COVID19 update, July 8, 2020: by CDC criteria about to fall below “epidemic” threshold in the USA?; Israel public health chief resigns, citing “frivolous” decision making process; Dr. Campbell on knowns and “known unknowns” of COVID19

(1) Instapundit reports that the death rate from COVID19 has fallen far enough that by CDC criteria it’s about to fall below the “epidemic” threshold. He comments:

WE CAN HOPE: Is The Pandemic Coming To An End At Last? “Well, firstly, it’s not actually us saying this. It’s the Centers for Disease Control, which reported that the death rate has fallen so far it’s now roughly equal to the threshold for even qualifying as an epidemic, which isn’t as severe as a pandemic.”

Death rates aren’t following case numbers up, at least not yet. In my area we had our first Covid deaths in two months last week, as case numbers climb — but we’ve had a total of 9 deaths in a county of over 400,000 people since the beginning of the pandemic. We’ve almost certainly lost more people to flu in the same period.

But case numbers are climbing, and death is a lagging indicator. Even so, though, if the disease is as fatal as it was in, say, March, deaths should be climbing much faster than they are. Some of that is no doubt because we don’t have the nursing home outbreaks we had back when Grandma-Killer Cuomo and other governors were sending infected patients into nursing homes, and some of it may be because Vitamin D levels are higher this time of year, and coronavirus fatalities seem closely tied to very low Vitamin D levels. Also, thanks to the marches and the general laxity that followed them, more of the infected are younger people, who typically don’t get as sick. That’s good, because it’s moving us toward herd immunity with as few fatalities as possible. But stay tuned; it’s still too early to know what’s really going on.

(2) Despite that, Israel is seeing a second wave of the same magnitude as the first, but again (tellingly) with much lower mortality than the first. Still, our country’s head of public health, Prof. Siegal Sadetski (on leave from Tel-Aviv U.’s medical school) suddenly resigned, and left a blistering public resignation letter.

In the letter sent to Health Ministry director-general Chezy Levy, she accused the government of “making frivolous and unsubstantiated decisions, without considering their widespread and long-term public health implications.” 

“Infinite time” is spent “calming the spirits” and “managing partnerships,” while the work that needs to be done in the field is relegated, Sadetsky said.

“Too much time is invested in debates, discussions, consultations and forums… while the operations and details required for the success of the various operations do not receive the proper attention,” she said, stressing that the work environment at the Health Ministry has become wrought with personal interests. 
“The [coronavirus] is a deadly, cunning and agile epidemic,” she added. “I feel with a high-level of certainty… that the coming months will be difficult and even tragic.”

[…] “Opening the education system first in a limited way and two weeks later in a sweeping way… led to widespread reinfection in Israel,” Sadetsky said. “Maintaining educational frameworks plays a major role in the ability to safeguard the economy and their importance to our children. However, in the absence of conformity to corona regulations, schools and kindergartens become fertile grounds for infection. 
“Israel opened the education system too quickly compared with most countries in the world. Without compatible conditions, education systems cannot be opened.”

“In the first phase, Israel’s achievements were reflected in the flattening of the morbidity curve, and the measures taken were inspirational and praised by other countries dealing with the plague. In contrast, the second phase was characterized by a vital but rapid and sweeping opening of the economy […] The atmosphere of illness treatment and decision-making has changed fundamentally, and the results are evident in the morbidity curve,” Sadetsky said. 
The government broke its promise of opening progressively and reviewing the impact of its decisions, continually moving forward even though the morbidity graph indicated the situation was getting worse, she said.

“The global experience in dealing with epidemics shows that actions and moves that are avoided due to the fear of difficult and painful decisions subsequently cost twice as much as making those difficult decisions,” Sadetsky wrote. “It was only last weekend that [the government] decided it was ready to return to preventative measures, which in my estimation is too little and too late.”

Another article in the Jerusalem Post (which sadly has gone downhill under its new editor) uses the term “ship without a rudder” and contrasts the clear voice with which authorities spoke during the first wave with the chaotic mess currently pertaining. 

The decision-making process is actually more complicated than the public is aware: Some decisions fall into the hands of the Health Ministry, some are the government’s and still others the Knesset’s, which means that even though the new directives were announced together, only some of them went into effect. 
“Sometimes, the directives are in the news, but they are not yet enforceable,” clarified Prof. Hagai Levine, a Hebrew University epidemiologist and chairman of the Israeli Association of Public Health Physicians.

But whether the directives are enforceable or not should not be a question for the public, he said, adding: “If the risk of attending a mass wedding is high, then regardless of the law, you should not organize such a wedding.” 
Nonetheless, Levine admitted that when it is unclear to the public that the decisions made by the government are based on science, rather than pressure by the loudest interest groups, it harms public trust and makes it harder for the people to follow them.

The current national unity government with its proliferation of redundant ministerial portfolios created explicitly for coalition reasons, led to the quip “we have more ministers than patients on respirators”.

In other Israel-related COVID news, El Al, Israel’s national airline which was privatized 15 years ago, is being renationalized. The company was struggling to begin with, but now was brought to its knees like many national airlines.

(3) I’ve been wanting to do a “Known knowns, known unknowns, and unknown unknowns about COVID-19” post for a while. This just-released video by Dr. John Campbell is a good starting point though.

For the impatient, there are some keyword-style talking points in the description of the video, which also links to two articles:

https://www.nature.com/articles/d41586-020-01315-7

https://www.nature.com/articles/d41586-020-01989-z

Watch the whole video (on high-speed if need be — I often run such videos at 1.25 or 1.50 speed) but I just want to highlight one aspect I haven’t ever discussed here. 

(a) viral load (around 11 minutes into the video). Paraphrasing: Ten viral particles or so might be enough to get to the throat, but are likely to be cleared by the mucociliary system. By the time viruses from the throat infection can make it down to the lungs, the innate immune system, the rapid-response part of the body’s immune system, has mobilized. For such people, it would end with a mild case.

In contrast, you get a hundred viral particles or so, and some may make it past the mucociliary system down to the lungs before immunity has had a chance to mobilize — setting you up for pneumonia and a severe case. 

(b) genetics (about 21 minutes into the video): 4,000 people in Northern Italy who got particularly bad seem to belong to two particular gene variants. There are precedents for this in, e.g., the bacterial disease tuberculosis and the viral disease Epstein-Barr. 

BEFORE I FORGET: This other video by Dr. Campbell, which is mainly about face coverings, also has a cute memory trick for the different kinds of immunoglobulins:

IgM for iMMediate action

IgG for aGGlutinating

IgA for sAlivA, sweAt, and teArs (or mucous membrAnes)

IgE in type 1 hypersEnsitivity

COVID19 update, June 29, 2020: March 2019 sample in Barcelona? Matt Margolis on lockdowns; Germans flock to Baltic beaches; 2nd wave in Israel

(1) Apparently, a sample of sewer water in Barcelona from March 2019 (!) tested positive for SARS-nCoV-2. Dr. John Campbell comments:

I am somewhat skeptical though.

(2) Matt Margolis blogs about lockdowns and argues they were a mistake. He also goes into the current spike, which does not seem to be accompanied by a spike in mortality (allowing for a 2-3 week lag).

Conventional wisdom suggests that a spike in cases should result in a spike in deaths, but that has not panned out. The protests and riots following George Floyd’s death have been going on for nearly a month now. Surely a spike in deaths should shave occurred by now. But so far, it hasn’t. 

Why not? 

According to Justin Hart, an information architect and data analyst from San Diego, “who” gets the virus is just as important as “how many” get the virus. “Right now the average age of infected cases has dropped nearly 20 years,” Hart told PJ Media. […]

According to the CDC’s current best estimate, the fatality rate of the coronavirus for symptomatic cases only are as follows:

0-49 years old: 0.05%
50-64 years old: 0.2%
65+ years old: 1.3%
Overall ages: .4%

As I mentioned the other day, it’s the same story in the UK, where mortality of COVID-19 hospital admittees has dropped from 6% to 1.5%.

(3) “Sunlight is the best disinfectant” — literally, in this case. 

In Germany, however, Die Welt worries (in German) about the epidemiological situation as tourists hit the Baltic Sea resorts 

(4) Israel has apparently a genuine 2nd wave on its hands. As in (2), it seems that cases are much younger than in the past. This infographic from the Israel COVID19 dashboard of the Ministry of Health makes this very clear. (Note that this is all documented cases — if the window were limited to those diagnosed in the past month, the distribution would be even more lopsided.)

[left=women, right=men, diffuse background=population pyramid, crisp bars=COVID19 case distribution]

Tomorrow school ends for kindergarten and elementary schools; junior high and high schools already finished. 

There were “corona cabinet” meetings yesterday and today. A second lockdown was dismissed out of hand, as were less restrictive closures, since “the economy won’t survive those blows”. For now, distance restrictions and masks remain mandatory (if seemingly honored more in the breach than the observance), and these will be enforced more vigorously. Some restrictions on attendance at public gatherings were re-introduced. 

Meanwhile, mothballed COVID-19 wards in various hospitals have been reopened. The general atmosphere in the healthcare system, as far as I can tell, is more relaxed than in March: more treatment options exist, more is knownabout how to manage moderate and severe cases, and younger patients typically mean mild cases that resolve on their own.

(5) I can’t add much to Instapundit’s response to Dr. Fauci’s complaint about the “anti-science bias in the US”.

If scientists were more pro-science, maybe the public would be. But when scientists are happy to subordinate science to politics or expediency — as the public health community has shown itself to be with masks and with its endorsement of mass protests — why should anyone trust them?

COVID19 update, June 23, 2020:Dr. John Campbell guest reports from Israel; Dr. Seheult on dexamethasone

Been an intense work day. Let me just share two videos:

(a) Dr. John Campbell has a guest on from Israel

(b) Dr. Seheult on the latest dexamethasone findings

COVID19 update, June 19, 2020: Second wave in Israel; Q&A with Dr. Seheult

(1) So it looks like, sadly, we have a real second wave here, with new cases per day now crossing the 300 mark. Unlike in the winter, most of the new cases are kids or young people for whom the disease is usually not life-threatening, and our hospitals are doing fine for ICU capacity thanks to the earlier scramble to set up new “machlakot keter” (lit.: ‘crown departments’) at the various hospitals. Healthcare officials are basically saying, “we’re ready” rather than “the sky is falling”.

In part thanks to that, presumably, it appears officials have decided that the cost of a second lockdown, both economically and in terms of collateral damage to human life, will exceed any benefit, and that therefore we’re staying open.

 

Below is a graph from the new, and highly informative, COVID19 data dashboard of the health ministry. Male in blue, female in green, population pyramid is the fuzzy background, the focused bars are the age distribution of active cases. 

(2) this Q&A section with Roger Seheult MD is long but highly informative. 

 

 

More later… Shabbat shalom…

COVID19 update, June 16, 2020: Blue-chip Oxford trial finds inexpensive steroid dexamethasone saves lives in severe COVID-19 cases; flare-ups in Israel and in China

(1) [Hat tip: Yves not-Cohen]: via De Standaard and the BBC, Oxford University reports a breakthrough in the management of severe COVID-19 cases: https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf

I have blogged earlier about anecdotal reports that steroids (for the group I was quoting, methylprednisolone) were being used in an attempt to hold “cytokine storm” at bay, and intuitively this makes a lot of sense. But now we have a large-scale clinical trial to back it up.

A total of 2104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%). Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75]; p=0.14). Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone. Given the public health importance of these results, we are now working to publish the full details as soon as possible.

In plain English, p=0.0003 means there are three chances in ten thousand that the difference is due to coincidence , p=0.0021 that there are 2.1 chances in a thousand of this happening. That the steroid would have no benefit in patients who show no signs yet of “cytokine storm” makes perfect sense.

The study’s authors tout this as the first drug that actually saves lives. Indirectly, Remdesivir and other antivirals may do so if given early in the disease progression, by preventing escalation to cytokine storm: once you get there, you have missed the boat for antivirals and need to focus on stopping the patient’s immune system from killing him.

That dexamethasone is a dirt-cheap drug that has been in common use for decades is of course a nice bonus.

(2) Related, via The Epoch Times (an expat Chinese newspaper fiercely opposed to the regime) a report by the British Heart Foundation about TRV027, an experimental drug by Trevena that restores the angiotensin II vs. angiotensin 1-7 balance (which the virus disrupts through binding to ACE 2 receptors) and thus tries to prevent excessive blood clotting at the source.

Also related, US Senate testimony  by Pierre Kory MD of the COVID19 Critical Care Group.

 

(3) Israel, after a lull and after essentially fully reopening, is now seeing a flare-up of about 200 cases per day. In part this can be ascribed to more intensive testing efforts: past data indicate we had about 10 undocumented asymptomatic or mild cases for each documented case.  (Yesterday, 13,425 were tested, of which 196 found positive.)

The head of the research division of the Maccabi HMO (one of the four authorized Health Maintenance Organizations in Israel, and one of the “big three”) explains to The Times Of Israel that this time around, most of the cases are children or young people (which are less vulnerable), and that many of the children are asymptomatic.

 

In Tel Aviv, which is seeing the fastest spread of the virus, some 57 percent of Maccabi members who tested positive in June are aged 18 or under, Anat Ekka-Zohar told The Times of Israel. There is a similar pattern in other central Israeli cities where cases are growing, she said. In Peta[c]h Tikva the figure is 77%, in Jaffa 60% and in Bnei Brak 43%.

Lots of the current adult carriers are aged 45 or under, Ekka-Zohar said. Some 73% of Maccabi members nationally who tested positive in June are 45 or under, and in Tel Aviv, the figure is 79%.

Maccabi, which is responsible for the health of 2 million Israelis, says that just 1.3% of the people it found to be infected in June are aged 75 or older, Ekka-Zohar said.

Looking at the figure for the 65-plus age group, which is considered the most at-risk of serious illness or death if infected, Ekka-Zohar said it stands at 6.7% for June cases. In April, that age group accounted for around 12% of Maccabi’s cases, she added.

The fact that the most vulnerable aren’t being infected in large numbers bodes well, Ekka-Zohar said, commenting: “It’s not going to provoke a crisis in terms of the number of hospitalizations or in terms of ventilators.”

 

(H/t: Mrs. Arbel.) A somewhat PG-13 rated piece of local humor about masks: the caption says “wearing your mask like thisis like wearing your underpants like that. [And underneath] Please wear your mask correctly.”

(4) “Nothing to see here, move along.” The regime is now blaming “European salmon” for a new coronavirus outbreak in Beijing?! Yeah right — if you believe that, I have some beachfront land in Arizona for sale. Most likely, this is just the 2nd wave of the epidemic they claimed they had under full control. Remember this piece of advice by a Hong Kong resident (warning: language alert).

COVID19 update, May Day edition: reduced contagion of and from children; reopening schools in Israel; miscellaneous updates

(1) De Standaard (in Dutch) reports on a study by the Dutch institute for public health about the infection risks from and to small children. I had intuitively expected that they would be mostly asymptomatic spreaders with a minority of mild overt cases (the few exceptions of young children who went into cytokine storm appear to be ‘man-bites-dog news’: newsworthy precisely because they are rare). Now the study[s main findings, mostly based on contact tracing, can be summarized as follows:

• children are much less likely to be infected (symptomatically or asymptomatically) than adults if both are exposed to the same infection source
• if they are infected, viral swabs of their throats show similar virus levels as in adults, but they cough less, and owing to smaller lung volumes, coughs can’t project as far

Needless to say, this has implications for whether it is safe to open schools (apparently, more so than previously assumed).

(2) Speaking of which, Israel is reopening Grades 1-3 of primary schools on Sunday, as well as preparation classes for the bagrut (high school leaving [and college placement] exam, like the French baccalauréat or the German Abitur) in the last two years of high school. (These exams play an important role in college admission and placement, together with the psichometri which is somewhat similar to the SAT.) Kindergartens will be opened on or before May 10 — originally they were to be opened on Sunday as well, but personnel requested more preparation time. Remaining elementary and high school grades will open June 1.

(3) Miscellaneous updates:

• According to De Standaard’s breaking news ticker, Portugal intends to start reopening on Monday. It has been much less hard-hit than neighboring Spain despite similar demographics and climate: Sarah Hoyt (herself born and raised near Porto, and an alumna of Porto University) attributes much of the difference to the continued existence of a parallel private medical system in Portugal, while Spain’s was nationalized. Choice is always good for quality.
• Shaarei Tzedek in Jerusalem, one of the largest hospitals in Israel (and the largest Orthodox hospital) is closing down its purpose-built corona ward as the last patient in it was discharged some days ago. The hospital had already gradually resumed normal operations as its COVID19 patient load declined.
• Le Figaro (in French) reports that France will reopen by Départements [France’s administrative regions/provinces], not one-size-fits-all. Based on various criteria such as new infections, mortality, and hospital case load to capacity ratio, the ninety-odd Départements are classified as green (most permissive unlock), orange (more limited unlock), or red (most limited unlock).
• And in what is probably the most exasperating thing I read on Victims of Communism Day, Die Welt’s reporter in Italy describes Italians looking on Germany as “the enemy” and China as “their friend”. Italians, remember timeo Danaos et dona ferentes. [I am wary of Greeks, even if bearing gifts.][*] As much as I can understand your resentment of the EU, becoming a client state of China will make even you nostalgic for the EU one day.

[*] There is a Hebrew idiom taken from 1 Kings 21:19 for one who unleashes a calamity, then sets himself up to benefit from the resulting devastation: ratzachta ve-gam yarashta? [Literally: hast thou murdered, and also inherited?]

UPDATE: a writer at City Journal calls for people to volunteer for “Hunan challenge trials” with the new Oxford University candidate vaccine, and put his money (or life) where his mouth is. In HCTs, willing subjects get the vaccine (or a placebo) then deliberately expose themselves to infection. This way it can be definitely ascertained whether a vaccine candidate has protective value. So far, over 8,000 others have signed on to a grassroots call for volunteers.

COVID19 update, April 27, 2020: Israel and Europe progress; worrisome signs in the US food supply chain; Bastiat and “non-urgent” healthcare

(1) Let’s have a quick roundup of the latest active cases data from worldometers (I’ll leave Israel to the last):

Germany’s active cases 39,794 are down to 55% of the peak value on April 4, 72,865. Switzerland is doing better still — 5,651 down from a peak of 14349 on March 31, or down to 39% of peak. Austria stands at 2,401, or down to 26% of its April 3 peak of 9,334. Norway’s graph has no info on recoveries (hence no useful info on active cases), but daily new cases are a fraction of their peak. Total dead are clearly nearing the top of the sigmoid at 201. Finland’s graph looks like a wild zigzag owing to intermittent reporting of recoveries — but seems to be trending the right way. Active case graphs in Spain, Italy, and France seem to indicate these countries are turning the corner — if they can prevent a second flare-up.

Belgium, however, is not out of the woods yet, nor are the Netherlands and the UK. Sweden looks murky, with active case numbers still climbing about linearly, but total deaths seemingly starting to level off. The US — overall looks pretty grim still, but if greater New York City were taking out of the equation, the rest of the country looks rather rosier.

As for Israel: our active cases have been dropping steadily since April 15, from a high of 9,808 to the present 8,511. Recoveries have exceeded new cases since April 16. The total number of dead has crossed the 200 mark, but the curve over time shows a clear sigmoid that appears to be close to leveling off. With 15,443 documented infections since the beginning of the crisis (of which 6,731 documented recoveries), our apparent “case fatality rate”, at 201/15,443*100% = 1.3%. However, keep in mind that Israel counts everybody who tests positive, whether they develop symptoms or not. Guesstimating about half of these to be asymptomatic, the true CFR may be closer to double that, while the true IFR (infection fatality rate) is certainly lower than 1.3%, as despite increased testing capability the country is sure to have a significant Dunkelziffer/stealth infection rate. (Do keep in mind Israel has a much younger population pyramid than the major developed countries — this alone accounts for our low number of severe cases. The stories of young and healthy people without pre-existing conditions getting severe COVID19 are “man bites dog” news, not significant shares of the patient population.)

Israel indeed has done something today that I can only hope the US is wise to do soonest: opened its hospitals and HMO policlinics for elective procedures. (A lot of “gray area” care is technically elective in that it doesn’t have to happen right this second — but any unnecessary delay will cause complications later.)

Finally, in India lockdown is to end May 3, but it’s getting rolled back already in some less-stricken locations.

(2) Rather more worrisome news from the US, with twin posts (here and here) reporting about food supply chain disruptions from the agricultural side of things. I reached out to a few people informed about goings-on, and the problems are basically threefold:

• Choke points in the distribution chain were created by COVID19 outbreaks at meat processing plants (like Smithfield’s in South Dakota), which necessitated closure, sanitation, and reopening at reduced capacity. (At some processing plants, workers are also reluctant to show up.) Hence, farmers are stuck with hogs etc. and no place to have them processed.
• Farmers whose chief outlet was to the large food service companies and institutional customers are now stuck with product they cannot unload, except at a loss. Their operational cash headroom is limited at the best of times;
• Meanwhile, those who supply to the grocery chains see shifting demand. Dairy, for instance, is down. This has caused prices paid to farmers to drop to “below cost” levels.

There are second-order effects: corn growers who primarily supply pig farmers etc… And with oil prices down to historical lows, selling corn for ethanol is not practical. (Incidentally, while some farmer supplies (e.g., fuel) are cheaper, others go up in price because imported from, you guessed it…)

I doubt dire predictions of famine in the USA will come to pass (and dearly hope and pray they won’t). However, remember the USA is a major food exporter — and that it is likely to apply the maxim “the poor of my own city come first” in a serious food crisis. So major shortages in countries that are dependent on US food imports are increasingly likely. 

“Just-in-time” supply chains can normally respond smoothly to ordinary shifts in demand, and thus keep prices down for the end consumer. However, they are fragile to major disruptive events like COVID19. The old engineer’s maxim “better, cheaper, faster — pick any two” seems to have a supply chain counterpart: “cheap, just in time, robust: pick any two”. 

The social distancing measures in the USA (outside greater NYC,  and perhaps a few other congested metropolitan areas) have crossed the line from diminishing returns territory into doing more damage than they prevent — it is high time to return no normality. Scott Atlas MD definitely agrees.

(3) On a final note: Dr. Paul Hsieh quotes Bastiat about “the seen vs. the unseen [costs]” in the context of emergency care. (Bastiat’s classic essay expounding the concept of hidden costs and consequences should be required reading, not just for any economics student, but for every public servant and every elected official.) The number of COVID-19 deaths are in the public eye. The number of people dying from cardiac complications or ruptured appendicitis because they were unwilling to come to the ER for fear of contracting COVID19 (a phenomenon seen in Europe as well as the US) are not so obvious — but they are still there. This is without going into the urgency level one step below: cancer surgeries, non-emergency bypass surgeries,…

UPDATE: John Tyson, chairman of the board of Tyson Foods, weighs in on the company’s blog: “Feeding the nation and keeping our employees healthy”.

UPDATE 2: more about the MIT study on the NYC subway as “the mother of all super-spreader events”.

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 19, 2020: Israel reopens; NYC vs. rest of USA; quick takes

(1) Today, Israel started Phase 1 of its “back to normality” plan. There appears to have been intense tug-of-war between economic and healthcare decision makers, which resulted in some tradeoffs. Masks were made mandatory, giving in to a strong demand from the Health Ministry, but in compensation, a large number of retail stores that were only supposed to reopen in Phase 2 are doing so right now.

I treated myself to a long walk around the Tel Aviv borough where I live. About 2 in every 3 stores was open for business, and of the remainder, some were setting up for reopening.

(2) Matt Margolis enters into the differences between NYC and the rest of the USA as far as COVID19 is concerned.

The numbers are shocking. Downstate has been so heavily impacted by the coronavirus that it skews the United States when you compare us to the rest of the world.

Downstate New York technically includes New York City, Long Island, and the Hudson Valley, but I am only including Kings, Queens, New York, Suffolk, Bronx, Nassau, Westchester and Richmond Counties. These counties have a population of 12,205,796, according to World Population Review’s numbers for 2020—bigger than many countries.

It’s currently claimed that the USA “leads the world in COVID19 cases and deaths”. In fact, as Matt points out, in confirmed cases per capita, the US is only #7 worldwide (Spain is #1). Bad enough, you say? But if we treated greater NYC/”downstate New York” as a separate country, it would have #1 worldwide by a longshot — with four times the per capita incidence of Spain at #2. “USA minus NYC” would only be #14 worldwide. In per capita fatality rates, the whole USA comes at #8 [I suspect actually as #9, since Sweden appears to be omitted in that list], but NYC treated as a country would again be the #1 by far, with double the mortality of the #2 (Belgium). “USA minus NYC” drops to #11.

(3) Germany apparently is starting broader community testing for antibodies. On a related note (via Instapundit), physicians from Mass General Hospital tested 200 random people in the marketplace of Chelsea, MA, and found that 1/3 had antibodies for COVID.

(4) The Great Decoupling? Legal Insurrection reviews worldwide signs of countries “socially distancing” from the Chinese communist regime. Even Emmanuel Macron [!] now seems to get it.

(5) The German tabloid BILD reports on successful use of Remdesivir in Munich. With every new report, I’m getting more positive about that drug.

(6) Prof. Jonathan Gershoni of Tel-Aviv U. claims to be “2/3 of the way toward a vaccine”. The basic idea of most vaccine developers seems to be to target the “spikes” of the coronavirus, which are responsible for getting cells to let the virus in. If the virus were to lose those in a mutation-evolution process in an attempt to ‘get around the vaccine’, it would become a lot less dangerous anyhow.

(7) And it appears that some applied mathematicians who noticed a repeated empirical pattern in the progress of the epidemic in several countries may have rediscovered Farr’s Law.

COVID19 update, April 13, 2020: Italy and Israel grappling with exit strategies

(1) Italy, which has seen mortality well past the peak and on a downward trend (on a moving average) since the beginning of the month, and where new cases are lowest since March 13, is starting to grapple with “the day after”. As reported earlier, both Austria and Denmark are starting the road back to normal on April 15, with Norway to follow suit on April 20. Spain has started some normalization measures today.

(2) Israel too seeks to emerge from its “induced economic coma”. [Not all sectors have been idled: in fact, transportation infrastructure works have been carried out ahead of schedule as they were minimally disruptive now.] COVID19 cases have crossed the five-digit threshold here and are still increasing, but this is nearly compensated by an upswing in the number of recoveries, leading to an apparent stabilization in the number of active cases. Sure, we’re not out of the woods yet, as deaths have now grown into triple digits, but according to deputy director general of the health ministry, Itamar Grotto:

“I think we can say that we’ve pretty much succeeded in the stage of stopping the spread” of the coronavirus. Speaking to Ynet, he said that although there could be unexpected results from the outbreak in Bnei Brak and some other [c]hare[i]di communities, which would only be seen in the next few days, “It can be said that we’re in a relatively stable situation, and we’re in the stopping phase. Now, we need to see how we get out of this.” 

A group of captains of industry and business published an open letter, calling to start reopening things after Passover, “or face economic collapse”. Well, according to Haaretz (h/t Mrs. Arbel; I will deviate from my usual policy of not sending links there) these are the recommendations of the National Security Council, in four phases:

Phase 1: could begin as early as Thursday. In a nutshell: 

• hi-tech and finance sectors reopen, as distance compliance etc. easier to assure there.
• Government offices, currently down to essential staff, are ramped up to 50% staffing again
• Preschools and special education are reopened. (Preschoolers are least in danger from the virus.)
• It is being considered to permit preparation of small groups of HS seniors for their Bagrut (matriculation) exams
• Public transportation, currently running on a severely curtailed schedule, to be partially restored again

Phase 2: two weeks later

• Reopen retail stores other than large shopping centers
• Elementary schools reopen

Phase 3: two more weeks later

• Reopen remaining stores
• Reopening cafes, restaurants, and hotels with social distancing and hygiene restrictions 
• Junior high and high schools reopen. Strict hygiene and social distancing required
• Universities and other postsecondary education will continue online teaching until the end of the school year, as they have already adapted to this
• large, crowded events will still be prohibited

Phase 4: only when pandemic is under full control

• Leisure and entertainment industries back in operation
• Flights resume
• Anyone over 60 and at-risk populations still under lockdown

One main worry expressed is whether, if a flare-up occurs, the public will abide temporary back-tracking.

Some might wonder if gregarious and notoriously “in your space, in your face” Israelis will adjust to a new normal of keeping at two arms’ length and no touching, hugging, backslapping, kissing,…

UPDATE: welcome, Instapundit readers!

COVID19 update, April 7, 2020: hemoglobin, COVID19, and hydroxychloroquine; miscellaneous updates

A potentially HUGE finding in a preprint suggests a radically different mechanism for hydroxychloroquine’s action in COVID19. TL;DR in layman language: that a lot of the hypoxyia (oxygen starvation) of severe COVID-19 patients is due to hemoglobin in red blood cells being disrupted by the virus (as it is by the malaria pathogen), and that hydroxychloroquine protects hemoglobin in both diseases. A layman’s discussion can be found here.

“Masgramondou” has an origin hypothesis for the outbreak that sounds disturbingly plausible to anyone who subscribes to the “incompetence before malice” or “c*ck-up before conspiracy” principle.

How helpful is soap against COVID-19? If yes, why? The American Chemical Society has a helpful YouTube video https://www.youtube.com/watch?v=K2pMVimI2bw

The leader article of German center-right daily Die Welt is entitled: “the end of globalization as we know it” https://www.welt.de/wirtschaft/article207072567/Corona-Krise-Unternehmen-aendern-ihre-Lieferketten.html

Ventilator outcomes discussed by Roger Seheult MD https://www.youtube.com/watch?v=uaIzj3s3p4A&t=7s . In another video, he weighs in on the beneficial effect of sauna baths for immunity in general and in COVID-19 in particular  https://www.youtube.com/watch?v=EFRwnhfWXxo (hat tip: Mrs. Arbel) Finnish statistics so far look enviable.

My friend Tom Knighton lives in  Dougherty County in rural GA, which found itself coping with a fierce COVID-19 outbreak following a “super-spreader” event at a funeral. But it seems they are now seeing the proverbial light at the end of the tunnel. https://www.walb.com/2020/04/05/phoebe-releases-sundays-covid-numbers/

Israel, which saw super-spreader events during Purim parties a month ago, is now taking the drastic step of imposing a curfew from a few hours before the Passover seder until the next morning. Seders are to be done strictly in the home, nuclear family only, no guests. 

Japanhttps://www.worldometers.info/coronavirus/country/japan, which was very reluctant to do so, finally declares pandemic emergency

And Instapundit minces no words in USA Today .

UPDATE: via David Bernstein, interactive COVID-19 map of the New York City metropolitan area. Counterintuitively, Manhattan is not the worst hit pro capita: that extremely dubious honor falls to the nearer commuter counties.
NY Gov. Andrew Cuomo, hovewer, points to an apparent “flattening of the curve” in hard-hit NYC.

COVID19 update, April 4, 2020: a brief look at Israel

The first case on Israeli soil was a returnee from the Diamond Princess cruise ship, who however stayed in isolation. A tourist returning from Italy appears to have been “Patient Zero”.

Israel was quick to stop flights with China. On 21 February, all returnees from South Korea or Japan were requested to go in 14-day home quarantine; subsequently the country placed a blanket 14-day home quarantine on all returnees rather than single out specific countries. At one point, 200,000 Israelis were in home quarantine — this number has dropped precipitously as most of the travel-related quarantines expired and were only partly compensated by new quarantinees who lived or worked with somebody who tested positive.

Unlike most countries, Israel counts everyone who tests positive as a patient, including asymptomatic cases. The only way to get off the list is to test negative.

As of the time of writing, 7,851 Israelis have tested positive, and the disease has claimed 44 lives so far (an apparent IFR of 0.6%). 126 patients are in serious condition, of which 108 on ventilators.

Most of the mild and asymptomatic cases are in home isolation, but several hotels have been commandeered by the government as an isolation option for asymptomatic and mild patients. About 700 patients avail themselves of this option at the time of writing. Once checked in, one can only leave after testing negative. Once checked in, one can only leave after testing negative for active virus.

The age profile of patients (like the population pyramid generally) is definitely younger than in the hardest-hit European countries, which is one factor that accounts for the low IFR.

Israel started introducing social distancing measures mid-March, but only started actively enforcing them later, then tightened them to the point of placing roadblocks. Everybody is confined to a 100m radius from home, except for shopping for essentials or medicines, to work at an essential job, or such. As of Thursday masks were made mandatory outside the home.

The effect of these measures can be seen in the COVID19 statistics about 10 days downstream: note the “kink” in the graph below that marks transition from doubling every 3 days, to doubling every 5 days or more.

Bnei Brak, a predominantly chareidi (fervently Orthodox) borough of Tel-Aviv, accounts for nearly 15% of all cases nationwide. This community regards considers communal religious study and activities to be its very reason for existence, and has hence been slow to embrace social raison d’être, especially as it eschews secular media sources. Recently the area has been placed on full lockdown.

Meanwhile elsewhere, even the WaPo is now assuming that the official fatality figures out of China are <understatement>severe underestimates</understatement>. https://archive.is/To94N

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 30, 2020: the quest for a vaccine, high-throughput testing

(1) Mrs. Arbel forwarded a long article that peeks inside the frantic efforts to develop a vaccine. An archived copy is here. Basically, the first step, coming up with a candidate vaccine, has been drastically shortened thanks to modern advances in biotech, genomics, and proteomics. What still takes almost as much time as it used to is testing in healthy subjects:

(2) Mako N12 (Hebrew news site) has an article on a novel high-throughput testing assembly developed by two PIs at the Weizmann Institute in Israel, in collaboration with two academic hospitals, Tel HaShomer in Ramat-Gan (one of the five Tel-Aviv boroughs) and Assuta Ashdod. The system can process up to 384 samples at a time, for a maximum throughput of 20,000 tests per day. Aside from automation and “massive parallelization”, one innovation is that the samples are dropped immediately into a kind-of “fixation” solution, which renders them biologically harmless. This eliminates the need for elaborate biocontainment facilities. Apparently the facility is going through final approval procedures.

(3) “masgramondou” brought this article by Dr. John Lee in The Spectator to my attention: https://spectator.us/understand-report-figures-covid-deaths/ on why the CFR (case fatality rate) statistics differ so widely. This affects both the numerator (do you count everybody who dies from any cause while COVID19-positive, or do you only count if COVID19 is definitely the cause of death) and the denominator (do you test aggressively, or do you only bother testing when it’s already pretty sure the person is ill).

(4) Speaking of statistics and comparing apples to apples: I remember this morning Mrs. Arbel gasping at a report in the Jerusalem Post that such a large percentage of the Israeli patients are between 20 and 30 years old. However, this is not entirely surprising once you compare Israel’s population pyramid with that of, say, Italy:

Another factor, which Mrs. Arbel pointed out, is the widespread custom of long post-army treks. The tendency of our young people to congregate in tightly packed quarters and in general not to keep people at a safe arm’s length adds to the ease with which an infection can spread.
The comparatively young profile of our general patient population is reflected in the low percentage (below 2%) of critical cases: As of today, 4,347 Israelis have been diagnosed, but only 80 people in serious condition (including one 20-year old man) of whom 63 patients requiring ventilation. 16 people have died. About half the diagnosed people appear to be asymptomatic (for now).
The age profile of critical patients is much the same as everywhere else: older people with pre-existing health conditions (referred to in Hebrew as machalot req`a , literally “background diseases”), or very old people.

UPDATE: FDA gives emergency approval for chloroquine and hydroxychloroquine for COVID19

On “Protestant” and “Catholic” Jews

An American Jewish visitor to our Israeli (NCT Base East) home wondered why, if there are so many non-Orthodox Jews in Israel, there are so few Reform ‘temples’ (sigh).

In fact, an immigrant from Antwerp came up with the best response: “American Jews are protestant Jews — Israeli Jews are Catholic Jews”.

What?! You say. No, his response made perfect sense. Allow me to elaborate.

In Catholic countries, there is one church — the Roman Catholic (literal meaning: universal) church. There is no competing ‘Liberal Catholic Church’ (okay, on the other side of the spectrum there are small traditionalist breakaway groups you could compare to the chareidim). The population spans a spectrum in observance from those who piously and diligently attend to every daily and weekly observance, via those who come to church once a week and otherwise may say some prayers, via those who come on a semi-regular basis, to the “twice-a-year Catholics” (Christmas and Easter), to those who only show up for life-cycle events. All of them are considered ‘Catholics’, good, bad, or indifferent.

In Protestant countries, if you had a fundamental disagreement with the established church (C of E, Lutheran,… depending on the country) and you found enough people who agreed with you the default option was to start a new prayer house of your own, which might grow into another denomination. At one level, this ‘unity in diversity’ has been a fount of strength for protestantism; at another level, it has been a source of fragmentation.

About half of the Jews in Israel (or their immediate ancestors) immigrated from Muslim countries. (They are often misleadingly named ‘Sephardic’ — as many of these communities are closer in ritual to the Jews of the Spanish Expulsion than to Ashkenazi Jews’ — but a more accurate term would be Yehudei Artzot haIslam [Jews from Muslim Countries].) These communities always operated on the ‘Catholic’ model: there was one  ‘denomination’, it was religiously Orthodox, but was very tolerant of less-than-perfect observance on a personal level. As long as you respected the rabbi and the community elders, driving to the soccer game after Saturday synagogue services was/is no big deal — but nobody would think of packaging this as a new form of Judaism. Tell Jews like that about Reform Judaism — be it in Israel or in France — and the response will be basically ‘huh?’

In contrast, the birthplace of Reform Judaism was a very different country: Germany. It arose there in the early 19th Century as one response to a phenomenon that largely passed by the Islamic countries: the Enlightenment and its (mostly Ashkenazi-)Jewish counterpart, the Haskala. In response to its perceived early excesses, two new movements arose: on the one hand, modern-Orthodoxy — which combines Torah Judaism with an openness to secular learning — and on the other hand, Conservative Judaism, which as a movement tries to steer a middle course between Reform and Orthodoxy. While Reform- and Conservative-like congregations sprang up in other countries (e.g. the Neolog movement in Hungary, which in Israel would be called Masorti, see below), by far their biggest success story was the United States. Why? The first major Jewish immigration wave (post-1848) came from German-speaking lands, and thus (although a few Orthodox synagogues have existed in the USA since Colonial days) the “establishment” congregations became first Reform, later a mix of Reform and Conservative. When the Great Jewish Migration from Eastern Europe hit American shores 30-40 years later, the newcomers did set up their own Orthodox and chasidic congregations, but especially the Conservative ones quickly gained a following among immigrants eager to acculturate.

In other words, just as the US diaspora is a sui generis  success story, so is the blossoming of Reform and Conservative Judaism in the USA a unique success story born out of circumstances and ‘being in the right place at the right time’. But just like the predominant non-Jewish religion in the USA, protestantism, American Judaism is a multidenominational affair, even though the differences between Jewish denominations are more about observance than about points of theology.

There is a flip side to the phenomenon of non-Orthodox denominations. In countries where these were strong,  Orthodox communities felt conflicting impulses: ‘go with the flow’ to keep their flock, or rather become more rigid to offer a clear alternative? By and large, the second won out, and typically American Orthodox congregations will expect you to actually be observant at their level to join, or make a good-faith effort to be so. Even in the age of the ba’al teshuva (‘born-again Jews’) movement, the latitudinarian approach of a Moroccan- or Algerian-born Orthodox rabbi (mixing fairly strict ‘official’ doctrine with great personal indulgence) will typically not be theirs. Which is only natural: after all, if people want to live as Reform or Conservative Jews, they have those other places to go to?

Back to Israel now. So we have a bit under half the Jewish population that  was either born in, or descended from, Islamic countries with a ‘Catholic’ Jewish community. Most of the recent Russian immigrants had no religious exposure at all (and a purely ethnic/cultural conception of Jewishness). Israel’s “founding fathers” by and large all immigrated from the former Pale of Settlement (spread over present-day Poland, Belarus, Ukraine, Moldova, Russia, …) — places where effectively religious pluralism was not between Reform and Orthodox, but between competing streams of Orthodoxy. The “yekkes” (German Jews) and “anglo” immigrants were the only two major(-ish) groups that came out of a ‘Protestant’ Jewish ambit.

As a result, Jewish religious life in Israel quickly acquired its ‘Catholic’ character: denominationally orthodox, in varied shades of observance. Significantly, an Orthodox Jew is not said to be ortodoksi (a loan word to begin with) but dati (religious) or shomer mitzvot (observing the commandments), with chareidi (lit: “trembling” [in awe of G-d]) reserved for the ultra-Orthodox (“blackhats”). A Jew who mostly keeps the ritual commandments but not all the way will self-identify as masorti  (“traditional”): in practice, in an Israeli context (with often still a 1-day weekend), that means somebody who keeps the dietary laws quite strictly (at least at home) but may engage in recreational use of electronics and motor vehicles on the Sabbath. But even somebody who self-identifies as chiloni (secular) may in practice still be more observant of Jewish law than 90% of US Reform Jews: they just may never set foot in a synagogue except for a family event. As an Orthodox wag had it: tell an Israeli secularist to come to an Orthodox synagogue, and he’ll say ‘no!’; tell him to come to the Reform synagogue, to the Russian Orthodox Church, or to a Hare Krishna center, and the answers will be the same: ‘huh?’.

The first Reform congregation (Har-El in Jerusalem) was founded in 1958, and despite massive efforts by the World Union for Progressive Judaism (the Reform federation), Reform has remained a marginal movement in Israel that is (among those who even know it exists) widely regarded as a foreign import.  The degree to which the Israeli Reform movement has allowed itself  to be politically identified with the far-left Meretz party (which represents mainly the Haaretz readership, enough said) does not exactly help matters. From what I have seen of Reform services in Israeli, they are more traditional than US ones (admittedly a very low standard).

Masorti Judaism (which is what Conservative Judaism calls itself in Israel) has had somewhat greater success attracting “native” Israeli congregants. In part this is due to (deliberate?) semantical confusion with the broader meaning of masorti (see above), but another main factor is its indeed decidedly traditional orientation. By US standards, the Israeli Masorti movement would be ‘conservadox’, and at least one such synagogue which I attended semi-regularly was using the mainline Orthodox prayer book (Siddur Rinat Israel) as recently as 10 years ago, and the corresponding High Holiday prayer books as recently as last year. Masorti Judaism has some following among Israelis who seek a more (gender-)egalitarian experience than is possible in a mainline Orthodox congregation (a few experimental congregations like Shira Hadasha in Jerusalem aside). Still, it has shown no signs of ever becoming anything other than a niche player here.

As an aside, it should be remarked that both the Hebrew Union College (Reform) and Jewish Theological Seminary (Conservative) maintain satellite campuses in Jerusalem where they expect their rabbinical students to spend at least one year.

Finally, there is a native-grown “secular yeshiva” movement where secular Jews meet in groups that study biblical and rabbinical source texts together. While a parallel can be seen to the havura phenomenon in the USA, it also reminds me of groups at the edge of the established  church in some historically Catholic European countries.

So, are Israeli Jews setting up altars and burning candles to saints? Heck no! But are they, sociologically more similar to the observance continuum in Catholic countries than to the denominational quilt of the USA or Canada? Sure, I’d say so.

Some of the worst things imaginable have been done with the best intentions

The front page of the Yediot Achronot had a story (sensationalist as is the wont of that paper) about a family tragedy.

Briefly: The head of the hematology department of a large hospital (I will not spell out his name out of concern for the privacy of the family — bad enough that the gutter press chose to do otherwise) was faced with a 34-year old daughter (he himself was 66) who struggled with cancer for over 3 years. Eventually she gave up and insisted that he put her out of her misery, which he did, and subsequently committed suicide, leaving a wife and two more children behind.

It is written “do not judge your fellowman until you have stood in his place” (Avot 2:4). I have not (G-d spare me) stood in this doctor’s place but have been in a closely related situation, which made me lose all respect for the (euthanasia-happy) medical establishment of the European country involved. (For the political establishment of said country, I lost none since I had none left to lose by then ;-)) Suffice to say that the participants in this “Greek tragedy” have suffered, and continue to suffer, enough without me shooting off my mouth on this specific case.

However, now the usual suspects (hyper-secularists, as well as those emoting rather than thinking) are calling for a law permitting active euthanasia — notwithstanding that Israel calls itself ‘a Jewish state’ last time I checked, that Jewish law prohibits active euthanasia in the strongest terms, and that it is also utterly incompatible not just with the Hippocratic Oath but with the Jewish versions thereof. (The situation regarding passive euthanasia is rather more complex, as has been recognized by a 2005 law.)

There is a well-known legal maxim in English: “terrible cases make for bad law”. Sometimes, moved to pity from a few individual heart-rending cases, lawmakers create laws, or judges legal precedents, that would have addressed these specific cases but have unintended consequences hundreds or thousands of times greater in magnitude for years or even centuries to come. Furthermore, dark forces can manipulate public sentiment on a few such terrible cases to generate public pressure for a change of law that suits their nefarious ends  — in this manner, somewhere in Europe, a nation was made to set the first steps on a slippery slope that led first to mass euthanasia of the mentally ill and special-needs children as having “lives not worth living” and “being too great a burden on those caring for them”, which then turned out to be the dress rehearsal for the murder of one-third of my people (plus an even larger percentage of Roma gypsies, as well as millions of Slavs).

It is, incidentally, interesting that the “T4-Aktion” (as the Nazi euthanasia program was known after the address of the headquarters of the program, Tiergartenstrasse 4 in Berlin) stands alone in the history of the Third Reich as an example where a widespread public outcry (backed, admittedly, by some prominent Catholic and Lutheran clergy) forced the regime to back down and discontinue it at least publicly.

It would be a tragedy on a cosmic scale if, moved by the Greek tragedy of a few individual families, the Jewish state of all countries would set the first steps down this “road to Hell paved with good intentions”. Fortunately, I would imagine that public support for such a law is mostly limited to the ‘Haaretz readers’ audience among the secular public, close to zero among the traditional public and the minority religions, and zero full stop among the Orthodox public.

Ayatollah Ghilmeini on “Pillar of Cloud and Pillar of Fire”

At Correspondence Committee, commenter “Ayatollah Ghilmeini” has some reflections on mivtza amud anan/Operation Pillar of Cloud (a.k.a. Operation Pillar of Defense) that need sharing:

I had wondered how many more rockets were going to hit Israel before there would be response.  It was clear the recent escalation, right after Obama was elected, stemmed from multiple needs of the people shooting rockets: Iran and Syria needed international community pressure off of them while they murder the Syrian people into submission, the radical Islamists in Egypt and Gaza, flush with the belief that Obama would protect them wanted to get the shooting started, lastly, and most importantly, all of these radical organizations and governments are committed to jihad against the Jewish people.  The jihadis are in political ascendancy throughout the region and they only know one way, permanent war until victory.

In blessing the rocket assault the triggered this war, they made one supreme political miscalculation.  They believed, that the Israeli government going into elections would be afraid to respond for fear that there be political backlash at the polls.  This fundamental misreading of the Israeli body politic is the reason for this war.  When Israeli political leaders acknowledged that 1 million Israelis were within missile range of Gaza, it was clear to me that any politician wishing to get elected that did not speak to this continuing and unacceptable situation faced certain defeat at the polls.

[…]Looking back over the last few days it was clear that the silence coming from the Israeli government as it checked its fire and the enemy kept shooting rockets was the implementation of the modern war plan.  The operation is currently called Pillar Of Cloud, and anyone who remembers their Bible, remembers that with the pillar of cloud [by day], there was also a pillar of fire [at night].  It is my belief that, unless the rocket fire diminishes immediately, Israel will shortly begin ground operations in Gaza on a major and significant scale.  Unlike the inconclusive war 2006, this time, they will go all the way.

[…] If a bunch of New Jersey separatists were firing rockets into New York demanding back Manhattan and the Statue of Liberty because they are part of the sacred religious property of the New Jersey people, the people of New York, and the United States for that matter, would shut that crap down in about a day.  But in the bizarre double standards of the modern world, Israel is expected to tolerate this. When the situation finally got so unbearable that they had to act, Israel’s leaders finally acted.  […]

I pray for her soldiers and people […] I also pray for the Palestinian people to be freed from the tyranny of the bunch of psychotic religious terrorist maniacs.  May this war be short and end in a complete and total Israeli victory. Am Yisroel Chai!

Amen. Go read the whole thing.

UPDATE: “Anne in Petach Tikva” has updates from the scene here and here. The named of the town in central Israel where she lives, fittingly, means Gate of Hope.

Healthcare — free, top-quality, available, pick any two

In response to a commenter here I wrote the following:

Healthcare — free, top-quality, available, pick any two. I have lived under multiple healthcare systems. If the price for “free” and “available” is involuntary euthanasia of the elderly, I’ll pass. If “free” and “available” means “7th-rate”, so will I. If “free” means “whoever has the best connections gets the best quality care”, it’s just “inequality” in a different way. (Except, of course, that the “deserving” New Class of bureaucrats, academia, and “helping” professions think they will get first dibs in a system run by them.)

Israel comes the closest to a workable socialized medicine system (thanks to an unusually healthy age pyramid) and even their system is increasingly becoming two-tier: gold-plated for those able to afford private care and bare-bones for everybody else.

Old Maggie had it dead to rights: “The trouble with socialism is that eventually you run out of other people’s money.” It was 0bama’s misfortune (but also his innumeracy — a common characteristic of “wordsmith intellectuals”, in my experience) to try and implement more socialist schemes just as the state ship was reaching the shoals of bankruptcy. [I couldn’t resist the Monty Python reference :-)]

0bama and Bloomberg: case studies in defense mechanisms of incompetent managers #Omustgo

Like all of us who have dealt with managers and/or work(ed) in management ourselves, I have witnessed on numerous occasions two defense mechanisms of incompetent and/or out-of-their-depth managers. Both of these are on ample display in the political environment today.

The two mechanisms are seemingly opposite but in fact closely related — both are misdirection/displacement/”red herring” tactics.

The first is: faced with large and seemingly unsurmountable problems, the outclassed manager instead focuses on some detail problem that (s)he judges manageable and declares this THE top priority, so that (s)he can “solve” it and declare victory. For example, the pathetic joke of a president suddenly declaring that not the $16T and swelling federal deficit, not the crash-and-burn of an Islamo-appeaser foreign policy, not an on-paper employment of 8% (out of an ever shrinking labor force), but… bullying or homosexual ‘marriage’ are the most important issue of the day.

The second mechanism takes an opposite tack: it instead redirects attention to some super-issue in comparison to which all other problems become trivial — so why waste time on them? For example, in Israeli politics, the agenda of the day is understandably dominated by the issue of ‘hamatzav’ (the [security] situation) — and any politician who wants public attention without the thankless hard work of writing and passing legislation that deals with mundane things like roads, crime, still pervasive oligopolies,… can instead pontificate about ‘the situation’/’the peace process’/… (Another such ‘super-issue’ there, albeit a distant second to ‘hamatzav’, are synagogue-state relations.)

Similarly, the pathetic joke of a New York mayor, rather than deal with the bed bug epidemic, a city that isn’t as safe as it was under his predecessor, or the vulnerability of the city’s infrastructure to man-made or (most recently) natural disasters — starts pontificating about ‘global warming’, and declares that we have to re-elect the Worst President In Living Memory because he has the ‘correct’ position on global warming.

I’ve dealt with incompetent managers who applied either tactic: more commonly they engage in both, like Bloomberg who also finds it necessary to regulate the size of sodas. They may be people that never belonged in any managerial role of any kind but wormed their way into one based on superficial, glib manipulation skills — like our president whom we at last have a chance to fire come next Tuesday.

Or they may actually be people who, based on their success at one managerial task, get appointed to one where they are manifestly out of their depths: Bloomberg’s manifest success in creating and building his financial news company clearly did not translate to anything resembling success in the unrelated field of running the municipal services of a metropolis. Here we actually see Peter’s Principle in action: people competent at lower-level managerial jobs (or those merely able to pass as such) eventually get promoted to their level of absolute incompetence.

But in private business, when a manager is clearly not delivering, (s)he gets sent packing. And Clint Eastwood was quite right in pointing out that it doesn’t matter that (s)he is a nice person or has a desirable social profile: “when somebody does not do the job, we got to let them go.”On Tuesday we have an opportunity to let go a chief executive whose main ‘achievement’ has been to stop the hapless Jimmy Carter from being the worst president in living memory. And #dontgetcocky, but… the polls suggest we have a very real chance of doing so — if we show up in numbers to do it. Let us do so in great numbers and send the fallen-upward empty chair back to the shady Chicago furniture store where he belongs.UPDATE: Walter Russell Mead:

Admittedly, getting public support and finding the money for flood protection would be hard, but it is exactly that kind of hard job that governments are supposed to do. Leadership is getting the important things done, not looking busy on secondary tasks while the real needs of the city go quietly unmet.

The problem with nanny state governance isn’t just that it’s intrusive. It isn’t just that it stifles business with over-regulation, and it isn’t just that it empowers busybodies and costs money. It’s that it distracts government from the really big jobs that it ought to be doing.

Mayor Bloomberg has done an admirable job under great pressure as the city reels from Sandy’s attack. But an ounce of prevention beats a pound of cure. The city needed flood protection for its subways and electricity grid—and it didn’t get it. If the Mayor had spent less time and less of his political capital focusing on minutiae, this storm could have played out very differently.

Bibi gives 0bama a Mideast history lesson (video)

Must-see (via Gateway Pundit):

On the other hand, Walter Russell Mead analyzes the non-Israel parts of 0bama’s speech, and says he’s (however reluctantly) embracing the Bush doctrine. (Here is a roundup of more reactions.)

Just minutes ago I got an Email from a Washington acquaintance (and Jewish 0bama supporter) who appears to be even more confused than I am. Is 0bama really throwing Israel under the bus, or did he seriously think he could bully Netanyahu (no slouch at dirty politics himself) into doing his bidding? Or do both sides know that a return to 1967 borders (read: pre-Six Day War borders, since I assume for Israel to reoccupy the Sinai is not the idea ;-)) is not realistic, but staged the disagreement just for show?

In any case, Netanyahu, whatever my misgivings about him as an actual leader are, has always been an impressive spokesman for his people, and together put in possibly the best performance of his career. Without benefit of teleprompters, may I add.