Maggie's Farm

Some preliminary numbers are being put together, but time will tell.

1. Powerline reports on a numbers-cruncher:  A DATA-DRIVEN LOOK AT THE WUHAN CORONAVIRUS

2. More details on the above here: COVID-19 - Evidence Over Hysteria

3. The median incubation period is 5 days.   So without symptoms after a close exposure for a week or so, you likely aren't infected.

4. In the US you can see numbers of cases (+ tests) rising rapidly. That doesn't mean the numbers of cases are increasing that rapidly. It means more people are getting tested.

5. This germ does not appear to be spread as easily as feared, but I were elderly (80+), frail, overweight, or with significant pre-existing ailments, I would self-quarantine for a while. Not sure what "a while" means, yet.

6.  What Does Having Coronavirus Feel Like? Here’s What Survivors, Patients Say

7. My expert medical friends tell me we'll have a good idea of when the infection rate will plateau or begin its downturn in the next 5-10 days. Can't go by "cases," though. 

Addendum: For those who chose to be quarantined at home, we recommend several activities: Sex, home workouts, taking hikes or runs outdoors, reading Maggie's, doing one or two of The Great Courses, getting some outdoor clean-up done, doing an hour of paperwork, cleaning some closets and getting rid of junk, and having civilized cocktail hours. All sorts of ways to make the most of it. Churches are live-streamed now, so that too.

Epidemics typically fizzle out with warm weather, and through "herd immunity." 

The real purpose of precautions is to change the shape of the epidemic curve from a steep up and down to a slower, gradual up and down. That helps with demands on medical care, but does not reduce exposure, or the numbers of people exposed. Viral epidemics can not be stopped, just slowed. Flattening the curve is the purpose of public health.

Thus far, the Covid-19 has not been very dangerous compared with the ordinary flu for those under 70. We'll know in the next two or three weeks as the curve peaks, and begins to decline in the US.

Viruses are strange, parasitic things, hardly living things in the ordinary sense. 

How Coronaviruses Cause Infection—from Colds to Deadly Pneumonia. The novel coronavirus outbreak raises questions about how such pathogens evolve and what makes infections mild or severe.

They are annoying in the kitchen, but why are they so useful? 

 Modern genetics would not be possible without the humble fruit fly.

It is hubris to imagine that all problems have solutions. It is nihilistic to imagine that none of them do. Curing death and other ills

This concerns myelin. Could be a theory:

 Researchers Link Autism To A System That Insulates Brain Wiring

 Brain Connectivity and the Role of Myelin in Autism Spectrum Disorders

 Inadequate Myelination of Neurons Tied to Autism: Study

A reader wondered about an article about the politics of medical research, with Alzheimer's as an example.

Everybody knows that academic politics are ugly. Alzheimer's is uglier than that, and there is lots of money available too.

The problem with searches for cures is that the #1 risk factor for Alheimer's is genetic, via the maternal line.  If your Mom has it, your odds for it are worrying but not certain. The second risk factor is being overweight. The viral idea doesn't really seem to fit with the genetic. Maybe they are synergistic? Who knows?

Genetic testing for Alheimer's risk is available at any age. With certain genetic conformations, your risk is almost certain. Bad news.

From all I have read about it (not an expert at all), the brain rot begins long (years, even decades) before there are obvious clinical symptoms other than, maybe, being less energetic, social, and driven.  My amateur guess is that the brain tangles and brain shrinkage are not causal, but results of a genetic brain rot, a sort of programmed obsolescence. 

"Cures" for genetically-weighted diseases are elusive, of course, because they are baked in the cake. Unbaking a cake is a tough challenge. 

Carpe diem. 

If you are serious, you get with the program today, not next year. January 1 is for suckers.

Of interest,  Exercise linked to lower risk of 7 cancers, study finds. Cancers of the kidney, liver, breast and colon may all be fended off by increased physical activity.

A recently-retired friend decided to take up EMT training. He wants to remain a useful citizen. Thus far, he loves it more than he ever liked his job. The chance to save a life is an appealing thing, while learning all sorts of new skills.

As an MD, I have to admit that these people can do things that I have no clue about how to do. Never learned, or can't remember. Most of the car crash victims I saw in ERs were DOA, and most MI people were beyond saving. Death happens, often, as it must. That was a while ago, though.

There are several levels of it, so you can keep aspiring. There is always work too, part-time or full, or volunteer.

When we walk into a patient’s room, we are entering a story.

That's the correct medical attitude. It doesn't apply to the purely technical specialties, though. 

Why Hard Belly Fat Is More Dangerous Than Soft Fat

People always say "Diet and Exercise." Unless you hike 10 miles daily, or work out 2 hrs/day, I just say "Nutrition" to lose bad fat. Not "diet," "nutrition" because diets fail but appropriate nutrition is a way of life. Just enough of pretty good things for the fitness you want. That article more or less says the same thing. 

Daily exercise is great for fitness, but not for fat. The bonus is that the less fat you are carrying, the better your exercise and activity endurance. 

That's enough annoying preaching for today. 

Brief article here.

Never forget that pain relief is one of the miracles of modern medical practice. 

Joseph Henry Green  (1791-1863), an English surgeon who became the literary executor of Samuel Taylor Coleridge.  The word was spoken upon checking his own pulse.

Joseph Henry Green, a surgeon and professor of anatomy, suffered from inherited gout and died of an acute seizure at his house in 1863.  

An account of his final moments has been given by Sir John Simon:

“I would show that not even the last sudden agony of death ruffled his serenity of mind, or rendered him unthoughtful of others. No terrors, no selfish regrets, no reproachful memories, were there. The few tender parting words which he had yet to speak, he spoke. And to the servants who had gathered grieving round him, he said, ‘While I have breath, let me thank you all for your kindness and attention to me’.

Next, to his doctor, who quickly entered – his neighbour and old pupil, Mr. Carter – he significantly, and pointing to the region of his heart, said – ‘congestion’. After which, he in silence set his finger to his wrist, and visibly noted to himself the successive feeble pulses which were but just between him and death. Presently he said – ‘stopped’. And this was the very end. It was as if even to die were an act of his own grand self-government. For at once, with the warning word still scarce beyond his lips, suddenly the stately head drooped aside, passive and defunct for ever. And then, to the loving eyes that watched him, ‘his face was again all young and beautiful’. The bodily heart, it is true, had become more pulseless clay; broken was the pitcher at the fountain, broken at the cistern the wheel; but, for yet a moment amid the nightfall, the pure spiritual life could be discerned, moulding for the last time into conformity with itself the features which thenceforth were for the tomb.”

You have to admire someone who takes his own pulse and pronounces himself dead.  Now that’s cool.

"To lengthen the life, lessen the meals."

Benjamin Franklin 

That's in Bill Bryson's excellent new book The Body: A Guide for Occupants. Even doctors can enjoy it.

The terror of medical opioids is on an upswing. I have seen the upswings and downswings during my career. I wish we could find a middle course, because medical opioids are a blessing to suffering people. Yes, I include Oxycontin in that because it is an excellent medicine.

Of course opioids are habit-forming. For refractory pain, they are also life-giving. For people with life-impairing chronic pain, there is something called "pseudoaddiction."  AGAINST AGAINST PSEUDOADDICTION

These days, I have seen people in that category treated like drug addicts. Sooner or later, there will chemicals with the pain effects of opioids but without the habit-forming effects. Not yet.

Excellent summary on the mental and physical benefits of exertion: The New Science of Exercise:

Doctors, researchers, scientists--even ancient philosophers--have long claimed exercise works like a miracle drug. Now they have proof.

As I have said before, a rigorous exercise program might not extend your life. It will definitely enhance and extend your quality of life even if you begin it at any age. Everybody knows that they ought to do it, but it's hard and it hurts and we're lazy and "busy."  Plus there is that terrible part: delayed gratification. Everybody hates that. As I say, "The flesh is willing but the spirit is weak."

Our quite well-informed recommendations for general fitness and conditioning for the ordinary person who wants to achieve or maintain maximal functionality for life:

1. Nutrition: Don't be visibly overweight - it's the worst thing you can do to yourself besides being an addict, and no exercise can help being fat. Does a demanding exercise program require a specific pattern of nutrition? Yes. We have discussed that in previous posts here. With a serious exercise program, you have to keep up with the protein and fats - approx. 70-90 gms of protein/day.
2. Weight training - as heavy as possible, approx 50 minutes twice a week
3. 1-2 hrs total of calisthenics/wk for mobility, balance, and athleticism
4. 2 or 3 twenty-min sessions of cardio intervals/wk  (HIIT). (For HIIT, I do stairs once, elliptical once, rowing once. Occasionally sprints in the pool.) Can add an hour of endurance cardio.

Under age 35, it can take 12 months to be whipped into decent shape. Over 35-40, depending on your fitness starting point, 18-24 months. Intense sports like basketball can substitute for calisthenics. Yoga is excellent, but does not substitute for any of the above. Many men find Yoga to be quite challenging and helpful. Lots of pro football players do it. If your day job is physical, all of the above recommendations would differ.

Choosing a Good Death

It's never too soon to have a Will, and a Living Will. Trouble can strike at any time as we all have seen.

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

The press makes it all even worse, just to make a story. People of the press rarely have STEM degrees. 

Not what they were cracked up to be: Meta-analyses were supposed to end scientific debates. Often, they only cause more controversy.

When and why did "medical care" become "health care"? It has been a puzzlement to me. When I first heard the term, I thought "What?!?"

Is it just euphemisn, or something more?  

At least 80%,  likely more. Genes plus errors in wiring.

Given the complexity, I have always been amazed by how often the wiring works fairly well.