Discussions of Book of Mormon issues and evidences, plus other topics related to The Church of Jesus Christ of Latter-day Saints.

Saturday, February 29, 2020

The Power of Trust

What a blessing it is to have friends who are truly honest and trustworthy! Can you imagine what life would be like if we lived in a society where such integrity was universal, where we did not constantly need locks and guards to calm our fears?

This topic comes to mind because it was the power of trust among multiple friends and acquaintances in China that just helped us in a difficult spot. My wife and I came back to the US as "medical refugees" from China who realized, while on vacation in Vietnam in January, that we had better not go back to our home in Shanghai for now, or perhaps forever, due to the rise of the Corona virus, now known as SARS-CoV-2. There were so many things we would have packed when we went to Vietnam if we knew we might not ever set foot in our apartment again. Sadly, as I previously reported, I argued against repeated feelings that maybe I should bring more medication, my journal, and other items. I had very logical reasons for traveling light and not bringing along precious things to a country where crime was said to be higher than in China.

After we abandoned China, at least for now, I realized how wise it would have been to at least extract a handful of needed items, especially my journal. My wife had the same experience, recognizing that for the welfare of students in her school, she really should have brought along a stack of tests to grade that she felt she ought to bring along as we were packing, but then offered logical reasons why that wasn't needed (there would be plenty of time after we returned to grade the tests). But now we were away from home, perhaps permanently, and like most refugees of any kind, were seriously unprepared. I'll say, though, that we have been the luckiest refugees ever, able to come back to family in the US and live in relatively comfortable conditions in cold Wisconsin with the joyous distraction of many grandchildren. Still, I felt so foolish for not bringing my journal and some other needed items, and really felt a need to also obtain some key documents back home in our apartment (birth certificates, etc.).

Three Sundays ago (a fast Sunday) after fretting about some of the things we needed to recover, if possible, I awoke with a crazy idea: what if we our part-time maid could get a key to our apartment into the hands of someone who could enter our apartment, and what if we could then use video to show them what we needed, pack it in a suitcase, and then get that suitcase into the hands of someone flying from Shanghai to the U.S.? As my wife and I discussed that, it really seemed like a preposterous long shot: the maid was probably locked down outside of Shanghai, and even if we could get a key, people outside the complex are not allowed in, and while my wife had a trusted fellow teacher in the compound, he might not even be in Shanghai, and even if we could get a bag of things packed for us, we didn't know of any Americans still in Shanghai who were going to leave soon at that late stage when most who wanted to flee were already long gone. And even if we found somebody, how could we get the suitcase from whatever distant location they would fly to? Such a long shot, but still I felt we needed to try. So I posted a note among friends from Church on a WeChat group, asking if anyone in Shanghai was coming back to the States soon. After several hours, there was no reply. But then during sacrament meeting that day, I received a message from our Elder's quorum president stating that he, his wife, and their miracle baby were going to the US the next Sunday. And can you guess their destination? Wisconsin! Our state. But we would meet at the nearby Chicago airport and then they would be driven to their town in Wisconsin and begin a quarantine there.

I should mention their miracle baby, because that beautiful little girl is actually what made our little blessing possible. The faithful parents have wanted a baby for a long time, but multiple doctors in the States could do nothing for them. Finally, after many prayers, someone suggested to them that they consider traditional Chinese medicine (TCM) rather than Western medicine. TCM is way outside the comfort zone of most Americans and is widely frowned upon by Westerners, but seems to sometimes have some surprising benefits for some who try it. They went to a recommended TCM doctor for help and shortly thereafter, the couple were expecting and eventually delivered a beautiful, healthy, miracle baby. When the virus loomed over China, they would have returned to the States right away but were forced to wait until their baby's passport was ready for them. They made plans to leave as soon as possible after that, which most fortuitously aligned so perfectly with our minor need to extract some items from Shanghai.

With the surprising result that someone we knew and completely trusted with our stuff would be able to bring a small bag for us from Shanghai, we tackled other elements for this operation. Was that fellow teacher who lived in our complex in town and willing to help? Yes! Was the completely trustworthy woman who worked part-time as our maid back in town and able to bring the key to our complex to hand it across a barrier to the teacher who lived there? Yes! Could our landlord also join the teacher and take out some cash to pay some future rent and take possession of our key to help prepare for future needs like clearing out our stuff if needed? Yes. Could we arrange for a trusted driver to receive the bag of precious packed items and take it straight to our friends who would soon be flying to the U.S.? Yes. We also hired him to take that family to the airport. With his large SUV, there was just barely enough space for our three friends, all their bags, and our bag. But it fit!

As my wife's fellow teacher was in the apartment with our landlord packing stuff for us, I noted how amazing it was to know such good and trustworthy people. We had a stack of cash that we had the teacher find and hand to the landlord, who then counted out her share of it for rent. We were able to do that without the slightest concern because we completely trust both of these good people, one a Westerner and one a local Chinese woman who feels like a relative to us, the best landlord I've even had in my life, who regularly brings us delicious food, tickets to musicals, and treats us with so much fairness and kindness that we really don't mind overpaying for our apartment.  We just love that woman and dare to trust her with all our possessions now that she has our key. How many problems can be solved, how much good can take place, when there is true trust between people!

It was great to have an excuse to go to Chicago, where we stayed with a sister that we really needed to visit. Wonderful to interact with her and her son and daughter. And so wonderful to be able to drive to the airport early the next morning and meet our trusted friends. So wonderful to see them and their miracle baby. We were wearing masks at the airport and carefully disinfected the bag just in case someone with the virus had handled it, not wanting to risk spreading the virus to our family and community.

That's my little story on the power and blessings of trust. For those who are in similar circumstances, there may be ways to have friends help you reduce some of the impact of a sudden departure from China or anywhere else.

To some of the critics who take offense whenever someone believes that they been blessed in some temporal way that is not uniformly distributed, I can understand the frustration, but be careful about the assumptions you make. 

Was this a blessing to us? A small miracle? To those who are instantly offended by such things, I will confess with some trepidation: Yes, so it seems to me, and I can't explain or justify why we were able to escape from difficult circumstances and, in spite of being unexpected refugees, avoid much of the pain of suddenly fleeing home. Random luck? Yes, possibly, but I prefer being grateful for too much than for too little. I prefer counting my blessings, and perhaps overcounting, rather than ignoring them altogether. And I prefer to overlook my grievances and losses when I can rather than to be angry at God or ignore His mercy even in the midst of my most painful trials. 

Should I not dare to be grateful and note that we were blessed in this matter by the kindness and trustworthiness of good friends? But sure, you can call that callous and insensitive when I know that others, in spite of their good friends, are smitten with disease or trapped in harsh conditions in locked-down cities filled with sorrow, or when others I know are suffering grievously due to health, being in jail, or other great trials? We have tried to help some others in such circumstances, but often we are helpless.

On this matter, may I suggest reading an old post of mine, "Do Big Tragedies Negate Small Miracles?"

For those who are offended by the diversity in the temporal conditions of individuals here on earth, and by God's apparent willingness to allow such diversity, I would suggest that nothing in the scriptures suggest that God's goal is to enforce uniformity on earth, in spite of His desire that we lift the poor and share our abundance, and that we seek to nourish the week and heal the sick. There is uniformity in that we will all die, but great diversity in terms of when and how. There is diversity on our talents, our places of birth, our cultures and languages, our financial status, our genes, our health, and so forth. Diversity is magnified by the terrible gift that God gives rather uniformly: the gift of moral agency, of being able to choose or reject Him, to be kind to others or malicious, to pursue peace or war. The results of that agency can be blood and horror or peace and joy for those whose lives we affect. But whether God calls us to live and serve in the midst of war or in a peaceful small town, in the midst of plague or in a healthy community, with rotten neighbors or with trusted friends (such as the world's greatest landlord living almost next door), there are some things that are uniform and universal: His love for us, His perfect Atonement completed for us at an infinite price, and His offer of grace to each of us, making it possible for us to overcome all barriers and all the diverse pain of mortality and return to endless joy in His presence.

Nephi described this situation well in 2 Nephi 26:
[24] He doeth not anything save it be for the benefit of the world; for he loveth the world, even that he layeth down his own life that he may draw all men unto him. Wherefore, he commandeth none that they shall not partake of his salvation.
[25] Behold, doth he cry unto any, saying: Depart from me? Behold, I say unto you, Nay; but he saith: Come unto me all ye ends of the earth, buy milk and honey, without money and without price.
[26] Behold, hath he commanded any that they should depart out of the synagogues, or out of the houses of worship? Behold, I say unto you, Nay.
[27] Hath he commanded any that they should not partake of his salvation? Behold I say unto you, Nay; but he hath given it free for all men; and he hath commanded his people that they should persuade all men to repentance.
[28] Behold, hath the Lord commanded any that they should not partake of his goodness? Behold I say unto you, Nay; but all men are privileged the one like unto the other, and none are forbidden.
[29] He commandeth that there shall be no priestcrafts; for, behold priestcrafts are that men preach and set themselves up for a light unto the world, that they may get gain and praise of the world; but they seek not the welfare of Zion.
[30] Behold, the Lord hath forbidden this thing; wherefore, the Lord God hath given a commandment that all men should have charity, which charity is love, and except they should have charity they were nothing. Wherefore, if they should have charity they would not suffer the laborer in Zion to perish.
[31] But the laborer in Zion shall labor for Zion; for if they labor for money they shall perish.
[32] And again, the Lord God hath commanded that men should not murder; that they should not lie; that they should not steal; that they should not take the name of the Lord their God in vain; that they should not envy; that they should not have malice; that they should not contend one with another; that they should not commit whoredoms; and that they should do none of these things; for whoso doeth them shall perish.
[33] For none of these iniquities come of the Lord; for he doeth that which is good among the children of men; and he doeth nothing save it be plain unto the children of men; and he inviteth them all to come unto him and partake of his goodness; and he denieth none that come unto him, black and white, bond and free, male and female; and he remembereth the heathen; and all are alike unto God, both Jew and Gentile.
All are alike unto God. I love that passage. All will have an opportunity to accept Him. All will be judged fairly. He does not deny any who wish to come unto Him, but invites all to receive His greatest blessings. Death is not the end nor the greatest tragedy, but an essential part of our individual and diverse journeys. Don't be offended that others escaped your current trials or face different challenges. Don't be deceived by those who say that God must not love you and must not even exist because of what you or others may be suffering. Christ has suffered all that and more for you and knows your pains, and is there to wipe away all tears in the end and take you forward to victory and joy, to resurrection and eternal life. There is painful diversity now, as there must be in this time of mortal probation, but there is God's love for all of us in whatever place we are. He may not choose to take away all current problems, and may say no a request that He miraculously grants to others for some reason (always seemingly unjust to us), but He gives us strength to endure and sometimes can give us kind help to move forward to be where we need to be for the next phase of each individual trek.

Friday, February 28, 2020

Requesting Review from Medical Experts: Can Glucosamine Help Reduce COVID-19 Mortality?

Update: 7/14/2020: While some here have disputed that nutrition could play a significant role in fighting COVID-19, a new study points to Vitamin D as a key factor. See "Vitamin D levels appear to play role in COVID-19 mortality rates" at ScienceDaily.com.

Update: 4/2/2020: An important new study explains why glucosamine may be an effective aid in coping with the Corona virus, as well as other nutraceuticals such as N-acetyl cysteine, sulforophane (found in broccoli and other cruciferous vegetables), spirulina and selenium (high in Brazil nuts, but don't take too much because this essential nutrient can be carcinogenic in excess). While the publication is in a peer-reviewed journal, it is not based on original clinical work but reviews numerous related studies and pulls together bits and pieces to offer a hypothesis that such nutriceuticals may be effective in coping with influenza and the Corona virus. It may not do any good, but there is little harm to making sure you have broccoli and a few Brazil nuts in your diet, and both glucosamine and N-acetyl cysteine are already popular nutriceuticals that are low in toxicity and known to have some benefits. However, I've also seen studies warning that excess anti-oxidants like N-acetyl cysteine can also increase cancer risk since our body's defenses against cancer cells often can involve oxidative reactions that can be hindered when anti-oxidants are too high. However, N-acetyl cysteine is well known as a treatment for cystic fibrosis because it reduces the viscosity of the biofilm mucous in the lungs, so using it for COVID-19 doesn't seem like an outrageous stretch. I am not a medical expert so get advice from competent sources before you do anything unusual based on the new publication See M.F. McCarty and J.J. DiNicolantonio, "Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus," Progress in Cardiovascular Diseases (in press, available online Feb. 12, 2020), https://doi.org/10.1016/j.pcad.2020.02.007. Here is an excerpt from the report:
Glutathione production can also be promoted by administration of N-acetylcysteine (NAC), which has been shown to be protective in rodents infected with influenza.16., 17., 18. In a little-noticed 6-month controlled clinical study enrolling 262 primarily elderly subjects, those receiving 600 mg NAC twice daily, as opposed to those receiving placebo, experienced significantly fewer influenza-like episodes and days of bed confinement.19 Although the rate of seroconversion to influenza A was comparable in the two groups – indicating that they were exposed at the same frequency – only 25% of the virus-infected subjects in the NAC group developed symptoms, as contrasted to 79% of those of placebo. (Given the carnage that influenza wreaks among the elderly, it is most regrettable that no effort has been made to replicate this study, conducted over 20 years ago.) The particular utility of NAC in the elderly might reflect the fact that plasma cysteine levels and cellular glutathione levels tend to decline with advancing age.20

Update, 2/29/2020: In light of helpful and competent feedback to me privately about the problems in the proposed mechanisms for the hypotheses examined here and about the weaknesses in some of the studies mentioned (e.g., lack of real clinical data), there is no compelling reason to believe that dietary factors have a clear effect on the mortality of COVID-19, or that glucosamine can reduce pneumonia mortality, though it may be possible. Given that some non-clinical published studies point to positive effects of glucosamine in lung-related matters, there may be a valid need for further research on the topic, but no need to insist that glucosamine should be shipped to China or to claim that significant dietary changes will have a strong impact. There's still the possibility that it might help in treating pneumonia from SARS-CoV-2, but large question marks remain, especially regarding proposals that certain foods and drinks may impact mortality.

For those interested in exploring the currently speculative role of glucosamine in lung health, the original post below will remain in place, but recognize that serious question marks remain in place about the proposal discussed therein.

Illustration of a SARS-CoV-2 virion,
courtesy of the CDC.
In response to recent posts about the impact of the Corona virus, now known as SARS-CoV-2 and its disease, COVID-19, on China and the Church (especially my branch and district in Shanghai), I was pleased to be contacted by one of my readers, C.T., who shared tentative findings from her investigation of  factors that may affect how severe pneumonia can become in once healthy patients. She posted some information on this blog, leading to the some of the pointed criticism that is normally reserved for me. She has not granted permission to use her name, but given the hostility she encountered from trolls when she posted her work originally on her own blog, I can understand a desire to remain anonymous. But I find her proposal interesting enough and, if correct, potentially valuable enough that I'd like to invite feedback from competent experts to see if there is any merit and if further work is warranted. If C.T.'s work could help alleviate some of the suffering that COVID-19 is causing, and specifically decrease the mortality rate, that would be fantastic. Or, like much of the output of creative thinkers and researchers, maybe it's just an interesting idea that in the end won't prove to be fruitful. Let's see.

In presenting some tentative possibilities below, please note that I am not making any medical claims or suggesting that nutrition or nutritional supplements can directly reduce the risk of dying from COVID-19 or pneumonia in general. I am not seeking to spread rumors about the disease (spreading rumors is strictly illegal in China, especially rumors or incorrect information about sensitive issues such as COVID-19 and its management, and as one who loves so much about China and its people, and still has an apartment there, I strive to abide by the regulations), but am inviting experts to review a tentative possibility that could be helpful to China and other nations. I also have no financial interest in this matter (apart from having an apartment and other things China made much less accessible by the severity of COVID-19, all of relatively minor importance to me). 

C.T.'s hypothesis involves the possible role of glucosamine and other aspects of nutrition in reducing the risk of severe pneumonia. Glucosamine is a natural material found in cartilage and in the shells of shrimp, crabs, etc. and the skeletons of marine animals. Perhaps offering an especially practical opportunity for China, it is also present in China's abundant and delicious mushrooms and other fungi (see "Dietary Sources" below). It is an antioxidant that our body can produce, though it is also commonly sold as a dietary supplement said to help treat osteoarthritis and reduce pain in joints (see an overview of reports on glucosamine at ScienceDirect). In what follows, I'll add some comments to C.T.'s points and  mix a few finds from my searching with some of the things she has found.

The relationship between glucosamine and cartilage health has a reasonable basis (though for relieving pain, as the BBC reports, it's not clear that glucosamine supplements actually do more than a good, full-strength placebo), and cartilage is present in several vital parts of the lungs, from the trachea through the bronchi. C.T.'s hypothesis is that viral disease may infect chondrocytes, cells that product cartilage, and that our own immune system in response may then attack those cells and lead to tissue damage that allows naturally present bacteria to cause severe infection. But could there be a relationship between glucosamine and pneumonia mortality? C.T. proposes a mechanism involving the SOX-9 protein and its role in driving a "cytokine storm" where dangerous cycles can lead to severe illness. She argues that dietary influences that inhibit or enhance the effect of SOX-9 (i.e., down regulate or up regulate) may help explain significant differences in pneumonia mortality among nations, with tea and perhaps pomegranate juice being likely to up regulate SOX-9 while diets high in shrimp and cartilage may provide the glucosamine that can may regulate SOX-9.  You can see her recent comments on the Coronavirus and the crisis in Wuhan in her post of Jan. 31, 2020, "My two bits about the novel coronavirus from Wuhan," which points to her earlier post with the key information she wishes to share. [Update, 2/28/2020: Shortly after I posted this information, the links to her blog and to her YouTube video below went dead. I have since learned that she has taken down that information today. I am puzzled about why and recognize that it raises troubling questions when a researcher doesn't want to be associated with their work. I don't know her reasons, but perhaps it is a privacy issue related to the harsh treatment she received when she originally posted her tentative findings.]

Whether or not C.T.'s proposed mechanisms and dietary considerations are correct, there are peer-reviewed studies suggesting that glucosamine may help reduce mortality from respiratory illness. If so, that could be helpful information for afflicted people.

The scientific literature on glucosamine tends to focus on its role in cartilage formation and in alleviating problems with joints and bones. But there are some surprising finds related to other effects. Here are a few to consider (the first and fourth were pointed out by C.T. in her original work):

1. Griffith A. Bell et al., "Use of glucosamine and chondroitin in relation to mortality," European Journal of Epidemiology, 27/8 (2012): 593-603; https://www.jstor.org/stable/23272500.

Abstract: Glucosamine and chondroitin are products commonly used by older adults in the US and Europe. There is limited evidence that they have anti-inflammatory properties, which could provide risk reduction of several diseases. However, data on their long-term health effects is lacking. To evaluate whether use of glucosamine and chondroitin are associated with cause-specific and total mortality. Participants (n = 77,510) were members of a cohort study of Washington State (US) residents aged 50-76 years who entered the cohort in 2000-2002 by completing a baseline questionnaire that included questions on glucosamine and chondroitin use. Participants were followed for mortality through 2008 (n = 5,362 deaths). Hazard ratios (HR) for death adjusted for multiple covariates were estimated using Cox models. Current (baseline) glucosamine and chondroitin use were associated with a decreased risk of total mortality compared to never use. The adjusted HR associated with current use of glucosamine (with or without chondroitin) was 0.82 (95 % CI 0.75-0.90) and 0.86 (95 % CI 0.78-0.96) for chondroitin (included in two-thirds of glucosamine supplements). Current use of glucosamine was associated with a significant decreased risk of death from cancer (HR 0.87 95 % CI 0.76-0.98) and with a large risk reduction for death from respiratory diseases (HR 0.59 95 % CI 0.41-0.83). Use of glucosamine with or without chondroitin was associated with reduced total mortality and with reductions of several broad causes of death. Although bias cannot be ruled out, these results suggest that glucosamine may provide some mortality benefit. [Emphasis added. For links to references cited by Bell et al., see the Springer page for this article.]

2. Kun-Han Chuang et al., "Attenuation of LPS-induced Lung Inflammation by Glucosamine in Rats," American Journal of Respiratory Cellular Molelcular Biology, 49/6 (Dec. 2013): 1110-9.

Abstract: Acute inflammation is often observed during acute lung injury (ALI) and acute respiratory distress syndrome. Glucosamine is known to act as an anti-inflammatory molecule. The effects of glucosamine on acute lung inflammation and its associated mechanisms remain unclear. The present study sought to address how glucosamine plays an anti-inflammatory role in acute lung inflammation in vivo and in vitro. Using the LPS intratracheal instillation-elicited rat lung inflammation model, we found that glucosamine attenuated pulmonary edema and polymorphonuclear leukocyte infiltration, as well as the production of TNF-α, IL-1β, cytokine-induced neutrophil chemoattractant (CINC)-1, macrophage inflammatory protein (MIP)-2, and nitric oxide (NO) in the bronchoalveolar lavage fluid (BALF) and in the cultured medium of BALF cells. The expression of TNF-α, IL-1β, IFN-γ, CINC-1, MIP-2, monocyte chemotactic protein-1, and inducible NO synthase (iNOS) in LPS-inflamed lung tissue was also suppressed by glucosamine. Using the rat alveolar epithelial cell line L2, we noted that the cytokine mixture (cytomix)-regulated production and mRNA expression of CINC-1 and MIP-2, NO production, the protein and mRNA expression of iNOS, iNOS mRNA stability, and iNOS promoter activity were all inhibited by glucosamine. Furthermore, glucosamine reduced LPS-mediated NF-κB signaling by decreasing IκB phosphorylation, p65 nuclear translocation, and NF-κB reporter activity. Overexpression of the p65 subunit restored the inhibitory action of glucosamine on cytomix-regulated NO production and iNOS expression. In conclusion, glucosamine appears to act as an anti-inflammatory molecule in LPS-induced lung inflammation, at least in part by targeting the NF-κB signaling pathway.

3. Yuh-Lin Wu et al., "Glucosamine Attenuates Cigarette Smoke-Induced Lung Inflammation by Inhibiting ROS-sensitive Inflammatory Signaling," Free Radical Biology and Medicine, 69 (April 2014): 208-18; DOI: 10.1016/j.freeradbiomed.2014.01.026.

Cigarette smoking causes persistent lung inflammation that is mainly regulated by redox-sensitive pathways. We have reported that cigarette smoke (CS) activates a NADPH oxidase-dependent reactive oxygen species (ROS)-sensitive AMP-activated protein kinase (AMPK) signaling pathway leading to induction of lung inflammation. Glucosamine, a dietary supplement used to treat osteoarthritis, has antioxidant and anti-inflammatory properties. However, whether glucosamine has similar beneficial effects against CS-induced lung inflammation remains unclear. Using a murine model we show that chronic CS exposure for 4 weeks increased lung levels of 4-hydroxynonenal (an oxidative stress biomarker), phospho-AMPK, and macrophage inflammatory protein 2 and induced lung inflammation; all of these CS-induced events were suppressed by chronic treatment with glucosamine. Using human bronchial epithelial cells, we demonstrate that cigarette smoke extract (CSE) sequentially activated NADPH oxidase; increased intracellular levels of ROS; activated AMPK, mitogen-activated protein kinases (MAPKs), nuclear factor-κB (NF-κB), and signal transducer and activator of transcription proteins 3 (STAT3); and induced interleukin-8 (IL-8). Additionally, using a ROS scavenger, a siRNA that targets AMPK, and various pharmacological inhibitors, we identified the signaling cascade that leads to induction of IL-8 by CSE. All these CSE-induced events were inhibited by glucosamine pretreatment. Our findings suggest a novel role for glucosamine in alleviating the oxidative stress and lung inflammation induced by chronic CS exposure in vivo and in suppressing the CSE-induced IL-8 in vitro by inhibiting both the ROS-sensitive NADPH oxidase/AMPK/MAPK signaling pathway and the downstream transcriptional factors NF-κB and STAT3.

4. Jean-Noël Gouze et al., "Exogenous glucosamine globally protects chondrocytes from the arthritogenic effects of IL-1β," Arthritis Research and Therapy,  8 (2006), article #R173; https://doi.org/10.1186/ar2082. (PDF also available.)

The effects of exogenous glucosamine on the biology of articular chondrocytes were determined by examining global transcription patterns under normal culture conditions and following challenge with IL-1β. Chondrocytes isolated from the cartilage of rats were cultured in several flasks either alone or in the presence of 20 mM glucosamine. Six hours later, one-half of the cultures of each group were challenged with 10 ng/ml IL-1β. Fourteen hours after this challenge, RNA was extracted from each culture individually and used to probe microarray chips corresponding to the entire rat genome. Glucosamine alone had no observable stimulatory effect on the transcription of primary cartilage matrix genes, such as aggrecan, collagen type II, or genes involved in glycosaminoglycan synthesis; however, glucosamine proved to be a potent, broad-spectrum inhibitor of IL-1β. Of the 2,813 genes whose transcription was altered by IL-1β stimulation (P > 0.0001), glucosamine significantly blocked the response in 2,055 (~73%). Glucosamine fully protected the chondrocytes from IL-1-induced expression of inflammatory cytokines, chemokines, and growth factors as well as proteins involved in prostaglandin E2 and nitric oxide synthesis. It also blocked the IL-1-induced expression of matrix-specific proteases such as MMP-3, MMP-9, MMP-10, MMP-12, and ADAMTS-1. The concentrations of IL-1 and glucosamine used in these assays were supraphysiological and were not representative of the arthritic joint following oral consumption of glucosamine. They suggest, however, that the potential benefit of glucosamine in osteoarthritis is not related to cartilage matrix biosynthesis, but is more probably related to its ability to globally inhibit the deleterious effects of IL-1β signaling. These results suggest that glucosamine, if administered effectively, may indeed have anti-arthritic properties, but primarily as an anti-inflammatory agent.

5.  Ji-Sun Hwang et al.,  "Glucosamine Improves Survival in a Mouse Model of Sepsis and Attenuates Sepsis-Induced Lung Injury and Inflammation," Journal of Biological Chemistry, 294/2 (Jan. 11, 2019): 608-622; DOI: 10.1074/jbc.RA118.004638.

The aim of the current study was to investigate the effects of glucosamine (GlcN) on septic lethality and sepsis-induced inflammation using animal models of mice and zebrafish. GlcN pretreatment improved survival in the cecal ligation and puncture (CLP)-induced sepsis mouse model and attenuated lipopolysaccharide (LPS)-induced septic lung injury and systemic inflammation. GlcN suppressed LPS-induced M1-specific but not M2-specific gene expression. Furthermore, increased expressions of inflammatory genes in visceral tissue of LPS-injected zebrafish were suppressed by GlcN. GlcN suppressed LPS-induced activation of mitogen-activated protein kinase (MAPK) and NF-κB in lung tissue. LPS triggered a reduction in O-GlcNAc levels in nucleocytoplasmic proteins of lung, liver, and spleen after 1 day, which returned to normal levels at day 3. GlcN inhibited LPS-induced O-GlcNAc down-regulation in mouse lung and visceral tissue of zebrafish. Furthermore, the O-GlcNAcase (OGA) level was increased by LPS, which were suppressed by GlcN in mouse and zebrafish. OGA inhibitors suppressed LPS-induced expression of inflammatory genes in RAW264.7 cells and the visceral tissue of zebrafish. Stable knockdown of Oga via short hairpin RNA led to increased inducible nitric oxide synthase (iNOS) expression in response to LPS with or without GlcN in RAW264.7 cells. Overall, our results demonstrate a protective effect of GlcN on sepsis potentially through modulation of O-GlcNAcylation of nucleocytoplasmic proteins.

In light of these studies, especially the first one, there seems to be some reason to believe that glucosamine may be helpful in reducing the mortality of pneumonia. If so, and that's still a definite "if" demanding further research and review, being prepared to have a diet with some glucosamine sources or to have some glucosamine on hand might be reasonable should COVID-19 become a serious threat in your community, or if you are traveling under conditions where you may be exposed to the SARS-CoV-2 virus. Your intelligent feedback on this is welcome -- but anonymous trolling comments that I too often tolerate will be deleted here in order to increase the chance of readers finding intelligent comments that help us better understand the issues raised here.

C.T.'s Proposals on Mechanism and Diet
C.T. posted the following note on my blog a couple days ago:
Hi, Jeff, I know it sounds presumptuous, but I think I figured out which environmental triggers are involved in making it so people exposed to this virus do/do not become symptomatic and how severe the symptoms are.

1) Damage to the hyaline cartilage (by the immune system targeting infected cartilage cells) is much less likely to happen where the diet contains glucosamine (in shrimp paste and cartilage), where there is no exposure to dry and cold air, and where there is not bleach being sprayed in the air (seriously, have Hubei's bureaucrats never heard of chemical pneumonia?).

2) The cartilage cells, if damaged, think they have to rebuild the hyaline cartilage matrix and so secrete chondroitin sulphate and other cartilage matrix molecules; the gene SOX9 is very instrumental in doing this, but if it is overly active it can cause there to be too many such molecules building up in the lungs. Voila! Viral pneumonia. What gets SOX9 going? EGCG appears to "stimulate exuberant cartilage matrix secretion" (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247298/), and EGCG is THE special molecule in tea leaves. What did the poor people of Wuhan ingest in their apartment quarantines: rice, veggies, legumes, and tea--no meat or shrimp. What else affects SOX9? Turmeric (curcumin decreases SOX9 activity--lucky Thailand), Fluoride (also helps decrease SOX9 activity--lucky India), Pomegranate (increases SOX9--unlucky Iran, where they drink pomegranate juice when sick). This hypothesis holds up even in Italy, where they drink wine and coffee all the time except when they're trying to lose weight or fight a cold--then they drink green tea. And it utterly refutes all the stupid internet trolls who were going on and on about how "Chinese people have horrible hygiene."

Doctrine & Covenants 89 is a beautiful piece of counsel for our times. 
C.T.'s original post on the relationship between glucosamine and mortality in pneumonia and the possible mechanisms involved is "Glucosamine to protect cartilage during influenza infection," Petticoat Government, Feb. 5, 2018. (Sadly, her blog and her YouTube video were taken down the day this was posted, as noted above.) Here is an excerpt with the key arguments she makes:
1) The flu infects chondrocytes, the cells in cartilage. They are the only cells in hyaline cartilage, which type of cartilage is coincidentally found in places--joints, rib ends, nose, larynx, trachea, bronchi--that are among the hardest hit by influenza. (https://www.britannica.com/science/cartilage)

2) Influenza-infected chondrocytes don't seem to actually experience obvious damage until the body's immune system goes on the attack. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC422866/; http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2567.2003.01621.x/full) [Edited 2/17/2018: Someone pointed out to me that chondrocytes are within an extracellular matrix that has no blood vessels, so other cells, including attacking immune cells, can't reach them. I looked more into that issue and found a 2015 cartilage transplant study which found that cartilage isn't as immune-privileged as it used to be believed it was (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522233/). I suspect that chondroblasts--the immature chondrocytes next to the blood-vessel-containing perichondrium--are the first chondrocytes which the immune system cells attack, and then due to their destruction the cartilage matrix becomes compromised; if that compromised state becomes severe enough, immune cells can then gain access to the mature chondrocytes within, as well.]

3) Cytokines are part of the immune system's attack arsenal. The cytokine IL-1beta is a critical component of lung inflammation during infection with influenza type A H1N1. (http://onlinelibrary.wiley.com/doi/10.1002/jmv.24138/abstracthttps://www.ncbi.nlm.nih.gov/pubmed/27714503)

4) Glucosamine--a natural compound found in cartilage--happens to protect chondrocytes by being a potent inhibitor of IL-1beta. (https://link.springer.com/article/10.1186/ar2082)

5) Damaged cartilage in the trachea/bronchi could allow for more penetrating infection by viruses/bacteria that normally would not be able to do much harm and in that way make flu sufferers much more susceptible to pneumonia. Most of the people who died from the 1918 flu died because "bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs." (https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-caused-most-deaths-1918-influenza-pandemic)

6) People who take glucosamine (it's a common supplement for arthritis) are much less likely to die of respiratory illnesses than their peers. (https://link.springer.com/article/10.1007/s10654-012-9714-6)

So if you're worried about influenza, it might be worth it to buy some glucosamine and take it when you're exposed to influenza so you can protect your hyaline cartilage and thus make yourself less likely to develop pneumonia....

Eat well cooked, or non-manufactured source- glucosamine rich foods (like shrimp) to help the cartilage stay strong, and stay away from tea plant and pomegranate for a second. (Pomegranates are healthy, but are rich in natural SOX9 stimulants... Which is good... But on a viral, over-production level ((what happens with this virus)) you get to much in the lungs too fast, and therefore pneumonia.)
There is also a related video on YouTube made before COVID-19 came along. [Update: Sadly, this was taken down, with her blog, shortly after this post. Sorry!]

By the way, I have worked with nearly pure EGCG as part of my consumer products research work in the past and was often surprised by how reactive it is. Dissolve a little white EGCG in water and combine with baking soda or other alkaline material and find out what strange, ugly stains you can create on materials such as tissue paper or fabrics after allowing it to sit for a few hours. It has many effects in the body, some clearly positive, but I can imagine that there are situations where this reactive material isn't helpful. Can it play the role that C.T. suggests? I don't know, but would like to learn more. Is it possible that giving tea to the ill might not be a good idea? I don't know, but it may not be helping in Wuhan, though so much of what's happening there remains opaque. If you have additional useful information, please let me know.

Dietary Sources
C.T. points to shrimp as an important dietary source of glucosamine. I should add that it appears that the glucosamine of shrimp comes from the shell, not the flesh. In Asia, many people eat the shells, or so it seems to me, especially small shrimp where the shell is quite thin and, in fried shrimp, can be tasty and easy to eat. She also mentions gristle, which is commonly consumed, especially chicken gristle. Another source may be soups in which the bones of animals have been stewed for a long period of time. Bone-rich soup, at least in China, especially when stewed long enough to create a white broth, is widely held to be very nutritious and ideal for those who are ill, and probably supplies some glucosamine. I find it delicious, too.

There are also options for vegetarians. Mushrooms contain chitin, the widespread natural polymer found in the shells of shrimp, crabs, insects, etc., and glucosamine is one of the building blocks of chitin and I believe it can be released when digested. See Tao Wu et al., "Chitin and Chitosan--Value-Added Products From Mushroom Waste," Journal of Agricultural Food Chemistry, 52 /26 (Dec. 29, 2004): 7905-10;  DOI: 10.1021/jf0492565. Also see Pin Zhang et al., "Kinetic Models for Glucosamine Production by Acid Hydrolysis of Chitin in Five Mushrooms," International Journal of Chemical Engineering, 2020, article ID 5084036 (2020); https://doi.org/10.1155/2020/5084036.

Unfortunately, for those in Wuhan, there are reports that the diet is now necessarily simple and thus there may be less meat (bone and cartilage included) and less shrimp than usual, so the protective effects of glucosamine, if real, may be less available than normal. C.T. worries that the combination of cold, stress, and confinement, coupled with a low-glucosamine and high-tea diet and even the occasional exposure to bleach or other harsh chemicals in the effort to kill the virus in many places might make a perfect storm for elevated pneumonia risk for those infected with the virus. If C.T.'s proposal is correct, then bringing glucosamine or glucosamine-rich foods to Wuhan and other affected areas may be a helpful step to help reduce loss of life.

One of China's great blessings when it comes to food is the richness of its fungi, with numerous wild and domesticated mushrooms and other fungi that are so delicious. Some are far too expensive for me, but there are many varieties that are relatively inexpensive but very nutritious, especially the black wood ear fungus called mu er (literally wood ear). It's more expensive than rice or common vegetables like carrots, onions, or cabbage, but it's still quite cheap and has also been touted for its immune strengthening benefits. I order some much of the time when I'm in Chinese restaurants in China. Perhaps adding this to the diet of the people in Wuhan and other afflicted cities could help?

Is Glucosamine Safe for Those Allergic to Shrimp?
Finally, one important issue is whether those with seafood allergies, including shellfish allergies, should take glucosamine since it is often made from the shells of shrimp. Please consult with your physician and don't take crazy risks based on random bloggers. However, something to consider as you discuss such matters with competent medical authorities is that several studies suggest that commercially available high-quality glucosamine may not contain the allergens that are harmful to some people. Here are a couple studies to consider:

J. Villacis et al.,  "Do Shrimp-Allergic Individuals Tolerate Shrimp-Derived Glucosamine?,"  Clinical and Experimental Allergy, 36/11 (Nov. 2006): 1457-61;  DOI: 10.1111/j.1365-2222.2006.02590.x.

Background: There is concern that shrimp-allergic individuals may react to glucosamine-containing products as shrimp shells are a major source of glucosamine used for human consumption.

Objective: The purpose of this study was to determine whether shrimp-allergic individuals can tolerate therapeutic doses of glucosamine.

Methods: Subjects with a history of shrimp allergy were recruited and tested for both shrimp reactivity via a prick skin test and shrimp-specific IgE by an ImmunoCAP assay. Fifteen subjects with positive skin tests to shrimp and an ImmunoCAP class level of two or greater were selected for a double-blind placebo-controlled food challenge (DBPCFC) using glucosamine-chondroitin tablets containing 1,500 mg of synthetically produced (control) or shrimp-derived glucosamine. Immediate reactions, including changes in peak flow and blood pressure, and delayed reactions (up to 24 h post-challenge) via questionnaire were noted and assessed.

Results: All subjects tolerated 1,500 mg of both shrimp-derived or synthetic glucosamine without incident of an immediate hypersensitivity response. Peak flows and blood pressures remained constant, and no subject had symptoms of a delayed reaction 24 h later.

Conclusion: This study demonstrates that glucosamine supplements from specific manufacturers do not contain clinically relevant levels of shrimp allergen and therefore appear to pose no threat to shrimp-allergic individuals.
Heather C. Gray, et al., "Is glucosamine safe in patients with seafood allergy?," Jounral of Allergy and Clinical Immunology,  114/2 (August 2004) 459–460; DOI: https://doi.org/10.1016/j.jaci.2004.05.050 (PDF also available).
Six subjects participated in the study. All 6 had a history consistent with a systemic reaction to shellfish. All 6 had positive skin prick test responses to shrimp, crab, lobster, or a combination of these. All 6 had negative skin test responses to the glucosamine extract (Table I) and uneventful oral challenges with glucosamine, with no change in skin, vital signs, or spirometry....

Approximately 600 patients must be recruited to ensure that the chance of rejecting an allergy rate of at least 0.5% is less than 0.05. This pilot study, which indicates that glucosamine is probably safe for patients with shellfish allergy, emphasizes the need for further investigation, with larger studies looking at different shellfish allergens and the consistency of glucosamine formulations.
Further research is needed on this issue and others raised above. If you have other information on the food safety issue or other issues raised here, please share. Thanks!

I welcome your feedback, but I will be deleting more anonymous trolling comments than I normally do because I would like the comments to be helpful. But to save the usual trolls the trouble, let me just jump the gun and recognize that yes, I am not trained in medicine or the life sciences and, as usual, am daring to offer thoughts that are amateur and worthy of ridicule. Ridiculous, absurd, idiotic, and a blight on humanity. There, done! Your non-anonymous criticisms are welcome, though, if they contribute to the quest to understand what measures we can take to reduce the mortality of COVID-19 or to help people prepare for the risks it may bring.

Other Related Resources:

Theodore M. Brasky, "Use of Glucosamine and Chondroitin and Lung Cancer Risk in the VITamins And Lifestyle (VITAL) Cohort," Cancer Causes and Control, 22/9 (Sept. 2011): 1333-42. See also Theodore M. Brasky et al., "Long-term use of glucosamine and chondroitin and lung cancer risk in the vitamins and lifestyle (VITAL) cohort," Cancer Research, 71/8 (April 2011), DOI: 10.1158/1538-7445.AM2011-1912.

Jody Braverman, "Nutritional Value of Bone Gristle," LiveStrong.com, September 30, 2019.

"Glucosamine sulfate," WebMD,  https://www.webmd.com/vitamins/ai/ingredientmono-807/glucosamine-sulfate. (Information on possible benefits, risks, interactions with other drugs, etc.)

Hao Ma et al., "Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank," BMJ 365 (May 14, 2019); DOI: https://doi.org/10.1136/bmj.l1628. (Potential benefits in preventing cardiovascular disease.)

Robert H. Shmerling, "The latest on glucosamine/chondroitin supplements," Harvard Health Blog, Oct. 17, 2016.

"Too much glucosamine can cause the death of pancreatic cells, increase diabetes risk, researchers find,"  ScienceDaily.com, October 27, 2010.

L.H. Toledo-Pereyra et al., "Lung Transplantation: Better Survival Results After Graft Pretreatment With Concanavalin A or Chondroitin Sulfate," Annals of Thoracic Surgery, 29/3 (March 1980): 209-16; DOI: 10.1016/s0003-4975(10)61869-3.

Update A, 2/28/2020: There's one study C.T. mentioned suggesting that chondroitin, which is often combined with glucosamine in supplements, can cause pneumonia rather than prevent it, based on a single patient. See Takeshi Satomura et al., "A Case of Drug-induced Pulmonary Disease Considered to be Caused by a Supplement Containing Chondroitin," The Journal of the Japan Society for Respiratory Endoscopy,  37/2 (2015): 214-18; DOI https://doi.org/10.18907/jjsre.37.2_214.
Drug-induced pulmonary disease can be caused by a variety of drugs including supplements. We examined a case of drug-induced organizing pneumonia induced by a supplement containing chondroitin. Case. An 80-year-old man had been taking supplements for knee pain since early July 2013 and subsequently developed a cough and fever. A chest radiograph demonstrated infiltrative shadows, and he was admitted to our hospital. His condition did not improved with antibiotic treatment and bronchoscopy was performed for diagnostic purposes. A transbronchial lung biopsy specimen showed organizing pneumonia, and the patient's condition was ameliorated with steroid therapy. We established a diagnosis of drug-induced pulmonary disease based on the results of a lymphocyte stimulation test for a supplement containing chondroitin. Conclusions. We conclude that the use of supplements containing chondroitin may result in drug-induced pulmonary disease.  
That single case may not be meaningful, but if you're concerned and want more glucosamine after consulting with medical personnel, you can just use glucosamine alone or a diet with glucosamine. Chondroitin tends to me relatively more expensive anyway. Consult your physician and don't rely on bloggers.

Update B, 2/28/2020:  One physician whom I deeply respect weighed in on this and said the link between SOX-9 and pneumonia seems very tenuous. He also fears that the proposed relationship to tea and pneumonia mortality may not be driven by data but by a bias in favor of the Word of Wisdom.  Those are reasonable responses.

As for the area that seems stronger to me, the possible link between glucosamine and respiratory illness, his view is that the studies were observational rather than carefully designed which can lead to bias and other distortions. Later after looking more carefully, he observed that there wasn't any data from a clinical setting that would support the idea of taking glucosamine to prevent or treat pneumonia. Further, he noted that pneumonia involves inflammation of the alveoli, not the cartilage in the bronchi. And he observed that SARS-CoV-2 infects epithelial cells almost exclusively, which does not fit her model. If there is merit to any of the proposals discussed above, further research and clarification is needed.

I also took a look at the article linking EGCG to SOX-9 and cartilage growth,  and agree that there's a big gap in the alleged link between drinking tea and being more likely to die from pneumonia. The ability of SOX-9 to encourage cartilage growth still isn't clearly connected to the lung tissue damage seen in COVID-19 patents. It's a tenuous link, but is not the key to C.T.'s core proposal regarding glucosamine.

Update C, 2/28 & 2/29/2020: The unexpected closing of C.T.'s blog and the YouTube video after this post was frustrating, though I have since learned that she has a valid reason related to privacy, though I don't know the details. But I can't argue against those who say that it doesn't bode well for research when the researcher won't be or can't be named and withdraws related publications. In spite of that problematic issue, I still want to be open minded to see if there might be merit to the proposals C.T. has made. However, feedback already suggests there may be some flaws in both the theory and the interpretation of some studies. So far it looks like the intriguing theory and proposal may not as promising as I hoped, but still might have value. Further work may be needed. Given the low risk of taking glucosamine, I might keep some around just in case. But I hope I don't have the opportunity to be part of a trial on surviving COVID-19, and also hope that none of you will have that opportunity (but likewise hope that all of you survive it you are infected).

Tuesday, February 25, 2020

I Hope You've Gotten the Message About the Corona Virus Threat

Don't treat the SARS-COV-2 virus lightly.
It's surprising to me to see how many people in the US are not concerned about the still mysterious disease, COVID-2019, which is causing so much havoc in China and now some other nations. While the numbers coming from China have been the source of some confusion and controversy, it is clear that the authorities there see something in Wuhan that is terrifying and requires draconian measures there in an attempt to contain the problem and draconian measures all over the country to prevent other communities from falling into Wuhan's tragic state. I am so grateful for the many resources the Church has sent to China and hope there will be more. But in my opinion, local communities in many parts of the world should prepare now. When the disease sweeps through a community, it rapidly overwhelms local health care systems, as may be happening now or soon in Korea, Italy, Iran, and other places. Face masks, food, and other supplies can suddenly be hard to get. Don't wait until there's an overwhelming crisis. Prepare now to get through this.

No, COVID-2019 is not just like a typical flu (which can be very deadly when millions are infected) nor is it even like SARS or MERS, which were very deadly, but did not spread rapidly. Failure to understand the profound differences could leave you and your family unnecessarily vulnerable. The disease has a long incubation period, making it hard to detect who is infected. Some infected, contagious people may not show serious symptoms or any symptoms at all. One of the things that kept MERS and SARS from spreading quickly was their deadly nature: people who got sick tended to become very ill and a high percentage died. But COVID-2019 does not take down its victims so dramatically, allowing it to spread much faster.

A sobering article was just published in the generally reputable Atlantic Monthly: "You’re Likely to Get the Coronavirus" by James Hamblin.  Credible epidemiologists see this virus as a serious threat that could infect 40 to 70% of the planet and kill millions. It may be hard to escape. For most, it may be an inconvenience and they will recover. But even then, there could be lasting impact from the measures taken to contain the virus. Preparation now is will. And perhaps at least understanding the threat may help us prepare to reduce risk.

The people I know back in China are affected in many ways by this outbreak. For those with loved ones in Wuhan or who may have been trapped there, it's a nightmare. For those in more distant, less affected cities like Shanghai, where I have been living for the 8+ years, the measures taken to control the disease have made life very difficult. Though there are not many scores of people dying in that beautiful city, the impact has been harsh for businesses, schools, and families. Many people feel like prisoners in their apartment complex. I wince just thinking of the many restaurant owners I know who probably can't operate at all or certainly won't get enough customers to survive for long. So many businesses are suffering and that means people will lose jobs, lose income, not have enough for rent, and have to forego many hopes and dreams, even if they all remain healthy. The impact this may have on students and their college plans (especially if they were preparing for study in a foreign university) may be devastating. So many lives are being affected in so many ways. But I worry most for my friends who are in the lower strata of that very stratified nation. My dearest friends include a family in a tiny farmer village of 180 people in Jiangxi Province who were already devastated with the swine flu that took out all the pigs that were an economic mainstay for many in that community. Now comes COVID-2019, on top of some other painful challenges they were already facing. How will they cope?

I have three friends currently in prison in China. One young Chinese man's mother, once a part-time maid for us, grieves, not even being able to find out what the status of her son is, apart from knowing that he was detained for allegedly transporting tainted food or fraudulent food. Lawyers we contacted recently to try to help her did not respond, and now the virus makes it much more difficult to find help. Two other expat friends are also in jail, awaiting trial, for whom we can do little and for whom I worry daily.

In any nation afflicted with an epidemic, I fear that the grave concerns over the virus might slow relief for all those seeking help in difficult circumstances. Those who are poor, who are in prison, who are ill and can't get medical care now, those in orphanages, those in refugee camps, etc. may be most grievously afflicted, but there is cause to mourn even for people in wealthy families where students may have hopes and dreams dashed, where fortunes may suddenly have reversed, or where businesses that employed hundreds may suddenly fail. I feel so helpless. We all do before such problems. But we can keep China and other afflicted nations in our prayers -- yes, Iran also, no matter how much political tension we have with that nation -- and do what we can to prepare for possible trouble in our own future, seeking to be able to help more in our communities should grave trials arise.

More research is needed to understand the virus and how it may be treated. Understanding why some nations and some communities have higher morality rates from this virus or from pneumonia in general may be valuable. I've seen some amazing quack medicine reports passed on by gullible friends such as claims that drinking garlic water eliminate the infection. But I've also seen some seemingly reasonable arguments for some unexpected but plausible connections between pneumonia mortality and other factors that I hope will be reviewed and explored by competent researchers. Funding for such R&D efforts may be a smart thing, along with efforts to create vaccines and other tools to help cope with a global pandemic (though I recognize that the sensitive and cautious folks at the WHO have not yet dared to call it a pandemic yet, though I suspect that will change shortly). Thanks to one of my readers who shared some fascinating information that could offer a valuable lead. This is a disease for which sharing and careful vetting of good information will be vital. Perhaps there are some breakthroughs just waiting for some open-minded scientific exploration.

Update, 2/28/2020: The missteps taken by the US in coping with the emerging Corona virus crisis are troubling. Why does China have functional test kits for the virus but the US does not? See the story, Caroline Chen et al., "Key Missteps at the CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus," ProRepublica, Feb. 28, 2020. I hope we can get this problem solved quickly, even if we have to reach out to China for help.

Saturday, February 22, 2020

A Church Prepared for Crisis: The Timeliness of the Church's Emphasis on Home-Centered Worship

When the Church announced in 2018 that it was shifting to less Sunday time in Church buildings and a greater emphasis on learning and worship at home, the reasons for that didn't seem especially clear to me. Frankly, I missed the three-hour block and was a little frustrated to have Sunday School only ever other week since I really enjoy it (partly because we have had such great teachers and such interesting discussions in our classes with so many diverse and intelligent people from all over the world). But in 2019, the year of experience we had with new programs and a home-centered curriculum and with more flexible approaches to ministering to one another clearly paved the way for the Church in Asia to prepare for the current crisis we are facing with the Corona virus and the disease it brings, now known as Covid-2019.

In China, all organized religious gatherings are forbidden now to reduce the risk of spreading the virus. Without the ability to meet as usual, the only way to worship now is at home. Fortunately, we have been prepared for that with a curriculum and some practice. The virus is now starting to rage in other parts of Asia, with some communities locked down in parts of South Korea, Vietnam, and probably other locations soon. Home-centered worship will become increasingly important.

It may become important in some areas in the United States. If you've followed the news about the Diamond Princess cruise ship in Japan where the virus is raging, perhaps you'll share my dire forebodings about the plane of evacuated passengers that was brought to the US. I'm gravely disappointed that the stern warnings from the Center for Disease Control were ignored when the State Department decided to give seats on that flight to 14 passengers known to have the virus. It was a tough call, but a potentially disastrous one. See the Washington Post story, "Coronavirus-infected Americans flown home against CDC’s advice," from Feb. 20, 2020. (Further, some people with the virus may have lied about being virus free and were put on that plane without requiring test results to reduce the risk, again raising questions about this evacuation flight.) I hope others were not infected on that flight and that dozens of new disease spreaders will not be walking casually among crowds across America. But with the surprisingly intense virulence of this disease and the apparent gaps in our quarantine procedures, it could strike suddenly and fiercely. Please be prepared. Be prepared to continue worshiping, but also be prepared to continue living. Build your supply of food, water, face masks, sanitation supplies, etc. (Those doing home schooling, by the way, are in a good position to reduce the risk of exposure in schools, which can be potent hotbeds for spreading viruses, and where simple screening measures such as checking temperature will miss many spreaders of the virus. The CDC has already warned that we may see school closures and other restrictions on public events in the near future.)

As COVID-2019 becomes a crisis that affects many lands, I pray that we can find ways to contain it without extreme and harmful measures, and that there can be relief to those areas that are afflicted. Meanwhile, I am grateful that the Church has prepared us with guidance on how to run a Church that is centered in the home more than in its buildings, and, of course, that we have been instructed for years on the wisdom of preparing for trouble with food storage and other forms of preparation. The financial reserves of the Church, the topic of so much unjustified anger, may be called upon in the future to help cope with such trials. The health risks of a world with so much international travel and so much traffic across borders without adequate health screening can be surprisingly high. Continue preparing!

Update, Feb. 22, 2020: The CDC has warned that we may need restrictions on churches, schools, etc. in the US, as has been done in China. See the Feb. 21, 2020 story, "CDC warns community COVID-19 spread could take place in US":
Today officials from the Centers for Disease Control and Prevention (CDC) warned that although the agency is taking historic measures to slow the introduction of COVID-19 into the United States, the country should prepare for the possibility of community spread, as seen in China and neighboring Asian countries.

"The day may come when we may need to implement such measures as seen in Asia," Nancy Messonnier, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said in a press conference, referencing the closing of businesses, schools, and churches in multiple countries where transmission is now occurring within the community.

Thursday, February 13, 2020

How to Win an Argument with God: A Lesson Sponsored by the Corona Virus

Ever since I participated in debate competitions in high school and maybe before, I have relished the occasional thrill of winning an argument against a smart opponent. Forgive me for bragging, but I can rightfully boast some pretty impressive victories, especially my many victories against the smartest opponent of all: God. That sounds pretty amazing, I know, but I've discovered that it's relatively easy to win arguments against Him. In fact, I won several in a row in the past few weeks.

The key to winning the argument is first listening so you can know what to argue against. Prayer is a great way to get started. Pray and seek for guidance in some aspect of your life. Humbly sense that guidance. Feel free to write it down. And then, think carefully of all the reasons why it is ridiculous and doesn't apply to you. Strong logical skills are a plus here if you want a decisive victory. Provide your reasons, dismiss His suggestion, and voila, you are likely to win because I've found that He often doesn't do much of a rebuttal.

God, in fact, is a terrible debater. No offense, but it's true. In debate, after one side critiques your proposal, it's important to carefully respond to and rebut each argument they have raised. God, I'm sad to say, is rather weak in this regard. Although He's the Ultimate in intelligence, His mastery of debate techniques seems to pale in comparison with the skills most of us mortals have.

For example, two months ago, in praying for guidance on the things I needed to do, I had a distinct impression: go to the Shanghai office of Woori Bank (a Korean bank that was said to be a relatively safe place to park some money in a world where many banks are now close to insolvency) and take out the money I had there in an unusual US dollar account. It wasn't much, but wasn't trivial. I actually wrote that down on my to-do list for that week. I would write it down again for two or three more weeks after that. I came close to going right before our recent trip to Vietnam, but fortunately was able to come up with some very logical reasons about why there was no need to do that. It would be 6 months before I left China and had plenty of time, and the time I took to do that in January would be time I couldn't do some important things for my work, my callings, whatever. It just made no sense, and I provided persuasive reasons why I could delay that prompting. No rebuttal. God walked away. Bingo, I won! Such an easy victory. (I say that with all due respect.)

I had similar victories as I was packing and preparing for our short trip to Vietnam almost a month ago. I was repeatedly prompted to bring my journal, to bring a backup hard disk, to bring extra cash, to bring a an unnecessarily large supply of medication, and most strangely of all, to bring some of my collection of magic tricks that I use daily when I am around my grandchildren. My arguments were to the point and overwhelmingly persuasive: "There's no way I'm going to be doing magic tricks for Vietnamese kids. There's no need for extra cash in Vietnam and it could be stolen. I need to travel light, so my heavy journal will be a burden that I can deal with after my short trip. And bringing my backup disk puts me at risk of having it and my computer stolen while traveling -- a disaster." God just didn't have any reply to such persuasiveness. Victory, victory, victory! So sweet.

On the other hand, now that the Corona virus has swept across China and made it impossible or unwise to return home to Shanghai after my short trip to Vietnam,  causing my wife and I to flee to the US as "medical refugees," where we are now hanging out with family, I can somewhat admit that some of those illogical suggestions might have been slightly useful after all. Since I may not be able to return to China before my visa expires, I may not ever see that money at Woori Bank. I called them yesterday and they explained that for my protection, the only way they will ever let me access the US dollars in my account is to show up at their office in Shanghai with my passport (and visa, of course). The good news, though, is that if I die and my wife can provide proper documentation and evidence of death, she may have a chance of getting some of it if she also goes to China. The helpful employee I reached was chuckling over my situation and the impact of China's and the bank's regulations. Hilarious, I know! My other bank accounts have ATM cards that allow me to withdraw money here in the US, but not that special US dollar account with the appropriately named Woori Bank.

The journal, with some precious accounts, would have been nice. The medication would have been useful but I found some more in Vietnam. The hard disk would have been helpful, but I bought another. The magic tricks, well, surprisingly, they would really come in handy now that I am staying much of the time with a family of six grandchildren who are magic addicts and visiting another grandchild in Minnesota tonight who also loves magic. So, grudgingly, I can sort of see some point to some of my Opponent's suggestions, but that doesn't change the fact that I absolutely won the argument -- and lost some valuable resources and time, while gaining some unnecessary worries.

I guess winning arguments is not always the best policy when dealing with God. Yes, I'll acknowledge His awesome intelligence, but wish He were a more vigorous debater so it wouldn't always be so easy for me to win.

Mercifully, we may have found a way to retrieve the journal and some other much-needed items. I'll report on that story in a few days, which abounds in examples of the great kindness of some foreign and local friends in China who made that possible as an answer to prayer (it was also a rare example of me finally not arguing when there was a good argument to be made against an implausible suggestion). God may not be the best debater by human standards, but He often helps us find second chances or new paths forward after we make major blunders in our lives (sometimes as a result of a very persuasive win in our debates with God). Keep seeking Him and listening to His guidance, in whatever situation you are in. He may have some interesting things for your to-do list, whether it's something small that might help you to bless your neighbor, relieve someone in distress, solve major problems in your life, or prepare to flee your home on your own journey to somewhere unexpected.

Wednesday, February 05, 2020

(Deja) View on the Corona Virus

Please keep China in your prayers. The unprecedented efforts to contain the Corona virus may bring rapid success, I hope, but also bring great hardship to millions for a time. The challenges for those living in fully locked-down cities like Wuhan, Huangguang, and Ezhou may be enormous. But even in areas where the virus is not raging, like the beautiful, modern metropolises of Shanghai and Hangzhou, life can be difficult. People coming home from travel, like two American friends of mine who just returned to Shanghai from Australia, or a European friend who just got back to Hangzhou from a visit in Shanghai, are finding that strict regulations make them prisoners in their own apartment as the government requires quarantine for travelers. That's if you are lucky enough to get home at all -- my friend in Hangzhou said that she got home just one day before a ban on travelers entering the city went into effect. I don't know how accurate that is, so I'm just reporting what she understands.

In Shanghai, people returning on Sunday and hoping to start work on Monday are in for disappointment and frustration. It may be one or two weeks before they can go back to work, depending on local rules. Once again, even while living temporarily overseas, the wisdom of having food storage and basic supplies in reserve is manifest, though quarantined residents may be able to go to the local market for essentials or have them delivered.

One man in Shanghai desperately needed to get his new passport that was sent by DHL to Shanghai, but had not been delivered to him for a number of days because DHL was largely shut down due to virus fears. It was only by going to DHL offices and "crying" for hours in front of the building that he finally got the attention of workers there who dug around in a pile of undelivered packages and found his passport, giving him time to get to the airport with just two hours to spare before his flight out of the country. Without that, he would have been in violation of Chinese law with an expired visa. You don't want to violate visa rules in any foreign country.

Such tales, though, may be nothing compared to the sorrows of those who are trapped in places they don't belong, without resources and friends, unable to leave. Or even local Wuhan residents struggling with the challenges of living life under a lockdown with so much uncertainty, in spite of valiant efforts now to provide support and services. An American trapped in Wuhan did manage to get a seat on a plane out organized by the US government, but the problem was getting to the airport, some 30 miles away from his home. A few weeks ago that would have been easy: just take a taxi. But taxis in Wuhan have been shut down except for a handful dedicated to taking patients to the hospitals, but this requires a complex process of getting approval from the local government committees for each region of town and there's no chance of getting a ride to the airport. With no feasible way to get to the airport, the man missed the flight and his seat was given to someone else. Fortunately, he had a second passport with Germany, and was able to get on the evacuation flight for Germany, a nation that kindly sent a bus to give German citizens rides to the airport. (Congratulation to those of you who recognize the many virtues of having a second passport. When things go crazy in your home country, it's nice to have another option.)

In spite of China now going all out to contain the virus, there seems to be widespread anger toward China and the Chinese people. There are accusations that China did not act quickly enough or still is not doing enough. But Chinese people are also experiencing blame and anger. Hotels, shops, and restaurants in some areas are turning away Chinese people. Rudeness and xenophobic hysteria abound in some hearts. As I left Asia a few days ago, after a two-week virus-free exile in Vietnam before I began a business trip to the US for an R&D project in Minneapolis (I just love the University of Minnesota, by the way!), I read a front-page article in the New York Times on my flight from Hanoi to Seoul and was pained to see further evidence of the worldwide anger toward China. Motoko Rich's Feb. 1-2, 2020 article, "Global Xenophobia Follows Virus." See also MarketWatch's "‘No Chinese allowed’: Racism and fear are now spreading along with the coronavirus" from Feb. 3.  This is a tough time to be Chinese. The video below from a Chinese man in Florence, Italy reminds us of the humanity of those facing prejudice because a virus originated in their country.

Some say there's a deja vu sense to this virus, which is causing so much hysteria around the globe. But there's reason for the hysteria: the virus has left China, and now has killed people elsewhere in the world, including (as of Feb. 4) Hong Kong (1 death) and Philippines (1 death), etc., etc., etc., for a total of, well, two deaths so far outside of China. But in China, nearly 500 people have died, so the death toll is on its way to reaching that of the worldwide 2009 influenza pandemic with the H1N1 virus. Well, on its way to some degree, I suppose. The H1N1 virus that started in the Americas spread worldwide and ended up killing over 200,000 people (maybe as many as 500,000). Not 200, not 500, but over 200,000.

Do you recall the the draconian measures taken by the US government to contain that virus in 2009 and 2010? And do you remember the worldwide hostility toward North Americans for that North American virus? The shunning of all things American, the refusal to allow Americans to stay in hotels or enter restaurants, the locking down of New York, Miami, and LA? The martial law, the quarantines, the months of delayed school and the crushing of the US economy? The inability to fly, travel, or even leave your apartment? My memory must be fading, because I don't remember any of that. I remember encouragement to get flu shots then and warnings about the virus, but not the massive, painful disruption of travel, work, school, and normal life, nor escalation in anti-American sentiment. It's our bombs that stir that up, not our virus management policies.

China is responding to the crisis by locking down many cities, stranding over 50 million people, with martial-law measures in many other cities with tough regulations forcing many to be quarantined and hindering travel, work, and normal life. Perhaps too extreme, one can argue. There is also the cessation of much public transportation or blockades on roads in and out of many cities, the shutting down of thousands of tourist attractions, delayed operations for millions of employees, delayed school for millions, and so forth. Such extreme measures to contain this virus, and yet there is still international hysteria and blame. Outside of China, two have died, a few hundred are affected. It may get much worse, but right now, it's noting compared to seasonal bouts of influenza and nothing close to our own H1N1 pandemic that generated hardly any hysteria and resulted in a government response that was not exactly aggressive (I'm not saying it should have been -- I really don't know what should have been done). My point is, do we really need to shun China and be angry at the Chinese people for this one?

Yet the virus has unusually dangerous characteristics and may merit the extreme measures to control it. I'm not sure. But I hope we'll keep this in perspective relative to the thousands of deaths the US experiences every flu season from related though perhaps less severe viruses. And I pray that we'll remember China and recognize the great burdens the Chinese people are bearing, and not add to their burdens unnecessarily. Keep China and the Chinese people in your prayers, and thanks to those who are taking steps to help rather than to blame.

Update, Feb. 5 & 6, 2020: Mortality Rates
Regarding mortality rates, the official data from China suggests the mortality rate may be around 2%, though an early estimate from a small sample suggested it could be 11%. Hopefully mortality will decline as experience in gained and as treatments begin earlier for those at the most risk. However, current morality rates are based on total death relative to total cases, but many of the total cases are very recent, while the deaths are coming from infections that began perhaps a week or two ago when the number of cases were much lower, so the reported fatalities now during a rapidly escalating pandemic are surely severely underestimated, even if all the numbers being reported are accurate.

Here is some information on the mortality rate of the Wuhan Coronavirus relative to some other related viral infections, provided by ScienceAlert.com:
The 2002/03 SARS outbreak (Severe Acute Respiratory Syndrome) started in Guangdong Province and killed 774 people out of a total 8,096 infected. The 2012 MERS outbreak (Middle East respiratory syndrome) killed 858 people out of the 2,494 infected.

The respective mortality rates for SARS and MERS patients was 9.5 and 34.5 percent, far higher that for the new coronavirus, which French health minister Agnes Buzyn put at "less than five percent".

That rate is likely to decline, experts say, as the ratio of deaths to reported cases continues to widen.

The coronavirus "is less deadly than SARS or MERS, but it is more contagious," Buzyn said in a press conference Tuesday.

The seasonal flu, by comparison, kills 290,000 to 650,000 people per year, according to the World Health Organization (WHO). In the United States, the mortality rate among people infected with influenza is about 0.13 percent, the Centers for Disease Control has calculated.

Sunday, February 02, 2020

Superbowl Culture Shock

Since leaving for China over 8 years ago, I occasionally experience some culture shock when I come back to the United States. A couple hours ago I felt so fortunate to finally be back in the US after having been caught outside of China when the Coronavirus scare became serious. Instead of returning to China as planned, we prolonged our stay in relatively healthy Vietnam, and then flew via Seoul, Korea to a major US airport in a city where I have a business trip this week.

After clearing customs, I went to a rental car desk and waited in line to get our car. Then I saw one of the more incongruous scenes I've encountered. A sweet, young Muslim girl wearing a hijab was at the desk helping people, and right behind her was a large TV screen showing what looked like a scene from a sordid "gentleman's club" a.k.a. "creepers club" with scantily clad women writhing to flashing lights. I looked away but was really shocked that this would be what a rental car agency would show to its customers. When I looked back, one of the women was now climbing a pole for what I feared would be a sketchy performance. I had gone off to the side of the line for a moment and could see a women at the front of the line looking shocked herself. What's going on?

I think in response to that woman's concern, the signal was cut and only later turned on again, revealing that this was the Superbowl and I had just seen a portion of the Superbowl's halftime show.  Welcome back to the States, Jeff! When we got to the front of the line, we were the only ones left and had plenty of time to chat with the Muslim girl there, who was probably the best example of great customer service I've had in renting a car. Kind, friendly, and professional, and with her manager's support, went the extra mile to solve a problem for us. It seems that they were just putting on the game as a service to customers and she had not seen the offensive performance (of the female performers, not the refs or the 49ers), but she could tell something was wrong from a reaction or two. She told me that so much has changed in the 8 years I've been away, and mentioned a couple of other offensive situations that school children are likely to be exposed to these days. "It's getting crazy," she said of the declining moral climate in the States.

OK, I only saw a few seconds of the show and may be taking things out of context, and undoubtedly am offending fans of the stars. Plus I am clearly out of touch with America’s vibrant pop culture. But for an old prude like me, I think it was not appropriate entertainment. This is a reminder to me of the harm to common sense and basic values that occurs when a nation and its elite influencers (Hollywood, the broadcast giants, the sports industry, etc.) lose their moral compass and become addicted to pornography or become insensitive to what used to be considered common family values.