COVID19 update, June 13, 2020: Belgium takes a breather; the Jewish community of Antwerp; High-fructose corn syrup

 

(1) Belgium for a stretch has had the highest per capita COVID19 mortality in the world (except for the microstate of San Marino — beware of statistics of small numbers), with almost 10,000 dead out of a population of about 11 million. But now it seems to have turned the corner at last—daily dead are in the 10 range, down from 2-300 at the peak of the epidemic. 

So the chair of the Corona Committee, virologist Steven De Gucht, gave his last of 54 press conferences for now, looking back at the past three months. “As quickly as the dark clouds gather, just as quickly can the sun break through again,’ Van Gucht said somewhat emotionally. This is the last press conference. We can let go of the reins a little. We’ve grabbed the virus by the neck and extinguished fires. It is clear that nature can be very harsh.” Future updates will be via weekly press releases, at least until (if ever) there is a second wave.

Current COVID19 measures are detailed on a dedicated website in four languages, including in (fairly idiomatic) English. At this point, all stores are open (night stores until 1am), as are (with capacity restrictions) restaurants with table service and bars. Sports teams, musical ensembles, and theater group may practice but not yet perform for an audience: starting July 1, audiences of up to 200 are permitted (which works for the local equivalent of off-Broadway theater and for junior league soccer teams). 

(2) Also in Belgium, in an area about six square blocks by the Antwerp railway station, is the Diamond District, home to about 20,000 mostly Orthodox or Chareidi (“ultra-Orthodox”) Jews. This community has given Antwerp the nickname ‘Jerusalem on the Scheldt’ in some circles. The Jerusalem Post looks at how this community has weathered the COVID19 storm: fairly well, all told. “The community projected in March that 85% of its members could contract the coronavirus because of its close conditions and frequent social interactions, and that over 500 could die. A communal taboo about dealing with the virus, which some labeled as a scourge of the secular world, added to the danger.” In the event, only 11 (eleven) community members succumbed to the virus, all elderly and/or with major pre-existing conditions. 

 

The community […] at first downplayed the danger of the virus […] but […]  took swift action following the death rate projection, implementing strict social distancing measures that included the closure of all synagogues on March 13 — five days before federal authorities imposed a nationwide lockdown. 
 
“It’s just a few days, but with a pandemic that grows exponentially it was a crucial early step,” said [Shlomo] Stroh, who was involved in the decision-making process led by the city’s chief rabbi, Aaron Schiff, and the city’s beit din, or rabbinical court. 

Getting the Orthodox Jewish community of Antwerp to adhere to social distancing was a “gradual process,” according to Claude Marinower, an alderman in charge of the city government’s communications efforts, among other portfolios. 
 
“At first there was some pushback” from some community members against the closure of synagogues, said Marinower, who is Jewish but is not Orthodox. But “there was more cooperation as the dimensions of the pandemic emerged — and especially in Belgium, where about 10,000 people have died of the coronavirus.” 
 
“When rabbis issued strong instructions against gatherings, it was accepted by all,” Marinower said.
 
Michael Freilich, an Orthodox Jewish lawmaker from Antwerp who serves in the federal parliament, also attributed the low death rate among Jews to a combination of rabbinical leadership and authorities’ strict enforcement. Together, he told JTA, “it meant we were saved from disaster.”

With the fairly narrow streets inside the district, a creative solution to communal prayer was found: a cantor would lead the service from the street and worshipers would join in from the balconies. Some non-Jewish neighbors lodged police complaints about the noise, but others welcomed the relief from the silence during the lockdown as well as “the chance to hear what goes on inside the synagogues”. (I would imagine that anybody who has serious issues with Jews would not voluntarily live in an area of Antwerp that is best described as an urban shtetl.)

 

(3) Roger Seheult MD has videoblogged extensively on the benefits of vitamin D and zinc for the immune system generally and during the COVID-19 epidemic in particular, as well as the value of the antioxidant and mucolytic NAC (N-acetylcysteine) as a food supplement.  This time, however, he talks about something to avoid for a change: fructose and specifically high-fructose corn syrup.

http://doi.org/10.3390/nu9040405

 

Diabetes prevalence was 20% higher in countries with higher availability of HFCS compared to countries with low availability, and these differences were retained or strengthened after adjusting for country-level estimates of body mass index (BMI), population and gross domestic product (adjusted diabetes prevalence=8.0 vs. 6.7%, p=0.03; fasting plasma glucose=5.34 vs. 5.22 mmol/L, p=0.03) despite similarities in obesity and total sugar and calorie availability. These results suggest that countries with higher availability of HFCS have a higher prevalence of type 2 diabetes independent of obesity.

https://doi.org/10.1080/17441692.2012.736257

And yes, much of it is about type 2 diabetes (a major risk factor with COVID-19) but there’s more to the story. Go watch the whole video.

 

 

COVID19 update, May 7, 2020: risk of severe case presentation increases with age too; meat processing plants; fraying lockdowns; Georgia (the country)

Busy day at work, so just some quick updates:

(1) There is a commonly quoted rule of thumb that 80-85% of COVID19 cases are mild, and the rest severe and life-threatening. But how constant is that ratio really?

I was emailed a copy of a report (in Hebrew) by a group that was consulted for our national COVID19 planning. In the section on expected hospital load was a table with a breakdown of hospital and ICU admissions by age bracket, apparently taken from a CDC Morbidity and Mortality Weekly Report, http://dx.doi.org/10.15585/mmwr.mm6912e2. Screenshotting the table here:

* Lower bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group; upper bound of range = number of persons hospitalized, admitted to ICU, or who died among total in age group with known hospitalization status, ICU admission status, or death.

Needless to say, these are data early in the epidemic (when the group had to make its recommendations). But if we use ICU admissions as a proxy for the number of severe cases, then we see a clear increase with age, the way it is seen for mortality.

(2) Elsewhere on the CDC site, one finds a report about the conditions and challenges at meat processing plants https://dx.doi.org/10.15585/mmwr.mm6918e3
Some quotes:

During April 9–27, aggregate data on COVID-19 cases among 115 meat or poultry processing facilities in 19 states were reported to CDC. Among these facilities, COVID-19 was diagnosed in 4,913 (approximately 3%) workers, and 20 COVID-19–related deaths were reported. Facility barriers to effective prevention and control of COVID-19 included difficulty distancing workers at least 6 feet (2 meters) from one another (2) and in implementing COVID-19-specific disinfection guidelines.* Among workers, socioeconomic challenges might contribute to working while feeling ill, particularly if there are management practices such as bonuses that incentivize attendance. 

 Facility challenges included structural and operational practices that made it difficult to maintain a 6-foot (2-meter) distance while working, especially on production lines, and in nonproduction settings during breaks and while entering and exiting facilities. The pace and physical demands of processing work made adherence to face covering recommendations difficult, with some workers observed covering only their mouths and frequently readjusting their face coverings while working. Some sites were also observed to have difficulty adhering to the heightened cleaning and disinfection guidance recommended for all worksites to reduce SARS-CoV-2 transmission.

Solutions to structural and operational challenges that some facilities adopted included adjusting start and stop times of shifts and breaks to increase physical distance between workers. Outdoor break areas were added at some facilities to decrease contact between workers. Some facilities installed physical (e.g., plexiglass) barriers between workers; however, this was not practical for all worker functions. Symptom and temperature screening of workers was newly instituted in some facilities and improved in others.

Sociocultural and economic challenges to COVID-19 prevention in meat and poultry processing facilities (Table 2) include accommodating the needs of workers from diverse backgrounds who speak different primary languages; one facility reported a workforce with 40 primary languages. This necessitates innovative approaches to educating and training employees and supervisors on safety and health information. In addition, some employees were incentivized to work while ill as a result of medical leave and disability policies and attendance bonuses that could encourage working while experiencing symptoms. Finally, many workers live in crowded, multigenerational settings and sometimes share transportation to and from work, contributing to increased risk for transmission of COVID-19 outside the facility itself. Changing transportation to and from the facilities to increase the number of vehicles and reduce the number of passengers per vehicle helped maintain physical distancing in some facilities.

(3) Lockdowns — useful as they undeniably are in densely populated urban regions — are not something that can be maintained forever. In the “hammer and dance” strategy of Tomas Pueyo, the “hammer” — the lockdown to break the epidemic’s back — is supposed to be hard and short, followed by a maintenance phase — the “dance” — that favors such social distance measures as yield the maximum reduction for minimal economic cost. (Face masks are one example.)
There are increasing signs that lockdowns in the US are fraying. Bethany Mandel, who lives in New York, speaks for many who express a sense that politicians of a certain stripe now keep “moving the goalposts” way beyond the original justification for lockdowns, and that they are completely oblivious to the staggering and still mounting economic costs for those who do not have guaranteed government paychecks. “We are tired of being treated like children,” one reads numerous times in the comments.[*]

Days ago, a hairdresser in Texas who had reopened her business made a tearful plea that she not be punished for wanting to feed her children. She was convicted to seven days in prison and a $7K fine. Now in a dramatic turn of events, not only have both the state Attorney-General and the Governor criticized the “excessive” punishment (the lockdown over hardressing salons ends Friday anyhow), but the state’s Lt.-Gov. donated the money from his own pocket and offered to serve the 7-day sentence himself as a proxy for the woman.

(4) DIE WELT looks at what it calls the “Coronavirus Model Pupil,” Georgia (the country, not the US state). The country, knowing it could ill afford such a calamity, locked down proactively rather than reactively, and is now exiting. (Possibly the most prescient thing it did was cut air links to China before they even saw their first case.) Now, despite a social culture much like Italy, it got a sum total of 610 cases, with just 9 (nine) dead.

(5) Finally, hard-hit Belgium is reopening after a few false starts. Summarizing the report from De Standaard (in Dutch):

• starting May 10, every household can receive and host four designated people (a fixed list of four). Recommended to sit outdoors. No travel distance limitation

• May 11, shops will open. One customer per 10m^2 (110 sq.ft.) floor area. Wearing a mask is recommended but not mandatory; generally recommended in situations where 1.5m (5ft) distance cannot be maintained (e.g. on public transit). If lines develop, elderly, handicapped, and care workers get priority

• public transit in principle reserved for people who have no private means of transportation (cars, motorcycles). In practice, this will not be enforced

• restaurants, cafés, cultural centers remain closed for now

• public sports events are put off until July 31

[*] Without engaging in partisan political rhetoric: one reason the lockdown in Israel was largely successful, and saw a compliance well above what one might expect of our garrulous nation, was that we were treated like adults. Economic trade-offs were honestly discussed, including the limits to how long we could lock down before irreparable damage to our economy would ensue — and we were given a realistic time horizon from the start. At no point was there a sense of “bait and switch”.

UPDATE: via the Jerusalem Post, this interesting paper in the Journal of Medical Virology has an interesting theory about why the SARS-nCoV-2 coronavirus may elicit potentially fatal “cytokine storm” so much more often than seasonal influenzaviruses: https://doi.org/10.1002/jmv.25866

We have applied mathematical modeling to investigate the infections of the ongoing COVID‐19 pandemic caused by SARS‐CoV‐2 virus. We first validated our model using the well‐studied influenza viruses and then compared the pathogenesis processes between the two viruses. The interaction between host innate and adaptive immune responses was found to be a potential cause for the higher severity and mortality in COVID‐19 patients. Specifically the timing mismatch between the two immune responses has a major impact on the disease progression. The adaptive immune response of the COVID‐19 patients are more likely to come before the peak of viral load, while the opposite is true for influenza patients. This difference in timing causes delayed depletion of vulnerable epithelial cells in the lungs in COVID‐19 patients while enhancing the viral clearance in influenza patients. Stronger adaptive immunity in COVID‐19 patients can potentially lead to longer recovery time and more severe secondary complications. Based on our analysis, delaying the onset of adaptive immune responses during early phase of infections may be a potential treatment option for high risk COVID‐19 patients. Suppressing the adaptive immune response temporarily and avoiding its interference with the innate immune response may allow the innate immunity to more efficiently clear the virus.

COVID19 update, April 24, 2020: Belgium reopening May 4, Israel reopens “phase 1.5”, NYC immunity testing, nicotine

(1) Belgium has been nibbling around the edges of its existing lockdown, allowing phone stores, garden stores, etc. to reopen, but (with the highest per capita COVID19 mortality of any country in the world) experts kept saying they were not out of the woods yet. Now the country’s national security council decided on reopening in two phases, May 4 and May 19. https://www.standaard.be/cnt/dmf20200423_04932921

In Phase 1 (May 4), the following will again be permitted:

• outdoor sports like tennis, angling, horseback riding (as a family, or in pairs — not yet in group)
• registered sports teams can resume training
• public parks etc are reopened
• car dealers/garages, bike shops, real estate offices may function “by appointment” (not yet walk-in)
• smaller home improvement shops (paint, tiles, lighting fixtures, kitchen stores,…) may reopen
• non-essential enterprises may resume activity, subject to social distancing
• masks will be mandatory on public transit. (Belgium has an extensive multimodal network.)

Phase 2 (May 18) adds:

• all remaining businesses may reopen. Hairdressers have to wear masks
• schools gradually reopen
• museums reopen for individuals or families, not yet for groups
• meetings up to 50 permitted
• visit to vacation homes (in practice, on the sea coast or in the Ardennes): details to be finalized

“Horeca” (hotels, restaurants, and cafés) are not to be opened before June 8.

(2) Israel was supposed to have its Phase 2 reopening in a week, but apparently decided to speed things along a bit. As of Sunday, remaining stores are allowed to reopen. In addition, hairdressers are allowed to reopen, with maximum 2 clients at a time, and disinfecting equipment between every haircut. Indoor malls still remain closed for now. Restaurants, which until now were only allowed to operate by delivery, are now also permitted to offer takeaway (not yet with seating).

The country will go in hard lockdown over Memorial Day and Independence Day, to prevent super-spreader events like there were at Purim, but that should be “it” for a while. Active COVID19 cases in Israel have been declining for a week now, as recoveries outpace new cases.

(3) Much ado about preliminary results from a community testing effort in NYC that appears to indicate as much as 20% of the NYC population has antibodies for COVID19. (The figure drops to 3.6% for upstate New York.)

(4) (Hat tip: Erik Wingren.) Peculiar and counterintuitive claims (see here and here) from France that smoking, and specifically nicotine, would have a protective effect — specifically, that the COVID19 patient populations contained an anomalously low percentage of smokers compared to the general population.

A French study from the Université Pierre et Marie Curie found that just 8.5 percent of 11,000 hospitalized coronavirus patients were smokers compared to 25.4 percent of the country’s population.

They are now experimenting with nicotine[*] patches. The initial data from China (caveat emptor) appeared to indicate that smoking was a risk factor because of damage to the lungs — but that damage comes overwhelmingly from tar, not from nicotine. (I wonder if anybody looked at “vapers” for comparison?) Anecdotally, a friend who is immunocompromised following an organ transplant, and has been having regular troubles with bronchitis, told me he took up vaping (which gives him nicotine but not tar), and it greatly reduced his respiratory issues.

[*] What is the purpose of nicotine in nature? Some plants produce alkaloids to deter animals from eating them: for this purpose, tobacco produces nicotine (named after Jean Nicot, the 16th century French diplomat who was the first to bring tobacco to France).

COVID19 update, April 21, 2020: Colchicine; more on COVID19-related pneumonia and “stealth hypoxia”; community testing in Los Angeles; Belgium as seen from Germany

(1) Via Mrs. Arbel, here is info on a clinical trial of the ancient-as-dirt drug colchicine. This has been in use since Antiquity for the treatment of gout (full disclosure: I have been taking it for a while, when a low-carb, high-protein diet intended to lose weight gave me a painful bout of this “rich man’s disease”): this clinical trial investigates whether its early administration to COVID19 patients may prevent “cytokine storm”. (More here at Physician’s Weekly) https://www.physiciansweekly.com/anti-inflammatory-drug-colchicine-on-deck-for-covid-19/

I am wondering more than ever whether the vast majority of dead from COVID19 aren’t killed by the patients’ own immune systems going amok. (This was what caused most deaths during the 1918 “Spanish” Flu: the main difference with the present epidemic — other than the causative agent which was an influenza virus then, a coronavirus now — is that in COVID19 the severe disease picture seems to be the exception rather than the rule, statistically speaking.

How rare? Consider Israel, which tests reasonably broadly and is conservative about diagnoses, albeit admittedly has a “younger” population pyramid than most Western countries. The screenshot below is from the daily report by its Ministry of Health: https://govextra.gov.il/ministry-of-health/corona/corona-virus/  

As of the time of writing, we have 13,883 verified cases (read: people testing positive for the virus): 9,072 of them in mild condition, 135 in moderate condition, just 142 in severe condition of which 113 on respirators, 181 deceased (of course, 181 too many), and 4,353 verified recoveries — defined here as previously diagnosed, now without symptoms and testing negative for the virus. (The “170” at the top of the graph are new cases added.) Moderate+severe+dead together is 4% (four percent) of the total infected. (Probably closer to 8% or 10% of symptomatic/overt cases — since anecdotally, it seems that about half of Israel’s verified “cases” [read: verified infections] are completely asymptomatic.)

(2) “masgramondou” Emailed me this one from the NYT (original link: https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html?action=click&module=Opinion&pgtype=Homepage archived here http://archive.is/QSBfc) in which an emergency physician named Richard Levitan MD at Bellevue Hospital in NYC talks about “stealth hypoxia” in COVID19 patients. Unlike the usual fodder at the NYT, this is a factual report with no obvious political axe to grind. Some moneygrafs:

And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?

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.

[…]

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.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

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.)

And then the best part!

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.

Read the whole thing.

(3) (via Instapundit) KTLA reports on a new community antibody study in Los Angeles County https://ktla.com/news/local-news/l-a-county-officials-to-provide-latest-update-on-coronavirus-crisis/?fbclid=IwAR3ItNdY_00D6FkDjQRn-x5rK71A2XqLg-xgvPQFSN0YfI9batMXXNA6-s0  which corroborates various earlier reports that the USA, at least, may have a very significant Dunkelziffer/“stealth infection rate”.

While Los Angeles County has reported a total of 13,816 coronavirus cases, early results from an antibody study conducted with the University of Southern California shows that hundreds of thousands more could have had COVID-19 in the past, officials announced Monday.

So far, 863 L.A. County residents have been tested between April 10 and 14 as part of the study.

The study estimates a prevalence of COVID-19 antibodies in the county to be 4.1%, with a range that could be as low as 2.8% and as high as 5.6%, when you factor in the reliability of the tests.

An estimated 221,000 adults to 442,000 adults at the high end may have been infected at some point before April 9 with COVID-19, suggesting that the number of total people in the county with a past or current infection is 28 to 55 times higher than the number of reported positive cases, Dr. Barbara Ferrer, L.A. County’s public health director said Monday.

[…]

Although the sample size was relatively small, Ferrer shared some early estimates about who was most likely to be infected:

Men were more likely than women to be infected. The estimated prevalence is 6% among men and 2% among women

7% of African Americans, 6% of whites, 4.2% of Asians and 2.5% of people who were Latinx who were tested were found to be positive for COVID-19

2.4% of people who were between the ages of 18-34 were positive

5.6% were between 35 and 54

4.3% who were 55 and older tested positive

(4) And in what is rather distressing reading, Die Welt (in German) wonders why neighboring Belgium (!) has the highest pro capita COVID19 mortality in the world — actually, the absolute numbers are larger than Germany’s, which has seven times the population of Belgium! Summarizing a few of their points:

(a) Belgium counts deaths “with” COVID19 as COVID19 deaths, in the name of “transparency”, even if the cause of death is different. Germany uses a  more restrictive definition.

(b) 50-70% of all deaths in Belgium are in homes for the elderly [about 20% of care home residents over 85 test positive in facilities where everybody was tested]. Die Welt cites a report in Belgium’s largest French-language daily, LE SOIR  Wie die Tageszeitung „Le Soir“ berichtet]  Staff went around without even face masks for weeks because of (c)

(c) there is an acute shortage of PPE, particularly masks. The emergency stockpile (from SARS days) had been destroyed pre-epidemic as it had passed the expiration date — and had not been replenished even though that could then easily have been done. (Now Belgium was forced to startup domestic production. [Becoming dependent on China is a recipe for disaster across the world.])

(d) Nevertheless, it’s not all doom and gloom. Spread in the general population has been contained, the number of cases grows more slowly, and the number of deaths has peaked and is now holding at about 300/day. But this is cold comfort, or as you say in both Dutch and German, “meager comfort”…

(e) Finally, as things are again picking up at my day job, I am grateful to the people who have started sending me article tips! 

COVID19 update in brief, April 2, 2020: (1) Belgium followup; (2) German RKI recommends masks for everyone, Israel mandates them in public

A very busy day at the (remote) day job, so just a brief update:
(1) Following up on the earlier report from De Standaard (in Dutch) reports a grim peak of 183 dead in a single day, for a total of  1,011 in a country with 11 million people.

However, and this is the good news, hospital admissions have held steady between 450 and 650 for the past week. The last day, 584 new admissions were offset by 363 discharges. Out of 5,376 hospital patients with COVID19, 1,114 are in ICU, an increase by 56 (the smallest since March 23). 906 of those need ventilation, an increase by 72.

teven Van Gucht, head of the National Corona Committee, is quoted as saying, ‘The nummer of new admissions fluctuates already for days in the same range, which indicates we’ve reached a plateau. This is surely due to the [social distancing] measures.”

A friend sent me this graph. Note that both the graphs for Belgium and for Israel show a noticeable “inflection point” around 14 days beyond the introduction of social distancing measures.

(2) While Belgium is still reluctant to mandate masks for everyone, Germany’s authority for infectious diseases, the Robert Koch Institute (named after the discoverer of, among others, the tuberculosis bacillus) now recommends masks for everyone. Their prime benefit is said to be stopping asymptomatic infection carriers from spreading the disease.
For the same reasons, Israel’s ministry of health today mandated the wearing of masks in public areas.

COVID19 update, March 31, 2020: a brief look at Belgium

Belgium, historically a crossroads between rival European powers, now is home to the European Union’s nerve center in Brussels. I have been following De Standaard (in Dutch) for updates on the situation there.
This article quotes virologust Steven De Gucht. A few bullet points:

• 485 new hospital admissions in the past 24 hours
• 94 new fatalities, but this included deaths since March 11 from care centers for the elderly that had not percolated through the reporting yet (all above age 65). Total mortality is 705, of whom 93 percent are over age 65
• the youngest victim yet is a thus far unique case of a 12-year old girl. Her status deteriorated suddenly after 3 days of fever. [Cytokine storm?!] De Gucht calls for investigating this rare and anomalous case in detail
• 876 new cases, the second drop in a row
• hospital admissions, at 485, are likewise down for the 2nd time. Total COVID19 hospital population is 4,920 — that number keeps mounting as COVID19 patients tend to be in for long hospital stays. 168 patients were discharged today.
• 1,021 patients total are in intensive care (an increase by 94).
• 786 patients need respiratory assistance of some sorts
• 20 are on ECMO (“heart-lung machines”)
• the article is accompanied by the following infographic:

green=new hospital admissions, teal=ICU, red=deceased

Elsewhere today, the same paper quotes medical sources as saying, “we’re off the Italian track, but not yet onto the Scandinavian one” . The subtitle says, “wait another few days to see if we’re really past the peak”.

And in what sounds like a bold bet, Johnson & Johnson, parent of local Janssen Pharmaceutica NV,  is planning to take a vaccine into production even while the clinical trial is running. It expects to be up to full production early next year. The article quotes Johan van Hoof, director of the vaccines division of Janssen, as saying “Theoretically this could go wrong. But we have enough experience with vaccines to be very optimistic. This virus uses the same ‘key’ [i.e., the so-called “spike protein] to penetrate the lungs as SARS did. So we know we can protect people if we can make the right antibodies be produced by the body.” [A DNA vaccine for the original SARS that expressed the spike protein never saw wide application in humans as the epidemic died out first.]

UPDATE: this isn’t Belgium, but in New York, Rabbi Daniel Nevins, dean of the Jewish Theological Seminary, who recovered from a mild case of COVID-19 earlier this month, is now donating plasma for an antibody therapy trial. https://www.jpost.com/Diaspora/Rabbinical-school-dean-participates-in-experimental-coronavirus-treatment-622670

Chair of Belgium’s largest party: “The Left must choose: open borders or a welfare state”

[For an interesting window into Belgian politics, see the following note that was posted [in Dutch, English translation mine] to the Facebook feed of Bart De Wever, mayor of Antwerp and chair of the center-right N-VA (New Flemish Alliance) party.

Had his name been Burt Weaver, it could almost be an article in National Review or another conservative magazine in the Anglosphere. Milton Friedman would surely nod in recognition at the title. — Nitay Arbel]

The Left must choose: open borders or a welfare state

Bart De Wever is the chair of [the] N-VA [party] and mayor of Antwerp

The migration crisis has confronted Europe with its own moral nihilism. Citizens that form a human chain around the [Brussels-]North [railway] station, or put up transient migrants for the night, touch a soft spot in all of us. Suddenly we are wrestling with the age-old question: what does it mean to be a good person? What are we bidden to do? And by whom? And to whom? The Christian heritage that we still nurse from after the twilight of G-d, dictates to us that we should treat our neighbor as we would treat ourselves. But how near must our neighbor be?

In this moral confusion, an industry of leftist lawyers, NGOs, and activists has found a meal ticket. The present government, they claim, follows a policy that is inhuman, egotistic, and heartless. This is a subtle form of moral blackmail. For whoever does not agree with them, cannot be a good person. And who wants to be a bad person? Out of sincere moral compassion, we are all inclined to go along with this leftist discourse.

But, though the migration industry seems motivated by the will to do only good, rather ideological motivations hide behind this moral facade. I cannot dispel the impression that the left is cynically exploiting the migration crisis in order to, through judicial warfare [lawfare] and moral blackmail, make the concept of ‘borders’ so porous as to hollow out the nation-state. For some cosmopolitans, this is wish fulfillment. But the consequences are enormous, and there is room for doubt whether they are equally advantageous for all citizens.

A healthy res publica [body politic]

Borders do not just delineate our democracy and citizenship, but also our implied solidarity. Today we know who can make use of our social security system and why. A healthy body politic creates an ethical community where every citizen shoulders responsibility for the collective, but  also knows (s)he can count on the community if needed. In this context, net taxpayers do not object to contributing, even as they do not personally know the fellow citizens who benefit. The social security system we have built on this bases is among the most open and generous ones in the world.

 But if we [start] say[ing] that there are no more borders and anyone should be able to count on our solidarity, we enter a situation in which there are no more fellow citizens with whom we can show solidarity, but only fellow humans who live here today, elsewhere tomorrow. Human rights are, however, not [the same as] civil rights. Everybody is born with the inalienable right to life — that is [an example of] a universal human right. But you don’t get born in Sudan with the universal and inalienable right to access to a Western European social system.  That is a civil right, which you have when you happen to be born in that Western European nation-state, but which can also be acquired if you follow certain procedures [for naturalization] and fulfill the requirements.

If we start universalizing every civil right, we need to accept the consequences and accept that our current standard of living becomes unsustainable, simply because we won’t be able to afford it anymore. Then you get a denuded social system for paupers, which has no more carrying capacity—for it is difficult to remain in solidarity with people who enjoy the fruits of the social systems, but never have contributed to it and in many cases never will contribute. The strongest will withdraw into gated communities where their children will attend private schools, and the denizens will pay themselves for their own private pension and healthcare. Such a system is perfect if you manage to turn your life into a success. If you don’t, tough luck.

North American model

Europe will then evolve toward a more North American societal model, albeit it with even less of a social safety net. For the US has the geographic advantage that they are surrounded by two oceans, and, to the North, by a rich country with a very high standard of living. Only on the southern border are their migration streams that are difficult to contain, and they have been trying to seal that border hermetically since long before the coming of Trump. Europe, on the other hand, is but a peninsula of the enormous Eurasian landmass and separated from Africa only by an inland sea. Without enforced borders, people can simply walk into Europe. Allowing this, or not doing so, is a choice.

And our federal government has made that choice. Transit migration is not a European problem but a Franco-Belgian problem. We are the only countries with a passable border to the UK. Through the dismantling of the tent camps in Calais, the problem has shifted entirely to our country. Our government policy is to prevent [the emergence of] a second Calais at all costs. But a second Calais is emerging out of sight. Through the collaboration between left-wing NGOs and ditto mayor, and through various acts to morally blacken government policy and to suspend it[s enforcement], the left is now de facto itself organizing the transit migration, even though it is de sure prohibited. At the same time, the moderate left keeps claiming they are not advocating open borders — at least the extreme left is upfront about this.

Don’t we have the duty to help people in need? Of course. But those who can help themselves are not in need. Anyone who can travel thousands of kilometers from East Africa to end up in a Western European welfare state — not with the intention to request asylum there but to travel to another country — may be in dire poverty, but is not in an acute emergency. An emergency is a threat to life, not the desire to lead a pleasant life, however understandable be that wish. There are 37 million Sudanese, each of whom undoubtedly wants a better life. Do we have the moral obligation to take in all 37 million? And what about the rest of Africa?

Absorb newcomers

The left must dare to speak things through: what do they really want? Do we have to take care of everyone, and does that need to happen via immigration? Fine by me, but then we won’t be able to maintain our social system at the current level any longer. If we choose that path, there are two options left for us: a closed social security system only accessible to people who contribute, or its collapse. Our left-wing “gutmensch” [German loanword, idiomatically equivalent to “bleeding heart liberal”] will in its absolute goodness achieve just the opposite of what he claims to want: the total demolition of the welfare state.

I stand for a different policy. A policy with European efforts to absorb refugees in their own region, and with closed borders. A policy with strict controls on legal migration, where, if necessary, those we allow in are emancipated/acculturated in the Enlightenment values, and put to work as quickly as possible in order that they are able to contribute to our prosperity, and thus to our social security. In this way, we can absorb newcomers and enjoy their talent. In this way, our social security can remain open, freely accessible and generous for everyone. But then we must first dare to make difficult choices and dare to implement the chosen policy. Politicians must let the common interest prevail over their personal conscience, however hard it may be.

Hannah Arendt concluded the second part of her book “The Origins of Totalitarianism” with a chapter that is controversial on the left until now: ‘The Decline of the Nation of the Netherlands and the End of the Rights of Man’. In it she argues that we need the nation-state and borders. It is not only the demarcation of our democracy, the outline of the rule of law, and the basis on which we organize our solidarity; it is also the only working mechanism that can enforce human rights. The nation-state is literally vital. Let us be careful that the dream of the “gutmenschen” does not end in a nightmare for us all.

Brussels, multiculturalism, and political AIDS

But I repeat myself.

“Belgium suffers from political AIDS in the literal sense of the word”  (La Belgique souffre du SIDA politique au sens étymologique du mot.) [Acquired Immune-Deficiency Syndrome, Ed.]

Thus then Minister of Justice Jean Gol, longtime leader of the Reformist Liberal Party (PRL) and himself an ex-leftist, described Belgium’s political situation over two decades ago, in the wake of a wave of murderous supermarket shootings and a reverse-infiltration scandal that rocked the State Security (Belgium’s nebbishy domestic intelligence agency).

He was excoriated for his remarks at the time. Jean Gol turns out to have been a prophet.

The horrifying attacks in Brussels struck very close to home: I fly through Brussels a lot for work, and at one point we had an apartment there not far from the metro station where one bomb went off. A work colleague of mine was supposed to have been at the airport on the day of the attack but her daughter’s flight was rescheduled at the last moment.

From a large collection of anecdotal evidence (from friends, family, and first-hand) we learned that the Belgian law enforcement apparatus might be able to find its own derriere with a voice-assisted GPS on a good day. The story of the bomber about which the Turks (!) issued a warning, yet walked around freely in Belgium, speaks volumes. Here are two articles well worth reading, one by a Belgian businessman now living in the US, another by an expat American in Brussels. Both jibe very closely with my own observations from my younger (ahem) years in Europe.

I have guestblogged at Sarah Hoyt’s place about the psychological phenomenon of “displacement”.  In brief, this is the psychological defense mechanism of a human who is facing a problem or enemy (s)he is unable or unwilling to confront, to go seek out some 7th-order issue or “small fry” enemy, which they can than easily “take care of”, so they can “prove” they are still relevant. We see this also in the EU: faced with the twin powder kegs of Islamofascism and the potential backlash of their own populations against the elites who have nurtured that viper on Europa’s bosom (see my earlier blog post Scenes from Europe before the storm), the Euro elites continue to bury their heads in the sand and instead obsess over such issues of crucial world-historical importance as the labeling of SodaStream dispensers: whether they are produced in Israel or in the “occupied”/disputed territories. (Needless to say, a number of snarky comments could be heard on the Israeli street the day after the attacks ;))

Belgium’s way of “coping” with Islamofascist extremism appears to have been primarily to… let them do their thing as long as they did not run too wild inside Belgian borders. St-Jean-Molenbeek, the borough of Brussels where the “he-goat milkers” (Kurdish insult for DAESHbags/ISISholes) hang out,  has effectively been abandoned by the ‘natives’ and has become a no-go zone for the locals. Other areas in the boroughs of St-Josse and Schaerbeek are at the very least in the same direction, and the last time I walked near the Brussels South station, I wished I were ‘packing heat’.

Speaking of which: some idiotic MSNBC (but I repeat myself) article claimed that the arsenals held by the terrorists “prove the need for gun control”. In fact, Belgium, despite being a major manufacturer and exporter of small arms (FN-Browning in Herstal, near Liege) has among the most stringent gun control laws in the world. Depending on the source, legal gun possession ranges between 4 and 6%, and the number of carry permits is minuscule. (When I used to live there, as an arms dealer explained to me, carrying a handgun required four separate licenses: purchase, possession, transport, and carry — the latter was only issued very rarely.) On the other hand, whoever has underworld connections and/or a lot of money and no questions can procure just about any lethal hardware illegally in Brussels if one knows where to go. This is nothing new, BTW: Brussels has had a flourishing black market in firearms (as well as forged identity documents, etc.) for decades — for so long, in fact, that Frederick Forsyth could incorporate it as a plot device into his classic thriller The Day Of The Jackal, set in the early 1960s.If nothing else, it proves that disarming the law-abiding populace merely empowers criminals and terrorists. (See my earlier reflections here.)

When I first took a job in Israel many, many years ago, a number of Belgian (and other) friends could not understand our decision to go live “in such a violent region”. My response then: “don’t worry, your turn will come”. I wish to G-d I had been wrong then.

There are some signs of hope. The strongest political party now is the conservative, Flemish-Nationalist N-VA, led by an avowed admirer of Edmund Burke. (N-VA is emphatically not to be confused with the collectivist, “blood and soil” Vlaams Belang.) The current government is making baby steps to rolling back the worst excesses of “de multikul/le multicul” as brainless multiculturalism is called in Dutch and French, respectively. (“cul”=’b*tt’ in French, hence kul=‘nonsense, BS’ in Dutch.) In an opinion piece in De Standaard (highbrow Dutch-language newspaper), veteran editor Mia Doornaert even argued for getting rid of the “hapless” (“heilloze”) term “Islamophobia”. She also rightly called the claim that Muslims are the new Jews “an obscenity”.

But will the European elites be mugged by reality, or will they continue to say “après nous le deluge” (after us, come the Great Flood)?

[…] The fate of all mankind I see
Is in the hands of fools

Confusion will be my epitaph
As I crawl a cracked and broken path
If we make it we can all sit back and laugh
But I fear tomorrow I’ll be crying…

PS: lest you think that Islamofascism is only a threat to the West, and not to non-Islamists elsewhere, think again.

PPS: French intellectual celebrity Bernard-Henri Levy, himself threatened by extremists from Belgium: Europe might be dying.

Do not go gentle into that good night
Rage, rage against the dying of the light…

UPDATE 3: Belgian soldiers standing on guard had no bullets. As “Dianne” quipped on Facebook, “it’s like a bad Monty Python skit”.

UPDATE 4: A penpal in Belgium sent me this article in Het Nieuwsblad (in Dutch), in which former Belgian minister of justice Marc Verwilghen reveals that his prior attempts to institute even limp-wristed anti-terrorist measures were blocked by former PM Elio di Rupo (Socialist Party chairman at the time, as well as alleged “Wicked Uncle Ernie“) and his party comrade, deputy PM Laurette Onkelinx, as “racist” and “creating stateless persons”.

Hawaii, tipping, and cultural misunderstandings

Fox News had a segment on about how restaurants in Hawaii are now proposing to add a 15% surcharge to the bill for Japanese tourist.
You say: “Whiskey Tango Foxtrot?” The rationale is: since Japanese tourists don’t tip (tipping is not customary in Japanese restaurants), the customary 15% tip should be added to the bill so the waiters are not cheated out of their money.
While Japanese are of course the most numerous/visible such group, let’s remove the racial component by pointing out the numerous times I’ve had to remind Belgian and Dutch visitors to the USA about tipping. Now the alleged “excessive parsimony” of the Dutch is a common theme of Belgian jokes about them (the Dutch have similar jokes about the Scottish — neither Belgium nor the Netherlands are big on “political correctness”), but neither the Belgians nor the Japanese have a reputation for stinginess. It’s simply a cultural misunderstanding: waiters in Belgium, the Netherlands (and presumably Japan) are salaried employees and restaurant bills in Belgium, for example, typically state “VAT and service included”. If you were to add a 15% “service charge” to a restaurant bill the Belgian would pay it without a second thought. When I explained to Belgian visitors to the USA or Israel that their tips are the income of the waiters, they understood immediately.
It remains to be seen how mainland American tourists would react if Hawaiian restaurants were to add on a blanket 15% “service charge” to all bills. Yet this would, to a naive outside observer, seem to be the obvious solution…

Belgian court introduces novel legal concept: “wrongful life”

On the C2 morning thread, commenter (and attorney) “buzzsawmonkey” shares this unbelievable news item:

Belgian Court approves “wrongful life” action; permissible for doctors to kill the disabled if they “should not have been born.”

“buzzsawmonkey” adds:

At the end of the film “Judgment at Nuremberg,” Spencer Tracy, as the head of the tribunal that has convicted a number of Nazi judges, meets with the jurist Emil Janning (Burt Lancaster), the only one of the convicted who had displayed a moral sense.  Janning says, “You must believe me; those millions of people.  I didn’t know that it would come to that.”   Tracy replies to him, “It had come to that the first time you condemned a man you knew to be innocent.”

The same thing is happening now: if the state [i.e., Belgium — Ed.] can decide arbitrarily whether a life “should” have come into being on the basis of disability, the devaluation of life from something owned by the person to something on loan from the state is in place.

The only question remaining is how rapidly this will descend into horror, not if it has.

Educational renaissance of New Orleans, post… Katrina?

Via Captain Ed at Hot Air, don’t miss this documentary about the renaissance of the school system in New Orleans after the rebuilding of Katrina.

[youtube http://www.youtube.com/watch?v=P12pgeV8ZQM%5D

Granted, this school system basically had nowhere to go but up. “As one person relates in this Reason TV video, one school had a valedictorian who could not pass a graduation exam in six attempts despite getting straight As in high school.”

In the comments, this nugget from the pseudonymous “MayorDaley”:

Guess who was was instrumental in changing the schools of New Orleans? No other than Paul Vallas, Superintendent of the Recovery School District of Louisiana, and former CEO of Chicago Public Schools. In 2002, Vallas narrowly lost the Illinois democratic nomination to none other than Rod Blagojevich. Davild Wilhelm, Rahm Emanuel and Barack Obama were Blago’s top strategists and secured a victory for Blago. How odd.

Somewhat surprisingly to some (not so much to me), school choice is not a strictly liberal vs. conservative issue: as commenter Khorum points out, none other than the filmmaker who produced Al Gore crockumentary is putting out a film “Waiting for Superman” about America’s failing public schools and what to do about them. And unions are actually trying to strong-arm Paramount into suspending its theatrical release. Many of the parents interviewed in the movie are politically liberal.

On a related note, if you have 40 minutes to spare, watch John Stossel’s “Stupid in America“. Unbelievably, John Stossel (not known for Europhilia), points out that Belgian schools do much better at much lower cost per pupil. You see, Belgium has no such thing as school zone assignment to pupils: parents can send their children to any state school (or state-subsidized school) they want. Even within the state school system (or within the Catholic school system, for that matter) this creates internal competition on quality. The phenomenon, known to any American or Israeli parent, of buying or renting a house in function of the school districts tends to come as a big shock to any Belgian (or most Euro) parents who relocate to the USA.

Report: Half of euthanasia in Belgium without consent

Daily Mail (h/t: multiple):

A high proportion of deaths classed as euthanasia in Belgium involved patients who did not ask for their lives to be ended, a study found.

More than 100 nurses admitted to researchers that they had taken part in ‘terminations without request or consent’.

Although euthanasia is legal in Belgium, it is governed by strict rules which state it should be carried out only by a doctor and with the patient’s permission.

The disturbing revelation  –  which shows that nurses regularly go well beyond their legal role  –  raises fears that were assisted suicides allowed in Britain, they could never be properly regulated.

Since its legalisation eight years ago, euthanasia now accounts for 2 per cent of deaths in Belgium  –  or around 2,000 a year.

The researchers found that a fifth of nurses admitted being involved in the assisted suicide of a patient.

But nearly half of these  –  120 of 248  –  also said there was no consent.

‘The nurses in our study operated beyond the legal margins of their profession,’ said the report’s authors in the Canadian Medical Association Journal.

It is likely many nurses ‘ under-reported’ their involvement for fear of admitting an illegal activity, the study said.

But it added that many were probably acting according to their patients’ wishes, ‘even if there was no explicit request’.

Last night, Dr Peter Saunders, director of the Care Not Killing campaign in Britain, said: ‘We should take a warning from this that wherever you draw the line, people will go up to it and beyond it.’

‘Once you have legalised voluntary euthanasia, involuntary euthanasia will inevitably follow,’ he added.

But pro -euthanasia group Dignity in Dying said rules that see the patient taking their own life, rather than a doctor administering the drugs, could still work.

As I have argued multiple times elsewhere: some slopes truly are too slippery to walk. If this is the only way Belgium’s model of socialized medicine can be kept solvent, what needs euthanizing is the model, not the patients.