Thoughts of a retired physician

Protest and Pandemics As the world continues to struggle with COVID-19 with its health and economic impacts, a white police officer in Minneapolis chose to kill an unarmed black man who was thought to be passing a counterfeit bill. The video of the death of George Floyd will remain indelibly etched into the minds of all for years to come. Protests against this act of overt police brutality swiftly followed, first in the Twin Cities and then across the United States and now the world. It appears that elements, either outside groups or among the protestors, have decided to make the protests bloody and fiery. At this time it is unclear who the instigators of violence are. There are signs on social media and in photos and videos of the protests that outside elements from the right-wing have decided this is an opportune time to seed further chaos in our society. It will require time and a full set of investigations, including forensic investigations of social media posts, to ascertain whe

Pacing and Podcasts As we passed Memorial Day this year, a vast unplanned experiment was unfolding in the United States and many other nations. After months of lockdown to slow the spread of COVID-19, the push to reopen society and the economy is gaining steam. Here in California, we are seeing a cautious set of strategies to do this. In some other places in the U.S., it seems a lot less cautious. Where are we going and what will happen? As part of my exercise program under lockdown, I have taken to pacing around our apartment to get my 10,000 steps daily done. I understand there is nothing magic about that number but it represents to me that I have made a reasonable effort on that day. A sort of psychological feel-good. To keep boredom at bay, and at the suggestion of several of my children, I find that listening to podcasts helps pass the time and allows me to understand more of what is happening in the world in the era of coronavirus. Two podcasts today were truly interesting. Bio

Memorial Day Today we honor those who gave their lives in service to the United States. We also honor the 100,000 Americans who have fallen to COVID-19 in the past several months. Decoration Day By Henry Wadsworth Longfellow Sleep, comrades, sleep and rest On this Field of Grounded Arms, Where foes no more molest, Nor sentry’s shot alarms! *** Ye have slept on the ground before, And started to your feet At the cannon’s sudden roar, Or the drum’s redoubling beat. *** But in this camp of Death No sound your slumber breaks; Here is no fevered breath, No wound that bleeds and aches. *** All is repose and peace, Untrampled lies the sod; The shouts of battle cease, It is the Truce of God! *** Rest, comrades, rest and sleep! The thoughts of men shall be As sentinels to keep Your rest from danger free. *** Your silent tents of green We deck with fragrant flowers Yours has the suffering been, The memory shall be ours.

Leadership One of my favorite authors is historian Jon Meacham. His essay in the New York Times Book Review of March 24th 2020 bears reading and contemplating. I was just beginning the 9th grade when the Cuban Missile Crisis occurred. It was very scary when the news presented the fact that Reading, Pennsylvania was within the range of Soviet missiles topped with nuclear warheads. I recognize now that, as Meacham writes, “President Kennedy was cool, rational, careful and willing to compromise.” And it was that approach that constituted real leadership in what many believe was a moment when the world could have easily suffered destruction from nuclear warfare. Meacham points out that Robert F. Kennedy’s memoir Thirteen Days: A Memoir of the Cuban Missile Crisis “shows us, the key point is that a president should be driven by facts, not preconceptions; by the larger good, not by pride. For pride, as the Bible taught us long ago, goeth before a fall.” While I am not a religious person

Squid Cephalopods such as the squid are often acknowledged as the most intelligent of the invertebrates. When threatened, squids have an interesting behavior: they release clouds of ink that baffle their predators and allow them to escape, much as warships have used smoke screens to escape when outnumbered or outclassed. This behavior is often used by politicians as well when they feel threatened. The release of disinformation by Donald Trump is a classic example of squid ink, meant to confuse and seed discord. With almost daily tweetstorms from his infamous Twitter account to bizarre statements in front of television cameras, he just piles disinformation atop misinformation atop gaslighting to create what Kellyanne Conway called “alternative facts”. While this is irresponsible and immoral in the best of times, it is a clear and present danger in the presence of a global pandemic that has sickened and killed and caused economic chaos worldwide. In reading his thoughts (if they may

Vaccines, Hydroxychloroquine, and Walls As have many days during this pandemic, strange things abound. A few days ago, Donald Trump announced that Moncef Slaoui would head Operation Warp Speed , the federal project to rapidly develop a vaccine for COVID-19. Slaoui, who has been the chairman of pharmaceutical giant GlaxoSmithKline’s global vaccines division and on the board of Moderna, a small biotech whose vaccine candidate was already in a Phase I trial in Washington state, made a cryptic statement regarding hopeful news on this front. Today the results of a preliminary report from that trial revealed some hopeful news ; there was no overt safety problem in trial participants and the vaccine appeared to generate antibodies to SARS-CoV-2 in the participants. On that news, Wall Street did one of its usual gyrations upward. The Dow rose today more than 900 points and the other major indices were also significantly boosted. We all like and really want good news in the midst of this pande

When You Post Disinformation I have had some interesting interactions with others on Facebook about the COVID-19 pandemic. One example was a post shared by someone from a right-wing website that alleged that wearing masks was dangerous and did not afford any protection from COVID-19. I read the post (after taking an antiemetic). It drew heavily from the work of a retired neurosurgeon who now makes a living writing books about alternative medicine and nutrition (no idea what his credentials are in those subjects), writing for conservative websites, and serving as a visiting professor at Belhaven University in Mississippi. In the post he alleges that wearing a mask makes healthy people sick because they have headaches and that masks allow SARS-CoV-2 to back up in the nasal passages and make their way to the brain via the olfactory nerves. Headaches are one of the commonest subjective complaints humans have. The scientific data implicating masks as the genesis of headaches are slim to

Four Pillars to Control COVID-194 This has been a long day with three Zoom calls and a lot of heavy discussion with others about controlling the COVID-19 pandemic, both in our own senior living facility and at other facilities as well. There is a wonderful article in the New Yorker yesterday by one of my favorite writers, Atul Gawande. Here is the link . Gawande is a surgeon at Massachusetts General Brigham in Boston, a group of large academic medical centers with 75,000 employees. He notes that they have significantly curbed SARS-CoV-2 infections among their staff by rigorously applying four pillars, what he calls a combination cocktail that can be applied to reopening the business side of our society as we deal with the pandemic. The pillars are already known to you. They are hygiene, distancing, screening, and masks. His cogent explanations for the science underlying them is written for the lay reader and is crystal clear. The importance of applying all  4 pillars is emphasiz

Fresh Air The disease is respiratory and airborne. Thousands are ill and dying. How to limit its spread and treat it are unknowns. COVID-19? No, tuberculosis. Called “The White Plague” for the associated pallor in its victims, it devastated populations around the world for millennia . In its complex history one can see the reflection of the pandemic we are living through today. And in that history are some genuine findings that can assist us in 2020 as this new pandemic is fought. The control of tuberculosis was well underway prior to the discovery of streptomycin, the first antibiotic with activity against Mycobacterium tuberculosis. The onset of the Industrial Age brought people in England and then in many other countries into crowded conditions which were often unsanitary and poorly ventilated. The air in industrial cities was foul with smoke and particulate matter now recognized as harmful to the lungs. Once TB entered a living space and was coughed out by the index case, the ba

Medicare for All I have been fortunate to have medical insurance for my entire lifetime. For many years I was not a large consumer of healthcare. While in the Navy I had care for a large kidney stone that required removal as well as a malignancy requiring surgery. The only bills I received were for the food I consumed while I was hospitalized. For those who have never been in the military, a reminder: military medicine is socialized medicine and it was damned good in my experience.  I needed spine surgery as a retiree. Medicare covered it along with my wife's Blue Cross/Blue Shield from her retirement as a government employee. I remember the explanation of benefits (EOB) for that procedure. The bills totaled almost $40K. That was not what was paid out by Medicare and the Blues, of course, but the providers accepted the payment. I did not have a bill. Earlier this year, as the COVID-19 pandemic was unfolding, I needed replacement of my aortic valve. I had a world-class team a

80,087. That is the number of American dead as I checked just now on the Johns Hopkins coronavirus website . I have been following the pandemic of COVID-19 from the outset and the Hopkins site has the best statistics available. We also just watched Trump at one of his typical pressers extol how well he has done in leading us through the pandemic. To believe Trump is to believe only his prescience and diligent work has saved millions of American lives. Tell you what -- believe none of it. There were two large signs flanking the platform in the Rose Garden he spoke from, saying “America leads the world in testing.” Despite being pressed by good questions from the journalists he sticks with the fantasy world he wants. As of May 9, Denmark has done the most tests for COVID-19 per thousand population: 53.34 per thousand, more than twice the rate of tests done in the United States. Italy, New Zealand, and Canada also exceed the U.S. rate. Trump loves to talk about raw numbers, probably beca

How has the Trump administration handled the COVID-19 pandemic? Answer: so poorly that the United States has almost 80,000 dead and is likely undercounting the death toll by a lot. All presidents must be prepared for a real crisis. The sociopathic narcissist currently in the office, caring nothing for anyone but himself, never prepared and then he and his minions bungled the response to a maximal degree. Without a vaccine, let alone a plan, the United States is floundering much as it floundered under the Articles of Confederation, multiple smaller polities doing in an uncoordinated way what should be happening at a national level. The consequences are both a grim public health problem and a grim economic situation. Other nations have handled both of these problems far better than the United States . The question of when this pandemic ends is unknown and not unitary as Gina Kolata notes. It is a multifaceted problem with public health, sociopolitical, and economic dimensions. I doub

In the time of COVID-19, what we all have is… time. In retirement, time may be viewed differently than when working. I empathize with everyone who has continued to work during stay-at-home and social distancing and even more so with those who have lost their jobs and are in economic peril. What are you doing with your time now? How might it be better? My favorite Founding Father was and is Benjamin Franklin. In his Poor Richard’s Almanac in 1746, Franklin wrote, “Dost thou love life? Then do not squander Time; for that’s the Stuff Life is made of.” Perhaps it really requires the accumulation of years to realize just how true this saying is. In reading the news today, I am struck how many people seem unable to deal with time in this public health crisis. There have been intervals in my lifetime that I realize have also been defined by time and place and a sense that something needed to be done to make me feel productive. A warship is a place of work but there is a lot of tim

My wife and I, both retired Navy medical officers, have lived in Southern California since 2016. With the lockdown necessitated by COVID-19, we have spent time educating our community (including our local League of Women Voters – Pasadena Area) about this pandemic. The stay-at-home orders leads one to find ways in retirement to feel productive. This was one of the first articles posted for our local LWV.   Life in the Time of Coronavirus Brought to you by Dr. TZ Healthy Living During COVID-19 Lockdown Anthony Fauci had a great saying about why we are practicing physical distancing during the COVID-19 pandemic: “The enemy of R naught is physical distancing.” Our job now in fighting this disease is largely to stop infections from occurring in the first place. This means we are primarily at home, avoiding contact with others. The stress of this isolation can lead to or worsen bad habits; we become even more sedentary in our ways and are tempted to eat and drink to help ass