Thoughts of a retired physician

  Covid-19. Some say the playing field has changed with the advent of the Delta variant. I think the playing field remains the same but in baseball terms, the minor league club we were playing was switched out for the San Francisco Giants or the Chicago White Sox. Delta is a fitter virus, with both greater transmissibility and data that suggests greater lethality. We need to play the game with the tools we have, which are very good. Nonpharmaceutical interventions (especially masks and improved ventilation) along with vaccines work. If they are applied. In the 12 August edition of The Atlantic , Ed Yong wrote that the pandemic will end but just not the way we all hoped for. This means the virus, SARS-CoV-2, will become endemic, as other cousin coronaviruses have become. This will happen when we can disconnect the virus infection with SARS-CoV-2 with the disease Covis-19. That road will heavily depend on a vaccinated population and Yong correctly points out that means a globally vacci

  Love is blind . That idiom came up in a dinner conversation with friends several days ago. We were discussing the ongoing mess in Afghanistan in the context of American exceptionalism. One of our dinner companions posited that the idiom applies to too many Americans when we think about our country. He said that love is when you recognize the faults of another but choose to love them anyway; it is not blind but discerning and all the more meaningful because of that recognition.  Commodore Stephen Decatur gave a toast at a celebratory dinner after his victory over the Barbary pirates in 1816. He said, “ Our country - In her intercourse with foreign nations may she always be in the right and always successful, right or wrong .” That was paraphrased into the more jingoistic conclusion “... but our country, right or wrong .” But Carl Schurz, a Union general during the Civil War and later a U.S. Senator made the conclusion “... if right, to be kept right, and if wrong, to be set right .” I

The world looks bleak. Afghanistan. Covid. Climate change. Sedition. I am taking one post off. Back soon.

  In one of Sam Kean’s popular books on science, Caesar’s Last Breath: Decoding the Air Around Us , he makes the fascinating point that your next inhalation may very well include molecules of the air expelled with Julius Caesar’s last breath. The human body contains an estimated 7 octillion atoms -- that is the number 7 followed by 27 zeros. Preservation of mass means that these are atoms that have been in existence for billions of years. Everything we see and touch and ingest and inhale is ancient. We are literally made up of star-stuff . In the mid-20th century, man found out how to make certain elements lose mass -- nuclear fission. The rush to do that involved a terrible war and the prospect that our enemies would beat us to unlocking the secret. Of course, it was a race that the United States (with help from our allies and scientists expelled from Nazi Germany and Fascist Italy) won. On 16 July 1945 the first nuclear device, called The Gadget, exploded in New Mexico. Only 1.06

  Between 1901 and 1903 , the city of Boston, Massachusetts experienced its last outbreak of smallpox. There were 1596 cases and 270 deaths in a city with a population of roughly 561,000. The attack rate was 3 cases per thousand and the case fatality rate was 17 percent. Blacks and immigrants were overrepresented and the case fatality rate in unvaccinated people was twice that of the vaccinated. Massachusetts was at the time one of 11 states that had compulsory vaccination laws . The Anti-Compulsory Vaccination League endeavored to have the state law overturned but failed. A pastor in Cambridge, Henning Jacobson, sued Massachusetts because he said he had had a bad reaction to vaccination in Sweden before he immigrated to Massachusetts and therefore refused vaccination. His case was heard in 1905 by the Supreme Court. By a 7-2 majority, the Supreme Court decided that the Massachusetts law did not violate the Fourteenth Amendment. The Court held The Court held that "in every well or

  Short post today. We are experiencing an increasing number of cases of Covid-19 with rises also in hospitalizations and (this will be later) deaths. As one who devoted a career to infectious diseases and their prevention and cure, I am both frustrated and angry. Zeynep Tufecki has written a guest essay this morning in the New York Times whose title, “ American Dysfunction Is the Biggest Barrier to Fighting Covid ” is the best summation of the moment of where we stand and why. I simply recommend today reading her essay and thinking about our country. We collectively got ourselves into a jam with how this pandemic was approached in the first place. I am reading I Alone Can Fix It: Donald J. Trump’s Catastrophic Year by Carol Leonnig and Philip Rucker. Our nation remains saddled with the debris from Trump’s corrupt, incompetent mismanagement not only of the pandemic but of this attempt to subvert our democracy. His administration bears responsibility for over 600,000 dead Americans an

  The CDC Director, Rochelle Walensky, warned us this week that we are facing a “ pandemic of the unvaccinated .” As of 2 days ago, CDC reported about 185.4 million people have received at least one dose of vaccine and that 160.7 million have received two doses of either the Pfizer-Biontech or Moderna mRNA vaccines. From a peak of 3.38 million people receiving a dose of vaccine on 13 April, now we are seeing barely more than half a million doses administered daily across the United States. Unsurprisingly, the resultant map is a patchwork quilt of states that have done very well in getting their population immunized (Vermont 86% with one dose and 77% fully vaccinated; Hawaii 84.1% with one dose and 64% fully vaccinated) while other states have more dismal numbers (Louisiana 50.1% with one dose and 46% fully vaccinated; Mississippi 47.7% with one dose and 43% fully vaccinated). The result has been a distinct upswing in cases and hospitalizations with the dominance of the Delta variant .