America 2020

An Open Letter to My Friends.

It has been a very hard week for most of us, here in the US and perhaps beyond, to say the least. There is nothing I can share with you that has not been already said by others in the press, on TV, by political commentators, social psychologists, ethicists, and historians already at work writing the next chapter of the US civil right movement - or already pointing to another stone anchoring the free fall of the American empire.

Yet, I can't help reaching out to you, my dear friends, in moments like this, if only just to unload my heavy heart and troubled mind. How can we humans be so cruel to each other, to kill someone as if his life is not even worth that of an animal, or to watch someone be murdered in cold blood and not lift a finger to stop the crime? How could our supposedly transparent democratic values be so hypocritical as to allow the persistence of systemic injustice and racism? How many more deaths, how much more denial, or political stunt shows, empty speeches and tweets of fallacies, and just plain, despicable photo-ops?

I can only hope that the horrible death of George Floyd will be the final catalyst for real change in the fiber of our society. Yet in these troubled times, it is so hard not to ask: Why does such a country blessed with so many good natural and human resources allow itself to fall into such a pitiful trajectory? So many good and dedicated healthcare workers, and yet such a dysfunctional health care system? So many great teachers and researchers, brilliant engineers and innovators, and yet for many of us, failing schools, falling bridges, broken sewage lines, and retarded information technology services? So much national wealth in calculated GDP, and yet a widening income gap, a struggling middle class and a sinking poor mass? So many kind and generous people, so many wonderful artists, musicians, writers and journalists, and yet a nation still searching for its soul?

I see so many paradoxes in our society that are built in the qualities that once "made America Great". The Pilgrim morality that sought religious freedom only to reclaim that their Bible is better than others' spiritual beliefs. The pioneer character that launches adventures and instills self-reliance, and the entrepreneur competitive drive for new opportunities, and but somehow along the way these principles have been used to grab land and destroy native cultures, to justify the worshiping guns to "defend liberty" and the exploitation and degradation of other human lives in past slave plantations and modern overseas sweat shops. Have we allowed our Jeffersonian "pursuit of happiness" - an undeniable right enshrined on the American Declaration of Independence, to become just an open ticket for some to seek power and wealth at the detriment of those less fortunate? Are these traditional values we were raised to admire and pursue the cause of our wealth and health inequities, and of the mad chaos in our streets and the pain in our hearts?

Perhaps the wide scope of the current demonstrations indicates a definite wake-up call for America. So many faces young and, so many different skin colors, so many hands reaching out and holding on to each other, so many voices chanting the dawning of hope after the initial burst of outrage. No, there cannot be a going-back to the old "normal".  Changes are not optional, they are a matter of life for all of us. A better life for all of us, actually.

But until then, I can only share with you the questions asked by Bob Dylan in 1965, albeit with a few different strokes. As lyrical as it may sound, we have listened to the wind for more than 50 years, but have found no answer there. If I twisted the verses and ended up saying "The answer, my friends, is in George's dying breath", I only meant that George's last breath may not be "the answer" either, but it may be the breath that, paradoxically, would light rather than blow out the candle in our hearts.

Please stay well, and let's continue to reach out for each other, Covid-19 or not.

Yours,

Chinh

June 7, 2020

"Blowin’ in the wind"/ George Floyd remembered

How many roads must a man walk downbefore you call him a man?
Yes, and how many seas must a white dove sailbefore she sleeps in the sand?
Yes, and how many times must the cannonballs flybefore they're forever banned?

       (How many times must the assault guns fire, before they're forever banned?)
            The answer, my friend, is blowing in the wind,
            The answer is blowing in the wind.

How many years can a mountain existbefore it is washed to the sea?

        (How many years must a glacier exist before it is washed to the sea?)
How many years can some people existbefore they're allowed to be free?

       (How many breathes can any one man take, as he dies under someone's knee?)
How many times can a man turn his headpretending that he just doesn't see?

     (How many times can other men turn their heads, pretending that they just did not see?)
               The answer, my friend, is blowing in the wind,
                The answer is blowing in the wind.

How many times must a man look upbefore he can see the sky?
How many ears must one man havebefore he can hear people cry?
Yes, and how many deaths will it take till he knowsthat too many people have died?

 The answer, my friend, is blowing in the wind, The answer is blowing in the wind.

(The answer my friends, is in George's dying breath, 

The answer is in George's dying breath.)  

Of bats, pangolins and Covid-19

So how did it start, this "Chinese virus" our President keeps referring to? 

I hope this brief scientific review can put this pandemic into a proper perspective.

Viruses are infectious agents that cannot survive or multiply on their own. So they hijack the DNA or RNA, protein-making mechanisms of other living organisms to thrive. But they first have to attach to, then pry open the host cell membrane. This mutual affinity is very precise and specific between a virus (famously diagramed with its "spikes") and the host cell surface "binding receptor" (think of this as a "key-and-lock" match).  This determines why some species are susceptible to a specific infection while others not at all. Another characteristic of viruses is their ability to mutate, meaning changing its genetic makeup and therefore (1) acquiring ability to infect new hosts; and (2), altering the severity of the infection or resistance to treatment.

Coronaviruses have been recognized since the 1960's as common causes of respiratory and gastrointestinal infections in humans and some other animals. Genetic studies have traced coronaviruses co-existing with bats for millennia as a primary host, but recently "jumped" to pangolins as new hosts, and now to humans. What makes this human SARS-CoV2 (otherwise called Covid-19) much more dangerous to humans is its selective mutation to (1) bind to human receptor ACE2, which is abundant in our respiratory tract; and (2) to activate furin, a host-cell enzyme found in many human tissues (lungs, liver and small intestines), allowing the virus to increase its infectivity and attack multiple organs. Call this natural selection: Pure luck for the virus, bad karma for us?

So now, what about the "Chinese connection"? The first reports of novel pneumonia came from Wuhan, China. Why China first? One can only speculate that the Asian traditional obsession of consuming exotic animal tissues as medicinal remedies has invited importation of pathogens along with illegally trafficked animals. While not conclusive, most revealing is that both Chinese and Western scientists have found pangolins imported into Guangdong province contain coronaviruses with receptor binding properties identical to SARS-CoV2, potentially identifying pangolins as intermediate hosts to human disease.

It was even a more heart-breaking revelation for me as I watched the PBS Nature show on pangolins (https://www.pbs.org/wnet/nature/worlds-wanted-animal-full-episode/16258/) documenting the effort of a few compassionate individuals who had tried, with little success, to stop the killing and trafficking of these adorable endangered creatures. Had the world listened to them, would this pandemic have ever occured? Who knows, as so many "exotic" wild animals, including ferrets, are sold in open markets and pet stores around the world. Viruses don't recognize human skin colors nor nationalities, they only exploit human weaknesses or follies, wherever we are.

Zoonotic diseases are a group of infections that humans acquire from animal reservoirs. There are too many of them to list here. From malaria already present in antiquity to Lyme disease and "swine flu" of modern times, West Nile encephalitis and Dengue fever expanding with the expanding range of their mosquito carriers, these are but a few examples. We need to remind ourselves that we live in a world where animal and human microbial cesspools are interconnected, ever-evolving, as humans encroach on wildlife habitats and contribute to climate changes.

This Covid-19 pandemic is likely the mother of all zoonoses we have ever seen, now described as catastrophic, or even apocalyptic. There are already, and will be many, many more stories written about it: more scientific studies; stories of human tragedies, courage and immense sacrifices; of economic collapse; of innovative changes in the workplace, social connectivity, responsibility and community health; and of course, angry finger pointing. Let's not forget the more existentialist lesson of how the wants, greed and follies of our human species can become our own peril, as we use our dominance on the world food chain to inflict cruelty over "lower" living species with whom we share, yes share, this beautiful blue planet.

Chinh Le

(A shorter version of this essay was submitted to the Gazette Times, March 26, and published on April 2, 2020)

What Covid-19 tells us about our healthcare system.

Ms Bailey used Italy's Covid crisis as a reason to say "I don't want the government taking over our healthcare system"(April 26). May I point out that the countries that have best responded to the pandemic are Taiwan, South Korea, Ireland and Singapore, which all have government-run healthcare. Such a system allows nations to better focus on public health, universal access to preventive and medical treatment, and to allocate resources when and where needed for the common good. There are many reasons for the tragic human losses in this pandemic, but please don't blame the Italians for incompetence.

Here in the US, where we have the best concentration of scientists, innovative technology companies and the highest healthcare expenditures in the world, we failed miserably to prepare for, and still have a hard time reacting to the crisis. The reasons are obvious: a fragmented, uncoordinated system, built on social inequalities, driven mostly by profit motives; and a current leadership that puts Wall Street over public health. Yes, politics and wealth over health. American exceptionalism at its worse.

During this pandemic, not a single person in Europe or parts of Asia where there is "government-run" health system lost their insurance, and the same applies to Medicare beneficiaries in this country.  With millions of Americans suddenly un-employed, this should be a wake-up call that employer-based insurance is no healthcare security at all. There is no better time to rethink replacing private medical insurance with an equitable, universal publicly funded healthcare system.

(Submitted to the Gazette Times, April 29; published May 9, 2020)

No more landmines

On Jan 31, the Trump administration issued a new policy allowing US forces to use anti-personnel landmines outside of the Korean peninsula, stating that restrictions would put our military "at a severe disadvantage". It reversed Clinton's 1993 moratorium, and Obama's 2014 ban to acquire and produce landmines.

Despite the global ban in 1997 signed by more than 120 nations, between 25,000 and 6,500 people a year suffer severe injuries or death from landmines planted during previous wars; 80% of the casualties are civilians, mostly children. In my own native country, Viet Nam, 800,000 tons of landmines and unexploded ordnance remained after "peace" returned to our rice fields and mountains, killing or injuring 100,000 people between 1975-2015.

Mr. Trump made the decision even after many US commanders agreed with a 1997 study by the International Red Cross that concluded mines have little tactical value and are costly and dangerous for forces deploying them. With modern warfare relying more on aerial bombing, missiles, drones and counter-terrorism, even "smart" anti-personnel landmines are obsolete.

In 2017, Mr Trump pulled the US from the Paris Climate Agreement; in 2019, from the Intermediate-Range Nuclear Forces Treaty, and the UN Arms Trade Treaty - without negotiating for safer substitutes. And now this - not the kind of American exceptionalism that protects our military, our allies, nor future generations.

Our President has frequently hinted he deserves the Nobel Peace price. Perhaps he should be reminded that the 1997 award went to the International Campaign to Ban Landmines.

(Submitted to the Gazette Times, Feb 18; published March 2nd, 2020)

Health impact of global warming

I would respectfully disagree with OSU Emeritus Professor Nebert  (GT Dec 29) about his conclusion that global warming is beneficial to human health, as he observed that cardiovascular and respiratory illnesses are more common during colder months, and that somehow population growth and vineyard expansion are historically associated with global warming.

Medical experts are still debating the multiple factors in the apparent seasonality of influenza illness in temperate climate, but most agree that the common denominator of morbidity and mortality of diseases is stress - and not thermal temperature.  Stress to our immune system, stress to our mental health, stress to our families not being able to afford healthcare when needed. There is no question that particulate matters from fossil burning contribute to the rise in cardio-pulmonary diseases, as reported globally in many respectable medical and public health peer-reviewed journals. Regional global warming trends in temperate zones have also been reported to enable the spread of disease-carrying mosquitoes and ticks, such as Dengue fever and equine encephalitis, outside of their native habitats.

The term “global warming” falls short at defining what science is describing. What is happening and most damaging is the extreme variation in regional temperatures, floods and drought, arctic vortex, hurricanes and wild fires, feast here and famine there, and the new ecology of zoonotic infectious diseases. These cataclysmic changes can cause population upheavals and geo-political insecurity. They are the universal stressors that can adversely affect our health, and even the most economically privileged individuals will feel them. There is nothing hysterical about acknowledging these problems and trying to work on solving them. Now.

(A shorter version of this letter was published on Jan 16, 2020 - Gazette Times, Corvallis)

Citing a multinational study reported in a 2015 Lancet journal that found an association (not causation) between colder temperatures and increased mortality, Mr Burreson (Jan 19), concluded that global warming is beneficial to human health. Conversely, should I link the recent increased mortality in US young adults to warmer weather? Obviously not!

I am weary of population studies that single out one variable (in this case, ambient temperatures) to correlate with one outcome measurement (mortality), while ignoring many important and complex co-determinants of health. The fact that this study also found substantial variations in mortality in different countries, yet tried to make a simple, over-reaching conclusion does not speak well for the quality of the data. Other studies cited in the Lancet suggest that specific periods of extreme temperatures are associated with increased mortality (by 12.1% for heat waves, 12.8% during cold spells), supporting my earlier remark that it is the extreme swings in weather that is stressful to human health.

Any clinic or hospital can tell us there are more sick patients and pneumonia deaths during winter, and yes, we should heed grand-ma's advice to bundle up when we go out in the cold. But to jump from there and ignore the negative effects of "global warming" on planetary and human health is beyond my humble reasoning.

Fro those seriously concerned with this issue, I recommend the Lancet Countdown on Health and Climate Change, published Nov 16, 2019; it uses 41 outcome indicators and lists 212 supporting scientific publications.

(Submitted Jan 20; published in the Gazette Times, Corvallis, Jan 29, 2020)

The title of Mr Petersen's letter (Feb 23) – "climate change science not settled" - definitely hit the right note. The virtue of science is to recognize that there is always data and dogmas to challenge, new observations to analyze, better models to reassess predictions, and therefore any scientific conclusion is but preliminary. That said, I know there are many cosmic forces of "nature" we can't control, but I am not ready to deny that human activities have accelerated our climate problem.

With more than 90% of world scientists agreeing with reports from many respectable institutions, where is the proof that they all collude "for money or power"? Even if only 4% of climate warming is anthropogenically driven, should we be paralyzed by cynically rejecting their warnings and proposals as "irrelevant"? Economists jump when the inflation rate rises over 2%, public health officials when influenza or COVID-19 mortality is 2%, and politicians when un-employment rate is above 4 or 6% (or pick a number). So what is so wrong about a global accord to prevent planetary warming rising 2% over pre-industrial level? What should our threshold be before calls for action get labeled as "hysterical?"

For myself, to combat climate warming is more about changing my own behavior: be less wasteful in my consumption of earthly goods; support resources that don't pollute or harm our health; and be mindful of other living creatures we share our planet with. Humanly possible and relevant things I can do, regardless of scientific controversies.

(A slightly different version was submitted on Feb 24 to the Gazette Times, and published on Mar 15, 2020)

Impeachment proceedings

This past week of impeachment hearings was certainly a trying time for me, as I listened to official testimonies, partisan bickering and analyses by media commentators.  That facts are seen through different filters we choose to wear over our eyes is a well-known cliché, and that the proceeding will not change the partisan divide in our country is an unfortunate but viable conclusion for now. 

Yet the week did not end in despair for me. It actually renewed my faith in America: that sooner or later, corrupt power can be challenged, constitutional checks and balances mean something, and most of all, that we can count on brilliant, dedicated and courageous civil servants in our government to carry out their duties in times of political turmoil. Personified in the dignity of Dr Hill and other officials, they are truly the under-recognized heroes of our democracy and represent the impeccable image that projects American power and values in the world.

(Published in the Gazette Times, Corvallis, OR, Nov 25, 2019)