!H for health --- agk's diary 17 January 2022 @ 0650 --- written on x61 while the baby breastfeeds --- This diary entry's about three things: health, how learning and assessment help produce it, and how current events shape knowledge about it. * * * Heath, World Health Org opines, is a complete state of well-being, not just absence of disease. Contrast David Werner's take on health. Werner and Sanders wrote in *Helping Health Workers Learn* (1982): > Health is self-reliance for the person, family, > village, and country. Do you think this is true? I think health's sort of self-reliance. Self-reliance was poisoned in my country by politics promoting selfishness. People are rational, dependent animals, according to Alasdair MacIntyre's Aristotlelian virtue ethics. If I don't have to reject interdep- endence, I agree with Warner. Phyllis Light, a fifth-generation herbalist in Ala- bama I studied under in the mid-2000s, critiques the industry of health, from "natural" to hospital. They sell a false, selfish ideal, she says. Their bread and butter depends on the desire they produce for unachiev- ably perfect fitness, free from lesions and aches, untroubled by life and behaviorally self-disciplined. In the south of our country, she holds, disease is social, not individual. The body that matters is the social body. Everyone has pains, injuries, and affl- iction. People become sick when they fail to meet responsibilities. Stop taking care of children or mother, get mean with neighbors, haven't been to church three weeks now. That's disease: bitter blood, mean spirits, low spirits, gall, bile, hot temper, heart so cold it hurts other people in the community. * * * Promoting health starts with learning---taking stock of the situation: person, family, village, and country. There's stuff everybody knows and secrets. Don't act without an idea of what's going on. Taking stock doesn't stop when interventions start. BaKongo village health worker Nzoamambu explained this to medical anthropologist Janzen in the 1960s with a case study: A man with fear in his heart was brought to Nzoamam- bu. Nzoamambu heard the man's heart go ko! ko! ko!, saw his agitation, and gave him a blend of tranquil- izing herbs without effect. The man's fear drove him nearly insane when he regarded the bush in a partic- ular direction. Nzoamambu sent a search party. They found the body of a man the patient, a hunter, acci- dentally killed. Now the man's recovery could begin. * * * For almost two years I've reviewed covid case and death count histograms biweekly. The disease arrived like goddess Sakpata (smallpox) destroyed 18th-cen- tury Abomey. Its soldiers sacked Hrounjroto, then returned with Mahi captives to sell to French slav- ers. Sakpata followed. Like them, we didn't under- stand and needed someone to blame. Clinical medicine learned a lot. We used steroids and ventilators too early (during the period of detectable viral replication), when we now (hope- fully!) use appropriate antivirals and monoclonal antibodies. Proning saves lives. We still underuse ECMO in my country; we expect too much too long from lungs. The healthcare industry here mines illness for profit. Concurrently, public health learned stuff. Covid lingers in dry air. N95/KN95 masks limit exhaled and inhaled virion counts. Suspended viral particles travel via HVAC and plumbing. Ventilation, humidif- ication, and high-quality filtration drop airborne concentration. To proxy for covid concentration, measure carbon dioxide. After the first case peak in New York City, deaths peaked 20 days later. Wastewater counts peak 5 days before cases, 25 before deaths. Cases enter my coun- try with business travel and initially spread via ostentatious weddings and parties. Port cities and wealthy peoples' redoubts peak weeks before inland cities. Rural crises begin once port cities are "done with it." Friday in my country 860,000 people tested positive. 3,000 died. Today's deaths belong to case counts from 20 days ago (200,000). Holding mortality equal, expect death counts 3x our previous high the Friday national death data goes away. We get 20 more days of national death data---just enough to judge Omicron's lethality. On 4 Feb, as rural cases continue to rise, my country's Federal government will stop collecting nine daily counts from hospitals: > 2a: All Hospital Beds > 2b: All Adult Hospital Beds > 7: Total Mechanical Ventilators > 8: Ventilators in Use > 14: ED Overflow > 15: ED Overflow and Ventilated > 16: Previous Day's COVID-19 Deaths > 21: Previous Day's Remdesivir Used > 22: Current Inventory Remdesivir COVID is currently the leading cause of death in my country. Our Federal administration has decided we'll fly, self-blinded, into our biggest pandemic wave in 104 years. A patchwork of county and state- mandated reporting remains, but those data are hard to access and reconcile. We'll learn what happened this year in a MMWR article after the fact, after midterm elections and more variants. This isn't the administration's first self-blinding. It stopped collecting data on breakthrough infections in vaccinated people before enacting a disastrous vaccine-only policy last summer. Too late, we learned mRNA vaccines decrease case severity but don't halt transmission. Nzoamambu led with meds too. Unlike my country, he didn't stop assessing a still-sick man. * * * My baby's healthy. She learned to crawl this week. I ache from the booster but turned in my schoolwork on time. Roommate uses vacation days while Walmart re- models the bakery. I look to the bush, heart beating ko! ko! ko! Maybe nothing's there. Health is a complete state of something, not just absence of disease. Disease'll always be with us. We can be decent and care when someone's ability to be decent fails. We need each other. Striving for health is striving to be able to rely on each other---creat- ing supports to make that possible. Beautiful snow fell last night, thickly blanketed everything. Linemen repair damage. EMTs collect my neighbors who need oxygen. I sit here warm and well, sipping rooibus and makoni tea in china from Cassie, learning. * * * UPDATE (7 Feb): My model was wrong. This wave's daily death toll has matched--not beat--last winter's in my country. As cessation of data-reporting arrived we recorded our fourth-highest daily death toll (4,154), and an upward trend.