Tickets to the other world

 I have two tickets which are getting me there:

1. The major stroke that is deepening towards the bulb, which I've had in January 2018. I have not been able to swallow things properly for a year and it's getting worse.

2. The foot infection which can't be stopped because of 1. It occurred, in part, due to not enough movement and bad circulation.

As a doctor I was best at giving advice. I did not pay attention to it myself, but I gave good advice, and people who listened to me did well and got well. So, I'll do this to the end.

Don't drink alcohol. My wife and daughter mostly drank warm water. I thought it was silly, but water is a good drink. It can, generally, be gotten from the tap. Natural fruit juices should be drank only occasionally because they have too much fast sugar for regularity. Don't smoke. Don't do drugs -- even coffee is not a good idea if you can avoid it. Use devices, don't let them use you. Don't play computer games. Don't watch movies often. Don't waste time on the internet -- this includes social media and whatever else will come after it. Don't overeat. When in season, overeat fruits and vegetables that grow in your area. They don't count as overeating. When you do the "don'ts" make sure they don't become a regular occurrence. The world will keep trying to get you to do the "don'ts" to an extent that is abusing to youself and to others because that is "cool". They are a way to pain, a way to loss and a way to premature tickets. They are a way for other people to take what you have in exchange of a fake and oversold form of happiness.

This is a message for my grandchildren. I had to preach. It's what grandparents, and what doctors do. I am both. I want you to remember that I love you. I love those of you I have met, those of you whom I have helped raise, and I love those of you I haven't met. I'll continue to love you from beyond.

I am not sorry for those of you who have not met me in this state. I drool a lot. Most people no longer understand me. I am mostly gone. I can still return when somebody enters the room, but it won't be for long. When one loses their ability to move, it's terminal. For those of you whom I have met, and have helped me, I hope it had taught you to not do what I did, and to care and be kind to those in need.

I want you to strive to love yourselves -- always -- and then you'll have the strength to love those around you.  Love gives boundless strength and helps you deal with whatever comes. And to forgive yourselves, forgive those around you, and forgive me and forgive your father for not being there for you and for not doing more. I've forgiven my son for not beeing there for me in my final years and I hope you will forgive him too even though you have more to forgive. I have one message for him from near the grave: "shave!", a long beard is dirty and might even get you arrested some day. Even though Mihai is not here, I feel I can almost see him and I still love him with my whole heart. I can still see an incubator with a tiny baby that almost burnt as I kept virgil, and I am so thankful that he made it to almost 42 and that I had the chance to watch him grow into a man.

I'd also like my grandchildren to know each other and built a strong network of strong, kind people. This might be harder than you think, but I do believe you'll find you have things in common, and that you will do amazing things together as you grow.

I am the past. My motto has been "while there is life, there is hope". However, in these three years and a half there was no hope. My health only got from bad to worse. It did not matter what I did or what my family did. I still hear my wife calling me "dearest darling" as she goes by. I am sorry for not doing more for her, for my children, and for you. I am finally able to exit this nightmare that seemed to never end. My body is distorted and in pain. It was magnificient once. I won't miss what it has become. You are the future. Once you are a bit older, try to get to know each other and to help each other when you can. There is power in numbers and in kindness. Those who are related are alike and can help each other more efficiently than strangers.

Another House, Another Story.

 It was 1996. I was 46 years old. My children were already high school, and kept dreaming of living in a house with a garden. The house I was building was not going to be finished any time soon. It was too large.  But I wasn't the kind of person who'd alter plans.  I had a strong personality -- in other words, I was difficult to live with. I had a way of annihilating my family verbally -- whether I was right or wrong -- and I was drinking and eating too much for my own good. So, it became a mathematical impossibility for a person to live with me full time. My wife sold the apartment they were living in to buy a house. 

We saw a number of houses -- this time by car because my wife owned the car.  I mostly gave up driving after that. She'd take me to the places I did not want to or could not walk to. My car simply froze in place until I sold it for scrap metal many years later.

On a dirt road, the last one before the city ended, we found a tiny house with a large garden. It was owned by an old couple. They were younger than I am today. Yet they seemed so very old at the time. He was bent at close to a straight angle. His nose was almost touching the ground. She was selling flowers at street corners to make ends meet. They had to sell the home they had built and raised their two sons in because the oldest son had taken a loan with a money lender, where he had placed his parents' home as a co-lateral. He took the loan without paying attention to the interest in order to buy floor tiles and faince for his apartment, and less than a year later, when the loan reached the value of the house it had to be sold. The house was already on the name of the money lenders. The old couple asked for twice the amount owned -- 16,000 Deutsche Mark. We had sold our apartment for 13,750 Deutsche Mark. My wife and I pulled together all our savings to reach the full amount so that I could offer them exactly what they asked for. We met with both parties at the notary. The money lender asked for all the money, but I asked them to write how much they were owned, and made sure they got only that, and that the old couple received their share. Had they sold the house to anyone else, they would have lost everything. With the money, they bought an apartment in a shared yard, which was central and ended up being more valuable than the house. She continued to sell flowers and strawberries. We'd sometimes meet her at street corners. Within five years or so they were both gone. I'd like to think I made their final years less painful than they would have been had they not met me.

We demolished their kitchen, and built a house of the same size with a ground floor and a finished attic. By the time we started building the house, it was 1998. My children were sick of basements. My basement wasn't finished yet. They wanted to prove a house can be built in under a year. My wife found two capable men from Maramures who built the house in a few months. It had two rooms and a bathroom: one room on the ground floor and one in a finished attic. My children were fighting over the room in the attic. In the end, Mihai received an Erasmus scholarship to go to Germany in 1999 -- just as the house was finished. Ruxandra lived there with my wife and mother in law for a year before she too went to college and graduate school in the US. At that point my salary had reached $400 a month. It was considered large. When Ruxandra left for college in 2001, I gave her all my savings. I had gathered $4000 in four years. My wife paid the plane ticket. It was $500. Ruxandra used the money to pay for tuition at Parkland college. One semester was $3600. This was the first and only tuition bill I paid for. With the other $400 she paid the rent to a small room. It was $200 a month.

My children had both talent and the ability to work hard in whichever direction they tried to go in. At first, they both chose astrophysics. They did well in school and, eventually, they both received full scholarships to go to college, and later fellowships to attend graduate school. They did not need more money from me or from their mother after their first year. They both chose to work and support themselves. As empty nesters, my wife and I finished our two houses. Eventually, street plumbing was installed. The city even paved the roads. She built seven bathrooms in hers. Each bathroom has a room and tiny kitchen attached to it. I built four bathrooms in my house. Now that the pandemic is almost over, we hope to rent them to help make ends meet. While my end is close, my children's life story still has plenty of parts left unwritten.

Defeating Dr. Death. A house, but not a home

 Since I remember I wanted to build a house. Many children have this dream and play house. So I suppose it's not unusual. However, the impossibility of it only made the dream dearer to me. During the communist period houses were treated like churches: they were demolished, and replaced by apartment buildings. My parents' home was one of the last houses to be demolished just before the Romanian revolution in 1989. The house that I still dream myself in was replaced by a parking lot.  

After I moved to Timisoara in 1988, I was going to be given an apartment from work. The apartment building was unfinished. I remember visiting it with my children, and dreaming we will live there. Then the laws changed. By 1991, I gathered my savings, sold our two cars, and prepared to buy a house for my family. I was 41 years old and still believed I and everyone I loved would live forever. I thought I had time. I saw all houses on sale by foot. I was armed with a map, and with a lot of ideals. I rejected proprieties for facing north, for being draughty and old, for having sandy soil, and for plenty of other reasons that don't make sense to me today. Then I found this house on a dirt street that seemed worse than most others. There was no plumbing, but it was close to work. It was also surrounded by gypsies, who were terrorising the old couple who had built it. The other neighbor was Dr. Death. He had an interest in the property, too, and worked together with the gypsies to get the property for 70,000 lei.

The gypsies beat up the old lady. She died two weeks later. Their daughter was desperate to sell the property, and, of course, the only people who would have had the courage to buy it were either the gypsies themselves, who would not have paid much for it, or Dr. Death who offered the 70,000. That was true until I showed up. 

I misguidedly liked to play the knight in shinning armor. I bought the house for exactly the amount they asked for -- almost 250 000 lei.  House prices in Timisoara varied between 70 000 lei (the price of a new car) to ten times the price of a new car. The market is similar today. The 70 000 lei usually implied one was buying a ruin. This house had 4 big rooms, and a nice garden. All my other considerations flew out the window once I decided to buy it.  I reconciled with my ideals by saying I was going to demolish it and build my dream house. It was going to have four levels: a basement, a ground floor where my wife and I would have our medical cabinet, a first floor with plenty of space for us, our children, and each set of parents when they wished to visit, and a finished attic. 

I moved from the apartment I shared with my family to the old structure. I bought lots of books that explained how to build a house and plenty of tools. I made friends with the few neighbors who had no interest in the house. The lady next door had a big German Shepard. His name was Rembo. She'd let me use her entrance, and I brought plenty of food for her dog, who adored me. I hired an architect, and had the plan drawn and re-drawn until I was happy with it.

At first, the neighbors thought they would scare me away. The grandfather gypsy had served an 11 months prison sentence for murder. They had killed a young officer. The sentence was light because the gradfather was old and suffered from tuberculosis. Next to them was Rembo and his lady, and after them there was Dr. Death. He was the coroner who had been named so by the mob for sending Timisoara's dead from the 1989 revolution to be burned in Bucharest. It was rumored that young men and women entered the County hospital shot in the arm or in some other non-life-threatening location, and were later sent to the crematory in Bucharest with a bullet to the head. They said he personally got the job done in some cases -- perhaps if the person reached him alive. However, staff who tried to testify against him were later found dead, not shot, just held down until they drowned in rain puddles. This was because Romania's leadership did not really change after 1989 and those involved in the cover-up were too strong to be found guilty. Some gypsy clans sometimes worked together with the police and with people like Dr Death and got the right kind of jobs done. They survived and sometimes even thrived.

At work I tried to be fair. I have never asked for bribes, and supported my staff. As a doctor in triage, I tried to make sure all those in my department had the maximum salary they were allowed to get. Most of my staff was formed from women, and I made sure they were promoted. My job was to find what was wrong with people as quickly as possible and to send them to the right department to get cured. I did that to the best of my ability for all the years I was in service. As a colonel and an officer, I hanged out with the soldiers and sub-officers, and ignored my superiors to the best of my ability. My inferiors loved me, and my superiors thought I was mad. I'd often make jokes, and I was known for remarks of the form "sa moara comandantul daca nu-i adevarat" (let my commander die if I am wrong) made sometimes while kneeling perferably in front of the painting made by my sister with the skull and the bones. I now believe that it was a combination of the devotion of the many people I had helped that kept me alive combined with luck and madness and fear or lack of fear. I also had a strong presence and a way of convincing the masses. They were right: I was mad since I don't remember being afraid of anything or anyone while they were afraid of death, and after the revolution they were afraid of paying for what they had done. None paid in this life since there seems to be an endless interest in this world in promoting the corrupt because they do what they are told and can be led easily. I'll find out soon enough what's after death.

When I was outside work, I'd hang out with Rembo while working on my new building. My neighbors would play various tricks on me. I'd often find my gate wide open, and in the middle of the path, there would be trash or shit. I mostly ignored them and entered my house via Rembo's territory to avoid seeing them. One day I told them to give up on their tricks and that if they don't I'll break their gate and put their trash inside. Later that evening I found myself surrounded by gypsies holding various garden implements. They told me they wanted me to leave their street or die. Another year in prison for the old man was not much hardship. So they declared they wanted to beat me to death like they did the young officer. I had an ax nearby. I had used it to cut fire wood. I brandished it around and told them that, yes, I was outnumbered, and if they tried they could beat me up and kill me, but I was not going to go down quietly. At least five of them would go down with me. So, I asked "who is ready to die? who will go down with me? which five of you?". Rembo joined me. He was growling and his fur was raised. He looked like a porcupine or like a wolf ready to strike in my defence. They were armed and willing to use their weapons, but I was much taller than most of them. They did hit me a few times. I hit nobody, but cursed them to the best of my ability and brandished the ax a lot while Rembo growled. I was full of bruises when my wife came that evening, but at the end of the day they had given up and accepted me as a neighbour. I told them to swear on the sharpness of the ax that they will cause no more trouble, and promised I'll rescind my curses in turn. They kept their word for the many years that followed. We formed a strange kind of friendship. We'd always say hello when we'd meet. I'd bring medication for them when they were ill. I even tried curing their grandfather from tuberculosis. He mostly chose to give the medication I provided to their pigs. It would make them fat, and they could eat them faster. He'd chew tabacco instead to cure his cough.

In time the gypsies lost their house. A dentist bought it. He eventually sold out too; as did the son of the lady next door after she died at the age of 91. The new owner demolished it. Now it's an empty lot (somebody will likely build another tall building on it. What the area needs is a parking structure and more trees.) Dr Death has died of old age some years before me. He left behind two children just like me. Only I also have grandchildren. He has some of the present through his children, I have more of the future through my grandchildren.

Other gypsies moved on the street. They are much richer. They no longer keep pigs or any other kind of animal. They have a huge mansion that looks like a palace. Part of it is rented to a furniture store. Scumpi (the Expensive one; the name of my neighbor) has a blond, beautiful wife who looks younger than my daughter. He had shown me his scar from an open heart surgery and told me it was performed when he was in prison abroad. I showed him my scar. I had an open heart surgery the year Edward was born, only mine was performed in Timisoara.

It took me 30 years to finish the house. For many years, most of what my wife and I earned went into either paying workers or building materials. My children went to school abroad. They studied hard and obtained fellowships, and even sent money home. Now the house is built. My parents and my in-laws have been dead for many years. I have never opened a medical cabinet. At 67 I had a major stroke from which I have not recovered. Since then the damage deepened and is getting closer and closer to the bulb. I am 70 now and I am heading towards the other realm.

I built a house. It was never a home, but perhaps it will be some day. It has not been a medical cabinet either. It might still be one day.

Ira George, my grandson who is 10 months old, was born in one of the bathrooms I designed. The hospitals were closed due to a case of COVID-19, and my daugther chose not to go and give birth in a tent because she wanted to breast-feed. The rule was that they would take the child away until their COVID-19 test came back negative, which would take days. Instead, she gave birth in the bathtub, while my wife, a retired gynecologist, led the delivery. He is one of the proofs that life moves on independently of the many mistakes we make. However, my daughter chose not to live in the house I built. It's too big and too central she says. She is trying to rent it instead. She moved into her grandparents' former house, which has always been a home to her, and is now preparing to leave yet again.

I hope the world will head towards economic recovery, and stop the lockdowns, and that we'll fight for sanity and not for some crazy new normal. Lockdowns are not compatible with democracy. They damage mental health and well-being. I won't live to see "the new normal" (I hear too much about it on the radio as it is), but I'd like to know my children and my grandchildren are safe and free.

My daughter points out I should not have my story harm minorities. I simply stated things as I remember them. I have had many gypsy friends throughout the years, and some of my daugther's best friends were of gypsy origin. Her best friend in grade school was Alina Litra -- a little girl who welcomed the friendship of lonely a child that had no friends because she had changed three schools in fewer years. Our best neighbor -- the only one who opens our door regularly -- since I've been sick is an old gypsy lady, who even wears the flowing skirt atire. Her extended family owns many houses in Lugoj. While her grandchildren and great-grand children are abroad she maintains the houses, and finds the time to befriend us. Here we have no Dr. Death nearby. However, the house next door used to be owned by Mr. Devil. The nickname arised from his connections with the special police. I don't know the details of his actions, since I never wanted to find out. I've heard enough about injustice. His grandson owns the house now. He works at the Town Hall. He likely is involved with the new order. I heard him the other day discussing with the gypsy neighbor under my window. They said something about returning from Germany because somebody hanged themselves or had to hang themselves. I did not understand the details. However, it seems that the street still is a safe place to discuss things, and that the old and the new orders are not as different as I hoped. Also, Western Europe is not a safe place we'd like to think it is...

I have, however, drifted from my title. I now think people should build homes, and be there for their children and significant others because life is finite. The world needs kinder people, fewer heroes, fewer houses, and more homes.

Battles lost and Battles won

My daughter tells me to think about the times I've won and of what I've left behind. Of course, I can't take anything with me -- not even memories -- yet talking about better times seems like something to do other than looking at my foot, which leaks and looks like a battle wound. I've left discussing memories until it was too late. Now every word is hard to say.

I liked fights and arguments because I always used to win. I was smart, handsome, and had an almost uncanny ability to work hard and see through things and people. I also had an amazing memory, and was good at telling jokes, which helped lighten the mood. Since I liked being in charge, I chose the military. However, I never wanted to kill people. I wanted to fight death and win. So, I combined the two ms: military and medicine and became a military doctor. These two interests are combined during the COVID period at national and world level in a way I did not belive I would live to see happen. Now I am too ill to fight anything other than my own body and with every battle lost more and more of my resources are gone. I struggle to breathe, I struggle to swallow and choke on every other mouth of drink or food. There is almost nothing left. Still life drags on.

I married the most smartest, kindest and most beautiful woman in medical school, and treated dating her as a form of battle. I did not give up no matter what she said until she accepted to marry me. The first time we went out together, I introduced her as my future wife. Some might think it was creepy. I'd like to think it meant I was determined, and knew what I wanted from life. I wanted a family with her. So with determination I pursued that goal, and when she turned 28 and worried that if she did not accept me she won't have a family, we married.

We soon found out that our family dream won't be easy to achieve. My wife suffered from a combination of severe hyperemesis gravidarum and a hormonal imbalance, which resulted in very difficult pregnancies that ended prematurely. The babies she miscarried moved, but could not breathe because they were too young. After a number of failed pregnancies, and progesterone treatment with pills that did not work for her, my wife wanted to adopt. Working as a gynecologist gave her the opportunity to see many abandoned children. She would have taken all of them home if she could. I did not agree because I did not want to accept defeat. I told her we will succeed in having our own children. Eventually, we found out that if she took intra-muscular progesterone injections instead of pills, it stopped the miscarrigies. I'd do the injections. They were painful and after some months the oily substance would come back out though what looked like mild infections, and so we could not reuse the same skin space, and ended up having to do them in many different muscles. However, unlike the pills, they worked. She gave birth to Mihai at 34 weeks. Neither of us had ever seen an uglier baby, but he could breathe. He was old enough. After almost four years of bed rest combined with vomitting almost everything she ate, we had won. My wife was so weak she could not walk over a threshold, but we had a son. The hospital put him in an incubator. We took turns watching him. The first night was my turn. At some point I saw cockroaches coming out of the incubator. The child was red and he was crying. I put my hand it. It was too hot. Another few minutes, and his lungs would have been affected. A few weeks later another child who had been born on term and had a cold, used the same incubator and died from the same malfunction. Several such accidents happend all over the country in the years to come.

Mihai did not have the strength to nurse, and at first my wife did not have any milk. So, I'd go to the maternity ward, and ask the nurse for milk. The lady who provided us with milk in those first days was a gypsy. Later we joked that it was the gypsy's milk that is causing his current nomad lifestyle (Of course, today, the assumptions that gypsies are nomad is a stereotype. Plenty of gypsies are settled and most take good care their families.) Once my wife was able to milk herself, we went home. It took two months for Mihai to start nursing on his own. The first month he lost a kg. In the second he started to gain weight. Once he started nursing, he seemed to almost never stop. At 4 months he weighted 8 kg. We were convinced he was the smartest and most beautiful baby in the world by then.

In Mihai's first winter my wife developed pneumonia, but eventually made it through. She wanted to live to raise her son. I remember I made tea for her by put half a tea pot of leaves, and added loads of sugar. She could not drink it because it was too sweet. I tried again without the sugar, and the same number of leaves. Then it was very bitter, but I made her drink it through tears. I told this story proudly until my stroke. I've been sick for almost four years since. For the past year, I have been able to eat only banans, unsalted cheese, and an egg from time to time. I can't even swallow water properly. I've learned, of course, that not everything is a battle. One should be kind and considerate especially when people are ill.

Once Mihai was a bit older, we fought to have a second child. My wife had an exam that year (primariat) and after that exam came the misscarriage. He was pasted 22 weeks, and might have lived had he been born today. He lived for more than half an hour even then. It was spring, and we buried him under a tree that was full of flowers. It seemed the price she paid for eventually becoming a full doctor (doctor primar) was too high. But life move on. Mihai was a year and a half. He was talking, walking, and we were so very proud of him, and so very lucky to have help from my in-laws and to be able to work. Our last son would have had my father-in-law's nose, had he lived.

Three years after Mihai our daughter was born. The director of the hospital was on duty. My wife had not felt comfortable having him there during the birth process. He also happened to be away at the time. So, she did not call him and since her colleague who had monitored the pregnancy was on vacation, my wife led her own delivery with a nurse. She was already the best gynecologist in the hospital and I supported her decision. At 37 weeks, the baby was almost on time. My daughter was beautiful. I remember saying she'll look like me and be stronger than her husband one day. An hour or so after the delivery we came home. Our departure correlated with the temerity to leave before being checked by a doctor caused an uproar. When the discussion arose, I told them the hospital was dirty, and that after my first child was almost burnt alive, he was ill with conjunctivitis for months. I only exerted my right as a father to protect my daughter and my wife from their dirty hands. They were furious.

I told the truth at a time when a mis-spoken word could lead to arrest, torture and death. The directors were not chosen on merit, but on political connections, and they were sometimes known for betraying their own colleagues and for sending them to prison for mis-spoken words. This would have been a fate worse than death. So, my wife and I left that night for Bucharest to try to mitigate the damage, while my mother and father in law cared for the baby. When they started the investigation, my wife wrote only positive things about her boss. He continued to make her life difficult for some of the 7 years that followed until we moved to Timisoara. Retrospectively, I wish I was more of a diplomat. Saying exactly what you think has a price, which I never quite paid. My wife always tried to predict when problems would arise, and did everything in her power to solve them peacefully and to protect me, and our family.

I loved fishing, walking and I loved spending time outside. It's funny how I have not been able to walk well for more than 10 years, and not at all for more than three years. It had seemed impossible that it would be my fate. I used to walk so fast that a few miles seemed nothing to me. I would cross both Bucharest and Timisoara by foot. For the first fifty years of my life I seemed invincible. I battled for my life with illness only once. We had gone fishing at Balta lui Ion near Alexandria -- it was a bigger pond with water weeds, mud, and some fish. When I stepped in the mud I cut my food on a broken can. My wife offered to clean my wound. I ignored her, and kept fishing. A few days later I developed very high fever. My skin and eyes were yellow. Death felt near. My wife suggested we go to the hospital. We thought it was a pseudo-viral hepatitis. They would have never diagnosed me properly or treated me correctly. I chose to stay home and signed that I was responsible for my own fate. I was in my mid thirties and did not want to die. My wife thought of the cut on foot, which had healed since. She took my urine to the hospital. The vial broke in her purse, but she gathered what was left and tested it. It came out that both the liver and kidneys were severly affected. My wife immediately thought of the healed cut. It must be leptospirosis, she said. I took antibiotics, and went into shock. The disease is weakly contagious, but the children were with their grandparents in Lugoj, and my wife did not catch it. Eventually, things got better and I recovered.

My main fault was that I did not compromise unless I was forced to. I did what I enjoyed until I lost my helath and stopped being able to do much. I overate and drank, and gained weight slowly -- a bit every year. I also spent too much time on various screens. I combined overeating with exercise, which kept things going to some degree. I built a huge house with my own hands and with help that my wife struggled to send along. I had a garden inside and outside, and I had pets. I never accepted moderation, and never thought of the consequences even though as a doctor my job was to help people make good choices.

As I struggle to breathe, the only thing I feel is pain mingled with a certain detachment from it as if it is not my pain any more. I've been bedrid for more than 3 years. I had a major stroke on the 11th of January 2017. I did not think I'll live, and I was not quite ready to die. I thought I'll either recover or die, but I did neither. I've been living in a form purgatorium since with a few more strokes which happened whenever things looked like they were improving. All my life I was so very sure I knew right from wrong. Now I am no longer sure what victory entails. I find it difficult to let things go even when there is nothing left to fight for.

Going Against Nature: Reproducing the Math?

In this post, I try to reproduce the mathematics that led the COVID Nature paper to conclude the COVID patients who die lose an average of 16 years of life.

First, let us place an upper bound for YLL (years of life lost) for people dying from a specific cause.

For a first estimate, we can assume that people live up to 100 years and all people who die have been born and their age is above zero. Thus, an upper bound for YLL would be 100*lives lost.

On second iteration we could look at how old people are at the moment of death. Thus, people dying aged 20 will lose 80 years per death.

We can then adjust the upper age to some realistic number. Lowering the life expectancy to 95, I was able to obtain a YLL of 14 years for Italy and 12.7 for Belgium. Still, the real life expectancy of Belgium is 81.6 and for Italy is 83.35. Thus, assuming the COVID patients would have lived to 95 seems unreasonable.

So, what went wrong in the article? I think the authors made an error of judgement as follows:

An 85 years old just died of COVID, in a country where the average life expectancy is 80, but, people aged 85 and alive will continue to live on average another 2 years.

The authors assume these 2 years to be the YLL. This is however wrong and not how YLL is generally calculated in the literature .

To make matters clear, I will propose a thought experiment:

Let us consider a disease X that does not exist. This disease will consist of marker people receive without any effect of their knowledge. The marker is assigned randomly by a computer based on their social security number or information from the telephone book.

Naturally, there should be no years of life lost to disease X. Thus, YLL_X=0.

People marked with the non-existent disease X will die in the same way as unmarked people. Some will die young, some will die old. Their average age at death will be the same as that of the general population and their life expectancy again identical to the unmarked population.

However, every individual who dies belongs to an age group that still has some years to live. If the average life expectancy at birth is 85, a child marked with X dying at birth will be accounted as a YLL of 85.

If 85 years olds in this population are expected to live to 90, a man dying at 85 will be accounted as having a YLL of 5 years.

Thus, if we apply this algorithm for calculating YLL to the disease X that doesn't exist, we get 15-19 years for various European populations. If we apply it to corona, we get 16 years.

A correct way to estimate YLL should yield zero for a disease that doesn't exist, like X.

The way I estimated the YLL in March 2020 was to look at the difference between the average age of the Corona deaths and the life expectancy of the general population. The result was 2 years.

I argued that this is an overestimate. Corona kills members of the general population who are more likely to be sick. Thus, unlike disease X, these people wouldn't, on average, reach the average life expectancy of the general population.

Thus, the YLL for Corona won't be the full 2 years I estimated in March last year, but the difference between their average age of death and their potential life expectancy as adjusted for their pre-existing conditions.

Thus, a 20 years old with terminal cancer who dies of Corona loses, perhaps, a few weeks of life and not 80 years.

It is however difficult to estimate the potential life expectancy of this heterogenous population as too many variables have to be taken into account. I guessed the 2 years YLL to be half Corona and half the other conditions. I think this guess is reasonable, but if someone would argue for a YLL 2 years, I wouldn't argue back.

The Nature paper, however argues for 16 years. That isn't something I can agree with.

One conclusion of the nature paper that I do agree with is that COVID-19 is between 2 and 9 times worse than the average flu. This is far more realistic than the 16 years of life lost. Corona has filled the hospitals worldwide and does appear to be a bad cold indeed. Twice as bad as usual is optimistic. I would have guessed three times.

Using the formula from the literature, we get the following results for YLL.

Italy
YLL_75=2
YLL_85=6
YLL_95=14


Belgium
YLL_75=2
YLL_85=3.9
YLL_95=12.7

YLL_75 is normally used when discussing the years of lost life in other illnesses or situations like war, traffic accidents, etc.

Going against Nature

I have on my desk a paper from Nature , the most influential and highly ranked multidisciplinary science journal. This paper addresses the reduction in life expectancy due to COVID-19, a very important topic. It makes the following claim: The average years of life lost per death is 16 years.

I have addressed this problem on this blog and in "COVID-19: Observations from a world upside down" in March 2020. My conclusion was that the loss of life expectancy for each Corona death was about 2 years. In later discussions, I rounded this number to one, as it's easier to manipulate.

So, how can Nature claim 16?

Here I am revising the argument I put forward in March last year with some updated numbers. Before I looked at the average age at death of Italian Coronavirus victims and found it to be 81. The life expectancy in Italy is 83

Thus, my natural conclusion is that the people who died of COVID-19 lost, on average 2 years. Clinically, they don't seem to be too different from the cohort of people dying from other causes -- old, with preexisting conditions, etc.

The thesis that the life expectancy of COVID-19 victims is very short and, thus, the YLL (Years of Life Lost) is of order 1 and close to my estimate of 2 years is supported by the fact that the excess mortality drops below zero (mortality drops below average) in the middle of the Corona pandemic.

For example, in April 2021, Belgian mortality from all causes dropped to 20% below average, despite the Corona virus killing some people (few, as, in my view, the Belgian population was thoroughly infected before and had good herd immunity by April). Still, cases of long Covid and the few new cases of Covid should have increase mortality to something above average.

If COVID kills people with long life expectancy (16 years, according to the Nature paper), these deaths should affect the mortality in April. If, however, COVID kills people with short life expectancy, many of the COVID victims from the winter would have naturally died in April, and, as they are dead already, they don't die again and don't show up in the statistic.

To their credit, the authors do acknowledge that their YLL of 16 years may be an overestimate, due to Covid selectively killing people who are already sick and have low life expectancy. I very much believe it is indeed -- and very much do.

'However, our key results are not the total YLL but YLL ratios and YLL distributions which are relatively robust to the co-morbidity bias.'

These alternative claim in that, in the most affected countries, COVID-19 kills between 2 and 9 times more than the average flu. In Figure 1 in the paper, we see that, even if we restrict ourselves to the last relatively mild flu years, there is considerable variation in the severity of flu in different seasons. In severely affected countries, like Italy, US, Spain and Belgium, the most severe recent flu comes fairly close to Covid.

This is more consistent with my claim that COVID-19 is part of the natural dying process in humans. It is like a bad flu -- perhaps comparable to 1958 or 1967, and worse than the typical flu from the past few years. The impact on life expectancy on most victims is low, with most of the life lost being end-of-life care often in specialized institution.

An Economist article stated that in about half of the US states, over half of COVID deaths occurred in care homes and other kinds of end-of-life institutions. In April, the NY times counts the deaths from nursing homes to be about a third of the total COVID-19 deaths.

I thank Anna Bojds for useful discussion.

The second wave in India

India is facing a massive wave of Covid-19. As about 1 in 5 people is Indian, this is a planetary problem as far as humans are concerned. Our survival depends on India. As a response, many conuntries have been closing borders with India. The US bans most travel to India with some extemptions for students, US citizens and permanent residents. Australia has been closed off for more than a year and continues with its strict policies. An Australian returning home from India can face 5 years in jail, if they don't cleanse themselves for 2 weeks in another country before joining the Australian quarantine. Will these new restrictions last? Let's look at the situation and then let's look at numbers.

The problem and the proposed way out?

As expected, despite having one year to prepare, India has failed to build sufficient capacity in the medical system to deal with the problem. Most other countries have done the same.

Several politicians, some rather prominent, have advised people to use readily available holy cow urine to treat COVID-19.

So, such statements beg the question, does cow urine kill people? Short answer: no! We routinely drink milk from cows, eat their meat, sometimes raw and we are generally safe. In India, people sometimes choose to drink cow urine or eat cow feces without notable negative consequences to their health. Thus, it is reasonable to assume that, when it comes to COVID-19, cow urine is a placebo. This means it will work just as well as holy water, a prayer, or a sugar pill. We know that, when it comes to common colds, we often have noting better. In fact, my father's favourite joke about the common colds is that they last a week without medication, and seven days with medication.

We do, however, have a lot of medicine that can do a lot of harm.

Especially now, I believe going to a hospital in India with Covid-19 can result in a lot of harm. Here's how:

Just like with common colds and flu, treatment for COVID-19 is largely supportive. It is used to temporarily relieve some of the symptoms. Doctors try to keep the patients alive and let the immune system take care of the virus. Most people -- and, when it comes to Indians, a lager fraction than in the West, will stay alive without any special measures when infected with COVID-19.

Supportive treatment starts with rest, warm tea and love. Just like with colds, the mind plays a big role in the evolution of the illness. Stress makes things worse. When we take someone to a hospital, we increase stress. The hospitals are stressful places in the best of times.

The hospitals are dangerous, dirty places. Sure, they look clean, but they are teeming with sick people and their germs -- a wide selection of viruses and bacteria that, when added to COVID, have the potential to make things much worse. Now, the hospitals are overcrowded, and require the patient and his family to put on a considerable fight to get in. Waiting doesn't help. All these make Covid worse. Thus, many people who would have survived at home die in hospitals.

If the lungs are affected, statistics show that changing position (i.e., turning the patient on their side or on their belly) increases survival more than being intubated. The former is more likely to happen at home. Doctors and nurses are overwhelmed. So, patients are often tied to their beds, which prevents movement and increases the probability of death and/or intubation. Intubation is a very sensitive process that can only happen in the hospital, but requires a lot of monitoring, which is simply unavailable in COVID times. Furthermore, hastily administered medication without monitoring its effects can be lethal.

The turning of the patient is called proning. It's a technique that has been used against respiratory infections for centuries. When we visited the Skansen museum in Sweden, I asked why their beds were so short. They said it was because respiratory infections were common, and if one laid down on a flat surface, they believed death would come. So, the bed was a short wooden structure on which there was not enough room to sleep lying flat like we do today.

Some people choose to go to a hospital when they have symptoms consistent with COVID, but are not sure they have COVID and not a normal cold or flu. If they don't have COVID, they will get it, and are more likely to die.

In some parts if India, hospitals only allow patients who bring their own oxygen. At home, one would get to use his oxygen bottle. In the hospital, it may get shared.

One should also consider the family. As hospitals are short of staff, often healthy family members are allowed to look after their loved ones. At home, these family members would be exposed only to the virus from their loved one. In the hospital, they have a wide choice of viruses and bacteria to get sick from. Added to this, is the stress that will make these people more vulnerable. Thus, going to the hospital may not kill only the patient, but his relatives as well.

So, to go or not to go to the hospital? It is a personal decision that should be taken by family and professionals on a case by case basis.

The Situation in India: From the beginning to now.

India had a relatively mild first wave of Corona, with mortality 20 times lower than the UK or 10 times lower than Germany. While in Europe, it looked like the virus stops after killing 0.2% of the population, in India, it seems to have stopped after only 0.01% were dead. While this is most likely an undercount, the numbers remain low. Furthermore, it looked like India had herd immunity and the decrease in infection rates and deaths was constant and solid -- until now.

In April 2021, a new wave of COVID infections sweeps over India. The deaths and incidence increase exponentially, as if there is no immunity at all. What could have India done wrong?

(1) The early, strict lockdown. While it did not seem to contain COVID-19, the lockdown lowered the incidence of the other harmless coronaviruses which are endemic in the Indian population. Infection with these harmless coronas provides a degree of immunity to COVID-19. This immunity isn't permanent. The longer the time since last exposure, and the lower the number of coronaviruses a patient was recently exposed to, the lower the immunity and the higher the potential of serious disease. Thus, by eliminating the harmless coronaviruses, the lockdown may have created the conditions for this new wave to take place and be deadly.

(2) Virus mutations. It could be that the COVID-19 has evolved in India in a way that it can evade immunity from the old version. The virus was under evolutionary pressure to do so. India may have been for a long time in a situation where COVID-19 was widespread and most people immune. Thus, if a variant of the virus evolves to be able to reinfect these immune people, it can have all of India and the world. The virus mutates randomly -- lots of infected people means lots of mutations. The Indian environment would then select the best variant that can cause an all-new pandemic worldwide.

I worry about (2). In this scenario, the whole world may follow India and experience a new wave of the COVID pandemic. This is common with other colds. The viruses mutate and reinfect. COVID-19 is more deadly and new, but should function on similar principles.

The Future as predicted by numbers

The new COVID wave won't last long in India. In a large part of India, 25-50% of tests carried out a positive. It can't last. The virus will run out of Indians soon. This new wave appears to have the dvcmic of New York or Belgium. The Indians no longer comply with lockdown rules and it doesn't appear to stop. Thus, in a short time, the entire population will be exposed to the virus. Rich people will be immunized by the vaccine, poor people naturally.

Given the structure of the Indian population, the overall mortality will remain well below Europe. Most Indians are young and healthy. In Europe, Corona generally kills people who are within about one year from their natural death. In India, these people have been killed a decade ago, by more deadly diseases that are endemic.

Sure, some people will die, but it won't be like Belgium or New York. I think it won't even reach Germany, or Sweden. May even stay below the most successful EU nations like Denmark and Norway.

India couldn't really hope for a better outcome.

Shockingly, it may even be that, overall, Indian life expectancy will continue to increase this year.

In 1900, the Indian life expectancy was only 22 years. It has increased almost every year since. The Spanish flu of 1918, which was about 10 times as deadly as Corona and it killed mostly young people, has lowered Indian life expectancy by 2.5 years from 23.5 in 1915 to about 21 in 1920. By 1925, it had recovered and increased to 25 and kept growing since. In 2020, it was the highest ever at nearly 69.27.

The current rate of increase in India's life expectancy is about 4 months a year. This rate was maintained since the Spanish flu.

In Europe COVID seems to kill 0.2% of the population one year earlier than normal. Thus, 2 lives and 2 years of life expectancy are lost for 1000 people. That amounts to a reduction in life expectancy by 1 day, for the entire population alive today. Indians are younger and less likely to die. Thus, a reduction of Indian life expectancy for of 1 day due to Covid appears an overestimate.

If we look only at the people dying tis year, they will be about 1% of the population dying of the usual causes, plus (at most!) 0.2% dying of Corona one year too soon. Thus, this year's deaths will be 20% more than last year and 2 months younger than they might otherwise have been due to COVID-19.

They are however, on average, due to be 4 months older than the people who died in India last year due to the normal increase in life expectancy seen for the entire past century. Thus, the people dying in India this year, will still be 2 months older than those who died last year.

It's not worth shutting the country down if people dying this year are only 2 months older than those that died last year.

Drinking cow pee may indeed be the best solution. Thus, India's politicians are right. I say this as a Caltech-educated scientist.

A fast moving and short pandemic is better for live and the economy than a deadly long lockdown.

The sun will raise tomorrow. The cows will pee. New babies will be born.

++++ Looking ahead: the problem of lower birth rates in India ++++

India has been through many pandemics. COVID-19 isn't the most deadly. The prospect of losing 0.2% of the population in addition to the 1% that die every year won't make India run out of people.

India will, however, be running out of people soon.

Indian brith rates have gone down just as living condition improved. Vast swathes of India a below replacement level and, India as a whole went below 3 children born per woman in 2005. They are under 2.18 today.

The lowest integer number of children a childless woman can aim for that is compatible with the existence of the human species is 3. Most Indian women aim for less and most don't reach this number.

If birth rates continue to drop at the same rate, they will reach replacement level within the next five years. It may temporarily settle after that at some value below two or it may continue to drop. If it continues to drop at the same rate, India will reach one child born per woman in the next 25 years and absolute zero in less than 50 years. Over time, the drop in birth rates should become a much bigger problem than diseases like COVID.

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I thank Anja Bojds inspiring discussions.