Adonis Diaries

Archive for April 12th, 2020

Hey you, stiff-necked Levantine

Note: Re-edit of “Ye, stiff-necked Levantine. April 4, 2009″

We Need you to Walk the Walk of the Free (April 2, 2009)

There are millions upon millions of Lebanese in the Diaspora.

Since the civil war in 1975, anyone who could borrow for a plane ticket immigrated.

In the city of Sao Paulo in Brazil there are more Lebanese descendents than all Lebanese citizens. Many boldly declared that they have cut the bridges and burned the ships, never to return to their homeland, as if infamy was a badge of honor.

This tiny land that was coveted by hundreds of Empires for its milk and honey; this land that exported to the world olive oil, wine, and dried fruit; this land that built cities and created the alphabet; this land that manufactured and roamed the seas and oceans and transacted with every people is reaching bottom.

This land of water and cool sources has no longer potable water.

International Zionism never relinquished its zeal to bust our doors and sap our energy and determination, even after being defeated twice in less than a decade.

This land that exported highly cultured and educated people is reduced to graduating sectarian, uncouth and poorly cultured new generations that barely can read or write.

We don’t want you to come and talk the talk of the sectarian.

We don’t want you to behave the pessimist and defeatist.

We need you to come and walk the walk of the free; to experience the harsh life of the brave, to participate in our miseries, to revolt and to change and reform a tiny Nation that led the world for millennia.

You in the Diaspora, you might have earned individual successes, medals, honors, or riches but you can never erase a tiny dot of the huge and ugly blotch that scars your forehead.

As long as your homeland is humiliated, shriveled, and under-developed among the nations then this scar will be prominent on your forehead and on your descendents’ because you bare a large part of the responsibility for our degradation and instability.

We need you to bolster the fainthearted who dream ever harder to inflating the rank of the Diaspora.

We need you to come and prevent those hot air arrogant bourgeois from taking away the weapons of the steadfast, brave, and resisting patriots.

“Ye, stiff-necked Levantine; ye the uncircumcised in heart, ears, and tongue. My curses are on you and your descendents in the Diaspora to the end of time.

Ye, blasphemous Levantine, wizen up; never dare take my curse lightly!”

Is harsh Procedure for intubating with ventilators killing the patients of Covid-19?

Doctors fighting coronavirus face a ventilator Catch-22

Physicians treating the wave of patients infected with the novel coronavirus face a difficult choice.

As critically ill patients struggle to breathe, healthcare workers have deployed invasive ventilators that take on the job for them—and help protect those around them from infection.

But as more information becomes available about the success of mechanical ventilation in Covid-19 patients, some doctors are questioning whether intubation is the best way to keep these patients alive.

Critically ill Covid-19 patients usually display symptoms of acute respiratory distress syndrome (ARDS)—they can’t efficiently transfer oxygen from damaged lung tissue to their blood.

Typically, the first line of treatment for ARDS is a non-invasive form of assisted breathing: Doctors try to raise oxygen levels by delivering it through a nasal tube, a face mask, or helmet.

Doctors treating Covid-19 patients with ARDS at hospitals, though, may skip less invasive methods and insert a breathing tube into lungs, a process called intubation, to avoid patients’ oxygen levels from falling dangerously.

Invasive ventilation is the most aggressive way to provide oxygen to patients; it literally operates their lungs for them when they cannot. But there’s another reason healthcare workers might favor ventilators over noninvasive breathing assistance: It could help prevent the spread of the disease in hospitals.

“With [Covid] patients we are really starting to bypass non-invasive ventilation, unless you have helmet masks like those Italy has been using, where the patient’s head from the shoulder up is cordoned off,” Robert Aranson, a critical care physician in Pennsylvania, told Quartz.

To be sure, intubating a patient is risky for physicians, nurses and respiratory technicians, who can be exposed to the virus during the insertion of the breathing tube. But after insertion, intubation is better at preventing the spread of coronavirus in the air than a tube or mask that doesn’t isolate the patient’s respiratory system.

“We don’t want to give them high-flow oxygen because when you cough against that jet, the chances you are going to spill [the virus] further is a big problem,” says Dr. Govind Rajan, the director of clinical services in the anesthesiology department at the University of California, Irvine, Medical Center.

That problem is exacerbated by the lack of sufficient protective gear for healthcare workers and resources to separate Covid-19 patients from other sick people.

In this environment, ventilators can start looking like a more attractive option. “The moment the tube goes in, the system becomes closed, the spread of the virus becomes zero,” says Rajan.

To make intubation as safe as possible, hospitals are setting up special rooms for the procedure and limiting the number of healthcare workers who are present. They can also give patients paralytic drugs to stop their respiration before the procedure, rather than after.

The choice to use a ventilator is becoming more fraught as information emerges about outcomes in intubated Covid-19 patients.

Critical care doctors are beginning to worry that stress caused by invasive ventilation may contribute to the grim measures of fatality among Covid-19 patients on ventilators: One recent study of 338 Covid-19 patients (pdf) in the UK who relied upon invasive ventilators to breathe found that two-thirds died.

The researchers compare that to a 36% fatality rate among sufferers of viral pneumonia who relied upon invasive ventilation from 2017 to 2019.

The high rate of ventilator deaths may simply reflect the virulence of the disease, which can progress with astonishing speed, doctors say.

“For Covid, by the time they come into the hospital in any kind of respiratory distress, they go downhill quickly,” Aranson says. “If patients are trending [downward] quickly, they’re going to be better off bypassing non-invasive ventilation.” In Italy, one recent study of 1,591 Covid-19 patients reported 88% received invasive ventilation.

But some clinicians believe that patients with plunging oxygen levels who would normally would be placed on a mechanical ventilator may do better receiving oxygen with less aggressive means.

Measures of oxygen saturation that might suggest the need for immediate intubation may be deceiving, Dr. Martin Gillick of Harvard Medical School told STAT, because the problem is not getting oxygen into the lungs, but from the lungs into the bloodstream.

In that case, using ventilators to increase the pressure of oxygen pumped into the body may do more harm than good.

Rajan echoed these concerns, saying that unlike more common causes of respiratory distress that stiffen the lungs and make ventilation a more sensible choice to get oxygen into the bloodstream, this “virus goes from the air side, hits the alveoli”—the sacs in the lungs where oxygen and carbon dioxide are exchanged—”makes them extremely inflamed and very susceptible to pressure-induced injury.”

He also worries that patients already weakened by fighting the virus and now stressed by invasive ventilation may spur an immune system overreaction known as a cytokine storm. That occurs when the immune system begins attacking the body’s own organs, and may be an explanation for the deaths of younger, otherwise healthy Covid-19 victims.

Even before Covid-19, medical researchers investigated the connection between ventilator-induced lung injuries and cytokine storms in an attempt to explain why so many sufferers of advanced respiratory distress syndrome ultimately die from multiple organ failure.

But the complexity of the interaction between the lungs, the immune system, and the diseases that lead to advanced respiratory distress make it difficult to derive a clear-cut answer. Some investigators say there is no connection between ventilators and immune system overreaction.

Another worry among doctors are the new ventilators being rushed into manufacturing to make up for shortages.

Typical ventilators can be carefully adjusted to change how often the patient breathes a certain volume of oxygen and at what pressure.

If simpler ventilators lack the controls to configure them to a patient’s needs, they could exacerbate ventilator injuries. Nurses and respiratory technicians can take action to ensure the new ventilators are used responsibly, but they are already stretched thin by the crisis.

“Nurses are often the ones setting up the various oxygen therapies,” says Aranson. “Were it not for them, there would be no one to run these vents.”

Rajan is part of a group of doctors who have developed a design for one of those simple ventilators.

The Bridge Ventilator Consortium’s goal is to make the simpler devices available for patients who need breathing assistance but have healthier lungs, in order to free up sophisticated machines for patients with damaged respiratory systems.

Now, he and his colleagues are looking at cheaper ways to build non-invasive ventilators that also prevent the spread of the virus in the air. In Italy, engineers have adapted full-face scuba masks into non-invasive ventilators.

“We do not have the technology to do non-invasive ventilation while at the same time there is no spillage happening,” Rajan says. “It’s Catch-22—if you do not intubate these patients, you risk all the healthcare providers.”

In social idiosyncrasies, the Devil is NOT in the Details

Note: Re-edit of “The devil is NOT in the details; (October 16, 2009)”

Details are the basis for any program execution.  Do details bring people together to communicate, dialogue, and negotiate to reach compromises?

Strong with draft details, can each organization start to sort out the differences and comprehend the big picture? Why it is never the way around in social behavior?

The main wall that separate among communities is the concrete wall mixed with myths, general concepts, and abstract notions.

I will discuss two cases, one religious and the other of political nature.

First case:

After the crucifixion of Jesus, many Christian sects were born in the Near East in the first four centuries.  Fundamentally, these sects were almost identical in applying the Jewish daily rituals or the Jewish 650 laws of “correct” conduct.

What separated these sects were abstract concepts that did not harm their peaceful coexistence in separate communities of believers: they never attacked by force one another. Actually, they tended to isolate their community from “outside” influence

Military persecutions started when the Church acquired central power in Constantinople; and entire “heretic” sects and entire communities had to flee to safety.

The Mighty Wall was erected after 325 AC when Byzantium Empire decided to adopt Christianity as the main religion of the Empire.

Thus, the central power concept of the Empire dictated that church should be centralized.  Instead of focusing in negotiating on the details that split the various sects an upper abstract superstructure on concepts was imposed.

Concepts such as the dual nature of Christ, the deity of the threes (the father, the son, and the Holy Spirit), the virginity of the mother Mary and on.  This time around, the sects were to join the Orthodox Church by force if need be: a central Empire cannot permit disunity, even on totally nonsense abstract conjectures!

Consequently, the labeled “heretic” sects had to flee beyond the eastern shores of the Euphrates River (to the Persian Sassanid Dynasty).

The Nestorian sect reached China and translated “their” Bible into the Chinese language. Many other “heretic” sects settled in the Arabian Peninsula.

The Christian-Jewish “Ebionite” sect was firmly entrenched in Mecca. The uncle of the Prophet Muhammad, Ain Warkat, was the Patriarch of this sect and Muhammad learned to read in the Aramaic Ebionite Bible.

Muhammad aided his uncle in the translation of this specific Bible into the Arabic slang of Mecca.  Thus, Islam is originally a common denominator “heretic” Christian sect, one of many Christian sects in the Arabian Peninsula. The Prophet had to delete all the abstract notions to unite the sects; it was named Islam or the belief in the One and only God.

The strong animosity of the Catholic Church of Rome against Islam was not directed at a religion such as Buddhism or Mazdean but at a new “heretic” Christian sect usurping its central power in the Near East, the Orthodox Church .

The Orthodox Church in Constantinople was more lenient with Islam because it understood its genesis and the causes for the need of this new “heresy”: for Constantinople, Islam was the oriental counterpart of Protestantism to Rome when Islam became the dominant religion in the region.

It is said: “the enemy of my enemy is my ally”; this Machiavellian principle was lost to obscurantist Catholic Church. Rome was too far away and fought Islam with the ignorance of abstract concepts.

For the Catholic Church in 1,000 AC, Islam was doubly “heretic” instead of just the counterpart to the central Orthodox Church of the Byzantine Empire: it failed to realize that if Islam spread so fast and so widely it is mainly because most the labeled Christian heretic sects quickly converted to Islam as representing their system of belief against the monopole of Constantinople.

Second case:

The other case is the concept of a Syrian Nation with well delimited natural borders including Palestine, Jordan, Lebanon, Syria, and part of Iraq to the west of the Tiger (Dujlat) River.

This concept was highly widespread among the people of the region as the Ottoman Empire was dying during WWI.  It was still even more alive during the mandate of France and Britain to the region (Near East) after WWI.

The people in the Syrian Nation speak one language and have the same customs and tradition.  This nation was as natural as ABC; the immigrants were first called Turks during the Ottoman Empire and then they were all called Syrians regardless of location or religion.

The main problem is that the political parties spent two critical decades proving the evident (according to the newer definitions of the West for a Nation) instead of making the effort to developing draft detailed programs on the type of political administrative structure for this nation, the social representation, and election laws.

( For example, is it a Federal structure like the USA where each mandated State is fully autonomous with local government and local parliament, or provinces tailored made to religious, ethnic, and sectarian majorities, or loosely united States with open borders, common money, central army, or centralized foreign affairs; is Syria to be a monarchy and what kind).

Instead of discussing detailed programs, political parties mushroomed with abstract concepts not based on facts or pragmatic long-term goals.

The colonial “mandated powers” of France and England had field days of “dividing to rule”.

Every sect established its political party in every potential State claiming either total independence, or seeking a pan-Arabic Nation of Arabic speaking majorities in States, or Islamic Nation. 

We watched the emergence of communist parties disclaiming the notion of affiliating to a nation, to sectarian parties claiming democracy, socialism, and progressive. The worst propaganda that was encouraged by the colonial powers is to incite citizens against the Syrian people with the objective of discrediting the word Syria and giving it a bad connotation.

Natural borders of chain of mountains, desert, or large rivers do not necessarily protect from invasions; natural borders certainly encourage people to trade and interact inside the borders.  It is the internal rough geography and terrain that protects from outside military incursions.

Once a force crosses the border then Syria is an open land all the way to Egypt. Syria, or the Near East, was continuously occupied by foreign armies: these foreign invaders had to retreat quickly or get absorbed culturally.

Whatever monuments, constructions, temples, sport arena, or scholarly works that were attributed to invading nations (Persia, Egypt, Greek, Rome, or Arab) are basically the work of the Near Eastern civilization, their scholars, their craftsmen, and their adventurous business acumen.

The City-States in the Near East (Tyr, Sidon, Byblos, Ugarit, Mary …) competed in commerce and trade but never attacked one another militarily.  In Greece, City-States frequently waged military wars against one another.  The Near Eastern people adopted defensive strategy; even Carthage in its apogee refrained to antagonize Rome militarily.

Egypt and Persia frequent invasions in the Near East did not last long.

The Greek were absorbed: what Europe claim as Greek civilization is nothing less than the civilization of the Greek translating Syrians authors who spoke Aramaic.

Rome was finally absorbed: the Roman Laws are of the legal minds from the school of Beirut and the latest Emperors were born, raised, and educated in Syria.

The Byzantine Empire was fundamentally a Near Eastern Empire.  The Arabs from the Arabian Peninsula were absorbed when Damascus was selected as Capital during the Umayyad Dynasty.

The “Arabs” were absorbed by the Persian civilization when the capital shifted to Baghdad.

The Mogul retreated quickly but established long lasting Empires in India and Afghanistan.

The Ottoman conquered this land and could not be absorbed: the Syrian people were already exhausted from many years of successive invasions, religious obscurantism, and immigration by scholars to greener pastures.

France and England retreated “officially” within two decades but kept deep footprints in the laws and the administration structure. 

Implanted colonial Israel failed to retreat on time and is now being absorbed as Near Eastern State in social behavior, regardless of Israel propaganda attempts to seeking European image.

Consequently, failing to writing a draft on a possible administrative program for the Syrian Nation opened the door to abstract concept instead of working out negotiation and dialogue on pragmatic matters that concerned the people.




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