Sunday, March 31, 2024

Better a vaccine without an epidemic than an epidemic without a vaccine

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 137. I found this whole chapter terrific.  In 1976 the CDC et al were forced to make a decision great uncertainty and with poor comprehension of future estimates and especially future trade-off risks.  Their position was virtually identical to that of the CDC in 2020 with Covid-19.  They could imagine how bad it might be but they could not know.  They were far better (though not especially good) at estimating the first order costs and benefits but terrible at estimating the second order risks and consequences.  Decisions were made on the hoped for up-side benefits while ignoring the easily anticipated downside risk costs.  

It was clear that we could not say the virus would spread. But it was clear that there had been human-to-human spread at Fort Dix. It was also clear that there was not any immunity in the population to this virus, not if you were under 50 (or maybe 62).” That meant, he said, that “most people were at risk, especially young adults. An epidemic spreading into a pandemic had to be considered as a possibility.”

And even though the virus seemed to have disappeared from Fort Dix, after infecting only a few men there, no one could guarantee that it was really gone, Dowdle said. “Flu could do strange things. Six weeks was a short time. We had to report our fundamental belief that a pandemic was indeed a possibility.”

The difficulty, Kilbourne said, was in assessing the risk. As an advisor to the proposed vaccine program and an advocate of it, he noted, “I found it difficult to convey accurately and understandably a scientifically informed perception of the relation of the new virus to the putative 1918 agent and of the hazard it presented.” The Fort Dix virus came from swine, but that was a slim reed for the scientists. They did not have any way of deciding how dangerous a flu virus was without seeing it in action in a population. They could not compare the Fort Dix virus to the flu virus of 1918 because no one had any samples of the 1918 virus for comparison.

Kilbourne described the dilemma: “Therefore, one could only say that the Fort Dix virus might be more virulent, as virulent, or less virulent,” in comparison to the 1918 flu virus. “The limited clinical information from authenticated Fort Dix cases was inadequate to judge the virus’ potential, but its association with pneumonia and death in young recruits certainly provided no comfort.”

If the government decided to go ahead with a national swine flu immunization campaign, there literally was no time to waste. It would take months to make the vaccine and eight to ten weeks to distribute it nationally, the first time ever that so many people would be receiving a vaccine. It takes two weeks for a vaccinated person to become immune to the flu. And so the time from the manufacture of a swine flu vaccine to the successful immunization of most of the nation was going to be at least three months.

One option was to make the vaccine and store it, waiting to see if a deadly swine flu pandemic really did occur. That, however, could prove disastrous, the scientists at the meeting decided, since the flu could spread throughout the world overnight. “Better to store the vaccine in people than in warehouses,” one meeting participant said.

But Dowdle and others were hardly enthusiastic about taking immediate action to immunize the nation against swine flu. Neustadt and Fineberg interviewed a staff member at the Centers for Disease Control at that March 9 meeting who requested anonymity and who explained:

“There was nothing in this for the CDC except trouble. Here we were at the end of one flu season with time to try to do something before the next flu season. The obvious thing to do was to immunize everybody. But if we tried to do that, guide it, help it along, we might have to interrupt a hell of a lot of work on other diseases.”

Suppose there was an influenza pandemic, the meeting participant said. An immunization program was an almost certain invitation to disaster. Those who had been unable to get the flu shots in time would be angry because they would be vulnerable. Those who were immunized but who caught another virus that they thought was the flu would be annoyed because they would assume that the vaccine did not work. All in all, millions of people would be upset. Yes, a repeat of 1918 was unlikely. But, the participant said. “who could be sure?” And if it happened, “it would wreck us.”

Then take the other side of the argument, supposing there was no pandemic. Then, the staff member said, the Centers for Disease Control could be accused of wasting money, of “crying wolf,” he said. Everyone, from the people who got the shots to those who administered them, would criticize the agency. “It was a no-win situation,” the participant concluded.

The final decision on March 9 was predictable, however. These, after all, were people whose mission it was to protect public health and prevent disease. “Better a vaccine without an epidemic than an epidemic without a vaccine,” Kilbourne said.”

"Better a vaccine without an epidemic than an epidemic without a vaccine" is true only if you know the effectiveness of the vaccine, the lethality of the virus, and the potential negative side-effects of a new vaccine on a whole population.  They did not know any of these things and therefore Kilbourne's dictum was inoperable. 

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Roofs of Paris by Yukiko Noritake

Roofs of Paris by Yukiko Noritake 































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Saturday, March 30, 2024

So small that it can be dismissed as a reasonable possibility.

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 135. 

In the meantime, doctors continued to monitor the situation at Fort Dix. Men were still becoming ill with influenza, but almost all of them had the A/Victoria strain. Yet there were troubling signs that swine flu was there. Virologists found swine flu virus in a fifth man who had gotten sick in February and eight men who had recovered from flu had had swine flu, according to blood antibody tests. When doctors at Fort Dix looked for swine flu antibodies among the men, they discovered that as many as 500 of them had swine flu antibodies, indicating that they had been infected by the virus as well.

At the same time, civilians who lived near Fort Dix did not seem to be infected with anything other than A/Victoria. Neither did people living elsewhere in New Jersey. And when the Army looked at other bases they could find no swine flu. Moreover, the National Institutes of Health and state public health officials could not find any swine flu cases among civilians. When the Centers for Disease Control asked the World Health Organization to check for swine flu cases in other countries, the group reported that it could find no evidence of the virus abroad.

Goldfield, speaking about the incident a year later, was frank about the dilemma. “The experience certainly was unusual,” he said. “A radically new strain had appeared in a civilian population and had died out, apparently, the first week of February. It would seem that it hadn’t survived competition with A/Victoria. On the other hand, there has never been a recognition of a radically new strain of A which spread from human to human and did not turn out to be pandemic. The likelihood that the new strain could have started at Fort Dix and was found by us at the first attempt is so small that it can be dismissed as a reasonable possibility.”

Kilbourne said he, too, was conflicted over the failure to find evidence that the swine flu virus had spread. “After Fort Dix, there was a long hiatus when nothing happened; in spite of the fact that there was a hothouse situation in the military barracks, it was not transmitted to the outside community.”

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Interior of a Prison with Saint Peter escaping with the Angel by Pieter Neefs the Younger (1620-1659)

Interior of a Prison with Saint Peter escaping with the Angel by Pieter Neefs the Younger (1620-1659)



























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Friday, March 29, 2024

The suggestion went unremarked.

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 87. An example of the role of contingency and serendipity in discovery.

On that fateful day in 1950, Hultin woke up early, as was his habit, in the small room in Iowa City that he and his wife, Gunvor, were renting. After breakfast, he set off immediately to work on his influenza project in a lab at the university. The lab was a large room filled with graduate students, each at his or her bench, each conducting experiments that would form the basis for a postgraduate degree. Every now and then, eminent microbiologists would pass through town and would be ushered into the lab to see the busy students at work. That morning, as Hultin looked up from his lab bench, he noticed that the head of the microbiology department, Roger Porter, was escorting William Hale, a well-known virologist from Brookhaven National Laboratory. Porter would stop at each student’s bench and tell Hale what the student was doing. When he came to a student whose work was particularly interesting, Porter would pause and explain the work more fully.

When the men came to Hultin’s lab bench. Hultin recalls, Porter said simply, “Here’s Johan Hultin. He’s from Sweden and he’s working on the influenza virus.” Then they moved on.

A few minutes later, however, Porter brought Hale back to Hultin’s bench, remarking, “Bill, you’ve got to see what this fellow Hultin here has made.” It was a jury-rigged device involving a Bunsen burner, one of those ubiquitous gas burners used in labs to heat liquids, and an alarm clock that Hultin had modified to solve a vexing problem. 

[snip]

Porter thought that Hale might be amused by Hultin’s device. “He asked me to demonstrate,” Hultin said, explaining to Hale that it would not take long. “Then he asked me to set the alarm for ten seconds. After ten seconds, the alarm rang and the gas turned off. Hale just stood there. He said, ‘My God. For eighty years people have been ruining experiments around the world. And no one thought of this simple solution.’”

The men walked away, with Hale shaking his head in amazement. Two hours later, a secretary walked up to Hultin in the lab and told him that Porter had invited him to have lunch with Hale and several other select students and faculty members. It was a lunch in the faculty dining room, the sort of gathering that universities often arrange as an opportunity for the most promising or most senior graduate students to meet leading scientists from elsewhere. Such visitors might prove to be valuable contacts for students in the future. In the meantime, faculty members can have an opportunity to exchange their latest thoughts and data with intellectual leaders in their field. Hultin’s faculty advisor was present, as was Porter, four other faculty members, and three graduate students. And, of course, Hultin, who was invited in recognition of his invention.

That day, Hultin said, the conversation around the table at lunch ranged widely, focusing on science but flitting from topic to topic. Then Hale made an offhand remark about the 1918 influenza epidemic. It was a remark that was to change Hultin’s life.

“Everything has been done to elucidate the cause of that epidemic. But we just don’t know what caused that flu. The only thing that remains is for someone to go to the northern part of the world and find bodies in the permafrost that are well preserved and that just might contain the influenza virus.”

Hale was saying that if someone could find bodies of flu victims that had been frozen since the day they died, the intact virus that had killed them might be chilled to a state of suspended animation. If those corpses had remained buried in permanently frozen ground in the northern regions, the influenza virus that was in their lungs might still be alive. And if the virus could be brought back to the laboratory and revived, scientists might study it and figure out why it was so deadly. They also might be able to produce a vaccine against the disease.

The suggestion went unremarked. “It was a very short comment, it took just ten or fifteen seconds,” Hultin said. “Then he went on to something else.” But Hultin was transfixed. Of all the people in the room, of all the people in the world, he was uniquely positioned to do just what Hale had suggested. By chance alone, Hultin knew where to find permafrost, he knew how to find tiny outposts where people lived in regions where the ground was frozen year-round, he knew how to get permission from relatives to exhume flu victims buried in permafrost, he knew how to take tissue samples and how to preserve them, he knew how to coax viruses to grow in the laboratory, and he was working with a professor who was a renowned leader in influenza and could help him figure out the virus’s secrets.

“I knew this was for me,” Hultin recalled.

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Spring, 1896 by Harald Slott-Moller (Danish, 1864-1937)

Spring, 1896 by Harald Slott-Moller (Danish, 1864-1937)





























Click to enlarge.

Thursday, March 28, 2024

Made a mockery of the newfound optimism

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 53. 

In asking why [nobody notices the lethality of the 1918 flu], Crosby proposes a combination of factors that, he said, acting together accounted for the world’s collective amnesia. For one, he argues, the epidemic simply was so dreadful and so rolled up in people’s minds with the horrors of the war that most people did not want to think about it or write about it once the terrible year of 1918 was over. The flu blended into the general nightmare of World War I, an unprecedented event that introduced trench warfare, submarines, the bloody battles of the Somme and Verdun, and the horrors of chemical warfare.

Moreover, the epidemic had no obvious dramatic effect. It did not kill a world leader. It did not usher in a long period in which death from influenza was a new and constant threat. It did not leave behind legions of crippled and maimed or disfigured survivors who would serve as haunting reminders of the disease.
His latest hypothesis, he said in an interview in August 1998, is that in the fifty years preceding the 1918 flu, the world had been through one of the most profound revolutions ever to change the course of history: the germ theory of disease. “Every eighteen months, a new pathogen was identified, and it went on for years,” Crosby noted. Each discovery drove home the message that science was conquering disease. As the drumbeat of infectious agents continued, people “heaved a great sigh of relief. At last infectious disease was not important anymore,” Crosby concludes.

Then came the flu epidemic, which made a mockery of the newfound optimism. And when it ended, Crosby posits, perhaps the most comforting reaction was to forget about it, to push it to the back of humanity’s collective consciousness as quickly as possible. To “see no evil, hear no evil.”

Arbitrary, inept, and unwilling to meet their most basic obligations

Whether his forecast is correct or not, I don't know but I think his analysis is well formed.  From Law and Order Is a Killer Problem for Democrats by Charles Lipson.  

Each of these issues – massive illegal immigration, biased law enforcement, the erosion of property rights, and “Get Trump” lawfare – is important in its own right. Together, they are even more important. Taken together, they reinforce Americans’ sense of unease, social division, and betrayal by a justice system tilted against political enemies. They are frustrated by governments at all levels that seem arbitrary, inept, and unwilling to meet their most basic obligations.

My fear is it did exactly that.

An entertaining and informative essay.  From Twilight of the Wonks by Walter Russell Mead.  The subheading is The 100-year reign of impeccably credentialed but utterly mediocre meme processors is coming to an end

Impostor syndrome isn’t always a voice of unwarranted self-doubt that you should stifle. Sometimes, it is the voice of God telling you to stand down. If, for example, you are an academic with a track record of citation lapses, you might not be the right person to lead a famous university through a critical time. If you are a moral jellyfish whose life is founded on the “go along to get along” principle and who recognizes only the power of the almighty donor, you might not be the right person to serve on the board of an embattled college when the future of civilization is on the line. And if you are someone who believes that “misgenderment” is a serious offense that demands heavy punishment while calls for the murder of Jews fall into a gray zone, you will likely lead a happier and more useful life if you avoid the public sphere.

The spectacle of the presidents of three important American universities reduced to helpless gibbering in a 2023 congressional hearing may have passed from the news cycle, but it will resonate in American politics and culture for a long time. Admittedly, examination by a grandstanding member of Congress seeking to score political points at your expense is not the most favorable forum for self-expression. Even so, discussing the core mission of their institutions before a national audience is an event that ought to have brought out whatever mental clarity, moral earnestness, and rhetorical skills that three leaders of major American institutions had. My fear is it did exactly that.

[snip]

Sitting atop these troubled institutions, we have too many “leaders” of extraordinary mediocrity and conventional thinking, like the three hapless presidents blinking and stammering in the glare of the television lights. Assaulted by the angry, noisy proponents of an absurdist worldview, and under pressure from misguided diktats emanating from a woke, activist-staffed Washington bureaucracy, administrators and trustees have generally preferred the path of appeasement. Those who best flourish in administrations of this kind are careerist mediocrities who specialize in uttering the approved platitudes of the moment and checking the appropriate identity boxes on job questionnaires. Leaders recruited from these ranks will rarely shine when crisis strikes.

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In the Hopper house Painting by Chiara Cappelletti

In the Hopper house Painting by Chiara Cappelletti






















Click to enlarge.

Wednesday, March 27, 2024

“21 million people? One sentence? Hello?”

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 52. 

Alfred Crosby, puzzling over the epidemic’s impact, went to the Reader’s Guide to Periodical Literature from 1919 to 1921 and counted the column inches devoted to the influenza epidemic as compared with other topics. There were, he wrote, 13 inches citing articles on baseball, 20 inches on Bolshevism, and 47 on Prohibition. Just 8 inches of citaions referred to the flu.

Crosby looked at a recent edition of the Encyclopaedia Britannica. The 1918 flu got three sentences. He looked at a recent edition of the Encyclopedia Americana. One sentence was devoted to the flu, and it said that the epidemic killed 21 million people. “That was a gross understatement,” Crosby says. But even so, he remarks, “21 million people? One sentence? Hello?”

When soldiers died of the flu, the cause of their deaths was sometimes hidden in euphemisms, Crosby notes. “At a memorial service for the pandemic dead at Fort Meade, Maryland, the presiding officer read the names of the dead one by one to a massed battalion, and as each name rang out, the sergeant of the man’s company saluted and responded, ‘Died on the field of honor, sir.’” 

When the history textbooks were written, recording for students the events that academic experts deemed important for them to know, once again the flu did not seem to be worth mentioning. Crosby examined college history textbooks, looking for the 1918 flu. He remarked that the epidemic was notable mostly by its absence. “Of the best-selling college texts in United States history, books by such historians as Samuel Eliot Morison, Henry Steele Commager, Richard Hofstadter, Arthur Schlesinger, Jr., C. Vann Woodward, and Carl Degler, only one so much as mentions the pandemic. Thomas A. Bailey in The American Pageant gives it one sentence and in that sentence understates the total number of deaths due to it by at least one-half.”

Medical scientists are amazed by the great silence, in view of the influenza epidemic’s dramatic impact, not just on mortality statistics or an army’s ability to fight but in everyday life. They recall that citizens wore white gauze masks in public in a vain attempt to protect themselves. Funerals were limited to fifteen minutes. Coffins were in short supply. Morticians and gravediggers could not keep up with the demand for their services. In Philadelphia, so many bodies had piled up in the morgue that the embalmers said the conditions were “so offensive” that they would not enter it. Public gatherings were prohibited in many cities and some places made it a crime to cough, sneeze, or spit in public. In Washington, D.C., even the Supreme Court adjourned so that, as Justice Oliver Wendell Holmes put it, they could spare lawyers from having to “enter this crowded and infected place.” And Washington hospitals were so crowded that they stationed undertakers at their doors to remove each body as soon as death occurred to make room for another patient. “The living came in one door and the dead went out another,” one doctor noted. No one could avoid knowing that a deadly epidemic was stalking the land.

But the flu was expunged from newspapers, magazines, textbooks, and society’s collective memory.

Crosby calls the 1918 flu “America’s forgotten pandemic,” noting: “The important and almost incomprehensible fact about the Spanish flu is that it killed millions upon millions of people in a year or less. Nothing else—no infection, no war, no famine—has ever killed so many in as short a period. And yet it has never inspired awe, not in 1918 and not since, not among the citizens of any particular land and not among the citizens of the United States.

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The Duchess by Vincent Figliola (American, b.1936)

The Duchess  by Vincent Figliola (American, b.1936) 


















Click to enlarge.

Tuesday, March 26, 2024

“So they thought it really worked.”

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 22.  Ignorance, fear, courage, anecdote, blind action with reason or evidence.  1918 looks like 2020.  Except that we were lucky in 2020.  Covid-19 was not as infectious or lethal as Spanish flu.  

Buffalo Bill Cody lost his daughter-in-law and grandson. Writer Mary McCarthy was orphaned and sent to live with her uncle.

In France, John McCrae, a Canadian doctor assigned to the Medical Corps, had written the most famous poem about World War I, “In Flanders Fields.” It is a paean to soldiers who died in battle: “In Flanders fields the poppies blow, between the crosses, row on row.” McCrae himself died in the war, but not in battle. He was felled by pneumonia in 1918—which leading virologists say almost certainly was caused by influenza.

A doctor at the University of Missouri, D. G. Stine, wrote that from September 26 until December 6, 1918, 1,020 students got the flu. “I saw one patient die within 18 hours of this disease and 12 hours after being put to bed. I have seen a number of others menaced with death during the first 48 hours of the disease. The statement that influenza is uncomplicated is, I believe, erroneous,” he wrote.

At Camp Sherman in Ohio, 13,161 men—about 40 percent of those at the camp—got the flu between September 27 and October 13, 1918. Of them, 1,101 died.

Army doctors tried every measure to stem the epidemic. They inoculated troops with vaccines made from body secretions taken from flu patients or from bacteria that they thought caused the disease. They made the men spray their throats each day and gargle with antiseptics or alcohol. They hung sheets between beds, and at one camp they even hung sheets in the centers of tables at mess halls. At Walter Reed Hospital, soldiers chewed tobacco each day, believing that it would ward off the flu.

Public health departments gave out gauze masks for people to wear in public. A New York doctor and collector of historical photographs, Dr. Stanley B. Burns, has a photograph in his archive of a minor league baseball game being played during the epidemic. It is a surreal image: The pitcher, the batter, every player, and every member of the crowd are wearing gauze masks.

In Tucson, Arizona, the board of health issued a ruling that “no person shall appear in any street, park, or place where any business is transacted, or in any other public place within the city of Tucson, without wearing a mask consisting of at least four thicknesses of butter cloth or at least seven thicknesses of ordinary gauze, covering both the nose and the mouth.”

In Albuquerque, New Mexico, where schools were closed and movie theaters darkened, the local newspaper noted: “the ghost of fear walked everywhere, causing many a family circle to reunite because of the different members having nothing else to do but stay home.”

Doctors gave out elixirs and vaccinated people against the flu, but to no avail. Crosby wondered about those flu vaccines. What was in them when no one knew what was causing the flu? He interviewed a doctor who had helped produce flu vaccines in 1918. The doctor, Crosby said, told him that the vaccines were just a soup made of blood and mucus of flu patients that had been filtered to get rid of large cells and debris. When they injected it into people’s arms their arms became horribly sore. “So they thought it really worked.”

Anecdotes spread. There was the story of four women who played bridge together one night. The next day, three were dead from the flu. There were tales of people who set off for work and died of influenza hours later.



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Tea And Toast, by William B Hoyt (American, b.1945)

Tea And Toast, by William B Hoyt (American, b.1945)















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Monday, March 25, 2024

Most cases went unreported and the true numbers will never be known

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 18.  In the modern city of Philadelphia, the account reads very similar to corresponding accounts from the Middle Ages and the Black Death or from ancient accounts from the Roman Empire and earlier.  

Perhaps Philadelphia was ravaged early in the epidemic’s course because the flu spread so easily from the city’s Naval Yard. The flu first struck those Navy seamen on September 11, 1918, not long after it had arrived in Fort Devens. Or perhaps it was because the city was near two large Army camps, Fort Dix in New Jersey and Fort Meade in Maryland, and both of them were hit by the flu a few days later. Or perhaps “the flu got its start in Philadelphia because the city had a huge Liberty Loan Drive parade, which drew a crowd of 200,000 on September 20. Or maybe it was all of these combined that gave the virus its foothold. But whatever the reason, Philadelphia was among the hardest hit of all American cities. And it was almost completely unprepared.

Few public officials anticipated the disaster and almost no members of the public did. The outbreak, in fact, was preceded by soothing words from medical authorities with a sort of band-played-on bravado. The Journal of the American Medical Association opined that medical authorities should not be alarmed by the flu’s nickname, “the Spanish flu.” That name, the journal wrote, “should not cause any greater importance to be attached to it, nor arouse any greater fear than would influenza without the new name.” Moreover, the journal said, the flu “has already practically disappeared from the Allied troops.”

Yet as the flu spread, the city did take a few precautions. On September 18, its health officials began a public campaign against coughing, spitting, and sneezing. Three days later, the city made influenza a reportable disease, which meant that records had to be kept of numbers of cases. On that same day, September 21, however, scientists reported good news—it seemed that the battle against influenza was won. The Philadelphia Inquirer wrote that researchers had found the cause of the flu—a bacterium called Pfeiffer’s bacillus. As a consequence, the paper wrote, the finding has “armed the medical profession with absolute knowledge on which to base its campaign against this disease.”

But by October 1, the city was under siege. In one day, 635 cases of the flu were reported to public health officials. That, however, was an underestimate. Doctors had become so overwhelmed caring for the sick that most cases went unreported and the true numbers will never be known. On October 3, the city closed all schools, churches, theaters, pool halls, and other places of amusement in a frantic attempt to slow the spread of the disease.

In the week that ended on October 5, as many as 2,600 were reported to have died in Philadelphia of the flu or its complications. The next week, the flu death reports reached more than 4,500. Hundreds of thousands were ill. Sick people arrived at teeming hospitals in limousines, horse carts, and pushcarts.

Within a month after the flu arrived in Philadelphia, nearly 11,000 people died from the disease. On one fateful day, October 10, 1918, 759 Philadelphia flu victims died.

“Visiting nurses often walked into scenes resembling those of the plague years of the fourteenth century,” wrote historian Alfred W. Crosby. “They drew crowds of supplicants—or people shunned them for fear of the white gauze masks that they often wore. They could go out in the morning with a list of fifteen patients to see and end up seeing fifty. One nurse found a husband dead in the same room where his wife lay with newly born twins. It had been twenty-four hours since the death and the birth and the wife had had no food but an apple which happened to be within reach.”

Undertakers were overwhelmed, observed Crosby. “On one occasion, the Society for Organizing Charity called 25 undertakers before finding one able and willing to bury a member of a poor family. In some cases, the dead were left in their homes for days. Private undertaking houses were overwhelmed and some were taking advantage of the situation by hiking prices as much as 600 percent. Complaints were made that cemetery officials were charging fifteen dollar burial fees and then making the bereaved dig graves for the dead themselves.”

At the city morgue, bodies were piled three and four deep “in the corridors and in almost every room,” Crosby said. They were “covered only with dirty and often bloodstained sheets. Most were unembalmed and without ice. Some were mortifying and emitting a nauseating stench. The doors of the building were left open, probably for circulation of air, and the Grand Guignol chaos was on view to anyone who cared to look in, including young children.”
 
Philadelphia’s nightmare was a prelude to an epidemic that roared throughout the world, bringing with it accumulating tales of horror. No place was safe, few families were spared. By the first week of October, the flu had spread to every part of the globe except for a few remote islands and Australia.

Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata

Just finished Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  In some ways an awkwardly written book but in others, revelatory.  Lots of passages worth quoting, which is always a good mark.  

I have more than a passing interest in the history of disease and have at least half a dozen and probably closer to a dozen books on the Spanish Flu of 1918, one of the great tragic mysteries of history.  

This book was published in 1999 and so now has quite a bit of value as it paints an independent picture untainted by the epistemology or the politics of Covid-19 in 2020.  

I learned a great deal from Kolata's account but there are probably two primary take-aways.

The first is the near exact replication of failure in terms of the Public Health response to the Swine Flu outbreak of 1976 and the global Covid-19 pandemic in 2020.  In both instances there is a pattern of almost always making the wrong decision in a sequence of decisions and there is a shared deficit in basic project management skills.  Simple things like defining the disease of concern.  Measuring it in a fashion that excludes similar diseases.  Failure to anticipate mass deployment issues, especially the challenge of monitoring responses to the vaccinations and confounding illnesses.  The failure to have a measurement mechanism in place which could distinguish between deaths from the disease, deaths from the vaccination, and deaths misattributed.  

The 1976 Swine Flu is just on the edge of my adult memory.  It first showed up at Fort Dix in roughly central New Jersey in January and February of that year.  I arrived from Sweden in August to attend the Lawrenceville School in August, my first time of living in the US.  I remember reading a few references to the Swine Flu outbreak but the news was actually dominated by the first deaths in late July from what would become known as Legionnaire's Disease from a convention of Legionnaires held in Philadelphia.  

So I knew of the 1976 Swine Flu outbreak but little more than that it had occurred and that there was a massive nationwide effort at immunization that petered out before it reached even the majority of the population.  

Kolata's account was new to me, revelatory and gripping.  Just as with Covid-19, it caught the CDC by surprise, they didn't know what to do, they had a knee-jerk fear of being held accountable for doing too little in the face of a virus which they anticipated might be highly contagious and deadly.  

Bad definitions, bad planning, bad measurements, bad estimating, bad forecasting, bad communication with decision-makers and the public, inadequate evidence-based decision making - everything that went wrong with Covid-19 was already in evidence in 1976.  You have to wonder where the CDC institutional knowledge was because the 1976 Swine flu was a huge professional black eye which wasted money, sullied reputations and achieved no success.  

The second take-away is our continued incapacity at a societal and institutional level to settle on established norms for assessing appropriateness of response when dealing with uncertain knowledge in the context of multiple chaotic, loosely couple, power-law driven, dynamic and evolving complex systems.  With the 1976 Swine Flu, the CDC quickly settled on the need for a nationwide mass vaccination campaign despite never having any real experience in this kind of preemptive vaccination under the time clock or good scientific foundation to justify the actual risk, the real costs, or the magnitude of possible consequences.  The Public Health response to Swine Flu in 1976 look like just as much a clown show as did the Public Health response to Covid-19 in 2020.  The experts seemed to have learned absolutely nothing.  

Lots of other good knowledge tidbits and insights in the book.  I enjoyed the read. 

A balancing act

From Lehrbuch der Finanzwissenschaft, 1871 by Lorenz von Stein.  Page 666

A state without public debt is either doing too little for the future or demanding too much from the present.

 

The Seven

The Seven
by Anonymous (Akkadian, c. 2000 B.C.)
Translated by Jerome Rothenberg

They are 7 in number, just 7
In the terrible depths they are 7
Bow down, in the sky they are 7
In the terrible depths, the dark houses
They swell, they grow tall
They are neither female nor male
They are a silence heavy with seastorms
They bear off no women their loins are empty of children
They are strangers to pity, compassion is far from them
They are deaf to men’s prayers, entreaties can’t reach them
They are horses that grow to great size that feed on mountains
They are the enemies of our friends
They feed on the gods
They tear up the highways they spread out over the roads
They are the faces of evil they are the faces of evil
They are 7 they are 7 they are 7 times 7
In the name of heaven let them be torn from our sight
In the name of the Earth let them be torn from our sight

History

 

An Insight

 

Not an infallible heuristic, but not unreasonable.

With the dissolution of information monopolies, the proliferation of alternate platforms and sources and the increasing freedom and democratization of information, we are all having to learn more and better ways of screening out distractions and cognitive pollution.

There will always be a greater supply of low, no, or negative information than there is time and interest to test and qualify those sources of information.  You have to pick up a host of rules-of-thumb and techniques to screen out the near infinity to a manageable portfolio of sources.  Then, once again, you have to filter a second time because even most good sources will produce a lot of low value material.  

When we were in a higher trust environment, when the quality of the monopoly product was higher and more reliable, it was easy just to accept it out of hand.  Now we have to work for truth.

And the reality is that we probably should have always been working this hard because the monopoly sources were not as trustworthy and quality as we thought.  It was just easier.  

All brought to mind by this pair of observations.
Just say no to anything that is not obviously useful and pertinent.  Not an infallible heuristic, but not unreasonable.

 

I see wonderful things

 

When reality is different than passionately held assumptions held by the Mandarin class

From Ban-the-Box Laws: Fair and Effective? by Robert Kaestner & Xufei Wang.  From the Abstract.

Ban-the-box (BTB) laws are a widely used public policy rooted in employment law related to unnecessarily exclusionary hiring practices. BTB laws are intended to improve the employment opportunities of those with criminal backgrounds by giving them a fair chance during the hiring process. Prior research on the effectiveness of these laws in meeting their objective is limited and inconclusive. In this article, we extend the prior literature in two ways: we expand the years of analysis to a period of rapid expansion of BTB laws and we examine different types of BTB laws depending on the employers affected (e.g., public sector). Results indicate that BTB laws, any type of BTB law or BTB laws covering different types of employers, have no systematic or statistically significant association with employment of low-educated men, both young and old and across racial and ethnic groups. We speculate that the lack of effectiveness of BTB laws stems from the difficulty in enforcing such laws and already high rates of employer willingness to hire those with criminal histories.

This is a more positive outcome than most of the research I have seen on Ban the Box outcomes.  Most that I have seen have found that the policy is actually detrimental to those it was intended to help.  It is one of those unintended consequences that illuminate the gap between good intentions and reality.  Most the research I have seen has found a 5-20% reduction in hiring among those with criminal records when BTB is implemented.

It appears that employers, when stripped of the ability to understand the nature and context of the crimes committed, end up being more cautious and more restrictive of employment opportunities to those with criminal records and estimated to be likely to have a criminal record.

There wasn't a problem that needed solving (labor demand was already strong) and the solution as implemented did not have any impact (at best.)  Advocates were vociferous that there was a real problem, and that the problem was at least in part due to racism with a disparate impact on African-Americans.  

Apparently, employee candidates were not being discriminated against in the first place and the solution had no beneficial impact.  All that time, all that political energy, all that money, and . . . Nothing!

Offbeat Humor

 

Only three of these things are bad ideas

From How We got Here by el gato malo.

We legalize crime, criminalize dissent, and elevate literal lunatics as luminaries and leaders.

While generally true, it is especially true in Blue States and Big Blue Cities.  

Data Talks

 

L'atelier des Entre-deux-Monts, 1928 by François-Emile Barraud (Swiss, 1899-1934)

L'atelier des Entre-deux-Monts, 1928 by François-Emile Barraud (Swiss, 1899-1934) 






















Click to enlarge.

Sunday, March 24, 2024

History

 

An Insight

 

I see wonderful things

 

Data Talks

 

The Staircase at 54, Rue de Seine, Paris, 1990 by Sam Szafran (French, 1934-2019)

The Staircase at 54, Rue de Seine, Paris, 1990 by Sam Szafran (French, 1934-2019)































Click to enlarge.

Saturday, March 23, 2024

History

An Insight

 

I see wonderful things

 

We greatly over-estimate our abilities to shape the world to our desires

From Can democracy work? by Dan Williams.  The subheading is In "Public Opinion" (1922), Walter Lippmann argued that the vastness, complexity, and invisibility of the modern world make democracy impossible. He got a lot right.

He notes that 

Public Opinion is one of the most important works of political theory ever written. It’s also one of the most underrated.

I agree.

A long and interesting essay.  I especially liked.

Lippmann is right that our naive realism is profoundly harmful. Because we instinctively treat the truth—even about complex political matters—as self-evident, we greatly over-estimate our abilities to shape the world to our desires. Moreover, if the truth is self-evident, there must be something wrong with those who fail to acknowledge the truth. They must be liars, victims of lies, or insane. Even setting aside bias and tribalism, this seems to shape how many people approach political disagreement in ways that generate unnecessary hostility and conflict.

I model the issue as our living on a continuum of complex processes.

At one end are the simplest of problems - processes with few inputs, few actions, few outputs, few users, and highly stable (not especially subject to exogenous events and pressures.)  These problems lend themselves to deterministic solutions.

From simple problems through reasonably complicated processes, our progress over the past 250 years of the Age of Enlightenment has essentially been the application of Rational Empiricism and the Scientific Method to low hanging fruit from solving problems related to simple actions, complicated actions, simple processes and complicated processes.  We have made enormous strides in productivity and well-being through these approaches.  There remains plenty of fruit to be picked, but we have solved many of the most obvious of problems.  

And we are encountering an epistemic frontier where the limitations of knowledge and wisdom are becoming more manifest.  What do we really want?  And what are the trade-offs we are willing to make to achieve those wants?  It becomes ever more critical to abide ever more closely to the values of Classical Liberalism and Scientific method empirical rationalism.  

What remains are problems arising from complex, chaotic, power law driven, evolving, dynamic, processes.  We are bounded by not knowing what we don't know.  And sometimes, can't know.  Our inadequacy of comprehending the trade-offs we need to make binds us.  Our unfamiliarity of dealing with the probabilistic nature of uncertainty harms us.  

It is in that context which I read Williams's word.  

We have the accumulated hubris arising from success at dealing with the low hanging fruit.  We can see we have been successful without fully acknowledging that part of our success has been due to dealing with the easiest problems.  But what worked with actions and simple processes will not be adequate for complex, chaotic, power law driven, evolving, dynamic, processes.  

But I had not really considered that our hubris in solving simple actions and processes might also incidentally encourage us to moralize problem solving.  

Williams is pointing us subtly to an important lesson.  As we increasingly engage with complex, chaotic, power law driven, evolving, dynamic, processes, we must become more humble.  Humility will be a necessary value because we inherently do not fully comprehend complex, chaotic, power law driven, evolving, dynamic, processes and the probability of our making things worse than better is significant.

Data Talks

 

Legacy mainstream media is addicted to the narcotic of cheap content from advocacy groups, NGOs, ideological academia and State Agency interests

From Why Is The Same Misleading Language About Youth Gender Medicine Copied And Pasted Into Dozens Of CNN.com Articles? by Jesse Singal.  

I frequently refer to our legacy mainstream media as practicing press-release journalism or copy-and-paste journalism whereby they simply copy-and-paste or lightly rewrite the press release or other information from advocacy groups and NGOs.  It is a far cheaper business model than actually investing in on the ground reporting or, heaven forbid, research reporting.  And with their collapsed revenue (loss of advertising and loss of readers/viewers), they need a cheaper way of creating content than the old model of researching and reporting journalism.

This particular column by Singal is an example of the phenomenon but explores its implications further.

He notices that CNN, in reporting on a transgender story out of the National Health Service in the UK, using a distinct phrasing which is 1) unusual, 2) counterfactual, and 3) which he recollects having seen before in their reporting.  

As myself and a number of others pointed out, the article contains a sentence that is, in context, rather wild: John [Tara John, the CNN reporter] writes that “Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender — the one the person was designated at birth — to their affirmed gender — the gender by which one wants to be known.” But of course, whether youth gender medicine is medically necessary and evidence-based is exactly the thing being debated, and anyone who has been following this debate closely knows that every national health system that has examined this question closely, including the NHS, has come to the same conclusion: the evidence is paltry. That’s why so many countries, including Sweden, Finland, the UK, and Norway have significantly scaled back access to these treatments for youth.1 So it’s very strange to see this sentence, which reads as though it comes from an activist press release, published in a news article in CNN, an outlet that generally adheres to the old-school divide between news and opinion.

Good catch on Singal's part.  

“Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender — the one the person was designated at birth — to their affirmed gender — the gender by which one wants to be known.”

Three howlers.  "Medically necessary" is an opinion without substance.  Feasible? - yes.  Necessary? - Well, that's the active debate and the balance of evidence over the past five years has swung increasingly sharply towards the conclusion that while the treatments to make the transition are possible, that there are complications which make such practice unwise.  One issue being that children are not cognitively and psychologically positioned to make such irreversible decisions and the second issue being that much of sexual identity orientation is complicated by confounding psychological issues.  Most countries which invested the most in exploring the issue have concluded that there is insufficient evidence of benefit and too much evidence of harm to sustain gender-affirming care.

The second howler is "evidence-based care."  At the beginning of the trans campaign some five years ago, one could have at best have claimed "evidence-informed care."  At best.  Even then the evidence was thin on the ground and quite mixed.  But as the research has gotten more structured and disciplined, it has become increasingly clear that gender-affirming care as it is currently practiced, for most individuals, improves nothing and often makes things much worse.  

The final howler in that one sentence is "a multidisciplinary approach."  Multidisciplinary suggesting many viewpoints and perspectives.  What has been in evidence has been motivated fanaticism which ignores that which is incontrovertible and advocates that which is contested.  It is a field dominated by Eric Hoffer's True Believers.  

Singal is correct to bring attention to this cognitive toxin.  That the sentence could be written and published the first time is somewhat remarkable given the three howlers.  That it is used repeatedly is astounding.  And that is what Singal investigates.

He finds thirty-five instances in less than two years in which CNN has used the identical or very close variants of the howler-sentence.  Multiple reporters, multiple stories, on a sustained basis over two years.  

This is certainly not reporting.  And it really doesn't feel like economic model driven press-release journalism.  This feels like advocacy on the part of someone or something within CNN.  

So what is going on?  If it is not economics driven press-release journalism, is it advocacy?  Is CNN a sleeper trans organization?  Sounds absurd.  But the pattern is too strong to ignore.

The only explanation I have is that this is an editorial appeasement strategy on the part of CNN.  Trans advocates have demonstrated fairly strident and kinetic actions in their public advocacy including threats of economic, career and personal danger.  Perhaps 

“Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender — the one the person was designated at birth — to their affirmed gender — the gender by which one wants to be known.”

Is CNN's effort to immunize themselves from the wrath of the trans mob.  An inoculation against danger from the advocates.  Possibly at the insistence of CNN's legal department?  

That seems a pretty weak supposition to me but still viable.

Singal's Doesn't have a ready explanation but he does have an interesting insight which I think extends beyond this trans issue.

It’s a pattern, unfortunately. Many outlets dug themselves into a deep hole on this issue by simply acting as stenographers and megaphones for activist groups rather than doing their jobs. And now that there is ever-mounting evidence undercutting the loudest activist claims, climbing out of this hole is going to be awkward. But there’s no other option, really. Because right now there’s absolutely no reason to take CNN.com seriously on this issue — the site has proven, demonstrably, that it doesn’t take itself seriously on this issue. 

  My supposition is that legacy mainstream media, in their search for cheap content, have resorted to unadulterated press-release journalism.  Their content is sourced from motivated advocacy groups and NGOs, from academia and from State Agency interests.  It is lightly rewritten.

All of that is I think a reasonably defendable description of what we see happening.  Singal extends it by observing that individual journalists and the press institutions themselves become hostage to advocacy groups and NGOs, from academia and from State Agency interests because they are so dependent on cheap content.

An interested party or community infiltrate and/or establish advocacy groups and NGOs, as well as academia and State Agency interests, and shape an agenda.  They start producing content.  Legacy mainstream media starts recycling that content as a cheap necessity and as documented by Singal.  

But once this begins to happen, they essentially lock themselves into the longer term agenda of the advocacy groups and NGOs, as well as academia and State Agency interests.  And once they are locked into the third-party content generator agenda, it is, as Singal points out, increasingly difficult to disentangle themselves even if the real world evidence against the agendas becomes overwhelming.

And we are seeing more and more of this all the time.  It is easy to assume that the legacy mainstream media are all steeped in derivative Marxism (Social Justice Theory, Critical Race Theory, Postmodernism, Deconstructionism, Intersectionalism, Gender Theory, Economic Inequality Theory, etc.), when in fact it may simply reflect economic need.  It is the advocacy groups and NGOs, academia and State Agency interests, who are steeped in those derivative Marxism movements.  They produce the content (press releases, flawed research, etc.) which is then simply consumed whole by the legacy mainstream media.

Some of these groups and interests are passing.  Some become a self-sustaining movement.  Self-sustaining in the sense that they find a way for governments to use their taxing authority to sustain them.

Think of some of these movements.  All without evidence, without broad support, all without actual need (i.e. they are not solving a clearly defined and agreed upon problem.)  

Anthropogenic Global Warming

MeToo Movement

DEI

ESG

Trans movement

Advocacy for illegal immigrants

Decarbonization

Net Zero

Equal Pay for Equal Work

Covid Origins

Mask Use

Lockdowns

Mueller Report

Russia Collusion

And so on.  Once you begin to look for it, virtually everything you see in the papers is lightly rewritten content from advocacy groups and NGOs, as well as academia and State Agency interests.  Content which serves financial and ideological interests.  

And which legacy mainstream media are financially powerless to resist.  They need that cheap content.  Even if it is contradicted by the facts.