It's been a few years since this blog has had a post, and for a couple of reasons. First, the concerns that have been expressed here about the behavior of the government have become so mainstream there's been less point in authoring posts on them here. Second, the investments that have occupied the author's interest haven't been publicly-traded assets but things like single-family homes and small retail centers, where generalized conversation isn't useful because it's not specific enough to be actionable and highly-specific conversation isn't useful because it involves assets that aren't available to parties other than those involved in the transactions.
But a neighbor of mine recently said she didn't understand why everyone should be so exercised about COVID-19 risk when H1N1 was worse. To get an idea what COVID-19 has done in this country since winter ended, one can look at the Centers for Disease Control and Prevention's page on the illness. As of this writing, the novel coronavirus has killed over 168,000 Americans. It's worth noting that it's currently August, and the flu season hasn't begun. By contrast, the CDC's page on the H1N1 pandemic presents full-year data from the H1N1 impact on the United States. From April of 2009 through April of 2010, the CDC's best estimate of deaths caused by the pandemic is 12,469 individuals. We're not yet one year in, and the death toll from COVID-19 is already over an order of magnitude worse than entire H1N1 pandemic.
Why's COVID-19 worse? First, it's more contagious. Contagiousness is often measured using the illness' spread in a population with no immunity, with R0 ("r-naught") representing the average number of infectees to whom one host will transmit the illness during its life cycle in the host. For H1N1, R0 is thought to lie in the range of 1.46 and 1.48. COVID-19's R0 is estimated to lie between 1.5 and 3.5. Two significant facts are worth keeping in mind. First, when R0 is less than one the infected population dwindles rather than grows: the illness dies out because infected carriers don't on average infect enough people to maintain a stable patient population. Second, R0 isn't a static figure: it can be manipulated with mitigation efforts. When Austria's government observed low spread rates in some Asian countries and mandated face masks, its infection rate dropped 90%. Apparently anyone can kill local spread by reducing the spread of airborne exhaled particles, which can be accomplished with face masks. Cheap.
The second factor differentiating the current coronavirus from the H1N1 "Swine Flu" pandemic of 2009 is severity. The published data on H1N1 are that the United States had 60.8 million cases of H1N1, 274,304 H1N1 hospitalizations, and 12,469 H1N1 fatalities. This means that an H1N1 case had a 0.45% chance of hospitalization and that 4.5% of those hospitalized died, with deaths amounting to 0.02% of total estimated cases. So far in the United States the CDC reports 5,340,232 total cases and 168,696 deaths, for a case fatality rate of 3.2%, which means a confirmed case of COVID-19 is more likely to kill a patient than a confirmed case of H1N1 was likely to put a patient in the hospital.
Naturally, these facts left me wondering what could possibly have left my neighbor thinking the current pandemic was a relative non-event, less disruptive on its own than an H1N1 season that closed no restaurants and halted no flights. The answer isn't hard to fathom: politics. Rather than base public health policy on data, quite a few elected officials have taken positions based on the positions of other politicians. Accordingly, some politicians have proclaimed that the current economic problems have been created by government restrictions rather than by the necessity of responding to an illness.
Sigh.
The article about Austria is dated in April, people. April. You can read, right? And now that you understand R0, you know how to stop the pandemic. You're better informed than officials who rushed to crowd people unmasked in bars, and can take action.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
Sunday, August 16, 2020
Friday, September 4, 2009
Student Bus Hijacking Resolved Bloodlessly
Disarmed by a fit football player, a fourteen-year-old girl was taken into custody without apparent injury to anyone after she drew a .380 semi-automatic to threaten bus-riding students whom she accused of teasing and bullying her. Video is available.
Bullying and teasing are both cruel, and also often overlooked or discounted. Some observe it's ironic that its victims are more likely to be caught retaliating than initial aggressors are for their instigating behavior (about which, The Onion has a take). Obviously, wielding firearms on a school bus is neither ideal nor likely to achieve effective bullying reduction: for would-be vigilantes there is worse bullying in incarcerated populations, and for those facing "justice" the message is surely lost behind the medium. However, it's possible that sober adults should exercise a bit of responsibility rather than abdicate solutions to the imaginations of outraged teens whose self-worth lays in ruins due to years of steady abuse.
Bullying and its sequelae are not a uniquely American problem. It likely derives from fundamental dynamics of social organizations, as it has analogs in other species that live in social groups, such as baboons. Fighting bullying is likely akin to creating an ideal government: it works against the instincts of many who would be subject to the rules but prefer to avoid their application. It's a problem that requires real study and not simply armchair quarterbacking by self-proclaimed experts. Imagine the improvement in the quality of life -- and worldview -- of future generations if we get a handle on bullying among youth.
Bullying and teasing are both cruel, and also often overlooked or discounted. Some observe it's ironic that its victims are more likely to be caught retaliating than initial aggressors are for their instigating behavior (about which, The Onion has a take). Obviously, wielding firearms on a school bus is neither ideal nor likely to achieve effective bullying reduction: for would-be vigilantes there is worse bullying in incarcerated populations, and for those facing "justice" the message is surely lost behind the medium. However, it's possible that sober adults should exercise a bit of responsibility rather than abdicate solutions to the imaginations of outraged teens whose self-worth lays in ruins due to years of steady abuse.
Bullying and its sequelae are not a uniquely American problem. It likely derives from fundamental dynamics of social organizations, as it has analogs in other species that live in social groups, such as baboons. Fighting bullying is likely akin to creating an ideal government: it works against the instincts of many who would be subject to the rules but prefer to avoid their application. It's a problem that requires real study and not simply armchair quarterbacking by self-proclaimed experts. Imagine the improvement in the quality of life -- and worldview -- of future generations if we get a handle on bullying among youth.
Thursday, July 16, 2009
Kidney Worth Maybe $1600 In Pakistan
If selling your spouse or children is a bit much for you, there's another option: your kidney.
Although outlawed in 2007, the sale of human kidneys to would-be recipients is apparently not hard to arrange, and doesn't net sellers much for their risks: $1100-$1600.
It'd be interesting to see long-term data on the population's health, to ascertain whether the ban had an impact, and if so, good or ill.
Although outlawed in 2007, the sale of human kidneys to would-be recipients is apparently not hard to arrange, and doesn't net sellers much for their risks: $1100-$1600.
It'd be interesting to see long-term data on the population's health, to ascertain whether the ban had an impact, and if so, good or ill.
Thursday, August 14, 2008
Fighting to Bleed: Medical Comment Fetches Comments
M.D.O.D. is an entertaining blog providing important education on valuable medical terms of art, and happens to include an emergency medicine doc's top-ten-style rant on why he's leaving emergency medicine. I commented in response to reason #5, which featured a misprioritizing supervisor's misdirected disciplinary behavior, inspired not by observed wrongdoing on the part of the victim but by the supervisor's own fear of personal consequences for shoddy work. My comment got a few of its own comments, and I thought I'd repost the comment here:
It's amazing what people will do to jeopardize care when they are afraid of liability. Folks think liability is a big problem in the U.S., and I'm willing to hear a case made about it, but I was surprised as can be to discover it was lethally dangerous in Honduras.
I traveled with a volunteer surgical team to perform operations on an impoverished and underserved community in the middle of noplace. While there, we had a patient whose kidney wasn't possible to save. There wasn't an ill part that could be removed; the whole thing was scar tissue, and it had grown in size several times and encroached upon and melded with numerous other structures in the area.
Including the ascending vena cava.
Needless to say, the operation ran long, and was bloodier than hoped. I kept an eye on the patient's face, and she was getting scarily pale.
The hospital didn't have a blood bank.
We went around the room trying to ascertain whether we had among us any plausible donors -- without the ability to test for pathogens, we didn't dare recruit locals -- and it turned out that as an O+, I was the only person in the room whose blood would not kill the B+ patient.
This is where the liability got crazy. The physician with the contract to attend the hospital -- a local Honduranian -- instructed the lab tech not to give me a blood bag. Without the blood bag, my mission to donate a unit of blood was in jeopardy.
After a while arguing -- they claimed the risk involved in not-exactly-type-matched blood was dangerous, and I explained that since they weren't planning to test for minor antigens anyway, it didn't matter, and that without the transfusion she was certainly going to die, which made the theoretical risk she might die due to a fatal mismatch among minor antigens a fairly good bet by comparison.
About this time they decided they didn't speak English any more. So I let into them with my broken Spanish. And, let me tell you, my Spanish was pretty broken. The upshot was that their behavior would kill the patient, and that whatever I was proposing, therefore, had only the possibility of helping.
However, it was more important to the physician contracted to the hospital that he keep his job by avoiding the appearance of having contributed to killing the patient. If the patient died under an American knife, he was blameless. If he allowed a donation using his blood bag and the donation's complications were implicated in the immediate cause of her death, then he could face trouble, and he feared for his position.
And they weren't offering any known clean B+.
Eventually, the tech took a blood bag out of a drawer, placed it on the table behind her counter without giving it to me, and took a break. I understood it was my responsibility to steal the blood bag without permission.
Then I donated into the blood bag, carried it to the OR, and passed out while I watched it given.
Turns out dehydration and blood donation don't mix.
My take-home lesson came in several parts. One, drink lots of fluids in the hot dry mountains of Honduras in the summer. Two, the U.S. isn't the only place folks do silly things for fear of liability. Three, the local nurses will make fun of you in Spanish if you are seen passing out, and they will make jokes about whether the patient will be doomed to pass out after getting your weak-assed gringo blood. But three is OK: they know you kept her alive long enough for the next three donors to get back from a supplies run in the next town, and that without you the poor girl would have died and her husband would have been left alone, so the nurses are smiling at you as they giggle when you pass.
I've worked a bit in the medical field (broadly defined; my activity at times involved psych patients, at times involved pharmaceutical research, and at times involved transplant tissue collection). I presently regard myself as an interested observer but a nonparticipant. That is, I try to stay well enough that I don't need to risk myself near physicians or hospitals, which as everyone knows are strongly associated with sickness and death.
It's amazing what people will do to jeopardize care when they are afraid of liability. Folks think liability is a big problem in the U.S., and I'm willing to hear a case made about it, but I was surprised as can be to discover it was lethally dangerous in Honduras.
I traveled with a volunteer surgical team to perform operations on an impoverished and underserved community in the middle of noplace. While there, we had a patient whose kidney wasn't possible to save. There wasn't an ill part that could be removed; the whole thing was scar tissue, and it had grown in size several times and encroached upon and melded with numerous other structures in the area.
Including the ascending vena cava.
Needless to say, the operation ran long, and was bloodier than hoped. I kept an eye on the patient's face, and she was getting scarily pale.
The hospital didn't have a blood bank.
We went around the room trying to ascertain whether we had among us any plausible donors -- without the ability to test for pathogens, we didn't dare recruit locals -- and it turned out that as an O+, I was the only person in the room whose blood would not kill the B+ patient.
This is where the liability got crazy. The physician with the contract to attend the hospital -- a local Honduranian -- instructed the lab tech not to give me a blood bag. Without the blood bag, my mission to donate a unit of blood was in jeopardy.
After a while arguing -- they claimed the risk involved in not-exactly-type-matched blood was dangerous, and I explained that since they weren't planning to test for minor antigens anyway, it didn't matter, and that without the transfusion she was certainly going to die, which made the theoretical risk she might die due to a fatal mismatch among minor antigens a fairly good bet by comparison.
About this time they decided they didn't speak English any more. So I let into them with my broken Spanish. And, let me tell you, my Spanish was pretty broken. The upshot was that their behavior would kill the patient, and that whatever I was proposing, therefore, had only the possibility of helping.
However, it was more important to the physician contracted to the hospital that he keep his job by avoiding the appearance of having contributed to killing the patient. If the patient died under an American knife, he was blameless. If he allowed a donation using his blood bag and the donation's complications were implicated in the immediate cause of her death, then he could face trouble, and he feared for his position.
And they weren't offering any known clean B+.
Eventually, the tech took a blood bag out of a drawer, placed it on the table behind her counter without giving it to me, and took a break. I understood it was my responsibility to steal the blood bag without permission.
Then I donated into the blood bag, carried it to the OR, and passed out while I watched it given.
Turns out dehydration and blood donation don't mix.
My take-home lesson came in several parts. One, drink lots of fluids in the hot dry mountains of Honduras in the summer. Two, the U.S. isn't the only place folks do silly things for fear of liability. Three, the local nurses will make fun of you in Spanish if you are seen passing out, and they will make jokes about whether the patient will be doomed to pass out after getting your weak-assed gringo blood. But three is OK: they know you kept her alive long enough for the next three donors to get back from a supplies run in the next town, and that without you the poor girl would have died and her husband would have been left alone, so the nurses are smiling at you as they giggle when you pass.
I've worked a bit in the medical field (broadly defined; my activity at times involved psych patients, at times involved pharmaceutical research, and at times involved transplant tissue collection). I presently regard myself as an interested observer but a nonparticipant. That is, I try to stay well enough that I don't need to risk myself near physicians or hospitals, which as everyone knows are strongly associated with sickness and death.
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