British scientists at the NIHR Oxford Biomedical Research Centre had previously used the glycoprotein spike on the surface of coronavirus—which allows them to anchor at a target cell—to produce a chimpanzee adenovirus—vectored vaccine against the Middle East respiratory syndrome coronavirus (MERS-CoV) They had called it ChAdOx1 MERS and represented many hours of study, research and hard laboratory work that would have hardly ever been funded by a private company—often only myopically seeking quick profits in detriment of the larger public good. When the Chinese authorities published the genome of the SARS-CoV-2, the Oxford scientists immediately started working on their template with messenger RNA.
The Oxford team partnered with other institutions in the United Kingdom and eventually got financial support from Astra Zeneca, a Big Pharma conglomerate. The ChAdOx1 nCoV-19 vaccine uses a replication-deficient simian adenovirus vector ChAdOx1 that contains the full-length structural surface glycoprotein of SARS-CoV-2 with a tissue plasminogen activator leader sequence. They had observed that one single dose of that vaccine had induced good humoral and cellular immune responses in monkeys; after high-dose vaccine challenges, there was a notable protection against the lower respiratory infection, a hallmark of the disease. They set up a combined phase 1 and 2 single-blind, randomized controlled trial, comparing it with a Meningococcal group A,C, W-135 and Y conjugate vaccine.
They recruited healthy adult participants aged 18-45 years old, excluding all those volunteers that had positive COVID-19 tests, had symptoms of acute respiratory distress, or were exposed to the disease like health care workers or first responders. The participants were randomly assigned to receive either the ChAdOx1 nCoV-19 vaccine or the meningococcal vaccine—they used an active vaccine because the lack of symptoms from normal saline injections could eventually “unblind” the controls. The participants were divided into four major groups:
Group I: they had intensive early follow-up visits the vaccine’s safety and immunogenicity.
Group II: they had higher blood volumes of humoral and cellular immunogenicity assessment than group 4.
Group III: it consisted of only 10 participants that received a booster shot 28 days after the first injection.
Group IV: participants that had a serum sample drawn for humoral immunology assessments only.
The median age of participants was 35 years old, 49.8% (536) were female and 50.2% (541) were male; the majority (9 or 90.9%) were white. Some received prophylactic paracetamol and some others did not; 328 (67%) of participants in the vaccine group and 180 (38%) of participants in the control group reported pain afterthe injection. The most reported systemic reactions were fatigue and headache. “In the ChAdOx1 nCoV-19 group, antibodies against SARS-CoV-2 spike protein peaked by day 28 (median 157 ELISA units EU) and remained elevated to day 56 (119 EU) in participants who received only one dose, and increased to a median of 639 EU (360-792) at day 56 in the ten participants that received a booster dose)”
Researchers concluded that one single dose of the ChAdOx1 nCoV-19 was safe and well tolerated, without any major reactions. A single dose of it produced an increase in the spike-specific antibodies by day 28 and the neutralizing antibodies in all the participants after a booster dose. Some studies showed that neutralizing antibodies in the dawn of the disease protected the rhesus macaque monkeys. Antibodies capable of neutralizing live SARS-CoV-2 were induced by day 28 and after a booster dose. T-Cell responses—considered essential for the ultimate defeat of the virus—were evident by day 7 after the dosage and peaked at Day 14. However, the booster dosages did not elicit a similar immunological response.
The researchers admitted that this study had serious limitations, foremost of all that it involved all healthy individuals that were not fully representative of their society. They designed Phase 2 and 3 trials that include older individuals and those at high risk of infection for the efficacy, safety, and immunogenicity of ChAdOx1 NCoV-19 given at a single or two-dosages in the United Kingdom, Brazil, and South Africa. Once they have enough data with adults, they will set up a study with children too.
The incidence and mortality rates of the COVID-19 infections vary widely across the countries, depending on their availability of human and material resources, level of Public Health preparedness and the authorities’ local and national responses. Also there might be differences in ethnic composition, dietary habits, climate differences, social determinants, genetic material, and civic institutions to consider. One of the latest influencing factors that caught the scientific attention is the degree of anti-tuberculosis immunization of the population with the BCG vaccine.
The Bacille Calmette—Guérin vaccine was prepared with a Mycobacterium bovis strain of the TB producing organism in the famous Institut Pasteur of Paris in 1921. Since then several variants have been produced in the developed and developing world. Those of us not born in the USA, still harbor the memory of the painful injection given in our primary school years that left a little scar on our right shoulder. The initial strain was distributed to several laboratories of the world and six major variants were produced: Pasteur 1173 P2, Danish 1331, Glaxo 1077, Tokyo 172-1, Russia BCG.I and Moreau RDJ. At present almost 100 million children are still been vaccinated worldwide; as the vaccine provides little immunity for adult pulmonary tuberculosis, it has been largely discontinued in most fairly developed countries.
The examples of Spain and Portugal are relevant for the vaccine’s importance. Spain, which never adopted the BCG vaccination nationwide, has a mortality rate of 336 people per million inhabitants. Portugal—a neighboring country that shares many of the Spanish societal and cultural features—adopted the BCG vaccination in 1965 and only has a mortality rate of 56 people per million inhabitants.
Abhibhav Shama et al., mathematical researchers from the School of Computer andSystem Sciences of Jawaharlal Nehru University of New Delhi, studied the COVID-19 data from countries that had either had vaccination or discontinued schedules or never had any vaccination. They said that: “disease incidence and morbidity are reduced in countries with universal BCG immunization compared with those that have not adopted the vaccine. The finding also applies to countries in which variables such as climate, dietary habits, and genetic origin essentially coincide.”
During its long utility, the BCG vaccine has shown protective benefits for patients with other diseases associated with mycobacteria like Leprosy. Being a strong immunomodulator, it has been used to treat bladder cancer and other neoplasias.
The researchers divided their morbidity results according to the BCG penetration:
Countries without a universal BCG policy (Belgium, Italy, the United States and the Netherlands) have an increased incidence of 9 +- 497.1.
Countries with an ongoing BCG policy have an incidence of 9+-155.6.
Countries that discontinued the BCG policy have an intermediate value of67 +-509.89.
The mortality results were divided as follows:
Countries with an active BCG policy have 4 +- deaths per million people.
Countries that discontinued the BCG policy have 5+- 33.6 deaths per mil.
Countries with no BCG policy had 1 +- 56.8 deaths per million people.
Considering that the COVID.19 infection affects the older individuals more than the younger ones, the researchers studied its incidence among different age groups. They found that: “The results indicate three significant features as follows: (i) the disease incidence is very low for subjects less than 15 years of age and does not show significant dependence on the presence or absence of universal BCG vaccination policies. (II) The number of infected cases across the age groups is always higher for countries without universal BCG vaccination policy. (III) The differences between countries with universal BCG vaccine policy and countries without such a policy increase and reach their peak for age groups 45-64 and 65-79 years old.”
The researchers found significant differences in countries that had used different variants of the vaccine or combinations of them. The Brazilian and Russian variants of the BCG vaccine were not deemed to work effectively against the coronavirus; in contrast the Australian variant of the vaccine seemed to confer more protection.
In a previous blog we discussed the ongoing clinical studies about the development of a safe and effective vaccine against the virus producing the Covid-19 infection. Thanks to the decades-old research efforts to design and develop a vaccine against AIDS—so far without results due to the complexity and mutations of that virus—there was a significant body of scientific work by the time the SARS-CoV-2 genome was published on March 16, 2020. Immediately several groups started working on the vaccine development and a few of them—counting on the “generous” pockets of Big Pharma and Uncle Sam—could even develop the industrial capacity in a parallel way to make the process faster.
The biotechnology company Moderna, located in Cambridge, Massachusetts, teamed up with the National Institute of Allergy and Infectious Diseases (NIAID) to create a novel vaccine candidate that uses a tiny bit of messenger RNA from the infecting virus to provoke an immunological response in the host. The researchers recently published an initial report in the New England Journal of Medicine. They said that: “The candidate vaccine mRNA-1273 is a lipid nonparticle-encapsulated, nucleoside-modified messenger RNA (mRNA)-based vaccine that encodes the SARS-VoV-2 spike (S) glycoprotein stabilized in its prefusion conformation.” The basic idea is to safely get a tiny amount of highly coated virus mRNA inside a living being to elicit an immunological response without triggering symptoms like respiratory distress. “The mRNA-1273 vaccine candidate, manufactured by Moderna, encodes the S-2P antigen, consisting of the SARS-CoV-2 glycoprotein with a transmembrane anchor and an intact S1-S2 cleavage site.”
The researchers have developed a phase 1-dose escalation-open clinical trial in the Kaiser Permanente Washington Health Research Institute in Seattle and Emory University School of Medicine in Atlanta. The 45 participants were healthy adults whose age ranged from 18 to 55 years of age that received two injections of trial vaccine 28 days apart at dosages of 25 ug, 100 ug or 250 ug; they were not previously vetted for the presence of the SARS-CoV-2. The deltoid muscle was injected with 0.% ml on days 1 and 29; follow-up visits were scheduled at days 7 and 14, after each vaccination plus four other appointments, being 394 the last one. For safety reasons there were four sentinel participants in the 25-ug group followed by four others in the 100-ug group. The participants were charged with recording any local and systemic symptoms and could not use acetaminophen or similar drugs.
There were no serious adverse effects in all the participants except in one of them who developed a transient urticaria after the first vaccination and had to withdraw. None of them reported fever after the first dose; after the second dose, none of the participants in the 25-ug reported feverish symptoms. In the 100-ug group, 6 participants had fever and in the 250-ug group 8 did—only one had severe fever. “Binding antibody IgG geometric mean titers (GMTs) to S-2p increased rapidly after the first vaccination, with seroconversion in all participants by day 15. Dose-dependent responses were evident. For both assays, the median magnitude of antibody responses after the first vaccination in the 100-ug and 250-ug dose groups was similar to the median magnitude in convalescent serum specimens, and in all dose groups the median magnitude after the second vaccination was in the upper quartile of values in the convalescent serum specimens.” The titers of both binding and neutralizing antibodies produced by the vaccine were similar to the ones found in the convalescent serum of patients that had been infected by the SARS-CoV-2. They found that S-P2—the antigen inside the vaccine—induced the activation of high-quality functional antibody responses and Th1-biased T-cells that block the replication of the virus in the respiratory system—one of the leading causes of death.
The researchers considered that the 100-ug dose of the mRNA-1273vaccine is the best shot to neutralize the virus and at the same time promote the activation of the immunological system. In a CNN interview, Dr. Tal Zaks, Moderna‘s Chief Medical Officer, said that they need to make sure that the benefit/risk ratio of the vaccine candidate warrants its deployment in a population that is still largely free of the virus. They have recruited thousands of volunteers for a big phase 3 efficacy trial this month.
Last April Moderna received U$ 472 million from the U.S. government’s BiomedicalAdvanced Research and Development Authority (BARDA) to contribute financially for the development of their promising vaccine. On July 26 the company announced that it had received an additional U$ 472 million to prop their project. As we said in a previous blog, the governments of the richest countries are already positioning themselves for the poleposition to claim priority for the precious vials of a functioning vaccine. Less financially endowed countries (like Argentina, Brazil and South Africa) that also have a significant pool of qualified scientists and a basic Public Health infrastructure became enthusiastic hosts of the trials (providing volunteers and services) to leapfrog to the queue’s front.
On July 27, both Moderna Inc. and Pfizer Inc. announced the start of their decisive and separate clinical trials that will involve thousands of participants in many countries.
May God Almighty grant wisdom and determination to these researchers and volunteers.
Note. The featured image is a reproduction of the oil painting of William Jenner, the English physician that designed the smallpox vaccine in the early 19th century.
Good morning. The very best food for your first meal of the day (be it breakfast, late breakfast or lunch) is half an orange or grapefruit squeezed in fresh water; the other half should be treated like we did when we were kids and our dear mothers or grandmothers gave us one. Just suck it and eat the pulp. splashing you face with its powerful vitamins.
There is empirical data about the healthy effects of the citrus fruits – lemons, limes, oranges, grapefruits – to fight the SARS-CoV-2 producing the horrible world pandemic. Why not follow the wise counsel of so many physicians and dietitians that observed it? Take the first step by picking some lemons and oranges next time you visit the market. Thanks to the wise recommendations of our “personal physician” (our son Gian Luca) this is how we have been starting our days at home ever since the middle of March.
Last Sunday, Betsy DeVos, the US administration’s Education minister showed up in a TV political show to defend the call of President Trump to “open the schools.” In a recent Washington Post article, Jennifer Rubin criticized her avoidance of the hard choices and expensive policy/administrative measures that the government has to previously put in place before allowing millions of children back into classrooms. “No, she does not have a plan. Does she want schools to follow the CDC guidelines? She talked in circles but really could not say. If there is an outbreak, should schools go back to distance learning? More double talk. Well, how about teachers who cannot go back because of their own health risks. More mumbo-jumbo.”
The Trump administration might be trying to play politics with such a delicate issue by trying to steamroll the opening of schools across the state and local authorities, but there are other voices from a different political stance that are asking the same. The American Academy of Pediatrics has called for their immediate re-opening. In a guidance paperpublished in their website, they said: “ Schools are fundamental to child and adolescent development and well-being and provide our children and adolescents with academic instruction, social and emotional skills, safety, reliable nutrition, physical/speech and mental health therapy, and opportunities for physical activities…” They enumerated several policy measures to make re-opening feasible.
The draconian socio-economic measures taken in the past four months to enforce the needed Social Distancing, including the closing on countless small businesses and myriad services across the country, has worsened wealth disparities in the USA. In a Yahoo Finance brief, Andy Serwer said: “According to a report earlier this year from the non-partisan Pew research Center, the richest families in America now take home 48% of aggregate income in the U.S. versus 29% in 1970, (with the top 5% faring best of all) Middle-class income fell from 62% to 42% over the same period.”
The closing of schools for so many long months will exacerbate the food insecurity already experienced by millions of US households before the pandemic; a survey of the U.S. Department of Agriculture stated that 14% households had children with food insecurity. For all those of us who are witnessing the incredibly long lines of drivers waiting in their cars for their turn to open their trunks and have food items stashed by the delivery stations’ volunteers from food banks/ charity organizations, we know that the income inequality and poverty are getting worse in our society. Sadly, the unemployment rate after the pandemic will affect Minorities much worse as the areas most resiliently affected will be Education, Care and General Services.
In an online comment in The Lancet, Wim Van Lancker and Zachary Parolin said: “research suggests that non-school factors are the primary source of inequalities in educational outcomes. The gap in mathematical and literary skills between children from lower and higher socioeconomic backgrounds often widens during school holiday periods. The summer holiday in most American schools is estimated to contribute to a loss in academic achievement equivalent to one month of education for children with low socioeconomic status; however, this effect is not observed for children with higher socioeconomic status.”
The carelessly hasty re-opening of most places of big public gatherings like bars and restaurants, without a statewide mandate to wear a face mask and to keep social distancing, produced a tragic spike of new Covid-19 infections in the state of Florida. In late March, the state authorities were gloating about the supposedly “mild” and “manageable” number of infected persons in our state, compared to New York. The influx of thousands of tourists fleeing the pandemic in the North and the crowding of beaches and entertaining venues produced a disastrous sanitary picture at present.
One of the associate factors that might have had a critical influence could have been the high incidence of Obesity in young people in Florida and the nation as a whole. S.L. Philip et al studied the state’s adult obesity rate by using the electronic healthrecords (EHRs) available from the statewide clinical data research network called the OneFlorida Clinical Research Consortium—filled with data from claims of more than 12 million patients of the Sunshine State. They found that: “Among the 1,344,015 adults in OneFlorida with HER data and who met inclusion criteria, the obesity rate was 37.1%. Women had higher obesity rates compared with men. Obesity rates varied within racial/ethnic groups, with the highest rate among African-Americans (45.7%)” [i] The Robert Wood Johnson Foundation prepared a report in 2018 called the National Report of Children’s Health where they found that the state of Florida ranked 13th in the nation with their rate of childhood obesity.[ii]
Graselli, Zangrillo and Zanella studied the characteristics and outcomes of 1591 patients infected with Covid-19 that were subsequently admitted to Intensive Care Units (ICUs) in the region of Lombardy in Italy; they found that their median age of 63 years, with only 203 patients (13%) younger than 51 years old.[iii] The initial epidemic outbreak in the province of Wuhan, China, had a similar age prevalence. When the pandemic struck the USA, similar results were expected, especially because, at least initially, the national and state authorities were mistakenly giving a “modicum of assurance” to young segments of the population as they emphasized the higher incidence in patients older than 65 years old and with chronic conditions.
In a recent communication to The Lancet, David A. Kass at al. wrote: “However, as the pandemic hit the Johns Hopkins Hospital in late March 2020, younger patients began to be admitted to our ICU, many of whom were also obese.” Slowly but surely, other professionals started to communicate that obesity was an underappreciated risk factor for the disease. The USA has a general prevalence of 40 % of Obesity in its population, compared to a meagre 6% in China, where the pandemic had started.[iv]
Using the least squares univariate and multivariate linear regression, they studied the data from 265 patients (58% of whom were males) that had been admitted to several major medical centers, including Johns Hopkins, to determine the relationship of body mass index (BMI) and age in patients infected with the SARS-CoV-2 virus. They found an inverse correlation between age and BMI, whereby younger patients admitted to ICUs were more likely to be obese; there were no gender differences. They said that: “Obesity can restrict ventilation by impeding diaphragm excursion, impairs immune response to viral infection, is pro-inflammatory and induces diabetes and oxidant stress to adversely affect cardiovascular function.” [v]
[i] S.L. Filipp, M.Cardel, J.Hall et al., Characterization of adult obesity in Florida using the OneFlorida Clinical Research Consortium, Obesity science Practice 2018 August; 4(4):308-317. Published online 2018 June 15.
[iii] Graselli G., Zangrillo A., Zanella A. et al., Baseline characteristics and outcomes of 1591patients infected with SARS-Cov-2 admitted to ICUs in the Lombardy Region, Italy, Journal of the American Medical association (JAMA) 2020; published online April 6, 20202.
[iv] David A. Kass, Priya Duggal, Oscar Cingolani, Obesity could shift sever COVID-19 disease toyounger ages, Correspondence, The Lancet, Published online April 30, 2020.
-“Doctor…when I arrive home, I can’t help lashing out at the kids—feel so guilty.”
Verschiebung. This German term can be translated as “Shift” or “move.” It was used by Sigmund Freud to describe a particular psychological defense mechanism; it entails the shifting or displacement of an aggressive and potentially dangerousemotion from an important person or object into other ones that are less relevant and often lame. [i] Our patient had many situations of emotional frustration in her blue- collar job with her despotic boss and his unreasonable demands at work but she hid her anger towards him and the system, fearful of losing her job in tough times. On many occasions, she scolded her children a little bit too much for not completing their homework or for just some obnoxious but inconsequential pranks.
This unconscious defense mechanism is an expression of what Freud had dubbed as the mortido—our basic aggressive drive. There are three basic mechanisms:
Displacement of object
Displacement of attribution
A – Displacement of object
Some acrid emotions are displaced from one person into another one. Our patient’s anger toward her boss—who has authority and power to decide on her economic survival—had indeed been transferred into her children—who are totally innocent and incapable of posing a threat to her as they are dependent on her. This situation will sadly become much more common in our modern societies because the SARS-CoV-2 pandemic has furloughed millions of workers worldwide and many of them will not be able to return to their old jobs due to inevitable closure of businesses. In the much more genteel days of Freud’s practice in nineteenth century Vienna, he put the example of children’s animal phobias; in order “to sanitize” their fears towards their parents, some children develop aversion to certain animals: dogs, cats, spiders.
B – Displacement of attribution
A personality trait that we might see in ourselves but that we consider as socially unacceptable or even reprehensible will be transferred to another person or entity. The typical example is a closeted homosexual who engages in continuous joking about gays or other LGBTQ individuals to perform a psychological projection. We can also find extreme examples in History like the horrific persecution of gays in Nazi Germany conducted by Ernst Röhm, co-founder with Adolf Hitler of the Sturmabteilung (SA); he was a barely disguised homosexual that was executed in the middle of an orgy by the German Army—fearful that his formations were gaining too much strength in the street—during the Night of the Long Knives in 1934. [ii]
C – Bodily Displacements
It consists of the attribution of a sensation experienced by one part of the body to another distant one; one of the commonest instances is when an oral sensation “is experienced” as coming from the vagina. John Cleland wrote a book in 1748 titled Fanny Hill or Memoirs of a Woman of Pleasure[iii]where he used funny euphemisms in order to refer to body parts that were not openly mentioned in prudish Albion; he dubbed the vagina as the nethermouth. He was a rebellious writer and some sources claimed that he finished it when he was serving a prison sentence for a bad debt. He printed it in two installments in November 1748 and February 1749; he was released from prison in March 1748 (he graduated from the University of Life…I like him)
“I picked two fights at work. One with a customer and one in a Slack [iv] queue with my colleagues, and I regret both terribly. They are possibly the first two fights I have ever instigated in my life. Wish I could have hashtagged those. #furstfightbearwithme.”
Ms. Chrissie, a lovely, clever, funny fellow writer and blogger [v], honestly shared her unfortunate event in a recent blog, which triggered this reaction from yours truly:
“The little anger that you inadvertently vented against two individuals is part of the humongous one building up in the street. It happened to almost all of us lately.”
Unfortunately as we slowly come out of our forced Social Distancing and we interact more with our fellow human beings, we will discover that not only they, but us as well, are displaying a shorter fuse and we might snap at the slightest incident. We might be able to contain ourselves outside our homes, with an occasional “mea culpa” if we allow our emotions to get the best of ourselves in the survival frenzy. What we have to keep clearly in mind that we cannot—absolutely cannot—bring that heightened state of alertness and potential aggressiveness to our dear families. Maybe we should go back to the old ways from our ancestors to vent off that stress.
Get the punching bag from the attic. Paste the image of your boss right up.
On April 27, 2020, The Sun, a British newspaper with an American edition, published an article about a National Health Service warning about a new presentation of the Covid-19 infection in children; it even had flashy pictures of the new syndrome. The alert was sent to general practitioners in North London where the chiefs of health care delivery said: “there is growing concern that a Covid-19 related inflammatory syndrome is emerging in children in the UK…Over the last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.”
On April 27, 2020, the Pediatric Intensive Care Society of the United Kingdom issued a statement warning health care providers and parents that there was “an increased number of novel presentations of a multi-system inflammatory disease in critically ill children infected with Covid-19.” They recommended parents to seek proper professional help if their children had any of the following symptoms:
Becomes pale, mottled and feels abnormally cold to the touch
Has pauses in their breathing (apneas), has an irregular breathing pattern or starts grunting
Severe difficulty in breathing, becoming agitated or unresponsive
Is going blue round the lips
Has a fit/seizure
Becomes extremely distressed (crying inconsolably despite distraction), confused, very lethargic (difficult to wake) or unresponsive
Develops a rash that does not disappear with pressure (the Glass test)
Has testicular pain, especially in teenage boys
On May 4, 20220, the New York City Department of Health issued its Health Alert#13 stating that 15 children in New York City hospitals have been identified with a multi-system inflammatory syndrome that resembles Kawasaki disease and/or toxic shock syndrome. The NYC experts said that: “clinical features vary, depending on the affected organ system, but have been noted to include features of Kawasaki disease or features of shock; however, the full spectrum of disease is not yet known. Persistent fever and elevated inflammatory markers (CRP, troponin, etc.) have been seen among affected patients. Patients with this syndrome who have been admitted to pediatric intensive care units (PICUs) have required cardiac and/or respiratory support. Only severe cases may have been recognized at this time.”
On May 9, 2020, Governor Andrew M. Cuomo of New York informed in his daily update that three children had died of this multi-inflammatory syndrome in the New York area hospitals. Moreover, they had already identified up to 75 children with the syndrome. They were initially admitted without any respiratory symptoms but they all testedpositive either for the virus or its antibodies. He warned that it is a developing serious situation.
Sadly, the emergence of this Kawasaki-like syndrome might just be the tip of the iceberg.
The quasi-centennial woman had been living in the same humble shack with a loyal dog and a dozen chickens in a small clearing of one of the most forbidding sub-tropical forests of South America—El Impenetrable, a large expanse bordering the Bermejo River in the northwestern part of Chaco province and the southwestern part of Formosa provinces of Argentina. One of her many grandchildren, and sometimes even a great grandchild, would come to check on her and bring supplies almost daily but they all preferred to live in a nearby small urban settlement.
She claimed that her social isolation in such natural habitat suited her just fine. She woke up early every day to do her homely errands with enthusiasm, preparing her own meals based on a largely vegetarian diet with some poultry or freshwater fish. She continued to smoke moderately, and she sometimes drank a little alcohol too. When the reporter asked her what the secret of her unusual longevity was, she said:
“Because I don’t have a man that heats up my head every day.”
The forced social distancing and isolation brought by the Coronavirus pandemic has forcibly obliged millions of people to stop working in public/ private institutions or attending educational institutions with a resulting estrangement from other persons. Individuals with stable sex partnerships have been traditionally considered as more apt to withstand the Mental Health consequences of this kind of social situation. However, the previous existence of millions of men and women who had expressly chosen a single lifestyle in modern societies has gravely questioned that assumption.
In an article of the Health section of The Washington Post, Joan DelFattore reviewed the responses from several singles contacted by e-mail or found in the social media. “This is the moment I’ve been training for all my life!’ an unnamed introvert asserts in a Facebook post…Edie Jarolim, a freelance writer and editor in Arizona, can relate to that sentiment—that adults who have chosen to live alone may be better adapted than many to the stay-at-home restrictions in place in large parts of the USA.” Most of the respondents were nonetheless concerned that they could be discriminatedagainst if rationing of the scarce health care resources—lifesaving ventilators for example—were eventually instituted in a dramatic junction of this terrible pandemic.
A longstanding complaint of the singlehood-by-choice surfaced again: the lack of respect for their lifestyle choice from the mainstream citizenry. Many persons confound the fact of “being alone” with the sentiment of “being lonely.” Especially because they disregard that many of these singles do have a strong social support. Moreover, the lack of sentimental strings prods them to seek a varied company.
Since Biblical times, humans have been strongly encouraged to socialize and live in partnership with the opposite sex for healthier social outcomes. There has been a large pool of scientific literature to buttress the need for a stable sexual partner to avoid anxiety/depression, insomnia, obesity, cardiovascular disturbances, etc. But how about those individuals that expressly chose the singlehood to be more creative?
Julie C. Bowker, Miriam T. Stotsky and Rebecca G. Ekin published a seminal paper in 2017 where they examined the links between the withdrawal subtypes and some psycho-behavioral variables, finding challenging results for the avoidance models of withdrawal; they found that unsociability is associated positively with creativity. Julie Bowker said: “they are not antisocial…they don’t initiate interaction, but also don’t appear to turn down invitations from peers. Therefore they may get just enough peer interaction so that when they are alone, they are able to enjoy that solitude.” In order to study these unsociable-by-choice from the truly shy individuals or those who exhibit abnormal anti-social attitudes, they recruited 295 college students and subjected them to a battery of psychological testing. They found that those who were in fact shy or antisocial scored lower than average on the creativity indicators; the participants who were “unsociable” scored higher on those same indicators.
These authors proposed that unsociable persons “may be able to spend their time in solitude constructively, unlike shy and avoidant individuals who may be too distracted and/or preoccupied by their negative cognitions and distress.”
A question that has lingered in our mind for many years might merit to come into the open on this occasion. Like most human beings, we have commiserated with the miserable and lonely life that Vincent Van Gogh endured until the very last instant of his tortured life. However, would he have been able to produce so many beautiful tableaux of so many simple situations if he had been a most happily married man?
A few days ago we attended a webinar given by a supposedly academic expert in Mental Health on the psychological consequences of forced social isolation. After an initial good exposure of expected consequences of loneliness and isolation in human beings, the presenter started to wallow in a sea of unbelievably banal platitudes, which were tagged by a cohort of naive attendees asking inconsequential questions. Right away we knew that she did not a have a clue about the effects of this kind of brutally enforced isolation.
For all the countless diplomas held by both the speaker and the attendees, they were evidently lacking the most important one to guarantee the expertise for this subject. Not a single one of them attended the tough course work of the University of Life. Not a single one of them was summarily given a crash course on isolation: jailtime.
In the seventies, the brutal military dictatorships of Uruguay and Argentina (where we were studying our medical career at the time) did not have any efficient methods to verify the identity and criminal records of anyone they stopped in the street during their frequent fascist “razzias” [i] to detect the presence of leftist political activists. When the officer in charge of the platoon decided that you could be a suspect, you had to silently comply with the arrest order and ended up in a police station, waiting for their request for records to go through the official channels. Without any protest.
In one of those “passes”, an ageing pickpocket who was a regular of that jail told us:
-“Listen, young man…I don’t know how long they are going to keep you here. Most likely just a few days and then they’ll let you go. But, just in case, you have to learn and use the two basic principles of survival in jail. It’s mandatory here—”
-“Oh, yeah,” we replied with a touch of sarcasm. “What are they?”
-“The first one is to always keep track of time, with any possible means. If you do not have any idea of what day of the week and what hour of the day you are living, you will progressively deteriorate…Seen too many guys like you going downhill.”
-“And the other one?”
-“Follow the leaders’ instructions and respect the discipline inside a jail…It’s the only way to survive without any lasting mental or physical consequences…Got it?”
-“Yeah…I guess so…”
-“Good. Grab this,” he said, handing us a broom.” “Last arrival, sweeps the floor.”
The two basic survival techniques in a situation of extreme forced isolation are:
Safeguard your circadian rhythm at all times
Adhere to a strict discipline of basic social and personal tasks
A – Safeguard your circadian rhythm at all times
An extreme situation of forced isolation from the rest of society will bring extreme anxiety and ultimately depression to any but trained soldiers or hardened criminals. One of the first things that happens is that, almost immobilized in a very limited space where the normal parameters of life vanish, you start losing the sense of Time. Slowly you lose track of the hours or the period of the day; if you spend more than a few days of seclusion in a closed space, you will start losing the sense of Seasons.
The multiple sensorial stimuli that our body receptors catch during a normal day will suddenly disappear or at least significantly diminish during a forced isolation. We will no longer feel the blinding effect of the early dawn Sun coming from the East. We will no longer smell the enticing aroma of a delicious dish signaling it is noon. We will no longer see the sudden rush of people in the street marking rush hour time.
Like a mechanical grandfatherly clock that, in spite of all its majestic presence, needs the regular clanking of a little winding knob in the back to keep working, our internal biological clock needs those stimuli to regulate our bodily functions properly. We all have our routine eating, grooming and sleeping schedules that suit our needs. When you are in jail, you might spend too much time sleeping or lounging in bed. Not in a mood to appreciate the little pleasures of life, you start to skip many meals. Resentful of your sort and disdain courtesy for others, you use the bathroom at will.
The first order of the day should be to wake up at a reasonable time during daytime; if you are used to working or studying at night, then you can revert the directive. The second order of the day should be to fill your day with meaningful tasks that are useful for yourself and the individuals that are sharing the compulsory confinement. The third order of the day is to always find a glimmer of sunshine or outside light. Even with a minor stimulus of the temperature and vision receptors, our hormonal system (with the Hypophysis directing the responses) will better regulate our bodily functions.
One of the most annoying side effects of this isolation is an unrelenting constipation. You must sit down at the toilet regularly, even though you might not feel the need. If the organic waste materials, which will continue to be produced even with a more meager amount of food intake, keep accumulating in our bodies, they will poison us.
B – Strict discipline for basic Personal ad Social tasks
One of the most disseminated misconceptions in popular lore is that prisons are a place of constant chaos, of unbridled lawlessness, of unchecked release of passion. On the contrary. The best run prisons are steered with a firm hand accepted by all. The only way to have a semblance of functionality with so many people with different interests in such a limited space is to prod everybody—prisoners, guards and administrative cadres—to respect the basic rules of a peaceful co-existence.
When one of your companions with a higher hierarchical role in your organization is also confined with you, you will naturally follow the informal power structure. One of the more memorable film scenes happens when the British Army survivors of the Fall of Singapore[ii], after a tough trek through malaria-infested territory , march in formation into the prisoners’ jungle camp, led by a solemn Alec Guinness playing their top officer, whistling the tune of The bridge in the River Kwai.[iii] Simply Stupendous.
First of all , you must respect the general guidelines, which in our case are enforced by the police and first-responders’ personnel who are bravely exposing themselves in the line of duty. Then come the particular guidelines of where you reside, which are related to the basic sanitary and safety measures of buildings, apartments, neighborhoods, etc. Finally you have to consider the personal guidelines for all those living under the same roof, i.e. your parents, your spouse, your children, your guests, your personnel, etc.
If you only have one bathroom, you cannot spend an hour singing in the shower. If there is a communal sharing of the kitchen, you must always clean up after yourself. If there is a pet in the house, you must take turns to clean it, to exercise it, etc. If there are children, you must consider their critical need for distraction with games, TV, etc. If you like to smoke, you must go out in the patio to avoid the secondary smoking damage to others. If you like to listen to music, you must lower the volume, especially at nighttime.
If you follow all the basic rules of co-existence, you will have the peace of mind to sit down in a comfortable setting to then read, study, write, work at a distance, etc. The methodical practice of studying and writing at home for many years already has prepared us to rather smoothly transition our lifestyle into this forced social isolation. Our son Gian Luca, a student at Florida State University, is sharing this ordeal with us and we are carrying our professional and academic tasks with a certain panache.
Gian Luca just told us that Stanley Kubrick, the famous cinematographer that loved Vincent van Gogh’s paintings, used the remembrance of the tableau that serves as our featured image to design a scene in A Clockwork’s Orange where the inmates of a juvenile detention center walk around in a small circle of the prison yard, surrounded by tall brick walls and under the attentive eye of the armed guard. Moreover in another one of his films, one of the lead characters offered a book about van Gogh as a gift. Even though we did see the film many, many years ago, we could not remember that scene. But the keen filmmaker’s eye of Gian Luca has stored thousands of images in his brain. The close interaction with our dear son in this forced isolation. A little heavenly perk.
As François Macron, the President of France, just said addressing the French Nation:
[i] Term in Italian that refers to the sweeping incursions of the police and military in their enemy’s territory, searching for opposition activists. The military dictatorships considered the civilian population of both countries largely as “their enemies.”
[ii] In the beginning of World War II, the British Army considered that their bastion of Singapore could not fall to the Japanese Army as high caliber artillery was arraigned against the sea entrance lanes and the British Navy patrolled them round the clock. But the Japanese marched down through Malaysia and swiftly approached the city from behind, where it was less powerfully defended.