Review of Book "The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss, and Long-term Health"

Dr. Campbell's credentials on the subject of nutrition may be matched but cannot be surpassed by anyone in the world. Combined with his own research and supporting references, which take 36 pages, plus sound logic, his admonition for a whole foods, plant-based diet is overwhelmingly convincing and persuasive. There's no need to repeat other readers' laudatory comments.

There are a few points that I wish could be further addressed. The suggestion that we not consume dairy food is based on the unhealthful effect of casein, the primary protein in milk. Numerous research articles have been published since he wrote this book 20 years ago. I checked most references on the Wikipedia page for "casein" related to potential health issues. Those that have found no health risks are now marked with disclaimers as a standard in scientific publication, typically claiming to have no connection with a commercial entity. That used to be a serious problem when Dr. Campbell wrote the book (see the part "Why haven't you heard this before?"). I believe flagrant violation of ethical rules has died down in the past few decades. In short, more research is needed to confirm or disprove the harm done by casein, or dairy foods in general.

Secondly, an unconditional attack on reductionism is not warranted. Science progresses by synthesis for sure, but more by analysis and reduction. Whole food is healthy and we all should embrace it. But it doesn't mean we should stop pursuing the science of finding the reason why any food, whole or not, is good or bad. Just because we can't narrow down to a few manageable ingredients out of a thousand in today's research doesn't mean we should give up in that direction for good, especially considering that food science may benefit from AI just as other branches of biological and medical sciences do. Reductionism is a fundamental principle in modern science, including nutrition studies.

Having said that, personally, I heed Dr. Campbell's advice and have adjusted my diet accordingly. I've long had in my mind a personal healthfulness rank of animal food, i.e. fish > chicken > pork > lamb ≈ beef. Now I completely avoid beef and lamb, greatly greatly reduced intake of pork, and cut down on chicken. But I still eat fish once in a while, because, well, I'm also a fan of Dr. Andrew Weil, another trustworthy health advocate, and because fish is a big part of Mediterranean and Japanese cuisine. I have changed the cow milk:soy milk ratio of about 3:2 to 2:3, and mostly changed Greek yogurt back to regular yogurt, as Greek yogurt contains more casein, even though I have some doubt about the health issues about casein as I said. Needless to say, I have significantly increased intake of various vegetables and further diversified my choice of vegetables and fruits. In case you missed one point while reading the book: Dr. Campbell has provided us a simple solution to the dilemma that you like to eat a lot of tasty food but don't like to gain weight by eating a lot, and the solution is to eat plant-based food so you can eat it to your heart's content and still maintain your weight. For this as well I do appreciate his wisdom.

Trivia: Some readers complain about the title of the book, because the China Study is only part of the book. According to Dr. Junshi Chen, the counterpart on the China side of this study, the book title was given by the publisher, so it's not that Dr. Campbell is a fan of clickbait. Also, there's one person in the book who is undervalued. Dr. Gopalan and his team published an important paper on aflatoxin in a little known journal in 1968 (Ref.13 of Chpt 2, 16 of Chpt 3). While Dr. Campbell acknowledges the significance of this research, it's worth pointing out that Coluthur Gopalan (1918-2019) is hailed as the Father of Indian Nutrition Science.

(originally published on Goodreads)

Two types of biological sexes and Olympic Games

The most common definition of biological sex is based on physical structure or morphology, but some definitions also include chromosomes. The two types of biological sexes are called phenotypic gender and genotypic gender, respectively. There are a very small number of people whose two types of gender are different from each other, which can cause some confusion. It is necessary to point out in what situations each of the two gender types should be used. Phenotypic gender is almost always the same as the gender assigned at birth because it is easy to determine. If a person's genotypic gender differs from it, he or she will grow up and participate in various activities without knowing it throughout his or her life (unless genetic testing is done). It is the genotypic, not phenotypic, gender that determines secretion of hormones, including testosterone and estrogen, determines some physical attributes, muscle mass, explosive power, etc.

Therefore, for people with the two types of biological sexes having different values, when gender must be specified, different gender types should be used for different occasions. For example, phenotypic gender is often used for surgery, genotypic gender for prescriptions, and should also be used for registration for sports events from now on. The International Boxing Association (IBA) determines gender by genotype. In a letter to the International Olympic Committee (IOC) in June 2023, they pointed out that Algerian boxer Imane Khelif had XY (male) chromosomes in two separate tests, and therefore disqualified her (him) from participating in the 2023 International Boxing Championships. The letter stated, "This situation epitomizes the importance of protecting safe sport, and the integrity of sport in which the Olympic Movement is jointly committed to." Unfortunately, the IBA did not disclose the test results. Meanwhile, the IOC accused the IBA of defaming the IOC. As a result, the IBA's test results were ignored by the IOC, and some athletes who may have XY chromosomes are allowed to participate in the women's events of the 2024 Olympics. It is regrettable that as a tradition, the Olympic Committee still determines gender based on the sex assigned at birth, i.e. phenotypic gender. For the very few who have a different phenotype from their genotype, XY chromosome athletes clearly have a greater advantage in participating in women's events. (Similarly, athletes with XX chromosomes but of phenotypically male gender are at a disadvantage in participating in men's events, although this may never actually happen, for obvious reasons.)

The cost of sex chromosome testing is currently as low as $50, and the average price per person may even be lower if we exempt the athletes who were tested before and exclude certain events that do not need this test. In four years, the Olympic Committee rakes in $7.6 billion. With this income, XY/XX chromosome testing on participating athletes should be routine. The ancients did not know about genes, much less the fact that it is genotypic gender that determines the male hormones which boosts performance in competitive sports (they didn't know because in most cases, this gender is the same as phenotypic gender). But in the second decade of the 21st century, it is high time we corrected this mistake. After all, unfairness in women's competitive sports caused by the XY chromosomes of the few is no less than or perhaps even greater than doping. In sports of body contact such as boxing, there is an added layer of concern, that is safety of the athletes.

Let me reiterate. There are two types of biological sexes. It's horrible to say that biologically male athletes should not compete with female athletes. We must say genotypically male, or as British biologist Dr. Richard Dawkins said, "genetically male boxers should not fight women" (my italics). Dr. Dawkins's Facebook account was deleted because he didn't make it clear to agitated readers as well as muddle-headed Facebook censors that his word "genetically" must not be replaced with the ambiguous "biologically", as those supporting or condemning him did. Once this distinction is made, it becomes clear that we are only advocating the unambiguous definition of gender based on genotype for competitive sports only, leaving the choice of the type of gender, genotypic or phenotypic, alone in other aspects of life. And at the same time, we should respect those people who have one type of gender different than the other, unconditionally in all circumstances. They are one type of intersex or bisexual people, but they are normal human beings just like everyone else.

Excess leads to harm on the same metric as benefit from moderation

Moderation is the key to health. For example, sunbathing can help synthesis of vitamin D in the body, but excessive sunbathing increases the risk of skin cancer. Resistance exercise can help increase muscle mass, but excessive exercise causes muscle strain. These excesses have one thing in common: the harm they cause is not on the same metric as the benefit brought about by the moderate use. For example, too much sun exposure will not actually reduce the synthesis of vitamin D. Excessive resistance exercise itself will not lead to muscle atrophy.

So, are there behaviors or food intakes where overdoing creates the opposite result on the same metric as doing it in moderation? Here is an example:
Can Eating Mangoes Reduce Women’s Facial Wrinkles? Pilot Study Shows Promising Results
A 2020 randomized clinical trial at the University of California, Davis, found that eating 85 grams of mango per day can reduce facial wrinkles, but eating 250 grams can increase wrinkles. The experiment described in the research article is simple and was well done. As for why increasing the intake of mango several times will cause increase in wrinkles, the researchers can only guess: It may be related to the large amount of sugar contained in mango. This guess is not very convincing, but there is currently no better explanation. The paper has been cited in other articles over the past two years, but the test was not further studied by any other team.

The above test only examines one indicator: the amount of facial wrinkles. Moderate intake and excessive intake of mangoes produce opposite results on the same indicator. It is not that excessive intake causes some damage unrelated to the indicator, nor is it that large intakes reduce the amount of wrinkles more, or reach a peak (i.e. Mango intake is no longer associated with wrinkle reduction). I don’t know if there is a special term for this type of test results in epidemiology, but it is certain that such test results are not common.

Another benefit about red meat

Red meat, most typically beef, but also including some others such as pork in spite of its white color after cooking, has had a bad reputation in recent years. International Agency for Research on Cancer (IARC) of the World Health Organisation (WHO) classifies red meat as probably carcinogenic to humans, but scientists caution against misreading of the news. Consumers should not rush to conclude that eating even a moderate amount of red meat is bad. In fact, unlike certain things some of us may intentionally or unintentionally consume, e.g. tabacco, or mercury, which have no safe low limit, red meat with a moderate intake is good to us because it is very rich in nutrition, especially protein.

Now, a new research, published in Nature has just found that red meat, as well as dairy products, can boost cancer therapies. More amazingly, the research even found benefit in trans-fat, which we have for quite some time regarded as a heinous villain against our health. On the other hand, reading this research, we must keep in mind that red meat is said to boost certain cancer treatments and the specific type of trans-fat is involved, but this definitely does not suggest we should eat a significant amount of red meat or even a small amount of trans-fat, because (1) this research is still new, and (2) the cancer treatments in this research are specific, at least for now. Nevertheless, this research is something we may keep an eye on because it sheds new light on our conventional wisdom.

East Asians more likely to carry a gene variant associated with long COVID but ...

According to a preprint research article Genome-wide Association Study of Long COVID, "[t]he allele frequency of rs9367106-C at the FOXP4 locus varied greatly among the different study populations, with frequencies ranging from 1.6% in studies with non-Finnish Europeans to higher frequencies such as 7.1% in Finnish, 19% in admixed Americans, and 36% in East Asians". In other words, non-Finnish Europeans have a 1.6% chance to have this gene variant associated with an increased risk of Long COVID and East Asians have a 36% chance. This is clear enough. But some people misread these simple numbers. One journalist's article LONG COVID GENE FOUND says that "[t]he Long Covid FOXP4 mutations are 7x more common in Finnish people than in non-Finnish Europeans, and 36x more common in East Asians". The author must be interpreting the ratios in the research paper as a number (numerator) over some unit denominator. But if we do care about an inter-race comparison, we ought to say that the mutations are 7.1/1.6=4.44 times more common among the Finnish people than non-Finnish Europeans, not 7 times more. Likewise, East Asians are 36/1.6=22.5 times, not 36 times, more likely than the non-Finnish Europeans to have this mutation.

When that journalist's English article was translated into Chinese and posted to Weibo, the Chinese Twitter-like social media network, an even worse headline was added, "东亚人患新冠长期后遗症的概率是欧洲人的36倍" (East Asians are 36 times more likely than Europeans to suffer from Long COVID), naively equating the ratio of carrying a gene variant to the ratio of getting the disease, a mistake I pointed out in my Weibo posting (along with the Chinese translation). If the doctor of Angelina Jolie, the actress who opted for mastectomy to forestall a possible breast cancer, had told her she would definitely get breast cancer because she carries that gene, he could be instantly famous among the cancer researchers world wide, as a laughing stock.

So, what is the chance of getting long COVID for each race? According to a February 14, 2023 article summarizing data from the US census, Asian Americans are the least likely to get long COVID among the five race categories. However, Asian Americans with long COVID have the highest chance to experience severe symptoms. To put simply, Asian Americans don't easily get long COVID, but if they do get it, their symptoms are very serious, relative to any other race. It would be interesting to reconcile this data with the latest research about the gene variant. It's possible that Asian Americans, the relatively well-educated and well-off group of Americans, follow common hygiene practices better than other Americans, hence lower rate of COVID and therefore long COVID. But due to the FOXP4 gene variant which many East Asians carry, long COVID causes the most severe symptoms to East Asians. There are still missing links in this logic, though. For example, Asian Americans are not necessarily East Asian Americans.

Sleeping pills and Alzheimer

Two seemingly conflicting reports about sleeping pills and Alzheimer:

1. Sleeping Pills May Increase Dementia Risk: Study https://www.webmd.com/sleep-disorders/news/20230303/cm/sleeping-pills-may-increase-dementia-risk-study

2. Alzheimer’s Disease Protein Levels Reduced by Sleeping Pill https://www.insideprecisionmedicine.com/topics/patient-care/neurological-disorders/alzheimers-disease-protein-levels-reduced-by-sleeping-pill/

How do we reconcile these two reports? The key here is to make a distinction among these drugs. The good one, in the second article, is suvorexant, which according to a Google search, is sold under the brand name Belsomra. The bad ones, in the first article, are flurazepam (brand name Dalmane), triazolam (Halcion), temazepam (Restoril), trazodone (Desyrel and Oleptro), and zolpidem (Ambien). So if we ever need a sleeping pill, choose Belsomra and avoid the ones in the latter list, in which the first three here are benzodiazepine (benzo for short). There are more research articles confirming the association of benzodiazepine with dementia than otherwise. To be safe, avoid it.

But why bother with sleeping pills? If you do need one, why not take melatonin, which is naturally secreted in your body and has no truly harmful effect?

Higher Cancer Rates in Men and Alzheimer Rates in Women Due to Genes

It's interesting to read the following two articles together:

Higher Cancer Rates in Men Likely Due to Biological Differences
X Chromosome-Linked Enzyme May Explain Women’s Higher Alzheimer’s Incidence

While men and women have different health-related characteristics, they don't account for the large differences in cancer and Alzheimer incidence rates. This implies that regardless future progress in medical sciences (barring significant gene editing), there will always be more women than men in a high-age group, and at the same time, more of these women suffering from Alzheimer than men unless this disease is completely eliminated.

Acupuncture, TCM, or alternative medicine in general will be fully deciphered

M.D. Anderson (MDA) Cancer Center, the best cancer hospital in the US, posted a message to Facebook, "Pressing pressure points and energy channels that we can’t see may help with headaches, nausea and anxiety." Most readers cheer for or agree with the message. But one reader, a former MDA employee and also cancer survivor, criticized MDA for bringing alternative medicine into its toolbox when even the terminology used by alternative medicine is unscientific, thus tarnishing the image of MDA as a prestigious hospital. He says "What energy channels? What basis is there for the existence of these channels? I note that “Qi” is always placed in quotes. Why? If it’s something that can truly be manipulated, it ought to have an actual name and evidence of its existence. If not, then MD Anderson ought not be promoting something that has no basis in fact."

As usual, this type of questioning leads to a hot debate, and the original poster (MDA) decides to filter out all messages except this reader's initial message and MDA's direct response. My long response to the reader's message is among those filtered out as well. But I'd like to present it below.

The terms "qi", "energy channels" etc. indeed sound pre-scientific. But lack of understanding of the real mechanisms and temporarily using these terms should not blind us from tried-and-proved efficacy of acupuncture to improve certain symptoms, most notably pain. Your attitude is very understandable, and I'd like to compare that to Einstein's toward the probabilistic nature of small particles such as electrons; his "God does not throw dice" implies that he believes the true, non-probabilistic, definite time and place of any particle will eventually be revealed and the quantum phenomena are just one stage in the history of science. Well, we don't know if he'll eventually be proven right on that but we're quite sure many pre-scientific-sounding terms and the theories associated with them in alternative medicine are being rendered unnecessary. Just like we no longer say four humors of a human body, we're gradually substituting pharmacological findings for TCM's classification of herbs into hot-cold-mild-sweet-... The latter can still be retained for pedagogically convenient tools or mnemonics. As to acupuncture, for some reason, the study of the mechanism is far slower than pharmacology. (I recall reading an article about a Chinese Academy of Science biophysicist's research in 1980's.) But just because we don't know the true nature of it doesn't mean we should stop using it if it doesn't cause serious side effects and it works most of the time. (For instance, one pressure point, called 风池--I have to look up the English name--has remarkable reproducibility in temporarily relieving headache.)

The gold standard of double or single blind trials has its limitations, particularly when it comes to pain management (and I think one more field, psychiatry). It's almost impossible for the trial participant to not know if he's in control or intervention group. Instead of blindly blaming reported effects of acupuncture as placebo effect, other strategies such as N-of-1 trials may be adopted. For all its shortcomings, N-of-1 bypasses the said problem of blind trials and most importantly, tests a specific individual's response. When it comes to pain relief, psychiatric treatment, and probably more, it's a norm not exception for one intervention to be valid for John but not for Jack. Acupuncture falls into this category.

(By the way, I'm sorry to hear that you had cancer but I'm glad it was cured or is in remission. I think it's you that I worked with 16+ years ago on the leukemia project. Back then MDA probably did not have integrative medicine. But I think it's a welcome addition, because it helps relieve certain symptoms.)

How to read medical statistics correctly?

The Bright Light News website claims to be "Shining a light on the Covid-19 narrative. Investigate. Facts matter." An article on the website dated August 23, based on statistics from the British government, is titled "More Fully Vaccinated Dying of Delta Variant Than Unvaccinated". This conclusion is surprising, and on the surface of it, is difficult to explain. I checked the original data of the British government website (see the small print after Source for the URL), and found that the Bright Light article quoted the data correctly (see Table 5 on pp.22-23): In the survey, 57.1% of the people who died of the Delta variant of the coronavirus in England were completely vaccinated, and 32.8% of those have not been vaccinated. So where is the problem?

The reality is that the vast majority of the people in the UK, about 90%, are fully vaccinated. Therefore, the ratios 57.1% and 32.8% cannot be compared in isolation. If the former were 90% and the latter 10%, i.e. matching the ratios of the vaccinated and unvaccinated population, and if there is no other factor that confounds the matter, we would be able to conclude that vaccination does not increase or decrease death rate; if the former were to exceed 90%, the latter less than 10%, then it would be that vaccination will increase the chance of dying. In case this is not clear enough, let's see another example. Imagine you have 1000 apples, 900 of them being red and 100 green. If there are a total of 10 apples that have gone rotten, 9 of them red and 1 green, and suppose there are no other confounding variables related to rotting of apples (e.g., some apples are kept in the refrigerator and others are not), then we can say that the color of the apple is unrelated to whether it rots, but we cannot say "Look! Red apples are more likely to rot than green apples, in fact by 9 times more likely!" If 6 out of 10 rotten apples are red and 4 green, we can't say that the color of the apple is unrelated to whether it's going bad or not. On the contrary, we should say that red ones are less likely to go bad, even though 6 is greater than 4!

Medical students must receive formal training in epidemiology. I have read such a textbook, in which there're plenty of such logical questions. But the case above is much simpler than the exercises in this type of textbook, and no special training is required to draw correct conclusions. Sadly, the website that claims "Shining a light" is lacking in basic logical thinking and misleads gullible people into vaccination rejection.

Choline helps reduce Alzheimer's risk for certain people: a new study

The following is a bullet-point summary of a recently published research. Specifically, this is a layman's summary of a medical news article, "APOE4 Alzheimer’s Risk Could Be Abated by Common Dietary Supplement", published on ClinicalOMICS magazine, supplemented with other information such as that on Wikipedia.

• The primary authors of the published research article work for MIT.
• People carry APOE (Apolipoprotein E) genes, which are involved in the metabolism of fats. The APOE2 variant is good, 3 neutral, 4 bad in terms of risks for late onset Alzheimer, as well as cardiovascular diseases. 14% of the general population, but almost half of Alzheimer's patients, have APOE4. Most people have APOE3.
• The Wikipedia page for choline states that "[s]tudies observing the effect between higher choline intake and cognition have been conducted in human adults, with contradictory results". And WebMD article says "Insufficient Evidence for ... Alzheimer disease". But the authors of this new study said "those trials were not targeted specifically to people with the APOE4 gene".
• "[C]holine supplementation ameliorated the APOE4-induced lipid defects... [M]ost people don’t consume that much [of recommended choline]... [P]eople who carry the APOE4 gene may benefit from taking choline supplements... The APOE4 carriers are more susceptible to choline deficiency."
• According to Wikipedia, beef liver contains the most choline per unit weight, 418.22 mg/100g, followed by chicken liver (290.03 mg/100g), hen egg (251.00), "wheat germ, toasted" (152.8), bacon (124.89), soy bean (115.87), pork loin (102.76). Vegetables are not rich sources of choline; the highest are brussels sprout (40.61) and broccoli (40.06), followed by cauliflower (39.10).
• Choline is not considered vitamin. Multivitamins you may be taking do not contain choline. Severe deficiency, which is unlikely, "causes muscle damage and non-alcoholic fatty liver disease" according to Wikipedia.

African/African-American and Non-Finnish European populations more susceptible to COVID-19

According to New insights into genetic susceptibility of COVID-19: an ACE2 and TMPRSS2 polymorphism analysis published on 15 July 2020 in BMC Medicine by Cleveland Clinic researchers,

"the distribution of deleterious variants in ACE2 differs among 9 populations in gnomAD (v3). Specifically, 39% (24/61) and 54% (33/61) of deleterious variants in ACE2 occur in African/African-American (AFR) and Non-Finnish European (EUR) populations, respectively (Fig. 1b). Prevalence of deleterious variants among Latino/Admixed American (AMR), East Asian (EAS), Finnish (FIN), and South Asian (SAS) populations is 2–10%, while Amish (AMI) and Ashkenazi Jewish (ASJ) populations do not appear to carry such variants in ACE2 coding regions"

If needed, Figure 1b can be viewed here. This research of course mean Latinos or Asians can take it easy when it comes to prevention. In fact, the outbreaks in Brazil and India appear to contradict this research. But this research is about genetic susceptibility, not considering the social factors that may play a greater role, such as whether people wear face masks and keep social distancing.

Advice against COVID-19, "wash hands" vs. "wear masks", in the past months

If you recall the advice from CDC and WHO since early 2020, you may notice that they strongly advised washing hands in the first few months, and did not emphasize wearing face masks as much, let alone social distancing. This is unfortunate misguidance to the public in view of the fact that the new coronavirus SARS-CoV-2 is air-borne and transmits more through people's breath and less through touching.[note1] I wish the experts at these organizations had emphasized wearing face masks and keeping social distance more than or at least as much as washing hands early on.

Anyway, to confirm my impression that the ratio of advice on wearing masks to hand washing increased in the past few months, I took advantage of Microsoft search engine Bing's historical searches.[note2] First I search on bing.com for "wash hands" (no quotation marks used) while limiting the time range to 1/1/2020 - 1/31/2020, 2/1/2020 - 2/29/2020, ..., 6/1/2020 - 6/30/2020. I record the approximate search result counts given by Bing. Then I search for "wear masks" and record the same counts. The result is in the following.

  wash hands  wear masks
1    524,000     362,000
2    643,000     557,000
3  2,220,000   1,640,000
4  2,090,000   3,620,000
5  2,490,000   5,350,000
6  2,270,000   4,860,000

The left column is the month, January (1) through June (6). The right column is the search result count for the month. We can tell that "wash hands" was found on much more webpages in March than February as if Americans woke up to the grim reality in March. So was "wear masks". But "wash hands" more or less reached a plateau, while "wear masks" overtook "wash hands" in April and stays in the lead ever since.

This comparison by no means is a direct proof of CDC or WHO's failure to advise the more efficient preventive measure, because the Bing-indexed webpages are authored by all sorts of people. But the public listens to these health authorities. If they say more about "wash hands" and less about "wear masks" and "social distancing", people do it, too.

By the way, the latest Economist magazine has an article Face-off over face-masks: Europe’s latest north-south split, which shows that more and more people in 14 countries started to wear face masks over time. It's interesting to see that Asian countries generally have a sharper rise of the curve than those in Americas and Europe, apparently reflecting the Asian tradition of collective compliance. (The reason China appears to be high all the time is that the data didn't start till February, when COVID-19 was already spread in China.)

_________________
[note1] Not that touching contaminated surfaces is less risky. But the probability of touching such surfaces and bringing the viruses into the body is lower than directly receiving air-borne viruses in an environment where at least one person is virus carrier or spreader.
[note2] Google also provides historical search results. But in these searches, the estimated result counts are not given.

Racial distribution of COVID-19 cases in New York

According to New York City data, age-adjusted rates of COVID-19 cases per 1000000 people as of April 16,2020 are

Race Ethnicity	Non-hospitalized	Non-fatal hospitalized	Known to have died
Black/African American	335.5	271.7	92.3
Hispanic/Latino	271.6	198.6	74.3
White	190.4	114.5	45.2
Asian	95.1	82.2	34.5

combined with NYC demographics

White: 63.79%
Black or African American: 15.64%
Other race: 8.76%
Asian: 8.31%
Two or more races: 3.05%
Native American: 0.41%
Native Hawaiian or Pacific Islander: 0.04%

We can see that African Americans are disproportionately represented as many media outlets or government organizations acknowledged. But less known is that the Asian population is significantly represented as well, if we factor in the proportion of the Asians in the whole population in the city. Note that White is 63.79% in the population compared to Asian 8.31%. This is 7.67 times as much. But the non-hospitalized cases are 190.4 and 95.1, for White and Asians respectively. Note 190.4/95.1=2.00. This means in NYC, Asians are 7.67/2.00=3.83 times as likely to contract the virus (but not hospitalized) as the white. Similar calculations can be done to non-fatal hospitalized cases and deaths.

Optimize bed positions in an area of limited space

The Spanish magazine El País article shows hundreds of beds in a big data warehouse structure.

All the beds are arranged as if they are on the points of a perfect square grid or mesh, each bed about 5 meters (16.4 feet) away from the two on the same row or the two in the same column, roughly as in this pattern

bed..bed..bed
.............
bed..bed..bed

But this is not the most efficient use of space in terms of keeping distance while maximizing the number of beds in this limited space. If we shift every other column of beds down (or up) by half a row, schematically like this

bed.......bed
.....bed.....
bed.......bed
.....bed.....

although the distance between two beds in the same column remains the same, the distance to the left and right beds has increased from 5 meters to sqrt(5^2+(5/2)^2) = 5.59 meters. This 59 cm or about 2 feet of increase in distance may not sound significant, but it's better to not waste any precious space in this situation. In this new arrangement, of course the position of a bed really has to be the position of the head of the patient in bed, since that's where the contagious cough comes out.

First country of a pandemic: guilty or not guilty

As of this writing, the number of confirmed cases of coronavirus infection is almost a quarter million in the world, and there are almost 10,000 deaths. While WHO has long established the convention to not name an epidemic or pandemic after the name of the country where the outbreak started, there's no cease of debate about whether that country is guilty if it had initial cover-up, denial, or do-nothing complacency. A simple answer to the titled question is definitely positive, for the reason that if the country promptly acted to notify the public, prohibit group gathering, and isolate the first few infected, there wouldn't be an outbreak beyond the limited area at all. In terms of deaths that could have been avoided, and the simple fact that death cannot be converted to life, the guilt is inexcusable.

However, there is another side to the argument. If a regular human ordinarily acts in a way that unintentionally leads to damage, the fault becomes excusable and the act is not considered guilt. If it had not been China where the coronavirus was first found and spread, if it had been Italy or Iran or the US, judging by the actions these governments took in the last two months, we may safely conclude that these countries would have made the same mistake as China, i.e. initial denial if not outright cover-up, and lack of preparedness for the spread of the virus (in spite of the extremely applaudable effort in the later stage of virus control). The ethical argument is that if every country or government, regardless its political classification, behaves the same in the initial wrongdoing, this wrongdoing can be attributed to human nature or the nature of a governing body. Even if this is a fault, it's a fault inherent in universal human nature. Just as to err is human, so to err is of the nature of a group made up of humans.

Is the country where a pandemic originates guilty if the country fails to control its spread due to negligence or misfeasance at the early stage? I say it is guilty, but does not warrant blame, because as of year 2020, human civilization has not progressed to the point where initial denial of a virus outbreak is a rare and universally condemned behavior, except when viewed in hindsight. That day will come, and a new epic in human history will begin, hopefully soon, at the end of this coronavirus pandemic. To err is, in general, human and of the nature of a congregation of humans. But to err on a specific type of event is not always so. In the case of initial denial before an epidemic outbreak, now is the time to change this error from being human to being inhuman.

---

[Update]

A reader: Naming a disease after a region is not inherently racist or stigmatizing. The idea that a country should be considered guilty for an outbreak resulting from negligence is completely unjustified. Authorities responsible for harmful cover-ups should be condemned.#2cents# ? I say, no.
Me: You have a good point. If I understand you correctly, we should treat the country and its authorities or government separately. The former is not guilty but the latter is. Correct?
The reader: I'm not going to blame a five-year-old Chinese kid because a fifty-year-old Chinese official lied. The debate is interesting, though. Hitler rose to power in a democracy (the Weimar Republic). Does this fact make the "Germans" collectively culpable? I say, no.

Disinfection and reuse of face masks

There is one topic related to the coronavirus outbreak but rarely covered in English: how to reuse face masks in the midst of their severe shortage in all stores, online or brick-and-mortar. Reusing masks for non-medical professionals is recommended and important. But I have not found any article in English about how to disinfect slightly infected masks in order for reuse.[note] Articles in Chinese however do abound. One written by a non-specialist, 好不容易买来的N95口罩，这么做就废了！！！（N95可重复利用方法） (Doing this to N95 masks you managed to buy would trash them!!! (Methods of reusing N95)), appears to make good sense. This February 8 article is posted by 澎湃新闻, a reputable news outlet. They claim the original author is a person by the Wechat ID 远方青木 or YFqingmu, whose article list around the date, however, does not include this article.

The main points of the article that I find most interesting are as follows (my translations in the parentheses):
KN95（口罩）能拥有这么强的防护能力，核心秘密在于静电吸附原理...静电最怕的就是水...消毒的重点有两个，第一个高温，第二个无水。可靠的消毒办法总共有三种，分别是： (The secret that KN95 (masks) can have such a strong protective ability lies in the principle of electrostatic adsorption ... What static electricity most fears is water ... The keys to disinfection is twofold, the first being high temperature, the second being lack of water. There are three reliable methods of disinfection:)
1、紫外线杀菌 (Ultraviolet sterilization)
2、干式烘烤 (Dry baking)
3、土法消毒 (DIY disinfection)
...酒精含水，能杀病毒没错，但口罩也废了 (Alcohol contains water. It sure can kill viruses, but masks also become useless)

While strong UV radiation works well, most households don't have such equipment. Dry baking or heating is good. But don't put the masks in a microwave because of the metal pieces in the masks. Many Chinese use alcohol to disinfect the masks. But it's said that the masks filter mainly by electrostatic adsorption of viruses instead of, as most people believe, through the tiny air passageways. Any amount of water, including that in alcohol in high concentration, much less 75% rubbing alcohol, disables the static adsorption capability. The article suggests putting the mask in a small jar, seal the jar and throw it in boiling water.

I personally find that a coffee mug warmer you would use in office can do the work too. If the warmer is at least 20w in wattage (no USB type), the surface temperature can be as high as 140F. Contact with the outer side of the mask for a few minutes should be enough for disinfection. You need to rotate the mask once in a while so the whole surface has a chance to touch the mug warmer surface.

Some people suggest using a hair dryer to blow on masks. It should work because the temperature is high enough to inactivate the viruses. The only caution to take is that this should be done outdoors, and the air should be blown away toward nobody, in case some inactivated viruses may fly into air.

Lastly, regarding reusing masks, we may also take the strategy of using multiple of them in turn. For example, you use a new mask on day 1, another one mask on day 2, but back to the first one on day 3, and so on. You can also rotate every 3 days. The reason for setting aside the mask to be reused at least 1 day after is that the viruses may be inactivated simply by loss of contact with their hosts. (The inactivated viruses might actually serve as vaccines!) You may disinfect the mask after you take it off. But leaving it aside for tens of hours alone is also a good way to "disinfect" it.

[Update]
According to the research led by an Academy of Chinese Sciences academician posted on the web on February 27 titled 用电吹风给口罩“充电” ("Recharge" face mask with a hair dryer), the electrostatic of the masks can be recharged, as follows (my translations in the parentheses)

1.将用过的一次性医用无纺布口罩置于大于56℃热水中浸泡30分钟（56℃ 30分钟可有效灭活病毒），通常沸水与室温水（按20℃算）1:1混合后约为60度，为提高灭毒杀菌效果，可适当提高沸水比例；(Put the used disposable medical non-woven masks in hot water with a temperature of higher than 56℃ for 30 minutes (at 56℃ for 30 minutes the virus can be effectively inactivated). Usually, boiling water and room-temperature water (assumed to be of 20℃) mixed at a 1:1 ratio reaches about 60 degrees. In order to improve disinfection and sterilization, the proportion of boiling water can be somewhat increased;)
2.将口罩从水中取出，甩掉表面液滴，平放在干燥的绝缘材质表面（如桌布、床单等），用电吹风机吹烘约10分钟吹干并荷电，或用普通电风扇吹口罩约15分钟，或用普通家用电子点火器对口罩进行全面覆盖的“电击”，通过口罩内部纤维的摩擦或外部放电等，使口罩材料重新荷电。(Remove the mask from the water, shake off the surface droplets, and lay it flat on a dry surface of insulating material (such as tablecloths, sheets, etc.), blow dry with a hair dryer for about 10 minutes to recharge, or blow the mask with a regular electric fan for about 15 minutes, or "shock" the mask with a general household electronic igniter. Recharge the mask materials through friction of the fiber inside the mask or external discharge.)

The video on the webpage shows exactly how this is done. Impressive! The same content of the article is also published on the Ministry of Industry and Information Technology webpage.

______________________
[note] 2020-04-07 Update: CDC just published an article Decontamination and Reuse of Filtering Facepiece Respirators. Interestingly, they recommend "vaporous hydrogen peroxide (VHP), and moist heat" instead of dry heat. There is no mention of electrostatic property of the face masks.

Vaccine for SARS?

Is there a vaccine for SARS (severe acute respiratory syndrome)? The following is a summary of various reports.

In December 2004, the official website of the Chinese Ministry of Science and Technology claims that "中国研制出安全有效的SARS灭活疫苗" (China has developed a safe and effective inactivated vaccine for SARS), which seems to contradict the Wikipedia SARS article, "[t]here is no vaccine for SARS ". According to a 2016 article from healthline.com, "[r]esearchers are currently working on a vaccine for SARS, but there have been no human trials for any potential vaccine. According to a 2018 article from medicinenet.com, “[n]o licensed vaccine had hitherto been developed for any human coronavirus”. But a November 2012 NBC News article says “Chinese researchers expect to begin human trials next month on an experimental SARS vaccine”. I have not been able to find any outcome of or follow-up to that 2012 human trial. According to a Jan 22, 2020 Time article, "[f]ollowing the SARS outbreak in 2003, researchers produced a vaccine that made it to phase one human trials, which test the safety of a new drug. But the effort never progressed further, mainly due to shifting research priorities as the outbreak came to an end."

Eating too much ramen may be linked to higher risk of stroke but not heart attack

The article published on Nutrition Journal on 09/04/2019 explicitly says "The prevalence of ramen restaurants, but not of other restaurant types, positively correlated with stroke mortality in both men and women (r > 0.5). We found no correlation between ramen restaurant prevalence and mortality from acute myocardial infarction." (my italics)

And yet some media such as nextshark.com ("Japanese Ramen Linked to Heart Attack and Stroke Risk, Study Says") or qz.com ("The researchers from Jichi Medical University suspected that ramen, which is high in sodium, might be linked to higher risk of strokes and heart attacks") incorrectly report that the research links ramen with heart attack, technically known as acute myocardial infarction. A heart attack is blockage of the blood vessels to the heart, while stroke is blockage of the vessels to the brain. It's a simple distinction naive people including some journalists are ignorant of. In any case, too much sodium is always bad, although what ingredient or ingredients in ramen are responsible for higher risk of stroke are not directly investigated in this research.

Amount of protein in food

Cleveland Clinic is a prestigious hospital in the US particularly for its heart program. So their newsletters about health are of top quality as well. In the July 26, 2019 newsletter, Which Is the Best Protein Source?, we read

Grams of ANIMAL PROTEIN per 100 grams of:
36.71 veal
36.12 beef
32.08 lamb
28.86 pork
28.74 chicken
25.51 tuna
24.62 sardines
23.63 cheese
22.10 salmon
20.50 crickets
12.58 eggs

Grams of PLANT PROTEIN per 100 grams of:
22.21 peanut butter
20.96 almonds
16.89 oats
9.04 tofu
9.02 lentils
8.86 black beans

This article is adapted from Dr. Hyman's book "What the 
Heck Should I Eat?" (© 2018, Hyman Enterprises, LLC)

On p.37 of Mark Hyman's Food: What the Heck Should I Eat?, we find this list, citing as its source a webpage on wired.com, Know Your Meat—and Bugs. Introducing the Periodic Table of Protein. Unfortunately, the wired.com article does not give the source, which is unusual among articles on a health topic. But it doesn't take long to find that the ultimate source of it (as well as many others such as nutritionvalue.org) to be USDA (US Department of Agriculture), where you can search for very detailed nutrition data, probably too detailed for a non-specialist. Since the amount of protein in 100 grams of eggs is surprisingly low, only 12.58 grams according to wired.com or its downstream book and webpage, let's search for "egg" on the USDA website, and we get (grams per 100 grams of eggs)

Egg, white, dried: 81.10
Egg, whole, dried: 48.05
Egg, yolk, dried: 33.63
Egg, yolk, raw, fresh: 15.86
Egg, whole, cooked, fried: 13.61
Eggs, scrambled, frozen mixture: 13.10
Egg, whole, raw, fresh: 12.56
Egg, whole, cooked, poached: 12.51
Egg, white, raw, fresh: 10.90
Egg, whole, cooked, omelet: 10.57
Egg, whole, cooked, scrambled: 9.99

We can see that wired.com's Periodic Table of Protein or other similar sources quote the protein content of eggs (12.58g) from USDA as probably "Egg, whole, raw, fresh" or "Egg, whole, cooked, poached", not for instance, "Egg, white, dried", which would be too high, nor "Egg, whole, cooked, scrambled", too low. If we search for "veal", the most protein-rich food in the Periodic Table of Protein, on USDA, we get a hundred of entries. I have not determined which of them most closely matches 36.71 grams per 100 grams of veal.

In short, the simple protein nutrition list is a good reference, but it hides a lot of details about whether the food is raw or cooked, which part of the food is measured, and how it is cooked.

Lessons learned from a story of a student that committed suicide

...

(6) If after the counseling, the child is less open to his parents, suspect the counselor, and stop the counseling immediately.

Note Lesson (6), which is related to (5). It is probably the most obscure aspect of mental counseling and yet is of vital importance, literally. It's not uncommon for a counselor to say, perhaps casually just like any non-specialist, that the parents are not caring (enough) or not doing a good job. Except in rare cases where the parents or one parent is truly irresponsible, these defamatory words alienate the child from the loving parents. And in view of the fact that an immature child may trust his teacher or counselor more than his parents, these words are particularly damaging, and could inadvertently push the child toward total isolation and possibly suicide.