Embracing Our Ignorance

I read a story yesterday in The Atlantic about how COVID-19 interacts with our immune systems. It opened with some humor about the complexity of our immune systems, and used that as a refrain throughout the article, but it nevertheless attempted to explain how the immune system works as if it were well understood! I want to explore why I think that - despite our immense knowledge - our physiology is not well understood. In fact I want to suggest that the rapid pace at which we are accumulating knowledge of biology is evidence, instead, of how much more we have to learn. And I want to make some observations about what this should mean for K-12 teaching of biology, where I have some experience.

Let’s take a minute to think about T-cells. My first memory of even hearing the phrase “T-cell” was in 1981 when AIDS was first being described and discussed. Articles in popular magazines like Discover and Science 80 called the new disease T-lymphotrophic virus and they were supplemented with imaginative descriptions of the human immune system. In communities where AIDS was a concern (as opposed to a hysterical panic) there was a lot of discussion about T-cell counts. But how old was knowledge of those T-cells? Not very.

The “T” stands for their source in the thymus, a small organ in front of your heart, and it is intended to distinguish them from B-cells, also small lymph cells, but arising instead in bone marrow. Less than thirty years earlier, the great Johns Hopkins pathologist Arnold Rice Rich (father of poet Adrienne Rich) who wrote the book on TB (really, Pathogenesis of Tuberculosis, 1000 pages) said “literally nothing of importance is known” of small lymphocytes and added that this was “one of the most humiliating and disgraceful gaps in all medical knowledge. By 1964, scientists had figured out that those lymphocytes had something to do with an immune system but hadn’t differentiated them into the many types students are now required to memorize with the aid of flash cards. They hadn’t yet divided them into B and T. In fact, they actually thought the thymus was a vestigial organ. As late as 1971, just ten years before I started hearing popular disquisitions on T-cells, medical dictionaries were still saying that the function of the thymus was “obscure.” That is definitely what I was taught when I took high school biology in 1967.

The Australian physician and scientist Jacques F.A.P. Miller spent the 60’s discovering its function, but his work had difficulty gaining acceptance. His politest critics merely accused him of “complicating things.” In 1968 when he presented evidence that T (thymus-originating) and B (bone-marrow-originating) were two kinds of lymph cells he was publicly reminded, in front of a auditorium full of immunologists) that B and T were the first and last letters of the word bullshit. By the 1980’s the receptors by which B-cells recognized foreign cells were mostly understood. Only in the 2000’s were T-cell receptors understood. Moreover, T-cells were broken down into distinctive subtypes: Cytotoxic, Killer, Helper, Memory, Regulatory, Gamma Delta, and Mucosal. (More memorization, more flash cards) This January, researchers in Wales happily publicized their discovery of a new type of Killer T-cell!

Before stepping back to reflect on the larger significance of this minutiae - the forest in which these leaf aphids reside - let’s think a little more about their discovery, naming, and classification. B- and T-cells are lymphocytes, two of at least three kinds of cells found in lymph, a fluid that circulates through the body in separate system from blood. Lymphocytes are one of at least five types of leukocytes, or white blood cells. While red cells (then called “corpuscles”) were noticed with fascination by the first microscopists in the 17th century when they turned their lenses on blood (Anton von Leeuwenhoek produced the first drawings in 1695) it wasn’t until a century later that a British surgeon noticed small transparent cells among the larger red ones. He accurately guessed that they came from the lymph system. Their appearance was described in 1843, but it wasn’t until the 1870’s that new staining techniques allowed scientists to see their structure. That work was done by Paul Ehrlich, who won the 1908 Nobel Prize in Medicine. It still didn’t allow anyone to know their function, or how they performed that function, or how very many kinds there were. The color “white” refers not to the cells themselves but to how they appear overall when blood is allowed to separate into different layers, whether through settling or centrifuging.

What does all this mean? For me a couple of observations emerge. One is the redundancy of biological systems. I reread the material above and note, for example, the existence of NK (Natural Killer) Cells, NKT (Natural Killer T) cells, and Cytotoxic T cells: different varieties of lymphocytes with similar abilities to destroy other cells. But these aren’t completely distinct categories, they overlap in their mechanisms and origins. I think that makes their redundancies different than redundancies created by engineers, such as fail-safe mechanisms or, say, drop-down menus coexisting with keyboard shortcuts. I will boldly say that immune mechanisms in particular have to evolve rapidly to keep up with rapidly-evolving viruses and that every single element of what we understand to be a system is under selective pressures. And the results of that evolution aren’t always good as we see with autoimmune and inflammatory diseases in which one or another component of the immune system attacks our bodies and makes us sick instead of healthy. So treating this as if we can somehow “understand how it works” may not be a good intellectual model. Thinking of it as an ecosystem - all elements interacting with all other elements - may be a better model. I will return to this idea later.

Second, look at how resistant people were to recognizing the existence of T-cells. Look at how resistant they were to the idea that their ignorance about the function of the thymus didn’t mean it was vestigial! That resistance to new fact is especially notable when compared to how quick they are to add new classes of T-cells now that their existence is recognized. As a teacher, it is another reminder of how shallow the practice of memorizing all these names is by contrast with learning something about how these discoveries were made instead of pretending that lots of facts equals understanding.

Third, the rapid pace of new knowledge about this field suggests that we still have a lot to learn. If we were anywhere near a complete understanding of immunology, the pace of discovery would have slowed considerably. And the absolute astonishment about how COVID-19 works should humble everybody.

I want to write more about this, especially about biochemistry, the nervous system, and our microbial biota, but I will save all that for another day.

South Dakota Governor Kristi Noem and the Trump Death Cult

Kristi Noem of South Dakota, more than any other state governor, has made a personal brand out of her refusal to implement public health measures to curb the COVID-19 pandemic. Here is a quick timeline of her insistence on "personal freedom," which is the death cultists' byword on why they won't protect themselves or anyone else.

In mid April the United States was reaching an early peak of 30,000 new coronavirus cases each day. (I say "early peak" because new daily diagnoses subsequently declined. We are now seeing about 200,000 new diagnoses each day.) Things here in New York were especially bad: we get a lot of travelers from around the country and world, we live really close together, and doctors had figured out very little about treating severe cases. The entire country was losing about 2,000 people every day. About half of them were here in New York! In South Dakota at that time, though, nobody was dying on an average day and they were diagnosing about 125 cases daily. 

Perhaps as important, President Donald Trump had been downplaying the seriousness of the pandemic since early February.  In fact, he said it would be over by April with the advent of warm weather. When various states began ordering schools and businesses to close, Trump jabbered about reopening by Easter, which was April 12 this year. He also absolutely refused to mask in public. On April 15 he was still pressuring the states to end the school and business closings. What did Governor Noem have to say? "I believe in our freedoms." She implemented no mandatory public health measures: no closures, no mask mandates.

In May, Governor Noem decided it was a good idea to demand that the Oglala and Cheyenne River Lakota take down the highway checkpoints they were using to try and reduce the spread of coronavirus on their reservations. She made a public show of issuing a 48-hour order to stop checking traffic and insuring that outsiders keep going. Cheyenne River Tribal Chairman Harold Frazier declined to take them down and wrote her to ask her if there had actually been any complaints by motorists. Oglala Sioux Tribal President Julian Bear Runner pointed out that the checkpoints wouldn't be necessary if she had implemented any kind of shut downs. In the end, she never actually took the tribes to court at all.

In June, Governor Noem was still talking about "freedom." She said that more freedom is the answer. While her talking points had previously included a reliance on science and data, on June 8 she warned against "blind reliance on insufficient modeling"!? By that time the worst of the initial stage of the pandemic in New York was past. The 7-day average showed that we were still losing seventy friends, neighbors, and relatives each day. But that was a dramatic improvement over the thousand a day in April. Nationally, the death toll passed 110,000 and President Trump was still promising that the virus was "going away."

But the July 4th holiday was coming. Trump was not only promising that it was going to go away, but claiming that if it weren't for "fake news" everybody would know that it already was. And he was itching to start up those rallies that feed his ego so much. The first rally since March was held in Tulsa, Oklahoma on June 20. His staff ran around the arena removing the "Don't Sit Here" stickers that the venue had put on seats at the request of the local government in order to create social distance. Most of the people who attended followed the President's lead by refusing to mask. In his immediate entourage, both Herman Cain, the former Republican presidential candidate, and Kimberley Guilfoyle, the Fox News personality (and Trump's son's girlfriend) apparently contracted COVID at the rally. Cain subsequently passed away from the illness. Coronavirus rates in the Tulsa area tripled in the weeks after. 

So starting the in-person rallies back up was a big opportunity for Governor Noem to demonstrate her loyalty to the President and his fans. She wanted Trump to appear at Mt. Rushmore for an Independence Day fireworks show. In interviews she acknowledged that when she first brought it up he told her how much he loved Mt. Rushmore and wondered aloud how he could get his face on it. When she realized that he wasn't kidding she had artists make a model that included him alongside Washington, Jefferson, Lincoln, and Teddy Roosevelt. By July 4th, New York's closures and mask regulations had further pushed deaths down to 25 a day. The country as a whole was still climbing to new peak of 70,000 cases a day, but South Dakota was only contributing 50 of them. And the average daily death rate there was still zero.

Sturgis was coming. If you have no connection with American motorcycle culture you may not know about the annual bikers gathering in the Black Hills during the first week of August. It has been going on since the late 1930's and every summer for the last few decades roughly half a million motorcyclists descend on the town of 6,000 for drinking, touring, racing, parading, and other revelry. Some people in town really didn't see how bringing in people from other places could possibly be a good idea during a pandemic. The local businesses who profit from the rally clearly thought the lucrative benefits outweighed any health risks. Governor Noem loudly supported them and it turns out that lots of regular attendees agreed with her about freedom, COVID, Trump, and social distancing. Close to 500,000 riders showed up. South Dakota was by then averaging 80 new cases of coronavirus a day and had inched up to a daily average of 2 deaths. I have no idea if any riders hurt each other during the bacchanalia (I can guess) but I do know that one woman was knocked unconscious and stripped of her jeans by a buffalo when she got too close to a calf. I am not making this up.

But COVID wasn't going to make a grand entrance during the week of the rally. The incubation period of the virus (and the lag before serious symptoms) guarantees that. Everybody got to convince themselves that they were right to be unafraid... at least for a few weeks. By September 8, Fox News was reporting that - of the 1.4 million cases during August - 20% were a direct result of the Sturgis Motorcycle Rally! New York State was by now down to ten deaths a day. South Dakota was averaging 236 new daily cases (up almost 300% from a month before) but zero deaths. And Governor Kristi Noem loudly denounced the Fox News story as "fiction."

In retrospect it should be obvious where this is going. Phrases like "tempting fate" come to the tongue. But the coming trajectory was clear to epidemiologists months before. By late October South Dakota had become a center for the nation's explosive growth. The state was experiencing 731 new cases a day and averaging six deaths. By comparison, New York, with a population 22 times larger was down twenty daily deaths. Another way of looking at this is to note that twice as many people live in the 34 square miles of Manhattan as in the 77,000 square miles of South Dakota. This is significant because it highlights the difficulty of social distancing in New York. It highlights the extreme ease a virus finds in spreading among a population of 48,000 per square mile as compared to a population of 11 per square mile. But we had just reopened our schools on split schedules to keep numbers down. Broadway was still shuttered and we were still requiring people to wear masks. Governor Noem hadn't budged in her opposition.

On October 20 she boldly claimed "We follow the science" while scientists and physicians begged her to implement mandatory public health measures. In vain. She boasted of South Dakota's total death rate (yes, she did) of only 37 per 100,000 making invidious comparison with New York's 171 per 100,000. She was comparing her state, which was still experiencing its first wave in the fall, with the state that had born the brunt of the pandemic back in the spring, when the disease was poorly understood and doctors in our hospitals were effectively practicing evidence-free medicine, trying to make up treatments while the ERs (and morgues!) were overflowing. Either she didn't know or she didn't care. 

Do I feel good about the fact that the South Dakota death rate she boasted about just a month ago is now 84 per 100,000? I do not. But that is a 227% increase during a time when New York only suffered a 2% increase. We are indeed suffering here. We are back up to averaging 30 deaths a day here. But so is South Dakota, and that is in a population 4% our size, smaller than the Bronx. And what does she say? She says she won't mandate masks just "to make people feel good." Just to make people feel good? How about to keep people alive.

I only want to make a few more points. One is about narcissism. When President Trump was asked in mid-September if he was afraid of getting coronavirus at his rallies he answered, “I’m on a stage, it’s very far away, so I’m not at all concerned.” As everybody knows he was helicoptered to Walter Reed Hospital for treatment only two weeks later. He repeatedly stated that the US was "rounding a corner" at precisely the moment that the national case numbers began climbing again after a late summer drop. In the weeks before his electoral defeat in early November he kept complaining that the press was only reporting on this calamity to make him look bad. "You won't hear a word about it after the election." That is untrue because every day is worse than the day before now. We are now averaging 200,000 new cases and 2,000 deaths every day: a 67% increase over two weeks ago in both categories. Trump is used to bullshitting his way out of personal problems. He clearly believes that a global pandemic is only a problem because it makes him look bad. He has not shown an ounce of empathy for the sick, for the dying, or for the mourners. And Governor Kristi Noem has shown no leadership in public health, just a desire to look as tough as the fake tough guy in the White House so that she can be considered for her party's nomination in four years.

Second, I want to stop and remember that - for all the low numbers South Dakota reported in the late spring and summer - one of the largest early COVID outbreaks in the entire country was at Smithfield Foods in Sioux Falls. 1098 workers at their pork processing plant were diagnosed with coronavirus in April! Why didn't that set off alarm bells? I have to wonder if it wasn't because most of those workers were members of what the company referred to as the plant's "large immigrant population." That company spokesperson said, “Living circumstances in certain cultures are different than they are with your traditional American family.” We have already alluded to Noem's colonial approach to the original people of South Dakota. I suggest that she has the same attitude toward the newest arrivals.

Finally I need to say why I take the time to air my irritation toward the governor of one of America's least populous states. South Dakota has only one Representative, but the same two Senators as California or Texas or Florida or New York. They have an outsized influence on the Senate, which has stonewalled progress in any area of governance since the election of Barack Obama awakened the nightmares of the white supremacists. And what I wrote above about her being her party's nominee in 2024? It's a real possibility. I don't want to forget one detail of her irresponsibility if and when that happens

The Maduro Regime Suppresses the Left

 This morning's New York Times reports on the violent repression of the Venezuelan left by the Maduro regime. The popular socialist radio personality José Carmelo Bislick was abducted and murdered in August, apparently for criticizing corruption by local party leaders. Socialist TV personality Osvaldo Rivero is receiving death threats for saying the same things on a national scale. Jose Pinto of the left Tupamaros Party was jailed on trumped-up murder charges. Isabel Uzcateguí of the Communist Party was detained repeatedly and threatened with death. There are more examples of the same thing. So why does the US left still defend Nicolás Maduro's violent, crony-capitalist government? 

First, anti-imperialists in the US have a long history of confusing the need to oppose intervention with the desire to lionize the subjects of that intervention. Authoritarian leaders shouldn't become our heroes just because American monopoly capital doesn't like them. Yes, the United States has waged economic warfare on Venezuela for years and under both political parties. The current sanctions began with an executive order by President Obama in 2015. Trump accelerated this with threats of invasion after Juan Guaidó declared himself President in 2019. Some of this was Trump's blah-blah: John Bolton writes that Trump bizarrely claimed that Venezuela is "part of the United States" and that invading the country would be "cool." But he also derided Guaidó as "weak" and a "kid," comparing him unfavorably with the "tough" Maduro. And there was no invasion. But it is also clear that Senate leaders like Marco Rubio really wanted one and that the CIA was recruiting Venezuela's neighboring states to do the job. So the imperialist threats were real.  But we also saw American leftists go beyond resisting attacks on Venezuela to defending Maduro.

Second, Venezuela has become a sort of bogeyman to the American right. Yesterday the official GOP Twitter account retweeted a weird claim by one of Trump's attorneys that the US election was stolen by software designed by former Venezuelan President Hugo Chávez! To my knowledge, Chávez never had any particular expertise in coding. Oh, also, he died in 2013. When Bernie Sanders was a viable candidate for the Democratic nomination his opponents seemed to think that yelling "Venezuela!" was an argument against a Green New Deal, student debt forgiveness, and a $15 minimum wage. In September and October the GOP's entire election strategy in Florida seems to have been yelling "Venezuela!" at - of all unlikely targets - Joe Biden. So I suppose it's not a stretch for actual leftists to think it must be an unintentional compliment. Maybe not true of centrist Democrats, but definitely for "real" ones.

Third, Venezuela has continued to masquerade as socialist. Even with the profound disparities of wealth between favored cadres and every other Venezuelan, even with the legalization of the black market, the Maduro regime has been able to rely on socialist support by claiming that they, too, are socialists... at least until recently. I suppose it's easier for socialists in the US - who are completely unaffected by the corruption, failures, and violence of the regime - to believe these claims. And both at home and abroad Maduro can blame all those failures on imperialist sanctions. The fact is that under Chávez the Venezuelan economy never broke its reliance on oil while prices hovered around $100 a barrel. They plummeted with the Obama Administration's embrace of shale and are currently about $36 a barrel. But, no, those are inconvenient facts... for everybody, both supporters and opponents of Maduro. In any case, American leftists may think Venezuela is "imperfect" but they seem reluctant to recognize that it is no longer socialist at all.

Fourth, the expose of Maduro's attack on the left was published in the New York Times, that tireless apologist for imperialism. Why should anybody believe it? This is the newspaper that defended last year's military coup in against President Evo Morales in Bolivia, saying that the difference between a "popular uprising" and a coup is "blurry." This is the newspaper that less than two weeks ago described Bolivia's reception of Morales's return as "wary" after his party overwhelmingly won the elections... again. This is the newspaper that claimed the US opposed the 2009 military coup in Honduras. That coup installed President Juan Orlando Hernández, whose brother was convicted a year ago by a Manhattan jury of running tons of cocaine into the United States. That coup resulted in a soaring crime rate that has fueled the unprecedented flight of Hondurans across Mexico asking for sanctuary in the US. And Hillary Clinton publicly acknowledged her support for that coup in her 2014 memoir, Hard Choices. I could go on. So it's easy for people who don't want to accept the truth of Maduro's antidemocratic violence to dismiss today's article as one more piece of pro-imperialist disinformation. And, frankly, there is a strong whiff of schadenfreude in that article. I, for one, would rather read about it elsewhere.

What about NACLA Report, the progressive journal on Latin America? Would that be an acceptable source. I did not find a discussion of repressive violence against the left, but I found this discussion of racist police violence in Venezuela from this summer. It reveals that nearly a third of homicides in Venezuela are committed by state security agencies. It reveals that Venezuela's police kill as many people as Brazil's: a country with a population seven times larger. It reveals that the victims of this police violence are overwhelmingly young, overwhelmingly poor, and overwhelmingly Native and Black. So, while the Venezuelan regime can hypocritically denounce the US for the murder of George Floyd, neither the Venezuelan government not the Venezuelan opposition can honestly say that Black Lives Matter to them.

My friend Ingrid was murdered in Colombia by FARC in 1999. The American right cried crocodile tears because they could use the death of an Indigenous human rights activist as a bludgeon against the left. The left was largely silent. In fact all I remember hearing from Democracy Now! was the FARC's initial denial. I have no interest in defending people who denominate themselves "socialists" or "leftists" if their actions are corrupt and anti-human. You can oppose US intervention in Venezuela and Nicaragua without pretending that Nicolás Maduro and Daniel Ortega are people's heroes... or even decent human beings.