Covid Risk Calculator

microCOVID Project has put up a risk calculator that you can use to determine your risk of contracting Covid-19 for various activities, depending on your location and your own tolerance for risk. Give it a go.

You can choose your country if you live outside the US.

Controls on ‘gain of function’ experiments with supercharged pathogens have been weakened despite concerns about lab leaks

It seems that people are failing to measure risks. David Willman and Madison Muller report in the Washington Post:

Adecade ago, scientists funded by the National Institutes of Health used ferrets to engineer a highly lethal flu virus. The purpose of the research — known as “gain of function” — was to better understand how viruses evolve and to help devise medicines to combat the potential disease threats.

It also came with a risk: A laboratory mishap could unleash a devastating pandemic.

The research, conducted in the Netherlands and at the University of Wisconsin, sparked an international controversy and led to new safeguards for such experiments. But over the past four years, NIH leaders and other U.S. officials have weakened key aspects of those controls, a Washington Post examination found.

The high-risk research has reemerged as a focal point because of speculation that such experiments in Wuhan, China, may have accidentally triggered the coronavirus pandemic. While Chinese virologists deny that their work is to blame, accidents have occurred on rare occasions in labs elsewhere in the world, leading to inadvertent releases of pathogens.

“The risks are absolutely real. They’re not intellectual constructs or hypotheticals,” said David A. Relman, a Stanford University physician and microbiologist who has advised NIH and other federal agencies on biosecurity. Eventually, he said, “something that you make or information that you release will result in an accident of some kind.”

Speculation about the work in Wuhan has focused new attention on gain-of-function research. This report details the U.S. support for such experiments and the secrecy undergirding them. It does not illuminate whether the coronavirus pandemic resulted from gain-of-function research.

In the United States, NIH Director Francis S. Collins and Anthony S. Fauci, director of the agency’s National Institute of Allergy and Infectious Diseases, have led the federal funding and oversight of gain-of-function research.

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The term refers to techniques used to enhance aspects of a pathogen. This is usually done via a combination of gene editing and serial passage of the pathogen between animal hosts.

Experiments that increase the transmissibility or virulence of certain strains of flu and coronaviruses create high risk. If such a pathogen infected a scientist or otherwise escaped, a pandemic could result.

These techniques have a wide variety of uses, including tweaking mouse genes to limit fat deposits and creating mutations in pathogens to estimate future threats.

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Eight years ago, Collins and Fauci helped put in place high-level reviews and other safeguards in response to concerns raised by Relman and aides to President Barack Obama, who were alarmed by what they saw as insufficient scrutiny of the research with ferrets. The NIH leaders and the Department of Health and Human Services pledged to subject the work to increased transparency and vetting. This included forming a review group of federal officials — known informally as a “Ferrets Committee” — to vet proposed projects for safety and worthiness.

However, Collins and Fauci in recent years have helped shape policy changes, directly and through their aides, that undercut the committee’s authority, according to federal documents, congressional testimony and interviews with dozens of present and former officials and science experts.

In 2017, a change made under their watch removed the committee’s power to block the projects, recasting the panel as strictly an advisory body.

Another change at that time redefined gain-of-function research, giving NIH leaders greater leeway to approve projects without referring them to the review committee. Some researchers had complained that far-reaching reviews would slow NIH approvals and scientific progress.

Since then, the experiments have continued to unfold amid secrecy, and HHS, which administers the review committee, has kept its work confidential: No agendas, meeting minutes or other records of its proceedings are public. Even the names of the federal officials assigned to serve on the committee, which has spanned the Obama, Trump and Biden administrations, are kept secret.

In an interview for this report, both Collins and Fauci and their senior aides disputed that the policy changes had weakened oversight of the research. Both NIH leaders pointed to safeguards that remain in place.

“Reasonable people do not all completely agree on the ideal way to frame the oversight of these very sensitive experiments,” Collins said, adding: “There are some who see the risks as greater and the benefits as less. And vice versa.”

Lab accidents, Collins said, “are certainly a concern. … You want to mitigate that by having the highest possible containment for any kind of experiment that might lead to trouble.”

As for loosening the controls in 2017, Collins and Fauci defended the resulting policy, which is formally known as the “Framework” for guiding gain-of-function research. . .

Continue reading. There’s much more, and I find it disturbing.

Later in the report:

The Post identified at least 18 projects that won funding from 2012 to 2020 that appeared to include gain-of-function experiments. Reporters examined research summaries in the database, along with articles published in scientific journals, and conducted interviews with experts.

Funding from NIH for the 18 projects totaled about $48.8 million and unfolded at 13 institutions. Eight were approved after the review committee’s power was weakened in 2017.

From 2017 to 2020, no more than “three or four” projects were forwarded to the review committee, said Robert Kadlec, who oversaw the panel and served as the Trump administration’s assistant HHS secretary for preparedness and response.

“They were grading their own homework,” Kadlec said.

Kadlec, a physician who earlier had held biodefense roles with the Pentagon, the White House and the Senate, said that the high-risk research has not been adequately vetted.

“Frankly, we didn’t have the scientific wherewithal,” Kadlec said of HHS, adding that the review committee’s capabilities were not “robust enough to make sure that bad things don’t happen.” (On June 7, Kadlec rejoined the Republican staff of the Senate Health, Education, Labor and Pensions Committee, where he said he will focus on biosecurity policy.)

At an NIH meeting last year, Christian Hassell, a senior aide to Kadlec at HHS, complained about how the research is vetted.

“We’ve only completed two reviews,” Hassell told members of NIH’s National Science Advisory Board for Biosecurity on Jan. 23, 2020, adding that a third project had been received by the committee for review.

Hassell suggested the lack of reviews reflected how narrowly the revised policy defines gain-of-function research, according to a video of the meeting.

“I’ll just probably be more frank than may be appropriate — I think that’s too narrow,” Hassell said. “My view on this thing is, don’t use too fine a filter.”

Hassell continues to serve as a senior science adviser at HHS in the Biden administration. He declined to be interviewed for this report.

Relman and other scientists said the federal policy governing the research is opaque and needs strengthening.

“If you’re going to ask society to take on a higher-than-normal level of risk, then I think there’s got to be more openness,” said Michael J. Imperiale, a University of Michigan virologist who served from 2005 to 2012 on the biosecurity board and who now is editor in chief of mBio, a journal of the American Society for Microbiology.

Skeptics of gain-of-function research question whether it is worth the risk. . .

There’s much more, and it sounds bad: secret decisions made by secret committees to fund research that could, through a lab accident, create a pandemic that would make Covid-19 seem like a walk in the park.

Costa Ricans Live Longer Than We. What’s the Secret?

Atul Gawande, a practicing endocrine surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard T.H. Chan School of Public Health, writes in the New Yorker:

The cemetery in Atenas, Costa Rica, a small town in the mountains that line the country’s lush Central Valley, contains hundreds of flat white crypt markers laid out in neat rows like mah-jongg tiles, extending in every direction. On a clear afternoon in April, Álvaro Salas Chaves, who was born in Atenas in 1950, guided me through the graves.

“As a child, I witnessed every day two, three, four funerals for kids,” he said. “The cemetery was divided into two. One side for adults, and the other side for children, because the number of deaths was so high.”

Salas grew up in a small, red-roofed farmhouse just down the road. “I was a peasant boy,” he said. He slept on a straw mattress, with a woodstove in the kitchen, and no plumbing. Still, his family was among the better-off in Atenas, then a community of nine thousand people. His parents had a patch of land where they grew coffee, plantains, mangoes, and oranges, and they had three milk cows. His father also had a store on the main road through town, where he sold various staples and local produce. Situated halfway between the capital, San José, and the Pacific port city of Puntarenas, Atenas was a stop for oxcarts travelling to the coast, and the store did good business.

On the cemetery road, however, there was another kind of traffic. When someone died, a long procession of family members and neighbors trailed the coffin, passing in front of Salas’s home. The images of the mourners are still with him.

“At that time, Costa Rica was the most sad country, because the infant-mortality rate was very high,” he said. In 1950, around ten per cent of children died before their first birthday, most often from diarrheal illnesses, respiratory infections, and birth complications. Many youths and young adults died as well. The country’s average life expectancy was fifty-five years, thirteen years shorter than that in the United States at the time.

Life expectancy tends to track national income closely. Costa Rica has emerged as an exception. Searching a newer section of the cemetery that afternoon, I found only one grave for a child. Across all age cohorts, the country’s increase in health has far outpaced its increase in wealth. Although Costa Rica’s per-capita income is a sixth that of the United States—and its per-capita health-care costs are a fraction of ours—life expectancy there is approaching eighty-one years. In the United States, life expectancy peaked at just under seventy-nine years, in 2014, and has declined since.

People who have studied Costa Rica, including colleagues of mine at the research and innovation center Ariadne Labs, have identified what seems to be a key factor in its success: the country has made public health—measures to improve the health of the population as a whole—central to the delivery of medical care. Even in countries with robust universal health care, public health is usually an add-on; the vast majority of spending goes to treat the ailments of individuals. In Costa Rica, though, public health has been a priority for decades.

The covid-19 pandemic has revealed the impoverished state of public health even in affluent countries—and the cost of our neglect. Costa Rica shows what an alternative looks like. I travelled with Álvaro Salas to his home town because he had witnessed the results of his country’s expanding commitment to public health, and also because he had helped build the systems that delivered on that commitment. He understood what the country has achieved and how it was done.

When Salas was growing up, Atenas was a village of farmers and laborers. Cars were rare, and so were telephones. A radio was a luxury. In the country at large, barely half the population had running water or proper sanitation facilities, which led to high rates of polio, parasites, and diarrheal illness. Many children did not have enough to eat, and, between malnutrition and recurrent illnesses, their growth was often stunted. Like other societies where many die young, people had big families—seven or eight children was the average. Many children left school early, and only a quarter of girls completed primary education. Salas said that most children in Atenas started elementary school, but each year more and more were pulled out to do farmwork.

Important progress was achieved in the nineteen-fifties and sixties in Costa Rica, with the kind of basic public-health efforts made in many developing countries. Salas was in kindergarten, he thinks, when his family was able to pipe running water to their home from the nearby city center. A national latrine campaign provided people with outhouses made of cement. National power generation brought electrical wiring. “The most happy person was my mother!” he said.

Vaccination campaigns against polio, diphtheria, and rubella reached Salas and his classmates when he was in elementary school, as did a child-nutrition program that the government rolled out across the country, with aid from the Kennedy Administration. “We had this lunch—hot food,” he recalled. “I still have the flavor in my mouth. It was very nice to have a plate of soup with rice.” His family, with its cows and its store, was never nutritionally deprived—Salas grew to six feet—but his friends were often hungry. And so school attendance jumped. “The mothers and the families saw that it was a good idea now to send the kids to school, because they were fed,” he said.

Along the way, the Ministry of Health provided an official in every community with resources and staff devoted to preventing infectious-disease outbreaks, malnutrition, toxic hazards, sanitary problems, and the like. These local public-health units, geared toward community-wide concerns, worked in parallel with a health-care system built to address individual needs. Still, both remained rudimentary in Atenas. The nearest hospital was sixteen miles away, in the city of Alajuela, and understaffed. “At that time, it was far, because the road was impossible,” Salas said.

So when did Costa Rica’s results diverge from others’? That started in the early nineteen-seventies: the country adopted a national health plan, which broadened the health-care coverage provided by its social-security system, and a rural health program, which brought the kind of medical services that the cities had to the rest of the country. Atenas finally got a primary-care clinic. “With two or three doctors,” Salas recalled. “With five nurses. With social workers. For everything.” In 1973, the social-security administration was charged with upgrading the hospital system, including in Alajuela and other rural regions. In this early period, the country spent more of its G.D.P. on the health of its people than did other countries of similar income levels—and, indeed, more than some richer ones. But what set Costa Rica apart wasn’t simply the amount it spent on health care. It was how the money was spent: targeting the most readily preventable kinds of death and disability.

That may sound like common sense. But medical systems seldom focus on any overarching outcome for the communities they serve. We doctors are reactive. We wait to see who arrives at our office and try to help out with their “chief complaint.” We move on to the next person’s chief complaint: What seems to be the problem? We don’t ask what our town’s most important health needs are, let alone make a concerted effort to tackle them. If we were oriented toward public health, we would have been in touch with all our patients, if not everyone in the communities we serve, to schedule appointments for vaccination against the coronavirus, the No. 3 killer in the past year. We would have coördinated with public-health officials to prevent cardiovascular disease, the No. 1 killer, by jointly taking aim at high blood pressure and cholesterol, smoking, and dietary salt intake. We would have made a priority of preventing disease, rather than just treating it. But we haven’t. [no money in it – LG]

In the nineteen-seventies, Costa Rica identified maternal and child mortality as its biggest source of lost years of life. The public-health units directed pregnant women to prenatal care and delivery in hospitals, where officials made sure that personnel were prepared to prevent and manage the most frequent dangers, such as maternal hemorrhage, newborn respiratory failure, and sepsis. Nutrition programs helped reduce food shortages and underweight births; sanitation and vaccination campaigns reduced infectious diseases, from cholera to diphtheria; and a network of primary-care clinics delivered better treatment for children who did fall sick. Clinics also provided better access to contraception; by 1990, the average family size had dropped to just over three children.

The strategy demonstrated rapid and dramatic results. In 1970, seven per cent of children died before their first birthday. By 1980, only two per cent did. In the course of the decade, maternal deaths fell by eighty per cent. The nation’s over-all life expectancy became the longest in Latin America, and kept growing. By 1985, Costa Rica’s life expectancy matched that of the United States. Demographers and economists took notice. The country was the best performer among a handful of countries that seemed to defy the rule that health requires wealth.

Some people were skeptical. Costa Rica had endured numerous economic crises before 1970; perhaps the subsequent decade of economic stability had made the difference. Or maybe it was the country’s large investment in education, which had lifted the proportion of girls who completed primary education from a quarter in 1960 to two-thirds in 1980. A careful statistical analysis indicated that such factors did contribute to child survival—but that eighty per cent of the gains were tied to improvements in health services. The municipalities with the best public-health coverage had the largest declines in infant mortality.

A big question remained, though: Could Costa Rica sustain its progress? Public-health strategies might be able to address mortality in childhood and young adulthood, but many people believe that adding years from middle age onward is a wholly different endeavor. Countries at this stage tend to switch approaches, deëmphasizing public health and primary care and giving priority to hospitals and advanced specialties.

Costa Rica did not change course, however. It kept going even farther down the one it was on. And that’s where Álvaro Salas comes in. . .

Continue reading.

Love Bombs — occasionally, but sometimes it doesn’t

“Love Bombs” might be used in the Cole Porter song “Down with Love” (sung at the link by Bobby Short), but probably we are not to read it as a sentence. It does have a good fragrance:

Dark Chocolate, Rose, Rosewood, Bergamot, Tea, Orange, Lemon, Black Pepper, Ginger, Palo Santo, Vetiver, Cedar, Tobacco, and Rose Absolute.

And mine is the CK-6 formula, so a lovely lather, here made using my Fine Classic brush. RazoRock’s Old Type is a terrific razor, and three passes left my face ready for a splash of aftershave, which it duly received.

A late start because working over some older posts to update them.