Saturday, April 25, 2020

VENTILATORS: EXTREMELY HIGH MORTALITY; OXIMETER: EARLY DETECTION OF COVID PNEUMONIA; SAME OLD PATTERN: WHAT NOVELS TEACH US ABOUT PANDEMICS; PROBLEMS WITH CLEAN ENERGY; STEVENS: THE BEAUTIFUL VS THE SUBLIME; SPINOZA;

Sunset in Provence; David Whyte

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BLANCHE McCARTHY

Look in the terrible mirror of the sky
And not in this dead glass, which can reflect
Only the surfaces — the bending arm,
The leaning shoulder and the searching eye.

Look in the terrible mirror of the sky.
Oh, bend against the invisible; and lean
To symbols of descending night; and search
The glare of revelations going by!

Look in the terrible mirror of the sky.
See how the absent moon waits in a glade
Of your dark self, and how the wings of stars,
Upward, from unimagined coverts, fly.

~ Wallace Stevens, Opus Posthumous

Wallace Stevens is one of the few poets I re-read for pleasure.  Not his long poems, the critics’ darlings, but his shorter lyrics, some of them luminous gems.  


Stevens often adopts the device of advising fictional female characters.  This can come across as condescending, but because of Stevens's ability to create enchantment through music, I forgive him everything.


In “Blanche McCarthy,” the poet urges the fictive woman — and the reader — to notice the "terrible infinite" in the "terrible mirror of the sky" rather than be preoccupied with the surface self in the actual mirror. 


THE DUALITY IN THE WOMAN’S NAME; THE BEAUTIFUL VERSUS THE SUBLIME


Let us first consider the name "Blanche McCarthy." The split between the transcendent and the mundane is contained already in the character's name. "Blanche" is a Romance name, evoking medieval romances, the moon, poetry itself. Note the choice of "Blanche duBois" and what she stands for as opposed to Stanley Kowalski in "Streetcar Named Desire." "Blanche Kowalski" would be too heavy-handed; the slight dissonance of "McCarthy" is just right.


The music is fabulous, and seems to derive both from repetition ("the bending arm/The leaning shoulder and the searching eye") and from each stanza's terminal rhyme with "sky." 

Why read poetry? Because we are intoxicated with music and its ability to affect the brain in a more rapturous, Dionysian way than prosaic speech can. The music of a poem also speaks. The more eloquent the music, the more a poem captivates us and affects us at a level that we can't readily explain, which gives it an extra dimension of mystery and transcendence. 


Then there is of course the more obvious transcendence derived from the use of archetypal images: sky, moon, stars, flight, eye, dark, and mirror.  To me one of the fascinating things about poetry is that these are such a staple of poetry, used over and over, and yet, century after century, continue to move us deeply.


A term used more often than transcendence is “the sublime.” I particularly like Joseph Campbell’s definition of the sublime: “The sublime in contrast to beauty?  That which is beautiful does not threaten you . . . The sublime is rendered by prodigious power or by enormous space” (Reflections on the Art of Living, HarperCollins 1991, p.136).  “The terrible mirror of the sky” is almost blatantly in the category of the sublime.  


ARCHETYPAL IDEAS


Poetry often relies on “archetypal images” such as sea, stars, sky. We recognize these as both beautiful and sublime (“For beauty is but the beginning of Terror/ and the admire it so because it serenely/ disdains to destroy us” ~ Rilke). Stevens also regarded certain ideas as inherently poetic, especially the idea of infinity. I've seen mathematicians and scientists absolutely enraptured by the beauty they saw in certain ideas – hence the frequent use of the word "elegant" for an equation or theory or experimental design.  There is a synergy of both simplicity and enormous richness opening up.


Here we come to the difficulty of defining “poetic." I've been trying for years, and ultimately have been stunned into delighted silence by a student who said, “When I finish reading something, and say 'Wow!' – that’s poetry. If I don't say 'Wow!', it's prose. And I say 'Wow!' much more often after reading a poem."  


Naive and paradoxical though it may sound, the more deeply I study poetry, the more I trust my "Wow!" response.  Those are the poems whose lines keep returning to my mind.  That's another test of poetry: how immediately memorable is it; do certain lines or phrases continue to run through your mind the way some songs and melodies do.


BLANCHE AS MEMENTO MORI; THE FUTURE IN THE MIRROR OF THE SKY


Thinking about which lines in "Blanche McCarthy" have affected me most, I reluctantly dismiss the sweet and non-threatening "See how the absent moon waits in a glade/ Of your dark self"  and return to the powerful and thrice-repeated: "Look in the terrible mirror of the sky."  The whole opening is magnificent and scary: "Look in the terrible mirror of the sky/ And not in this dead glass."  


What is it that we see reflected in the mirror of the sky? Presumably Stevens means the night sky, given the rest of the imagery. There is also the “descending night,” which in poetry cannot really be dissociated from dying and death.  


In the night sky we do not see our own current, visible, outer face, at least not the way it's reflected in an ordinary mirror ("dead glass” — this is absolutely brilliant!).  Rather, we see a cosmic face — call it the face of God, if “Universe” is not sufficiently capable of having a face. 


Above all, we see darkness. We see perhaps our own future as part of the universe after we "disincarnate," as my New Age friends so melodiously call it.  

But above all we see the stars, one of the most frequent archetypal images, connected here with wings, flight, and revelations.  Stars also often symbolize inspiration, high ideals, and hope and guidance. Here ultimately the star symbolism prevails, making this a romantic poem.  Nevertheless, the poem could also be read as a memento mori.


For the reader of modern poetry, Anne Sexton’s “The Starry Night” comes to mind:


Oh starry starry night!  This is how
I want to die:

into that rushing beast of the night,
sucked up by that great dragon, to split
from my life with no flag,
no belly,
no cry.

There is also  a beautiful passage from Rilke that appears relevant here.  I wrote it down many years ago, from one of the Elegies I think — I apologize for not having a reference.


And we,
animals of the soul, confused
by everything in us, not yet
ready for nothing;
we grazing souls:
do we not implore the Alotter by night
to grant us the not-face
which belongs with our darkness.

“Dead glass” strikes me as brilliant not only because of the obvious meaning — the image in the glass is "dead" rather than living flesh — the image is unreal, all surface.  But there's also the chilling effect of "dead" due to the transposition from the mirror to the mortal person.
I also always shudder at the line in one of the poems by Charles Simic, where he tells a pig, "Don't admire yourself so much / in the butcher's knife."


And then there's Cocteau's lovely, "If you want to see death, look in the mirror. Mirrors are the doors through which death comes and goes."  


Stevens believed that poetry should help us live. It should certainly help us deal with aging and mortality. One of the answers that Stevens gives is contained in this largely ignored lyric: look not into the dead glass, but turn your gaze toward the sublime.


 

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“Old age. All the facial detail is visible; all the traces life has left there are to be seen. The face is furrowed, wrinkled, sagging, ravaged by time. But the eyes are bright and, if not young, then somehow transcend the time that otherwise marks the face. It is as though someone else is looking at us, from somewhere inside the face, where everything is different. One can hardly be closer to another human soul.” ~ Knausgaard, My Struggle


Karl Ove Knausgård

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WHAT WE LEARN FROM NOVELS ABOUT PANDEMICS


~ The initial response to the outbreak of a pandemic has always been denial. National and local governments have always been late to respond and have distorted facts and manipulated figures to deny the existence of the outbreak.

In the early pages of “A Journal of the Plague Year,” the single most illuminating work of literature ever written on contagion and human behavior, Daniel Defoe reports that in 1664, local authorities in some neighborhoods of London tried to make the number of plague deaths appear lower than it was by registering other, invented diseases as the recorded cause of death.

Much of the literature of plague and contagious diseases presents the carelessness, incompetence and selfishness of those in power as the sole instigator of the fury of the masses. But the best writers, such as Defoe and Camus, allowed their readers a glimpse at something other than politics lying beneath the wave of popular fury, something intrinsic to the human condition.

Defoe’s novel shows us that behind the endless remonstrances and boundless rage there also lies an anger against fate, against a divine will that witnesses and perhaps even condones all this death and human suffering, and a rage against the institutions of organized religion that seem unsure how to deal with any of it.

 
Humanity’s other universal and seemingly unprompted response to pandemics has always been to create rumors and spread false information. During past pandemics, rumors were mainly fueled by misinformation and the impossibility of seeing the fuller picture.

Defoe and Manzoni wrote about people keeping their distance when they met each other on the streets during the plagues, but also asking each other for news and stories from their respective hometowns and neighborhoods, so that they might piece together a broader picture of the disease. Only through that wider view could they hope to escape death and find a safe place for shelter.


In a world without newspapers, radio, television or internet, the illiterate majority had only their imaginations with which to fathom where the danger lay, its severity and the extent of the torment it could cause. This reliance on imagination gave each person’s fear its own individual voice, and imbued it with a lyrical quality — localized, spiritual and mythical.


The most common rumors during outbreaks of plague were about who had brought the disease in, and where it had come from. Around mid-March, as panic and fear began to spread through Turkey, the manager of my bank in Cihangir, my neighborhood in Istanbul, told me with a knowing air that “this thing” was China’s economic retort to the United States and the rest of the world.


Like evil itself, plague was always portrayed as something that had come from outside. It had struck elsewhere before, and not enough had been done to contain it. In his account of the spread of plague in Athens, Thucydides began by noting that the outbreak had started far away, in Ethiopia and Egypt.


The disease is foreign, it comes from outside, it is brought in with malicious intent. Rumors about the supposed identity of its original carriers are always the most pervasive and popular.


In “The Betrothed,” Manzoni described a figure that has been a fixture of the popular imagination during outbreaks of plague since the Middle Ages: every day there would be a rumor about this malevolent, demonic presence who went about in the dark smearing plague-infected liquid on doorknobs and water fountains. Or perhaps a tired old man who had sat down to rest on the floor inside a church would be accused by a woman passing by of having rubbed his coat around to spread the disease. And soon a lynch mob would gather.

These unexpected and uncontrollable outbursts of violence, hearsay, panic and rebellion are common in accounts of plague epidemics from the Renaissance on. Marcus Aurelius blamed Christians in the Roman Empire for the Antonine smallpox plague, as they did not join the rituals to propitiate the Roman gods. And during subsequent plagues Jews were accused of poisoning the wells both in the Ottoman Empire and Christian Europe.


The history and literature of plagues shows us that the intensity of the suffering, of the fear of death, of the metaphysical dread, and of the sense of the uncanny experienced by the stricken populace will also determine the depth of their anger and political discontent.


As with those old plague pandemics, unfounded rumors and accusations based on nationalist, religious, ethnic and regionalist identity have had a significant effect on how events have unfolded during the coronavirus outbreak. The social media’s and right wing populist media’s penchant for amplifying lies has also played a part.


But today we have access to a dramatically greater volume of reliable information about the pandemic we are living through than people have ever had in any previous pandemic. That is also what makes the powerful and justifiable fear we are all feeling today so different. Our terror is fed less by rumors and based more on accurate information.


As we see the red dots on the maps of our countries and the world multiply, we realize there is nowhere left to escape to. We do not even need our imagination to start fearing the worst. We watch videos of convoys of big black army trucks carrying dead bodies from small Italian towns to nearby crematories as if we were watching our own funeral processions.


The terror we are feeling, however, excludes imagination and individuality, and it reveals how unexpectedly similar our fragile lives and shared humanity really are. Fear, like the thought of dying, makes us feel alone, but the recognition that we are all experiencing a similar anguish draws us out of our loneliness.


The knowledge that the whole of humanity, from Thailand to New York, shares our anxieties about how and where to use a face mask, the safest way to deal with the food we have bought from the grocer and whether to self-quarantine is a constant reminder that we are not alone. It begets a sense of solidarity. We are no longer mortified by our fear; we discover a humility in it that encourages mutual understanding.


When I watch the televised images of people waiting outside the world’s biggest hospitals, I can see that my terror is shared by the rest of the humanity, and I do not feel alone. In time I feel less ashamed of my fear, and increasingly come to see it as a perfectly sensible response. I am reminded of that adage about pandemics and plagues, that those who are afraid live longer.


Eventually I realize that fear elicits two distinct responses in me, and perhaps in all of us. Sometimes it causes me to withdraw into myself, toward solitude and silence. But other times it teaches me to be humble and to practice solidarity.


Historically it had always been harder to convince Muslims to tolerate quarantine measures during a pandemic than Christians, especially in the Ottoman Empire. The commercially motivated protests that shopkeepers and rural folk of all faiths tended to raise when resisting quarantine were compounded, among Muslim communities, by issues around female modesty and domestic privacy. Muslim communities at the start of the 19th century demanded “Muslim doctors,” for at the time most doctors were Christians, even in the Ottoman Empire.


From the 1850s, as traveling with steamboats was getting cheaper, pilgrims traveling to the Muslim holy lands of Mecca and Medina became the world’s most prolific carriers and spreaders of infectious disease. At the turn of the 20th century, to control the flow of pilgrims to Mecca and Medina and back to their countries, the British set up one of the world’s leading quarantine offices in Alexandria, Egypt.


These historical developments were responsible for spreading not only the stereotypical notion of Muslim ‘fatalism,’ but also the preconception that they and the other peoples of Asia were both the originators and the sole carriers of contagious disease.


When at the end of Fyodor Dostoyevsky’s “Crime and Punishment,” Raskolnikov, the protagonist of the novel, dreams of a plague, he is speaking within that same literary tradition: “He dreamed that the whole world was condemned to a terrible new strange plague that had come to Europe from the depths of Asia.”


In maps from the 17th and 18th centuries, the political border of the Ottoman Empire, where the world beyond the West was considered to begin, was marked by the Danube. But the cultural and anthropological border between the two worlds was signaled by the plague, and the fact that the likelihood of catching it was much higher east of the Danube. All this reinforced not just the idea of the innate fatalism so often attributed to Eastern and Asian cultures, but also the preconceived notion that plagues and other epidemics always came from the darkest recesses of the East.

The picture we glean from numerous local historical accounts tells us that even during major plague pandemics, mosques in Istanbul still conducted funerals, mourners still visited one another to offer condolences and tearful embraces, and rather than worry about where the disease had come from and how it was spreading, people were more concerned about being adequately prepared for the next funeral.


Yet during the current coronavirus pandemic, the Turkish government has taken a secular approach, banning funerals for those who have died of the disease and making the unambiguous decision to shut mosques on Fridays when worshipers would ordinarily gather in large groups for the week’s most important prayer. Turks have not opposed these measures. As great as our fear is, it is also wise and forbearing.


For a better world to emerge after this pandemic, we must embrace and nourish the feelings of humility and solidarity engendered by the current moment.~


https://www.nytimes.com/2020/04/23/opinion/sunday/coronavirus-orhan-pamuk.html?smid=fb-share&fbclid=IwAR0caSPlbJ4pnTW_xvR1wY6wF2zbhUCcLmMr3ZSjgquHPSsU4prkVUMNYaI


  
An illustration in Manzoni's novel about the plague in 1630

Oriana:

“The initial response to the outbreak of a pandemic has always been denial.” Fascinating, the sameness of the human behavior during a pandemic over the centuries: the initial denial by the authorities; the need to blame someone for the disease (sometimes with violent consequences); the spread of misinformation; the protests against quarantine. We are seeing it happen all over again, even though we supposedly live in an age of science and advanced medicine.


Still, there is no denying that our medicine is more advanced than that in the novels about the past pandemics. And people do know that scientists — our best minds — are working on drugs and vaccines. Even deeply religious people, like the majority of Turkish Muslim, do not oppose the closure of mosques and the ban on funerals. This shows that a deeper understanding can take root and help keep the infection rate low.


(As for misinformation, it doesn’t take a pandemic. Almost all of us deeply desire to stay healthy and not die. I remember when we were encouraged to drink our own urine first thing in the morning. When that trend ended, we were told that the answer was hydrogen peroxide: we were to pour it by the gallon into the bath water, and yes, to try to drink it too, mercifully diluted. And diets: no meat, all meat; no fat, lots of fat. And we tried, we really tried.)

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“To the last we will have learned nothing. In all of us, deep down, there seems to be something granite and unteachable. No one truly believes that the world of tranquil certainties we were born into is about to be extinguished.” ~ J.M. Coetzee, Waiting for the Barbarians

Oriana:

Freud remarked that no one believes in his own death. I think this is related to how difficult it is for us to accept the end of the world as we’ve known it — we lucky ones, who got the chance to live in relatively safe and prosperous times. 

But the pandemic is teaching us. I don’t believe that we are unteachable.



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CLEAN ENERGY COMES WITH ITS OWN SET OF PROBLEMS


~ The phrase “clean energy” normally conjures up happy, innocent images of warm sunshine and fresh wind. But while sunshine and wind are obviously clean, the infrastructure we need to capture it is not. Far from it. The transition to renewables is going to require a dramatic increase in the extraction of metals and rare-earth minerals, with real ecological and social costs. 


We need a rapid transition to renewables, yes—but scientists warn that we can’t keep growing energy use at existing rates. No energy is innocent. The only truly clean energy is less energy. 


In 2017, the World Bank released a little-noticed report that offered the first comprehensive look at this question. It models the increase in material extraction that would be required to build enough solar and wind utilities to produce an annual output of about 7 terawatts of electricity by 2050. That’s enough to power roughly half of the global economy. By doubling the World Bank figures, we can estimate what it will take to get all the way to zero emissions—and the results are staggering: 34 million metric tons of copper, 40 million tons of lead, 50 million tons of zinc, 162 million tons of aluminum, and no less than 4.8 billion tons of iron. 


In some cases, the transition to renewables will require a massive increase over existing levels of extraction. For neodymium—an essential element in wind turbines—extraction will need to rise by nearly 35 percent over current levels. Higher-end estimates reported by the World Bank suggest it could double. 


The same is true of silver, which is critical to solar panels. Silver extraction will go up 38 percent and perhaps as much as 105 percent. Demand for indium, also essential to solar technology, will more than triple and could end up skyrocketing by 920 percent. 


And then there are all the batteries we’re going to need for power storage. To keep energy flowing when the sun isn’t shining and the wind isn’t blowing will require enormous batteries at the grid level. This means 40 million tons of lithium—an eye-watering 2,700 percent increase over current levels of extraction. 


That’s just for electricity. We also need to think about vehicles. This year, a group of leading British scientists submitted a letter to the U.K. Committee on Climate Change outlining their concerns about the ecological impact of electric cars. They agree, of course, that we need to end the sale and use of combustion engines. But they pointed out that unless consumption habits change, replacing the world’s projected fleet of 2 billion vehicles is going to require an explosive increase in mining: Global annual extraction of neodymium and dysprosium will go up by another 70 percent, annual extraction of copper will need to more than double, and cobalt will need to increase by a factor of almost four—all for the entire period from now to 2050. 


The problem here is not that we’re going to run out of key minerals—although that may indeed become a concern. The real issue is that this will exacerbate an already existing crisis of overextraction. Mining has become one of the biggest single drivers of deforestation, ecosystem collapse, and biodiversity loss around the world. Ecologists estimate that even at present rates of global material use, we are overshooting sustainable levels by 82 percent. 


Take silver, for instance. Mexico is home to the Peñasquito mine, one of the biggest silver mines in the world. Covering nearly 40 square miles, the operation is staggering in its scale: a sprawling open-pit complex ripped into the mountains, flanked by two waste dumps each a mile long, and a tailings dam full of toxic sludge held back by a wall that’s 7 miles around and as high as a 50-story skyscraper. This mine will produce 11,000 tons of silver in 10 years before its reserves, the biggest in the world, are gone. 


To transition the global economy to renewables, we need to commission up to 130 more mines on the scale of Peñasquito. Just for silver. 


Lithium is another ecological disaster. It takes 500,000 gallons of water to produce a single ton of lithium. Even at present levels of extraction this is causing problems. In the Andes, where most of the world’s lithium is located, mining companies are burning through the water tables and leaving farmers with nothing to irrigate their crops. Many have had no choice but to abandon their land altogether. Meanwhile, chemical leaks from lithium mines have poisoned rivers from Chile to Argentina, Nevada to Tibet, killing off whole freshwater ecosystems. The lithium boom has barely even started, and it’s already a crisis. 


And all of this is just to power the existing global economy. Things become even more extreme when we start accounting for growth. As energy demand continues to rise, material extraction for renewables will become all the more aggressive—and the higher the growth rate, the worse it will get. 


It’s important to keep in mind that most of the key materials for the energy transition are located in the global south. Parts of Latin America, Africa, and Asia will likely become the target of a new scramble for resources, and some countries may become victims of new forms of colonization. It happened in the 17th and 18th centuries with the hunt for gold and silver from South America. In the 19th century, it was land for cotton and sugar plantations in the Caribbean. In the 20th century, it was diamonds from South Africa, cobalt from Congo, and oil from the Middle East. It’s not difficult to imagine that the scramble for renewables might become similarly violent. 


If we don’t take precautions, clean energy firms could become as destructive as fossil fuel companies—buying off politicians, trashing ecosystems, lobbying against environmental regulations, even assassinating community leaders who stand in their way. 


Of course, we know that poorer countries still need to increase their energy use in order to meet basic needs. But richer countries, fortunately, do not. In high-income nations, the transition to green energy needs to be accompanied by a planned reduction of aggregate energy use. 


How might this be accomplished? Given that the majority of our energy is used to power the extraction and production of material goods, the Intergovernmental Panel on Climate Change suggests that high-income nations reduce their material throughput—legislating longer product life spans and rights to repair, banning planned obsolescence and throwaway fashion, shifting from private cars to public transportation, while scaling down socially unnecessary industries and wasteful luxury consumption like the arms trade, SUVs, and McMansions. 


Reducing energy demand not only enables a faster transition to renewables, but also ensures that the transition doesn’t trigger new waves of destruction. Any Green New Deal that hopes to be socially just and ecologically coherent needs to have these principles at its heart. ~


https://getpocket.com/explore/item/the-limits-of-clean-energy?utm_source=pocket-newtab


silver mine in Argentina
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SLOWLY, AND THEN ALL AT ONCE

“I fell in love the way you fall asleep: slowly, and then all at once.” ~ John Green


Oriana:


It seems to me that that’s also the way insight operates. Mainly on the unconscious level, the brain can be working on a problem — e.g. religious beliefs — for many years. Then a searing, revolutionary thought suddenly arises, the brain rewires itself in a fraction of a second, and there is no going back: whether to idealizing a person you now clearly perceive as a self-destructive addict, or to believing in god, angels, heaven, hell, the devils armed with pitchforks, pushing the sinners deeper into the fire or into huge cauldrons of boiling pitch.
And your mouth falls open: how could you have other believed those things? An invisible dude in the sky? LOL. Then you remember the power of brainwashing, especially in childhood. Or the power of romantic yearning, of really wanting to see X a magical person.
“Slowly, and then all at once” — that’s the corrective to the view that insight takes no preparation. Ripeness is all.


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“PURE DUMB LUCK”: DON’T TELL YOUR FRIENDS THEY ARE LUCKY

~ Cornell professor of economics Robert Frank says he’s alive today because of “pure dumb luck.” In 2007, he collapsed on a tennis court, struck down by what was later diagnosed as a case of sudden cardiac death, something only 2 percent of victims survive. Frank survived because, even though the nearest hospital was 5 miles away, an ambulance just happened to be responding to another call a few hundred yards away at the time. Since the other call wasn’t as serious, the ambulance was able to change course and save Frank. Paddles were put on him in record time. He was rushed to the local hospital, then flown by helicopter to a larger one where he was put on ice overnight. Most survivors of similar episodes are left with significant cognitive and physical impairments. Frank was back on the tennis court just two weeks later. 


Frank says his research ideas often come from his own experience, and his work on luck is no exception. His book, Success and Luck: Good Fortune and the Myth of Meritocracy, argues that the role of luck in life, and specifically in economic success, is not as widely appreciated as it should be. The book claims that if the prosperous were more cognizant of luck’s role in their success they would be more supportive of government efforts to spread opportunity, and of the higher taxes they’d have to pay as a result. 


Frank’s other writings include the books The Winner-Take-All Society (with Philip J. Cook), The Darwin Economy, and Principles of Economics (with Ben S. Bernanke.) as well as an economics column that has run in The New York Times for over a decade.


What evidence is there that people don’t appreciate the role of luck in their lives as much as they should? 


If people want to see a vivid example of that, I would steer them to the website that chronicled the reactions of voters to two political campaign speeches in 2012, one by Elizabeth Warren, the other by Barack Obama. The content of the speeches was essentially the same and if you read both transcripts carefully you’d say, “Wow. There’s nothing controversial here.” What each one said in effect was that, in addition to working hard and being good at what you do, if you’re a business owner, also you ship your goods to market on roads that the community paid for, you hired workers that we helped educate, we hired policemen, firemen to keep you safe. So your success such as it is, is a product not just of your own talents and efforts, but it’s a community project. 


The reaction was overwhelmingly hostile to the speeches. The people who run businesses seemed to think that Obama and Elizabeth Warren were saying that they didn’t deserve to have succeeded, that they were impostors by occupying these lofty positions that they had won. That wasn’t the message at all, but it was hard for people to hear the totally reasonable and uncontroversial messages of those speeches. 


The whole process of constructing life narratives is biased in ways that almost guarantee that people won’t recognize the role of chance events adequately. So, you’ve been successful, you’ve been at it 30 years. It’s true that you’ve worked hard all that time, you got up early, you put in a lot of effort, those memories are all very plentiful and available in your memory bank. You’ve solved lots of difficult problems. You remember examples of those, too. You know the formidable opponents that you’ve vanquished along the way. How can you forget them?  So, if somebody says, “Why did you succeed?” those things are going to get top billing in your story. 


Maybe there was a teacher who helped steer you through trouble in the 11th grade. You don’t remember that. Maybe you got a promotion early on when one of your colleagues who was slightly better qualified had to turn it down because he had to stay and take care of an ailing parent. You don’t remember that either. Then there’s all this work on the asymmetry of memory. 


You’re running into the wind, you’re keenly aware of it every second. You turn the corner and the wind is at your back. That’s good. You like that. But then two minutes into the return course you’ve forgotten completely about the fact that you’ve got something helping you along. Because a headwind is something that you have to work actively to overcome, you almost can’t fail to notice it. But a tailwind helps you along; it’s out of your field of vision mostly. You don’t think about it because you don’t have to think about it. 


And that’s where luck comes in, in addition to talent and effort?


Talent and effort obviously matter, but if you have technology such that you only need one producer from one person in a job slot, say you need somebody to record Bach’s unaccompanied cello suites. How many people do you need to do that? Well, you need a cellist, same as you did hundreds of years ago. It used to be that there was a market for many thousands of cellists because the way that you would listen to those pieces was necessarily to go to a concert hall, and sit there and listen to a live performance. Now most of us who listen to pieces like that, if we do, are listening to a recording of them. 


And then, what do we want? Of course, once a recording is made it doesn’t cost anything extra to stamp out copies of it. So if you have a choice between listening to the best cellist perform the piece or the second best, why would you want to listen to the second best? You might be willing to pay a few cents more only to hear the best, because they’re all good. But, even if you’d be willing to pay a few cents more, the fact that there are millions of copies of these things sold means that the fact that the company that bids successfully for Yo-Yo Ma or whoever is regarded as the best cellist is going to get that market all to himself. 


And so the price that you have to pay to get the best recording artist is set accordingly. One earns eight or nine figures a year while the cellist who is almost as good is teaching music lessons to third graders in New Jersey somewhere. It’s a dogfight now to see who gets to be regarded as that best performer. The person who is eventually successful got there by defeating thousands, maybe tens of thousands, of rivals in competitions that started at an early age. 


The top guy, if you select only on talent and effort, isn’t going to be any luckier than anybody else. He’ll be average luck. OK, then find those who are just a hair’s breadth less talented and effortful than he is. And among the set of people in that set, find the luckiest one, and you don’t need a very big set for the luck of the luckiest one to be substantially greater than average, and it’s that person who is going to win the contest most of the time. 


So, even if luck counts for only 1 percent, you’re going to see the winners most of the time won’t be the most talented people. Most of the time they’ll be among the luckiest of all the contestants. Let luck count for more than 1 percent, and it’s very easy to construct narratives where it matters enormously more.


[another example: an actor getting a breakout role because famous actors who were the first choice happened to turn it down]


You propose that we should replace the income tax with a very progressive consumption tax, that would tax spending rather than income and that would collect more revenue overall, in particular from the wealthy. What does that have to do with luck? 


I wrote the book and a lot of people find the transition between the luck chapters and the progressive consumption tax chapter jarring. What’s this doing here? 


The way I saw it was that the first part of the book tries to establish why chance events are often decisively important and that chance by its very nature is something that we can’t really control. If you can control it, it’s not really chance. The one dimension of things that you as an individual can’t control, so therefore counts as chance on that scale, the most important thing on that scale is where and when you’re born. If you’re born here you’re just so much luckier than if you were born in Somalia. 


Choosing your parents, what genes you get, what kind of upbringing you’re going to get, and the country where they live is the hugest dimension of all the chance events that effect outcomes in your life. You can’t affect any of those, but we can affect those. We can make the investments that make our environment one that if you work hard and have some talent you’ve got a reasonable chance to succeed, at least on a decent scale, unlike Somalia where no matter how hard you work and how talented you are you’re not ever going to get anywhere. We could affect that outcome. We can’t do it as an individual, but collectively we could affect that outcome. 


So, we are lucky to have been born in the United States, but you’re saying that we could make the landscape even more prone to good luck. 


Yes, and the landscape is not as supportive of good luck for people now as it was when I was coming up. I came up in a family that didn’t have much money. I graduated from Georgia Tech debt free. Today to graduate from a good school I’d be $40,000 in debt coming out of college. That’s if I got to college. The poor kids today don’t get to participate in music programs, art programs, sports programs—there’s extra fees for those. There’s this really very grim statistic I mention where if you’re the top scorer in math you’re less likely to graduate from college if you’re from a low income family than if you’re a bottom scorer in math from a high income family. 


Plus you believe that wealthy people’s happiness wouldn’t be negatively impacted by higher taxes, since the increase would affect them all similarly and just tamp down on what you call a “positional arms race” in their spending. 


I think the term “positional arms race” is an attempt to tie into the metaphor that everyone’s familiar with and regards as uncontroversial, which is the military arms race. A pair of military rivals buys additional armaments hoping to gain an advantage in their contest, but the effect is merely to restore the balance but at a higher level of expense. Neither one is more secure than if they each spent less on armaments and more on schools and hospitals, and everybody would’ve been better off. 


That’s why countries sign military arms control agreements. They agree that they won’t build bombs. You need to have inspectors and other enforcement to make those work, but where they can make them work nobody says, “What could the reason for an agreement like that be?”  Everybody knows what the purpose of it is. 


Coming back to luck, how much do you think people’s resistance to higher taxes stems from a lack of appreciation of the role of luck in their success? 


My research assistant did an experiment. We discussed it, how could we design an experiment that would help to answer that question? 


What she did was to ask people to describe a good thing that had recently happened to you. She divided people into three groups. The first group, that’s all she asked them to do. The second group, she asked them in addition to describing the good thing that happened, list three things you did that helped cause that good thing to happen. The third group, she asked them to list three things that others did or that were in some way external to you that caused the good thing to happen. 


Then at the end students got a bonus for their participation experiment and they were told that they could donate some or all, any fraction of their bonus, to one of three charities, their pick, just by saying so to the experimenter. What she found was that people who had listed external causes of the good thing happening donated about 25 percent more of their bonus to a charity than the people who had listed things they had done to cause the good things to happen. The control group was somewhere roughly in the middle of those two. 


There have been many experiments that have shown if you prime people to feel the emotion of gratitude, they become much more generous toward others, much more willing to pay forward to the common good. 


Given that, how do we make people who’ve been successful realize how lucky they’ve been?
I do think I have a very important practical message to offer, which is don’t try to tell your successful friends that they’re lucky. We saw that when Obama gave his speech in 2012 and Elizabeth Warren gave a similar speech, people didn’t like that. Those speeches were completely reasonable, as I was telling you, but people didn’t hear the reasonable part. The message they heard was that they didn’t deserve their success. That’s not the message of those speeches. If you want people to think about the fact that they’ve been lucky, don’t tell them that they’ve been lucky. Ask them if they can think of any examples of times when they might have been lucky along their path to the top. 


I’ve tried this many, many times and can report to you that the successful people who would get angered and defensive if they were reminded that they were lucky, instead don’t get angry or defensive at all when they think about the question, “Can you think of examples of times when you were lucky?” Instead their eyes light up, they try to think of examples, they recount one to you, and that prompts them to remember another one, they tell you about that one too, and soon they’re talking about investments we ought to be making. ~


 
https://getpocket.com/explore/item/don-t-tell-your-friends-they-re-lucky?utm_source=pocket-newtab

Oriana:


I once heard a story about — possibly apocryphal, since now I can’t find validation — about how Joan Sutherland got to be an opera diva. She was the understudy for Lucia in Lucia of Lammermoor. One night the then-famous soprano who sang Lucia got sick — and Joan went on the stage and delivered a legendary performance, especially in the mad scene. The audience went wild; the applause went on and on. 


Perhaps the story isn’t true, but the fact that we can so easily imagine it is true attests to our knowledge of the power of luck: you get a “lucky break.” I got such a break during the time I was working as a free-lance  journalism. An acquaintance let me know that his magazine wanted to cover a medical convention, and the regular staffer in charge of covering conferences wasn’t available. I wrote to the editor. They took a chance on me — and were very pleased with the results. From then on I never had any problem assignments. Until . . . the editor changed, and brought his own people. 


The funny thing is that at that point I’d been thinking of quitting anyway — I’d gotten to feel like “writing machine,” with not enough time to enjoy life. So for weeks I’d been composing a letter of resignation in my head, expressing my gratitude, saying it was the best job I’d ever had, but . . . and then boom, no letter was required. 


So in a way that was luck too — “pure dumb luck.” Rather than be devastated by the loss of a job, I turned to other activities and soon had a rich and busy life as if nothing happened. A chapter had closed, with neither a bang nor a whimper, but almost with bird song.


But those are minor examples of luck. Luck, good or bad, starts with the parents you had and the place and time you were born. Add to it gender and race, and you see how little we are in control of the hugely important factors that govern our lives. 


Mary: WE WANT TO BE RESPONSIBLE FOR OUR ACHIEVEMENTS BUT NOT OUR FAILURES.

The questions about luck I think have to do with our desire to see things in terms of a comprehensible narrative, to see our lives as stories with direction. We also want to see ourselves as the directors...determiners of our own success. If there are failures, it is easier to shift the blame elsewhere, even to ideas of “chance” or “luck.” We want to be responsible for our achievements but not our failures. And the idea of "chance" is itself a kind of threat...if it's all just chance, what happens to meaning?? Is there any sense to what happens, any sense to our lives, if it's all just basically a crapshoot?

Being lucky or unlucky is one way to understand our lives, but the resentment of being called lucky is a reaction to being denied the virtue of your actions and decisions. Don’t be so proud of yourself, you were just lucky. Being unlucky is also a way to be forgiven your failures...you weren't stupid or careless or bad, just unlucky.

None of these psychological reactions say anything about the actual degree of chance, the chain of circumstance leading to any particular event or state. We tend to think of chance as random, but chance events are part of a string of conditions that determine them, like anything else. It's a string of determinants we may not have been aware of, did not decide on or anticipate, so it looks like luck to us.


Oriana:

I can only nod my head. But my concern is more with the alleged individual failure. Children in my generation grew up with a lot of shame and blame, learning that when something went wrong, it was their fault. When I finally, belatedly, discovered the power of circumstances, it was a great liberation — comparable with leaving the church and no longer seeing myself as a wretched sinner.

As for pride in achievement being tempered the same way, yes again. That I owe first to my father, who, when I was in my teens, pointed out that I grew up with intellectual privilege. Then two men in my life, who happened to to rise up from poverty, said, “I think intelligence is genetic, so it’s not something you can be proud of.” Pride, as such, is not a virtue, and we should perhaps speak of the feeling of satisfaction when we manage to accomplish something well. “I like to work hard” is a more accurate statement than “I take pride in working hard.” I’m in favor  of staying away from both pride and shame.


*
In this short Life that only lasts an hour
How much — how little — is within our power

~ Emily Dickinson, 1292
 

*
 

*
SPINOZA’S GOD


~ “Cursed be he by day and cursed be he by night; cursed be he when he lies down, and cursed be he when he rises up; cursed be he when he goes out, and cursed be he when he comes in.”


In July of 1656, the congregation of the Talmud Torah in Amsterdam lit candles, prayed, and issued a herem — a curse. The subject of that highest censure of Judaism was Baruch Spinoza. The young philosopher was accursed and expelled from the community that had raised him.


Not only was Spinoza a refugee Jew in a Christian country, he was now a refugee from his fellow refugees.


The young philosopher was also a threat their belief system. He was attacked on the steps of the Synagogue by a knife-wielding assailant after he had questioned the authorship of the Torah. Spinoza kept his torn cloak as a souvenir of his lucky escape.


*
At the root of the “abominable heresies” so upsetting to Jews and Christians was Spinoza’s peculiar — but ancient — idea of God. Spinoza believed that God was in everything: us, the world, the sky, space, animals, particles and other people. God and nature, according to Spinoza’s philosophy, are the same thing.


Spinoza was a “monist”, he believed that there could only be one substance behind everything. The definition that he took for substance comes from René Descartes: substance is that which is not dependent on anything else.


No matter what you reduce down — tables, trees, people, planets, stars — you will find a substance that can no longer be reduced and nor is it dependent on anything else.


If substance can’t be reduced, it can’t be different. Therefore, the philosopher reasoned, there is only one substance. All the different things in the world are simply modifications of the same fundamental substance.


The computer I’m writing on now is dependent on millions of things to be here now: metal, glass, silicone, all the processes of manufacturing, the logistics of getting to me etc. All these are causes of its coming into being. But existence itself — substance — isn’t dependent on anything at all.


Things get interesting at this point. The one substance must be limitless and self-sufficient. This is because substance is outside of the laws of cause and effect.


Substance is the cause of all beings and therefore must be self-created (eternal). We’re now starting to see that “substance” as Spinoza defines it is identical to what we would expect God to be like (whether we believe in God or not).


Spinoza believed that God is the substance that lies beneath everything. If God is limitless, the philosopher reasoned that it must be the case. If God wasn’t in everything, God would not be all-powerful and infinite.


The common image of God in the Christian world is the paternal old man with the white beard in the clouds of Heaven. The Christian God enacts miracles and pays attention to what is going on here on earth. Spinoza’s God is impersonal; a deterministic system through which everything happens by necessity.


If God had a reason to create the universe, then God would be subject to cause and effect: God’s decision to create the universe would have been caused somehow. For Spinoza, the universe is the unfolding of God’s nature in accordance with laws that are eternal. God doesn’t act, God just is.


If God is substance, and everything is composed of substance, God must also be nature. This is why Spinoza used the words “God or Nature” (Deus sive Natura).


Spinoza did not believe in the immortality of the soul. The philosopher believed that our body and spirit are one and the same thing and unified with God. “Mind” and “matter” are simply different “modes” of the same substance.


*
“God or Nature” is limitless and perfect. If that’s the case then everything is as it should be. Everything is perfect.


Spinoza believed that the law of cause and effect, and the perfection of existence, means that everything — including our lives — is predetermined. This is what philosophers call “determinism” — the idea that even our mental “choices” follow the laws of cause and effect. Spinoza has a great deal in common with the ancient Stoics in this respect.


Free will is a misunderstanding of reality. We believe we have free will because we are conscious of our actions. However, we are not entirely aware of all the causes of our actions. The huge web of causes and effects of which we are a part is too complex to understand. ″The infant believes that it is by free will that it seeks the breast; the angry boy believes that by free will he wishes vengeance; the timid man thinks it is with free will he seeks flight.”


If we truly had free will, we would be the cause of ourselves. Actions, after all, require causes. Only “God or Nature” can be the cause of itself.


What about freedom? Freedom, as the philosopher defined it, is the capacity to know that everything is determined. Since “knowing” this needs no powers of observation (in fact it’s impossible prove things are determined by empirical observation), the key to freedom is reason.


Instead of being anxious about our choices in life — and a God that judges and intervenes in the world — Spinoza thought that people’s awareness of this reality would bring tranquility. The attitude we take to our circumstances determines our happiness. If we see the order of existence as perfection, our mind can be put to ease.


Knowledge and understanding are distinct. Knowledge is something you accumulate. You can accumulate more knowledge by buying books or going to an expensive school.
Understanding is free. It comes from the process of reasoning. What’s beautiful about Spinoza’s philosophy is that it shows that we can find freedom through reason alone, not by buying books or going to a school.


Spinoza’s philosophical system is one of the most influential in history. Even if they found problems with Ethics, countless philosophers have expressed admiration for the philosopher’s ambition. Spinoza is one of the few to theorize an all-encompassing system that seeks to explain the most difficult questions we face.


Einstein wrote in 1929: “I believe in Spinoza’s God, who reveals himself in the harmony of all that exists, not in a God who concerns himself with the fate and the doings of mankind.”

 
Spinoza was one of the first truly modern men. This is not only due to his secular life, but because of the original ideas that brought him to his conclusions. Einstein noted that “Spinoza is the greatest of modern philosophers, because he is the first philosopher who deals with the soul and the body as one, not as two separate things.”


https://medium.com/@stevengambardella/spinoza-finding-freedom-in-understanding-a8ff38493b


MARY: GOD IS NO MORE SEPARATE FROM THE UNIVERSE THAN TIME IS SEPARATE FROM SPACE

Spinoza’s god sounds very much like quantum theory. Both seem to suggest our habit of seeing distance and division is an illusion, perhaps a handicap of incarnation, of being physical bodies that exist in time, while the reality is everything is one thing existing simultaneously. So the action of quantum particles is not “spooky action at a distance” because there is no distance.

Imagining a creator separate from creation is a construct of seeing divisions instead of the continuity of the whole. God is no more separate from the universe than time is separate from space. And thinking in these terms actually obviates the need to postulate god in any traditional religious sense, as an Actor putting everything in motion, but basically apart from that everything, a creator, a cause, a manipulator.


Oriana:

There is a book that influenced me deeply — and hardly anyone seems to have heard of it. It’s Jesse Bering’s The Belief Instinct. It shows the cognitive errors that underlie the assumptions of most religions. For one thing, we always seek meaning — hence everything is a potential sign, guidance coming to us from some divine (or infernal) source.

It’s hard to read a biography of Spinoza without falling in love with the man. But he was still a product of his age in feeling the need to postulate god — even if one identical with nature.  “God, or Nature” can be understood as “God, meaning Nature.” There is not separation. But we might as well say “Nature.” We will never run out of mystery.

We truly don’t need to ponder imaginary problems such as “the mystery of the Trinity” — or, worse, “Why did god allow school shootings, or the coronavirus?” It’s simply nature, human or non-human. If non-human, then with malice toward none, but with consequences if we disturb the ecological balance. I am not suggesting a worship of nature. But let us keep on studying it, trying to understand it.
 

*
A PULSE OXIMETER, AVAILABLE OVER THE COUNTER AT PHARMACIES [AND ONLINE], CAN PROVIDE EARLY WARNING OF COVID-19 PNEUMONIA

 
~ We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.


Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.


To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.


A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.


We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps keep the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.


Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until their oxygen levels plummet. In effect, the patient is injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)


A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.


Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.


There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.


Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.


 
Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.


Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.

But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.


(written by Richard Levitan, an ER physician with 30 years experience)

https://www.msn.com/en-gb/news/coronavirus/the-infection-thats-silently-killing-coronavirus-patients/ar-BB12XKKy?fbclid=IwAR1yKssb9t8o5BhpPhtramDLgo8SRua_dkpMCPhP37N7gTMaeKm5CnEZhJ8

Kestrel:

"I have a number of doctor/nurse friends since I'm in healthcare myself (not patient centered - IT). They've verified the pulse-ox info. They said the reports of extremely low ox measures are true and that it has been surprising to them as well - and how everyone coming in now is tested even if they're there for some seemingly unrelated issue. They tested a guy with a broken arm - very low pulse ox and a subsequent chest xray found pneumonia. One anesthesiologist said he'd never seen a pulse ox that low in his life and would have thought the patient would be passed out on the floor."

Oriana:

I got mine at Walmart for $39. Many drug stores are sold out, but you can still order online.  I'm happy to report that my oxygenation level in in the 97-98% range. This is great news, since last September I was hospitalized for life-threatening pneumonia and was put on oxygen. By the way, that was my first experience with oximetry.

EXTREMELY HIGH MORTALITY OF COVID PATIENTS ON VENTILATORS

~ Nearly 90% of patients hospitalized with COVID-19 who required mechanical ventilation (MV) died, with fatalities reaching nearly 100% among those aged >65 years. In stark contrast, just one-quarter (26%) of those aged >65 years who did not require MV died.
The findings come from the first large case series of sequentially hospitalized patients with confirmed COVID-19 in the US. Among the 5700 cases reviewed, older persons, men, and those with obesity, hypertension, and diabetes were highly prevalent, a pattern similar to data that have been reported in China, according to the study authors.  The report was published online April 22, 2020, in the Journal of the American Medical Association. ~


https://www.patientcareonline.com/coronavirus/fatalities-high-among-intubated-patients-covid-19?rememberme=1&elq_mid=11741&elq_cid=174251&GUID=86BA8AB4-ECE8-42F3-A95A-81AB7C4F9CB9




Oriana:

And to think that a cheap over-the-counter oximeter could have prevented at least some of those deaths, since the patients would not require ventilators, thanks to early detection of hypoxia . . .

Mary:
 

First, I ordered my oximeter!! The evidence seems to indicate it may offer an early warning, and allow some intervention before only the most drastic, and largely unsuccessful, interventions become necessary.

If the covid patients are injuring their lungs as they breathe harder and faster to compensate for low oxygen levels, imagine how a ventilator, that pushes air into the lungs with mechanical pressure, is exacerbating that damage. Premature infants who don’t have the adequate surfactant for their lungs also do not fare well on ventilators — and no one does, really, who is on a ventilator for very long, more than a few days. I think we are still at the beginning of our learning curve with this illness, but know enough now to see that mechanical ventilation should be avoided if at all possible, and only used a a treatment of last resort. The miserable survival statistics of vented covid patients is clear and undeniable.

As we learn more and see more of how devastating and widespread the effects of covid are, every new step in our knowledge is reason for hope, for knowing how we may combat it.

Thinking about the situation we're in, the shutdowns, social distancing, and the universally bad news that this thing's still growing and we are just at the very beginning of knowing anything about it, a few things are clear. First, there's no escape, no where to run and hide, it's everywhere..in large part due to our ability and habits of international travel and trade. Then there is the discomfort of separation, going against our basic nature as social animals, creating anxiety, loneliness, even grief for a way of living that may never be returned to. Then, a seeming contradiction that is really a result of these, a sense of community, solidarity, of love and gratitude for all the suffering and all who are working to alleviate it..the doctors and nurses, first responders, service workers, those who ensure the most basic needs are filled. Every day people are expressing these feelings, affirming that even alone we are together.

And this is despite the deniers, conspiracy theorists, exceptionalists, blame casters, and religious ideologues  screaming and waving signs and shouting about infringements on their personal freedoms. I think many people are facing the dangers of economic collapse and ruin, terrified and unable to see a way out . Balancing the demands of economics and health is now an enormous, extremely difficult job, maybe impossible to accomplish within the present economic system, with its huge imbalances and its profit and growth driven structure.  Whether something new and better can be accomplished despite that order remains to be seen. The costs of an inadequate response are sure to be high.

Some of those costs we are seeing in the recent suicides of a nurse and a first responder, the terrible desperation coming of the daily burden of so much death, and such helplessness to stop it. These two may be the canaries in the coal mine, warning of worse to come. It is hard for me to imagine the burden these front line workers are carrying. As a nurse, I was not unfamiliar with death, and it was never easy, never, no matter the circumstance. To encounter death at the rate it's occurring in the epicenters of big urban hospitals, the sheer numbers, the lack of usual decorum
bodies stacked in refrigerated trucks, overwhelmed morgues, people dying without a single family member allowed near — has to exact an almost unimaginable toll. Suffering on suffering, grief on grief.
Oriana:

With US covid deaths now past 62,000 (as of April 30; and that’s likely to be an underestimate), some hard questions — not answers, only questions — have cropped up on the media. Why have South Korea, New Zealand, Australia (and, arguably, Israel if we dismiss the non-compliant Ultra-Orthodox) been so successful while the US is struggling? What is the state of national morality re: letting many more people die to prevent further economic losses? Can the lock-down and other restrictions indeed go too far?

It’s not that there are no answers — it’s that they are uncomfortable. As you observe, “Balancing the demands of economics and health is now an enormous, extremely difficult job, maybe impossible to accomplish within the present economic system, with its huge imbalances and its profit and growth driven structure.” But it’s high time for a deep and difficult discussion.

But first and last, I am thrilled that you ordered an oximeter!!


*
ending on beauty:


They say Ulysses, wearied of wonders
Wept with love on seeing Ithaca
Humble and green. Art is that Ithaca
A green eternity, not wonders

Art is endless like a river flowing
It passes, yet remains, a mirror to the same
Inconstant Heraclitus, the same
And another, like the river flowing.

~ Jorge Luis Borges, Are Poetica


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