How blood from coronavirus survivors might save lives

Amy Maxmen in Nature:

Hospitals in New York City are gearing up to use the blood of people who have recovered from COVID-19 as a possible antidote for the disease. Researchers hope that the century-old approach of infusing patients with the antibody-laden blood of those who have survived an infection will help the metropolis — now the US epicentre of the outbreak — to avoid the fate of Italy, where intensive-care units (ICUs) are so crowded that doctors have turned away patients who need ventilators to breathe. The efforts follow studies in China that attempted the measure with plasma — the fraction of blood that contains antibodies, but not red blood cells — from people who had recovered from COVID-19. But these studies have reported only preliminary results so far. The convalescent plasma approach has also seen modest success during past severe acute respiratory syndrome (SARS) and Ebola outbreaks — but US researchers are hoping to increase the value of the treatment by selecting donor blood that is packed with antibodies and giving it to the patients who are most likely to benefit.

A key advantage to convalescent plasma is that it’s available immediately, whereas drugs and vaccines take months or years to develop. Infusing blood in this way seems to be relatively safe, provided that it is screened for viruses and other components that could cause an infection. Scientists who have led the charge to use plasma want to deploy it now as a stopgap measure, to keep serious infections at bay and hospitals afloat as a tsunami of cases comes crashing their way. “Every patient that we can keep out of the ICU is a huge logistical victory because there are traffic jams in hospitals,” says Michael Joyner, an anaesthesiologist and physiologist at the Mayo Clinic in Rochester, Minnesota. “We need to get this on board as soon as possible, and pray that a surge doesn’t overwhelm places like New York and the west coast.” On 23 March, New York governor Andrew Cuomo announced the plan to use convalescent plasma to aid the response in the state, which has more than 25,000 infections, with 210 deaths. “We think it shows promise,” he said. Thanks to the researchers’ efforts, the US Food and Drug Administration (FDA) today announced that it will permit the emergency use of plasma for patients in need.

More here.

Tuesday, March 24, 2020

The Tip of the Iceberg: Virologist David Ho Speaks About COVID-19

From Caltech Magazine:

Are you optimistic that these measures combined with research will be enough to combat the coronavirus?

I personally believe we will blunt this epidemic, but I think we wasted a good four to six weeks largely because of lack of testing and lack of a certain preparedness. But I think we could still make a difference and bring it under control with very harsh measures.

But again, are these measures sustainable? We’ve got to expect that businesses must reopen and schools must teach again. Whether it’s travel or sports or live entertainment, we’re going to have to return to some semblance of normalcy. But what are the measures that are effective and sustainable? That’s a question we as a society have to deal with. We need to buy time so that gradually the population will have a degree of immunity.

Most importantly, we need to buy time to allow science to deliver solutions. We’re going to have to develop drugs, antibodies, and vaccines. I think the mobilization by the scientific community, from my perspective, is amazing. So many people have mobilized and jumped on this and are contributing, from discovering small-molecule drugs that could block various enzymes of this virus to coming up with antibodies that could neutralize the virus.

More here.

Recalling Djuna Barnes, A Modernist Mover and Shaker

Jade French at the TLS:

As the subtitle of this collection of essays plainly implies, Barnes did modernism her way. She might have been ambivalent about the movement, resulting in what Daniela Caselli calls her “aesthetics of uncertainty”. But there is no doubting her credentials as a modernist mover and shaker: as a Left Bank journalist, an interviewer of James Joyce, the author of that late modernist masterpiece Nightwood (1936) and the beneficiary of Peggy Guggenheim’s largesse. Yet Barnes also slips away from easy chronology and canonization, not least because of her longevity. Born in 1892, she died in 1982, at the age of ninety, having outlived many of her peers by decades. On its dust jacket and between chapters, Shattered Objects acknowledges that longevity by featuring photographs of her in later life. The visual representation matters. Barnes’s reputation has long been framed as a story of decline – as that of a once dazzling author turned (by the mid-century) recluse.

more here.

Schlock Sculpture

Morgan Meis in The Easel:

When you look at the work of an artist like Richard Serra, or better yet, stand next to a classic Serra piece, you begin to understand how important the physical problem of balance and uprightness is for contemporary sculpture. Take one such classic work, Fulcrum (1987). The work consists of five fifty-five-foot tall slabs of COR-TEN steel. It dominates one of the entrances to the Liverpool Street station in London. Standing next to Fulcrum can be genuinely scary, all the more so when (and if) you realize that the huge slabs of steel are balanced one against the other simply by weight and angle. So, these slabs of steel can, theoretically, kill you. In fact, Serra’s sculptures have killed before and might do so again. Serra’s Sculpture No. 3 famously ended the life of a rigger named Raymond Johnson, who was crushed by it during installation at the Walker Art Center in 1977.

Hearing Serra talk about sculpture, it’s hard not to come away with the feeling that, while he has no desire directly to harm anyone with his art, he endorses a kind of aggressive and confrontational attitude toward artmaking. “Art, for the most part,” he has said, “is about concentration, solitude and determination.” The quietness of the steel versus the implied sense of power and violence-it is all part of the Richard Serra act.

More here.

Azra Raza talks about her book “The First Cell” with EconTalk host Russ Roberts

From the EconTalk podcast of The Library of Economics and Liberty:

Raza argues that we have made little progress in fighting cancer over the last 50 years. The tools available to oncologists haven’t changed much–the bulk of the progress that has been made has been through earlier and earlier detection rather than more effective or compassionate treatment options. Raza wants to see a different approach from the current strategy of marginal improvements on narrowly defined problems at the cellular level. Instead, she suggests an alternative approach that might better take account of the complexity of human beings and the way that cancer morphs and spreads differently across people and even within individuals. The conversation includes the challenges of dealing with dying patients, the importance of listening, and the bittersweet nature of our mortality.

More, including the podcast and a transcript, here.

Watch the Films of Éric Rohmer on His Centenary

Richard Brody at The New Yorker:

Those young movie nuts would launch the French New Wave, along with Rohmer, who was its virtual godfather; yet it took him two decades to put his ideas into practice. What made the difference for this group’s movies was a new mode of production—scant budget, small crew, rapid shooting. For Rohmer, these methods helped him fuse his way of filming with his way of living—and he lived a very strange life. (There’s a remarkable biography of him by Antoine de Baecque and Noël Herpe.) His practices—blending documentary and aestheticism, subjectivity and classicism—also made his characters’ romantic doings seem deceptively frivolous, their intellectual disputations ironically austere. The overarching subject of his films is avoiding the temptations of a false love (often but not always in the form of lust) while pursuing, awaiting, anticipating, or hardly even hoping for a true one. In a handful of films, such as the deeply disturbing “The Marquise of O” and his final film, “The Romance of Astrée and Céladon,” he tips his hand with the abstract extremes of his ideas—including the nearly impossible radicality of Christian love (which, in his view, is also romantic).

more here.

The Age of Surveillance Capitalism

Tim Wu at the NYRB:

To most people, the assertion that we are living in Skinner boxes might sound alarming, but The Age of Surveillance Capitalism goes darker still. Skinner, at least, saw himself as a do-gooder who would save humanity from its own delusions. His behavioral engineering was meant to build a happier humanity, one finally at peace with our lack of agency. “What is love,” Skinner wrote, “except another name for the use of positive reinforcement?”

Zuboff, in contrast, sees Silicon Valley’s project of behavioral observation in the service of behavior control as lacking an interest in human happiness (other than as a means); its goal is profit. That’s why Zuboff calls it “surveillance capitalism.”

more here.

the greatest threat isn’t the loss of human life but the loss of what makes us human

Jill Lepore in The New Yorker:

When the plague came to London in 1665, Londoners lost their wits. They consulted astrologers, quacks, the Bible. They searched their bodies for signs, tokens of the disease: lumps, blisters, black spots. They begged for prophecies; they paid for predictions; they prayed; they yowled. They closed their eyes; they covered their ears. They wept in the street. They read alarming almanacs: “Certain it is, books frighted them terribly.” The government, keen to contain the panic, attempted “to suppress the Printing of such Books as terrify’d the People,” according to Daniel Defoe, in “A Journal of the Plague Year,” a history that he wrote in tandem with an advice manual called “Due Preparations for the Plague,” in 1722, a year when people feared that the disease might leap across the English Channel again, after having journeyed from the Middle East to Marseille and points north on a merchant ship. Defoe hoped that his books would be useful “both to us and to posterity, though we should be spared from that portion of this bitter cup.” That bitter cup has come out of its cupboard.

In 1665, the skittish fled to the country, and alike the wise, and those who tarried had reason for remorse: by the time they decided to leave, “there was hardly a Horse to be bought or hired in the whole City,” Defoe recounted, and, in the event, the gates had been shut, and all were trapped. Everyone behaved badly, though the rich behaved the worst: having failed to heed warnings to provision, they sent their poor servants out for supplies. “This Necessity of going out of our Houses to buy Provisions, was in a great Measure the Ruin of the whole City,” Defoe wrote. One in five Londoners died, notwithstanding the precautions taken by merchants. The butcher refused to hand the cook a cut of meat; she had to take it off the hook herself. And he wouldn’t touch her money; she had to drop her coins into a bucket of vinegar. Bear that in mind when you run out of Purell.

“Sorrow and sadness sat upon every Face,” Defoe wrote. The government’s stricture on the publication of terrifying books proved pointless, there being plenty of terror to be read on the streets. You could read the weekly bills of mortality, or count the bodies as they piled up in the lanes. You could read the orders published by the mayor: “If any Person shall have visited any Man known to be infected of the Plague, or entered willingly into any known infected House, being not allowed: The House wherein he inhabiteth shall be shut up.” And you could read the signs on the doors of those infected houses, guarded by watchmen, each door marked by a foot-long red cross, above which was to be printed, in letters big enough to be read at a distance, “Lord, Have Mercy Upon Us.”

More here.

Can a century-old TB vaccine steel the immune system against the new coronavirus?

Jop de Vrieze in Science:

Researchers in four countries will soon start a clinical trial of an unorthodox approach to the new coronavirus. They will test whether a century-old vaccine against tuberculosis (TB), a bacterial disease, can rev up the human immune system in a broad way, allowing it to better fight the virus that causes coronavirus disease 2019 and, perhaps, prevent infection with it altogether. The studies will be done in physicians and nurses, who are at higher risk of becoming infected with the respiratory disease than the general population, and in the elderly, who are at higher risk of serious illness if they become infected. A team in the Netherlands will kick off the first of the trials this week. They will recruit 1000 health care workers in eight Dutch hospitals who will either receive the vaccine, called bacillus Calmette-Guérin (BCG), or a placebo. BCG contains a live, weakened strain of Mycobacterium bovis, a cousin of M. tuberculosis, the microbe that causes TB. (The vaccine is named after French microbiologists Albert Calmette and Camille Guérin, who developed it in the early 20th century.) The vaccine is given to children in their first year of life in most countries of the world, and is safe and cheap—but far from perfect: It prevents about 60% of TB cases in children on average, with large differences between countries.

Vaccines generally raise immune responses specific to a targeted pathogen, such as antibodies that bind and neutralize one type of virus but not others. But BCG may also increase the ability of the immune system to fight off pathogens other than the TB bacterium, according to clinical and observational studies published over several decades by Danish researchers Peter Aaby and Christine Stabell Benn, who live and work in Guinea-Bissau. They concluded the vaccine prevents about 30% of infections with any known pathogen, including viruses, in the first year after it’s given. The studies published in this field have been criticized for their methodology, however; a 2014 review ordered by the World Health Organization concluded that BCG appeared to lower overall mortality in children, but rated confidence in the findings as “very low.” A 2016 review was a bit more positive about BCG’s potential benefits but said randomized trials were needed.

More here.

Tuesday Poem

At the Un-National Monument along the Canadian Border

This is the field where the battle did not happen,
where the unknown soldier did not die.
This is the field where grass joined hands,
where no monument stands,|
and the only heroic thing is the sky.

Birds fly here without any sound,
unfolding their wings across the open.
No people killed—or were killed—on this ground
hallowed by neglect and an air so tame
|that people celebrate it by forgetting its name.

by William Stafford
from
The Way It Is: New & Selected Poems
Graywolf Press, 1998

Sunday, March 22, 2020

What ‘Distributive Justice’ Means for Doctors Treating Covid-19

Laura Kolbe in the New York Review of Books:

When I became an attending physician at New York–Presbyterian’s Weill Cornell Hospital last summer, after graduating from a residency at Brigham and Women’s Hospital in Boston, I became a hospitalist: a doctor of general internal medicine who takes care of patients for the duration of their inpatient hospital care. Besides my own writing and research, I also teach medical students and residents in a variety of courses and electives. But for me, as for roughly a million other doctors in the United States, that regular routine is changing very suddenly. Part of the challenge we’re facing with Covid-19 is that even knowing this is an event of shocking magnitude, we are not yet able to measure or foresee exactly how fast the disease’s progress through the world’s population will be.

What doctors call the “natural history” of Covid-19 can be envisioned as four stages; most people’s individual cases will stop at the first or, at most, the second stage, while an unlucky minority will experience the third, or all four. First, there is either an asymptomatic or a mildly symptomatic, nonspecifically “flu-like” illness. In Guangzhou province in China, researchers found that the median incubation period is about four days before symptoms, if any, set in. A portion of those with symptomatic, positive disease then experience a second stage: viral pneumonia, often visible on chest X-rays and CT scans by the varying degrees of inflammation of the lung’s interstitium, the connecting and supportive tissues that line the small airways and blood vessels where oxygen and carbon dioxide are exchanged between blood and air with each breath and heartbeat.

More here.

This Time, Can We Finally Turn a Financial Crisis Into an Opportunity?

NEW YORK – OCTOBER 24: Protesters gather outside of the New York Stock Exchange October 24, 2008 in New York City. The demonstrators were frustrated with the goverment bailout package and voiced concerns about poor and working class Americans. It was another tumultuous week on Wall St. with the Dow finishing down over 300 points Friday. (Photo by Spencer Platt/Getty Images)

Mark Blyth and Eric Lonergan in Foreign Policy:

After sitting on its hands last week, the European Central Bank has now announced its own “bazooka”—a 750 billion euro ($800 billion) bond-buying program, looser collateral requirements, a new refinancing program for banks, and an expansion of existing “quantitative easing” programs. Various fiscal spending programs are emerging too.

The response so far has been mostly impressive. Why, then, are markets still falling?

The most obvious answer is that the fiscal response is not big enough and that more must be done. We think that’s half-right. More must and will be done. But maybe we should return to that first bad idea about the efficiency of markets. Are these markets that we have built—that we are bailing out again with taxpayer money, and that are tanking our savings and retirement plans once again—really fit for their supposed purpose?

One clue that the markets aren’t working for us are those U.S. airlines that are now asking for a $50 billion bailout. Those same airlines spent the past decade abusing customerscharging usurious fees for basic services, and squeezing their employees. They then used almost their entire free cash flow to buy back their own shares, juicing the returns to stockholders and C-suite insiders while leaving the companies themselves financially fragile. Surely their shareholders and management deserve to bear the cost this time around?

The airlines were not alone. Since 2008, the world’s corporations have accumulated debts totaling some $13.5 trillion, as they counted on the Fed and other central banks to keep interest rates near or below zero for the long term. Yet rather than invest the cash they raised in productive investment, including in their employee’s skills, they used most of the cash to buy back their shares and award themselves profits on their options. Why bother with real engineering when financial engineering is so much easier?

More here.

The Doctor Who Helped Defeat Smallpox Explains What’s Coming

Steven Levy in Wired:

LARRY BRILLIANT SAYS he doesn’t have a crystal ball. But 14 years ago, Brilliant, the epidemiologist who helped eradicate smallpox, spoke to a TED audience and described what the next pandemic would look like. At the time, it sounded almost too horrible to take seriously. “A billion people would get sick,” he said. “As many as 165 million people would die. There would be a global recession and depression, and the cost to our economy of $1 to $3 trillion would be far worse for everyone than merely 100 million people dying, because so many more people would lose their jobs and their health care benefits, that the consequences are almost unthinkable.”

Now the unthinkable is here, and Brilliant, the Chairman of the board of Ending Pandemics, is sharing expertise with those on the front lines. We are a long way from 100 million deaths due to the novel coronavirus, but it has turned our world upside down. Brilliant is trying not to say “I told you so” too often. But he did tell us so, not only in talks and writings, but as the senior technical advisor for the pandemic horror film Contagion, now a top streaming selection for the homebound. Besides working with the World Health Organization in the effort to end smallpox, Brilliant, who is now 75, has fought flu, polio, and blindness; once led Google’s nonprofit wing, Google.org; co-founded the conferencing system the Well; and has traveled with the Grateful Dead.

More here.

Sunday Poem

Walt Whitman writing of a walk in the woods —and now that we’re left to walk outdoors somewhat alone and think… :

A Quintette

“While I have been kept by the rain under the shelter of my great oak, (perfectly dry and comfortable, to the rattle of the drops all around,) I have penceill’d of the mood of the hour in a little quintette, which I will give to you:

………… At vacancy with Nature,
………… Acceptive and at ease,
………… Distilling the present hour,
………… Whatever, wherever it is,
………… And over the past, oblivion.

Can you get hold of it, reader dear? And how do you like it anyhow?”

Walt Whitman
from
Whitman, Poetry and Prose
Viking Press, 1982

Disease as Political Metaphor

Susan Sontag in NYRB (February 23, 1978):

Punitive notions of disease have a long history, and such notions are particularly active with cancer. There is the “fight” or “crusade” against cancer; cancer is the “killer” disease; people who have cancer are “cancer victims.” Ostensibly, the illness is the culprit. But it is also the cancer patient who is made culpable. Widely believed psychological theories of disease assign to the ill the ultimate responsibility both for falling ill and for getting well. And conventions of treating cancer as no mere disease but a demonic enemy make cancer not just a lethal disease but a shameful one. Leprosy in its heyday aroused a similarly disproportionate sense of horror. In the Middle Ages the leper was a social text in which corruption was made visible; an exemplum, an emblem of decay. Nothing is more punitive than to give a disease a meaning—that meaning being invariably a moralistic one. Any important disease, whose physical etiology is not understood, and for which treatment is ineffectual, tends to be awash in significance. First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things. The disease becomes adjectival. Something is said to be disease-like, meaning that it is disgusting or ugly. In French, a crumbling stone façade is still “lépreuse.”

Epidemic diseases were a common figure for social disorder. From pestilence (bubonic plague) came “pestilent,” whose figurative meaning, according to the Oxford English Dictionary, is “injurious to religion, morals, or public peace—1513”; and “pestilential,” meaning “morally baneful or pernicious—1531.” Feelings about evil are projected onto a disease. And the disease (so enriched with meanings) is projected onto the world. In the past, such grandiloquent fantasies were regularly attached to the epidemic diseases, diseases that were a collective calamity. In the past two centuries, the diseases most often used as metaphors for evil were syphilis, tuberculosis, and cancer—all diseases imagined to be, preeminently, the diseases of individuals.

Syphilis was thought to be not only a horrible disease but a demeaning, vulgar one. Antidemocrats used it to evoke the desecrations of an egalitarian age.

More here. (NOTE: Thanks to Rima Zaheer from New Delhi)