On Dr Anthony Fauci

After years of reading individual opinions in this newspaper column, I have learned not to get myself upset by reacting to those whose sources of information are so contradictory to my own take of life realities. I have also restrained myself from offering a different viewpoint to the authors of those opinions, since they have already made up their minds. As humans, our brain processes only what our heart have already chosen to believe, and so there is no point in engaging myself in a civil discussion with people who are not ready to open their hearts.

But I will have to pick up my pen here to stand up for Dr Anthony Fauci, who has been viciously attacked ( Gazette Times mailbag June 21). I have known Dr Fauci for years, his scientific intellect and personal integrity is stellar and exemplary among those who have worked with him in medicine and public health. He is staying on in his official position only because of his deep sense of social responsibility and civic duty in this nation currently so battered by an irresponsible and misleading administration. To accuse him of financial conflict of interest in this pandemic is simply outrageous.

At the end of the day, people will believe and can say what they want, but when we choose to speak ill of others, we only end up disclosing what kind of person we ourselves really are.

(Submitted June 21, published in the Gazette Times, July 2, 2020)

Re-directing our resources in health and criminal justice

For decades, healthcare professionals and advocates have recognized the importance of "social determinants of health" that are beyond the scope of clinical practice and hospital care. Starting with fetal and childhood adverse conditions, and throughout one's life time, diseases and stress-related illnesses are more associated with unsafe environment and poor housing, limited access to good nutrition, education, recreation, jobs, and healthcare services than with genetic factors. Having good hospitals is important, but they often function as fancy and expensive "repair shops" owned by for-profit corporations and are now the greatest cost figures in our health expenditures. 

We are now having a similar re-examination of the role of police and our entire criminal justice system. They have never been effective as deterrent to bad behavior, nor accountable for their social class bias and abuse of force, whether the systemic violence is a knee over someone's neck or a harsher sentencing of marginalized individuals. In practice they ignore the "social determinants of criminality" while deepening injustice and increasing human and societal costs.

I see a historical parallel between the failure of previous half-hearted police and healthcare "reform" measures. There is now a unique opportunity to address in tandem the above social determinants of ill health and crime, their solutions coming down to similar moral and practical interventions. We can, and must shift the huge expenditures we are now spending on our police "forces" and hospital excesses toward investment in our community social services and our preventive public health outreach.

(Submitted to the Gazette Times, Corvallis, June 13, and published on June 25, 2020)

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)