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September 30, 2021

I’m a sucker for most any popular article that explains Hausdorf dimension.

The breath of life

September 28, 2021

Man_dressed_in_Black_by_Calcar_(Hermitage)Though doctors have discovered some drugs that are useful in treating Covid-19, and large randomized trials are starting for three more prospects, the core technology for those infected and in respiratory distress are aids to respiration: mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Neither of those were available a few decades past. It is a bit sobering to realize that most every Covid-19 patient who enters ICU would have died, if similarly struck in 1950. That also is a reminder that the mortality rate for a disease is as much a function of the larger culture as it is of the underlying biology. The history of mechanical ventilation makes interesting reading. Alas, the ability of modern ICUs to keep a body alive is not matched by the ability to make sure that body heals fully.

The media has taken some notice that US deaths from Covid-19 surpass the number from the Spanish flu a century past. There are two major qualifiers to that statistic. First, that the US population now is more than three times as large. Second, that our death toll has been much less than it would have been without advances in medical practice, including those mentioned above. Those caveats work in opposite direction, in how one might view this disease. The first might cause one to think that the Spanish flu was much worse, that so many more died per capita. The second makes one realize we have not suffered the worst case scenario, but a scenario where modern medicine has been able to save a large fraction of those who would have died in times past.

Modern aids to respiration won’t save someone who refuses them, because their politically misinformed friends persuade them to leave ICU.

Pacific thrusts and parries

September 27, 2021

A friend living on a nearby island pointed me to this story on how China has expanded its influence in Tonga, in a pattern it is following elsewhere in the Pacific.

The palangi partied or preached, but the Chinese — at least as far as I could see — did neither. So I accepted then and there that the Chinese would, in any battle of wits or money or general grit, beat out the Westerners in Tonga.

And not just in the Pacific. Also in Africa. Also in Latin America.

SomeIslandInPacificOf course, large, richer nations always have influenced smaller, poorer ones. It is not yet clear that China’s efforts in that are yet any worse than the UK’s or US’s in times previous.

China now is applying for membership in the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP). The US pulled out of that in 2017. The other nations participating clearly benefit from a larger economy joining. And that nation then gains Pacific influence. In some more ideal world, the US would have been a member, would have pushed for terms that provided more environmental and labor protection, and would now be in a position to negotiate on China’s inclusion. Note that we might want that. But on particular terms.

Taiwan wants to join separately. That creates quite a diplomatic issue for the nations already members. If the US lobbies on that, it is doing so from a position of weakness, as a nation that already has snubbed the pact.

The US is exploring a four-way alliance with Australia, Japan, and India — the Quad — likely to exert more influence over the Pacific and provide some counter to China.

The military, vaccination, and Poe’s law

September 23, 2021

Military forces long have taken a variety of measures to prevent disease from tearing through their ranks. When George Washington was fighting the British, vaccines had not yet been invented. The inoculation against smallpox he mandated for incoming recruits gave a case of the actual disease. The idea is that the manner of infection usually resulted in a minor case. That nonetheless killed 1% of those so treated. The preacher Jonathan Edwards famously had died from smallpox inoculation two decades earlier.

Two decades later, Jenner would invent the world’s first vaccine. In 1840, Britain outlawed smallpox inoculation, in favor of vaccination, because the latter was so much safer.

Those entering the US military long have received several vaccines as part of their initial training. More are mandated in their career, depending on their deployment. Some still receive the smallpox vaccine, despite the fact that smallpox now exists only in labs. The recent order on Covid-19 vaccines adds one more to that list. Everyone understands that serving in the military requires a bit more regimented lifestyle in order to meet the military’s goals. So it is hard to imagine a more ridiculous response to the Covid-19 vaccine order than what Tucker Carlson said Monday:

The point of mandatory vaccination is to identify the sincere Christians in the ranks, the free thinkers, the men with high testosterone levels, and anyone else who doesn’t love Joe Biden and make them leave immediately.

Poe’s law states that it is nigh impossible to distinguish extremist views from parody of them, except that you know the author’s intent. Here is a different take: that impossibility shows how cultish an audience has become, that repeatedly saying nonsense does not discredit a speaker, and perhaps even helps cement the speaker’s bond with that audience. It’s not hard to spot the theme that tickles Carlson’s audience in that absurdity. “Biden is trying to destroy the military!” He’s not, of course. He’s just ordering one more vaccine, during the disease’s epidemic. I began the week with an example from Breitbart. It is not surprising that Tucker Carlson would provide a related example on that same day.

In the 2020 election, Idaho went for Trump by 19 percentage points, the fifth largest margin in the nation. Which makes it ground zero for the kind of disinformation Tucker Carlson shovels. That now results in an ugly medical consequence. Carlson is vaccinated, makes many of millions of dollars playing anti-vaccination themes to the rubes, and seems not the least bothered by their deaths.

History of mRNA medicines

September 22, 2021

There is a nice article in Nature summarizing the history of mRNA medicines.

Invasive lanterns and cannibal butterflies

September 21, 2021

MilkweedButterflyIt is quite common in the animal world to see cannibalism in a species, with offspring eating each other, or parents eating offspring. Somehow, though, it just seems wrong when a butterfly does that.

A Kansas student entering his bug collection at the state fair showed an invasive lantern fly further west than hitherto spotted.

The unreachables

September 20, 2021

Some number crunchers make an estimate of the unnecessary death toll we experienced this summer, from vaccine hesitancy:

During the latest coronavirus wave, in July and August, at least 16,000 deaths could have been prevented if all states had vaccination rates as high as the state with the highest vaccination rate.

CostUndervaccinationThe graphs right show that difference. (Click on the image for full size.) A couple of Yale faculty look at the same issue from the perspective of which states are suffering the greatest case rates.

That bloody gap has caused significant worry from a variety of medical professionals. Especially those in public health. They wonder how they could better shape their message to encourage vaccination uptake. Especially among the right wing. And even postulate that part of the problem may be the lack of political diversity in their own fields. I have some sympathy with that.

The contrary argument is that neither science in general nor public health as an application of it are politically neutral. Much of today’s right wing traffics in conspiracy theories, freely dismisses science inconvenient to its preferred politics or religion, and views with suspicion public funding of research, government efforts toward public health, and any professional tied to those. Consider what a pro-vaccine Breitbart editor does to convince his audience to get vaccinated. He does not reference the studies on the vaccines’ safety and efficacy. Instead, he concocts a story. A great conspiracy. That evil liberals are trying to kill the right. Through reverse psychology. By pushing the vaccine.

There is a time for talking with flat earthers. There also is a time for recognizing the outer reaches where rational discussion has no traction. Talk radio and the internet have proved fertile fields for the growth of cults, conspiracy theories, radical preachers, populist politicians, health fads, and grifters generally. Breitbart is far from the most crazed outlet. Those working in public health must face the reality of these times. There will continue to be a fraction of the population resistant to or actively working against their efforts. Even their best, life-saving efforts. The broad, liberal consensus of the mid-20th century, where everyone listened to Walter Cronkite and most parents eagerly lined up their children for the Salk vaccine, was more an aberration than some expected norm to which we will return. To the extent that it was real.

Reading John Nolte’s article above should give the rude awakening to public health professors who dream that a few more conservative voices among their colleagues will help them sway the vaccine hesitant in the future. There is no rational way to convince those who are batshit crazy. What public health professionals must do instead is to fit public health practice to the nature of the public, and to recognize that they never can rely on near universal consensus. As in all science, practices and policies should take account of the facts, rather than building on some counterfactual ideal that doesn’t exist.

Cross-dressing hummingbirds

September 16, 2021

FemaleJacobinSeemingly, some fraction of young, female Jacobin hummingbirds sport the breeding plumage of males. Because male hummingbirds are quite aggressive, that provides the cross-dressed females some advantage to accessing food. It’s always a bit of a risk to make the leap from perceived advantage to thinking it was somehow selected. It will be interesting to see how the distribution of that attribute changes over time.

How to be green, redux

September 15, 2021

Auden Schendler correctly points out that the emphasis on individuals and corporations lowering their carbon footprint is not a solution to global warming, but rather, a distraction, fostered by the fossil fuel industry:

What do fossil fuel companies prefer? They like consumers and corporations to do anything and everything as long as they stay out of the companies’ way and avoid doing anything that could actually make a difference.

I explained much the same, a few years back. Everything else individuals do en masse matters much less than the politics they enable. An individual supporting politicians who raise fuel standards, close coal plants, and accelerate the shift away from internal combustion engines is doing more for the environment than one who doesn’t, even if the first drives a gas-guzzler and flies twice a week, while the latter bicycles everywhere.

Update: Business Insider ran an article on fossil fuel company advertising, pointing out the same.

Testing whether masks work

September 14, 2021

The evidence for the benefit of masking against Covid-19 has been fairly lukewarm. There is some evidence, not strong, that wearing masks may a bit reduce an individual’s risk of catching the disease. Which is the natural thing to study first.

That does not address the issue of whether masks slow community spread. Studies designed to look at individual benefit don’t measure that. By design. While any practice that lowers individual risk also should some lower community spread, if used widely, the converse is not the case. It is quite feasible that some practice might lower community spread, even though those who practice it see negligible benefit vis-a-vis those who don’t.

Which makes studying that difficult. There have been some observational studies. Such as one in Kansas, comparing counties with different masking policies. That showed benefit to public masking mandates. (Cite.) The problem is that observational studies always raise questions about what other differences there are between the communities compared, that might have caused the effect? It is easy to imagine all sorts of confounders, from income to geography to political orientation. Today, sadly, that last correlates with a variety of behavior related to disease transmission.

Randomization is a well-known solution to confounders, that highlights the putative cause in question. But how do you randomize at the community level?

Well, Yale researchers went to Bangladesh, and did that. They selected a set of study villages, and provided masking intervention to a subset chosen at random:

The latest finding is based on a randomized trial involving nearly 350,000 people across rural Bangladesh. The study’s authors found that surgical masks — but not cloth masks — reduced transmission of SARS-CoV-2 in villages where the research team distributed face masks and promoted their use. .. By randomizing entire villages, Gandhi says, the latest study improves the assessment of both mask adherence and community-level transmission.

(Cite, preprint.)

They saw a significant difference in Covid-19 spread, between the test and control villages. The 11% might seem modest on first read. It shouldn’t. That measures a wedge between two curves in time, after just a few weeks. Modelers will have to turn that into a rate as a function of degree of use, to estimate longer-term benefit. Surgical masks were more than twice as effective as cloth masks in the study.

I don’t know how often there have been randomized control trials where communities are the unit of study. Doing that requires significant resources, and a kind of intervention that can be done or not at the community level. Such studies can’t be blinded, in the sense that is applied to human subjects. The psychology and human interaction that makes that so important with human subjects isn’t so present with communities. It will be interesting to see how this work is viewed in retrospect, assuming it holds up to review. I will not be surprised if it spurs similar studies on other issues.