Category Archives: Covid-19

The myth of the free range human

… Is a myth that I, as much as anyone, wish were true. My dream is to have a little place in the middle of nowhere, off the grid, with a couple of greenhouses, a composting toilet, a 12gauge loaded with rifled slugs, and a pair of vicious dogs. The truth is though, the only way to realize my dream involves relying on things made on the grid. Even after I am established, I’m going to need things from town – in other words, from other people – to maintain my little homestead.

One might argue that my situation is artificially contrived. Nobody asked me to begin in the middle of a civilization, I was just born here. I had no part in constructing it, and I am quite justified in feeling that the whole thing could’ve turned out a lot better than it did. But that would be wrong too. We are all stuck with something like what we’ve got. It’s inscribed in our genome. When my children were born, I did not have to give them any special instruction in speech and language. I simply talked to them, and soon enough, they began to speak. That’s because they have special structures in their brains which are receptive to language learning. We are social animals, and there’s no getting around that.

We are stuck with a duality. We are fully individual, but we can only realize our individuality by way of our social nature. There are no arts, sports, or academics without other people. And as social creatures, we direct our communal effort towards the full expression of individuality. From the isolated point of view of the collective, arts, sports, and academics are a waste of resources, yet we pursue such things as a group because of their benefits to the individual participants.

The dialectic of the social individual permeates all of our institutions, even medicine. Medical professionals treat patients one by one, but on the basis of the statistical effectiveness of each treatment. In fact, our most effective treatments – interventions involving nutrition, sanitation, and immunization – purely play collective odds to benefit an individual patient’s health.

By the same token, our best treatments are not things done to the patient by the physician. Our best interventions require the participation of the individual, and the exercise of individual virtues like patience, generosity, and courage. The current pandemic is a perfect example. Public health institutions aim to immunize the population, in the hopes of preventing individual tragedies.

Libertarians object to such collective efforts, in defense of individual integrity. But this is where the dialectic flips. To exercise individual virtues, and so maintain individual integrity, each person should participate in the treatment. The failure to do so does not demonstrate rugged individualism, but mean spirited cowardice.

In defense of individual integrity, our society allows meanness and cowardice. Nobody is going to hold someone else down and give them a shot. But neither is anyone obliged to give credence to all the excuses and objections expressed when measures are taken to mitigate the collective effect of failed individual character.

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In terms of what we know and how we know it, we are really no better off than scorpions, who are guided by shadows, cthonic vibrations and the fading scents of long gone passersby. For example, if I have a headache, I take some ibuprofen. I believe it will help me because I know how it works. I learned about the mechanism of action in my chemistry classes, and in subsequent review of the medical literature. But I have never seen the chemical do what those sources say it does. Nobody has seen ibuprofen at work, because the molecules are too small, and the reactions are too fast. However, there are ways to magnify the actions of the chemicals in question, so that those actions may be observed indirectly.

I have not even done that. I have read papers and listened to people who explained how they carried out those observations. Having compared their methods to the methods which I learned in chemistry classes and validated in the lab, I believed their report.

Therefore, I take the pills from the bottle labeled ibuprofen when I have a headache, and expect relief. As I choke down the maroon tablets, I act on a belief even more flimsy than the notion that ibuprofen will help my headache in the first place. I have no idea how the pills were made, and no way to know whether they contain ibuprofen at all. Within an hour, my headache is better.

I keep taking ibuprofen from those types of bottles, because it keeps making my headache go away. Maybe someday, I will unknowingly take a cyanide tablet instead. The risk is negligible though. The same biochemists, pharmacists, and physicians who taught my classes, and subsequently formed my beliefs about ibuprofen’s effect on pain, have declared their commitment to assuring the integrity of those maroon tablets in the bottle labeled ibuprofen on the drugstore shelf. The company that makes those pills has also committed to the recommendations of the biochemists, pharmacists, and physicians regarding the purity of the pills, and the company charges a price which reflects its commitment to giving me ibuprofen, the listed dose of ibuprofen, and nothing but ibuprofen in the bottle.

Philosophers have contended that knowledge is justified, true belief. It turns out though, that truth is probably too small for that purpose. Yet even without truth as a necessary condition, we know something. We go to sleep without fear of never waking again. We take one step after the other confidently, apparently certain of the ground’s persistent solidity. We move about justified by an interlocking network of constant correlations. Any single one of those correlations may be dubious, but taken as a consistent whole they support actionable beliefs – knowledge.

Like the scorpions’, our basics seem pretty janky. Nevertheless, though we are occasionally crushed by a boot or have to sting our way out of a situation, we survive for the most part, and even manage to snag an invigorating insect or two along the way.

It is possible to doubt a functional view of knowledge however. Anything less than absolute certainty merits some doubt. I think about that stray cyanide tablet now and again. Yet, I don’t doubt the justifying power of consistency built of constancy. I know that my pills are ibuprofen even though they might, in principle, be cyanide. Doubt in the method of justification itself invites fear, and fear is contagious.

Such doubt in our body of knowledge, driven by attendant fear, has spread in the populace recently. In place of functional knowledge – beliefs justified by their ties to a massive network of constant correlations – the afflicted strive to reclaim truth as their foundation for knowledge. They cast about the culture for a suitable candidate, what they find is revealed truth. Revealed truth has always lurked about in the cultural murk. Religion harbors it, but not the superstitious type of religion which one might reflexively suspect of such activities. The God of the Old Testament felt the need to carve a tablet, burn a bush, and drop some manna now and again. Revealed truth instead finds refuge with the more philosophical types. Think divine command theory or moral intuitionism.

Revealed truth acts something like Platonic form. Taken as a form, a circle is not a good model, it is the underlying reality which the flawed material of our world imperfectly represents. The circle itself is not the stuff of experience. Revealed truths differ from forms on that point, though. Revealed truths can be apprehended, and so blur the line between analytic and synthetic truths. The statement, “all unmarried men are bachelors”, is an analytic truth. The statement, “Bob is a bachelor”, is a synthetic truth. The statement, “Bob is an inherently unlovable person” is a revealed truth. On the same basis, what the Bible says is true because God wrote the Bible, which we know because it says so in the Bible. It is a truth by definition, but only in reference to a given assertion, in this case that an infallible God is the Bible’s author.

With revealed truth in hand, a person can know something with absolute certainty again. The result is appealing. We needn’t waste our time on the uncomfortable task of finding a date for Bob. We know what he is now.The problem with revealed truths should be obvious at this point. Such givens undercut justification. Consistency with the constancies does not matter anymore, only consistency with the given. If Bob actually gets married, we already know that the marriage is a sham. What remains is to discover the structure of the sham.

The justifying structures are easily built, and unassailable, since they have a given between themselves and any assault. The givens themselves are not beliefs, but natural conditions or kinds revealed by an authority, whether it be an intuition or the speech of a erstwhile prophet. Pick your definitive source; there are no limits.

This spoiled conception of knowledge has spread, generating Q anons, Antifas, and vaccine microchips. Similar epidemics have washed over us in the past. They never last, because eventually, the pragmatic view of knowledge outlasts them. Knowing the spells tucked in their jackets will protect them from bullets, a few of the participants in the Boxer Rebellion manage to avoid being shot. Most die. The scorpion who knows that he can wander around in the daytime because he feels the protective hand of God upon him will survive, for a while. The patient on the ventilator may know that Covid is a hoax because evil people lie, and evil people told him about Covid. He will still drown.

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Realism in the Time of Covid

I walked down the broad, sandy track, distracted. The path was built for motorized traffic, so it required no attention to route finding, and my mind could wander elsewhere, in places far from plagues and Gumby revolutions. But I did not stray for long. Behind me, I heard barking. The noise was the sort of high-pitched yap which a dog makes when something frightening, yet fun, is in progress.

I had assumed that a dog made the sound, but I began to doubt as the yammering grew closer at an unnatural rate and became accompanied by a growl that fluctuated in uneven gasps. I stepped off the track, waiting nervously. But of course, no extraordinary monster appeared around the last bend. What did roll into sight was a standard, biomechanical amalgamation. The dog, a German Shepherd mongrel, sat lashed to the vehicle frame up front, shaking and yelping. Behind the mutt, a lumpy man in a down coat steered the buggy from the comfort of its silver roll cage. He gunned the engine over little rises, and coasted around the curves. He gave a little smile and a wave as he passed me. A small American flag fluttered from the apex of his sun-shade.
The commotion rapidly faded, and I turned my attention back to the walk, and the granite towers at the walk’s end. I could see the formations now. Poking up from the slopes of the Little Valley, they were squat spires, the color of the sand beneath my feet. Most were not monoliths, but stacks of huge blocks, each brick 40 feet or more on a side.
At the apex of a small rise in the trail, a single, rhomboidal flagstone, and a small prickly pear with three leaves marked the turnoff to my objective. They looked as if they had been placed there, but they were no more intended for my purpose than the track of hoof prints which led away from the landmark towards the climb. A dotted line, stamped in the sand by deer and elk, and punctuated with mounds of pellets along the way, wove through the Manzanita until it intersected with a line of Cairns leading to a gigantic stack of boulders.
I dropped my pack at the base. I could not tell if the staging area had been manufactured or not, but it was a perfect little patch of dirt, sheltered by cypress and laurel. I fished the rope out from the bottom of the pack and donned harness and helmet. I carried no more gear, because my goal for the day was not to climb the 4 inch wide crack above me from the bottom up. My goal was to find out if I was still a climber, and if so, to begin to claw my way back to a respectable condition. To those ends, I would crawl through gaps between the blocks above, anchor the rope to a pair of unseen bolts, descend the rope, and climb back up to the bolts as many times as I could.
With the rope tied to my back, I made my way around the side of the formation until I could tunnel through the cracks. The way led down and across to a small alcove. A scraggly alder tree grew there, apparently supported by a very shallow bowl of sand alone. In retrospect, it had made a mistake. Though the spot was secure, the soil was too shallow, and the tree’s highest leaves could only catch sunlight for a couple of hours every day. It could never thrive, but it was a pleasant decoration for the time being. From the alcove, a short, awkward squeeze led to a hidden ledge, and the anchor. I secured my rope to the two bolts.

After descending back to the base, I loaded my self-belay device and began to climb. I moved methodically, not at all like I would climb with a partner belaying from the base. I used a single device for fall protection. This was on purpose. The set up relied on hands and feet as my first line of protection, with the rope and device as backup only. Having a second chance put an edge on the whole project which was lacking in the case of third chances and single chances alone. With a third chance in play, the focus shifted to the equipment and allowed for some slop in the climbing. Committing to one chance only demanded fatalism, and fatalism shifted the focus to the mental equipment needed to accept one’s fate, at the expense of free movement.
I climbed through the route, slowly convincing myself that I could still move smoothly. The effort meant ignoring the grind my left shoulder when I loaded it in extension, and the stiffness in my leg on the right when I tried to step high.
I made it through an acceptable number of laps and pulled the rope. The sun was now as high as it would get in midwinter, and it illuminated a small tuft of leaves poking from the alcove between the boulders above.
I turned my back on the formation and wandered down past the Cairns, the elk pellets, the rhomboidal rock, and the three-leaf pear. With the full warmth of the sun on the Little Valley, the trail was now bustling. A grade school child teetered over a bump on his motorbike. A parent followed, riding a matching cycle nearly on the kid’s back tire. Groups of people, some wearing facemasks, some not, nodded to me politely as I stepped off the trail to let them by.
As usual, I could gauge my distance from the trailhead by the age and attire of passing hikers. I first passed those kitted out with boots and daypacks, then the sneakers lot with their coats tied around their hips, then the shorts and flip-flops crowd. By the time that the expensive homes which flanked the start of the trail were visible, the vast majority of passing travelers wore boat shoes and elastic waistbands and would plainly go only a few more steps beyond the gate. What they sought by this activity, I could not imagine.

The parking area had filled up since my departure, and in the usual fashion. When I had arrived in the morning cold, the only other cars parked in the lot were a dated Subaru and a Toyota truck. The Subaru had a Sierra Club sticker on the back window. The truck was covered in dust. Between morning and afternoon, cleaner vehicles had filled in the rest of the parking spaces. A few of these had American flag decals, and one of the flags was blue with a prominent blue line through the middle of the stripes. One rear window bore a red white and blue “Q”.
I wondered who belonged to those stickers. Nobody on the trail looked crazy. Certainly, nobody looked like a revolutionary, and if my fellow travelers that day really were the sons and daughters of the Revolution, then the revolution would be over as soon as the propane and Slim Jim’s ran out.
I had them entirely wrong, though. What a person trusts depends on what a person wants. What a person wants depends on the depth and breadth of their perception. The revolution was against the untrustable unseen. They revolted against rumors of an invisible pathogen. They revolted against the idea of murky social, political, and personal depths. Most of all, they revolted against a start in the cold and dark which they had somehow been convinced that they were entitled to avoid.

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For Anyone

…who believes that, “we have more cases because we have more testing”.

Testing for an infectious disease is like counting the number of balloons in a dark room by tossing darts through the doorway. Say you throw 10 darts in the room and hear two pops. There is still a good chance that a number of balloons remain uncounted. But if you throw 40 darts in the room and hear two pops, the likelihood of a two-balloon scenario soars. When the rate of pops drops below a certain proportion, you can be sure that you have counted most of the balloons in the room. A low percentage of positive tests is what you’re after.
Once you have established the adequacy of your testing, you can sort out what the results reveal about containment. The raw numbers don’t tell you that much. In the case of national case counts, it is reasonable to expect a country with a large population to experience higher numbers than a country with a small population given similar degrees of disease containment. A true measure of containment is cases per population, or in our analogy, how crowded the room is with balloons.
So when a pinhead like Trump says that we have more cases because we have more testing, that standalone statement is pure bull shit. What’s worse, it’s a distraction from what really indicates the adequacy of our understanding of the outbreak’s extent and the effectiveness of our efforts to contain it: percent positive tests and infections per population.

How is the US doing?

Top of the heap with >15,000 cases/1 million persons (European Centers for Disease Control)

Percent positive tests: 7.9 (an adequate percentage is less than 5%)

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H plus or minus the A

Wee Donnie loves his Plaquenil. He says that hydroxychloroquine may be a game changer. He is not a doctor, and he is certainly not an academic, but he says that he has common sense to guide him. His common sense tells him that the drug might have some beneficial effect in Covid-19 infections, times are desperate, and so why not give it a go – what do you have to lose?

Of course, common sense is what tells us that the earth is flat and the sun goes around it. Shockingly, common sense is just as dependable when it comes to bio-statistics. Trump has no idea what he is talkiing about (as usual). Let me heap a fair helping of scorn on his contentions. To do that, Donnie’s argument has to be split into its two components; otherwise, the load would collapse the full-length argument before even a third of the deserved disparagement were dispensed.

Part one concerns the effectiveness of hydroxychlororquine for corona virus. There are a couple of observational studies from China suggesting that moderately ill people given the drug may have been less likely to progress to severe illness. There are also in vitro studies of viral replication which show hydroxychloroquine to be inhibitory. Finally, there is a study examining viral shedding in patients given the drug versus patients not given the drug. This last study is open label, not randomized, and examines a surrogate endpoint – what we want to know is whether the medicine makes people get better, not whether it makes their nasal swab get better.

All of this evidence generates a hypothesis (that hydroxychloroquine may improve clinical outcomes in coronavirus infection) but doesn’t yield any conclusions at all.  To illustrate how this can be so, witness research on the use of this very same drug for influenza treatment. Because, hydroxychloroquine inhibits replication of the influenza virus as well, in vitro. When given to patients in a randomized, controlled trial however, it didn’t make anybody any better, any faster.

But why let the perfect be the enemy of the good? We can go on hope and the possibilities implicit in the observational studies. The med is safe, right? Just give it. To clarify the consequences of such proposals, lets say that the putative cure for Covid-19 is not a Q/T – prolonging antimalarial. Let’s say, it’s a chocolate brownie. The instructions are: chocolate brownies cure corona. That’s it; that’s all we know.

Now, some people are going to take a tiny pinch of brownie, and secure in its protection, head off to the church picnic. They will get the virus and wind up in the ICU.

Other people will eat 5 brownies per day, sending their triglyceride levels through the roof. Those in this group who are also taking certain medications, will develop pancreatitis and wind up in the ICU (drug-drug interaction).

Some will go beyond the 5 brownie dose, to 7 per day. Among this lot are bound to be some latent diabetics who will subsequently land in the unit with hyperglycemic hyperosmolar non-ketotic coma (drug -disease interaction).

Finally, a few true believers will bump the dose to 10 brownies daily. They will experience nausea, vomiting, and diarrhea with subsequent dehydration and acute kidney injury, buying them an ICU bed right beside the Covid patients (adverse drug effect).

The point is: common sense sees no farther than its own nose and is blind to all these eventualities. Scientific method is not, largely because it admits that we can’t know all the eventualities. That’s why good clinical trials measure hard endpoints, like death or time to hospital discharge, and not surrogate markers, like the presence of virus on nasal swabs.

Don’t rely on that nitwit shyster Trump, his toadies, and their common sense. Rely on scientific method instead.

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