Theory of Everything

Einstein’s Field Equations: In four-dimensional space-time, the indices take on four values, thus each indexed variable has 16 components. G is the curvature of space-time, T is the stress-energy tensor, and g is the metric. The second term is lead by the capital lambda, the Cosmological constant.

Regrets

Approaching mid-seventies, I suppose everybody contemplates the ultimate ‘end’. It would be unnatural, really, not to. And yet I do not wish to descend into some maudlin recantation of my regrets. I find myself, rather arrogantly, shuddering at the loss of information I have garnered over 75 years.

Physicists of today study the flow of information, much as those of the 1900s studied the flow of energy, those of the 1800s studied the flow of disorder (rise of entropy). The flow of my thoughts is far more erratic, and I am not about to change that now. I look back at what I have written over the last seven years, and I guess it overwhelmingly brings sadness…sadness at what I have neglected. There are things I might have done, but the competition of what might have been and what probably would have been caused the latter to always win, in my somewhat pessimistic mind. My thoughts of what could have been, rather than what were, seem always to have dictated my decisions.

I think of my university friend with whom I should have re-connected, only to find some years later when I did that he had died of the disease I knew he feared…Huntington’s. That should have been a lesson, it was not.

My quite wonderful cousin…which one? The girl who looked like me (in spite of being quite beautiful). Her husband who is my greatest fan and whom I know so inadequately. The much older cousin come uncle who read me bed-time stories, and whom I loved, but who my mother expelled because in her mind, homosexuality was an abomination, and akin to pedophelia…a lie if ever there was one. That older male model who was essentially perfect. The family friends who welcomed me into their parental circles, who watched me vicariously, and a bit proudly, whom I lost permanently when my father died. Their children who were my friends as a child, and total strangers as an adult.

I must reframe all this to ‘wonderful that I had them’ from ‘sorry that I lost them’.

But I do not need to reframe my childhood nuclear family (four first degree relatives, mother, father, two brothers). My greatest strength there was my ability to separate. One by death alone (and sadness and devotion and attempted emulation), the others decision guided by circumstance. If I am anyone, I hope to god I am my father.

Everything Is Relative

My driving desire as an individuated person was to understand the world. There are two worlds…the physical world…and the personal humans (the personal world). There is a third group. The rest of the natural world of people who start as impersonal in importance and may progress to personal with experience and exposure. The impersonal world. Maybe the ‘unpersonal world’ is better.

So the world is really divided in three: the ‘physical world’, the ‘personal world’, and the ‘unpersonal world’, more or less, with some smudging of this boundary over time. Physics, mathematics and chemistry are easy, relatively speaking, compared to the personal world. And what of the rest?

The ‘personal world’ and the ‘unpersonal world’. Not bad. But what of the creative, imaginative, artistic world?

Where is music?…Oh god, that, or at least the appreciation of it, has to be the ‘personal world’. It’s too good to be impersonal…or unpersonal. But part of it, maybe the best part, is not rational enough to be the physical world. And what does that say…the rational intellectual world that makes sense, or the personal world that soothes and moves me.

I have a Facebook friend whom I have never met in person. Only one really, as I think about it.

The Australian artist, Cat Leonard.

She and I have both trolled a religious or anti-religious site (depending on who is commenting). From opposite sides, though Cat, of all of them, tends to have more integrity, honesty and kindness than most theists I meet on such internet sites (I almost never ask my friends their religious views, so really do not know about them). She is proof that ‘there are very fine people on both sides’. (Now why does that quotation from the Orange Orangutan in the White House come to mind, in this context?)

Exit Stage Left, Enter Stage Right

I went to sleep when I was about four years old, and woke up again when I was nine. As is often strange in life situations, that seeming adverse events might actually have some benefit, deafness proved a bonus. I missed a lot of bad stuff. When I woke up at age nine, I found people talking about God and Jesus and miracles and changing water into wine. For the life of me, I could not figure out why they all seemed to believe it. There was no evidence. God didn’t talk back when you called Him. While I briefly remember marvelling that two Sundays in a row were sunny days, that correlation fell apart pretty quickly…there was nothing special about God’s day of rest. A little older I learned the phrase, “correlation does not mean causation,” under a proudly displayed picture of a pussy cat sitting in the valley of a broken aluminum awning.

I was deaf, essentially, from age four to surgery five years later. I could communicate with my father because, being deaf, he didn’t talk at all. I could communicate with my dog…his facial expressions told me I could, and anyway, dog is just ‘god’ spelt backwards. I missed a lot of concepts in school. On the other hand, I missed a lot of my mother’s explicitations. My mother taught me that tricking people was clever, especially when you did so without lying. That was the cleverest! She praised my brothers for being clever. I could not hear enough to be clever. But I heard enough to learn that courtroom lawyers were the cleverest, like my grandfather, her father, like the desired profession of her brother, until he saw the horrors of the war and retreated to less violent pastimes. She taught me that if you count ten seconds between when you saw the lightning, and when you heard the thunder, the storm was a mile away.

I could communicate with my older brother because he always looked straight at me and spoke loudly. And when the eldest was not around, he was around.

It was this older brother who told me about Relativity. His claim was that ‘only five men in the world understood Relativity, but Relativity explained the world.’ Or so it seemed. Only five men, and apparently my older brother acknowledged that he was not one of them, but he was only a couple years older than I, so he must have been closer. And he listened to me. He taught me that if you count five seconds between when you saw the lightning, and when you heard the thunder, the storm was a mile away.

And that is when, sitting in our father’s unoccupied studio, to the sound of lightning in the distance, I silently determined that one day, I would understand Relativity! The Theory of Everything…well, in my worldview when I was four, anyway. Understanding beat out everything. Because, coincidently at that time, out the north window of the studio, there was a thunder storm just five seconds away. One mile away.

Seventy years later I still don’t understand Relativity. In fairness, I think my brother might have been talking about Special Relativity, the kind that tells us we cannot discern the difference between two frames of reference which are travelling at a velocity relative to one another. Not General Relativity. While I understand Special Relativity well enough, even now, I may have understood General Relativity ten years ago, but that ability is passed now. It passed when I lost track of differential transformation rules for four-dimensional second order tensors, both co-variant and contra-variant.

Put us in the apocryphal freight train with an open side door, and have us pass another freight train, we cannot really tell which one is moving without looking at the surrounding landscape (yet another frame of reference) or the ground beneath. That’s Special Relativity. Maxwell’s equations already tell us the speed of light is constant in all reference frames, and with those two ideas (constant speed of light and no preferential frame of reference) time and space change with speed; a purely logical thought experiment, beautiful in its completion, and yet so bloody simple a slightly precocious nine year old could actually understand it (oh, not me…I was eighteen when I really understood it). Distances shrink, and time slows. In theory, and yes, we have proven it. Muons from the sun, subatomic particles spewed out by the sun’s solar wind radiation, could not get though our atmosphere in their life time, to be detected on earth, if time did not dilate and atmospheric height did not contract enough for the poor dears traveling so close to the speed of light, to make it through unchanged.

And lots of other direct tests, amazingly leading to that famous equation for energy equal to mass times the square of the speed of light. E equals McTwo! Yes, Special Relativity is true because all subsequent data fits the theory!

That’s science for you. Create a theory based on your best knowledge so far. If the data fits better than current theories, and you did your measurements well, you have the current best theory. But don’t rest on your laurels. “Scientific knowledge is always provisional.” [Priamvada Natarajan]

But as I look back, was my older brother talking about General Relativity? He didn’t specify. General Relativity is the kind that tells us we cannot discern the difference between an accelerating frame of reference in which we are travelling, and a frame simply existing in a gravitational field (like the ground under our feet).

And yes, maybe when my brother told me of this Relativity, back in 1953, some thirty-six years after Einstein’s ground-breaking paper (1917), maybe only a handful of men understood it. Indeed, when Einstein (a German man) received the Nobel prize in Physics, in 1921, Sir Arthur Eddington (an Englishman, just after a war to end all wars between England and Germany) was one of very few who understood General Relativity. Eddington’s experimental observations (in 1919) put Einstein on the map (in a brief glimpse of science transcending politics) essentially proving that light is bent by gravity. The James Webb telescope has recently sent back beautiful pictures which contain examples of gravitational lensing (light bent by gravity), proving Einstein and Eddington were right. And yet, Eddington could not accept Subrahmanyan Chandrasekhar’s concept of Black Holes (but then, neither did Einstein, even though probably all galaxies have them, even ours).

Back in 1921, so few physicists understood the implications of either form of relativity that the big prize was given, to Einstein, not for the Special or the General Relativity, but for the Photoelectric Effect, a discovery that only lead to Quantum Mechanics. Relativity still had to wait.

Beauty Is Truth, Truth Beauty

Cat Leonard paints truthful portraits. I found out one day, conversing back and forth about religion and art. I don’t know that many theists, and it was refreshing to converse with one who would listen. Her Facebook page has numerous references to her work, and as the son of an artist, a man to whom I was devoted, I knew a little bit about art.

I had a special stool in my father’s studio. It was red with white legs. In fact, there were two…a small one which I chose, early in life, and a bigger one that appeared later, unheralded, as I grew bigger, also red and white. There was no fanfare with this second stool, and oddly in my memory, it always looked just as beaten up as the first. The stool was always about ten feet behind the position my father preferred in the studio. That position might change with the season, much as the Sun’s position relative to Stonehenge, but the relativity remained the same, whether the short stool in the beginning, or the tall stool later in life.

I would sit for long periods of time on that red and white stool, watching my father work, his back, head looking at his work, and his left arm extended forward to his creation. His body covered the view of the painting and I had to lean a bit to peer around when I wanted to see what he was doing, which oddly, I usually didn’t. And, again oddly, the stool always seemed placed so that I couldn’t.

Occasionally, his right hand would come up to the pipe in his mouth, and a plume of smoke would arise from the other side of his head, from my point of view. Then glancing down to his palette, a large flat marble thing with various tiny mounds of paint, he would work his paints with a palette knife, slightly stooped, face closer to the paints…and there would be the briefest of glances back at me, as if he suddenly realized I was there. And back to work.

I used to have that red and white stool, after my father died. As I glance now at the portrait he did of me, hanging in our living room, that four year old almost in tears because he/I wanted to be outside with my dog instead of trussed up here in my cowboy suit…even now I know I am sitting on that red and white stool. It’s there, in my memory of the agonizing fifteen minutes I had to sit, even though the painting shows only my head and shoulders. The four year old covered to the neck, complete with red neckerchief, like Tom Mix, looking for all the world exactly like my namesake grandson. I used to have that red and white stool. It broke before I learned enough woodworking to fix it. It broke when I was angry about my father’s death, one of the very few times I troubled deaf heaven with bootless cries. It broke when I felt so alone. It broke as I flashed the memory of resuscitating him in the hospital where he died a month later.

It broke when I realized my father was my only connection to my family. I wish now I had kept it. The stool.

My Facebook friend, Cat, enjoyed dad’s paintings which I displayed as I packed them up to move to the city where my kids had grown up, where my grandchildren were. I had to pack each painting carefully, and the photos helped me document the boxes in which the paintings were. Many of my friends knew dad’s work, and since I had left home permanently only a couple of years before his death, I knew them all, had seen it all. I even knew the ones that were still in his studio when he died, even though they all resided, mostly packed away, in my mother’s house until the late nineties when she passed away. Now my third are all hanging in my house…all forty of them, or so, about a third of them upstairs, the rest in the workroom downstairs…destined for periodic rotation. I see them every day.

Cat’s tattoo which so intrigued me

Cat likes them, likes dad’s paintings, so I looked at Cat’s work.

Her portraits took my breath away. Not all of them…but damn, a whole lot of them.

And Einstein’s field equations remind Cat that G is everywhere, causes everything.

Dad hated doing portraits. Cat loves her portraits, and loves her subjects. She rather kindly suggested that dad would have liked portraits more had he had the advantage of photography to help. I let her know that mother did all that. Though I confess, there were not many photographs of dad’s subjects when it came to portraits.

I knew, everyone in our family knew, that dad could not get his feelings about someone out of the portrait. Best I could tell, the subject almost never knew, and I think dad never tried to hide, the portrayal of character seen in the portrait. I see it now as I look at that four year old on the wall: sadness, longing, some isolation in his deafness that only really his dog can assuage. Every parent who looks, certainly every grandparent, sees the tears about to rain forth. As if I knew my father was dying twenty-two years later. As if I knew I would struggle with the humanitarian decision of whether or not to resuscitate him twenty-two years later, egged on by the nurse who knew I would suffer from the decision if I didn’t.

No, I just wanted to go outside and play cowboys and first nation aboriginals.

I have seen lots of portraits, by some of the very best artists in the country, some friends of my dad’s. Many in the parliament buildings and museums, and boardrooms of companies and, yes, hospitals and girls’ camps! And dad’s portrait ability was one of the very best…but he hated it. And I think he hated it because he thought his subjects were telling him to change stuff, as they most surely were…and his deafness was thereby exposed. All he could do was nod, smile and puff on his pipe. But Cat has the advantage, if you will. Cat loves her subjects…well, most of them I think. Cat could be destined to become better than dad. In fact, I think she is.

My two brothers’ portraits are head and shoulders, like mine, except they are naked. I am clothed. They are happy (even though possibly cold), but not me. Apparently, that two to three years difference in age, theirs were painted in 1945 and ’47, brought changes in community acceptance of the nakedness of children, even when only an idea, a suggestion. So dad did change with the times.

My father had good reason to intensely dislike my grandfather, the one on my mother’s side. Grandfather, or ‘Grandsire’ as he insisted, was a cruel, sadistic, well concealed drunk, always the acerbic court room lawyer who probably never saw a day in court, and who never took a case he was not absolutely sure of winning. I watched in utter horror, and personal fear, as he reduced my father to tears in front of the entire family, at a Sunday dinner table…while he, my grandfather, in his cups, attempted to carve the turkey with the blunt side of the knife. I could not hear what transpired, but I saw it. And I hated the little shit ever after. And the portrait of my grandfather, completed by my father, so clearly exposed his character that nobody in the extended family would take possession of it upon the painting distribution at my mother’s death. Not even cousins unrelated to my father.

But Cat loves her subjects. I think she gets to choose them, instead of the other way round. But then, I am not at all sure there are people in the world that Cat doesn’t love. I think, though, that some of Cat’s portraits are of relatives, even first degree relatives. And maybe those are the breath taking ones.

In The Beginning, There Was G

My theory of everything is that Cat and I share a life view:

The big ‘G’.

G is infinite. No matter how weakly G might be respected, how infinitely far from G one might get, G is never really gone. G is the source of all energy and force in the world. G creates everything.

In the beginning, there was G. And the big G of huge galaxies showing the subtly encircling, curved smear of more distant galaxies aligned directly behind, well…if so finely aligned, it becomes a big circular halo, well…that’s an Einstein Ring. A halo. Due to the big G!

And Cat Leonard has a tattoo of Einstein’s field equations on her arm. I don’t think I have ever been so shocked in my life. It is Einstein’s original equation, the one only a few men in 1953 understood, without yet the second term on the left which represents the Cosmological constant that he called his biggest mistake (it wasn’t, but he didn’t know until later, when Edwin Hubble showed the universe was expanding).

The big G governs everything. The massive explosion of energy at the Big Bang spread throughout the universe which didn’t even exist yet…the ‘spreading’ was the universe. As the universe cooled and protons mopped up electrons into hydrogen, photons could then travel further, unobstructed. The universe became transparent some 380 thousand years after the Big Bang. The big G kept on rollin’, pulling masses together until two hydrogens became a helium, two heliums and two hydrogens pushed together became a carbon, and the rare helium and a carbon became an oxygen. Still the big G pushed, and heavier elements lead to supernovae and neutron stars. The big G pushed, or we should say pulled, two neutron stars came together and even heavier, less stable elements spewed out to the hinterlands rotating around some central G. The hard rocky planets, created by the big G working its magic on hydrogen, helium and neutron stars, those peripheral planets developed molten iron cores with some of the heaviest unstable elements. They radiated particles, heating that core and keeping it liquid. Rotation of liquid ferromagnetic material produced the magnetic fields which protected those rocky planets from solar winds, allowing occasional fragile complex molecules to be born but still allowing some protons (ionized hydrogen) from the sun in to react with oxygen, providing lots of water.

Billions of years in the making, earth, soil, water and nucleic and amino acids lead at last to the precarious roll of the dice: Life. At least on one planet. Quite probably on billions. And intelligent life at that, given they clearly have not tried to contact us!

And sometimes the big G is catabolic instead of anabolic, forcing the other galaxies away, and expanding space-time. The Cosmological constant expands the universe so that some parts escape beyond the constraint of the speed of light. At some point in the future of the universe, those other galaxies will wink out, too far away for light (information) to ever reach us. It will exist only in our history books, if indeed they or their memory exist at all.

The big G giveth, and the big G taketh away.

For me, G is gravity…for Cat, G is God.!

How did the big G give Cat the ability to paint such lovely portraits? Do her portraits, like dad’s capture the beauty of the subject, the truth of the subject? I think so, but why? Because she chose to wear the big G on the skin of her arm, on her sleeve, as it were? No. It’s because she worked at it. And she still works at it.

How long did that portrait take?

Twenty years and thirty-five minutes.

Good work, Cat.

Case Fatality Rates: Covid’s Quiet Fear

Figure 1. Case Fatality Rate (CFR) reflects the percentage of deaths due to Covid-19 of the number of identified cases of Covid-19. This graph extends from mid March 2020 to the initial of vaccination programs, December 2020 (V-day was December 19th for Canada and most other modern countries). There are many confounding features due to reporting variances from region to region, the quality, availability and speed of front line health care, the level of immunity of the local population, and even the social culture of that population. It is important to recognize that the CFR is reported based on confirmed cases and confirmed deaths, a process of data collection which may vary over time (for example, if you look now the peak for UK is only ~16%…data gets updated over time). Failure to capture all cases (denominator) for example, may significantly increase the ratio. A full description of these confounding factors may be found at the Our World in Data website, cited below. Thus intra-country comparisons are problematic, and trends in change over time are more valuable.

Covid Takes English Countries by Breath

The first case of Covid was some time in late 2019 and its pattern became pretty clear in the first few months of 2020. It spread quickly from person to person. Initially, contact with fomites on surfaces prompted us to be using sterilizing agents everywhere, as we struggled with vegetables and other groceries. Peculiarities such as frozen materials harbouring the virus without much loss of viability provided weird practices, like wiping down frozen packages. Ultimately, however, patterns convinced us all that the mode of transmission was largely by exhalation/inhalation, and droplet formation melded with airborne patterns. Rooms quickly filled with virus, suggested by outbreaks on cruise ships and aircraft carriers. Neat displays of microscopic water droplets bursting forth from infected upper airways lead us all to recognize the value of distancing and masks, while abandoning the package sterilizing routines.

The initial rationing of masks to health care personnel was prompted by several considerations. Public health was really not sure that masks would help the general public who are untrained in their use; there was real concern that masks would provide an outer reservoir of virus which when touched by untrained hands would all too quickly spread the virus to eyes and mouth. The second issue was the general lack of high quality masks which would protect the health care worker AND their patients from the illness as patients started filling hospital ICUs. Of course, access of the virus to the upper airways is by mouth, nose, AND eyes, the latter being largely unknown by the non-medical and forgotten often by the medical.

In June, 2020, a meta-analysis in Lancet confirmed the value of distance, masks and eye protection. Advice from public health physicians quickly changed, much to the delight of polarizing political opportunists who mistook advancing science for flip-flopping, a silly and irresponsible accusation failing to understand that scientific knowledge is always provisional, unlike determinations of morality.

By March and April of 2020, the experience in Italy and New York City was frightening, and it had been a long time since death came so quickly at the feet of a viral infection best known for the causing the common cold. Oh, we had been warned twenty years earlier, with SARS and MERS, but as usual, we had forgotten. Almost. I had been burned by SARS because nobody had enough N95 masks, so I, and some of my colleagues, still had a box or two in the closet, awaiting the next pandemic, long past expiry date. Now ten more boxes, and two gallons of 70% isopropyl alcohol will carry me through the next decade or so.

Figure 1. shows the Case Fatality Rates (CFR) due to Covid for Canada, USA and the UK since the beginning of the pandemic to V-Day, the beginning of the vaccination program. One of my favoured dependable websites, ‘Our World in Data’, specializes in amassing data about Covid in a variety of useful formats. Concise visual displays are vital aspects of statistics. One has to wonder what factors affect the daily variation of such data points. The list those factors is larger than you might think.

Health Systems

The UK, USA and Canada have roughly comparable front line care. Excellent physicians and nurses with superb training, adequate high technology. The internet and air flight have made medical knowledge available to all, and even socialized medicine is superfluous in an ICU; you get it whether you can afford it or not, in Canada and its mother country UK as part of the social safety net, in USA as some kind of noblesse oblige.

Thus, initial resuscitation, intubation in an ICU, and medication should be moderately consistent between countries. There is a learning curve, of course. We didn’t know that patients could present in advanced respiratory failure with low oxygen saturation and somehow not ‘feel’ the same intensity of shortness of breath. We didn’t know that treating Covid pneumonia was easier in the prone position, not an easy feat with an intubated patient. We didn’t know that such maneuvers as keeping the ventilation controls outside of the room so that adjustments could be made on each patient without the bothersome repeat hand-washing and glove and gowning would be so easy to organize. We didn’t know about steroids and other anti-virals.

Surprise thus was a major confounding factor. We didn’t then, and still don’t, know about exposure dose of virus, depending on distance and mask and source. Will a smaller initial dose exposure (number of virus particles) lead to lower symptoms, mimicking the older version of immunization called variolation, leading to immunity through infection (not a good idea!).

The nature of funding of public systems can lead to better access to health care, and better quality of health of the patient population. Everything from diet to smoking prevalence and alcohol consumption, and even genetics. Some countries are better than others.

Public Health Systems

Certainly the initial control of public health instructions can be where the rubber hits the road. Direction from experts is dependent on the expert knowledge base as well as the political climate affecting funding, public relations communications, and coordination of retail outlets, service industries and education. Leadership is important, as I shuddered even more than Bob Woodward did when then President Trump admitted, “I like to play it down!”

More serious interventions such as mask mandates, lockdowns, border control and vaccine mandates are opposed by political considerations, and public attitudes like concepts of freedom and liberty, as they relate to barriers to the control of viral spread, if not so much viral ferocity. But I think public health information went a long way toward reducing the initial population death rates, demonstrated by the deaths per 100K persons to be three times higher in USA (to date, 329) than in Canada (128). So the hodgepodge system in USA lead to more deaths, but CFR was roughly the same as the two countries learned what they were doing (see Figure 1., in December 2020).

Look at Figure 1. again. I don’t think we can gain a lot of insight from the serious difference here. It seemed like the UK was taken a bit by surprise, and the two ‘historical colonies’ learned vicariously from their ‘mother’. Genetics might be mildly different, perhaps historical patterns and acceptance of expert advice, but documentation and testing, as well as reporting of personal health information, may have more to do with these differences. Maybe Covid didn’t get across the pond quite as effortlessly.

But Figure 1. is scary.

Most of us did not know at the time what the CFR really was, and how it related to the Infection Fatality Rate (IFR). Opposition to attempts to control viral spread by various mandates was raised by citing IFR, hinting at ‘secret information’ such as the rates of asymptomatic infection: there is still no widely used test of prior/past infection, partially because Corona Virus and its sub variants have been around a long time, causing the common cold even before its discovery and identification in the 1970s. But the unknown IFR could ‘bring down’ the CFR by adding another fifty percent to the denominator. The variation in records by country certainly makes inter-nation comparisons swampy.

What Figure 1. tells us is that this virus could have been very serious indeed, showing us the potential of killing 10 to 20% of the population. One and a half billion people around the world is more devastation than a world war or two, and we all saw, if we were watching, what the initial months in Italy, and even New York City, could look like.

If Figure 1. tells us anything at all, it tells us that pandemics like the Black Death, the Spanish Flu, even Corona Virus relatives SARS and MERS could devastate the planet. As could Covid-19, had it had a free hand.

So What Happened?

We learned. The general public learned. Those who paid attention took care, personal hygiene, social events, bumping elbows in greeting, even learning from the Asians who already masked. The anti-expert conspiracy theorists were temporarily embarrassed and didn’t hit the internet in full force because it was hard for them to claim they had ‘done their research’ after only two months.

People moved outside, changed to take-out, put something over their faces and kept their distance. And we probably culled the weakest of our population early in the pandemic. Indeed, Canada’s current excess mortality rates, mortality above and beyond the expected from all causes when compared to average rates over the previous five years…these rates are now below normal…8% below! suggesting the weakest of us had already joined the departed.

But, we also saw the virus change. It changed far more rapidly than we expected, going through multiple iterations of itself, attempting to find a genetic formulation which evades the immunity developed to the original virus. [It is hard not to commit the academic sin of biology, ‘anthropomorphizing’, but I am no longer quite so academically virtuous.] Darwin always wins, and in the case of common cold viruses, we have never before had a successful vaccine against the common cold…we probably still don’t, but we may have reduced a lot of the pain and suffering with human know-how.

Figure 2. Continuing from Figure 1., starting with the first vaccine in December 2020, with scale change on the vertical axis, and two years on the horizontal axis (instead of one). The CFR of three countries as their respective vaccine programs progressed to totally or partially vaccinated: Canada (90% vaccinated), USA (81%). At this point, all three countries have similar CFR. It is important to recognize that the CFR is reported based on confirmed cases and confirmed deaths, a process of data collection which may vary over time. Failure to capture all cases (denominator) for example, may significantly increase the ratio. A full description of these confounding factors may be found at the Our World in Data website, cited below. Thus intra-country comparisons are problematic, and trends in change over time are more valuable.

Vaccines

Edward Jenner, in 1798, was a wholly unethical physician…by today’s standards. And by today’s standards he would be hanged, drawn and quartered by his regulatory body of physicians and surgeons, had we retained such brutal punishments. Jenner inoculated James Phipps, the son of his gardener, planting the cowpox on small furrows carved into the eight year old’s arms, and then, once the boy had recovered, he tried to infect him with increasing doses of variolous material (smallpox from some pustules), unsuccessfully, bringing vaccination and medicine into the 21st century. True to form for the era, the hide of the young female, Blossom, from whom the cowpox was obtained, hangs in the St. George’s Medical School library. It is perhaps only fair to British history to point out that Blossom was not a usual milkmaid. Blossom was a cow…but, like a milkmaid, Blossom did not get a vote.

While this discovery helped wipe out smallpox (many of us in our 70s still retain the scar of this vaccination, as a remembrance that vaccines save lives), the newer platforms of technology, mRNA vaccines, send a blueprint to our immune cells to temporarily produce a protein to which our subsequent reactions will prepare our immunity to fight. Sadly, this ‘vaccine’ does not completely stop the ‘common cold’, even though it reduces its symptoms, but does vastly reduce our chances of dying from Covid. A nasal spray form may help to immunize the airways, thus reducing that nasty common cold aspect, and further reduce the transmissibility (and reduce the symptoms and transmission of infection).

Figure 2. above (notice the vertical units only go up to 4% CFR instead of 20%, and the time frame spans two years instead of just one) shows the CFR for our exemplar countries, and the slightly mogulled slopes during the vaccination campaigns amazingly show the final descent and plateau to the limits of vaccination effect on CFR. As well, perhaps the effects of medications introduced or re-purposed co-align with an ultimate dip in the fall/winter of 2021/2022.

It is valuable, as well, to recognize that lockdowns, mask mandates and travel restrictions have largely been eliminated. Now. Now that we have won. For all but the most vulnerable, this virus has lost the fight.

But remember Darwin and anthropomorphism? All mutating viruses trend towards the arc of increasing transmissibility and decreasing fatality: killing one’s host is bad business for DNA’s (well, RNA’s) prime directive. “Spread out, increase the suffering if not the death, go forth, and multiply”. The virus did not know God was talking to the humans.

This Is My Take

I have not done the thorough research I might have in younger days; I don’t have the time or the inclination. But I have read enough, over the last three years, and know enough of the professionals involved, to come to major conclusions now. Call it speculation if you must, but educated speculation.

1. The Covid pandemic responded to initial public health directives. We cocooned our elderly, helping them where we could, in a wonderfully Canadian way. My wife and I have people up and down the street offering all manner of care. They seem happy to support us in our decrepit state in return for my medical information which I freely provide where I can, reminding them all the while that I am no longer a physician.
2. Masking helps dramatically. The landmark article in the Lancet (referenced above) suggested 60% reduction, but such measurements are fraught with difficulties. I recognized how powerful masking was when I entered a Perfume Department of a Pharmacy, and did not notice the odours until my mask was temporarily dislodged. Molecules of SOME odorants are smaller than Covid-19 virus, and certainly smaller than floating microscopic droplets. And I have not had any upper respiratory viral infection in three years.
3. Distancing helps, unless you are in an enclosed space for prolonged periods of time. The virus, largely airborne or floating droplet (less than 50 microns), is subject to the inverse square law, or even the inverse cube law, and numbers do count.
4. The vaccines do what they were meant to do, what their authorizing studies said they would do. The new technical platform of messenger RNA directing the construction of specific epitopes of proteins and viral constituents has proved extremely safe. Indeed, it is difficult to find even one death definitively caused by mRNA vaccines thus far. Research studies show that the side effects one gets are correlated with the immunity each achieves (No Pain No Gain!). Billions of doses have been given around the world. The internet trolling nay-sayers claim the evidence of damage will be in the future…it certainly is not in the past, and this technology has been tested now extensively on humans for two years now, and on animals for the last thirty years.
5. The virus rapidly mutates. This is characteristic of common cold viruses, which is why vaccines are so unlikely to stop a common cold. The virus mutates when it infects a mammal and divides. Most mammals, including us, develop immunity quickly enough to fight it off, but often only once it is deeply inside us. The infections on the surface (mouth, nose, pharynx, larynx even trachea) may not stimulate our system sufficiently. The unchecked virus, only partially embattled by immunity, tends to mutate to a variety which is not bothered by our defences. Thus the original Covid deferred to Delta, then Omicron BA.1, then BA.4/BA.5 and now BQ.1 and XBB. But typical of such systems requiring Darwinian evolution, these viruses trend towards less virulent and more transmissible, since that combination favours more efficient spread of their genetic influence.
6. The vaccines are adjusted to mutations as they occur. As the virus changes, the mRNA in the vaccine is quickly adjusted. We now have the ability to sequence RNA, determine the needed protein structure to be attacked, and deliver the appropriate mRNA sequence in the same platform of nanoparticle as the original vaccine…quickly. Thus the vaccine boosters stay up-to-date almost as quickly as the virus changes. There is no need to extensively retest each new vaccine.

Remember that Figure 1. shows the Case Fatality Rate during the non-vaccine year (2020), Figure 2. during the vaccine years (2021-22). Each country achieved at least single vaccination in 50% of its population by May 23rd, 2021, although United Kingdom got there by April 26th. All three countries achieved 80% vaccination (singly at least) by September 2021. The countries do not apply the same policies toward boosters or children, but that should be seen more in total numbers of cases than in CFR. In addition, each country had varying policies toward lockdowns, mandates and travel restrictions, and various different vaccines including the mRNA. Canada found itself short on vaccinations in early 2021, and chose to get a higher percentage vaccinated once, before finalizing initial vaccination in everyone.

Lockdowns and mandates were largely gone by 2022, if not earlier, and return to school was a welcome relief, though the subsequent massive surge of cases (red graph in Figure 4.) to many times the initial surge of cases was frightening to everyone in winter of 2021-2022, even though the CFR (white graph) was very much less for all three countries. The peak of cases in Canada in winter 2021/22 was 35 times the peak in May 2020, 25 for USA and 33 for UK. The deaths (white graph) did not follow the surge in cases (red), not nearly as we saw in May 2020. Since deaths were so much lower, we in Canada stopped looking for Covid cases in the general community in January 2022! Canadians tested at home, behaved responsibly with self-isolation, and didn’t report their infection.

Either the virus had changed by January 2022, or we had!

The truth was both had! Delta and Omicron didn’t kill as many, and vaccines protected the people against all forms, more or less. Natural immunity was playing a part as well, with some sources suggesting 2/3 to 3/4 the populations had actually been infected, at least with a resulting Covid Common Cold, if not the dreadful Covid Systemic Illness. Natural immunity is probably pretty good…it’s just hard to get without dying if you are not vaccinated.

Look again at the two figures, remembering that the vertical axes are different scales (max. 20% to 4%). Even without looking at cases, we know we have won. The vaccines worked, and so did lockdowns, mandates, travel restrictions and school closures. Hindsight is always 20/20, though we will never know the ideal timing of the more socially obtrusive aspects of our public health directives with this one pandemic.

Covid will be with us always, as a nasty cold reaching out to attack the vulnerable. You will see the immune-impaired wearing masks in public, and it will be a while before we all get back to restaurants and large gatherings without masks. We will have Covid with us for a long time, and will probably see the CFR dwindle as the frail elderly and immune suppressed are taken by it, and as natural immunity with vaccine protection strengthens all our immune resistance, getting annual deaths down to Influenza levels of 5 to 10 per 100,000 or less.

We will likely see mRNA vaccines to each new significantly different variant trying our knowledge of the Greek alphabet. We will probably see smoother more practiced responses to the next pandemic, with assumptions up front of social distancing, masks and eye protection.

But more importantly, we may see mRNA vaccines used against other diseases like Cancer, engaging our immune systems in that battle.

Anti-Vaxxers Listen Up

I hope, too, we will see less of the anti-vaxxer movement, and their Jabberwocky, who must have a hard time with the reality of numbers as above. But they will doubtless make something up. Like the idea surfacing on the internet now that there have been more deaths due to Covid in 2021 than in 2020 due to failure of the experts. Indeed, there have been more deaths, but many less than there would have been as this ocean liner-like pandemic slowly turned around; and vaccination programs were incomplete in 2021. The first complete year of at least 80% vaccination is 2022. The rate of infection is proportional to the number of cases (infection is exponential, a first order differential equation, as all anti-vaxxers I am sure must understand). Figure 3. shows CDC data for deaths in USA (those for Canada and UK are not readily available, to me anyway), but it is obvious that the overall death rates are slowing down, even though no country had greater than one third of their population documented to have had Covid. Had the exponential curves continued, deaths from Covid in USA would have been over 780,000 in 2021 and those in 2022 would be closer to one and a three quarter million. As it was, the numbers are only marginally higher in 2021 than they were in 2020, and then actually lower in 2022.

Figure 3. Recent data (as of Dec 28, 2022) from the CDC on USA and Covid showing the rapid reduction of deaths in 2022. Percent of Expected Deaths in the fourth column demonstrates the burden of the Covid-19 pandemic. For comparison, deaths due to Influenza are seen in the seventh column.

Figure 4. Data from Johns Hopkins (worldwide) graphically showing weekly numbers for cases (red), deaths (white), and vaccination doses administered (green). While cases surged in the winter of 2021-2022, deaths were relatively lower in comparison to earlier weeks. By the end of December 2022, there were over 660 million cases of Covid-19 worldwide, with ~6.7 million deaths and over 13 billion doses of vaccine administered (there are still many around the world who remain unvaccinated). One may roughly estimate the Case Fatality Rate from individual data points of deaths divided by cases for the same week (or slightly more accurately two weeks later for deaths); underline roughly!. Go to the live site to do this, reference below.

Take another look at Figure 3. data from the CDC for USA and recall that United States vaccination program has not been as robust as Canada’s, with only 69% completing the first protocol and 81% partially vaccinated to date. Nevertheless, absolute numbers of deaths from Covid-19 are markedly reduced in 2022 compared to 2021, even though such exponential functions as infection rates are not linear…we would expect 2022 to be much worse than 2021 in absolute numbers, even if the rate of infection had been significantly abated. Notice as well that Influenza deaths, the endemic problem we all deal with, has a total death number that is only ~2.5% that of Covid-19. Notice as well ‘Deaths from All Causes’ and ‘Percent of Expected Deaths’ (columns 3 and 4). The total death rates from everything are coming down; this includes from Covid-19 and from vaccination fatalities (if there were any). To date there is no evidence of excess death due to vaccination in USA (nor anywhere else…certainly not from mRNA vaccines). To my knowledge, there has never been a death reported as caused by mRNA vaccines in USA or Canada (I have seen one reported from New Zealand)…I’m sure they exist, but in USA, 60,000 people die every week, surely some following vaccination (and NONE ‘before vaccination but due to vaccination’, for obvious anthropic arguments…I know this sounds silly, but it his important when balancing data; you cannot die of the vaccine before you get it).

Is it possible that this reduction in death reflects a change in the virus? Yes, though at the end of 2021 we had the opportunity of observing the differences between contemporaneous infections of the vaccinated, and the unvaccinated. In every jurisdiction, as vaccination levels grew, so too did the ratio of unvaccinated serious illness compared to the same illness in the vaccinated population. In the latter half of 2021 we were seeing the unvaccinated populating our ICUs and exhausting our front line health care staff, all of whom were pleading for everyone to get vaccinated.

Understanding how vaccinations spread throughout United States, and remembering that their Commander in Chief told Bob Woodward, ‘I like to downplay it,’ the clarity of vaccination program effect comes into focus, with deaths per 100,000 being three times higher in USA than in Canada, yet with similar front line treatment and effect. Our public health mandates, and our vaccination program really worked. Complain in Druthers magazine, or at the Truck Convoy…you have, relatively speaking, more people to do so, because they didn’t die from Covid in Canada. You can complain whether it was all worth it, now in hindsight, but then you must remember that whatever we did, we had 49,238 deaths…had we been more like USA, as perhaps many of you would have liked, we would have had 100,000 more deaths than we did.

Now look at Figure 4. This is the Red-White-Green data from the Johns Hopkins internet site, and reflects data for the entire world. Take care with the scale of numbers on the vertical axis, but note that the time scale in years is the same for all. If you go to the actual site, individual data points are expressed in weeks (you can choose months). The end of the timeline is the end of 2022, and the Green vaccination points begin essentially in 2021 (last week of 2020 really). To orient in time, the surge in cases (red peak), is the winter months of 2021-22. By the fall of 2021, but not until then, the modern countries had achieved about 3/4 of their authorized vaccinations.

It is pretty easy to see that the deaths due to Covid-19 worldwide are reducing: the area under the curve of the white graph (Figure 4.) is greater in the first half of the pandemic…than in the second. The total cases (red) are closer to equal, if not even a little worse, which means that CFR must be less. It will be interesting in another year. I think the verdict is in, though…vaccines clearly save lives. Indeed, vaccines have curtailed the pandemic and converted Covid-19 from an often serious illness, even deadly illness, to the common cold. Importantly, the mRNA vaccines, even allowing they may cause the easily treatable pericarditis and myocarditis (both worse and more frequent after Covid infection)…the vaccines are extremely safe.

References

1. COVID-19 Dashboard: Johns Hopkins, Center for Systems Science and Engineering, https://gisanddata.maps.arcgis.com/apps/dashboards/bda7594740fd40299423467b48e9ecf6
2. Coronavirus (COVID-19) Vaccinations, Our World in Data, https://ourworldindata.org/covid-vaccinations
3. Center for Disease Control and Prevention, https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
4. Edward Jenner, Wikipedia, https://en.wikipedia.org/wiki/Edward_Jenner

The Measure of a Human Life

Twenty three years ago, almost, I was the a member of a team involved in a huge project, a project which usurped my life. My title was undecided and controversial. I was certainly the Regional Vice-President of Cancer Care Ontario, but what was I to Grand River Hospital? The first CEO of the virtual cancer centre, Grand River Regional Cancer Centre (or Program)…or was I a Vice President of Grand River Hospital, in Kitchener-Waterloo. As it happened, I left before I found out, to start a new career in London at the London Regional Cancer Program, eventually becoming Senior Medical Director, Chief of Oncology, and Associate Professor of Western University. Soon after I left KW, two of the other Vice-presidents of the Grand River Hospital, both heavily involved in the project, left as well, as did the CEO of the hospital. So too the Heads of Medical Oncology, and Radiation Oncology. But the cancer program rose from those early hiccoughs, and became all that we planned it to be because of the dedicated staff who remained, I hope with this mission of care I outlined to Hopespring in Waterloo, as construction was beginning. I met so many wonderful people as we set to the vision, planning, building, staffing, and setting policy of that new facility…still one of the most marvellous projects I had the opportunity to work on during my career.

Speech to Hopespring, Nov. 1999

Manulife Centre, Waterloo

November 20th, 1999

My wife tells me I have the gift of the gab. Gift of the gab. What an awful expression. It has an onomatopoeic sense to it, don’t you think. Gift of the gab. No, I didn’t like this. The phrase, I think is more aptly applied to that stereotypical politician who can stand up and talk for 45 minutes without ever thinking. Gift of the gab. No this wasn’t good. This was a moment of tension in an otherwise unblemished marriage. I was really upset.

Really upset… Until… I heard her refer to her father as the ‘mental midget’, admittedly in jest. Mental midget! here is a man who graduated from high school second in his province… Mind you it was New Brunswick, but nevertheless… That’s still a couple of large Ontario high schools, don’t you think? Here’s a man who is a Rhodes Scholar… Of course I periodically remind him that Bill Clinton was also a Rhodes Scholar…but here was a man who was a gold medalist in medicine at McGill…the first medical oncologist at the Princess Margaret hospital…Dean of the Faculty of Medicine at the University of Western Ontario… Vice President of that university…and oh yes, member of the Order of Canada! Mental midget! Ladies and gentlemen, if you had any lingering doubts about this man, reflect on the fact that he married Barbara Yvonne Gzowski, the most wonderful woman in the world. This is no mental midget.

So I was relieved that I had only been referred to as having the gift of the gab. After all I had done better than Harold. 

Unfortunately, I didn’t have Doctor Harold Warwick as a role model when I was growing up. That’s because I didn’t marry his daughter when I was six, as I should have. But then, I never would have made it out of high school, let alone medical school, so preoccupied would I have been.

No I didn’t have Harold Warwick as a role model when I was growing up, but I did have two wonderful men as role models. My own father was a well loved and respected Canadian artist, but he was almost completely deaf from childhood and as the consequense he was almost pathologically quiet, lost in his world of art, hard work, and very very very loud music. But as most good parents know, children do what you do, not what you say, and so it was that he was a wonderful role model for hard work and behavior toward others.

One of his closest friends was a man with whom I spent the majority of my childhood summers. He was like a second father to me. He was an inspiration, an idealist, an orator, a visionary, a teacher… And he dedicated his life to helping troubled young boys and young men… And he achieved those goals admirably. 

I shall tell you more of him later, but one thing he taught me when I was very young was that if you want to make friends, you have to share something with them. I was five or six at the time, so I handed him my chocolate bar. He kept half, gave the other half back, and said “No, that’s not what I mean.”

He said, “If you really want to make friends you have to share something of yourself, something intimate…some hope, some dream, some wish, some fear, some angst, some failing… You have to share something of yourself.”

What then, shall I share with you tonight, that we might all be friends.

Well, I can share with you the fact that I am growing older, but that’s not much of a revelation. But as I grow older, I seem to be forgetting more. And the older I get, the more I forget, until it really seems to me that I have forgotten more than I ever knew. That’s not something you want to hear from your doctor.

To me, modern medical knowledge is rather like an ever increasing cascade of grains of sand, little tiny grains of sand, grains of knowledge. At first you hold out a cupped hand to capture the knowledge, but soon it runs over, so you try harder and hold out two cupped hands, but again it soon runs over. Then you make the egregious tactical error of attempting to embrace the falling grains of sand with open arms, and the deluge increases and smothers you.

That is what it feels like, I suspect for many physicians, as we enter middle age and come to the realization that we can never have the command of the knowledge of medicine that we once naively thought we could. And it is frightening ladies and gentlemen. It is frightening.

But I do take some solace in the fact that over the 20 years that I have been practicing internal medicine, hematology and oncology, I have gained a certain measure of experience. Indeed, I would have had to be comatose to do otherwise. And it is comforting to know that I can sit down with a patient and within a short period of time I can map out a path for them to take. And it is comforting for them to know that although the outcome may be unkind, that they will take a path with someone who has gone that route before.

If you were charitable to me this evening, you might consider this experience, in the face of ever decreasing knowledge, to be a form of wisdom. 

With this newfound wisdom, and ever decreasing knowledge, I can look back at my life… And consider the mistakes that I have made.

My father in law, Harold, periodically calls me up, and one of the first times he called me he asked me if I “had made any mistakes this week.” Not realizing that I had been set up, I answered as honestly as I could, “No…I don’t think so.”

He said, ”You will rue the day you said that to me,” for he knows as I know that if you practice medicine, you make mistakes. And if you practice complex medicine you make complex mistakes. Often those mistakes go completely unnoticed. Occasionally they require some minor correction, rarely they cause your patient some discomfort, and very rarely… they cause the death of the patient. It is one of the realities of medicine that if you practice complex medicine you make complex mistakes, and very rarely these mistakes kill your patient. When this tragedy happens, it is the burden of the physician to pick up the pieces and learn from the mistake, and carry on, for that is indeed what is best for his future patients, his community, and himself. But it is not easy, ladies and gentlemen. It is very, very difficult. It is very difficult.

But as I look back over my professional practice and think of my mistakes, I really think of those higher level or generic errors that have occured over my life, those changes in values and goals and aspirations that I have for my patients, compared to 20 years ago when I was more knowledgeable, but less wise. 

Let me give you an example.

Over the last 10 to 15 years there has been an increasing focus on outcomes. What was the outcome? What was the bottom line? Outcome analysis is an important aspect of quality assurance and performance management in medicine, just as it is in other sectors such as finance and business. What was the outcome? How many patients did you see? How many patients did you treat? How many patients survived? What was the time from referral to consultation, from consultation to diagnosis, from diagnosis to treatment?

What was the outcome?

Sometimes I fear we have concentrated too much on the outcome to the detriment of the process. After all, what is the measure of a human life? Is that the outcome? I think not, for in the entire history of man the outcome has always been the same. 

The measure of a human life is the sum total of its life experiences, little tiny life experiences which cluster and coalesce to form larger life experiences, which when summed and integrated over the entire lifespan forms the sum total life experience. This is the measure of a human life.

Some life experiences we would simply rather not have had. Others we desperately try to have again, but alas, only the most demented of us can have a first time life experience for the second time.

Some life experiences loom very large and weigh very heavily on the minds of the patient and their loved ones. These life experiences can be so overwhelming as to eclipse the others and consume the total life experience or measure of the human life.

The investigation, diagnosis, planning, treatment and follow up of a patient with malignant disease is a cancer scenario life experience which looms very large and weighs very heavily on the minds of the patients and their loved ones, and it can overwhelm the entire life experience regardless of its outcome.

It behooves us who are members of the health care professions to try to ensure that the cancer scenario life experience is as positive as possible. 

I guess what I’m trying to tell you is that most of the time, if not all the time, the life experience is more important than the outcome…the process may be more important than the outcome. The process may be more important than the outcome.

I told you that I would say a bit more about my second father, my non biological father.

Doctor Bruno Morawetz was a professor of philosophy at the University of Toronto and Trent, and for over 50 years was the owner and director of a boy’s camp, Camp Ponacka, on Lake Baptiste south of Algonquin Park. He was a marvelous role model to me, important in my growth as a boy and a young man.

I attended this camp at a very early age, four or five. I continued on until I was a counselor, and returned later as a camp doctor. My son was a camper there, and a counselor and swimming instructor. I have heard all Dr. Morawetz’s lessons.

Grand River Regional Cancer Centre twenty years after opening

Perhaps because he died in April of this year, at the height of planning activity for the new cancer centre, and perhaps because he died of a malignant disease for which I was peripherally consulted, my memories of his lessons and talks will forever be intertwined with my thoughts of the cancer centre, and I know when the cancer centre is finally up and functioning and I can stand outside and look at it, I will think of him.

My own father died of cancer. He entered hospital on September 19th, 1974, and died during that same admission on December 22nd, 1974. He underwent six operations. He spent two and one half months in a surgical intensive care unit. He had the first Swan Gantz catheter inserted into his heart that was ever inserted into a patient at that hospital. He had the best that medical science had to offer. He had the best that medical technology had to offer. Of course he did. He was the father of a doctor on staff there. But he did not have a Hopespring, and he had a horrid cancer scenario life experience…As did his family.

Dr. Morawetz was diagnosed with metastatic cancer two and one half years ago. After the initial diagnosis, he declined any further medical therapy. He lived a full life during those two years. He attended his own wake, he gave his own obituary, as was his wont, and he predicted his own death to the day. I watched as he chastised a 55 year old former camper for stepping to the head of a line queueing to say goodbye to him. And when he died in April, I was but one of over 3,000 people to attend his funeral, in a small church in Peterborough.

He had a good cancer scenario life experience, as good as it gets. 

I paint these two pictures for you as a poignant reminder that medical science and medical technology, particularly when injudiciously used (though that was not the cause in my father’s case), can lead to counterintuitive, and counterproductive results.

In 1975, during the camp season, four young counselors were returning to camp from a day off. As their car drove around the lake, it slipped over the edge of the road and plummeted into the lake. All four young men perished.

This tragedy shattered the camp. It staggered the camp director. It left a gaping open wound. In an attempt to heal that wound, Dr. Morawetz planned and constructed an open air cabin on the brow of a cliff overlooking Elephant Lake at the north end of the camp, as a memorial to those counsellors. It contains articles and pictures of these four young men. It is visited on an annual basis by the campers and staff of the camp, and by friends and relatives, even now, 25 years later. It is a place of solemn reflection. It is fondly referred to as “High Flight”.

Over the door to High Flight Dr. Morawetz wrote the following words. He wrote:

“Let he who enters these hallowed walls reflect…That life is fleeting but rich, for those who open their eyes to the beauty of nature around them, their ears to the voice of God, and their hearts to their fellow man.”

I was captured by that self directed concept of enriching my life by opening my heart to others. I know this is something well experienced in the healthcare sector, and in other sectors, but the opportunities for this in the healthcare abound. There are many material things in this world. There are trips and cars and houses, fine food and fine wines…And they all bring a certain measure of comfort and joy. But it pales in comparison to the feeling one gets from truly helping someone, from saving someone’s “Life… experience.”

You can enrich your life by opening your heart to others, you can enrich your life by opening your heart to others.

Well…what have I shared with you this evening, that we might be friends. I have shared with you that which I have learned, with my ever decreasing knowledge and my newfound wisdom, that most of the time the process may be more important than the outcome…and I have shared with you that which I have been taught, that you can enrich your life by opening your heart to others.

How can I take these two threads and weave them into a rich fabric of vision for the Grand River Regional Cancer Centre. Now, it would be premature and presumptuous of me to define for you the vision of the Regional Cancer Centre. That is a work that I believe should be done by the staff and community of the cancer centre once it is up and functioning. It might take six months, it might take a year, it might take longer, but it is important that the vision is embraced by the community of the cancer centre and that they come to live with the vision, and to live the vision. Having said that, it does not preclude me from having my own personal vision, and since I am involved in the development of the cancer centre, it is appropriate that I share that vision with you.

It is my hope…It is my goal, that this cancer centre will be known and respected for the caring and empathetic way by which it guides its patients through the cancer scenario life experience with sensitivity and thoughtfulness and kindness and respect. If we can achieve this vision, I am sure all those good outcomes we are looking for will follow.

The question is, “How do we do it?”

Well there are many ways by which we can inculcate a spirit of caring and empathy into an institution. We can hire people who are caring and empathetic. We can make it an expectation to be caring and empathetic, we can put it in the job description. But we must, we must, we must provide them with the time and resource’s needed to be caring and empathetic and, having done all that, sometimes I think the human spirit being such as it is, we need only then give them the permission to be caring and empathetic.

I think, for me, the overriding principle should be that in everything we do, every brick we lay, every mortar we trowel, every document we produce, every care path we map out, every policy we write, every balance sheet we add up…in everything we do we should focus on creating the potential for everyone involved in the cancer centre, be they patient or staff or visitor or volunteer…that in everything we do we should be creating the potential for all who are involved with the cancer centre… to be provided the opportunity to open their hearts to others.

For after all, “… Life is fleeting and yet rich, for those who open their eyes to the beauty of nature around them, their ears to the voice of God, and their hearts to their fellow men and women.”

Thank you ladies and gentlemen, for coming out this evening to enrich your lives and the life of your community by opening your hearts to others; thank you, thank you, and goodnight.

Fast Forward to March 9th, 2022

My wife was angry with me for abusing a confidence, for telling her father in this speech that she had referred to him so ungraciously. I knew that it was in jest, that Harold was so obviously superior intellectually in so many ways, but she worried that her father would take the insult seriously. I don’t believe he did, but my wife remains angry with me, years later. I have apologized to her profusely, several times in the past, but it may really be one of the very few differences on which we have held opinion.

Harold did talk to me frequently, over the years. Indeed, we had a relationship closer to father and son than to father-in-law to son-in-law; I felt adopted by Harold and his wife, Barbara, which helped to heal the dreadful abandonment I felt at the early death of my father and the betrayal I felt from the rest of my first family. He mentioned his daughter’s comment to me for time to time, always with a rueful smile. He knew too, that our relationship was something deeper than usual, even commenting once that I treated him like a father when I offered to provide a home for him and his wife with us together in London, some years before he died.

My relationship to Harold was often one of minor rivalry, the comparison of the alma maters of physicians disciplined by our provincial college to determine which defrocked doctor came from which of our two prominent universities, Toronto or McGill (sadly, I think he was winning this by the time of his death). Between ourselves, we compared spelling and grammar, love of music and oratory, and moving large rocks at his cottage, ultimately our cottage (I suffer to this day from grandstanding, having attempted one rock more than I could safely manage). I sat at his bedside in the hospital he had built, on his last full day. At his death, I gave his eulogy, drawing quotations from the song, “Superman”, by none other than the Crash Test Dummies, an allusion which might have been positively and negatively embarrassing for Harold, or so I hoped, “For sometimes I despair, the world shall never see another man like him.”

Our competition continued beyond his death, as I self-published his book (posthumously) and mine (not posthumously!), but priced his slightly higher in order that mine out-sell. A joke he would have enjoyed.

But once, Harold felt comfortable enough to ask me why I had married his daughter? It was a shocking question to ask a son-in-law, or even a son. His question was not probing his daughter’s merits, it was probing mine. I thought briefly of her profuse wild and curly brown hair, her humour and radiant smile, her lovely figure, but within three seconds, I answered him, with all the cutting honesty I could produce.

“She was the smartest and most honest woman I could find,” and we both knew the thought, ‘You mental midget.‘

Harold just nodded his head and smiled. In agreement, I might add. My God I miss that man.

My Take on Covid-19 Vaccine Success

Distribution of Covid-19 illness result in Canada, November 2021

This is all Canada data. Most peope want their information to fall into two buckets only. They want a binary answer, a dichotomy. Is the vaccine good or is it not. If it works, why are people still getting Covid?

So, as Fareed Zacharia would say (dare I compare?) this is my take. MY SPECULATION so don’t quote me here.

Corona viruses have caused the ‘common cold’ for many years. Nobody has seriously tried to create a vaccine against them, and they cause a great deal of economic and personal difficulties. But the risk of dying is small…it happens all the time, but it is small, so small nobody thought a vaccine was such a good idea. Some elderly frail are about to die at any moment. They have reached the end of thier thread, and some minor nothing common cold takes them out, barely without causing any symptoms because they blissfully pass away in the early hours of the morning, while asleep. The loyal dog changes beds because the body is going cold.

1. Nobody bothers with the non-Covid corona virus. Nobody gives it a ‘no-never-mind’. To some extent it is a blessing.
And every kid gets it because it exists in the community. They get it, and the immunity wanes and they get it again, and again, and again. Then later, as parents, they get it from their kids, and on it goes, building immunity but never permanently, always superficially: mouth, pharynx, larynx, trachea: Cough, coryza, headache, sneezing, stuffiness. These surfaces are actually ON the outside of the body. Blood and lymph do not get out there easily. And the immune system does not worry about them as much. That’s where they put their scouts, not their artillary.

2. Does this virus invade any of those tissues? Does it get deep inside. No, not if the immune system is tuned and ready (previous infection with natural immunity, or vaccinated). The immune system does not extend well to the surfaces because it is mediated by the liquids inside the body, the blood and lymphatic fluids. It barely gets into the mucous and the saliva until the memory system of immunity ramps way up very high, temporarily.
Why temporarily? Because the substances that the immune system produces are not pleasant. They destroy cells and some of them break down tissues, in order to get the other soldiers (cells and immune mediated molecules) in there to fight. It would not be helpful for those things to persist, and cause auto-immune disorders. So it is a graded response, with the surfaces warning the interior. But when the immune system is functioning well, the virus NEVER makes it inside, not for long, anyway.

3. In the beginning, Covid killed 7 to 10% of its symptomatic targets (we were not looking for the asymptomatic ones, so we don’t know how many of them there were (big mistake numero uno, we did not test enough)), but doctors quickly learned about a) oxygen levels falling and patients not being aware of it b) prone positioning to drain the lungs c) steroids to control the overzealous immune response d) patterns of spread and how to warn the public e) distancing, lockdowns and eventually masking (May 2020). Covid case fatalities then dropped and public health measures which were not impeded by politicians (like Trump’s favourite ‘downplaying’) reduced the incidence. The April-May 2020 surge was abated, controlled.
The virus went into quiet search and invade mode, gradually spreading throughout the healthy younger population as the older people cocooned (isolated at home), and a slow simmer persisted throughout the summer. But return to school and other activities, relaxing of commitments, soon lead to the fall surge which was unrelenting in spite of what we did, and by the end of December we were in deep doo-doo again with death rates higher then ever.

4. V-day in Canada was December 16th, 2020, I think, with USA only slightly ahead of us. Vaccines, amazingly speedy, even worrisomely speedy, were an accomplishment of combined government funding and private capitalism…a vaccine in less than five years!!! Unheard of, but there is was.
This has scared experienced vaccinollogists, like Bridle and Malone, who speak out with warnings of toxicity of the spike protein, suppression of the immune control of cancer and who point to deaths due to vaccines. But medical community is not seeing these worries materialize. I’ve asked Cancer Care Ontario and my former colleagues at LRCP, and I’ll let this thread know, but Dr. Bridle’s comments about cancer are total news to me.

This graph shows death rates from all causes in Canada (red) and USA (purple). Data obtained from Our World in Data, much of the data from established sources worldwide, and sources are listed in their website. The display is complicated. The line represents percentage of deaths above and beyond previous rates in 2015-2019, at weekly points in time from January 1, 2020 to September 30, 2021. Peaks of death rates are seen in March-April 2020, Winter of 2021, and the recent surge of the Delta variant that is only now starting to come under control. The yellow vertical line depicts the start of the vaccination program, roughly the same time in both countries. The area under the curve is related to the total deaths due to Covid in each country (~30,000 in Canada, ~750,000 in USA). This graph is usually stable at 0% to 2% (representing population growth), with fidelity to thee seasonal pattern typical of death rates (higher in winter than in summer). Notice the three peaks, the first in March April 2020 as we learned, and then stabilization due to public health directives, the rise in Fall Winter of 2020, the peak that was the highest, and then the recent surge of Delta variant through the non-vaccinated and immune incompetent patients recently (August November 2021). Notice the rapid descent in January through May of 2021, as the vaccination program expanded. Deaths now are mostly in the non-immunized people by a ratio of 10-20:1, but spreading rapidly through the unvaccinated because of the nature of the new variant. Thus the recent surge of deaths is almost entirely in the unvaccinated, as demonstrated in the first figure

VAERS data, a surveillance program of the CDC in USA, shows some six thousand deaths following vaccines in the first six months, all the while warning people they CANNOT use this data to judge the vaccine…WHY? because VAERS is correlation, and everybody knows that correlation does not equal causation.

But still, six thousand???

60,000 people die every week in the USA. That is a quarter of a million every month. How many of those will occur in the 6 months following a vaccination, during which 1.5 million Americans die. Everybody forgets we are not immortal. Even Conrad Black bemoaned the fact we were shutting down his blessed right wing economy just because Covid was killing the elderly and not changing the over all life expectancy (79 or something). In that rant he forgot that the typical 79 year old has more than 0 years to live [sigh…its closer to 6 if I remember correctly].

5. As the vaccine program spread and advanced, the death rates plummetted from close to 50% ABOVE expected to actually slightly below zero in Canada, and about 5 to 10% above normal in USA. Certainly by May-June of 2021, the death rates looked close to the death rates from all the previous years of 2015 to 2019, only about 5 to 10% above in USA.
And it was not like vaccines were causing deaths; deaths were going down consistently, linearly, throughout this time. 40 ICU physicians were polled by a physician at UC Davis: “Have you seen Covid pneumonia?” Ans: Many cases, some right now. “Have you seen Covid vaccine catastrophe?” Ans: No, not one!!

6. Then the Delta variant hit North America and the August 2021 surge was initiated. Now this virus has a higher R value…many more people infected than the originals (plural: there are several by now), and so can infect 10 to 100 times more from each case, and we see a peak in death rates almost as high as initially (though not as high as winter of 20-21). But many of us noticed the ‘Disconnect’.
That’s what my Infectious Disease specialist called it while I was in hospital in July (not with Covid…that little blessing hit the floor I was on, brought in by some clown who would not divulge his vaccine status, or so the nurses told me…perhaps they were not allowed to say). The ‘Disconnect’ was that the fatality rates in countries where the fall surge had already occurred was NOT the usual 2%. Some were closer to 0.8%.or 1.0%.

7. What was the Disconnect due to? Why had the fatality rate dropped. The UK, Greece the Netherlands. I quickly calculated the deaths and divided them by the cases for previous 28 days. Not an accurate way, but it gave me the idea. Many, well some, of the cases occurring in these countries were in fully vaccinated people. In fact, I created a spread sheet to quickly calculate the ratios and showed, to my satisfaction, that if fully vaccinated did not die, and the unvaccinated died 2% of the time, the data totally fit. That was the Disconnect. Covid vaccine does not stop you from getting Covid, or even spreading it…it stops the virus from killing you.
And that’s kind of important.

Data for United Kingdom from Johns Hopkins. The important pattern ‘The Disconnect’, is the ratio of deaths (white) to cases (red). Vaccinations start at the green line, and the disconnect is the change in the ratio.

8. And that takes us to the final paragraph. What does this chart of Canada say (recent reports from Texas say almost exactly the same thing). It says the vast majority of people are protected by the vaccine…but we always knew that. It says the vast majority of the deaths are in the unvaccinated. We already thought that was the case, but as the population increasingly is fully vaccinated, paradoxically the number of deaths in the fully vaccinated will likely increase at least as a percentage…and until you think about it carefully, it looks like vaccines don’t help. But you have to look at total deaths and hospitalizations. They are going back down now.

The vaccines reduce the number of people who get the illness, and massively reduces the number who get the illness on the interior, inside their physical bodies…not just those superficial areas causing sniffles and sneezes and headache and anosmia. That’s exactly because the interior is where the immune system reigns supreme, and it doesn’t really care about your head cold, it cares about keeping you alive!!!

Thought experiment: Once the enire population is vaccinated, 100% of Covid infections will be in the vaccinated, as will 100% of deaths, and mostly, sadly, in those who cannot get the vaccine, have underlying illness like Colin Powell, that prevents vaccination functionality, or natural immunity for that matter, from working. There is no doubt that the vaccines are preventing serious infection, hospitalization and death.

I think the fully vaccinated transmit the virus for a shorter time, and clearly they get the infection less frequently BUT

The fully vaccinated may get, harbour, and spread the virus while they are totally without symptoms. It just doesn’t let you die!

This is actually the perfect virus. It does not kill its host frequently enough, not like SARS did…I never got to see SARS because it disappeared…SARS killed over ten percent of its hosts. And I do worry that if we reduce the symptoms to nothing, and reduce the deaths to nothing, with the vaccines, we are helping the virus hide.

Covid may drift into the background melange of common colds which every child gets, thus imparting immunity for the future and reducing the over all deaths. There are also possibilities it gets totally fed up and leaves as others have done before.

The worst result is that it mutates into more virulent extinction virus, and we, as homonid sub-species before us, will bight the dust. But it cannot really do that unless it infects more people, and its best target right now are the unvaccinated.

Our best defence against it, against permanent recurring death and suffering, is to get vaccinated, and, sadly, as long as it remains at one case or more per ‘x’ people (for me x is currently 100,000, but that may change) we shall need to practice distancing, wear a mask in unventilated places, probably install air exchangers with Hepa filters,

and get the damn vaccine every year. Maybe every six months, we’ll see. And if background cases pop up to above 1 per 100,000, (I think), wear a mask in public.

But the vaccine works and is not kiling people as others might suggest. There is nothing there, no added illness complication, the virus would not do, de novo, in spades!

The Unfairness of Covid

Delta is Prolific

The Delta variant of Corona virus 19 has some special characteristics. While it is not clear that each individual virus particle is more or less likely to induce illness, and death, it is certainly clear that the Delta variant reproduces faster. These viruses require a safe harbour to reproduce…essentially a living human cell, often in the oro-pharyngeal and tracheostomy’s bronchial tree. The virus itself does not have its own enzymes that guide reproduction, and uses the animal cell (which does have these) to reproduce. As a consequence, the virus is not really thought of as being alive.

But for whatever reason that we may figure out later, Delta produces many more progeny, and thus infects many more cells, and many more people. The mathematics of reproduction allows us to model the growth.

It is not clear yet that the Delta is more virulent…in fact it almost seems not to be, but the epidemiological appearance may be more related to its speed of spread.

Level of Virus Infection

We do not know specific numbers yet, but can talk about viral numbers in qualitative terms. It is not unreasonable to assume that symptoms of infection correlate to numbers of viral particles in the host. The location is almost certainly the oro-pharynx and tracheo-bronchial tree at first. We know that the surface machinery of the Corona virus has a definite preference for receptors on the surface of these cells. Notice, as you think about this, that these cells which line this area of the body are topologically on the ‘outside’ of the body…you can get directly to them without passing through any biological barrier, similar to the entire gastro-intestinal tract.

When you breath in Covid laden air, virus particles stick to the lining, and eventually dig their way into the cells to start the reproductive process (remember, the virus cannot do this one its own…it needs to invade an animal cell).

When the virus replicates, hundreds to thousands of new viruses are produced and spew out of the cell to travel further down the tracheo-bronchial tree, or alternatively further into the interior tissues. It is also during this replication phase that mutations occur, which then die or proliferate depending on their new characteristics.

Once the virus enters host cells, the immune system is activated. Rapid proliferation of immune defences are pretty standard, but the timing and quantity are much greater in someone who has been vaccinated, especially fully vaccinated. From then on it is a race between immune systems and viral proliferation. But notice that if you start with a high initial dose of virus, particularly before the host immune system is triggered, you’re in more trouble.

Notice too, that more viral particles mean more potential spread.

Droplet Transmission vs. Airborn

The usual doctrine upon which medical management is based is that droplet transmission is less infectious than airborne. In hospitals, the patient’s room is often labelled with signs indicating one of the other, which would then require greater or lesser personal protective equipment and procedure. I confess, I was never terribly convinced by differences in transmission, and the distinction may not really make a difference.

Droplets from 50 to 0.1 microns spew forth from everyone, more so during loud speech and singing (like in church). A micron is one millionth of a meter; a millimeter is one thousandth of a meter, or one thousand microns. A human hair is fifty microns in width!

These droplets mostly cannot be seen. Theatre lovers in front rows are aware, or should be, of the droplets coming from thespians on the stage. Each droplet can contain a lot of virus particles. In fact, viruses are measured in nanometers, and there are usually between 20 and 200 of them in a droplet, a little bit smaller than the smallest droplet (100 nanometers).

Transition to Airborne

One 1 micron droplet can evaporate in seconds, but the viral particle can live for hours, and N95 masks, the masks mostly used by front line health care workers, screens out 95% of particles that are 100 nanometers (0.1 microns).

Odorants that give you that wonderful chocolate chip cookie odour while they are baking in the oven, are in the order of Angstroms, each Angstrom being about 0.1 nanometer, and they mostly reach your nose in or outside of droplets. So you can see that free virus in the air is bound to occur after aerosolizing procedures (such as removing tubes from the trachea, or extubation) or simply in dry environments.

Since the droplets can disappear quickly, and leave the virus to hang in the air for hours, I simply cannot see a distinction between droplet and airborne, but we certainly know that airborne infections are typically more infectious. When I suggested the chocolate chip cookie analogy a year ago or more, many people pushed back, suggesting that such transmission should have resulted in even faster spread than we saw. But at that time we did not realize how frequent asymptomatic infection was.

The Ultimate Unfairness of Delta Covid

Notice the lead-in graphic at the top of the page. This represents the model of spread from the known parameters of the Delta variant. The true numbers are unimportant, but the relative consequences of Original (Alpha) vs. Delta should be obvious, even though there is still a lot we don’t know.

Recent reports strongly suggest that the Delta variant requires a higher anti-body titre to get Delta under control.

Imagine this mathematical model of spread of Covid Delta outside the body, and recognize that Delta does this inside the body too. Symptoms (all the way to severe illness) are a reflection of the amount of virus in the body. That amount is inhibited by reducing the initial ‘dose received’ (mask vs no mask, distance which reduces amount received by 1/r^2 so 6m is 36 times lower than 1m, small groups of exposure vs. large groups, single brief exposure vs. repeated long exposure as in health care front line workers), and by improving the ability of the immune system to destroy the virus (fully vaccinated vs no vaccine, healthy immune system vs. immune deficiency diseases, chemo drugs, alcohol).

The balance is critical, and while the body sorts this out, transmission can continue until the body wins.Thus Delta can cause more transmission, even briefly in fully vaccinated people (the body’s immune system still takes a day or two to ramp up to full capacity, a level much higher earlier than it would be in the unvaccinated).

Perhaps the worst aspect of all this is that this fine balance can result in many fully vaccinated people with not enough virus to produce symptoms, but more than enough to spread to others, and even allow mutation. Obviously super spreader events are an added danger to the community when the fully vaccinated attend, think everything is fine, and then unknowingly transmit the infection to their friends and relatives back home. This is probably why Delta spreads so much.

Thoughtful, considerate people have no idea of the part they play! The confusing lesson is that the fully vaccinated still have responsibility to not spread the virus…thus, all people should mask, including the fully vaccinated, especially when the local prevalence is high (hot spots, communities with more than 1 new case a day, super spreader events). The actual number of worrisome cases is as yet unknown. The important concept is that vaccinated people may never know they are spreading the disease, and thus must take care. Certainly until health care personnel come up with numbers tailored to each community, I would be wearing a mask in stores, restaurants, theatres, etc. as long as daily cases in my community are threatening occult of asymptomatic infection.

The unvaccinated gain personal protection (from the mask), while the vaccinated meet their civic responsibilities of not spreading the virus. But there is some reason to think that the occasional infected but asymptomatic fully-vaccinated carrier, attending unmasked at a Delta-dominant super-spreader event, is the most dangerous vector out there! There is no clue he is spreading the disease, and many believe that they cannot transmit the disease if they are vaccinated.

Patterns of Disease

If we consider that density of viral particles relates to symptoms, we should remember that the lining of the tracheo-bronchial tree, technically ‘outside’ the body, is always the very first area to be infected. Symptoms would obviously include cough, coryza, stuffy nose, sore throat, headache due to inflamed lining structure in the sinuses. The invasion in the upper airway regions might even extend to the receptors for smell and taste

Once sufficient virus has accumulated the invasion of tissues goes deeper to the tracheo-bronchial lining, into lymph and blood, lung tissue and down to the alveoli (air sacks), and beyond to heart, liver, kidney…ultimately over-whelming the host.

But the deeper the penetration, the more the immune system is warned.

Asymptomatic Disease

Here, whether due to rapid response of immune system (as in healthy children and young adults), the virus progresses to the lining of the airways, but not enough to result in cough or sore throat. Indeed, the immediate production of immune weapons halts the virus. Symptoms just never have a chance to start, or are so mild as to be ignored. The mucous of the surface of the airway lining is rife with virus, but the circulating immune products kill off the virus successfully. In a fully vaccinated person, this is likely very common. The virus cannot get passed the superficial linings of the airways, and just never causes any trouble.

In an unvaccinated person, it would be rare for the older and sicker groups, but still common among the youngsters, even though the potential for spread to others is still very high.

In a vaccinated person, probably all groups could fight the virus off the deeper levels, leaving only superficial airway lining infection for a couple of days. Deeper, internal structures of the body, serviced so well by vascular circulation, are protected much better by the active immune system, than such shallow or superficial tissues as the lining of the mouth, throat and airways. But even that superficial level of infection can travel out with every breath.

Symptomatic Disease

Unvaccinated

Here, the balance favours some kind of recognizable manifestation, and the race between viral number and symptoms follows the individual course, depending on initial exposure.

Thus, early on, we saw cruise ships, aircraft carriers, nursing homes as primary risks. Some of this represents the initial physical circumstances.

In an open environment, like a park, the density of viral particles from a patient decreases as 1/r^2, where ‘r’ is the distance between you and the patient. Thus the density at 1 meter is 36 times higher than the density at 6 meters. But in a closed room, the density quickly equilibrates and becomes essentially constant throughout the space of the room. Visiting an infected patient in a park is far safer than visiting the patient in his room (even if at the moment in time, he is not there).

Vaccinated

Here there is less chance of symptomatic disease unless the vaccinated person has some underlying illness, or the exposure is excessive. Consider the ER physician, fully vaccinated, using personal protective equipment. She sees ten sick Covid patients in isolation rooms, examines and sets up treatment programs. But since no PPE is 100% effective, the accumulated exposure during the shift could exceed the doctor’s immune abilities.

Similarly, consider the attentive, considerate, vaccinated person, happy in the knowledge that they cannot get the disease (well, 94% of the time, early in the months after full vaccination) and thus cannot spread the disease (well, 94% of the time), but attending a rock concert with 2,000 of his closest and dearest friends, 75% of whom have been vaccinated! Repeated exposure, of long duration to 500 carriers who are not as yet symptomatic, or at least, who don’t think their symptoms are significant, and 1,500 others, several of whom have asymptomatic disease.

The virus is received into their airways, in large dosages over several hours, and before their immune system even knows what is happening, the entire tracheo-bronchila tree is coated inside with virus. They go home, free of symptoms, spreading the virus to everyone they meet, including many unvaccinated loved ones.

In a few days, they start having symptoms they cannot believe is Covid, but eventually test positive…but they are lucky…the vaccine they received is still helpful and in spite of some minor symptoms they recover quickly. Sadly, a young niece they saw the day after the concert was still unvaccinated, and not nearly so lucky.

Though vaccinated, the patient in question desperately wished the virus had taken them instead of the niece.

The Disconnect

Recently talking to an infectious disease expert, I commented on the patterns of sickness and death I was seeing in countries dominated by the Delta virus. They were all going through a fourth wave.

But this time it was different. UK, Netherlands, Greece,…you can look it up if you like…surges of Covid cases. In the previous three waves, the Case Fatality Rate was about 2%. The populations by the time of the fourth wave were about 60 to 70% vaccinated. I saw the huge surge of cases, when you look at the Johns Hopkins database, but oddly, the deaths were not there! Case Fatality Rates as low as 0.17%, knowing that some of these are unvaccinated people, the stark difference is remarkable.

Third wave cases, but far less deaths. That was the effect of the vaccination. But each one of those cases is probably matched by another totally asymptomatic case. Transmission yes, death no. The Disconnect! but ‘transmission yes’ means “wear your damn mask, even though you are vaccinated”. ‘Transmission yes’ means “increased risk of more deadly mutations, more deadly variants, arriving in the future.” Masks reduce transmission AND mutational opportunities.

You may not suffer from your infection, but for God’s sake, don’t let anybody else get it.

[I need to extend my sincere thanks to my cousin’s husband, Barney Gilmore, former Professor of Psychology at University of Toronto, for his editing and contribution to this posting, so especially important to me at this time.]

You Don’t Have to Be a ‘Rocket Scientist’ to Be a Rocket Scientist

I have always felt my education was lacking because I chose the STEM subjects instead of Humanities.

Figure 1. Examine the four memes above, one of music, three of mathematics, and decide what they mean to you.

With an artist father, two brothers and an uncle (before WW II interfered to push him to be a lieutenant-colonel) as lawyers, it was assumed by my lawyer grandfather that I would study ‘Soc and Phil’, as he put it…Sociology and Philosophy…and then study ‘The Law’.

My grandfather was not an easy man. He was opinionated and authoritarian, and while I appeared to be a favorite of his among many grandchildren, he often humiliated  me in public, and disapproved of me, almost as much as I disapproved of him. Having a stubborn streak inherited somewhere, but perhaps mostly because I could not really hear properly from age two years old until surgery at age eight, I had learned to often ignore him, and occasionally openly dispute what he said, berating him for some perceived demand, which I was told by my mother he rather enjoyed.

Even with that he reduced me to tears, and worse still, I had seen him reduce my father to tears, planting very early in my life a deep-seated disrespect of the man. To me, he looked, and acted, like a little Hitler. Living so close to him (a three minute walk through the woods to his home overlooking the Mississauga golf course) I had many chores I was called upon to do. Raking his leaves, shovelling his walk and filling his wood box were boring enough, but my tolerance of this was improved by the grandmother I simply adored. Mimi, we called her, no idea why.

The job for him which I actually enjoyed, was dropping his empty whiskey bottles down the old abandoned well by the long meandering front drive. There is something mysterious to a young lad about the crashing of glass two to three seconds below surface, on the rock floor. 

And two on Sundays! 

Eight a week. Two on Sundays. Every week. Why me? Why some tacitly accepted silence. I was a childhood enabler. I guess it looked strange for mildly decrepit sixty year old man with a tremor to be seen out dropping bottles down a well, but then, there were at least five hundred yards of forest on each side. Anyone of them equally alcoholic I suspect. But then, there was my grandmother, until her passing in 1962, after which I guess my surreptitious visits were no longer necessary. But she must have known.

And my other job, refilling the telltale supply of Listerine mouthwash in his study washroom, from the cache in the basement, a related addiction I only understood later in life. The alcohol fed his habit, and the Listerine hid it: abusiveness of the acerbic courtroom tongue. He never lost a case!

Two conversations with my grandfather stand out. One in which he denied that I was studying calculus in high school, a curriculum change that had occurred only quite recently, but well beyond my grandfather’s awareness. He told me that I was wrong, that I was not studying ‘the calculus’ as he put it. ‘The dreaded calculus’ as Churchill put it. That subject was far too difficult. I think his daughter (yes, my mother) had told him of my love of mathematics, and all things science, but my likes and dislikes were hardly important when it came to my future. No, I should be a lawyer, marinated in the humanities of literature, perhaps Greek and Latin, certainly philosophy, all the subjects that bored me then. No, I wanted to be a rocket scientist. Really, a ‘rocket scientist’ in the quotation bookmarked meaning of the word. I wanted to understand and work in stuff that others could not.

His second conversation which is vivid in my mind was about the issue of racism. I may have been telling him of my contest with Robert Hurst (who was to become a news anchor and subsequently President of CTV) in which we had both decried the deplorable state of American cultural progress (https://drbriandingle.wordpress.com/2016/01/07/euthanasia-and-six-degrees-of-separation/). It was 1964, the beginning of the Civil Rights Movement. In this instance my grandfather questioned my attitudes and determined whether I might indeed marry a Black woman if I chose to. Or whatever euphemism for marry was in his mind. These were tricky questions at age sixteen, and my grandfather in the past had very commonly teased me publicly about seeing me in town with some attractive blonde girl (he never did, of course). But as to a Black girl?

“You would not wish to sully that good Dingle blood.”  Silence, and a malevolent gaze.

I cannot remember what I did, short of telling him that I would marry whom I chose and that such forms of discrimination as he was suggesting were inappropriate. I hope I then left him to his cups, but I just don’t remember. All I remember was the surging knot in my stomach and bile in my mouth, and the stinging tears of frustration in my eyes…and perhaps an enduring commitment to never study ‘Soc and Phil’ and never read ‘The Law’.

And so it is that I have always felt my education limited, inadequate, and incompleted, because I pursued everything but Humanities, and argued, impressively I like to think, that mathematics and physics subsumed the useful bits of the ‘Phil’ when it renamed itself ‘Science’ instead of Natural Philosophy. Music was my parents’ addition, a love-hate relationship which I greatly appreciate now, and which I used to compare to art with my father, much to his amusement and superior understanding. I objected that art was less exciting because music, which, like sex I said, progressed to a climax. Art was right there, all at once. Dad smiled knowingly, but suggested that there was more mystery than I thought. Certainly more than I knew, and he knew I did not know.

So my education was in music (before and during formal education), chemistry, math and physics, pharmacology, experimental design, statistics, medicine and cancer. I did not read Dostoyevsky, Nietzsche, even Freud. I read Hemingway recently, For Whom the Bell Tolls, and didn’t like it. I read War and Peace, which had an interesting page on hypochondria. 

Inadequate and incomplete. My barrister and solicitor family had superior educations, or so I thought, certainly for the drawing rooms, for measuring out lives in coffee spoons.

And yet that image of a post by a friend, depicted above, I can read. After years of piano and bassoon, music theory and harmony, counterpoint, I saw, read, and heard in my mind the haunting South American El Condor Pasa. I could not remember the name of the song, but thought it might be Simon and Garfunkel, and the opening line something like, “I’d rather be a hammer than a nail…”. But I knew for sure as soon as a found a piano, a few days later. The initial experience was almost synesthetic, a learned synesthesia, I suppose.

But to the next meme, the mathematics.

I knew the integral immediately. The curve in the integrand is famous.

Indeed, you all know it. Napier’s discovery of logarithms, with the base ‘e’ equal to the irrational and transcendental number 2.718281828459…, the function of this number raised to the power of a variable ‘x squared’ tells us it is symmetrical around zero…the value at 1 and -1 is the same (since it is squared) equal to about 1/3, slightly more…and the whole function descends rapidly to almost zero (never quite, but asymptotically) because the exponent is negative (the function is a reciprocal…that’s what the minus sign tells you). The value at x=0 is 1. A screwy but justifiable characteristic of exponents (you multiply it by itself ‘no times’, so it is equal to 1). When x=2 (or -2) the function’s value is 1/55.

Can you see the curve? Although it extends with positive ordinate value to infinity, on both sides of the abscissa zero, it looks like a bell. It is the bell curve! The area under that curve (the meaning of this expression as integral calculus) is also a strange transcendental irrational number…the square root of pi.

But you all know this, that 15% of the area under the curve is below the first standard deviation below the mean. In the most common presentation, the distribution of IQ, average is 100, and 15% are below 85, 2% below 70…and 15% are above 115, 2% above 130. 0.1% are above 145.

It is almost magical that the number pi, the ratio of ‘circumference to diameter’ of a circle should be the normalizing factor of the normal probability density. It is almost magical that the Central Limit Theorem in statistics should point so clearly to this function as the probability of the result of counting a limitless number of coin flips. It is almost magical (but as with the others it is not magic) that this function, and this integral, should be ‘transformed’ into parametric tests such as Student T-Tests, and Chi Square, and ANOVA, and Cox Regression analysis. This Bell curve has become the source of so much advancement in scientific discovery, in life survival analysis in medicine, in the basic arguments of all of science…and in much of its controversy by its implications.

But the beauty of the calculus to solve this integral (the first equation, but second meme of the four memes above in figure 1.) is outlined here by a trick. A trick frequently used in physics and mathematics. Square the integral, converting an infinite line to an infinite plane, then the infinite cartesian plane to an infinite polar coordinate plane. Then complete the easy integration in polar coordinates after another simple change of variables, and out pops pi.

Well, the square root of pi, really, since we multiplied the integral by itself at the beginning. How neat is that?

The second mathematical formula in figure 1. is more identifiable as the infinite Fourier series, which engineers will know as an aid to solving tricky complicated functions, because by clever choice of coefficients, this monstrous thing can be used to estimate and reproduce just about any function or curve you can imagine. Since the trigonometric references within the expression can be easily integrated (added up numerically to within whatever error limit you like), the impossible equations can be estimated accurately often without even subjecting them to “grinding out” the calculation with a computer.

And when you introduce imaginary numbers, like ‘i’, whose square equals -1, soon you can see the relation between the first equation and the second. Certainly once you recognize that the second equation above (in figure 1.) is essentially the same as this one that follows below (called Eq. 5), thereby introducing an interesting use and meaning of the imaginary number ‘i’ as it relates to trigonometric functions.

It is the third equation in figure 1. which is probably recognizable to everyone, the solution to the quadratic equation. With luck you may remember that a real solution only occurs when the discriminant (that bit inside the square root sign) is greater than zero because you cannot take square root of a negative number. No number multiplied by itself is negative. Well, no Real number anyway. But imaginary ones are. ‘You can’t make a silk purse out of a sow’s ear…unless you start with a silk sow,’ nor can you get a negative from a square, unless you start with imaginary numbers.

A nice simple quadratic equation, which almost always has two answers, not one, unless that bit in the square root is zero. Then you get two answers alright, but they are both the same. Go figure. And sometimes those answers can be negative when they should not be, as when Dirac noticed a negative energy solution to his quantum equation which I think stimulated him to think of a positron (the anti-particle of the electron).

None of this is in the Humanities, in The Law, in ‘Soc and Phil’. None of it is rocket science (that would be elliptical and parabolic functions, with conservation of momentum and general relativity), nor even ‘rocket science’ (as in an estimate of the intellectual capacity of the participant, the rocket scientist). None of this is particularly difficult when compared to Socrates or Aristotle, or to Heigel or Sartre…it is just different, and thus often neglected by teachers and students alike. There are difficult parts, needless to say, but as funny as these equations look, they are not difficult…they are just Greek to those uninitiated. Or French, even. French is not TOO difficult. Neither are these equations.

There are too few of us, too many of them. I think somehow our schools, and our parents, and our traditions (like ‘Soc and Phil’), are signalling to our students that this is stuff they cannot read. We teach them English. We teach them French as well in this country. I can still read French to a large extent, but most students can learn it. When we teach them music, they can hear it as they read. When we teach them Spanish, they can hear it as they read. 

When we teach them mathematics, they can see the curves. When we teach them physics, they can see the fields of energy, the lines of force. When we teach them chemistry, they can see the molecular bonds.

Music and mathematics are just other languages. While I agree with the point of my friend’s post above, that schools should teach music as well as mathematics, why stop there? I have been known to rant about our political leaders all being lawyers, all with the same recipe: ‘Soc and Phil and Law’.

If the anti-science Trump administration of the last four years has taught us anything, it is that we need all the disciplines. For those others of us who swim in statistics and medicine and mathematical modelling and physics, those other languages they don’t teach in the Humanities, our opposition to anti-science, anti-vaxxer needs more voices in political leadership, lest we again get politicians who do not understand the need for lockdowns, and for masks, and for vaccines, and for public health. We need more people in leadership who can read the images above. We need people to whom statistics is as familiar as the Bible, or ‘To Kill a Mocking Bird’, or as ‘The Republic’. We need leaders whose PhD in Economics actually does certify that they know what ‘independence’ or ‘independent variable’, in probability theory, really means, rather than absurdly claiming that wide changes in voting numbers are statistically impossible.

They, our leaders, don’t need to be rocket scientists (who study the launching of rockets) nor ‘rocket scientists’ if by that you mean goofy nerds who understand the impossible. But this stuff above is not impossible…it’s about as difficult as ‘Soc and Phil and Law’. The vast majority of politicians just never get exposed to it, because we don’t teach this stuff in school, because too many people think it is impossible. It’s not. It is just a different language. Like French, or Law.

We should teach music in school. We should teach science in school. We should teach history and philosophy and literature and art and languages and logic and medicine in school. And the dreaded calculus. And if you want to teach mystical and magical thinking in school, go for it, because all the rest will simply blot that nonsense out.

The Truth About Covid Mortality

Although tedious, numerical integration between early March and the end of November gives a number for excess mortality this year compared to the average of the previous five. Below is the data, graph form, for USA, (but the site also provides the numbers). [from ourworldindata.org...go there, look for excess mortality and check out other countries was well]. 

The total is 385,000 EXCESS deaths, roughly 191,000 in the first wave, 194,000 in the second (admittedly lower in peak, but more prolonged) and still increasing.

Notice the deaths per week in previous years, all showing the same pattern, with only minor increases most likely related to general population growth. COVID is really the only major factor in this.

Barring some other catastrophe, for which there is no evidence (war, famine, pestilence, other pandemic) this EXCESS mortality is due to Covid. This is not simply due to people dying of cancer but labelled Covid…this is excess. It may reflect other diseases which could not be treated because of Covid overwhelming health care. It is possible a reduction in deaths in future years could suggest lead time bias, but the distance into the future represents lost time for those who died regardless.

Nor is there evidence that suicides have increased to cause all this.

Some people are mislead by the fact that average life expectancy has not changed; this is due to the small numbers comparatively, and the fact that the 78 year old who dies of Covid, even in a population that enjoys an average life span of 78 (when predicting for birth)…that same person statistically, on average, would have died at 85. They already made it to 78!!

Compare this data, for example, to the silly superficial thinking in Conrad Black’s piece from October 23, 2020:
https://nationalpost.com/…/conrad-black-coronavirus…

“But in Canada, we have been sluggishly and doggedly attached to a shutdown policy based on infection rates, even though our fatality rate has been comparatively good”.

No Conrad. Excess deaths in Canada are 10,230 (to the end of August, just the first wave really) by similar numerical integration techniques. About 1/40th that of USA, perhaps 1/4 on a per capita basis, or 1/2 if you just compare first waves (we are just entering our second).

Canada is doing better because of our lockdown policies, inspite of our disadvantage of weather. What we do NOT have is the despicably poor modelling by the American leadership, largely the Republican one that Conrad favours. We must cooperate with our experts, Conrad, even you, as brilliant as you are, because science matters.

Many other countries are doing MUCH better than we did, with stricter lockdown rules, better contact testing and tracing, better use of technology which admittedly invades privacy to a degree. Science rules here, and science denial, such as expressions of frustration by those like Conrad, whose grasp of science is rudimentary, and yet still has a bullhorn, only contributes to deaths of Canadians.

If you do not go to your experts for expert advice, where do you go to get YOUR expert advice??? 

Corona Virus: Size Matters. So Does Distance

Viral particles as seen under an Electron Microscope. Each Corona virus particle is 125 nanometers in diameter.

CORONA VIRUS: SIZE DOES MATTER

 

I decided to teach my grandchildren about orders of magnitude. Most of us ignore THAT which we cannot see, and some believe that what we cannot see is not really there. And yet those things we cannot see can do us great harm, as everybody surely knows by now.

 

I decided to stick with metric, because it is a lot easier. A meter is a little more than the average stride. 1.8 meters is about 5 foot 10 and is just above an average height for a male adult human.

 

Once we have a good feel for this, we use prefixes to expand these names. We all know what size a kilometer is roughly, but of course it is exactly 1,000 meters. Similarly, a millimeter is exactly 1/1,000 of a meter (or, put another way, 1,000 millimeters make a meter). These prefixes expand out in both directions, so that kilo-, mega-, giga- , and tera-, become a thousand, a million,  a billion, and some number I don’t know, respectively.

 

Scientists make this more concise by writing 10 with a superscript number like 10⁶ for a million. (The 6 here is called the exponent, or the power, or the number of zeros). Kilo- is 1 with 3 zeros, mega- is 1 with 6 zeros, giga- is 1 with 9 zeros, and tera-, as in 1 tera-byte of memory, is a 1 with 12 zeros! In 1969 when I first programed computers as part of my summer job in High Energy Physics at the University of Toronto, I used an IBM 360/365 computer, and I had to set delimiters for my volume of memory from 8 to 16 kilobytes. You can go into just about any computer accessories store now, and buy some storage device for one terabyte of memory, essentially 1,000,000,000 times the amount of memory I could eek out of that old IBM, a computer that consumed a lot of Convocation Hall at University of Toronto (about the size of a house).

 

Again, similarly, the meter can be further subdivided to milli-, micro-, nano- and pico-. This gets tricky, because we are now dividing by tens instead of multiplying and writing this out like the fraction representing milli-, micro-, nano-, and pico-, gets very cumbersome. Scientists just use the exponent of ten again, but now with a negative number to show we are dividing by that many, not multiplying. A millimeter is 10^-3 meters. A micro-meter thus becomes 10^-6. One one millionth of a meter, or 1/1,000,000 of a meter. Have I lost you? This is pretty small. It is smaller than can be seen by the naked eye, and its other common name is the micron. But to give you an idea, the width of a human hair is often 50 microns or fifty micro-meters. Remember, 20 human hairs side by side, is 1 millimeter wide, because one milli-meter is 1,000 micro-meters. (Well, trust me. 20 x 50 = 1,000). Microns are neat…some cells are 10 microns in size, but they have this magnitude in all three dimensions. We cannot see them.

 

But can we really see that small, as small as 50 microns, the width of a human hair? Well, you see hair. And if you pull one out and look at it, you see a single human hair, usually, especially with your glasses on. Try it. It hurts a bit, but it is worth it. Can we really see 50 microns? In truth, our limit is probably mostly above 100 microns, or 0.1 millimeter. The reason we can see the human hair is because it has length as well as width (and depth), and the length is well within our ability to see…just not the width (or depth). Amazing, eh? Can you see a thread of a spider’s web? Yup. And yet it is only about 7 microns or 0.007 millimeters wide. But the length could be several centimeters. This gives you a glimpse of human perception, a whole other, but important topic.

 

The usual smallest division on a ruler in System International, is the millimeter, about the size of an ‘i’ and a little bit smaller than an ‘m’. 1,000 microns.

 

In fact, if you cut 50 microns off the end of the hair, so now the piece is a tube, 50 microns in both diameters and fifty microns long, you probably will not see it at all (I welcome you to try, but you will need a very sharp knife, a powerful magnifying glass and a strong light source). Take it from me, you cannot see it! Weird.

 

A closely related issue, but complicated by trigonometry and geography, as well as atmospheric interference and pollution, is how big an object you can see at a distance. This turns out to be about 0.3 meter (a little more than a foot) at a distance of one kilometer (a little less than 2/3 of a mile). Take it from me, that is like looking at 300 microns from as close as you can get your eye to the page and still be able to focus.

 

So, fifty microns is quite small, right at or just below your limit of your sight. And what you see depends on all three dimensions, not just one or two.

 

How big is Corona virus? Well, it’s about 125 nanometers, equivalent to 0.125 micro-meters, or microns. One micron is 1,000 nanometers. The smallest we can maybe see is 50,000 nanometers (or 50,000,000 pico-meters…save that for later), but that was the width of a human hair, and we really only see that because it has length. 400 corona viruses lying side to side would be about the width of a human hair.

 

But if masks can stop airborne (naked, no water droplet around them, and this requires high quality N95 masks really) corona virus, won’t that stop oxygen? Nope.

 

Oxygen (made up of two oxygen atoms), molecular oxygen, not the atom, is about 150 pico-meters.  (I told you to save that). The pico-meter is 1/1,000 of a nanometer, so a thousand oxygen molecules can line up beside a corona virus and be about the same size (125,000/150 = 833 actually, but close). Masks do not block oxygen or carbon dioxide, in either direction, in or out, but they certainly can block corona virus. And corona virus is most often contained in 50-micron droplets or larger, which lots of face coverings and even those silly plexiglass plates in front of the cashier, can catch.

 

So, wear a mask! (Psst, even behind those plexiglass shields, wear a mask, especially if you are at risk.)

 

DISTANCE DOES MATTER

 

Why does distance help prevent Covid?

 

I think the first answer really should be, “It doesn’t.” If you are in the room of a patient, or patients, spewing corona virus with every breath, every spoken word, every cough, every song, it doesn’t take long to fill the room. Sure, big droplets will slowly sink to the floor. If the air is humid, and the droplets get bigger, they fall faster, but that would be like a sauna where water was dripping off every piece of metal in the place. Mostly, especially during winter, the air is dry, and the droplets which may start as 50 micron (0.050 millimeter) bundles of water, well, they shrink incredibly quickly by evaporation to 1 micron, or 0.1 micron (remember, the width of a thread of a spider’s web, which you can see,  is 5 microns), well, these droplets are so light they will float in the air currents and follow the breeze wherever it goes.

 

But let’s say you are outside, in quiet, still air, no enclosure to your space…say it is dusk and nothing is moving. The sun is down and no longer beating down on surfaces, heating them up and changing all the air currents. Someone with you, maybe one of those 40% who have Covid and spread it unknowingly, never ever getting symptoms but spreading the illness like Typhoid Mary…say they cough. The puff of air, the head of steam if you will, spreads out like ripples from a stone thrown into the water, but in all dimensions, not just the surface. This is like a bubble, like the light from a candle, like the sound waves from a speaker. The intensity reduces quickly with distance. The question is, how quickly?

 

With many physical phenomena, like light, the reduction is related to the inverse square law. Scientists often speak of some substance like this as flux. If you start with stuff at the centre, and it travels out to one meter, you figure it had spread equally over the imaginary surface like a bubble, a sphere. The area of that surface is related to the distance, ‘r’,  from the original centre by a proportion related to the radius ‘r’ squared. Well the density of the virus distributed across that sphere proportional to something divided by that area, so is proportional to 1/4πr². You can ignore the constant terms, and just think of the amount coming your way at distance r to be proportional to 1/r².

 

Take it from me, you probably learned, and actively forgot, this formula for the surface area of a sphere. The important issue is that the amount of stuff that started at the centre decreases with every meter your move from the origin. So, whatever you have at one meter, is reduced by one quarter at two meters, and one ninth at three meters, one sixteenth at four meters, and so it goes forever.

 

If you cough in someone’s face at a one foot distance, the amount of virus at two feet is one quarter what it was at one foot.

 

In fact, it may be even less than that, because the virus doesn’t all keep going. Some of it stops, bumping into other particles in the air, and so the inverse square law may deviate towards the inverse cube law, closer to 1/r³.  The stuff at one meter becomes 1/8 at 2 meters, and 1/27 at three meters.

 

If this makes no sense, don’t worry. Just understand that the amount of virus spewing your way goes down quickly with distance, but never goes to zero.

 

But that is really only out in the open, or maybe in a large department store where ventilation is forcing air up and out. Nevertheless, distance reduces the amount of virus that hits you, and that is important.

 

Also, the droplets that are heavy, and carry some momentum, travel in a straight line. These are the 50 micron droplets or greater. Full of corona virus, they splat onto the plexiglass plate, or the mask, or the goggles, and end up being cleaned up later. The droplets that are smaller, or the naked virus which is only 125 nano-meters (remember, 1 one thousandth of a micron, 1 billionth  of a meter!), these all travel with the flow of air, and do not have enough momentum to bump into walls and corners when the air flow turns around. They continue with the middle of the stream, because they are not heavy enough to break away and travel in a straight line.

 

Let’s pause here and think. If the 50 micron droplets go splat on the barrier between you and the cashier, what happens to the 1 micron droplets and less. Think about sitting in the backseat of a car and going around a corner. Say you are sitting beside a person you really do not want anything to do with. There is effort you have to produce to prevent leaning into that person. The 50 micron droplet has the same problem. If it hits the wall, it gets stuck. If it goes with the flow, it escapes to carry on.

 

We know that fifty-micron droplets are big enough, have enough mass (weight?) that they get smeared on the walls of any channel that turns a corner. The ten-micron droplets are not big enough to travel a straight line always. But they often get stuck in the throat instead of travelling all the way to the lungs, because that’s where the major corner in the airway is. The 0.1-micron droplets, and of course the naked virus, have no trouble at all traveling with the flow. This is possibly the distinction scientists make between ‘droplet transmission’ and ‘airborne’. Go with the flow. So droplets of corona virus get reduced as they travel, but never to zero…unless the cashier is totally enclosed in the plexiglass. And they never are, are they? In fact, when you talk to the cashier, don’t you lean around the plexiglass so your voice carries far enough that she can hear you, or you her?.

 

So, why do I think the smaller droplets do not hit the plexiglass but actually take a circuitous route? Because other well-known physical substances do exactly that. Here I often call upon the chocolate chip cookie analogy. If the cashier were baking chocolate chip cookies back there beside her cash register, could you smell them? How about someone in a living room striking a sulphur tipped match to light a cigarette, can you smell that? That is the big difference between droplet transmission and airborne. Small odorants, lit matches, cigarettes, and baking chocolate chip cookies have odours that permeate space and are like gaseous substances (gaseous substances are those which expand to fill their containers…this, to me, has always been consistent with the definition of a teenager!!).

 

The analogy is a little unfair, because some of the cookie odor, and definitely other odorants, can get to us through molecules probably even smaller than corona virus. But baking cookies does it better than cookies that have cooled down, I suspect because of water droplets, carrying the odorants, are originally produced by steam, from the heat of baking. And steam is like an aerosol, or tiny water droplets. Sure, odorants are smaller than corona virus, but small water droplets, 0.1 microns, are bigger…and that is what most often carries the wonderful smell of chocolate chip cookies, or perfume and other odorants…well they are pretty damn small. They travel with the airflow, not along the usual straight line. And the nice, smiling, coughing cashier is really not all that far away even behind a plexiglass plate, is she?

Barriers, like plexiglass, add to the distance the virus has to travel, as well as reducing the amounts that actually get to you if they hit a barrier. So, reduction, yes, but never eradication. All of these efforts are to reduce the risk, but none ever removes the risk. Sure looks to me as if the cashier should be wearing a mask as well as standing behind the plexiglass shield.

 

 

NUMBER DOES MATTER? DOESN’T IT?

 

I think so, but I cannot find proof.

 

The number of virus particles that one needs to be exposed to, to induce disease, is not clear. It is a probabilities game, really. One virus probably will not do it. It is far too easy for that virus to end up in the wrong place. We simply do not know if it takes three, or one hundred, or one million virus particles to cause symptomatic infection. We do know that a lot of people get the infection but never have symptoms. These people are still contagious.

 

The virus has to grow in people (occasionally animals). It cannot grow in the air or on a surface because it needs the chemicals of a human cell (or some animal cell). And we know it grows best in the back of the throat and in the lungs.

 

But could it be that people who get a small amount of virus initially are less likely to get symptoms? Could it be that the race between the body’s defenses (the immune system) and the total numbers of the virus (which depends on initial exposure) determines the symptoms in the end? It makes sense. Massive exposure versus minimal exposure. There seems to be evidence of this with other infectious diseases.

 

Children have more rapid defense mechanisms, and children tend to get symptoms from exposure far more rarely…but children can still pass it on to others. Suppose you are standing ten feet away from someone with the disease, instead of six feet. Suppose that is enough of a change in initial exposure to cause you to have fewer overall symptoms, to make the difference between someone who suffers and dies with the disease, and someone who merely gets the sniffles, or someone who remains without any symptoms and just passes it all on to someone else.

 

We simply do not know the answers yet, and it is very complicated anyway. But we do know that the more distance you keep from someone with Covid, the less likely you can get it and pass it on. And the more times you protect yourself by wearing a mask, the less likely you are to become part of the problem. This is the dynamic cycle Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), talks about. You can break that cycle by wearing a mask and keeping your distance.

 

Since 40% of patients with the infection do not realize it, there is no way we can know. You can get a rough idea from the numbers in your community. If your town is a hot spot, the risks are higher. If your town has not had a case in three weeks, your risks are lower.

 

So, wear a mask, and keep your distance from everybody who is not in your pod. Wear a mask if you can see the whites of their eyes. Keep a distance so you cannot see the whites of their eyes. Wear a mask even behind the plexiglass. It is your responsibility, to yourself, to your community, to break this cycle of Covid.

 

Pestilence: Corona Virus RULES

Exodus 9:13-15

 

‘Thus says the Lord God of the Hebrews: “Let My people go, that they may serve Me, for at this time I will send all My plagues to your very heart, and on your servants and on your people, that you may know that there is none like Me in all the earth. Now if I had stretched out My hand and struck you and your people with pestilence, then you would have been cut off from the earth.

 

Background

 

There have been many plagues over the earth. Our interaction with bacteria and viruses is extensive; a significant weight of our bodies is due to the bacteria we contain, our cells ‘breath’ and burn oxygen for energy because eons ago, during our evolution, they incorporated microbes which became mitochondria. We suffer from diseases associated with a lack of bacteria…an imbalance really…such as the old ‘pseudo-membranous enterocolitis’, now understood as clostridium difficile.

Plagues, like the Bubonic, lead to architecture and music and Passion Plays, or punished us for our wars (the Spanish Flu, which Trump refers to as the 1917 flu, though everyone else calls it the 1918 flu, and did not begin in Spain anyway). Some

Electron micrograph of poliovirus, infamous for its predilection for childhood paralysis.

plagues came to warn us, like SARS (severe acute respiratory syndrome…which turns out comparatively not to be as severe as the one it was warning us about). Some came to taunt and torture us, by maiming our children, and inducing hardships for great human beings to overcome.

 

And some came as weapons, like the smallpox laden blankets given to aboriginals as part of our ancestral goal of genocide.

 

 

 

 

Caveat

I am no longer a licensed physician, though I retain an Emeritus status with our judicial college. I was never and infectious disease expert. I did, however, work on the front line of hospitals protecting against SARS, and I was an administrator involved in pandemic planning for a Canadian city. I was an Oncologist (not certified…that occurred after I entered practice), a Haematologist, and an Internist.

 

Covid-19

Corona viruses have been around quite a while, have most often caused a ‘common cold’ type of illness until the acute respiratory form came along in 2002. It killed chickens in the 1930s, and the genes were investigated in the 1970s by pathologist Dr. James Robb, whose short bio below appeared on the internet, along with his advice:

“Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.”

His advice included ‘no hand-shaking’, gloves, masks, hand sanitizers and social distancing, and a bunch of other important stuff I first collected and passed on to our children on February 29th. At that time I had concluded this virus would infect the entire world, with a growth which would be largely exponential in the idealized assumption, but Gompertzian in reality, because the upper limit to which the

Gompertzian curve.

curve asymptotically approaches is the total population. In truth, we know that not everyone will be infected…herd immunity is likely to quell the spread and slow it down to about 40 to 60% of the world.

But with a fatality rate 10 to 20 times that of Influenza, that is small comfort.

 

 

Lessons From Wuhan

These viruses typically have some animal reservoir, with Middle Eastern Respiratory Syndrome being largely in camels…not too many of those in New York City. Open markets with live animals first were suggested, but a certain variety of bat now seems to be the vector. Not that different from Influenza where ducks and other water fowl have been incriminated in the past.

What was truly surprising, though, was the high death rate in people over 65 years of age, and the almost non-existence of the disease in children. This distinguished the disease from Influenza which characteristically affected a bimodal distribution of young and old.

And a significant male::female disparity in China, and other areas…was this related to cigarettes smoking in countries where women have not yet achieved that degree of equality.

The stories of illness lasting a few days, sometimes even with some improvement, followed by abrupt deterioration, and occasionally sudden cardiac death, not just respiratory.

 

Emerging Symptoms

 

Many viruses cause unusual neurologic symptoms, and rare cardiac symptoms; corona virus, Covid in particular, is no exception, but with vastly larger numbers of patients (3.6 million as I write) small numbers of unusual presentations abound: coma, seizures, loss of taste and smell, cardiac arrhythmia, and the usual plethora of symptoms like many ‘flu’-type illnesses. But the worrisome, and somewhat unusual symptom is shortness fo breath which appears to affect oxygen levels far more than the symptoms actually suggest. It sneaks up on people, and oximetry levels typically showing 60% levels of hemoglobin saturation (this is not like a math test…acceptable is 93-96%) while the patient still ‘looks’ relatively well.

 

Fatality

 

Of the corona virus families, MERS is the worst, with 30% mortality, but fewer total cases. SARS is closer to 10%. Covid-19 has a variable level of mortality from almost none in children, 2 to 3% in young adults, but rapidly increasing between 50 and 80 to 10 to 15% in the elderly.

With Influenza, the virus is more contagious or similar, but less mortal (about 1 in a thousand).

 

 

The True Denominator

 

Many patients may have mild or asymptomatic infection, like a flu-like illness, or  no symptoms at all.. And where screening of population have been done in conjunction with outbreaks of large numbers, suggesting 30 to 60% infection and infectious patients who never have symptoms. Some have used models which suggest far larger numbers which would suggest a much lower fatality rate. What stands out is the relationship we see between high density populations that lead to frequent repeated exposures in the early few days of initial infection: cruise ships, nursing homes, aircraft carriers, high density housing. What may also be important is the infectious dose…the number of viral particles needed to cause infection, and the number required to cause fatal disease.

 

How to Protect Yourself

I don’t know. I can only guess. But there is much conflicting and (government) self-serving information on the ‘Net.’ Sometimes I worry that organizations proclaim ideas they have heard elsewhere, which have little or no basis in experimental evidence. After all, you really cannot conduct trials where one person enters a Covid positive patient’s room without appropriate PPE, and another enters with PPE…such an experiment would be clearly unethical. So we have to extrapolate. Somebody says something, and all of sudden it is gospel.

So I don’t believe some of it because I don’t think it makes sense.

 

Chocolate Chip Cookies

When I made speeches about cigarette smoking in public, I would refer to the sulphur tipped matches used as a solution to bathroom smells. Unpleasant topic, unpleasant imagery, but a typical solution. Some GI distress can be made partially more acceptable by lighting a sulphur tipped match in the bathroom nobody wants to admit they recently used. Whatever.

The point is, it takes only a few seconds for the sulfurous odor to travel throughout any room in which it is lit. This is airborne transmission, and the sulphur particles have to enter the mucosa in your nose, travel to capillaries, be absorbed into the bloodstream locally, and then trace the very short distance to scent receptors. By the time you smell it, it is in your blood. Literally. Much more pleasant to think of this as chocolate chip cookies…sort of…

It’s fast, and so is airborne transmission. Measles, tuberculosis and some influenza is airborne. But the distinction may not have much of a difference. Contagion may be equally fast, or almost as fast, with droplet transmission. The true difference is really in how long the virus can ‘live’ (if alive it is) in air as naked virus, and how long as virus coated in liquid droplet.

Because Covid is spewed out in breath in multiple droplet form, it is ‘droplet’ transmission. But some estimates have ‘airborne’ types of transmission due to aerosolizations, tiny droplet or naked virus due to intubation procedures in the airways (due to sticking tubes into the throat for ventilation), or perhaps simply because the droplets evaporate pretty quickly in the air when they are so small…maybe 80% of transmission is droplet, 20% airborne. This makes a difference of which mask stops them.

 

What do we know?

Droplets from 50 to 0.1 microns spew forth from everyone, more so during loud speech and singing (like in church). A micron is one millionth of a meter; a millimeter is one thousandth of a meter, or one thousand microns. A human hair is fifty microns in width!

These droplets mostly cannot be seen. Theatre lovers in front rows are aware, or should be, of the droplets coming from thespians on the stage. Each droplet can contain a lot of virus particles. In fact, viruses are measured in nanometers, and are usually between 20 and 200 of them, a little bit smaller than the smallest droplet (100 nanometers).

One 1 micron droplet can evaporate in seconds, but the viral particle can live for hours, and N95 masks, the masks mostly used by front line health care workers, screens out 95% of particles that are 100 nanometers (0.1 microns).

Odorants that give you that wonderful chocolate chip cookie odor, they are in the order of Angstroms, each Angstrom being about 0.1 nanometer, and they mostly reach your nose in or outside of droplets. So you can see that free virus in the air is bound to occur after aerosolizing procedures (such as removing tubes from the trachea, or extubation) or simply in dry environments.

So they can get airborne, last in the air for several hours, and fail to fall to the floor in droplet form, particularly in dry (low humidity) environments. And find their way through an N95 mask, albeit with more difficulty than a surgical or cloth mask.

 

Infectious Dose

It is well established in infectious disease, that the amount of virus or bacteria to which the patient is exposed is critical in developing active overt infection. This makes obvious sense. Often, it is believed, one viral particle is not enough to cause infection. It probably could be…no real reason why it could not…but likely it is a matter of probabilities. One hundred or one thousand, or even one million viral particles may not be enough. But could be enough.

Exponential growth rules. Basic differential calculus (you wondered why you studied it?) concludes that whenever the growth rate of a population is proportional to the amount present, the solution to that differential equation is an exponential function. Exponential growth.

And you can see how that ‘rate’ of growth increases with the amount of virus. Twice the virus means twice the growth. So suppose the virus doubles inside your oro-pharynx (throat and back of nose) which is where it likes.

1 becomes 2 becomes 4 becomes 8 … becomes 1024 after ten doublings. Go ahead, add it up. It does. Now if, say, you need a million viral particles, and each doubling takes half a day, you need five days for ten doublings to get to 1024, and another five days or ten doublings to get to about a million, and then another five to get to a billion (1,000,000,000).

What this means is, simplistically (nothing is ever this simple) is that if you start with one virus particle, it is five days to get to a thousand. But if you start with a million particles, it takes five days to get to a billion.

Symptomatic Disease

I don’t know what the real numbers are, but let’s pretend that it takes one billion particles of virus to be symptomatic (sore throat, sniffles, aches and pains, pneumonia and worse as the numbers grow). Let’s suppose further it takes a thousand to get you infected at all. So for about ten days, from one thousand to one billion, you have no symptoms, until growth reaches one billion. Five days later still, the growth gets to one trillion (1,000,000,000,000).

What slows it down? Your immunity does. It often takes several days to develop for the first time, less so thereafter.

So it becomes a race between the speed of growth and the speed of your immune system. And the larger your ‘initial dose’ is, the sooner the symptoms start, and the more likely your symptoms will be significant…or even overwhelming. Now, I don’t know what the critical infectious dose is, in terms of real numbers, but you can see that the initial exposure might affect the severity of disease, and by extension, the death rate.

 

Balance Between Exposure Dose and Speed of Immunity

If your immune ‘speed’ is very fast, or the infection growth is very slow (or starts from a low number), you can see that symptoms might be totally avoided; on the other hand, in the reverse,  devastatingly severe. No matter how you look at it, if the balance of immunity to growth favors the virus, you’re in trouble.

Does unfavorable balance in viral growth and immune response dictate the severity of disease? Does this balance fit patterns you might expect?

What Supports Immune Development (Speed)

Youth probably does, especially if this virus is brand new to us all. If adults have never been exposed to this virus before (a ‘novel’ virus), then speed of immune development might be solely dictated by the underlying health of the individual. Age slows this immune development down, as does underlying chronic illness, and presence of immune suppressants like anti-inflammatory drugs or steroids.

In fact, it suddenly becomes easy to understand why children don’t manifest symptoms of disease. Their infection may be brought screeching to a halt by the rapid development of immunity compared to the amount of initial exposure.

What Supports Growth of the Numbers of Total Virus

The amount of initial exposure would seem to have a definite effect on the total number of virus particles achieved before things are brought to a stop, as does the speed of immune response. The virus, we know, prefers the airways to multiply in, and has to invade a human being in order to start to multiply. During the asymptomatic phase, and after, the virus may be spread to others. The distance the virus travels to get to the patient, and the size of the droplets containing the virus will dictate how long the virus hangs in the air to be inhaled by a patient. Humidity seems likely to cause the droplets to fall to the ground before they get inhaled, but the virus can still live without the the droplet dampness for several hours to days. Agitation can kick the virus up off a surface and start some infection.

In General, What Protects You

Some of this is my reasoned speculation, because questions either have not been answered, or cannot even be asked. I remind you again, I am no longer a physician, and I never was a microbiologist.

Disenfectants

60 to 70% alcohol, ammonia compounds, bleach, detergents like routine soap, all help to destroy the outer coating of the virus. Time helps. Freezing DOES NOT HELP…the virus can live for a couple of years frozen. You clean surfaces and wash with these substances. YOU DO NOT DRINK IT. YOU ALSO SHOULD NOT DRINK ALCOHOL, NOT TO EXCESS! You cannot get blood levels of alcohol high enough without dying of alcohol poisoning and respiratory depression, and you cannot get lung levels of alcohol high enough without drowning.

Barriers

Skin is a good barrier, but mucosa in mouth, eyes, and other tender areas probably does not offer as good protection. Oddly, the virus does not seem to enter the body through cuts and abrasions, and I would guess stomach acids are protective (of people with stomach acid…remember, if you take antacid drugs like H2 blockers and proton pump inhibitors your stomach may not deactivate the virus well).

Masks which cut out 95% of 0.1 micron (100 nanometer) virus droplets help reduce the amount getting through, like N95 or N99 masks. Surgical masks probably do something close to 60% of the job, and cloth more like 40% but who really knows. The study looking at projection of droplets from an open mouth during speaking in the New England Journal of Medicine showed that droplets in the range of 50 microns were largely stopped by a wet washcloth, but I suspect a lot of virus is in droplets that study would not have seen.

Distance

In our three dimensional world, many physical phenomena rely on the inverse square rule. The intensity of light spreading out from a central source reduces as the division by (inverse of) the square of the distance. Say the amount of energy produced by the source is measured at one foot from the source at a unit A per square inch, then the amount at two feet will be 1/4 that per square inch, and the amount at 3 feet will be 1/9.** A similar distribution should be experienced to some extent with a source of virus, at least until mixing of air within the room (assuming it is an enclosed space) results in general uniform concentration everywhere.

[** Some of you particularly clever mathy types may realize the distribution could be closer to an inverse cube law, because not all the virus particles travel the full distance; many are left behind en route, and the bus arrives at its destination without the full starting complement of virus particles. Respective densities of viral particles may therefore be down to 1/16, or 1/27. Indeed, this may be why organizations like governments and CDC, WHO suggest six feet***, because after six feet, the numbers are too low for symptomatic disease. You get the drift (excusing the pun)]

[***Some of you quantum mechanical types will also observe that viruses are particles, not waves; they are discrete or digital, not continuous or analog. The virulence of virus does not follow some Boltzman energy partition distribution. You do not have probabilities of viruses forever as you get away from the source. The virus does not pop in and out of existence like some cat in a box. This is just subversive.]

Virus has been detected twelve feet from a patient, and any surface in the room of an active patient is suspect. Six feet is not enough from infected or unknown patients. But six feet may be just enough to cause asymptomatic infection for a while, instead of initially overt disease. And in a room occupied by someone with Covid, the virus could well be everywhere.

Why We Really Have No Idea

Suppose someone with active Covid infection stands in the middle of a store, aisle three, say, and coughs. Suppose some virus is aerosolized and becomes airborne, and floats for three hours, descending, if at all, ever so slowly to the floor below. Perhaps a burst of air, maybe from the door the shedding patient is leaving by, pushes the sailing virus over to aisle four, or it settles on some boxes or packages. Within minutes the shedding patient has left the  building, but not the virus.

Suppose an innocent un-infected, unprotected person walks through that unseen cloud, breaths in the air, and virus lodges in the back of his or her throat. That’s Monday. From Monday to Friday, the virus grows, is released by this new patient everywhere they go, and no symptoms show up until Friday.

How do they know where this new case was exposed to the virus? They don’t. Six feet of social distancing may be deemed enough, because nobody identifies cases like this. Since nobody identifies this transmission, the six foot rule seems nice.

Suppose now, on Saturday, this patient ends up in the Emergency Department with ten other Covid positive patients, and all ten are seen by one health care worker in full protective armor: gown, mask, faceplate, gloves, hair net, even booties. Suppose tiny groups of airborne virus make their way through the N95 mask (maybe only 50 of the 1,000 virus particles in a cough…5%) or the spaces around the eyes where the mask fits less securely, or with some stray breach in infection technique. But suppose this small amount occurs with five of the ten patients in a repeated form of initial exposure.

Or worse yet, suppose it is any of a small few totally unsuspecting people the patient has interacted with repeatedly, such as friend, co-worker, wife, husband child.

The race between the virus and the immune system is engaged, and the result hangs in the balance.

 

Light, UV Radiation

Apparently this kills the virus, probably by disruption of the lipid coat. I really don’t know.

Humidity

Prevents evaporation, causing less airborne virus and creating droplets which are heavy enough to overcome air friction and drop to the floor.

Brain Power

You have to think about your clean surfaces, your barrier protection, the order of touching things. Protecting yourself takes thought, and just as alcohol leads to poor decision making it also leads to breach of your personal hygiene care. Stay sober.

Avoid Symptomatic People

Stay as far away as you reasonably can, and take measures to reduce initial and subsequent repeated exposure. If they live with you, try to isolate them from you within the confines of your living space and wear masks and gloves and goggles in their presence.

Avoid Asymptomatic People

Many studies have shown that lots of people get the virus, and probably mount an immune response sufficient to get rid of it even before it causes symptoms you can recognize as an infection. Since you don’t know who these people are, then the ‘enemy is us’. Avoid everybody.

Reduce Repeated Exposure

The commonalities between cruise ships, nursing homes, air craft carriers, Emergency Departments, high density populations suggest that repeated exposure of small amounts in the phase before immunity develops may cause more critical disease or more frequent disease. This idea also suggests it would be wise reduce contact even with those with whom you live, and to wear best mask possible in their presence (WHEN THEY HAVE THE DISEASE).

 

What Do I Do?

1. Wipe down commonly touched areas with disinfectant: 60+% alcohol, Lysol, bleach, but be careful and know your surfaces. Shellac furniture will be ruined by alcohol, fabrics by bleach, some glass materials like mirrors so test first. Daily or more frequently
2. Wear the best mask you can get (N95>surgical>4 ply cloth>scarf or bandana) but since I believe ‘initial dose’ or frequently repeated dose adding up to a critical early exposure effects severity of illness, I don’t believe the public proclamations which state masks are unnecessary. Whenever someone is close enough to be recognized I wear one, based on the idea it cannot hurt and might at least reduce volume or frequency of exposure. There is just no sufficient evidence compelling a decision either way, so best to be safe. [This advice differs from major organizations, such as MoHLTC and CDC. I just think their ideas are wrong, perhaps influenced by concerns of  resource shortages, and I think that they have no realistic way of knowing that masks provide NO PROTECTION at all. Even if they provide some protection, I think it is worth it, especially for the vulnerable. I do not use materials that health care personnel could use. Re-use the mask as long as you have not soiled or damaged it, but always wash/sanitize your hands before and after handling it. If you can get new ones for each use, without compromising health care access, do so, but otherwise you may have to rely on time (a few days) between use and rotate the masks to give sufficient time to kill the virus (sadly, no guarantees). You only need three of four, a compromise for being unable to obtain a new mask for each use (not as good, better better than nothing).
3. Wear goggles/glasses and gloves too (if you might touch things, as when shopping). Learn how to remove all this stuff without re-infecting yourself. Your eye surfaces are connected to your airways.
4. Wash external layers clothes after returning from shopping.
5. Carry hand sanitizer in one pocket and wet wipes (Lysol) in the other. You can use a ziplock bag if your clothes are better quality than mine (but that is not a high bar), but I don’t bother.
6. Use a finger wrapped in a wet wipe to scratch your face while wearing the mask.
7. Use gloves when getting gas…cleaning those surfaces is not easy.
8. Wash outside packaging of merchandise with Lysol wipes.
9. Don’t forget common surface cleaning like the inside of your car: steering wheel, ignition etc.
10. Self-isolate when or if you change locations such as municipalities.
11. Use hot water for washing machine, dishwasher.
12. Try to achieve ideal weight while you wait for the infection.
13. Self-isolate with your family or partner.
14. Do everything on the internet.
15. Do not go to crowded places or participate in any group activities
16. Protect the vulnerable: elderly, sick, those who cannot be vaccinated because of illness, when a vaccine becomes available, those with repeated exposures like first responders and health care workers.
17. Do not hug or shake hands with people you don’t live with until this is over.
18. To all the anti-vaxers: GET THE BLOODY VACCINE, WHEN IT ARRIVES (and it will). The time for silly arguments about autism and cancer and fibromyalgia are over; this is serious. Your civic duty is to protect all who dwell about you. You have missed the chance to save millions of influenza patients because of your ignorant ideas, give it up with this one. Swallow your baseless beliefs and get the bloody vaccine!
19. Remember what I said about speculation. Much of what is above is gleaned from the Net without good solid science proving it, mostly because we simply cannot know everything. But the drugs that physicians offer, and the vaccines that they use will have the science behind it when it comes. And many of these behaviors can be eased or stopped when our knowledge and control improves.
20. Rejoice when we win, because we will, due to logic, hard work, kindness and human ingenuity.

 

What Rules? Corona Virus does.

And the title? Yes, the word ‘Rules’ in the title is intentionally a super-position of two quantum states, that of both a ‘noun’ and a ‘verb’ at the same time, until you misinterpret it as one of those two, and that state then collapses.

 

 

 

 

Coronavirus

From first 41 patients in China, SORE THROAT seems NOT to be present, and sneezing and runny nose are not mention. Other symptoms are typical of Coronavirus.

 

I am moving this up to my blog quickly without refining it much. Covid is 20x as fatal as Influenza, much more contagious, spreading far faster. Doubling every six days, this could be all over the world in four months. We need to spread cases out, delay as long as we can. With limited information, I think these suggestions are helpful.

 

Covid-19

Details:

• Can be spread by pets (very weak data)
• Fatality seems to be 1% or less for young healthy adults, almost no obvious cases so far in children (?!?!) who may well carry it and spread it without much more than a cold
• Fatality increases with age, up 1-3% per decade after 50 so that 80+ may be 10% or moreChina may be curtailing it, but too early to tell; but they are authoritarian, and have no difficulty telling people to stay home. They are actually doing a good job reducing interactions. Iran, on the other hand, is dismal, and one Canadian got his Covid-19 in Egypt!I see two possibilities:

1. We curtail it,

 

2. Everybody gets it. (mathematical modelling suggests 40 to 70%, then low level endemic thereafter)

 

 

The longer we delay acquiring Covid, the closer we are to a) medications b) vaccines being developed c) spreading out the use of medical high tech. If 2% of Canadians died next week, we wouldn’t have enough health care personnel.

What are we doing?

• Two weeks of food (frozen, or canned) stored.
• Cancelled all elective meetings, parties, doctor’s appointments until further notice
• Personal distancing, 1 meter+ (no hugging, shaking hands, etc….especially etc.). Bow instead…that’s why some took karate classes
• Sterilizing surfaces commonly touched (door knobs, cell phones, counters, computer keyboards) routinely
• Hand washing, soap and HOT water, >60% alcohol base lotions, 70% isopropyl alcohol
• Alcohol-based hand lotions are very effective as long as no visible debris on hands (then use soap and water first)
• Change to hottest or steam function on dishwashers, laundry
• Covid is not here yet, we don’t think, but we are starting this as practice for when it does

 

Tips

• Alcohol hand rubs are sold out, but 70% isopropyl alcohol works, is less irritating, and comes in handy spray bottles. Don’t use it on your whole body…no point (it’s a silly myth…didn’t know if you had heard).
• Tell your clients, friends, to stay away if they have any symptoms!
• Don’t use a mask, unless you are a health care worker getting close to a patient (if you have a cold you shouldn’t be there, if they have a cold THEY shouldn’t be there)
• We are using Lysol or Clorox (although not sure about porous surfaces and efficacy against Covid-19) wipes for surface cleaning, but above-mentioned rubbing alcohol works too, may be better. Just test the surface first to ensure no damage.

I carry a spray bottle, emptied and filled with rubbing alcohol, in my pocket, for hand use after any risk contact, and a wet Lysol wipe in my coat pocket to use on a counter

 

 

World Health Organization

Data on Current Cover-19

(copy and paste or type…the link does not always work out of Word)

 

This is not just to protect you, or us for that matter. The more we slow this down, the better we do medically and economically. In a very real sense, this is all civic duty.
Note, most novel viruses like Covid-19 are as yet untested for Lysol and Clorox, but historically work with less virulent Corona viruses

 

Here is something off the internet which seems to be (most likely is) from James Robb, a virologist with a history of research into Corona Virus:

 

Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.

The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:

1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
 5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What I have stocked in preparation for the pandemic spread to the US:

1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.

Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average – everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you – it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep you from touching your nose or mouth.

3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.

4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

 I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us! Jim

James Robb, MD FCAP

I believe the bit about Zinc is open to question,  but notice he advises it mostly as a local action on the back of the throat. Thus pills will probably not be effective, unless chewed and sucked (?stain teeth???) or crushed and suspended in water.

 

Truth about Zinc and James Robb attribution

I also do not endorse any particular product. I am merely quoting here what I believe Dr. Robb wrote. I personally believe that Zinc, if used at all, should probably be used as a gargling agent to be then swallowed eventually, and that the best would be Zinc bound to  an anionic agent (citrate, gluconate for example) that is best tolerated by the individual and most easily dissolved for use in gargling. I have no knowledge at all with respect to that issue (retail Pharmacists might). Other elements present may also affect tolerability (some forms of magnesium appear to give me headaches for example, and other things may be contraindicated because of allergy or kidney problems).