled on a pair of heaving, planetary breasts. Trust the show’s didactics and you could see Saul as a rough-around-the-edges liberal crusader—but you’d have to ignore the actual works.

more here.

On the Timeless Music of McCoy Tyner

Craig Morgan Teicher at The Paris Review:

There are many ways to understand the passage of time—it’s not just one thing after the next, the pinhead of the present gnarling the flesh of your foot as you try, impossibly, to balance upon it. Not just peering through the mist of memory. Not just cutting through the ice ahead. Time moves back and forth, slows down, speeds up, it eddies—it does a lot of eddying. It concentrates itself in one moment and becomes diffuse and vague in another. We’re always in the present, though we can never quite get there, nor can we leave. All of this is what the music of McCoy Tyner, who died on Friday at the age of eighty-one, teaches, though as soon as one tries to paraphrase music in anything other than other music, it’s robbed of some of its magic and much of its meaning.

more here.

Tuesday Poem

Looking for Differences

I am struck by the otherness of things rather than their sameness.
The way a tiny pile of snow perches in the crook of a branch in the
tall pine, away by itself, high enough not to be noticed by people,
out of reach of stray dogs. It leans against the scaly pine bark, busy
at some existence that does not need me.

It is the differences of objects that I love, that lift me toward the rest
of the universe, that amaze me. That each thing on earth has its own
soul, its own life, that each tree, each clod is filled with the mud of
its own star. I watch where I step and see that the fallen leaf, old
broken grass, an icy stone are placed in exactly the right spot on the
earth, carefully, royalty in their own country.

by Tom Hennen
from
Darkness Sticks to Everything: Collected and New Poems
(Copper Canyon Press, 2013)

Why does the coronavirus spread so easily between people?

Smriti Mallapaty in Nature:

As the number of coronavirus infections approaches 100,000 people worldwide, researchers are racing to understand what makes it spread so easily. A handful of genetic and structural analyses have identified a key feature of the virus — a protein on its surface — that might explain why it infects human cells so readily. Other groups are investigating the doorway through which the new coronavirus enters human tissues — a receptor on cell membranes. Both the cell receptor and the virus protein offer potential targets for drugs to block the pathogen, but researchers say it is too early to be sure. “Understanding transmission of the virus is key to its containment and future prevention,” says David Veesler, a structural virologist at the University of Washington in Seattle, who posted his team’s findings about the virus protein on the biomedical preprint server bioRxiv on 20 February1. The new virus spreads much more readily than the one that caused severe acute respiratory syndrome, or SARS (also a coronavirus), and has infected more than ten times the number of people who contracted SARS.

To infect a cell, coronaviruses use a ‘spike’ protein that binds to the cell membrane, a process that’s activated by specific cell enzymes. Genomic analyses of the new coronavirus have revealed that its spike protein differs from those of close relatives, and suggest that the protein has a site on it which is activated by a host-cell enzyme called furin. This is significant because furin is found in lots of human tissues, including the lungs, liver and small intestines, which means that the virus has the potential to attack multiple organs, says Li Hua, a structural biologist at Huazhong University of Science and Technology in Wuhan, China, where the outbreak began. The finding could explain some of the symptoms observed in people with the coronavirus, such as liver failure, says Li, who co-authored a genetic analysis of the virus that was posted on the ChinaXiv preprint server on 23 February2. SARS and other coronaviruses in the same genus as the new virus don’t have furin activation sites, he says. The furin activation site “sets the virus up very differently to SARS in terms of its entry into cells, and possibly affects virus stability and hence transmission”, says Gary Whittaker, a virologist at Cornell University in Ithaca, New York. His team published another structural analysis of the coronavirus’s spike protein on bioRxiv on 18 February3.

More here.

Impostor syndrome: do you sometimes feel like a fraud?

Clancy Martin in The Economist 1843:

The feeling of being a fraud isn’t new, nor is our preoccupation with it. “All the world’s a stage…And one man in his time plays many parts,” wrote William Shakespeare. The principle of “fake it till you make it” has long propelled incompetents to greatness. The success of phoneys is endlessly fascinating. In the 2000s “On Bullshit”, a book by Harry Frankfurt, a Princeton philosopher, spent many weeks at the top of the New York Times’ bestseller list. But recently we have become fixated on a particular aspect of fraudulence – impostor syndrome – the sense that we are always posturing, that our accomplishments are in some way undeserved, no matter how consistent the evidence to the contrary. Impostor syndrome seems to have become an epidemic. That is partly because we have given the phenomenon a name. Two psychologists, Pauline Clance and Suzanne Imes, are credited with coining the term in a landmark study in the late 1970s, in which they identified the “internal experience” of feeling like an “intellectual phoney”. But our growing preoccupation with impostorism is also a result of profound social change. In the past most people were employed to make things – and it’s fairly easy to distinguish an expert chairmaker or bricklayer from a novice. Many more of us now work in the service economy: our lives are spent creating impressions rather than tangible items. There is no objective standard for providing a “great customer experience”. To be an excellent manager is a nebulous thing. At every level of every field, the number of roles where achievement is neither entirely measurable nor objective has grown.

Professional life today leaves us straining to redefine ourselves. We no longer have “a job for life”, but instead search endlessly for promotion and variety, which leads us to promise things we don’t yet know how to do. “Pitch culture” has created an environment in which each of us is almost required to be an impostor in order to succeed. The breakdown of class structures has exacerbated this phenomenon. The demise of the feudal system is a good thing, but when we are no longer born into a role, or when we find ourselves in a job that would have been unfamiliar to, or even impossible, for our parents, it’s hardly surprising that we worry about whether or not we deserve it. These social factors also help to explain why the authors of that first academic paper on impostor syndrome immediately identified its greater prevalence and intensity among women rather than men (a finding that later studies have supported). They suggested that both early family dynamics and “societal sex-role stereotyping” meant that many highly successful women they interviewed attributed their achievements to luck, mistaken identity or faulty judgment on the part of their superiors. These same social expectations also probably contribute to the frequent feelings of being an impostor that many people from ethnic minorities also report.

More here.

Sunday, March 8, 2020

The United States is in the throes of a colossal health crisis

Helen Epstein in the New York Review of Books:

Drawing by Anders Nilsen

In 2015 life expectancy began falling for the first time since the height of the AIDS crisis in 1993. The causes—mainly suicides, alcohol-related deaths, and drug overdoses—claim roughly 190,000 lives each year.

The casualties are concentrated in the rusted-out factory towns and depressed rural areas left behind by globalization, automation, and downsizing, but as the economists Anne Case and Angus Deaton demonstrate in their new book, Deaths of Despair and the Future of Capitalism, they are also rampant in large cities. Those most vulnerable are distinguished not by where they live but by their race and level of education. Virtually the entire increase in mortality has been among white adults without bachelor’s degrees—some 70 percent of all whites. Blacks, Hispanics, college-educated whites, and Europeans also succumb to suicide, drug overdoses, and alcohol-related deaths, but at much lower rates that have risen little, if at all, over time.

The disparity is most stark in middle age. Since the early 1990s, the death rate for forty-five-to-fifty-four-year-old white Americans with a BA has fallen by 40 percent, but has risen by 25 percent for those without a BA.

More here.

German researchers identify existing drug with potential to treat coronavirus Covid-19

From Tech Startups:

Viruses must enter cells of the human body to cause disease. For this, they attach to suitable cells and inject their genetic information into these cells. Infection biologists from the German Primate Center – Leibniz Institute for Primate Research in Göttingen, together with colleagues at Charité – Universitätsmedizin Berlin, have investigated how the novel coronavirus SARS-CoV-2 penetrates cells. They have identified a cellular enzyme that is essential for viral entry into lung cells: the protease TMPRSS2. A clinically proven drug known to be active against TMPRSS2 was found to block SARS-CoV-2 infection and might constitute a novel treatment option (Cell).

More here.

Steven Pinker: ‘Evolution Has Saddled Our Species With Many Irrational And Destructive Psychological Traits’

Rainer Zitelmann in Forbes:

Zitelmann: In your book Enlightenment Now, you frequently refer back 200 or 250 years into the past. You make a powerful case that the main line of history since the Enlightenment has been one of progress in all areas of life. But this was also the same period that saw the birth of capitalism. Doesn’t it have to be said that the majority of the positive developments you describe are a result of capitalism?

Pinker: That would be a stretch. Certainly capitalism deserves credit for the spectacular increase in prosperity that the world has enjoyed since the 18th century, including the global east and south in the past forty years. Prosperity, on average, tends to bring other good things in life: democracy, peace, education, women’s rights, safety, environmental protection, to name a few. Also, the spirit of commerce pushes nations toward peace. It’s bad business to kill your customers or your debtors, and when it’s cheaper to buy things than to steal them, nations are not tempted toward bloody conquest. And as morally corrupting as the pursuit of wealth can be, it’s often less murderous than the pursuit of the glory of the nation, race, or religion.

But capitalism can coexist with many evils, as we see in authoritarian countries, and progress depended as well on science (particularly advances in public health and medicine), on the ideals of human rights and equality (which propelled the women’s and civil rights movements, and declarations of rights), on movements which led to legislation protecting laborers and the environment, on government provision of public goods like education and infrastructure, on social welfare programs that protect people who are unable to contribute to markets, and on international organizations which encouraged global cooperation and disincentivized war.

More here.