Coronavirus studies by Engin Akyurt via pixabay.com
A Journal of the American Medical Association (JAMA) Network article published June 19 indicates that use of common antihypertensive medications ACEI/ARB does not affect outcomes related to COVID-19. The retrospective cohort study using data from Danish national administrative registries covering February 22 to May 4 and looking at 4480 patients found 895 who used these drugs to control high blood pressure. The study concluded:
Conclusions and Relevance Prior use of ACEI/ARBs was not significantly associated with COVID-19 diagnosis among patients with hypertension or with mortality or severe disease among patients diagnosed as having COVID-19. These findings do not support discontinuation of ACEI/ARB medications that are clinically indicated in the context of the COVID-19 pandemic.
This study is reassuring because there had been concerns related to the mechanism of infection, namely that the virus SARS-COV-2 uses cell surface ACE-2 receptors to gain access and infect epithelial cells in the respiratory tract. Apparently, taking drugs that inhibit ACE or block the angiotensin receptor do not enhance the virus’ ability to infect or kill cells. Therefore, it is not necessary for patients taking these drugs to control their blood pressure to discontinue them for fear of enhanced infection. This is good because high blood pressure in general as well as advanced age (and higher rates of hypertension) has been found to be associated with higher mortality rates from COVID-19.
The findings from this study confirm prior research that found no association of taking the drugs with increased mortality or infection rates.
EM of sars-cov-2 budding from apoptotic (dying) cells–NIAID
This article comes from Science Direct — Comprehensive Psychiatry for July 2020. It is titled “How to manage obsessive-compulsive disorder (OCD) under COVID-19: A clinician’s guide from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive and Related Disorders Research Network (OCRN) of the European College of Neuropsychopharmacology” and the article is almost as long as the title. It is available without a paywall under a Creative Commons license.
Here is the first paragraph:
The rapid advance of the coronavirus COVID-19 pandemic has significantly increased mortality but also has demonstrated considerable potential to negatively impact mental health, including in the young. From a public mental health perspective, guidelines for responding to mass trauma and disaster emphasize the importance of focusing on resilience. In the immediate and ongoing response, consensus guidelines emphasize the importance of interventions that maintain calm, build community, and sustain hope.
The article is a consensus statement from the ICOCS and OCRN on how to manage patients with obsessive-compulsive disorder (OCD) during the pandemic. It recommends temporizing measures to control symptoms rather than any attempt to perform insight-oriented psychiatry (what we normally associate with psychiatric treatment– breaking down barriers and rebuilding a healthier psyche.) The rationale is that any attempt at insight will only make symptoms worse– albeit temporarily– and what is needed now is to keep patients calm while we await “rescue” in the form of a vaccine, or at least abatement of the current emergency situation.
The article recommends, first, to take a calming, compassionate approach to the patient to reduce symptoms. Use telemedicine, that is , phone calls and video calls, to reach out to patients who are isolated by the quarantine. Take a careful history to confirm the diagnosis of obsessive-compulsive disorder and any associated conditions, particularly hypochondriasis. Clarify whether the symptoms represent a rational response to current events or a worsening of previous OCD symptoms.
Establish the patient’s level of insight into her condition– does she feel that her symptoms are irrational or excessive? Are there tics? Are contamination fears being exacerbated by directions to wash hands and avoid fomites? Are there idiosyncratic fears, such as fear of sexually transmitted disease or of antibiotic-resistant bacteria? Comorbid conditions may be exacerbated by the stress, such as anxiety, depression, bipolar disorder, or post-traumatic stress disorder. If other conditions are the primary presenting problem, see also general recommendations here. (These are general psychosocial recommendations for everyone, suffering from mental disorders or not, in dealing with the pandemic.)
Assess suicidal risk. OCD doesn’t usually present a high risk for suicide, but comorbid conditions do, particularly bipolar disorder, substance abuse disorder, and even latent schizophrenia. People with a recent increased severity of OCD, people who are experiencing the illness of close relatives or associates, and people who are feeling extreme stress from isolation in quarantine are at increased risk for suicidal ideation. Use a rating scale and specific questions to assess risk; here is one scale you can use, the Columbia Suicide Severity Rating Scale. Here is a gateway to using the scale in multiple settings: the Lighthouse Project.
Provide balanced information about what to do to keep from catching the virus and what is known about it currently. It is important to have the patient recognize that the situation may persist for a long time, and they need to manage their stress levels over a long period. Tell them to set up a routine that they can continue indefinitely that will help to keep a manageable stress level.
Find out how much TV and internet they are consuming. Ask them to limit themselves to a reasonable amount of this– say, half an hour in the morning and a half hour in the evening. Recommend health education websites, like CDC, (hand sanitizer) WHO, and Johns Hopkins. Or this hand-washing video.
If OCD symptoms are the main problem, assess the effectiveness of medication treatment or start medications. The first choice is a selective serotonin reuptake inhibitor (SSRI)– there are several drugs available and if one doesn’t work, another should be tried. As a third choice, clomipramine is effective but it may require evaluation for safety with an electrocardiogram (ECG). Start the SSRI at a low dose and gradually increase it to reduce side effects. If the SSRI is really not working, an antipsychotic drug like olanzapine, aripiprazole, or quetiapine might be added in severe cases, especially if the patient has a tic.
The patient should be evaluated for adherence to treatment. It is very important to be sure that she is taking the medication regularly as it takes time to work. Using a pill organizer box with slots for each day is helpful to keep the patient on track. If she is not sleeping well, this needs to be treated too; make sure she is going to bed at the same time, avoiding night-time disturbances, not watching TV late at night, and not eating or exercising right before bedtime.
Enlist help from anyone staying with the patient to keep her taking medicine and not watching too much TV. Support from a significant other is necessary, especially for patients who are confused or agitated.
Ordinarily, cognitive behavioral therapy is used for OCD, but during the pandemic this may not be possible and exposure could be dangerous. If symptoms are distressing to the patient during this time, medication is preferable to exposure-based or cognitive behavioral treatment.
A new form of treatment, deep brain stimulation, is available for patients with severe symptoms. If the patient has deep brain electrodes implanted and battery-powered, they should be checked for battery failure if symptoms return. Unfortunately, new patients can’t have electrodes put in when elective surgery has been put on hold due to isolation.
Finally, maintenance of routines, with regular morning arising and evening bedtimes, and social interaction with frequent contact by phone or video, are very important to keep the patient from feeling too isolated. The article recommends morning physical activity under bright lights to help keep up the circadian rhythm. It also advises against late night meals just before bedtime.
Here is a particularly useful quote:
Offer guidance regarding a rational amount of time spent listening to news as a distraction to occupational or preferred activities, provide acknowledgement of fear but also a balanced perspective on risk, address grief and loss of control and recommend hedonic activities especially those that involve children, such as baking, cooking, gardening, inventing a new game or watching a movie.
Help the isolated patient to overcome loneliness and build stability by increasing communication with friends, family members and loved ones, even if at a distance via the multiple online platforms including Facetime; Skype and Zoom. Learning to use these can be a helpful experience in terms of the acquisition and mastery of new skills as well as the pleasure of social contact. In the case of those with a poor social network, telephone helplines such as those run by OCD charities are particularly useful, especially if managed by qualified trained professionals.
There is much more in this long article, but the most important guidance is that patients who are undergoing or considering cognitive behavioral therapy and exposure response prevention (graded exposure to stimuli that induce anxiety) should have their treatment re-evaluated and/or paused during the pandemic because of potential risks. The consensus of these experts is that patients with OCD will need to be more or less cocooned during the pandemic.
Early Buddhism versus the concept of the unchanging self in Hinduism– a highly condensed summary
Gandhara Buddha circa 1900 years ago, courtesy of wikimedia commons
Hinduism and Buddhism derive from the same roots in prehistoric northern India, in the culture of the Ganges River before 500 BC. They share parallel beliefs and have existed side by side. One of the primary differences between the two is that, in Hindu thought, there is a constant and unchanging “Atman” or permanent self, whereas in Buddhist thought, the self is not permanent or even non-existent.
Despite their differences, the two religions are intermingled in important ways; there are even temples devoted to both. Angkor Wat is said to be a combination of the two, originally dedicated to the god VIshnu but changed to a Buddhist temple in the twelfth century. To Hindus, Buddha is an avatar of Vishnu.
The two schools of thought share many concepts. First, there is the eternal cycle (sansara) of birth, death, and rebirth. Second, there is the concept of karma or “the fruits of action”– that is, actions have consequences although the effects may be remote or even occur after one has undergone death and rebirth. Third, there is the concept of dharma, which is natural law, religious duty, right conduct, or simply virtue.
They also share a number of terms that have different meanings in each school. To Hindus, yoga is thought of as a practice of assuming postures that induce union of Atman (the individual self) with Brahman (the universal soul). To Buddhists, however, it has different meanings. In Tibetan Vajrayana Buddhism, “yoga” refers to any of a number of spiritual practices involving tantras (esoteric systems.) This is too complex to even begin to describe here (this includes Vajrayana Buddhism in general.)
Meditation is also shared by both schools of thought. In Hindu meditation, it is a means to attain self-realization. Buddhist meditation, however, is a means to self-effacement. There are several levels of enlightenment attained in meditation, but, to Buddhists, the best is the sudden insight that can even be achieved by a child under certain conditions.
There are major differences between the two schools of thought. First, the Buddha rejected the existence of a Creator God (Brahman) and the idea of an eternal Self (Atman), which are central to Hindu thought. Perhaps “rejection” is too strong a word, however, for Buddhists simply ignore the Brahman and Atman as unnecessary to the liberation from suffering obtained by meditation, right view, and right conduct. The Buddha felt that the devas (the Hindu gods) were still trapped in the same cycle of birth and rebirth as ordinary humans– so they weren’t worthy of special veneration.
The Nobel Eightfold Path does not require that one unify with the Godhead (Brahman) but merely follow right intentions and conduct oneself arightly. One is to attain liberation from suffering by extinction of self-will, selfish desire, and passions, not by yearning for union with Brahman.
To Hindus, the thought of withdrawal from everyday life and existence as a mendicant was escapism. They felt that one must perform the dharmas, or duties of day to day life, study scriptures, support family, and take care of one’s children and parents, before retiring to the forest to meditate in one’s later years. Union with Brahman really only occurred at death– not during daily meditation.
To Buddhists, attachment is the source of sorrow, and to be liberated, one must detach and become “non-involved.” To Hindus, sorrow and happiness is the result of karma (good and bad), and bad karma can be overcome and good karma can be obtained by following dharma or righteous duty.
An example of the difference between Buddhist and Hindu concepts is the Agganna Sutta, a discourse by the Buddha in response to questions from two aspiring monks who are from the Brahmin caste. Brahmins are a high caste and hold a predominant position in society. To the Buddha, the two aspirants describe their origins and say that when they decided to become monks, they were ridiculed by their peers. They were told that it would be foolish for someone of high caste to abandon his position and mix with those of lower caste in the Sangha (religious community) of the Buddha.
The Buddha responds by explaining that everyone, regardless of caste, is allowed to become a member of the religious community, because what matters is not one’s birth but what one does in life. He explains that anyone who does wrong will get into trouble for it, regardless of their caste, while anyone who conducts themself rightly, no matter what their origins, will be rewarded. The Buddha goes on to describe a sort of cosmology, in great detail, reciting the origin of the world and the development of the castes. The reason behind this cosmology is that he is explicitly rejecting the brahmanical doctrine of caste which separates people on the basis of their birth rather than their behavior.
One commentator even describes this cosmology as a satire of the “Brahminical claims regarding the divine nature of the caste system, showing that it is nothing but a human male convention.” (Wikipedia) The sutra is explained as a satire of the Rig Veda “Hymn of the Cosmic Man.” This is not a well-accepted explanation; others describe the verses as a fore-runner of currently accepted scientific cosmology. The real point of the verses is that one’s position at birth does not preordain one’s position throughout life; it is more important to adhere to the truth and do right.
Buddhists appear to reject the Hindu teachings that there is a fixed, permanent self, but they do not seem to have been rejected by Hindus. Rather, the Hindu position looks like one of tolerance to all religions. Hindus do not appear to have been proselytizers, while the Buddhist religion has spread throughout Asia by proselytism. Originally, Hindus were defined by ethnicity rather than by doctrine, although that view is obsolete and has been rejected by India’s Supreme Court.
Buddhists touted their faith without regard to the ethnicity of their subjects, and Buddhism was taught to every ethnic group in Asia (although it seemed to mostly die out in India as it spread elsewhere.) Typically, rulers acquired Buddhism from monks who taught their faith to the court; the countries involved then became officially Buddhist while their subjects were still unconverted.
This quote from Wikipedia summarizes the core difference between the two schools of thought:
Upanishadic [Hindu] soteriology is focused on the static Self, while the Buddha’s is focused on dynamic agency. In the former paradigm, change and movement are an illusion; to realize the Self as the only reality is to realize something that has always been the case. In the Buddha’s system by contrast, one has to make things happen.
Thus, the Hindu worldview is static and the Buddhist is dynamic. To a Buddhist, the universe is characterized by constantly changing phenomena; nothing remains the same and there is no constant upon which one can rely. To the Hindu, there is a universal axis which is stationary and around which the universe revolves; there is a Brahman (Godhead) which is reliable and to which the self (Atman) can be connected.
To both forms of thought, the empirical Truth is the most important thing. Both believe in the primacy of one’s experience and the promulgation of Truth. A person should always see the truth and tell the truth. There is no space for lies and deception. There are no secrets (until you get to esoteric Vajrayana Buddhism.)
[This post is a radically condensed summary of the relevant Wikipedia pages on Buddhism, Hinduism, the Agganna Sutta, soteriology, and so on. The reader is warned that important details have been omitted. Additional posts on these subjects are forthcoming.]
John Bolton, from CNN
John Bolton is a notorious conservative war hawk who was given an interim appointment as ambassador to the UN by George W Bush. He resigned at the end of the interim period when it became clear that the Senate would not confirm him to the position. He was poorly suited to the post, having famously claimed that the UN would function just as well with ten floors chopped off. He was too much of a hawk even for He-who-must-not-be-named, who didn’t want to actually get involved with a war overseas– merely to end all alliances and “foreign entanglements.”
Now, after 17 months as national security adviser, Bolton has become the bete noir of the administration by publishing a book confirming hidden details of the president’s unfitness and ignorance.
While we appreciate the “friendly fire” from Bolton, we need to remember that the only reason conservatives don’t like the president is that he is unable to deliver on their most cherished dreams because of his incompetence. “Never [redacted]” are still unacceptable as leaders for this country because they still push the priorities of the Republican Party: more power for those who already have too much power, and no help for the downtrodden masses.
Remember: those who voted for this president in the first place still want things that are unacceptable to the majority of the country. Just because they have turned on him doesn’t magically make them good people.
photo by belajati raihan fahrizi courtesy of pixabay.com
Before the pandemic, nursing homes would discharge patients without their consent on a regular basis. Since the pandemic began, the involuntary discharge problem has become a crisis. Nursing homes can take patients who have been discharged from the hospital after a severe bout of COVID-19 and promise to rehabilitate them, getting paid extra Medicare dollars for their care. Usually Medicaid pays for long term patients, but Medicare pays much more for short term nursing home stays.
From a New York Times article of June 21, 2020:
They [nursing homes] are kicking out old and disabled residents — among the people most susceptible to the coronavirus — and shunting them into homeless shelters, rundown motels and other unsafe facilities, according to 22 watchdogs in 16 states, as well as dozens of elder-care lawyers, social workers and former nursing home executives.
Many of the evictions, known as involuntary discharges, appear to violate federal rules that require nursing homes to place residents in safe locations and to provide them with at least 30 days’ notice before forcing them to leave.
While the popular conception of nursing homes is of places where elderly people live, much of their business is caring for patients of all ages and income levels who are recovering from surgery or acute illnesses like strokes. Medicare often pays for short-term rehabilitation stints; Medicaid covers longer-term stays for poor people.
Nursing homes have long had a financial incentive to evict Medicaid patients in favor of those who pay through private insurance or Medicare, which reimburses nursing homes at a much higher rate than Medicaid. More than 10,000 residents and their families complained to watchdogs about being discharged in 2018, the most recent year for which data are available.
The pandemic has intensified the situation.
…
Last fall, the Centers for Medicare and Medicaid changed the formula for reimbursing nursing homes, making it more profitable to take in sicker patients for a short period of time. Covid-19 patients can bring in at least $600 more a day in Medicare dollars than people with relatively mild health issues, according to nursing home executives and state officials.
From a website by people’s law, frequently asked questions regarding “involuntary discharges”
Can a nursing home transfer or discharge me?
Nursing homes can only discharge or transfer residents for very limited reasons. If you do not agree to leave, it is called an involuntary transfer or discharge. Federal and state laws have strict rules about involuntary transfers and discharges. In most cases, there are only five reasons a nursing home can involuntarily transfer or discharge you:
- A transfer or discharge is necessary for your welfare and your needs cannot be met by the nursing home. Your doctor must write in your medical chart why the discharge or transfer is necessary.
- The transfer or discharge is appropriate because your health has improved sufficiently so that you no longer need the services provided by the facility. Your doctor must write in your medical chart why the discharge or transfer is appropriate.
- You are endangering the health or safety of an individual in the nursing home. A doctor must write in your medical chart why the discharge or transfer is necessary.
- You have failed to pay or have others pay the nursing home for your stay. The facility must have given you reasonable and appropriate notice of the amount you owe.
- The facility has stopped operating or, if you are a Medicare or Medicaid recipient, the facility has been decertified or withdrawn from the program.
Do I receive advance notice of a discharge or transfer?
The nursing home must give you a written notice at least 30 days before the proposed transfer or discharge date. A continuing care retirement community must provide 60 days notice. The notice must also be sent to the local Long Term Care Ombudsman, the Department of Health, and any of your relatives who have acted as your representative.
…
Hospital “Dumping”
One tactic that facilities use to achieve an involuntary discharge in a roundabout way is “dumping.” This occurs when a nursing home transfers a patient to a hospital and then refuses to readmit them. In some states, there is a policy in place that requires a facility to hold the resident’s bed for a certain number of days while they are hospitalized. Medicaid will pay for all or part of this bed-hold period, depending on the state, but if a resident is paying privately, they may be responsible for these fees. Regardless of the strategy used to discharge a resident, the facility must still provide a comprehensive care plan for the patient and ensure that they have a safe place to go.
From an NBC news article posted November 19, 2019:
Nationally, long-term care ombudsmen, who advocate for elderly and disabled residents of nursing homes and assisted living facilities, received 10,610 complaints about discharges and transfers in 2017, up from 9,192 in 2015. The ombudsmen, whose work is federally mandated and state-funded, receive more complaints about discharges and transfers than any other grievance.
…
Advocates, experts and the federal government say that nursing homes tend to evict low-income, longer-term residents who receive Medicaid, to make room for shorter-term rehabilitation patients who are covered by Medicare. Medicare reimburses nursing homes at a higher rate than Medicaid, so it’s more lucrative for facilities to house Medicare patients who stay for short stints before recovering and moving elsewhere.
My conclusions: The result of the pandemic has been this: weak, debilitated patients who have barely survived a run-in with COVID-19 are a lucrative business for nursing homes. They respond by kicking out vulnerable long-term elderly or disabled patients to make room for better paying post-COVID recovery patients. The vulnerable patients are easy prey for the virus. The end result is that nearly half of the deaths due to COVID-19 have occurred in nursing homes and another large percentage are elderly, vulnerable people who are not yet in homes– if they survive, they will be sent there to be rehabilitated.
picture courtesy of pixabay.com
Reference this opinion piece by Simon Hattenstone in the Guardian on June 21.
The one thing I hate the most, especially from politicians, is lies. Simon Hattenstone gives a list of Boris Johnson’s most famous lies during his long career and uses the terms “pseudologia fantastica” and “mythomania” to describe his obsession. Compared with [redacted], Boris is something of an amateur. [redacted] lies almost every time he opens his mouth. He even induces people to lie for him: witness Attorney General William Barr.
Friday night, late, Barr announced that Southern District of New York (SDNY) Attorney General Berman had “stepped down” when it wasn’t so, according to Berman. In fact, Barr had held a discussion with Berman in which he offered him another position in the Administration. According to Berman, he had declined the offer and the discussion ended without a conclusion. Barr seems to have jumped the gun and issued a press release saying Berman had resigned. On Saturday, Berman finally agreed to resign after he was told Berman’s deputy Audrey Strauss would take his place instead of an outsider, New Jersey Attorney General Craig Carpenito– the person Barr had wanted to replace Berman.
It seems that, in having [redacted] fire Berman instead of his voluntarily resigning, the post automatically devolved on Strauss instead of Barr being able to hand-pick his successor. This is a defeat for Barr and [redacted]– it appears that it was intended that Carpenito would torpedo the investigations Berman is directing against [redacted] and his cronies.
There are several consequential investigations going on at the SDNY, including one that names [redacted] as “Individual 1” in an inquiry into an illegal “campaign contribution” that actually went to pay off one of [redacted]’s mistresses for her silence during the 2016 presidential campaign. This inquiry includes a subpoena for the president’s financial records from Deutsche Bank which is presently in front of the Supreme Court. We should hear a decision from the high court this summer as to whether that subpoena can go forward.
In fighting the subpoena, the Justice Department absurdly claimed that SDNY could not even investigate a sitting president, much less indict him for criminality. This is not exactly a lie, but it certainly stretches credulity to claim that the law or the Constitution prevents a state attorney general from investigating criminal conduct committed by the president of the United States. Whatever happened to “equality before the law” and “no-one is above the law”? Defending a liar generally requires the defender to add to the lies.
See also this opinion piece by Jennifer Rubin in the Washington Post on June 20: “A Friday night massacre that backfired.”
Gandhara Buddha circa 1900 years ago, courtesy of wikimedia commons
The dates of Siddhartha Gautama Buddha’s life were thought to be c. 563 BCE to 483 BCE (Before the Common Era, or Before Christ), but more recently, a later date has been estimated. Dates of 480 to 400 BCE have been given based on archaeological evidence, but these are certainly not universally accepted. A shrine described in 2013 in a National Geographic article was dated to around 550 BCE at Lumbini, Nepal at the traditional site of the Buddha’s birth. The original shrine consisted of a wooden structure found beneath the modern brick buildings. Nepalese authorities even dated the Buddha’s birth to 623 BCE.
The shrine may have been related to pre-Buddhist worship, however. Traditions of tree worship go back to perhaps 1000 BCE, when the site may have been first cultivated. The Buddha’s mother was said to have grasped a tree at the moment of his birth, providing continuity with previous tree veneration. The Buddha was born into the Shakya tribe, which was “non-Vedic” or “non-Aryan” (not part of the tradition that includes a large body of religious texts including the Rig Veda– origins of Hinduism.) The Shakyas included among their traditions the idea of tree-worship.
There are two important schools of thought that were prevalent at the time of the Buddha: that represented by the Vedic scriptures or Brahmanism and that of the “sramanas”, or those who toiled in the quest for enlightenment. Two sramanas are identified as teachers of the Buddha: Udraka Rāmaputra (“son of Rama”) and Ārāḍa Kālāpa — both names are given in the Sanskrit version here. The first teacher, Arada Kalapa, taught “dhyana”, which is, according to Wikipedia, meant to “withdraw the mind from the automatic responses to sense-impressions, and leading to a ‘state of perfect equanimity and awareness'” or also to attain “‘concentration,’ a state of one-pointed absorption in which there is a diminished awareness of the surroundings.”
The second teacher, Udraka Ramaputra, taught another form of meditation that is known as the “immaterial attainments” or “formless realm.” There is no adequate information in Wikipedia as to these teachings. It does state that the Buddha was recognized by Udraka Ramaputra as having “already attained” the “sphere of neither perception nor non-perception” so it is unclear to me what he taught the Buddha. From Buddhanet.net: “He found that Uddaka could not teach him how to stop suffering, old age and death either, and he had never heard of anyone who could solve these problems.”
A fuller biography of “Shakyamuni Buddha” (“sage of the Shakyas”) is available here. An excerpt describing the ascetic practices and the Buddha’s study under the two teachers is here. The excerpt tells how the Buddha starved himself nearly to death and was revived after he was given a bowl of rice cooked in milk. The five ascetics who accompanied him were apparently turned off by his revival and the fact that he had given up the practice of asceticism.
It is at this point that the Buddha realized, apparently, that he could not learn the secret of life (or how to stop suffering) through ascetic practices and turned to the “middle way.” He is said to have sat meditating until he remembered an experience that he had as a child– a spontaneous enlightenment. He decided then that meditation or “dhyana” was the path to enlightenment.
I am struck by the legendary nature of all the stories about the life of Buddha. There are similar legends surrounding the life of Moses and Jesus. It is difficult to separate the legendary from the real, and I profess considerable skepticism about the details of all the life stories. The existence of actual people behind these legends is probable but not always certain.
Buddhism draws on pre-Buddhist thought in several respects. The idea of karma, that is, that actions have remote consequences, was already established. The theme of rebirth, or being born again, repeatedly, into another body, was also well understood. Jainism, which apparently predates Buddhism, taught that we are trapped in a cycle of rebirth and that we should try to get out of it through practicing non-harm and achieving enlightenment through meditation and self-denial. Asceticism was a practice of the Jains.
Buddhism rejects total asceticism and emphasizes ethical behavior, the practice of loving-kindness or compassion, and treating all living beings as well as humans. There are no gods central to Buddhism, although there are many peripheral god-like beings.
Buddhism rejects many Brahmanical doctrines, first, the idea that the Vedas were divinely inspired texts. The Buddha also criticised ritual bathing, animal sacrifice, and the secret mantras (which is ironic given the later development of Vajrayana– see below.) He held that all his teachings had to be presented openly to everyone. He also rejected divination, fortune-telling, astrology, and the idea that people were born to be superior or inferior (the caste system as it is now known.) The Buddha held that a person is superior only to the extent that he or she behaves in an appropriate fashion.
There are now several varieties of Buddhism, which developed in the centuries after the Buddha’s death. Theravada Buddhism is the oldest and most conservative form. Mahayana or “Great Vehicle” Buddhism is a later form and one of the two main forms now recognized. In Mahayana Buddhism, it is said that “enlightenment can be attained in a single lifetime” even by a layperson.
Vajrayana Buddhism is a variant which is currently practiced by a small number of adherents, particularly in Tibet; it is also called esoteric Buddhism. “Vajra” is a mythical weapon that is used as a ritual object. It involves esoteric transmission– that is, directly from teacher to student in a secret ritual.
Tantric rites are included, which are secret rituals associated with taboos. The Vajrayana Buddhist uses mantras (sacred utterances or words), chants, symbolic gestures or poses, mandalas (geometric figures used to concentrate the mind), and visualizations. This form of Buddhism is highly complex and full of symbolism understood only by the adept.
The variants of Buddhism after Theravada are “Great Vehicle”, “Lesser Vehicle”, and “Diamond (or Thunderbolt) Vehicle”– Mahayana, Hinayana, and Vajrayana respectively.
Electron micrograph of SARS-COV-2 virions in vitro
A graph of the daily new case counts for the US versus counts for Europe (Washington Post June 19, free) shows a peak in early to mid-April, with Europe about a week before the US. Since then, the new case counts have rapidly dropped in Europe, from 30,000 a day to about 4,000 a day. In the US, new cases dropped somewhat, from a peak of near 30,000 to roughly 20,000 a day. New cases have been increasing during the last two weeks. The lowest seven-day average was around June 11, but new cases have been on the rise since. Yesterday, June 19, there were 31,630 new cases reported– the first time over 30,000 since May 1, when 33,263 were recorded.
Whatever the reason, cases in Europe have dropped dramatically since the peak in early April. Cases in the US dropped somewhat, but have remained high. As the Northeast (especially New York) saw relief from their peaks, other regions have seen increases. Some areas, particularly Florida, California, Arizona, and the Southeast, have seen dramatic increases. The Washington Post has an article devoted to graphics (free) of tests, cases, and deaths broken down by state.
Why are cases increasing in the US? It is not due to an increase in testing– daily tests for the US have remained about 500,000 for several weeks. Experts say the lack of precautions is a primary driver. People are not wearing masks and not distancing themselves from one another. They are mingling in sites like bars without masks. Places like Oklahoma have seen more than double the average in cases over the last two weeks, with record highs in the last few days.
There is great danger that the outbreaks in these areas will become out of control. In California, masks were made mandatory a few days ago. Other states, especially those with Republican governors, have not responded well. There has been a lot of political talk. Even the president claims that some people are wearing masks as a sign that “they don’t like me.”
Contact tracing has fallen far behind the number of new cases. Not enough contact tracers have been hired. Cooperation with tracers has been poor. This article in the Washington Post from June 20 (free) discusses the varied state efforts to hire contact tracers– without sufficient money to pay them. Only New York State has been up to speed.
This lack of precautions and failure of contact tracing will lead to uncontrolled outbreaks of COVID-19 in rural areas and red states. The failure of control will manifest more fully this fall. A second wave will start before the first wave has subsided. We are looking at a serious problem this fall and winter.
picture by Open Clip Art Vectors courtesy of pixabay.com
A report in WIRED on June 18 revealed that there was a low incidence of positive COVID-19 tests in people who were voluntarily tested after the protests in Minneapolis. After May 25, there were large-scale protests against police brutality due to the killing of George Floyd. The first night of protests, there was arson, vandalism, and looting, especially in the area around the site of Floyd’s death. After that, there were peaceful all-day marches and demonstrations all over the city. Responding to the protests, free testing sites were set up and over ten thousand people had COVID-19 tests. From the WIRED article:
Of the 3,200 people tested so far at the four popup sites across the metro, 1.8 percent have tested positive for Covid-19, says Ehresmann. HealthPartners, one of the largest health care providers in Minnesota, also reported to the state that it had tested about 8,500 people who indicated that attendance at a mass gathering was the reason they wanted a test. Among them, 0.99 percent tested positive.
These positive rates are low and reflective of a background level of infections rather than transmission during the protests. This low rate may be due to the fact that most of the protests took place during the day and all were outdoors. Most of the protestors wore masks. These findings alleviate the concerns expressed by a number of experts that the protests might be a cause of increased infections. While it is too soon to be certain, Minnesota has not shown an increase in new cases as a result of the protests.
The article goes on to report a low incidence of positive tests in Seattle and Boston. In addition, total rates of new cases in the state of Minnesota have been going down in the last two weeks. The article mentions the protective effects of mask-wearing and the politicization of same. Finally, it discusses the potential effects of the rally in Tulsa– if masks are insufficiently protective in an indoor setting, then the rally could cause an increase in new cases.
The effect of the protests on new cases was also mentioned in an article in Medpage Today for June 18.
picture by mohamed hassan courtesy of pixabay.com
This from an article summary in JAMA Network on June 18:
This survey study of 204 patients with coronavirus disease 2019 found that taste reduction was present in 55.4% of patients, whereas smell reduction was present in 41.7% of patients. Severe nasal obstruction was uncommon at the onset of the disease (7.8%).
The subjects were Italian patients with COVID-19 diagnosed from March 5 to March 23 and who were contacted by telephone afterwards. They had an early onset of loss of smell and taste (taste is mostly dependent on sense of smell, but is more noticeable), usually before they were diagnosed with the disease and before symptoms of fever, cough, and shortness of breath occurred. They also had a low incidence of nasal obstruction, which obviously would impair sense of smell. The significance of this finding is that the virus appears to invade the nose and specifically nasal nerves early in the course of disease. This symptom should be looked at early when asking whether a patient has COVID-19.
It has become more apparent that, in severe cases, the virus will also invade the brain and cause encephalitis– which may be overlooked in cases where the patient is so ill that they are placed on a ventilator. The neurological symptoms may be masked by drugs used to sedate the patient in order to facilitate ventilation. The symptoms that at-home patients relate– night-time hallucinations and nightmares– may also be related to neurological involvement.
Conrad Theodore Seitz 