According to statistics from Worldometer.info, on May 22 there were 1,645,094 diagnosed cases of COVID-19 in the USA. Furthermore, there have now been 500,848 cases with final outcomes in which the patient got well or died. Of those cases with final outcomes 403,201 got well (81%), and 97,650 died (19%). Are these numbers shocking?
Some say, “Yes, the numbers are horrible!” Others say, “No, the numbers are false.”
Now, it happens that the statistics are, quite predictably, being manipulated to suit those quoting them. But medical evidence is appearing to confirm that deaths and serious cases are very much higher among those who have other conditions which are exacerbated by the virus. The Sunday, 24 May 2020 edition of Medscape begin its lead article by saying, “The hospitalization rate for COVID-19 is 4.6 per 100,000 population, and almost 90% of hospitalized patients have some type of underlying condition according to the Centers for Disease Control and Prevention.” Some believe that this means no matter what combination of conditions the person had, COVID-19 was listed as the cause of hospitalization. This leads to unreliable statistics. “This virus is not so bad.” The virus is merely a catalyst. Those being killed would die soon anyway.
The argument continues by concluding that attributing deaths to COVID-19 is fomenting panic. Panic is blocking economic recovery. So, since the numbers are unreliable, just open things back up, separate the vulnerable into safe keeping, and let the young and healthy go back to work and to school. Massive shut-downs are causing political discontent and economic disaster.
On top of that, closing factories, churches, businesses, borders and travel is causing economic disaster without impacting the eventual outcome of the epidemic. Epidemics evolve and the shortest way to get past them is to let them take their course so that populations develop herd immunity. Herd immunity depends on people being immune to the virus once they have gotten over being infected. It is achieved when enough people have acquired immunity so that the virus no longer reaches vulnerable victims. Herd immunity advocates insist this is the way epidemics always work with diseases to which people develop immunities through prior exposure. It is best, according to this theory, to let people be exposed and get over it, which 98% will do, so that in the end there are too few without immunity for the virus to spread. [As of this date there is no indisputable proof that COVID-19 patients develop immunity to further infection. The plan in Sweden was to count on herd immunity. The plan in Germany was not to do so, but to impose social distancing to break the chains of infection until medication is discovered.] If this were Ebola, where death rates are 50% (30% to 90%) rather than 1% of those infected, relying on herd immunity would be unthinkable.
What is being ignored by this reasoning is that even if the virus is no more than a catalyst, it can and has caused great spikes in illness, particularly illness related to lungs. These spikes can overwhelm hospital facilities, and that has happened, but it can be avoided by slowing down the spread by spreading out the population so that everybody has a chance to be treated. Even if keeping people at home is only slowing down the epidemic it is keeping people alive.
Is this "flattening the spike" worth the cost in terms of hardship, social disruption, actual starvation, and loss of emotional health as the epidemic conditions continue? Who is being protected by these measures and who is being subjected to collateral tragedy. This brings the matter into the moral-ethical realm. That sort of discussion always revolves around debatable values. On the one hand are those who believe, "If you save a life you save the world." It is immoral to resign any proportion of the population to suffering and death if it can be avoided. On the other hand, are those who insist, "It is unreasonable to operate as if we expect everyone to live forever. We will all die ... so if the choice must be made, it is better to do it when it serves the greater good." It’s about numbers.
Behind all the medical and economic realities that COVID-19 has imposed on us is another development with great potential. People in this decaying postmodern era are beginning to have to think again.
Naturally, all along, we have thought we thought … and we did. We thought all sorts of thoughts, profound and paltry. But the virus has exposed how we think in ways we haven’t thought about for a long time.
First, a little background. Postmodernism began as a protest against modernism. Modernism had brought us Art Deco, jazz, nuclear fission, Fascism, penicillin, and “1984” in 1948. Postmodernism worried that we were being manipulated by giant puppeteers who control us by powerful narratives. “Those stories are lies,” Foucault told us. “You are the only legitimate story-teller of your life story.” So we went to Woodstock, found joy in sexual freedom, overcame syndicated TV, and ate what we wanted without a care about “what is good for you.” This heedless freedom came at a cost: the loss of critical thinking. Instead, we have preferences based primarily on affiliations. Our social attachments are terribly important to us. In the serene center of consensus we are secure. Whatever disturbs this consensus needs to be kept away. And thanks to Information Technology it can be.
Now comes the virus threatening us. Postmodernist responses emerged immediately. The over-riding postmodern reaction is to protest, especially to protest whatever disturbs the domain we, ourselves, inhabit. Postmodernists that we are, we intuit our core belief system (without naming it), shared with our group, and we look for the giant puppeteer who is invading our zone. That’s what postmodernists do.
COVID-19 is a virus but the narrative we need to understand it is what we look for. Groups have agreed among themselves, (1) the puppeteer is fake because the story of the viral threat is a hoax; (2) the puppeteer is a charlatan trying to subject us to a medical panic in order to sell medicine; (3) the puppeteer(s) are frauds bent on creating panic to undermine the economy of the world and replace the former puppeteers with new ones; (4) the puppeteer(s) are tyrants using this medical situation to strengthen their power; (5) the puppeteers don’t know squat and we can ignore them; (6) the puppeteers have expanded the effects of the epidemic in order to kill off as many as possible of those outside their group; (7) the puppeteer has stubbornly stuck to a script even after the audience has lost interest and gone for refreshments.
Now we are being driven to think again.
We are being forced by our circumstances to think critically, to evaluate how we are doing our thinking, and to admit that knee-jerk reactions are not thoughtful.
The immense numbers of dead and sick and the encroaching illness have cracked the bunkers into which we have retreated. Undeniable reality is no longer simple. It is impossible to attribute the cause of the pandemic to a fake narrative. Medical science has gained increased respect, complex and methodical though it is. The power of governments to promote the common welfare, if they want to, is being recognized and people are getting aroused. Angry defensiveness and magical incantations are essentially ineffective against a powerful, mindless protein. Liberty is a different realm of discourse from epidemiology.
Stubbornly entrenching ourselves inside the opinion stockade of our affiliates is not working. When that mental strategy stops working postmodernism is done for.
[Thanks to Christians in Chiang Mai, Thailand for distributing free meals at the height of the COVID-19 crisis. Thanks for the picture.]
It seems incumbent to at least comment on turning 80, today, May 14, 2020. On the whole, getting this old is not as surprising as I thought it would be when I was 40.
In all fairness, however, I think I have made about as much impact on the world as I will. And I have to admit I’m a little disappointed not to have achieved some things I thought I might. I did not become an Eagle Scout, get inducted into Phi Beta Kappa, get a Fulbright scholarship, earn a PhD from St. Andrews University, become pastor of Fourth Presbyterian Church of Chicago, get an honorary degree from my alma mater, be awarded a Royal Thai decoration, have a book published by a well known publisher, or become vice president of a university. All of those things were real possibilities at some point.
I feel much more keenly about a couple of other near-accomplishments.
In the 1980s I discovered how to transform pastoral theology seminary courses (preaching, church administration, worship, pastoral counseling) from performance-oriented skill-building into academically advanced courses with research potential. It could have improved and upgraded the seminary and the level of leadership in the church here in Thailand. But I didn’t get to continue on the staff of the seminary.
Twenty years later I finished the third re-write of a book, 40 years in the making, about holistic spirituality – how to assess what really is going on when one is growing and when one is deteriorating spiritually. I have the concept, and it is refined and compelling. Spirituality is a growing topic to which I could have made a significant contribution. But I have never been able to get a handle on how to present it in an accessible and usable format.
These two big ideas would have been very helpful to “the world”, but they will die with me. I’m resigned to that now.
At this point in birthday reminiscences I’m supposed to turn to positive memories and list things that turned out right. That list would be acceptably long. Failing to do it might seem like a ploy to coax others to shower me with reassuring compliments.
Let’s agree that those who know me can name reasons they are thankful for our relationship. For my part, I am satisfied that during the past 80 years I have fulfilled one of my high school teacher’s commandments, “Ken, you are part of the answer. Stay that way.”
I have been neither heroic nor historic. But as that philosophy teacher understood, the first task is to discern the real questions, and the second is to resolve to be part of the answer. In that I have done tolerably well.
The rice planting season officially begins tomorrow (Monday, May 11). After giving consideration to cancelling several May holidays, the Thai government declared they would go ahead but people are advised to stay at home, meaning that how they are observed would be mostly on TV. The most spectacular and ancient of the holidays is the Royal Plowing Ceremony, traditionally help in the Sanam Luang in front of the Grand Palace in Bangkok on the second Monday of May.
This ceremony, revived by HM King Rama IX in 1960, features a representative of the King (usually the Minister of Agriculture) plowing a furrow in 9 circuits, with the plow being pulled by a team of white oxen. Rice is then cast into the furrows by the royal representative from gold and silver baskets of seeds carried on shoulder poles by four women. The whole event is presided over by the Royal Family. Part of the ceremony also involves offering the oxen their choice of food and drink; what they choose is considered by astrologers to portend agriculture productivity. At the conclusion of the ceremony crowds of people surge onto the newly plowed field to retrieve as many grains as they can to mix with their own seeds to expand the kwan (“life force” which is part of the official name of the ceremony, พระราชพิธีจรดพระนังคัลแรกนาขวัญ).
The Thai ceremony is carried over in toto from a ceremony held in the Khmer Empire and even before. It reiterates an event in the Ramayana, the mythic saga that legitimizes the lineage of royalty throughout South and Southeast Asia. It recalls the ancient agricultural origins of culture and validates the king as the Lord of the Land. In this way, the Plowing Ceremony, along with coronations and funerals of royalty, symbolizes the stability, prosperity and wealth of the people, the country, and the culture.
Some say we have entered a post-agricultural age, but COVID-19 has reminded us of the fragility of metropolitan life. We forget our agrarian roots at our great peril.
Birth, Enlightenment and Death of the Lord Buddha
Visaka Bucha Day is the premier of three annual Buddhist holy days. On this day, which comes on Wednesday May 6 in Thailand this year, the birth, enlightenment and death of the Lord Buddha, the Self-Enlightened One, is celebrated. In short, the person of the Buddha is commemorated, and the Buddha is worshiped.
The birth of Gautama was in various ways miraculous (as births of divine saviors must be). According to the basic Thai narrative, at his conception his mother dreamed that a divine white elephant entered her side. His birth was painless to his mother, and the precocious infant arose at birth and took several footsteps which were cushioned by lotus blossoms springing from the ground.
The prince was first destined for a royal heritage, for which he married and bore a son. But he became fixed on discovering life’s greatest mystery, the cause and resolution of human suffering. For this quest he abandoned his family and home to practice extreme asceticism, finally resolving to meditate until he discovered the Truth. After 40 days he achieved this stupendous break-through into enlightenment.
Thereafter, he spent decades disseminating this understanding to all who were inclined to receive it. He acceded to the requests of a few (eventually growing into a multitude) to be his disciples. In order to sustain and spread the Dharma-Truth, he permitted disciples to form a monastic order and gave them instructions for living in ways that would further the cause while enhancing their own progress toward Nirvana (the cessation of suffering and the eradication of its cause). At the appropriate time, the Buddha, having accomplished all he needed to do, yielded to death. He reclined in acquiescence and passed away.
This year, because of COVID-19 restrictions on gatherings, the usual massed morning chanting, group meditation, and evening circumambulation of chedis (stupas) will not be held. Mass gatherings, including the famous pilgrimage up mount Doi Sutape here in Chiang Mai, are expressly prohibited. However, I have no doubt that people will still find their way to neighborhood temples to make merit.
[The picture of the birth (left panel), death (right), and enlightenment (center) is from the west wall of the assembly building of Wat Ta Pong, Sanpatong District, Chiang Mai. In virtually every temple, the enlightenment is the symbolic center of attention.]
Early detection of COVID infection is extremely important for the best results from medical intervention. Nobody argues with that. Now it is clear that there is an additional, rather simple, non-invasive test that really helps. It’s something you probably already have become acquainted with. It is a test of oxygen saturation in the blood. THIS TEST SHOULD BECOME AS WIDESPREAD AS TEMPERATURE MONITORING.
It is not hard to learn how to do PULSE OXIMETER MONITORING. It has the huge advantage of telling us when the COVID virus may be active before ANY OTHER SYMPTOMS are suspected.
When oxygen saturation of the blood begins to drop below 80% it would be important to get medical attention. Physicians are now agreeing that a drop in oxygen saturation might be the first symptom of things going wrong as a result of COVID infection.
Here in Thailand I understand every neighborhood public health clinic has pulse oximeter monitoring equipment that will show pulse rate as well as oxygen levels.
In the USA as well as here, pressure to reopen businesses and relax quarantines is becoming overwhelming. People argue, “I’m not sick!” because they don’t feel sick. But the facts are that COVID is a more devious virus than most others. The majority of people who are positive do not feel sick. It’s no use arguing with them. They are beginning to ignore restrictions meant to protect them and impede the spread of the virus. But they might have a second thought if there was some irrefutable fact they could find out in less than a minute such as, “Your oxygen level is dangerously low!”
[Thanks to my friend Roy for drawing my attention to a New York Times article about this, just after I had read several reports of the US Vice President and people at a funeral refusing to take standard precautions for various reasons, including a relative who believes the media is making all this up.]
Creativity has been called forth to deal with the circumstances Chiang Mai has been confronting this month. Here are examples that have attracted attention.
1. A company was wondering how to sell a truck load of durian now that markets are deserted. Other fruit venders were moving to street-sides, but these guys drew a lot of attention when they displayed their assets to advantage. [I’m not sure about sales, but pictures of their attempt drew thousands of views on social media.]
2. Social distancing specifies that people keep two meters apart. So when a fellow wanted to give food to a monk he tossed his bag of rice into the monk’s bowl, and then the monk tossed it to his companion to carry. [The video clip of them doing this was another big hit by on-line viewers, although some of us are convinced it was staged.]
3. Mplus+, an LGBT support community led by Dr. Pongthorn Chanlearn, mobilized to provide lunches to people at the out-patient departments of hospitals during the early panic when there were crowds. [In a blog later, I’ll describe how Chiang Mai is responding to COVID induced hunger.]
4. With hair-care shops all closed, Chiang Mai residents have taken up new skills. Scores of social-media friends congratulated themselves for crossing the sartorial frontier. [Yes, this particular picture did not grab wide-spread attention, but some friends thought it was better than the selfie of me making a mango milkshake.]
5. Finally, thanks to young novices being near at hand when fire threatened Wat Phrabatpanam in Lampoon, the fire caused no damage to the famous temple. [Schools are closed due to both the hot-season vacation and the pandemic.]
The differences in coronavirus infection rates between the USA and Thailand are astounding. Actually, as the virus became epidemic Thailand had reported cases earlier than the USA. However, for reasons not yet clear, the USA is faring worse than Thailand.
In round figures the USA has a population of 330 million, while Thailand has about 65 million. The USA is 5 times as large. As of Sunday, April 19 there are 2733 cases of COVID-19 in Thailand and 726,800 cases in the USA. Instead of 5 times the number of infections in the USA compared to Thailand (5 times 2733 cases would be 13,665 cases in the USA) there are 265 times as many (which is 53 times as many cases if the two countries were the same population). There have been 47 deaths in Thailand but 34,789 deaths in the USA. The US death rate attributed to COVID-19 is 735 times as great as Thailand, or 148 times as many deaths if Thailand and the USA were the same size.
The level of medical competence and availability of healthcare between the USA and Thailand is not really significant. We are both pretty good. The levels of reporting and honesty about the virus could be a factor, but the amount of testing is about the same.
Until analysis becomes dependable the difference between these two countries is a mystery. People guess as to why the virus hit Italy so much harder than Germany, but the facts are still unclear and the disease isn’t over. It is still spreading. Wave two in some countries is starting, and new areas of the world are being affected.
The difficult facts for people to digest are that this virus is more contagious than viruses that have caused epidemics in the last 50 years. It spreads easier, it hides longer in people who spread it without knowing they are spreading it, and we don't have ways to suppress it, yet.
Two medical breakthroughs will need to take place. First, we'll need effective medicines to treat those with the disease. But until a vaccine becomes tested and available to prevent the disease it will continue to spread. It'll spread faster if people begin to refuse to pay attention to medical realities.
Note: Image courtesy of https://www.pharmaceutical-technology.com/
Easter around the world is over; Songkran is upon us here in South East Asia, with Ramadan soon to come. Everywhere, the cry is heard, “That was different!”
Easter, the day churches are traditionally full, was celebrated with empty churches for the first time in memory. Songkran normally fills the streets with revelers happily (or at least wantonly) engaged in water warfare interspersed with visits to elders to bless and be blessed. This year the roadways and streets are lacking crowds. Hotels are empty. Businesses are shuttered. It’s a holiday without the good times. Ramadan will take on equally unusual form as the fasting and feasting are redesigned, mosques are empty, and Mecca is as forlorn as St. Peter’s Square was last Sunday (see the picture above).
By and large, pastors did their best, reminding absent congregations via the Internet of the core symbols: the empty tomb and echoing Hallelujahs. Parishioners appreciated their pastors’ attempts but missed great parts of Easter as they loved it, stalwartly trying to cherish at least some small parts of the new way to Zoom in on Easter. For many the conclusion is “That was not better.” The wait is on to return to normal.
Is normal right around the corner?
US President Trump called for full churches on Easter, but that was before social networks began to show drone clips of mass graves being dug and used in New York, and the US death count passed all other countries. Prime Minister Prayute here in Thailand has extended emergency measures beyond April 16 to the end of the month with the real possibility of close-down going on through May. Even though there are hopeful signs that the epidemic has been turned around in places it hit hardest, it’s clear we’re just entering what I’ll call PHASE TWO.
During Phase One we were required to learn new behaviors symbolized by face masks and social distancing, but also home schooling and frugality. We saw what an epidemic can do, how it spreads, and how it is battled. We grew tense, afraid of things like door knobs and invisible particles in the air. We waited to hear “who’s next.”
Then things began to get better. Air quality was one thing that improved, but so did the news about the disease.
Phase Two, we need to be aware, will be worse than Phase One in several respects. Sequestering, closed borders and businesses, isolation, and suspended plans take their toll. Suicides have begun, protests against the restrictions are gaining the inflamed rhetoric needed to become vigorous, and the disease itself will arise again where it was thought to be spent as it has in parts of China and Korea. A second shut-down order will be harder to enact. In some countries enforcement may need to take on military assistance. If a third shut-down were to loom, hardly any political authority will dare to propose it. The cost of imposing it would be considered greater than the cost of letting the disease run its course.
During Phase Two, the disease will finally begin to ravage populations where massed-living is unavoidable, great slums in particular. Then healthcare systems really will be overwhelmed. People living far from cities will succumb because of their distance from substantial healthcare institutions.
For us who are reading this essay, Phase Two is close at hand. Its first sign will be a collective yell of relief as the infection curve begins to dip and we dare to think we will probably make it through this. Our hand washing will go down from 20 seconds to 15, we will dare to use our masks repeatedly, and we will reconsider travel. Self-imposed restrictions will slip as we relax.
We do not want to hear that this disease will be lethal among us for at least six more months. But part of the dynamic of Phase Two is not only our own battle fatigue, it’s also bound to be tied to the invigorating idea that something is already working. Certain diet plans, exercise regimes, and cutting-edge medicines will gain traction. Pharmaceutical tests will be top news in Phase Two. We will become confident that a medicine is proving itself increasingly effective. We could relax too soon.
If Phase Two goes long enough a vaccine will be on the horizon. When that gets going, it marks the start of Phase Three. COVID-19 will be around for a long time. It’s more devious and lingering than most viruses, but it will eventually become manageable.
However, we will personally benefit from that conquest of the pandemic, only if we collectively navigate through Phase Two successfully without growing weary of doing well.
In the SPRINGTIME when the frost has fled,
The ground becomes a feasting place for life
And fertile seeds in secret spring awake,
Bursting slowly from their hidden tombs
While being somehow nourished, blessed, and fed
By springtime’s cornucopia of grace.
Life is lush and green with hope and growth.
The ground itself turns green and skies are blue
When spring brings on the salad-time of life.
In the SUMMER’S liquid heat the seeds
Are magically transformed as suns enrich
And rains enhance what life’s prospective dares.
Lanky green and springing tall and strong
The plants transform the landscape with their strength
And turn to jungle what was desert waste.
Life itself these grasslands renovate
To change the very space in which life thrives,
Through strength, and growth, and bold maturity.
In the FALL the seeds have borne more seeds
When sun, and rain, and drought have dried the stalks
And death must seem to linger nearer still.
Age has changed the leaves to brittle fronds.
The hardy stalks have lifted up their grain,
A sacrifice, as nature needs, to life.
Golden, bleached with age, the harvest comes.
A scythe cuts down the ripened staff of life
And brings an end to storm, and fear, and strife.
In the WINTER life has lost its grip,
It seems, and once again the ground is bare
And even seeds seem dead, encased in hulls.
Strength is sapped from life and only storms
Are strong where ice is queen and darkness king.
And so, the seeds must seem to die each year.
In the wintertime of life, there’s life
Remaining, hidden for a season’s span
Until the seeds have spent their time at rest.
Rev. Dr. Kenneth Dobson posts his weekly reflections on this blog.