Monday, October 20, 2014

A previous Ebola outbreak -- in the United States.


I just read the chapters in Virus Hunter: Thirty Years of Battling Hot Viruses Around the World about the Ebola outbreak in monkeys in Reston Virginia in 1989. The principal author, C. J. Peters, is one of the rare breed of physicians who has chosen to specialize in virology, and especially in research on rare and emerging viral diseases.

The outbreak was in monkeys that were in quarantine after being imported to the United States for medical research. They had been imported from the Philippines, and the variety of Ebola that came from the Philippines was different from the several African varieties that are known. The differences seem to be very important. It seems clear that the virus in Reston was able to travel in the air from room to room in the facility (via the air conditioning) and infect monkeys by air; the African varieties appear to require contact with fluids (blood, urine, feces, vomit, mucus) from an infected person (after an incubation period).

The monkeys in holding were also suffering from an epidemic of another fatal simian hemorrhagic virus (SIV). All 500 monkeys in the facility were euthanized and the facility was cleaned. A second epidemic in new shipments of monkeys was similarly infected. Efforts to eliminate the infection from the source of the infected animals in the Philippines seem to have failed.

It was discovered after the fact that four of the employees of the facility carried antibodies to the Reston variety of Ebola in their blood, indicating that they had been infected. None appeared to have clinical illness. Apparently the variety of the virus that hit Virginia did not make people sick, although it was deadly to monkeys. That was great good luck for the USA!

The book makes clear that the veterinarian in charge of the Reston facility did a great job, recognizing that something was seriously wrong and keeping the monkeys in place after the mandatory 30 day quarantine. So too, the company owning the monkeys was willing to take a half million dollar loss sacrificing the monkeys and was willing to move quickly to limit the epidemic. Had the sick monkeys been sent around the country, the loss of animals might have been much greater.

I was impressed at how lucky we were that the epidemic occurred close for Fort Detrick, the site of the U.S. army's medical research command. Peters had previous experience with Ebola in Africa, and the command had a full spectrum of experts needed to identify the virus and construct new diagnostic tests. It had one of the only two facilities in the country in which the virus could be studied (relatively) safely. And it had linkages with the CDC which had the epidemiological staff and skill to follow up the disease in humans.

In the United States there are many agencies with responsibilities for health and safety. Thus Virginia and Maryland state public health officials were involved. The military has medical facilities, including those needed to transport servicemen with infectious diseases and to hospitalize them in quarantine. There are federal agencies responsible for assuring the safe disposal of medical waste, etc. The chapter gives a brief but informative summary of how complex it is to manage investigation of a new epidemic, especially one of an emergent disease.

The fundamental point is that the Reston Ebola outbreak was in many ways unique. However, such dangerous but unique outbreaks of (emergent) diseases occur relatively frequently. The country needs the dedicated and brave folk with the expertise to deal with them.

Global Hunger Index



Sunday, October 19, 2014

The 4th Installment on The Long Shadow.


This is the 4th post as I read The Long Shadow: The Legacies of the Great War in the Twentieth Century by David Reynolds. (See my first, second and third posts.)

Chapter 8 it titled "Evil". I think the chapter is primarily about the shadow of World War I on the way evil was handled after World War II. Certainly there was evil, and Reynolds focuses on the Holocaust. Interestingly, he suggests that there was little British emphasis on the Nazi genocide against the Jews during and immediately after the war.

Wikipedia estimates that 11 million civilians were killed by the Nazis, of which 6 million were Jews.

Reynolds does not address Japanese atrocities. This is from Wikipedia:
(T)he Japanese slaughtered as many as 30 million Filipinos, Malays, Vietnamese, Cambodians, Indonesians and Burmese, at least 23 million of them ethnic Chinese........ 
According to the findings of the Tokyo Tribunal, the death rate among POWs from Asian countries, held by Japan was 27.1%. The death rate of Chinese POWs was much higher because—under a directive ratified on August 5, 1937 by Emperor Hirohito—the constraints of international law on treatment of those prisoners was removed. Only 56 Chinese POWs were released after the surrender of Japan. After March 20, 1943, the Japanese Navy was under orders to execute all prisoners taken at sea. Around 1,536 U.S. civilians were killed or otherwise died of abuse and mistreatment in Japanese internment camps in the Far East...... 
(T)he Manila massacre of February 1945 resulted in the death of 100,000 civilians in the Philippines. It is estimated that at least one out of every 20 Filipinos died at the hands of the Japanese during the occupation........ 
Special Japanese military units conducted experiments on civilians and POWs in China. One of the most infamous was Unit 731 under ShirĊ Ishii. Unit 731 was established by order of Hirohito himself. Victims were subjected to experiments including but not limited to vivisection and amputations without anesthesia and testing of biological weapons. Anesthesia was not used because it was believed that anesthetics would adversely affect the results of the experiments....... 
Many written reports and testimonies collected by the Australian War Crimes Section of the Tokyo tribunal, and investigated by prosecutor William Webb (the future Judge-in-Chief), indicate that Japanese personnel in many parts of Asia and the Pacific committed acts of cannibalism against Allied prisoners of war....... 
There are different theories on the breakdown of the comfort women's place of origin. While some Japanese sources claim that the majority of the women were from Japan, others, including Yoshimi, argue as many as 200,000 women, mostly from Korea and China, and some other countries such as the Philippines, Burma, the Dutch East Indies, Netherlands, and Australia were forced to engage in sexual activity.
The Allies were hardly blameless; strategic bombing carried out by the Allies during World War II killed many hundreds of thousands of civilians; the use of atom bombs in Japan at the end of the war is more famous, but firebombing such as that of Dresden and Tokyo also killed large numbers of civilians. The acts of Russians as they retook territory in Eastern Europe and invaded Germany are not mentioned.

British involvement in World War I was in part justified by German actions in Belgium and the responsibility that Germany had for starting the war. Efforts by the victors in the war to bring German individuals to account for war crimes after the war largely failed.

In the aftermath of World War II, the Allies sought to firmly pin the blame on Germans for the much worse atrocities committed in that war, and to do so through trials that would reveal the evidence of those crimes. The war crimes trials and the punishment of many Nazi leaders were successful in this. Reynolds suggests that the Allies in 1945 were acting in part on the basis of their interpretation of the experience in the aftermath of the First World War.

Cultural Memories

Chapter 9 is titled "Generations" and deals especially how the cultural memory of World War I evolved after World War II. The way a new generation understands the events of the past may differ substantially from the way those events were understood by the previous generation. By the 1960s, the people who actually fought in the First World War were old or dead, the national leaders of 1914-1918 more so. World War II had formed the minds of the 1960s generations. So too, different nations with their different cultures and different experiences of the wars formed different "cultural memories" and commemorated the 50th anniversary of World War I in different ways.

Reynolds offers a scathing assessment of The Guns of August: The Outbreak of World War I by Barbara Tuchman. He notes that John Kennedy was deeply affected by the book, and credits its impact as influencing Kennedy to take considerable care to avoid blundering into world war during the Cuban missile crisis (as Kennedy had been led to believe European leaders had blundered into World War I.)

The emphasis of the chapter is on the British reconstruction of its cultural memory of the war, as influenced by the work of historians, and by literary critics as well as publications of anthologies of British war poetry after the war (something he sees as unique to Britain). Popular (as opposed to academic or professional) historians produced books of considerable popularity about the war, but to Reynolds' critical eye, less well informed works. The major change was the introduction of television, and very popular, long histories of World War II. Again, 15 segment program broadcast by the BBC more than once, is described as having a major impact on the public memory of the war; it had a definite view, and was apparently controversial among professional historians. Reynolds mentions in passing that schools included World War I in their curricula, not only as history but as literature, and this too must have contributed to the cultural memory.

In the final section of the chapter, Reynolds discusses the commemoration of the 1916 Easter Rising and of the Battle of the Somme in Northern Ireland. He suggests that the recreation of the cultural memories of the half century old events led to the Troubles that began in 1968.

I was in my 20s during most of the 1960s and I suppose my view of World War I is partly formed by the reconstruction of the cultural memory from that time -- albeit primarily as an American. I recently read The Sleepwalkers: How Europe Went to War in 1914 by Christopher Clark (here is my post on the book). It seems to me that power politics had evolved to such a state by 1914 that the maintenance of peace was beyond the capacity of the institutions of the time; the leaders of the various nations could not maintain the peace, but perhaps to do so would have been beyond the capacity of any leaders facing the challenges of the time.

The massive killing and the inhuman suffering during World War I were apparently beyond the imagination of the leaders and of civilian populations before the war, (I wonder if that was equally true of Americans who had a cultural memory of the Civil War?) While World War I seems much less cruel than World War II, it was certainly bad enough to merit being avoided. One wonders if it might have been avoided if people had more fully understood what they were getting the world into.

The Common Soldier

Chapter 10, titled "Tommies", suggests that in the late 20th century, attention in Britain, Australia and France focused on the common soldier in the First World War more than it earlier/ He describes this as both the result of books by new authors, not professional historians, but rather people interested in capturing the stories of common soldiers in popular books as well as of professional historians writing in a new paradigm. These new works are linked to the 50th and 75th anniversaries of World War I, and new commemorations of the war. Interviews with people who actually experienced the front lines clearly would no longer possible much later/

It is perhaps worth remembering that official war histories tended to focus on battles and fronts, armies and large units. It tended to be the generals who got the most attention, not the foot soldiers. There were soldier poets from England (and Reynolds points out that there were thousands of poets who published on the war), but the best known of these tended to have been from affluent backgrounds, educated in the best and most expensive schools, serving as junior officers.

While the previous chapter focused on the social construction of cultural memory, this chapter attends to the unreliability of the individual's memory of long past events. How large a grain of salt do we have to apply to the stories told to modern authors by men who served on the front lines many decades before? I would add, how much can we trust letters from soldiers at the front to their families at home to tell the unvarnished truth about the war? We know that eye witness testimony about crimes is unreliable, so perhaps is eye witness testimony about war.

In one sense, the later publications about World War I are part of the shadow that war left on the rest of the century. Reynolds in earlier chapters describes how the influence of elites decreased after that war, in part as a result of the war. Suffrage was extended, a middle class and even the working class became more educated and affluent, and radio, movies, and television made the news of the day vividly available to a huge public. Perhaps it is not surprising that that new audience wanted to learn more about people like themselves; they certainly had less trust in the royals and aristocrats that had ruled European governments in the first decades of the 20th century.

I do wonder about things that Reynolds left out. For example, there is a long history of interest in the "common men" who fought the American Indian wars and who fought at the Alamo. Stephen Crane's Red Badge of Courage , published in 1891, focused on a private soldier in the U.S. Civil War and won international recognition. Indeed, I recently read Leander Stillwell's memoir of his time as a common soldier in the Civil War. So too did Hemingway's novels A Farewell to Arms and For Whom the Bell Tolls focus on common men and women in war. George Orwell's Homage to Catalonia was widely read in the English speaking world, describing his experience in the Spanish Civil War. In the United States, Sergeant York in the World War I and Audie Murphy (the most decorated U.S. soldier) in World War II were the subjects of great public interest and even biographical movies, Thus there seems to have been a lot of interest in the common man at war before World War I was a half century past.

The First World War saw the destruction of the Ottoman and Austro-Hungarian empires, and the German empire stripped of territories in Africa and the Pacific; immediately after the war, new nation states were carved out in a band between Western Europe and the USSR. After World War II, the weakened Western European powers could no longer hold dominion over their African and Asian colonies and scores of new countries were born. Indeed, the India of the Raj is now a number of large countries.


It is now being recognized that half the world's population lives in a relatively small part of the world's area in Asia. The countries in that circle are regaining a larger share of the world's productive economy, recalling the first millennium after Christ when they led the world. Russia and Japan fought wars in the East, and the war in the Pacific (fought largely between Japan and the USA) in World War II was important. Reynolds has a Eurocentric view of the world, but he recognizes in this chapter that Australia is increasingly seeing itself as a Pacific nation, and less as a distant outpost of a British empire or Commonwealth. (Obama's shift towards Asia is similarly a rccognition that the the United States is a Pacific nation, one that has fish to fry in Asia as well as in Europe.) If this shift is not a shadow of that first world war, it is at least a development of a long historical process advanced by that war.

Comments

The book seems bloodless given the reality of war. It is hard to face the evil inflicted in wars, the suffering inflicted on civilian populations in modern war; the death, disability and suffering of common soldiers in battle. It is perhaps especially difficult to empathize with that suffering that took place in earlier times and different places, and across cultural differences. Yet I think we must try to do so.

Utilitarianism is a philosophy that holds we should organize to achieve the greatest good for the greatest number. It is based on a concept of utility -- that we can judge two policies that have different impacts across a population by seeing which field of impacts most improves the total utility measured across the population. Economists regularly look at policies in terms of their impact in GDP and perhaps the distribution of income in the population. Utility is similar, but recognizes that a dollar of added income might have considerably more benefit for a poor person than for a billionaire; that a good meal would more benefit a hungry man than a full one or one on a diet.

In the case of war, it think the issue may be to minimize suffering. If the leaders who lead the world into the great world wars of the last century recognized the suffering that they were unleashing on the world, perhaps they would have tried harder to avoid those wars, or at least to limit their length, to limit the numbers of people affected, and to limit the pain inflicted. Even if the leaders proved insensitive to the pain that their policies were inflicting, perhaps the citizens of their countries would have prevented the wars. We saw popular revolutions and military coups that were attempted to end those world wars. So, rub the noses of leaders and the public in the misery of war! Make them understand.

Saturday, October 18, 2014

Friday, October 17, 2014

A thought about measurement of national performance.



Consider a utopia in which no one works. Farming, fishing, forestry and manufacturing are fully automated. So are buses, planes, ships and trains. A robot can cut your hair or cook and serve you a meal. Even health services are automated, with machines providing better care than human providers ever could.

Everyone gets free lodging in comfortable quarters, a good and healthy diet, clothing, and all the basic goods without charge. Thus no one works.

People spend their time doing what they want to do. Some are artists, others write. Many play sports and some reach such levels of excellence as athletes or actors that people watch them perform. Many study, improving their minds. Some conduct research. Some love public policy, and volunteer to help govern.

The question is, how would you measure growth in such a utopian society? GDP would have little or no meaning. Perhaps you could try to measure gross national happiness. Or perhaps you would try to measure the degree to which people were living "the good life" -- achieving what the philosophers among them felt to be worthwhile in life.


Here is some good news about the world!


Child mortality has dropped and life expectancy has grown around the world since 1950.

Vaccines have helped eliminate many diseases from much of the world entirely.




Read more: http://www.businessinsider.com/whats-the-best-time-in-history-to-be-born-2014-9#ixzz3GO4Jtwxm