(1) Via Instapundit, a popular writeup of a study that found samples acquired by the patients themselves were more accurate than the usual deep nasal and pharyngeal swabs, and not just more comfortable. Besides, they are less likely to expose healthcare personnel, as deep sampling often causes sneezing, coughing, and gagging.
I should perhaps clarify here that the accuracy-limiting factor of RT-PCR testing, at this point, is not the testing apparatus at all (with lab-prepared samples, accuracy approaches 100%) but the sampling technique.
Here is an animation of how, once the sample has been acquired, RT-PCR testing works in the lab.
(2) There were several reports that, counterintuitively, smokers were underrepresented among COVID19 positive cases. Now in https://www.medrxiv.org/content/10.1101/2020.06.01.20118877v2.full.pdf is an intriguing large-sample study from doctors associated with Clalit Health Services, the largest HMO in Israel which has about 3 million patients in its central database. [Full disclosure: we are insured through a competitor. All four authorized HMOs operate such databases—unlike with Surgiscape, I have every reason to believe these data are kosher.]
As of the cutoff date (May 16), over 145,000 adults insured with Clalit underwent RT-PCR testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), 3.3% of which tested positive. After discarding cases aged under 18 and over 95, as well as those where it was unknown whether they smoked or not, the authors were left with 4,235 positive tests and 124,192 negative. Out of the latter, they randomly selected a control sample of 20,755 patients (5x as many) that matched statistical make-up of the positive sample in terms of gender, age distribution, and ethnosocial group — Jewish Orthodox, Arab, General(mostly Jewish non-Orthodox).
Guess what: Statistically, 9.8% of the COVID19 positive cases smoke currently, one-half the percentage in the control group 18.2%. Because of the large sample size, p<0.001, i.e., the probability that this result could have arisen from “the luck of the draw” is less than 0.1%. There was no significant difference for past smokers (11.6 vs. 12.9%) — it’s definitely got something to do with current smokers (nicotine or some other component of tobacco smoke).
Of the COVID19-positive tests, 1.8% deceased, 2.0% hospitalized in severe condition, 4.0% in moderate condition, 15.0% in mild condition, the remaining 77.2% did not require hospitalization. There was no significant correlation between the degree of severity and the patient’s smoking status.
Changeux et al11, relying on similar observations, propose a crucial role for the nicotinic acetylcholine receptor (nAChR) in COVID-19 pathology. According to their neurotropic hypothesis, SARS-CoV-2 invades the central nervous system through the nAChR receptor, present in neurons of the olfactory system, as reflected by the frequent occurrence of neurologic symptoms, such as loss of smell or taste, or intense fatigue in patients affected by COVID-19. Other mechanisms may also affect SARS-CoV-2 infection potential in smokers. It is widely accepted that the angiotensin converting enzyme 2 (ACE2) represents the main receptor molecule for SARS-CoV-2, and smoking has been shown to differentially affect ACE2 expression in tissues12–14. Other putative explanations could involve altered cytokine expression such as IL-6, for which increased levels are associated with unfavorable disease outcome14,15.
(4) This is the sort of behavior that makes me cringe in embarrassment for my profession. True scientists follow the facts wherever they lead, and seek the truth wherever it may be found. Political hacks exist in every profession — but they are especially grating in ours. And when the public loses all faith in us because of such politicized hacks, it will be blamed on “anti-science” and anti-intellectualism.
(1) Sweden’s Sonderweg (“special road”, idiomatically, “going its own way”) is the subject of heated debate pro and con.
At first sight, per capita mortality is an order of magnitude higher than in adjacent countries with similar ethnic profile, climate, and sociology. (Sweden does, however, have a higher percentage of 1st-generation immigrants than Norway, Denmark, and Finland — see below.)
On the gripping hand, while the Swedes may have avoided the economic ruination of a full lockdown and may be closer to herd immunity now should a second wave arrive, there are costs to this epidemic for everyone (the travel and airline industries, for instance, are on life support everywhere, lockdown or no lockdown). Some aspects of the world economy will be changed forever — and some already existing ‘creative destruction’ trends will be accelerated worldwide. Sweden will see a recession, just not as deep, and possibly with a quicker recovery.
But let’s come back to those care homes. Die Welt has an exposé on what is going on there: “The true problem of the Swedish sonderweg“. If it were in English, I’d say “read and weep”. But as it’s in German, let me summarize a few points (reader beware):
As explained earlier, the Swedish elderly care model is based on encouraging people to live independently for as long as possible, with paid ‘home helpers’ if needed. Assisted living facilities seem to be primarily a private-sector option, while true homes for the elderly are seen as the last resort. Median survival time in them is less than a year
Caregivers in these homes were alleged not issued PPEs, and testing was only carried out people who showed symptoms, despite adequate testing capacity being available.
The Swedish newspaper Aftonblådet quoted gerontologist Prof. Yngve Gustafsson of Umea University as saying that 70-80% of care home residents admitted to geriatric hospitals with COVID-19 are sent back to the care home. Residents checked into the hospital with COVID19 were often sent back to the home, where of course the infection then spread.
He adds that in many cases they don’t die from COVID19 but from secondary infection with bacterial pneumonia, and could be saved with intravenous antibiotics. However, the prescribed care protocol for such patients is purely palliative — Morphin, Midazolam and Haldol – which according to him is a nearly 100% certain death sentence
A man named Thomas Andersson, who discovered that his father Jan, aged 81 had been put on this protocol (following diagnosis over the phone!) managed to get the decision reversed after first contacting the care home management, then going to the media. His father was put on an antibiotic IV and, once the bacterial pneumonia receded, managed to fight off the relatively mild COVID19 infection on his own. Below is Jan celebrating his recovery with children and grandchildren. Thomas still cannot believe such a thing was possible in Sweden.
Infuriating and appalling as such stories may be, they have a flip side: that if Sweden hadn’t gone “full Cuomo” on its elderly, its mortality might well have been a fraction of what they have now, and Sweden’s sonderweg might look a good deal better.
It sounds a lot like what Norway envisages as its strategy for a second wave: individual test, track and trace as the first line of defense, where speed is of the essence; localized isolation measures as a second line of defense; expanding the ring of those if necessary; but national lockdown only as a very last resort. (It sounds like nobody in Israel, Norway, nor for that matter Belgium has any stomach for a second lockdown. This is especially true as Norway is wondering, with hindsight in numbers, if voluntary social distancing might night have been adequate. Your mileage may vary, of course — Norwegians and Italians, for example, would react very differently to strong social distancing recommendations.)
[…] In Israel, the HaMagen [“The Shield”] app, which was developed and endorsed by the Health Ministry and can tell people if they have been in the presence of anyone who has been diagnosed with coronavirus, could play a key role, he said. “The more people who download it, the better.” [In addition, the] Shin Bet [Israel’s domestic security service] was reported to have traced a third of Israel’s coronavirus cases, some 4,089 people, [through their cell phones. Israel’s Supreme Court has however ruled that this cannot continue past the emergency order, unless anchored in law.]
[…] Waxman said South Korea has two advantages over Israel: It learned the importance of moving fast from its experience with Middle East Respiratory Syndrome (MERS) in 2015, when the virus killed 36 people, infected 186 and put thousands of citizens into isolation. The outbreak was ultimately traced to a single visitor from overseas. In addition, South Korea has leveraged some technological tools that “Israel cannot and should not be able to use” because they might infringe on privacy rights, he said.
(3) One “industry” which will be hit hard is higher education. Especially in the US, much of it is built upon an unsustainable base, with people paying extortionate tuition for amenities and administrative overhead that has nothing to do with education — be it the country-club level gym and dormitories, the football stadium (which only in a few places is net profitable), or the ever-expanding army of administrators. Now that these places were forced to move to distance learning, they found themselves competing with much cheaper online colleges. Instapundit has endlessly blogged (and written a book) about the “Higher Education Bubble” and the coming wave of creative destruction in that industry: COVID19 only accelerated a process waiting to happen. I had always assumed, however, that blue-chip brandnames like Harvard would be largely insulated.
Many of our income streams will continue to be diminished: Housing revenue will be reduced due to fewer students living on campus; income-producing events and programs will continue to be limited; and clinical, research and philanthropic income streams will be challenged. At the same time, expenses in some areas, such as student financial aid, will increase. The market volatility affecting our endowment also can be expected to continue, given the seismic disruptions occurring in the national and global economies.
We previously asked university units to prepare FY21 budget plans based on a scenario with a 15 percent reduction in funding from endowment payout and a 10 percent reduction in support from general funds. We sincerely hope that the reductions needed will be smaller than this, but for now we need to plan to these targets as a contingency. We expect to provide final allocations of general funds and endowment payout to units by the end of June, enabling them to finalize their budgets in July.
As units plan for budget reductions, we expect there will be reductions in some of the programs each of them is able to offer. We will work to ensure that any program reductions still allow us to sustain Stanford’s core academic strengths and our long-standing commitments to student access.
Given the magnitude of the budget challenge, we also expect that program reductions will make some workforce reductions unavoidable as we enter the new fiscal year. We don’t yet know the scale of job reductions. We hope they will be limited, but they will be driven by the program needs and budget capacity of individual units. Our expectation is that some of these reductions will be temporary layoffs (furloughs) until we are able to resume services and bring employees back, and that other reductions will be permanent layoffs. At this time, we expect to be able to communicate more detailed decisions about layoffs in late July.
It would be too much to hope that the “programs” affected would primarily be silliness such as courses on “the poetics of the lowrider” (as Victor Davis Hanson has described elsewhere), rather than the STEM programs that made Stanford such a powerhouse. But never underestimate the reverse Midas touch of professional college administrators….
(4) And just because: “June came upon us much too soon…”
In the past year, I’ve written roughly 5,000 pages of scholarly literature, most on very tight deadlines. But you won’t find my name on a single paper.
I’ve written toward a master’s degree in cognitive psychology, a Ph.D. in sociology, and a handful of postgraduate credits in international diplomacy. I’ve worked on bachelor’s degrees in hospitality, business administration, and accounting. I’ve written for courses in history, cinema, labor relations, pharmacology, theology, sports management, maritime security, airline services, sustainability, municipal budgeting, marketing, philosophy, ethics, Eastern religion, postmodern architecture, anthropology, literature, and public administration. I’ve attended three dozen online universities. I’ve completed 12 graduate theses of 50 pages or more. All for someone else. […]
I work at an online company that generates tens of thousands of dollars a month by creating original essays based on specific instructions provided by cheating students. I’ve worked there full time since 2004. On any day of the academic year, I am working on upward of 20 assignments.
In the midst of this great recession, business is booming. At busy times, during midterms and finals, my company’s staff of roughly 50 writers is not large enough to satisfy the demands of students who will pay for our work and claim it as their own.
You would be amazed by the incompetence of your students’ writing. I have seen the word “desperate” misspelled every way you can imagine. And these students truly are desperate. They couldn’t write a convincing grocery list, yet they are in graduate school. They really need help. They need help learning and, separately, they need help passing their courses. But they aren’t getting it.
For those of you who have ever mentored a student through the writing of a dissertation, served on a thesis-review committee, or guided a graduate student through a formal research process, I have a question: Do you ever wonder how a student who struggles to formulate complete sentences in conversation manages to produce marginally competent research? How does that student get by you?
I live well on the desperation, misery, and incompetence that your educational system has created. […] Of course, I know you are aware that cheating occurs. But you have no idea how deeply this kind of cheating penetrates the academic system, much less how to stop it. Last summer The New York Times reported that 61 percent of undergraduates have admitted to some form of cheating on assignments and exams. Yet there is little discussion about custom papers and how they differ from more-detectable forms of plagiarism, or about why students cheat in the first place.
It is my hope that this essay will initiate such a conversation. As for me, I’m planning to retire. I’m tired of helping you make your students look competent.
From my experience, three demographic groups seek out my services: the English-as-second-language student; the hopelessly deficient student; and the lazy rich kid.For the last, colleges are a perfect launching ground—they are built to reward the rich and to forgive them their laziness. Let’s be honest: The successful among us are not always the best and the brightest, and certainly not the most ethical. My favorite customers are those with an unlimited supply of money and no shortage of instructions on how they would like to see their work executed. While the deficient student will generally not know how to ask for what he wants until he doesn’t get it, the lazy rich student will know exactly what he wants. He is poised for a life of paying others and telling them what to do. Indeed, he is acquiring all the skills he needs to stay on top.
As for the first two types of students—the ESL and the hopelessly deficient—colleges are utterly failing them. Students who come to American universities from other countries find that their efforts to learn a new language are confounded not only by cultural difficulties but also by the pressures of grading. The focus on evaluation rather than education means that those who haven’t mastered English must do so quickly or suffer the consequences. My service provides a particularly quick way to “master” English. And those who are hopelessly deficient—a euphemism, I admit—struggle with communication in general.
Speaking of which:
It is late in the semester when the business student contacts me, a time when I typically juggle deadlines and push out 20 to 40 pages a day. I had written a short research proposal for her a few weeks before, suggesting a project that connected a surge of unethical business practices to the patterns of trade liberalization. The proposal was approved, and now I had six days to complete the assignment. This was not quite a rush order, which we get top dollar to write. This assignment would be priced at a standard $2,000, half of which goes in my pocket.
A few hours after I had agreed to write the paper, I received the following e-mail: “sending sorces for ur to use thanx.”
I did not reply immediately. One hour later, I received another message:
“did u get the sorce I send
please where you are now?
Desprit to pass spring projict”
Not only was this student going to be a constant thorn in my side, but she also communicated in haiku, each less decipherable than the one before it. I let her know that I was giving her work the utmost attention, that I had received her sources, and that I would be in touch if I had any questions. Then I put it aside.
Two days had passed since I last heard from the business student. Overnight I had received 14 e-mails from her. She had additional instructions for the assignment, such as “but more again please make sure they are a good link betwee the leticture review and all the chapter and the benfet of my paper. finally do you think the level of this work? how match i can get it?”
I’ll admit, I didn’t fully understand that one.
It was followed by some clarification: “where u are can you get my messages? Please I pay a lot and dont have ao to faile I strated to get very worry.”
Her messages had arrived between 2 a.m. and 6 a.m.
[…] It’s not implausible to write a 75-page paper in two days. It’s just miserable. I don’t need much sleep, and when I get cranking, I can churn out four or five pages an hour. First I lay out the sections of an assignment—introduction, problem statement, methodology, literature review, findings, conclusion—whatever the instructions call for. Then I start Googling.
I haven’t been to a library once since I started doing this job. Amazon is quite generous about free samples. If I can find a single page from a particular text, I can cobble that into a report, deducing what I don’t know from customer reviews and publisher blurbs. Google Scholar is a great source for material, providing the abstract of nearly any journal article. And of course, there’s Wikipedia, which is often my first stop when dealing with unfamiliar subjects. Naturally one must verify such material elsewhere, but I’ve taken hundreds of crash courses this way.
After I’ve gathered my sources, I pull out usable quotes, cite them, and distribute them among the sections of the assignment. Over the years, I’ve refined ways of stretching papers. I can write a four-word sentence in 40 words. Just give me one phrase of quotable text, and I’ll produce two pages of ponderous explanation. I can say in 10 pages what most normal people could say in a paragraph.
[…] My client was thrilled with my work. She told me that she would present the chapter to her mentor and get back to me with our next steps. Two weeks passed, by which time the assignment was but a distant memory, obscured by the several hundred pages I had written since. On a Wednesday evening, I received the following e-mail:”Thanx u so much for the chapter is going very good the porfesser likes it but wants the folloing suggestions please what do you thing?:
“‘The hypothesis is interesting but I’d like to see it a bit more focused. Choose a specific connection and try to prove it.’
“What shoudwe say?”
This happens a lot. I get paid per assignment. But with longer papers, the student starts to think of me as a personal educational counselor. She paid me to write a one-page response to her professor, and then she paid me to revise her paper. I completed each of these assignments, sustaining the voice that the student had established and maintaining the front of competence from some invisible location far beneath the ivory tower.
The 75-page paper on business ethics ultimately expanded into a 160-page graduate thesis, every word of which was written by me. I can’t remember the name of my client, but it’s her name on my work. We collaborated for months. As with so many other topics I tackle, the connection between unethical business practices and trade liberalization became a subtext to my everyday life.
So, of course, you can imagine my excitement when I received the good news:
“thanx so much for uhelp ican going to graduate to now”.
Via Insty, I discovered this long blog post at “Musings from the hinterland” on the education bubble. It mostly, together with two earlier posts here and here, addresses the wrong-headed policy of pushing everybody to get a college degree — regardless of interest or aptitude — and the consequences, such as “diploma inflation” and crippling student debts on the part of college dropouts admitted at schools that were beyond their intellectual means in the first place.
Interesting discussion in the comments, especially at the first post.