George Floyd photo by CNN
According to a paper by the National Bureau of Economic Research (NBER) dated “June 2020” (assembled after June 20, the end date of the collected data) the nationwide street protests/demonstrations following the murder of George Floyd did not result in an increase in COVID-19 cases. The results of this study directly contradict the assertions of right-wing media, political figures, and a certain president whose name will not be used.
According to the abstract:
Event-study analyses provide strong evidence that net stay-at-home behavior increased following protest onset, consistent with the hypothesis that nonprotesters’ behavior was substantially affected by urban protests.
…we find no evidence that urban protests reignited COVID-19 case growth during the more than three weeks following protest onset.
Whether the protests themselves caused an increase in SARS-COV-2 transmission but they were counterbalanced by “stay at home” behavior, or there simply was no increase, is not clear. The paper describes a complex analysis of behavior informed by cell-phone data and county-by-county daily COVID case counts.
The net result, however, was that cases did not increase in the worst-affected state, Minnesota, but cases did increase in the least-affected state, Florida. This is shown by the daily case-count graphs for Minnesota in the New York Times, in which the date of the murder, May 25, was followed by a sustained decrease in case counts which did not pick up again until June 17-19 and did not exceed the case count on May 24 until July 11.
In Florida, new cases started to increase on June 3 and continued without let-up until a peak on July 12. Since that date, there has been a relative plateau in new cases. Texas, which had few protests, showed an increase in daily cases in late May, which accelerated in June. In Tennessee, which saw early protests in Memphis, new case daily rates did not increase until late June.
In any case, as shown by the figures in the paper, protests occurred in every state with a large population, so statewide data are insensitive (except perhaps for Minnesota, which has almost all of its population concentrated in a few cities.)
The NBER study used anonymous cell-phone tracking data to examine people’s movements and ” we demonstrate that cities which had protests saw an increase in social distancing behavior for the overall population relative to cities that did not…”
They evaluated the rate of new cases identified by testing in 315 cities larger than 100,000 population, of which 284 had protests and 31 did not. The first large cities that experienced demonstrations were Minneapolis, Los Angeles, and Memphis, Tennessee. Cities that did not have protests included Aurora, Colorado, Hialeah, Florida, and Irving, Texas.
Ohio House Speaker Larry Householder was arrested on Tuesday morning, hours ahead of a planned announcement of a $60 million bribe investigation by federal prosecutors. Householder is seen here in March 2019. Associated Press
The NPR (National Public Radio) website published an article July 21 about this man, who was arrested along with four others by the FBI this morning “in connection with a $60 million bribery scheme allegedly involving state officials and associates.”
The scheme involved Generation Now, a 501(c)(4) nonprofit secretly controlled by Mr. Householder, which obtained nearly $2 million from a company described in the indictment as “Company A”, which in fact is “Energy Harbor” (previously FirstEnergy Solutions) to support his and the others’ candidacies for State House seats.
The money flowed between March 2017 and March 2020. Some of it was also spent on personal expenses by the alleged offenders. An opponent of the bill estimated the actual cost to have been $15 million.
After obtaining the Speakership, Mr. Householder pushed through a law that provided “bailout” money to the company, which operated nuclear power plants, and gutted subsidies to renewable energy projects:
Last year’s nuclear bailout law tacked on a charge to residents’ power bills, sending $150 million a year to the nuclear power plants. They are owned by the company Energy Harbor, which was previously known as FirstEnergy Solutions. The law also included an additional subsidy for two coal plants.
By the way, Mr. Householder is a Republican. Company A is expected to be indicted in the near future.
This is only the tip of the iceberg. Lobbyists for numerous companies operate hand-in-glove with government regulators. For example, Polaris, a company which makes off-road vehicles, engaged in a scheme with lobbyists that involved federal officeholders (elected by the people) who made personal appeals to regulators who eventually provided them with exemptions from tariffs for parts such as aluminum wheels (which could have been made in the US) imported from China.
The scheme by Polaris is apparently perfectly legal, but involves people like Democratic Minnesota Rep. Collin Peterson, chairman of the House Agriculture Committee, who personally contacted the office of the US Trade Representative to obtain special treatment for Polaris. Others, like Republican Sen. Pat Toomey of Pennsylvania, who opposes tariffs, wrote numerous letters on behalf of other companies seeking relief.
The reason for this activity? Campaign donations from the companies involved. A quid pro quo cannot directly be established, so laws do not appear to have been broken. This is the process of lobbying for one’s constituents that is a large part of Congress-people’s work. People who make large monetary contributions to political campaigns receive special favors, while those who cannot afford to pay get little or no attention.
This is a perversion of the process of representation which is so common that it is impossible to control by investigating individual cases. There is a cost to this form of government: the people elected to high office, whether state or federal, do nothing for people who cannot afford to contribute to their campaigns. As a result, the voters receive nothing but good wishes from the people they elect, and the rich people and companies who bankroll their campaigns get special treatment, including relief from taxes and “burdensome” regulations.
This is why poor people and minorities still suffer at the hands of those who are supposed to take care of them. One possible answer? Public financing of election campaigns, free airtime for people who qualify in low-level contests like primaries, and prohibiting contacts between regulators and Congress-people. We will soon discover what laws, regulations, and taxes really do when they are applied equally across the board to all citizens and companies. Perhaps equal treatment would induce Congress to pass laws that equally affect everyone.
photo by William Iven via pixabay.com
There does seem to be a reduction in the increase lately, although that sounds stupid. An increase is an increase, but if there’s an exponential increase rather than a linear increase, that’s not as bad. Look at this chart from “Our world in data” that shows the biweekly trend of daily positive cases. Back in June, between June 13 and June 17, the daily case count remained the same for several days (this was after a drop in the daily case count in May.) Then, until July 6, the daily case count increased and peaked on that day at 80% more than before. After that, the increase gradually dropped to today, where the daily new case count is “only” up by 42%.
This makes it appear that the increase is decreasing. Not good news, but not as bad as two weeks ago.
Here are the state numbers for the worst-affected states:
Now look at the new case rate in Arizona. After a peak on June 30 of 4,797 new cases, the number has dropped and yesterday was only 1,676 new cases. The 7 day average has shown this drop since peaking on July 6. So that’s a thing. The new deaths peaked on July 18 at 138 and has been less the last couple of days. You’d expect the deaths to peak a couple of weeks after the peak in new cases, so that looks reasonable.
In Florida, new cases peaked at 15,300 on July 12. The 7 day average peaked on July 16. There has been a slight downward movement since then. New deaths peaked at 156 on July 16. New deaths have dropped, but the 7 day average is still high– until July 23, we won’t be past the peak on July 16 so don’t expect much improvement yet.
In California, new cases peaked at 10,387 on July 14, only slightly higher than the rate on July 7: 9,897. The daily death rate has plateaued since July 11.
In Texas, the new cases peaked at 15,038 on July 16 and dropped every day, to 7,636 on July 20 (about half that of four days earlier.) New deaths peaked at 154 on July 16 but were high again yesterday at 127.
Louisiana is getting worse, with two big numbers of new cases in the last two days (I’ll leave off the details– too depressing.) I think you can expect Louisiana’s deaths to be much higher in about two weeks– as high as they were after the peak of new cases on April 2 (which was not as high as the peaks now.) (Mardi Gras was February 25 this year– how that relates to the peak of cases in Louisiana is problematic, since that was over a month later…)
Mississippi is also getting worse; they didn’t have a peak in April.
Georgia peaked at 4,904 on July 10 and again on July 18 at 4,074. The last couple of days have been much less: 2,453 on July 19 and 1,994 yesterday. It’s impossible to say if they’re getting better or not after only two days.
(All the above state level numbers are from the New York Times interactive web pages.)
I’ll leave the other states to you to explore if you’re interested. The bottom line: most of these states, except California, have only required masks for the last week or so; Georgia still doesn’t require masks except for Atlanta (and that’s being fought in court.)
What does this mean? Will there be a reprieve this summer?
What will lead to a reduction in new cases? I don’t know, but I’m guessing whatever it is, it started two weeks ago and is beginning to take effect in most places where the virus has been spreading out of control since the middle of June. Maybe it’s the mask mandate, maybe it’s fear of the virus finally taking hold in the South. We will know in a couple of weeks.
Then when school starts, if it starts with all the kids congregating in schoolhouses the way it normally does, the virus will spread again rapidly. That’s how it normally works every year: as soon as school starts, the colds and flu start spreading. Kids are highly susceptible to coronaviruses and influenza viruses and every other infectious organism (they don’t get very sick, but they are highly contagious.)
When kids get it, they take it home and everyone in the household gets it– not right away, but soon enough. So I’m saying we should not let kids go back to school this year. I know it’s bad for their education, but we should put our money into improving online school with better web access and better laptops for the poor kids. If we make them go back to school, this whole nightmare will just get worse.
EM of coronavirus by NIAID
JAMA on July 10 reported a study done at St. George’s University Hospital, London, that found an increase in stillbirths during the pandemic (none of the mothers with stillbirths had symptoms of COVID-19):
We compared pregnancy outcomes at St George’s University Hospital, London in 2 epochs: from October 1, 2019, to January 31, 2020 (preceding the first reported UK cases of COVID-19), and from February 1, 2020, to June 14, 2020.
…
There were 1681 births (1631 singleton, 22 twin, and 2 triplet pregnancies) in the prepandemic period and 1718 births (1666 singleton and 26 twin pregnancies) in the pandemic period. There were fewer nulliparous women in the pandemic period than in the prepandemic period (45.6% vs 52.2%; P < .001) and fewer women with hypertension (3.7% vs 5.7%; P = .005) in the pandemic period than the prepandemic period, and there were no significant differences in other maternal characteristics (Table 1).
The incidence of stillbirth was significantly higher during the pandemic period (n = 16 [9.31 per 1000 births]; none associated with COVID-19) than during the prepandemic period (n = 4 [2.38 per 1000 births]) (difference, 6.93 per 1000 births [95% CI, 1.83-12.0]; P = .01)
The study reported a total of 19 mothers with COVID-19 in the delivery ward during the pandemic.
This might, at least partially, account for the decrease in preterm deliveries that I posted about yesterday– although the number of stillbirths was small (16 during the pandemic) in comparison to the potential number of premature babies. As I noted yesterday, there is as yet no obvious explanation for the observed decrease in prematurity. However, this just adds another layer of uncertainty because there is no obvious explanation for an increase in stillbirths either.
There were limitations in the study, most notably that the mothers with stillbirths were not specifically evaluated for presence of SARS-COV-2 RNA by nasopharyngeal swabs; the study noted that as many as 90% of mothers in another study were asymptomatic despite having positive tests. They did note that there was no pathological evidence of viral infection in the placentas or fetal tissue, although it doesn’t appear that virus RNA was specifically looked for.
The authors speculated that mothers with warning signs, such as cessation of fetal movement, may have hesitated to come to hospital emergently because of the pandemic and fear of being infected. Reduced attendance at prenatal clinics or reduced use of ultrasounds might also have played a role. None of these things was specifically evaluated.
In addition, the number of premature deliveries at this hospital was not evaluated. This information could have been valuable.
We are left with more questions than before. Why more stillbirths at this one hospital? Was it chance or the pandemic? Why fewer premature births at other hospitals?
Coronavirus studies by Engin Akyurt via pixabay.com
The New York Times (NYT) published an article on July 10 about a study published in MedRxiv on July 8 that showed that a much higher proportion of pregnant women who identified as Black or Hispanic were SARS-COV-2 antibody positive than of women who identified as White. The study was performed on de-identified blood samples taken from 1,293 pregnant women who presented for delivery at two Philadelphia hospitals between April 4 and June 3. The hospitals together deliver about 50% of all women in the Philadelphia area.
The results show that there were significant race/ethnicity differences in seroprevalence rates with higher rates in Black/non-Hispanic (9.7%) and Hispanic/Latino (10.4%) women and lower rates in White/non-Hispanic (2.0%) and Asian (0.9%) women. The number of Asian women in the sample was probably too small to allow conclusions about the significance of their low positivity rates. Overall, 80/1293 (6.2%) of samples were positive for IgG or IgM antibody (or both.)
In addition, nasopharyngeal swab specimens were obtained from 1,109 (85.8%) women who were also tested for antibodies; however, these were obtained at various times before delivery so they could not be directly compared with the antibody tests. “We found that 46 of 72 seropositive women (at the time of delivery) who were NP tested had a SARS-CoV-2 positive PCR result (at some point during their pregnancies), whereas only 18 of 1,037 seronegative women (at the time of delivery) who were NP tested had a SARS-CoV-2 positive PCR result” (at some point.) Thus, the 18 positive PCR tests were in some sense discordant with the antibody tests.
What was striking, however, was the difference in seropositivity between Black or Hispanic women and the White women– about five times as many of the Black or Hispanic women had positive antibody tests. It seems that there is much greater exposure to the virus among these ethnic groups.
The data should be compared to information in another NYT article published July 5 based on a Freedom of Information Act lawsuit. The CDC data revealed by the lawsuit provides “detailed characteristics of 640,000 infections detected in nearly 1,000 U.S. counties.” That data says that three times as many Black or Hispanic people per 10,000 population were infected with the virus as White people and that twice as many died. “For people who are Asian, the disparities were generally not as large, though they were 1.3 times as likely as their white neighbors to become infected.”
In Missouri, for example, “40 percent of those infected are Black or Latino even though those groups make up just 16 percent of the state’s population.” Native Americans were far more likely to be infected as well. Another example: “In Kent County, which includes Grand Rapids and its suburbs, Black and Latino residents account for 63 percent of infections, though they make up just 20 percent of the county’s population.”
The test results revealed by the CDC are incomplete; of 1.5 million positive antigen tests, only 640,000 had information as to the subject’s ethnicity.
For age-specific test results, the disparities in death rates were even greater:
Latino people between the ages of 40 and 59 have been infected at five times the rate of white people in the same age group, the new C.D.C. data shows. The differences are even more stark when it comes to deaths: Of Latino people who died, more than a quarter were younger than 60. Among white people who died, only 6 percent were that young.
Whether people in these ethnic groups were infected because they were among “essential” workers who were exposed on the job or because they were in households that had greater exposure (or both) is unknown. Either way, Black or Hispanic people are being infected at about three to five times the rate of White people. They are also more likely to get sick or die because so many of them have “co-morbid” medical conditions. Does this have anything to do with the widespread denial of the impact of the virus among Republicans?
It is no wonder that public anger over the murder of George Floyd has become so prevalent in the last two months. Black people are being struck down by the virus and are being brutalized by the police at the same time. They have a right to be angry.
Be Here Now– photo by Harald Lepisk courtesy of pixabay.com
Most of my blog posts are about medical things, or at least things that have something to do with things that are medical. That’s because my training was in medicine and that was my experience for 27 years. So I have some expertise in that.
I’m taking this opportunity to ask you what kinds of posts you want to see on this blog. The reason I’m asking is that I appear to have more people actually reading, or at least clicking on, my posts. I could write about anything, but I don’t want to just repeat what other people are saying or just vent about whatever obsesses me. If you search, you can find people writing about almost everything, from every point of view. I don’t want to duplicate what other people are saying.
I don’t get many comments. I don’t know if that’s because you agree with me or you’re just apathetic, or too depressed to do anything. Remember “learned helplessness”– it affected Mary [redacted], and it could be affecting you, too… so here’s your chance to break through the helplessness with something that would make a difference.
“What have you got to lose?” Remember that statement? It was said by a certain president who shall remain unnamed. It applies to a lot of things. He applied it to African/Caribbean-Americans voting for him. He thought it was funny. It’s not.
You could lose your life from voting/not voting, especially this year. Some people have already died because of him.
On a personal level, though, I have little left to lose. I am living on a pension from Social Security. They most likely, probably can’t take it away from me. I can’t get fired for what I say or write. But I could be killed. I can’t make any money because it would probably be taken away from me. But I could be killed. So for all the mistakes and stupid things I’ve done, I say, it doesn’t matter any more. I can’t do anything about the harm I’ve caused. The good I’ve accomplished has faded away. It doesn’t matter any more. But I can still write.
Why do I keep writing? I’m outraged, on an almost hourly basis, by things that happen.
I’m outraged today by the report that people are being swept up in unmarked vans full of un-identified federal “police” who are just taking people off the street for exercising their right to protest. Because somebody in the crowd is throwing things, or writing graffiti on federal buildings, or trying to burn police stations.
I’m disturbed that the people in the “Justice” Department are taking this opportunity to judicially murder people who are dying already from the effects of incarceration. They did awful things, but I don’t believe that gives anyone the right to kill them in cold blood. They’re not doing anything to right the wrongs that caused the deaths in the first place. They’re just satisfying their urges to exercise their power and wreak revenge on helpless miscreants.
I’m dismayed by the results that we’ve seen another high in new cases: over 70,000, some say over 75,000. Different web sites say different things, but most are over 70,000.
So, there’s a lot of things I could write about. Please write a comment if there’s something in particular that you want me to write about.
photo of a great-grandson by Mary Molina, copyright reserved
I have previously posted about the odd changes in emergency room visits that have occurred as a result of the pandemic. Normal emergency cases have suddenly disappeared; drops in heart attacks, strokes, appendicitis, car crashes, and other “normal” (expected) incidents have been observed. One thing that had not been remarked before is the disappearance of premature babies.
This article in the New York Times of July 19 details the drop in premature deliveries that has occurred in many hospitals since the pandemic began. The article begins with the observations of a doctor in Ireland.
According to the Times article, Dr. Roy Philip, a neonatologist at University Maternity Hospital Limerick in Ireland, noticed this when he first returned to his hospital in March at the onset of the lockdown. He found that demand for a milk replacement used by premature babies had vanished. When he ran the numbers, he found that premature births had dropped to a quarter of the average from previous years.
He published the results of his observations in MedRxiv as a “preprint” (not yet peer reviewed) report: compared to a historical rate of 8.18 (95% CI: 7.21, 9.29) per 1000 live births from January to April 2001 to 2019, 2.17 per 1000 live births was observed in January to April 2020. The rate ratio of 3.77 (95% CI: 1.21, 11.75), p = 0.022, represented a 73% reduction.
A Danish group reported similar results in MedRxiv on May 22. There, a registry of 31,180 live singleton infants born in Denmark between March 12, and April 14, from 2015 to 2020 was evaluated. “The extremely premature birth rate during the lockdown was significantly lower than the corresponding mean rate for the same dates in the previous years (odds ratio 0.09 [95 % CI 0.01 – 0.04], p < 0.001).” That is, a greater than 90% reduction in very premature births was seen.
Doctors in Rotterdam, Melbourne, and Alberta reported similar drops. The Times article continues, “In the United States, Dr. Stephen Patrick, a neonatologist at Vanderbilt Children’s Hospital in Nashville, estimated there were about 20 percent fewer NICU babies at his hospital than usual in March.”
The article states that not all hospitals have seen the same drop, although examples were not provided.
The causes for this dramatic drop during the last six months are unknown as yet. It is not even clear whether the drop is localized or general. Explanations could include reduction in air pollution, imposition of reduced activity outside the home, or many other changes unique to the lockdown. Whatever the reason, this is a fascinating finding and will certainly stimulate a lot of research.
Trends in premature birth in prior years:
In the US, premature deliveries have increased for the last four years in a row, according to the CDC. “White women had about a 9 percent risk of premature birth in 2018, while African-American women’s risk was 14 percent.” According to Statista, premature births in the US increased from 10.62% in 1990 to 12.8% in 2006, but then suddenly dropped to 10.4% in 2007 (perhaps a change in definition? It’s not clear.)
The overall birth rate dropped from 16.7 per 1,000 people in 1990 to 11.6 per 1,000 in 2018. That same year, there were 50 births per 1,000 women among White women and the same among Asian women. There were 54 births per 1,000 among Black women, 55 among Latino women, 59 among Native American women, and 67 among Pacific Islander or Hawaiian women.
According to CDC, premature births and low birth weight accounted for 17% of infant deaths in 2017.
Here is some general information about premature birth that you may find interesting:
Premature babies (“preemies”) are defined as those born before 37 weeks of gestation (normal is 40 weeks) and this occurs in about ten percent overall of US deliveries. Prematurity is more common in non-white mothers and those with fewer socioeconomic advantages. Prematurity is one of the leading causes of death for children born to non-white American mothers.
Preemies are faced with a variety of problems, starting with low birthweight (1500 grams or less; average babies weigh 2500 grams) and including underdeveloped lungs as well as heart defects and problems related to the reasons why they are born early. Premature infants are prone to vision and hearing problems, developmental delays, and cerebral palsy.
Premature delivery is most often heralded by amniotic sac breaking, leading to fluid leaking from the vagina. Uterine contractions may precede of follow the loss of fluid. Once the amniotic sac breaks, the baby must be delivered within 24 hours, or the risk of infection rises steeply.
Premature delivery is most often caused by infections including vaginitis (vaginal inflammation or infection) and systemic infections but often the underlying cause is unknown. Risk factors for prematurity include diabetes, high blood pressure, multiple pregnancy (twins or more), overweight or underweight, air pollution, tobacco use, alcohol and drug abuse, and psychological stress.
Treatment for premature birth:
Those at risk or having premature contractions can be treated with progesterone (one of two major female hormones, the other being estrogen.) Once delivery is inevitable, treatment with corticosteroids like dexamethasone and prednisone can improve outcomes, in part by stimulating maturation of the fetus’ lungs.
Nifedipine (normally used for blood pressure) and other drugs can reduce uterine contractions, delaying delivery. Once the baby is born, supportive treatment by warming, skin-to-skin contact with the mother, and oxygen supplementation aid survival. In extreme cases, it may be necessary to intubate the newborn and provide mechanical ventilation. Adding pulmonary surfactant (similar to detergent) to the oxygenated air greatly improves expansion of the lungs and therefore aids survival.
Complications of premature birth:
Premature birth is the most common cause of neonatal mortality; those born at 22 weeks’ gestation have about a 6% chance of survival, improving with each week after that, up to 72% at 25 weeks. Survival is often followed by numerous complications, from acute respiratory distress syndrome due to insufficient secretion of surfactant (called hyaline membrane disease) chronic lung disease (which used to be called bronchopulmonary dysplasia), blindness (sometimes caused by oxygen toxicity), bleeding into the brain (intraventricular hemorrhage, affecting 25% of those born before 32 weeks), to hypoxic-ischemic encephalopathy (brain damage caused by lack of oxygen.)
Other problems of prematurity include anemia, low blood platelets, high ammonia, low calcium, low thyroid hormones, and high bilirubin.
Normally, the fetus has a type of hemoglobin (Hgb) which has a greater affinity for oxygen than adult Hgb (fetal Hgb.) After birth, fetal Hgb is broken down and replaced by adult Hgb. Breakdown of fetal Hgb increases blood bilirubin levels, and this has to be metabolized in the liver. The newborn liver is not well equipped to do this work, and as a result, blood hemoglobin can rise rapidly. In addition, Rh-incompatibility can cause breakdown of red blood cells. A common and feared complication of elevated bilirubin (icterus) (signalled by yellow skin) can lead to brain damage (kernicterus) or death.
Icterus is common even in normal newborns and usually resolves spontaneously or through exposure to ultraviolet light (such as in sunlight) but if the level of bilirubin rises too high, it accumulates in the brain and kills nerve cells. Emergency treatment of high bilirubin is by exchange transfusion, in which the blood is replaced by equal amounts of normal blood.
If the ductus arteriosus (a bypass circuit in the heart which diverts blood from the lungs during growth in the womb) doesn’t close (known as patent ductus arteriosus or PDA) over time the pressure in the right side of the heart can increase and lead to right-sided heart failure. The earliest sign of PDA is low blood oxygen and shortness of breath. Normally the ductus arteriosus closes shortly after birth, but preemies often fail to close the ductus. and eventually show pulmonary hypertension (high pressure on the right side of the heart) and develop right heart failure.
Long term complications:
Nearly half of survivors born at 22-25 weeks of gestation have moderate to severe disabilities, including visual or hearing loss, cerebral palsy, and learning problems. Twelve percent have cerebral palsy and fifteen percent have hearing loss. Only 20 percent of these children are completely free of disabilities.
The 2007 Institute of Medicine report Preterm Birth found that the 550,000 premature babies born each year in the U.S. run up about $26 billion in annual costs, mostly related to care in neonatal intensive care units, but the real tab may top $50 billion.
The youngest known survivor of premature birth was born in San Antonio, Texas in 2014. She was born at 21 weeks 4 days and weighed 410 grams (14.4 ounces); she was attending preschool in 2018 and had a “slight speech delay” but was “otherwise normal.” The smallest known survivor was one of twins delivered by Caesarean section at 25 weeks gestation (due to the mother’s pre-eclampsia) in 2004 and weighed 261 grams (9.2 ounces) while her twin weighed 563 grams (1 lb 3.9 oz)… both twins had to have laser eye surgery to correct visual problems but were said to be otherwise healthy… (Wikipedia)
(Any otherwise unattributed information may be found in Wikipedia; I don’t make anything up.)
john lewis as a young man
John Lewis was born in 1940 in Troy, Alabama to a family described as sharecroppers; he was the third of ten children. He recalled later that by the time he was six, he had only seen two white people. His parents tried to teach him to live with things the way they were, but after he heard Martin Luther King Jr. on the radio when he was fifteen, he couldn’t accept it. He was drawn by Reverend King’s message of Christian nonviolence in search of human rights for black people, and he spent his life fighting nonviolently for his people.
According to this web page from history.com, on December 1, 1955, Rosa Parks (a member of NAACP since 1943) had been sitting in the first row of the seats reserved for “colored” people when the bus filled up and the bus driver demanded that she give up her seat so that a white man could sit. Three other black people in the same row stood up to accommodate the bus driver’s demand to turn the row into a whites-only row, but Ms. Parks refused. She later said that her feet weren’t tired after working all day as a seamstress at a department store, but she was “tired of giving in.”
She apparently already knew that the local chapter of the NAACP had been planning a bus boycott for months with Reverend King in the lead, but had been divided on its exact implementation. The boycott was in response to the law which had recently passed by the Montgomery City Council, requiring black riders to give up their seats to whites if the whites-only section of the bus was full. She was arrested by two officers who met the stopped bus, handcuffed, and taken to jail. She was released on bail later that night and scheduled for trial on December 5.
At trial, she was fined a total of $14– $10 plus court costs. The bus boycott, which began prematurely on December 5, lasted more than a year and deprived the bus line of the 70% of its riders who were not white. According to history.com, “On November 13, 1956, the U.S. Supreme Court struck down Alabama state and Montgomery city bus segregation laws as being in violation of the equal protection clause of the 14th Amendment to the U.S. Constitution.” On December 20, Reverend King called for an end to the boycott, and the next day, black riders including Rosa Parks returned. Most of the black ridership of the bus line had been walking to work for more than a year.
John Lewis attended the American Baptist Theological Seminary and Fisk University in Nashville, Tennessee, “historically black” educational institutions which granted him a bachelor’s degree in Religion and Philosophy. While still a student, he participated in attempts to desegregate lunch counters and attended workshops in nonviolence led by local religious leaders in the basement of the Clark Memorial United Methodist Church in Nashville. He was arrested many times for his non-violent demonstrations and attempts to desegregate downtown Nashville.
Student Non-violent Coordinating Committee
Mr. Lewis attended the conference that organized the Student Nonviolent Coordinating Committee (SNCC) in 1960 and became its chairman in 1963. SNCC grew out of the sit-in movement with the encouragement of the Southern Christian Leadership Conference (SCLC) as a commitment to “participatory democracy” instead of top-down leadership. SNCC developed a new strategy of not paying bail, in part to save money, but more to signal its opposition to the corrupt legal system which allowed people to be punished before (or without) conviction for any crime.
Mr. Lewis continued as chair of SNCC until 1966, when it was taken over by Stokely Carmichael, who emphasized “black power”. Thereafter, the SNCC’s influence waned and it was infiltrated by FBI agents.
One of SNCC’s first successes was the tactic of “kneel-ins” in which they knelt outside of white-only churches. In August 1960, the United Presbyterian Church’s 172nd General Assembly wrote to SNCC: “Laws and customs requiring racial discrimination are, in our judgement, such serious violations of the law of God as to justify peaceful and orderly disobedience or disregard of these laws.” (Wikipedia)
In 1961, Mr. Lewis became one of the thirteen original “Freedom Riders” who attempted to desegregate the interstate bus lines from Washington DC to New Orleans, Louisiana. Seven white people and six black people were the tip of the spear for groups like the Congress of Racial Equality (CORE) who wanted to help enforce the 1960 Supreme Court decision that declared segregation of interstate bus routes to be unconstitutional, invalidating multiple state laws. In response, the Federal Bureau of Investigation sent agents to tag along with the Freedom Riders. They did not intervene when the Riders were beaten and arrested on multiple occasions, but they did take notes.
President Kennedy called for a “cooling-off period” after the violent incidents and CORE abandoned the project. Mr. Lewis persisted, and was imprisoned in the Mississippi State Penitentiary for forty days. He was beaten in numerous bus stations, including Montgomery, Alabama. He said, “It was very violent. I thought I was going to die. I was left lying at the Greyhound bus station in Montgomery unconscious…”
The beatings will continue until morale improves…
Federal Legislation to achieve Civil Rights and Voting Rights
The federal government passed laws reinforcing the Supreme Court decisions and helping to implement the Fourteenth Amendment to the Constitution. President Kennedy proposed a law in June 1963 that was held up by a filibuster in the Senate. After Kennedy’s assassination, Lyndon Johnson took up the cause; after a 54-day filibuster, a law was passed in June 1964. It “outlaws discrimination based on race, color, religion, sex, or national origin. It prohibits unequal application of voter registration requirements, and racial segregation in schools, employment, and public accommodations.” (Wikipedia)
The law was supplemented by further legislation that asserted Congress’ authority to regulate interstate commerce, ” its duty to guarantee all citizens equal protection of the laws under the Fourteenth Amendment, and its duty to protect voting rights under the Fifteenth Amendment.” (Wikipedia) A year before the Civil Rights Act of 1964, an act called the Equal Pay Act of 1963 was passed which prohibited pay discrimination “based on sex.” Oddly, this act was added to the Civil Rights Act for controversial reasons– and was used by the Supreme Court in 2020 to bar discrimination against LGBTQ individuals. (See Wikipedia on the controversy under “Civil Rights Act of 1964– Women’s Rights“)
In 1964, the SNCC tried to organize a parallel Democratic Party primary in Mississippi which sent a delegation to the Democratic National Convention in August to challenge the all-white Mississippi delegation. The delegation was not allowed to be seated, despite the nationally televised testimony of an SNCC member who had been a sharecropper and had been brutalized attempting to register to vote. The black delegates were offered two “at-large” seats from which they could observe the convention but not vote. They turned them down and walked out.
Selma
Organized attempts to register black people to vote were violently resisted by the white establishment. Sit-ins at lunch counters in Selma, Alabama began after the bombing of a church in Montgomery on September 15, 1963 and were met with beatings and arrests. As chairman of the SNCC, John Lewis was a prominent member of the protests, and was among more than 300 people arrested in two weeks.
The Dallas County Voting League was organized to help blacks register to vote in Selma. Only two days a month were available for the public to come in to register at the courthouse. At one event, in October 1963, more than 300 blacks waited in line all day in an attempt to register; members of SNCC who tried to bring water to those waiting were arrested.
On July 6, 1964, four days after the Civil Rights Act was signed into law, John Lewis led 50 black people to the courthouse to register on one of the two allowed days that month; they were all arrested instead. Three days later, a judge issued an injunction forbidding any group of three or more people from assembling under the leadership of any civil rights organization.
The Selma Voting Rights Campaign began on January 2, 1965 (a day when the sheriff was out of town and couldn’t enforce the injunction) with a mass meeting led by Reverend King. On January 15, Reverend King called President Johnson, who agreed to start a big push to pass a strong voting rights act; Johnson also wanted to pass additional anti-poverty legislation. The local town police chief wanted to suppress violent anti-black activities (although he was still in favor of segregation) and he arrested a man who beat Reverend King. He also arrested George Lincoln Rockwell, the head of the American Nazi Party, who had come to town voicing violent threats against Reverend King.
The sheriff, however, controlled the block around the courthouse, and he continue to beat and arrest any blacks who tried to register. On January 25, 1965, a US District Court judge ordered that at least 100 people be allowed to wait in line to register at the courthouse; the sheriff arrested everyone over that limit. The demonstrations and violent arrests continued. On February 4, President Johnson made his first public statement in support of the blacks’ attempts to register to vote in Selma.
By the end of the month of February 1965, 300 black people were registered to vote in Selma (as opposed to 9500 white people.) During a demonstration in February in the nearby town of Marion, a protestor, Jimmie Lee Jackson, was shot by a state trooper and died eight days later; the trooper claimed that he had tried to grab his gun and there were no witnesses or video to contradict him.
Reverend King and the SCLC wanted to provoke a public outcry, but John Lewis and many in the SNCC were more concerned with trying to help people register to vote. Despite his reservations, Mr. Lewis agreed to lead a march with the Reverend Hosea Williams from Selma to Montgomery on March 7, 1965.
That march led to a confrontation on the Edmund Pettus Bridge in Selma. Between 500 and 600 marchers were stopped by a wall of state troopers and volunteers, some on horseback. They were brutally beaten and tear-gassed. Seventeen were hospitalized, and Mr. Lewis received a fractured skull (one of many beatings he endured at the hands of racists, for which he never fought back.)
The whole affair was televised, and national audiences were treated to views of peaceful black protesters being beaten unconscious by white thugs in uniform. President Johnson released a statement “deploring the brutality with which a number of Negro citizens of Alabama were treated.”
In 1965, the Voting Rights Act was passed after a national outcry over the vicious beating of black marchers on the Edmund Pettus Bridge in Selma, Alabama known as “Blood Sunday.” This law stopped “literacy tests”, poll taxes, and other racist impediments to voting registration that had prevailed across the southern United States.
This Act was eviscerated by the Supreme Court in 2013 when it declared a portion of it unconstitutional, making it impossible to enforce the requirement that certain states with a history of discrimination obtain prior approval before making changes to voting laws. See Wikipedia’s “Voting Rights Act of 1965” for details.
Outrage and Aftermath of Bloody Sunday
Bloody Sunday was only the most televised and best known of many beatings that black people have endured at the hands of racist thugs in uniform (and out.) Malcolm X planned to start fighting back, but he was assassinated. Many other nonviolent demonstrators were murdered. Black people are still being murdered at the hands of police, but not as many as in the past– a small improvement, to be sure.
However, as a result of national outrage over Bloody Sunday, the Civil Rights Act of 1965 made it possible for black people to register to vote and develop some political power. In places where they are a majority of the population, black representatives are carrying their voices in Congress as well as in local offices. In places where they are still a minority (which means most places) they can at least vote and demonstrate with some degree of safety.
Mr. Lewis was first elected to Congress in 1986, representing the 5th District, (which is 58% black and 99% urban), including the northern three-quarters of Atlanta, Georgia. He served 17 terms, dying in office yesterday. He was diagnosed with stage 4 pancreatic cancer in December 2019 and died on July 17, 2020. He is best known for his civil-rights activism and his adherence to non-violence, positions he shared with Reverend King. He was probably the last of the well-known civil rights activists from the sixties, and he was known as the “Conscience of the Congress.” He will be missed.
Obtaining the right to vote and the right to integrate public facilities is only the beginning. There are many things that are still separate and unequal. We can only hope that the end of the beatings will result in better morale.
Coronavirus studies by Engin Akyurt via pixabay.com
SARS-COV-2 enters human cells by attaching to a cell surface protein called the ACE2 receptor. The ACE2 receptor is found on the cell surfaces of epithelial (surface) cells in the lung, vascular endothelium (lining), and intestinal epithelial cells. It is also on vascular smooth muscle cells and the endothelium of the urinary tract (kidneys, bladder, and tubing). There is some ACE2 in the brain, but not as much as on the surface epithelium and vascular smooth muscle.
When it was first discovered in 2000, ACE2 was found at high levels in the kidneys(on the endothelial (lining) cells), heart (now known to be in heart muscle cells as well as blood vessels within the heart), and testis. Later, somewhat lower levels were found in the lung, vascular endothelium, vascular smooth muscle, and intestinal epithelium.
ACE2 functions in blood pressure control by relaxing smooth muscle lining the blood vessels. It does this by breaking down angiotensin II, which is a vasoconstrictor. Angiotensin II also has pro-inflammatory and pro-fibrotic effects. It is hydrolyzed (one amino acid is removed from its end) to angiotensin(1-7). This has the opposite effect to angiotensin II and “mediates vasodilatation, anti‐proliferation, and apoptosis…”
Normally, the body has a finely-tuned balance between higher and lower blood pressure. The kidneys balance retention of sodium and water with and excretion of sodium and water– this regulates total body blood volume and affects blood pressure. The inflammatory system balances between attacking foreign cells and proteins and accepting domestic cells and proteins. The body’s repair systems balance between killing off severely damaged cells (apoptosis), replacing them with scars (fibrosis), versus repairing mildly damaged cells and encouraging production of new cells. One of the balance-setting hormone systems is the renin-angiotensin complex.
There is some preliminary evidence that, when the virus invades an ACE2-bearing cell, it damages the ACE2 and leads to loss of function, causing a loss of the balance between angiotensin II and angiotensin(1-7). This seems to result in acute lung injury and respiratory distress syndrome. Invasion of the circulatory system may lead to increased blood pressure and an inflammatory cascade.
The most critical tissues directly invaded by SARS-COV-2 are lung epithelial cells, vascular endothelial (lining) cells, and intestinal epithelial cells. The virus gains entry to the body through the epithelium of the nose and through the lungs, but the nose is not severely affected. Instead, virus invasion of the deep lungs results in dry cough and shortness of breath. Most of the specific symptoms of infection relate to the lungs. Even in mild or asymptomatic cases, damage can be seen on lung computerized tomography (CT) and in pulmonary function tests.
The virus is responsible for diarrhea (sometimes watery) but not consistently– many patients do not experience intestinal symptoms. However, the virus readily invades the intestinal epithelium and virus RNA is consistently isolated from the stool. We do not know whether the virus can be transmitted by the fecal-oral route– all attention has been to the airways: droplet and aerosol infection.
Most cases also present with anosmia (loss of sense of smell) and/or ageusia or dysgeusia (loss or perversion of sense of taste) but this symptom is frequently overlooked. It is unclear whether this symptom is caused by damage to surface neurons in the nose and mouth, to epithelial cells, or even to deeper nerve cells in the brain.
/Update with data from article below:
Information From “New Understanding of the Damage of SARS-COV-2 Infection Outside the Respiratory System”
SARS-COV-2 invades the central nervous system through the olfactory nerves, and might also invade through nerves from the lungs. A patient with encephalitis was found to have the virus in his cerebrospinal fluid (CSF), and the authors of that case report worried that the virus might persist in the central nervous system even after apparent recovery. The presence of virus in CSF suggests that headache might be related to central nervous system infection; additional, more serious symptoms could be expected if encephalitis becomes established.
The “New Understanding” article discusses the possibility that gastrointestinal (GI) infection by consumption of an infected animal may have been the route of transmission for the initial jump from animals to humans. In cases where the GI tract is the infection route, we would expect diarrhea and other non-respiratory symptoms to predominate.
/End update
Fever, muscle aches and fatigue are prominent nonspecific symptoms that may be caused by the release of hormones that react to all viral infections rather than to specific invasion by the virus of tissues. The virus does not appear to invade immune cells in the blood or immune tissues like lymph nodes or bone marrow.
When the virus infection spreads beyond the lung epithelium, it attacks the vascular endothelium of the blood vessels and the smooth muscles of the capillaries. Here begin the more serious consequences of infection. Once the virus has invaded the blood vessels, we see the effects of the virus throughout the body, with small blood clots everywhere, reduced kidney function, high fever, delirium, reduced cardiac function, and so on. Oddly, virus RNA is usually not isolated from the blood; it is unclear what happens to the virus once it gets into the endothelium.
In autopsies, increased numbers of megakaryocytes (the cells that are parents to platelets) were found in the lungs and heart. Small and large blood clots rich in platelets (the cells that participate in blood clotting) were found throughout the body. Blood clots were found in the venous side of the heart as well as within the heart muscle. Prominent “acute tubular necrosis” (death of the kidney’s tubules) was found in most autopsies with tiny blood clots within the kidneys.
In all autopsied lungs, there was “diffuse alveolar damage” (breakdowns in the terminal sacs where oxygen is exchanged from the air to the blood) and the lungs were filled with fluid and pus. There were also signs of growth of new lung cells that were attempting to repair the acute lung damage.
The autopsy findings show that the lungs were the first site of infection, but damage to the kidneys and heart was prominent, and blood clots formed throughout the body.
This sketch shows the multisystemic nature of COVID-19 and how it relates to the ACE2 receptor and its normal function in the body.
Robert R. Redfield photo courtesy Wikipedia
Medscape reports on July 15 (see also ABC on July 14): In an online interview with the Journal of the American Medical Association on Tuesday, July 14, Robert R. Redfield, Centers for Disease Control (CDC) director, stated that the situation in the US (a currently out of control pandemic of COVID-19) could be brought under control within 4-8 weeks if “everyone wore a mask.” He also said, “I am glad to see the president and vice president wear a mask. Clearly, in their situation they could easily justify they don’t need to … but we need for them to set the example…”
That’s good, but consider the source. Dr. Redfield is another administration figure who got his post by being 1) highly religious; 2) a well-known figure among conservative activists. He has little experience running agencies and is over his head as director of CDC (although he apparently really wanted the job.) He is careful to avoid saying anything that might be seen as critical of his boss. He won’t be the source of scandal, but he won’t be a leader, either.
This article on CNN from June 4 (see this also for an even more jaundiced view) tells a lot more about who Dr. Redfield is and where his loyalties lie. He was described by former colleagues as a “bad leader” who put politics before science. He was also described as a loyalist to authority, making him perfect for this administration– which values loyalty above all else. Most important, he is close to conservative evangelists who think AIDS is a judgement from God.
Never mind that he worked on AIDS research for many years, first in the Army (he retired as a full colonel in 1996) and then in the private sector as a co-founder and former co-director of the Institute for Human Virology at the University of Maryland School of Medicine (which he started in 1996 with Robert Gallo, who is the current director.) Robert Gallo is famous (and notorious) in AIDS circles as the co-discoverer of HIV in 1984 (he admitted in 1991 that he had been sent a sample of HIV by the lab that first described it in 1983– and Gallo was left out of the Nobel Prize awarded in 2008 for the discovery of HIV.)
While he worked as a researcher on AIDS 1) Dr. Redfield promoted abstinence as a preventive measure for AIDS; 2) he derogated the importance of wearing a condom and “safe sex.” He clearly did this because of his religious views, in which abstinence holds a high place.
In 1992, Dr. Redfield deceptively edited early data about a vaccine for AIDS (based on the HIV gp160 protein) to make it look like it might be effective. This resulted in years of wasted studies trying to show this vaccine to be effective. It was not. That deception in the early stages of evaluation for the vaccine led to an Army investigation for Dr. Redfield. The investigation was dropped, but not before it left a bad taste in the mouths of many other AIDS researchers.
No other vaccine has emerged for AIDS, in part because the resources wasted on study of his vaccine left people thinking no vaccine could work. Drugs have come out that are highly effective for “pre-exposure prophylaxis.” The profits to be had from drugs to prevent AIDS far outstrip any potential profit from a vaccine.
A decision was made somewhere in the administration to bypass the CDC in reporting hospital data and to send the data directly and in secret to Health and Human Services “HealthProtect” where it can be manipulated before being selectively released to the public. This decision has only magnified the confusion around the data. Dr. Redfield was unable to prevent this knee-capping of the CDC and he said nothing about it in his interview yesterday– but today he says he supports it.
He did claim yesterday that the recent surge in virus infections down south was due to people from the Northeast vacationing down south over Memorial Day. This is to counter the widespread accusation that premature re-opening of southern states led to the increase in new cases– something his boss doesn’t want to hear.
No matter. We sincerely hope that he will lose his job in January. Otherwise, we will be in for more kakistocracy than this nation can handle.
