paranoia


In a comment below Thomascordatus asked me what I think about this video recorded by microbiologist Sucharit Bhakdi.

My first reaction is that as the former head of the Institute of Medical Microbiology and Hygiene, Prof. Bhakdi must know about what he is talking. According to Aelianus, that is the German in me. On the other hand, as a sort of scientist myself, I know that even renowned professors have been known to tell utter nonsense about a topic related to their field. Here are my thoughts:

It is true that we cannot know the true mortality rate, because we do not reliably know the number that is infected (which leads to overestimates, because those seriously ill are far more likely both to be tested and to die). It is also true that the mere presence of a virus infection in a person who then dies does not prove that they died FROM that virus. As is the case with influenza, it seems we will only be able to estimate Covid-19-related deaths after the epidemic is over, namely through ‘excess mortality’, i.e. deaths beyond the background mortality.

These arguments, however, do not explain away the fact that a number of regions experience a surge of severe respiratory illness that requires ICU care, to such an unprecedented extent that hospitals in these regions (first Hubai, later Lombardy, the northeast of France, Madrid) are utterly swamped . There must be some reason for this, and if a large number of these patients tests positive for SARS-CoV-2, this seems to indicate some causality.

So we have an easily spread virus (easily spread particularly since (still) asymptomatic patients can transmit it) in a population with little if any immunity against it. I have not yet heard any experts who claim that it will not infect the majority of people (although I stand to be corrected). Even if the proportion of infected people requiring ICU treatment is much smaller than current infection number suggest: As long as the virus spreads exponentially (which it appears to do, and what you’d expect it to do), the number of these cases should also increase exponentially. In Italy, currently 0.1% of the population have been tested positive for SARS-CoV-2. Even if this underestimates the actual infections by a factor of 100, there would still only be a 10% infection rate and rapid growth of infections as well as severe cases should still be expected. Incidentally, according to this, while 22.7% of Italian tests were positive as of 20th March, this was true only for 3.9% of tests in Germany (15th March) or 5.3% of tests in the UK (20th March). In all cases, tests were restricted to probable cases (symptoms and/or close contact to infected person), so the proportion in the general population should be far lower.

For me, it is the very real risk of overwhelming the health care system that makes it sensible to slow down the spread of SARS-CoV-2 at this point. A Spanish report of 22nd March looks at the age distribution of confirmed SARS-CoV-2 infections, of deaths among these, and of treatment in the ICU. Of the infected, 62% were younger than 60; of the deaths, only 3.3%. However, 32% of the ICU patients were younger than 60, and the majority of these, apparently, did not die. In fact, hardly any of the over 80-year-olds, who made up two thirds of the fatalities, had been treated in the ICU at all. This indicates to me that having sufficient ICU capacity for all severe cases will save lives, and that especially among younger people, among whom it is far more likely that any acute severe respiratory illness is actually caused by SARS-CoV-2 and who would not ‘have died anyway from something else’.

Related to this, I have not found out where Prof. Bhakdi gets his number of 99.5% of infections of whom he says that they may be ‘infected’, but they are ‘not ill’. The only numbers I found are from a WHO report based on data from 55924 confirmed infections up to 20th February. Of these, 80% were ‘mild to moderate’ – which, however, does include pneumonia, unless it requires hospitalization. A proportion of 88% had a fever, about two thirds a dry cough. This may not be dangerous, but I still would not say that they are not ‘not ill’. The same report speaks of 13.8% of ‘severe’ cases, which means ‘dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation ≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours’, and 6.1%  ‘critical cases’, namely ‘respiratory failure, septic shock, and/or multiple organ dysfunction/failure’.

It is open to debate which measures will buy us the needed time to spread out the cases requiring ventilation, to increase production of needed materials and, if possible, intensive care capacity, without causing more harm socially, economically and regarding other health conditions. I just think ‘this is all utterly unnecessary’ is not correct.

 

Continuation of yesterday’s post:

3. Just to take one of the examples from the talk: energy. Of course gas is in many, many respects much better than coal or oil, even including fracking. Nevertheless, it does not solve the problem of limited fossil energy source that will run out at some point in the future (some point that may come before end of times – and we are explicitly told not to base our decisions on calculating when this is most likely to occur). This aspect was somehow left out of the talk.

Or: Fewer people die in connection with energy production from nuclear energy than with that from coal. How much might that have to do with the fact that nuclear power is a high-end technology mostly used by rich countries, using qualified workers and because of its very danger potential run with tight security measures, while coal mining often uses cheap and easily displaceable labour that makes enhanced security uneconomical?

China-coalmine-accidents_1-6-2014_133128_l

4.  Which leads to economic interest: The video points out that environmental exaggeration may prolong and increase poverty. This is true. But on the other hand, there are many, many cases where the few may make a lot of money by exploiting natural resource, and the bill is paid by the many (in term of lack or bad quality of drinking water, or respirational diseases due to industrial smog, or part of the beauty of creation destroyed by the extinction of species, etc.)

Now the few who profit from irresponsible behaviour have the money to try and influence public opinion in their favour (had it in the past, at least, and are, after what seems to me to have been a lull, increasingly successfully employing it in that direction again). Anyone seeing this, and rightfully resenting it, may have my excuse to quite some extent for playing the knight in shining armour for those who cannot, on their own, defend themselves. (They should not lie, of course, no true knight would, but they may well honestly be swept by their enthusiasm for the good cause into some imprudence).

Ever thought about WWF like that?

Ever thought about WWF like that?

5. Finally, there is an aspect about risks that did not feature very much in the talk either.

Who of our readers does have some sort of insurance? I do. It does seem highly improbable that I will ever do anything that will make my indemnity insurance worthwhile. However, if I ever should accidently burn somebody’s house down, or similar, it would utterly ruin my life financially. The yearly equivalent of some six or eight (secondhand)  trivial novels seems a small price to pay against that risk.

In regard to this marvel, material creation, the maximum sum that might be to pay if we in some way significantly damage it might be rather large. I do not think it likely I will ever burn down someone’s house. For many of the things discussed under the category of ‘environmental scare’, I have no clue how much more or less likely it is for us, mankind, to drop that fateful smouldering match. It seems  to err on the side of caution in regards to the one earth that has been given to us, on which God Himself has trod, would not be an entirely impious thing.

No exaggeration ;-) (But wouldn't it be a shame?)

No exaggeration 😉
(But wouldn’t it be a shame?)

A while [read: ages] ago, Aelianus sent me a link to this video, asking for my comments:

These are the messages another blogger derived from it:

  • MSG is not unhealthy
  • Nuclear Power is the safest method of energy production there is
  • Fracking is not as bad as the media/NGOs would have us believe
  • Gas is efficient
  • NGOs market just as much as Industries

Of course, I felt flattered by this question and would, ideally, have written a pithy, succinct summary of the results of my profound meditation on the subject.

Reality intervening, I will give you my random thoughts in two posts.

1. Just to clear the air: yes, I DO think that ‘environmentalists’ exaggerate with the aim of advancing their agenda. This may be caused by ignorance, ideology, or strategy, and, in any case, is annoying.

And let us just disregard, in what follows, most of the environmental scares linked to health. Exaggerated concerns about one’s health by far pre-date any environmentalism, at least in the classes that had the leisure for it because they were not starving or regularly dying of illnesses caused by poverty. Nearly everything can kill you, depending on circumstances. If you want to avoid all possibly health-damaging stuff, life will probably not be worth living anyway. ‘You’ll just die healthy’, as my family says.

Come on, I grew up eating school meals from ALUMINIUM cutlery.
Come on, I grew up eating school meals from ALUMINIUM cutlery.

2. I guess Aelianus asked me for my opinion because I was one of the scientists amongst his friends. I would like to stress that the label ‘scientist’ does not go very far in qualifying me for judging the statements made in this talk. In fact, in nearly every case of ‘environmental-concern- against-the-rest-of-the-world’, the issue has been very – complex. No easy yes-and-no, conflicting experimental evidence, many things depending on circumstances, the whole an optimization process depending on many inputs.

You cannot have it all, snobby philosophists/theologists – this is a hazy area where we only know stuff by percentage of probability, and not absolutely. You cannot have your cake and eat it: while in your field, absolute certainty is possible, in OUR field, certainty should be proportional to actual knowledge of the field.

alpha_beta_error

THIS is what we are dealing with. (And yes, it is bad enought to split infinitives over.)

For this reason, opinions can be swayed so easily from either side. In most cases, proponents of both sides do not tell direct lies, but present a one-sided choice of known facts, blow things out of proportion, or jump upon the one new scientific study that appears to support their claim. In judging what is really more or less likely to be the truth, you have to actually have to have very, very good factual knowledge. [Which is one of the reasons why I detest all arguments about evolution.]

To cut a long story short: I try to be extremely careful about my opinions on any of these environmental topics when they do not fall into my field of expertise.

… to be kontinewed, ehem, continewed, tomorrow.

Forty-five hours ago I set foot, for the first time of my life, on Chinese soil (or, for that matter, on non-European soil at all).  I would have written a brilliant and detailed essays on my reflection, indeed, I had written a witty and thoughtful piece of some 2000 words – which was eaten by wordpress. I a steaming with vexation. Nevertheless, a helpless and impatient second attempt; just jutting down my thoughts as they come (and no guarantee for spelling / grammar / language given).

1. Forty-five hours. Already I miss bread. Never would I have thought that I am one of those people who within a day pine for simple, plain European food. Or in fact, for simple, plain rice. Rice and noodles seem to be so much the staple food here, that at a really good dinner, you are given enough more expensive stuff to gorge yourself so that it would be lowering the tone to offer something as simple as rice. Today’s dinner, as yesterday’s dinner and lunch, were eaten at big round tables with a revolving glass plate in the middle. At the beginning of the meal, this plate contains eight (or nine, I forget) starters. One by one, eight (or nine, whatever) main courses are added. You turn the plate (taking care no-one just has their chopsticks in anything to serve themselves) and choose what you like. This enables you to avoid chicken feed, accusingly-looking crabs, thousand-years-eggs, pig’s ears, turtle and other not easily identifiable stuff without too much offence. In general, anything I had was very well cooked, but still there were some – surprises – as to taste and texture that made me rather careful the second day. I would not have thought how demoralising the uncertainty into what culinary experience one’s next choice of dish will plunge one can become after a while. This morning, at any rate, I already made a straight bee-line towards a lowly side table, ignoring all the tables with (probably) mouth-watering Chinese dishes, right, to find some sourt of buns, butter, little cream cakes, coffee and milk. I am never too adventurous before coffee, I have to say. Give me your steamed taro, if you must, but not for breakfast.

2. So far, we have spent most of our time in the hotel. It is a curious mixture of probably being one of the grandest hotels I have stayed at, with seemingly at least twice the staff one would expect, and yet sporting, spread over the building, non-flushing / non-locking / raining (probably some water damage somewhere) toilets. The rooms are furnished very tastefully, even if the elegance is somewhat faded. I could give balls in mine (but the very high-up window looks out on some service roof).

3. Jet-lag must be a myth. What knocked me down yesterday was a night with only four hours of fitful and uncomfortable sleep. In the ensuing haze in which I spent the day, my body could not have cared less what time it ‘actually’ was and took darkness outside and the completion of the third square meal that day as sufficient indicators that it was now night, even though it might ‘really’ be only 4 pm. It likewise slept like a stone and was no more reluctant to get up in the morning at 7.30 pa than it would have been had it not ‘in fact’ been 1.30 am.  I guess having an utterly random night-and-day rhythm even when one is not joining the jet set sufficiently confuses one’s body clock after a while to send it off with a frustrated ‘whatever’ whenever anything irregular happens.

4. The spaciousness of my room feels all the more decadent as flats are probably none too large around here. There are many pretty newly built large houses, some of which, however already have a somewhat lived-in look. Nearly all have outside drying facilities for washing, be the place for these ever so improbable. For all that, what we have seen looks all pretty European. One is nearly glad (in a way) to get the occasional glimpse in a curvy, narrow side street, or into a tiny shop stuffed with a seemingly haphazard collection of goods and apparently the family’s dinner table behind the last shelf. In the ‘picturesquely Chinese’ category there were also bamboo building scaffolding, tiny little food stalls, and transport bicycles laden with ridiculously large piles of cartons.

5. Though large roads have bicycle lanes that would put European cities to the blush – they are some four or five meters wide and entirely separate from the road, packed with both bicycles and motor cycles – roads in general are full of cars and mini busses. When we drove in one, I voluntarily fastened my seat belt. It is hard to perceive if ‘red’ means ‘go’ and ‘green’ ‘stop’, or the other way round. The people with whom I travel, being scientists, tried the empirical approach, but data were to conflicting to allow any conclusions. These colours nevertheless seem to have some significance, as next to each traffic light there is a countdown showing the seconds up to the next change of colours. Not many people seem to pay attention. Instead, blowing one’s horn appears to be the main way of negotiating; there are even ‘don’t hoot here’ signs.

6. Though Aelianus would say that, as a non-British, this is my natural state anywhere, I feel very much that I am a foreigner here. Never have I felt so obviously and so foreign a foreigner. It is not only the language – I have, at least, by myself, identified the signs for ‘fire’, ‘door’ and ‘China/Chinese’. I also fear with every step that I am doing something wrong. Come to that, I probably do. Ever heard that in some Asian countries exchanging cards is an important part of good manners in business settings? So did I, only I just remembered when I was offered one for the first time, and, for the first time in four years, was not in possession of any of my own (having just changed jobs, and waiting for my final certificate to put the ‘Dr.’ on them). That said, everyone is very kind and friendly, no-one made me feel the rude foreigner so far, but still.

7. Given the culinary, and other, stress, one is grateful not only for coffee, but even more for beer, even if it is some sort of Chinese Lager. However, even this has its pitfalls, since their seem to be rather elaborate toasting customs. Apparently, in a group of forty at three tables, in the course of the evening everyone gets up once, and speaks a toast not only at their own, but at the two other tables as well, and separately chinks glasses with everyone (moving around the table) before either everyone drinking a little, or everyone draining their glasses. During this ceremony, those not saying the toast either sit, or stand. This seems to be related to hierarchy, and I might have figured out eventually, had not the German  senior scientists sitting at my table, themselves clouless, apparently had confused even the Chinese sitting with us. Only two or three of the German delegation voluntarily made their round. A third one, as the youngest member of that delegation, was most politely invited by the Chinese host to do so. I guess I got through it quite creditably, though.

It is shocking, I know: the first time I ever thought that doing a doctorate had a certain charme was at the party following the viva of a Syro-Malabar agriculture PhD from my hall of residence.  Days were spent preparing Arabian delicacies all over our shared kitchen. Colleagues and friends stood outside the examination room with laboratory implements most suited to making an awful noise by slamming them together: actually producing quite a cacophony when time drew on, clamoring so that the poor examinee might be released – at length, the proclamation of a very good mark – the thank you speech of the new doctor, starting, against all convention, with, first: God; second: his parents, unfortunately not being able to be there – and me thinking: this is rather fine.

Forward some six years, and it’s my turn.

And, quite interestingly, this throws up a whole  issue of feasts and hospitality. Some colleagues of mine speak of not thinking their finishing their PhD being such a cause of celebration. Be it a PhD, or a birthday, or similar occasions, I think there is quite a danger of misunderstanding: Is it about ME, or is it about me being grateful to all those people who made those years I worked on that thesis, those years I lived on this earth, such a splendid time? For to be honest, hosting a party is often quite a stress. But is it not, at its core, a way of saying ‘thanks’ to people who did us good? I, at least, have often enjoyed parties given by friends (birthday, wedding, PhD,…)  of friends most intensely. How selfish not to offer this to ones friend! This feeling of impropriety of feasts ‘about oneself’ must have its roots in some severe notions of Puritanism or Pietism.

As it is, my own notion of personal feasts are those of a Polish Wedding (if I get Berenike right; sorry if not), though possibly with somewhat less strong drink: Invite everyone you know, provide food and drink for a multitude –  good quality, though not fancy – rejoicing in all your friends from different parts of your life  meeting, enjoying themselves. Being paranoid, however, I always feel it quite an imposition to invite people I know less well: I would like them to come, of course; I would hate them to be offended at not being invited; still, they might think it impertinent of me believing them to be quite that interested in my goings on [Aelianus would probably say: How hard it must be to be a German. It is, I assure you.] So today I got an answer e-mail from the person I was most obsessing about having been impertinent to: it was the most cordial e-mail I ever had from her! So that’s for you, paranoia!

One really has to make the utmost of being Catholic, at all times, I think.

[Plus learning, that, not only, one’s University’s rector being called ‘Magnificence’, but also one’s faculty’s Dean being called ‘Spectabilty’ in the course of an ordinary SCIENCE conference – MUST give one quite some buoyancy, even after having re-re-read Gaudy Night…]