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kottke.org posts about medicine

The Paradox of Preparation

posted by Jason Kottke   Mar 16, 2020

Coronavirus, social distancing, exponential growth, flatten the curve, pandemic, immunocompromised — those are just some of the concepts related to COVID-19 we have had to come up to speed on over the last few weeks. We should add the “paradox of preparation” to that list.

The paradox of preparation refers to how preventative measures can intuitively seem like a waste of time both before and after the fact. Most of us don’t stop brushing our teeth because the dentist didn’t find any cavities at our most recent checkup, but with larger events that have effects more difficult to gauge (like COVID-19, climate change, and Y2K), it can be hard to spur people to action. From Chris Hayes:

A doctor I spoke to today called this the “paradox of preparation” and it’s the key dynamic in all this. The only way to get ahead of the curve is to take actions that *at the time* seem like overreactions, eg: Japan closing all schools for a month with very few confirmed cases.

That was in response to Dr. James Hamblin:

The thing is if shutdowns and social distancing work perfectly and are extremely effective it will seem in retrospect like they were totally unnecessary overreactions.

Epidemiologist Mari Armstrong-Hough made a similar point earlier on Twitter:

You won’t ever know if what you did personally helped. That’s the nature of public health. When the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction.

Preparation, prevention, regulations, and safeguards prevent catastrophes all the time, but we seldom think or hear about it because “world continues to function” is not interesting news. We have to rely on statistical analysis and the expert opinions of planners and officials in order to evaluate both crucial next steps and the effectiveness of preparatory measures after the fact, and that can be challenging for us to pay attention to. So we tend to forget that preparation & prevention is necessary and discount it the next time around.

The good news is that while unchecked epidemics grow exponentially, another thing that can also spreads exponentially is behavioral norms. The basic expert advice on how we can slow the spread of COVID-19 in our communities is pretty unambiguous — wash your hands, don’t touch your face, maintain social distance, self-quarantine, etc. — and so is the huge potential impact of those precautions on the number of people who will get infected and die. To help overcome the paradox of preparation, let’s continue to spread the word about what the experts are urging us to do. Because if we don’t, there might be a lot fewer of us around in a month or two.

Update: In the same vein, Vaughn Tan writes:

This means that any effective actions taken against coronavirus in the few days before the epidemic curve shoots upward in any country will always look unreasonable and disproportionate.

By the time those actions look reasonable and appropriate, they will be too late.

And Now Is the Time to Overreact Ian Bogost in the Atlantic:

The idea that an extreme reaction, such as closing schools and canceling events, might prove to be an overreaction that would look silly or wasteful later outweighs any other concern. It can also feel imprudent; just staying home isn’t so easy for workers who depend on weekly paychecks, and closing is a hard decision for local companies running on thin margins. But experts are saying that Americans can’t really over-prepare right now. Overreaction is good!

It’s hard to square that directive with the associations we’ve built up around overreactions. Ultimately, overreaction is a matter of knowledge-an epistemological problem. Unlike viruses or even zombies, the concept lives inside your skull rather than out in the world. The sooner we can understand how that knowledge works, and retool our action in relation to its limits, the better we’ll be able to handle the unfolding crisis.

Michael Specter writing about America’s weakened public-health system for the New Yorker:

Few people have trouble understanding the purpose of public education or public housing: they are tangible programs that, at least in theory, are designed to improve our lives. Public-health accomplishments, however, are measured in an entirely different way: success is defined by what is prevented, not by what is produced. This creates an odd psychological dynamic.

When public-health programs are successful, they are invisible, and what is invisible is almost always taken for granted. Nobody cheers when they remain untouched by a disease that they hardly knew existed. That makes it easy for shortsighted politicians to deny long-term realities. And that is what they almost always do.

Excellent Presentation on the Latest COVID-19 Research, Hygiene Tips, and Treatment Options

posted by Jason Kottke   Mar 16, 2020

From Stanford professor of neurobiology and bioengineering Michael Lin, this is an excellent 31-page PDF presentation (Slideshare) on what we know about COVID-19 so far and how to deal with it, with extensive references to the latest research (as of 3/15). I’m going to include a few of the most interesting and important slides right here, but do read the whole thing — it is very informative.

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

Michael Lin Covid

And here are a few other quotes I pulled out:

Compare to Spanish flu of 1917-1918: Cumulative infection rate 27%, IFR 2%. Spanish flu might have higher IFR than COVID-19, but medical care was much worse then (no ventilators, no drugs). In reality COVID-19 is likely the more severe disease. In any case, Spanish flu was devastating.

Large meetings that bring people from around the country are obviously a big risk. Large numbers of people who might breath the same air and touch the same things (e.g. at Biogen meeting, attendants used the same serving utensils at a buffet, and 70 got infected)

If you are young, the worry is more about transmitting virus to older people than about yourself.

Death rates will lag infection rates by 3-4 weeks (2 weeks from diagnosis but that’s 1 week from infection time on average with current testing practices)

Read Lin’s entire presentation here.

Expert Advice and Harsh Truths About Social Distancing

posted by Jason Kottke   Mar 14, 2020

Social distancing has been recommended by epidemiologists and public health officials as a way to slow the spread of COVID-19, flatten the curve, and save lives. Avoiding rock concerts and sporting events is easy, but what about going to the grocery store or visiting with a friend? The Atlantic’s Kaitlyn Tiffany talked to a number of public health experts about The Dos and Don’ts of ‘Social Distancing’.

Q: Should I be avoiding bars and restaurants?

Cannuscio: People should avoid gathering in public places. People should be at home as much as possible. The measures that have worked to get transmission under control or at least to bend the curve, in China and South Korea, have been extreme measures to increase social distancing.

Q: Should I stop visiting elderly relatives?

Cannuscio: I think if we are fortunate enough to live near our elders and we get into the mode of seriously isolating our own families, then one person should be designated to go and visit. If we’re not in a situation where we can truly limit our own social contact, then we will be putting that elder at risk by going to visit.

In my estimation, the answers that Carolyn Cannuscio, of Penn’s Center for Public Health Initiatives, gives are the ones to follow. Dr. Asaf Bitton’s advice is even stricter:

2. No kid playdates, parties, sleepovers, or families/friends visiting each other’s houses and apartments.

This sounds extreme because it is. We are trying to create distance between family units and between individuals. It may be particularly uncomfortable for families with small children, kids with differential abilities or challenges, and for kids who simply love to play with their friends. But even if you choose only one friend to have over, you are creating new links and possibilities for the type of transmission that all of our school/work/public event closures are trying to prevent. The symptoms of coronavirus take four to five days to manifest themselves. Someone who comes over looking well can transmit the virus. Sharing food is particularly risky — I definitely do not recommend that people do so outside of their family.

They both rightly talk about how the early actions we take will end up having a big impact in limiting the damage. (Check out this video about epidemics & exponential growth if you haven’t already.) Singapore, Hong Kong, Taiwan, and other places were able to nip the epidemic in the bud in part because of aggressive social distancing practices.

How to Wash Your Hands Properly

posted by Jason Kottke   Mar 13, 2020

Most humans have been washing their hands since childhood, but I bet very few of us have been doing it correctly. Because of the effectiveness of hand-washing with soap in preventing the spread of COVID-19, the CDC and the WHO (and health professionals everywhere) both make it their top recommendation and provide guidance on how to do it properly: CDC hand-washing instructions, WHO hand-washing instructions.

Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.

Here’s a video from the WHO on proper hand-washing technique (and a similar one from Johns Hopkins that has subtitles):

And a graphic from the WHO:

Wash Hands Instructions

And if you’re getting sick of singing Happy Birthday while washing your hands, a site called Wash Your Lyrics can help you make a hand-washing infographic with your favorite song’s lyrics.

Why Is the US So Behind in COVID-19 Testing?

posted by Jason Kottke   Mar 13, 2020

According to an ongoing investigation at The Atlantic, the US has tested only about 14,000 people for COVID-19 so far (a stat CDC data seems to confirm). 14,000 out of 330 million people. Olga Khazan writes about the four main reasons why the US is so behind in testing for the virus.

Interviews with laboratory directors and public-health experts reveal a Fyre-Festival-like cascade of problems that have led to a dearth of tests at a time when America desperately needs them. The issues began with onerous requirements for the labs that make the tests, continued because of arcane hurdles that prevented researchers from getting the right supplies, and extended to a White House that seemed to lack cohesion in the pandemic’s early days. Getting out lots of tests for a new disease is a major logistical and scientific challenge, but it can be pulled off with the help of highly efficient, effective government leadership. In this case, such leadership didn’t appear to exist.

Here’s another take on the problem from a few days ago in the NY Times.

The US has bungled the situation so badly that a pair of Chinese foundations announced this morning that they were donating 500,000 testing kits and 1 million masks to the US. Last month in my Asian travelogue, I wrote that my main observation after spending three weeks in Asia was: “America is a rich country that feels like a poor country”. That we have to rely on foreign aid in situations like this is a good example of what I was referring to.

Washing Your Hands Is Important Because Soap “Absolutely Annihilates” Coronavirus

posted by Jason Kottke   Mar 13, 2020

The number one recommendation on the list of protective measures for COVID-19 from both WHO and the CDC is to regularly wash your hands. The CDC in particular recommends hand-washing over using hand sanitizer.

Wash Hands

Vox recently talked with chemistry professor Palli Thordarson about why washing with soap is so effective when dealing with coronaviruses.

The soap takes care of the virus much like it takes care of the oil in the water. “It’s almost like a crowbar; it starts to pull all the things apart,” Thordarson says.

One side of the soap molecule (the one that’s attracted to fat and repelled by water) buries its way into the virus’s fat and protein shell. Fortunately, the chemical bonds holding the virus together aren’t very strong, so this intrusion is enough to break the virus’s coat. “You pull the virus apart, you make it soluble in water, and it disintegrates,” he says.

Then the harmless shards of virus get flushed down the drain. (And even if it the soap doesn’t destroy every virus, you’ll still rid them from your hands with soap and water, as well as any grease they may be clinging to.)

And why do you need to wash for 20 seconds? Because that gives soap time to do its work.

First off, your skin is wrinkly, and it takes time for soap to penetrate into all the tiny folds and demolish the viruses that lurk within. Then the soap needs a few moments to do its chemical work. “You do need a bit of time for all the soap to interact back and forth with the virus particle,” he says. Twenty seconds should do the trick just fine.

See also Why Soap Works from the NY Times, which explains why soap & water is better than hand sanitizer in these cases:

On the whole, hand sanitizers are not as reliable as soap. Sanitizers with at least 60 percent ethanol do act similarly, defeating bacteria and viruses by destabilizing their lipid membranes. But they cannot easily remove microorganisms from the skin. There are also viruses that do not depend on lipid membranes to infect cells, as well as bacteria that protect their delicate membranes with sturdy shields of protein and sugar. Examples include bacteria that can cause meningitis, pneumonia, diarrhea and skin infections, as well as the hepatitis A virus, poliovirus, rhinoviruses and adenoviruses (frequent causes of the common cold).

Update: Thordarson also wrote an article for The Guardian on how effective soap is at killing coronavirus.

Recipe for Making Your Own Hand Sanitizer

posted by Jason Kottke   Mar 12, 2020

Many stores have long since sold out of hand sanitizer in the US and washing your hands is a better move anyway, but if you’d like to have some sanitizer on hand for when you can’t get to a sink, the World Health Organization has you covered. The WHO recipe is for making 10-liter batchs, so Popular Science helpfully scaled it down to a more reasonable size:

1 cup 99% isopropyl alcohol
1 tablespoon 3% hydrogen peroxide
1 teaspoon 98% glycerin/glycerol
1/4 cup, 1 tablespoon, and 1 teaspoon sterile distilled or boiled cold water

To the alcohol, add the hydrogen peroxide & glycerin and stir or shake if you’re mixing in a container with a lid. Then add the water.

For COVID-19 prevention, the CDC recommends a hand sanitizer that contains at least 60% alcohol; this recipe will end up being about 75% alcohol. The Popular Science piece also includes another recipe for a hand sanitizing gel that’s much closer to store-bought gels that involves mixing isopropyl alcohol, aloe vera gel, and tea tree oil. They also note that vodka does not contain enough alcohol to meet the CDC’s recommendation, especially when mixed with the other ingredients.

Media Paywalls Dropped for COVID-19 Crisis Coverage

posted by Jason Kottke   Mar 11, 2020

In recent years, many media outlets have joined publications like the WSJ and NY Times in erecting paywalls around their online offerings, giving visitors access to a few articles a month before asking them to pay for unlimited access. Due to the continuing worldwide COVID-19/coronavirus crisis and in order to make information about the pandemic more accessible to the public, several publications have dropped their paywalls for at least some of their coronavirus coverage (thanks to everyone who responded to my tweet about this).

Among them are The Atlantic, WSJ, Talking Points Memo, Globe and Mail, Seattle Times, Miami Herald (and other McClatchy-owned properties), Toronto Star, Stat, Dallas Morning News, Medium, NY Times, Washington Post, Baltimore Sun, Chicago Tribune, Christian Science Monitor and several medical/science journals. Notably, The Guardian relies on online subscription revenue but doesn’t put anything behind a paywall, including their coronavirus coverage.

In addition, a group of archivists have created an online directory of scientific papers related to coronaviruses, available for free download.

“These articles were always written to be shared with as many people as possible,” Reddit user “shrine,” an organizer of the archive, said in a call. “From every angle that you look at it, [paywalled research] is an immoral situation, and it’s an ongoing tragedy.”

Kudos to those media organizations for doing the right thing — this information can save people’s lives. Let’s hope others (*cough* Washington Post) will soon follow suit. And if you find the coverage helpful, subscribe to these outlets!

BTW, like The Guardian, kottke.org is supported by readers just like you who contribute to make sure that every single thing on the site is accessible to everyone. If you’re a regular reader, please consider supporting this experiment in openness.

Update: Added the NY Times to the list above. I am also hearing that many European papers are not dropping their paywalls in the face of the crisis.

Update: Added several media outlets to the list, including Washington Post and Chicago Tribune. At this point, it seems to be standard practice now (at least in the US & Canada) so this will be the final update. (thx, @maschweisguth)

WHO Declares COVID-19 Outbreak Is Officially a Pandemic

posted by Jason Kottke   Mar 11, 2020

In a media briefing that’s still ongoing as I’m writing this, Dr. Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization, has officially characterized the COVID-19 outbreak as a pandemic. A pandemic is defined as:

An influenza pandemic is a global epidemic caused by a new influenza virus to which there is little or no pre-existing immunity in the human population. Influenza pandemics are impossible to predict; and they may be mild, or cause severe disease or death. Severe disease may occur in certain risk groups, which may correspond to those at risk of severe disease due to seasonal influenza.

Here’s a transcript of Dr. Tedros’s opening remarks from the briefing.

WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterized as a pandemic.

Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.

Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.

Progress on fighting COVID-19 can be made everywhere when the right steps are taken:

If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.

Even those countries with community transmission or large clusters can turn the tide on this virus.

Several countries have demonstrated that this virus can be suppressed and controlled.

The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same — it’s whether they will.

But WHO also acknowledges how disruptive the pandemic can be:

We are grateful for the measures being taken in Iran, Italy and the Republic of Korea to slow the virus and control their epidemics.

We know that these measures are taking a heavy toll on societies and economies, just as they did in China.

All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights.

And in closing he deflects attention from the word “pandemic”:

Let me give you some other words that matter much more, and that are much more actionable.

Prevention.

Preparedness.

Public health.

Political leadership.

And most of all, people.

We’re in this together, to do the right things with calm and protect the citizens of the world. It’s doable.

How to Stop the Spread of COVID-19: Cancel Everything

posted by Jason Kottke   Mar 11, 2020

Yascha Mounk writing for The Atlantic:

These three facts imply a simple conclusion. The coronavirus could spread with frightening rapidity, overburdening our health-care system and claiming lives, until we adopt serious forms of social distancing.

This suggests that anyone in a position of power or authority, instead of downplaying the dangers of the coronavirus, should ask people to stay away from public places, cancel big gatherings, and restrict most forms of nonessential travel.

Given that most forms of social distancing will be useless if sick people cannot get treated-or afford to stay away from work when they are sick-the federal government should also take some additional steps to improve public health. It should take on the costs of medical treatment for the coronavirus, grant paid sick leave to stricken workers, promise not to deport undocumented immigrants who seek medical help, and invest in a rapid expansion of ICU facilities.

This is very close to my own personal thinking right now, particularly after watching this excellent video about exponential growth and epidemics.

Exponential Growth and Epidemics

posted by Jason Kottke   Mar 10, 2020

From 3blue1brown’s Grant Sanderson, this is an excellent quick explanation of exponential growth and how we should think about it in relation to epidemics like COVID-19. Depending on how rusty your high school math is, you might need to rewind a couple of times to fully grasp the explanation, but you should persevere and watch the whole thing.

The most important bit is at the end, right around the 7:45 mark, when he talks about how limiting person-to-person exposure and decreasing the probability of exposures becoming infections can have a huge effect on the total number of people infected because the growth is exponential. If large numbers of people start doing things like limiting travel, cancelling large gatherings, social distancing, and washing their hands frequently, the total number of infections could fall by several orders of magnitude, making the exponential work for us, not against us. Small efforts have huge results. If, as in the video, you’re talking about 100 million infected in two months (at the current transmission rate) vs. 400,000 (at the lowered rate) and if the death rate of COVID-19 is between 1-3%, you’re looking at 1-3 million dead vs. 4-12,000 dead.

So let’s start flattening that exponential curve. South Korea and China both seem to have done it, so there’s no reason the rest of the world can’t through aggressive action. (thx, david)

Update: Vox has a nice explainer on what epidemiologists refer to as “flattening the curve”.

Yet the speed at which the outbreak plays out matters hugely for its consequences. What epidemiologists fear most is the health care system becoming overwhelmed by a sudden explosion of illness that requires more people to be hospitalized than it can handle. In that scenario, more people will die because there won’t be enough hospital beds or ventilators to keep them alive.

A disastrous inundation of hospitals can likely be averted with protective measures we’re now seeing more of — closing schools, canceling mass gatherings, working from home, self-quarantine, avoiding crowds - to keep the virus from spreading fast.

Epidemiologists call this strategy of preventing a huge spike in cases “flattening the curve”.

Here’s the relevant graphic explanation from Our World in Data’s COVID-19 package:

Flatten The Curve

COVID-19: Not Just A Bad Flu

posted by Jason Kottke   Mar 10, 2020

A few days ago, Dr. Daniele Macchini, a physician in Bergamo, Italy, made a long post on Facebook (also reprinted here) about how the outbreak of COVID-19 (coronavirus) is overwhelming the hospitals there and pleads with the rest of the world to take the virus seriously. The original post is in Italian and Google Translate does pretty well with it. Dr. Silva Stringhini translated the important bits of Dr. Macchini’s post in this Twitter thread and is somewhat easier to read:

After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.

“I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.

“I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly ‘emptied’, elective activities were interrupted, intensive care were freed up to create as many beds as possible.

“All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.

“I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I’ve seen what’s happening. Well, the situation now is dramatic to say the least.

“The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.

“The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.

Dr. Macchini urges: “Let’s stop saying it’s a bad flu.” But this is the part that stopped me in my tracks and got me to write this post:

So have patience, too, that you cannot go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate.

His overall message is that we shouldn’t panic, but that we should take COVID-19 seriously. The goal here is to keep the most vulnerable of us as safe as possible and work to slow the spread of the virus so it doesn’t overwhelm our healthcare system. So let’s do that — the elderly and those most at risk are counting on us.

How Iceland Has Dramatically Lowered Rates of Teen Substance Abuse Over the Past 20 Years

posted by Jason Kottke   Mar 02, 2020

There are certain links I’ve posted here that I think about more often than others. One that I think a lot about — weekly at least — is Emma Young’s story for Mosaic about Iceland’s very successful program that’s steered the nation’s teens away from drug and alcohol abuse. At the center of the Icelandic strategy is an insight by psychologist Harvey Milkman about a strategy of replacing substance and other unhealthy addictions with healthier natural highs:

At Metropolitan State College of Denver, Milkman was instrumental in developing the idea that people were getting addicted to changes in brain chemistry. Kids who were “active confronters” were after a rush — they’d get it by stealing hubcaps and radios and later cars, or through stimulant drugs. Alcohol also alters brain chemistry, of course. It’s a sedative but it sedates the brain’s control first, which can remove inhibitions and, in limited doses, reduce anxiety.

“People can get addicted to drink, cars, money, sex, calories, cocaine — whatever,” says Milkman. “The idea of behavioural addiction became our trademark.”

This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry — because it seems obvious to me that people want to change their consciousness — without the deleterious effects of drugs?”

BTW, this is a somewhat controversial view but it has always made sense to me for those with mild addictions or depression. Speaking strictly for myself, I’ve found that when healthier alternatives are available to me (spending time with family & friends, exercise, exploring, reading a good book), I spend a lot less time mindlessly doing things that give me the same sort of brain buzz but which I don’t consider positive or worthwhile (drinking alcohol, watching TV, eating poorly, and especially reloading Instagram over and over again like a lab rat slapping that lever to get more cocaine).

But back to Iceland. By giving teens access to more healthy activities, getting parents more involved in their children’s lives, implementing curfews, and administering annual surveys, the country has made great strides over the past two decades:

Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.

The way the country has achieved this turnaround has been both radical and evidence-based, but it has relied a lot on what might be termed enforced common sense. “This is the most remarkably intense and profound study of stress in the lives of teenagers that I have ever seen,” says Milkman. “I’m just so impressed by how well it is working.”

Young did a follow-up last year about the expansion of the program into other areas of the world.

Why Don’t Blue Whales Get Cancer?

posted by Jason Kottke   Mar 02, 2020

Even though larger animals like elephants and blue whales have up to 100 billion more cells than humans in their bodies — and therefore many more chances for harmful mutations to develop — they are much more immune to cancer. This is called Peto’s paradox the subject of Kurzgesagt’s latest video. Scientists aren’t sure why this happens, but one hypothesis is that in order to have grown so large, the evolutionary process that resulted in these animals provided built-in defenses against cancer that other animals didn’t need. Further reading on the topic is available here.

An International Eye Test Chart (circa 1907)

posted by Jason Kottke   Feb 27, 2020

Mayerle Eye Test Chart

From the collection of the US National Library of Medicine, an eye test chart designed by George Mayerle around 1907 to be a complete vision testing solution for speakers of several languages.

Running through the middle of the chart, the seven vertical panels test for acuity of vision with characters in the Roman alphabet (for English, German, and other European readers) and also in Japanese, Chinese, Russian, and Hebrew. A panel in the center replaces the alphabetic characters with symbols for children and adults who were illiterate or who could not read any of the other writing systems offered. Directly above the center panel is a version of the radiant dial that tests for astigmatism. On either side of that are lines that test the muscular strength of the eyes. Finally, across the bottom, boxes test for color vision, a feature intended especially (according to one advertisement) for those working on railroads and steamboats.

Mayerle was a German optometrist working in San Francisco when he made the chart, designing it for use in a city with a diverse population. My pals at 20x200 are offering limited-edition prints of Mayerle’s chart in a variety of sizes.

See also the history & typography of eye test charts, Optician Sans (a font based on eye chart typography), and Eye Charts for Drones.

We Interrupt This Brain Surgery to Bring You a Violin Solo…

posted by Jason Kottke   Feb 20, 2020

This is the most metal shit ever: the doctors removing violinist Dagmar Turner’s brain tumor woke her up during the procedure to play the violin to make sure that she didn’t lose any parts of her brain vital to her playing.

After explaining concerns she had over losing the ability to play the violin, Prof Ashkan and the neurosurgical team at King’s devised a plan. Prior to Dagmar’s operation they spent two hours carefully mapping her brain to identify areas that were active when she played the violin and those responsible for controlling language and movement. They also discussed with Dagmar the idea of waking her mid-procedure so she could play. This would ensure the surgeons did not damage any crucial areas of the brain that controlled Dagmar’s delicate hand movements specifically when playing the instrument. With her agreement, a team of surgeons, anaesthetists and therapists went on to meticulously plan the procedure.

During the operation Prof Ashkan and the team performed a craniotomy (an opening in the skull) and Dagmar was brought round from the anaesthetic. She played violin while her tumour was removed, while closely monitored by the anaesthetists and a therapist.

Face ID Compatible Respirator Masks

posted by Jason Kottke   Feb 17, 2020

Face ID Respirator Masks

This site is making N95 respirator masks that work with facial recognition software, so that, for example, you can unlock your phone while still wearing a mask.

After uploading your face, we use computational mapping to convert your facial features into an image printed onto the surface of N95 surgical masks without distortion.

Our printer uses inks made of natural dyes. It’s non-toxic and doesn’t affect breathability.

You can use your mask for everyday life as a barrier for airborne particle droplets.

Face ID Respirator Masks

Face ID Respirator Masks

It is unclear whether these will actually ship or not — “Q: Is this a joke? A: Yes. No. We’re not sure.” — but they’re definitely not planning to make them while there are mask shortages related to COVID-19. And it appears the masks will work with iPhones…you just add a new face (while wearing the mask) to your phone’s face database.

Map of Areas Most Often Missing During Handwashing

posted by Jason Kottke   Feb 17, 2020

With news of more than 70,000 confirmed cases and 1700 deaths from the COVID-19 virus, the importance of handwashing is once again front and center. Using data from a 1978 study on the hygiene of health professionals, this is a map of the most missed areas when washing hands.

Hand Washing Map

This more recent paper contains a short review of various studies of missed areas, most of which conclude that people often forget to wash their fingertips:

In 2008, the WHO designed a handwashing leaflet, making reference to Taylor, who indicated that the fingertips, interdigital areas, thumbs, and wrists are the most commonly missed areas in handwashing. Pan et al. also found that the tips of the nails and the fingertips had the largest amount of residual florescent stains left after handwashing among healthcare workers in Taiwan. The commonly missed areas among medical students in the study conducted by Vanyolos et al. was the first metacarpal, the proximal part of the palm (lateral), the distal phalanges, and the nail beds. In healthcare workers in Škodová et al.’s study, the thumbs and fingertips were the most commonly missed areas. In this study, the most frequently missed area was also the fingertips. However, the medial aspect and back of the hand were the second and third most missed areas, respectively. Moreover, the interdigital area and the front and back of the fingers were the least missed areas, which is in contrast to Taylor’s study.

So wash those fingertips! Here’s the CDC-recommended guide to washing your hands properly.

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

See also this TED Talk on how to properly dry your hands with a paper towel. (via a map a day)

Ghost City Photos of a Usually Bustling Shanghai During Coronavirus Outbreak

posted by Jason Kottke   Feb 12, 2020

One Person City

One Person City

One Person City

For her series One Person City, photographer nicoco has been taking photos of Shanghai that emphasize how deserted the city was due to the COVID-19 outbreak that has killed more than 1000 people in China. In an interview with Hyperallergic, the photographer said:

My objective for this series was to capture the feeling of apocalyptic emptiness. Some of the photos may look as if they were captured at strange early morning hours, but as a collection, it seeks to reinforce there were no people, anywhere.

These are Shanghai’s busiest locations that can compare to Times Square in New York City, Big Ben in London, the Bean in Chicago, or the Washington Monument in DC. They are very popular on an average day, and very, very popular during holidays as domestic tourists and residents spend time with their families and check out festive displays, shop, or just meander around.

You can find the photos on her Instagram.

Shake: A Typeface with Parkinson’s Disease

posted by Jason Kottke   Feb 01, 2020

Shake typeface

Shake is a typeface made from the real handwriting of a person living with Parkinson’s disease. Creative director Morten Halvorsen:

My mother was diagnosed with Parkinson’s eight years ago. And her handwriting has changed in the years since. I created this font to preserve her handwriting, and enable her to continue to write with her own letters.

A new version of the font will be available each year to capture his mother’s worsening condition. Donate a few dollars (or more!) to download the font — all proceeds go to finding a cure. You can also download a template so that you can document the handwriting of a loved one living with Parkinson’s — for a fee (donated to Parkinson’s research), Halvorsen will turn it into a font for you. (thx, kevin)

Pandemic - How to Prevent an Outbreak

posted by Jason Kottke   Jan 23, 2020

With the Wuhan coronavirus in the news, this is a timely release from Netflix: Pandemic is a 6-part series on the inevitable worldwide disease outbreak and what’s being done to stop it, or at least to mitigate its effects.

Departing Gesture

posted by Jason Kottke   Oct 31, 2019

At the Sebrell Funeral Home in Ridgeland, MS (just outside of Jackson), they perform funerals and cremations for people with HIV/AIDS, some of whom have been abandoned by their families because of their disease or sexual orientation.

In almost one-third of the AIDS-related deaths serviced by Sebrell Funeral Home, the family or next-of-kin will either abandon the deceased entirely or refuse to accept the cremains.

HIV/AIDS is a growing problem in the American South, due to social stigma, poverty, and decreased access to healthcare. In this short documentary, we meet Trey Sebrell, who thinks of caring for all deceased people, no matter who they were in life, as part of his mission as a funeral director.

“My Day as an Abortion Care Provider”

posted by Jason Kottke   Oct 24, 2019

In a piece for the NY Times, obstetrician-gynecologist Dr. Lisa Harris shares her experience of a typical day at her practice, where she and her staff provide abortions.

My youngest patient of the day is 14 and here with her parents. The oldest patient is 41, here with her husband. As on all days, my patients come from every walk of life. Most have children already; many have arranged their appointment so that they’ll be done in time to pick them up after school. They assure me, again, that they are certain about their decision.

By the end of the day, I’ve seen 17 people, and made sure each received the care and time she needed. After counseling, two others left without having an abortion. One decided to continue her pregnancy and become a parent. Another appeared to need more time to think about it, and I encouraged her to do that. I support all of my patients’ decisions and needs; doing so is core to my work.

This was a typical day, and on the way home some of it plays back in my mind. A mother of three crosses herself and then takes the mifepristone pill she requested. Another requests a copy of the ultrasound picture for her memory box. After the abortion procedure, one asks to see what had been in her uterus and is relieved that the fetus is less than an inch, so much smaller than she had imagined.

See also What Illegal Abortion Was Like in the 1960s and Harrowing Illegal Abortion Stories from Before Roe v. Wade.

Nobody Dies in Longyearbyen

posted by Jason Kottke   Oct 21, 2019

From filmmaker David Freid, Nobody Dies in Longyearbyen is a short film about Longyearbyen, Norway, the one of the northernmost towns in the world. The town of about 2100 residents is situated on the Svalbard archipelago and is the home of the Global Seed Vault. Freid went to investigate the rumor that no one is allowed to die in Longyearbyen and discovered that if climate change results in the permafrost melting in places like this, diseases from long ago may be released back into the world.

But for more than 70 years, not a single person has been buried in Longyearbyen. That’s due to the region’s year-round sub-zero temperatures: Bodies don’t decompose, but are preserved, as if mummified, in the permafrost. Should anyone die there, the government of Svalbard requires that the body is flown or shipped to mainland Norway to be interred.

See also A Trip to the Northernmost Town on Earth.

How Flu Vaccines Are Made

posted by Jason Kottke   Oct 10, 2019

Ten years ago, in the midst of the 2009 swine flu pandemic, I wrote about the manufacturing process for the H1N1 flu vaccine. It involves billions of chicken eggs.

The most striking feature of the H1N1 flu vaccine manufacturing process is the 1,200,000,000 chicken eggs required to make the 3 billion doses of vaccine that may be required worldwide. There are entire chicken farms in the US and around the world dedicated to producing eggs for the purpose of incubating influenza viruses for use in vaccines. No wonder it takes six months from start to finish.

The post holds up pretty well because, according to the CDC, this is still the way most flu vaccines in America are manufactured. Here’s a look at pharmaceutical company GSK’s egg-based process:

Two other techniques for making flu vaccines were approved for use in the US in 2012 and 2013 respectively, cell-based flu vaccines:

‘Cell-based’ refers to how the flu vaccine is made. Most inactivated influenza vaccines are produced by growing influenza viruses in eggs. The influenza viruses used in the cell-based vaccine are grown in cultured cells of mammalian origin instead of in hens’ eggs.

A cell-based flu vaccine was developed as an alternative to the egg-based manufacturing process. Cell culture technology is potentially more flexible than the traditional technology, which relies upon adequate supply of eggs. In addition, the cell-based flu vaccine that uses cell-based candidate vaccine viruses (CVVs) has the potential to offer better protection than traditional, egg-based flu vaccines as a result of being more similar to flu viruses in circulation.

And recombinant flu vaccines:

NIAID and its industry partners have made progress in moving from both the egg-based and cell-based flu vaccine production methods toward recombinant DNA manufacturing for flu vaccines. This method does not require an egg-grown vaccine virus and does not use chicken eggs at all in the production process. Instead, manufacturers isolate a certain protein from a naturally occurring (“wild type”) recommended flu vaccine virus. These proteins are then combined with portions of another virus that grows well in insect cells. The resulting “recombinant” vaccine virus is then mixed with insect cells and allowed to replicate. The flu surface protein called hemagglutinin is then harvested from these cells and purified.

Both of these new techniques make production quicker, thereby resulting in more effective vaccines because they are more likely to match the strains of whatever’s “going around”.

As a reminder, you should get a flu shot every year in the fall. The CDC recommends that “everyone 6 months of age and older should get a flu vaccine every season with rare exception”, especially those “who are at high risk of serious complications from influenza”. Flu vaccines are covered by your health insurance without copay (thanks, Obama!) and are often available at drug stores without an appointment or a long wait. So go get one!

Fighting the Measles and Dangerous Ideas

posted by Jason Kottke   Aug 26, 2019

For the New Yorker, Nick Paumgarten writes about this year’s measles outbreak in the US, the largest such outbreak in decades. The outbreak is solely due to a growing number of people who decline to vaccinate their children, so the fight has become one not against a disease, as it was decades ago, but against dangerous ideas.

But, if we have to pick a Patient Zero, Andrew Wakefield will do. Wakefield is the British gastroenterologist who produced the notorious article, published in The Lancet in 1998, linking the M.M.R. vaccine to autism. The study, which featured just twelve subjects, was debunked, the article was pulled, and Wakefield lost his license to practice medicine — as well as his reputation, in scientific circles anyway. But, owing to his persistence in the years since, his discredited allegations have spread like mold. In the anti-vaxxer pantheon, he is martyr and saint. There are also the movement’s celebrities, such as Jenny McCarthy and Robert F. Kennedy, Jr., stubborn in the face of ridicule, and the lesser-known but perhaps no less pernicious YouTube evangelists, such as Toni Bark, a purveyor of homeopathic products, and the Long Island pediatrician Lawrence Palevsky. If your general practitioner is Dr. Google, you can find a universe of phony expertise. The movement seems to sniff out susceptibility. Not surprisingly, there is money there, though the financial incentives behind this strand of advocacy are less clear than, say, what has led the Koch brothers to champion fossil fuels. This spring, the Washington Post reported that the New York hedge-fund manager Bernard Selz and his wife, Lisa, have given more than three million dollars to anti-vaccination causes and helped finance “Vaxxed,” Wakefield’s 2016 documentary, which purports to reveal a C.D.C. conspiracy to cover up the connection between vaccines and autism. Needless to say, the anti-vaccination ethos is by no means exclusive to the New York tristate-area Orthodox community. It thrives in certain pockets — affluent boho-yoga moms, evangelical Christians, Area 51 insurgents. The vaccination rates are about the same in Monsey and in Malibu. Before New Square, the three most recent big outbreaks of measles occurred among Somali immigrants, in Minnesota; Amish farmers, in Ohio; and a hodgepodge of visitors to Disneyland.

“It’s shocking how strong the anti-vax movement is,” Zucker said. “What surprises me is the really educated people who are passionately against vaccinations. I see this as part of a larger war against science-based reality. We need to study vaccine hesitancy as a disease.” He gave a TEDX talk recently about the crippling disconnect between the speed at which information, good or bad, spreads now and the slow, grinding pace of public-health work. He managed, by way of the general theory of relativity, to establish the equivalence of H1N1, Chewbacca Mask Lady, and Pizzagate: “How do we immunize and protect ourselves from the damaging effects of virality?”

The internet is such an efficient way to spread ideas (regardless of their validity) that you begin to wonder if instant global individual-to-individual and individual-to-everyone communication is an insurmountable Great Filter for societies.

The Restaurant of Mistaken Orders

posted by Jason Kottke   Aug 19, 2019

The servers at The Restaurant of Mistaken Orders, a series of pop-up restaurants in Tokyo, are all living with dementia, which means that you might not receive what you ordered.

All of our servers are people living with dementia. They may, or may not, get your order right.

However, rest assured that even if your order is mistaken, everything on our menu is delicious and one of a kind. This, we guarantee.

“It’s OK if my order was wrong. It tastes so good anyway.” We hope this feeling of openness and understanding will spread across Japan and through the world.

At the first pop-up, 37% of the orders were mistaken. This video explains a bit more about the concept and shows the restaurant in action.

The Mosquito: Humanity’s Greatest Enemy

posted by Jason Kottke   Aug 13, 2019

For the New Yorker, Brooke Jarvis reviews Timothy C. Winegard’s The Mosquito: A Human History of Our Deadliest Predator.

It turns out that, if you’re looking for them, the words “mosquitoes,” “fever,” “ague,” and “death” are repeated to the point of nausea throughout human history. (And before: Winegard suggests that, when the asteroid hit, dinosaurs were already in decline from mosquito-borne diseases.) Malaria laid waste to prehistoric Africa to such a degree that people evolved sickle-shaped red blood cells to survive it. The disease killed the ancient Greeks and Romans — as well as the peoples who tried to conquer them — by the hundreds of thousands, playing a major role in the outcomes of their wars. Hippocrates associated malaria’s late-summer surge with the Dog Star, calling the sickly time the “dog days of summer.” In 94 B.C., the Chinese historian Sima Qian wrote, “In the area south of the Yangtze the land is low and the climate humid; adult males die young.” In the third century, malaria epidemics helped drive people to a small, much persecuted faith that emphasized healing and care of the sick, propelling Christianity into a world-altering religion.

And then there’s this:

In total, Winegard estimates that mosquitoes have killed more people than any other single cause — fifty-two billion of us, nearly half of all humans who have ever lived. He calls them “our apex predator,” “the destroyer of worlds,” and “the ultimate agent of historical change.”

Two other recent reviews of the book: In ‘The Mosquito,’ Humans Face A Predator More Deadly Than The Rest (NPR) and The mosquito isn’t just annoying — Timothy C. Winegard says we’re at war (LA Times).

What It Feels Like to Die from Heat Stroke

posted by Jason Kottke   Jul 23, 2019

From Outside magazine, an article on what your body goes through and what it feels like to die from heat stroke. A perhaps unnecessary note: this gets intense and a little graphic.

There are two kinds of heatstroke: classic and exertional. Classic heatstroke hits the very young, the elderly, the overweight, and people suffering from chronic conditions like uncontrolled diabetes, hypertension, and cardiovascular disease. Alcohol and certain medications (diuretics, tricyclic antidepressants, antipsychotics, and some cold and allergy remedies) can increase susceptibility as well. Classic heatstroke can strike in the quiet of upper-floor apartments with no air-conditioning.

Exertional heatstroke, on the other hand, pounces on the young and fit. Exercise drastically accelerates temperature rise. Marathon runners, cyclists, and other athletes sometimes push into what used to be known as the fever of exercise and is now called exercise-induced hyperthermia, where internal temperatures typically hit 100 to 104 degrees. Usually, there’s no lasting damage. But as body temperature climbs higher, the physiological response becomes more dramatic and the complications more profound. The higher temperature can ultimately trigger a cascading disaster of events as the metabolism, like a runaway nuclear reactor, races so fast and so hot that the body can’t cool itself down. A person careens toward organ failure, brain damage, and death.

It’s a sequel of sorts to this piece about what it feels like to freeze to death, which I vividly remember reading many years ago.

At 85 degrees, those freezing to death, in a strange, anguished paroxysm, often rip off their clothes. This phenomenon, known as paradoxical undressing, is common enough that urban hypothermia victims are sometimes initially diagnosed as victims of sexual assault. Though researchers are uncertain of the cause, the most logical explanation is that shortly before loss of consciousness, the constricted blood vessels near the body’s surface suddenly dilate and produce a sensation of extreme heat against the skin.

The Possible Link Between Seasonal Allergies and Anxiety & Depression

posted by Jason Kottke   Jul 11, 2019

Olga Khazan on The Reason Anxious People Often Have Allergies:

“There is good circumstantial evidence that’s growing that a number of mental illnesses are associated with immune dysfunction,” says Sandro Galea, a physician and epidemiologist at the Boston University School of Public Health.

If the link is in fact real, allergies could be causing anxiety and other mood disorders in a few different ways. For one, it’s stressful to be sick, and people with allergies frequently feel like they have a bad cold. The experience of straining to breathe, or of coughing and wheezing, could simply make people feel anxious.

Then there are biological explanations. Allergies trigger the release of the stress hormone cortisol, which can interfere with a feel-good brain chemical called serotonin. It’s not clear how the cortisol does this, Nanda says; it might inhibit the production of serotonin or make it fail to bind with its receptors properly. But when something goes wrong with serotonin, the theory goes, depression or anxiety might set in.

Huh. I definitely suffer from seasonal allergies (they have thankfully slacked off for the summer) and have struggled with anxiety since I was a kid (though I’ve never been clinically diagnosed). I’ll be following this research with interest.