A GENTLEMAN IN MOSCOW

April 11, 2020


This COVID-19 lock down has given me time to read, write, paint, rearrange furniture, seed and fertilize my front and back yard, etc etc.  You get the picture.  Also, my wife and I are streaming video from On Demand and Net Flicks:  Homeland, Outlander, Eco in the Canyon, Seal Team, Manifest etc.  You get the picture.  I just completed one of the VERY best books I have ever read— “A Gentleman in Moscow.”  This great book was written by Amor Towles.   Let me give you a little data on the book itself.

AuthorAmor Towles
PublisherViking
Publication dateSeptember 6, 2016
Media typePrint (hardcover and paperback)  

THE MAIN CHARACTERS:

  • The Count Alexander Ilyich Rostov. The Count is the protagonist and titular character of A Gentleman in Moscow. …
  • Mikhail Fyodorovich Mindich (Mishka) The Count’s best friend, whom he met at school and who keeps him company at the hotel. …
  • Anna Urbanova. …
  • Nina Kulikova. …
  • Sofia. …
  • The Bishop. …
  • Andrey Duras. …
  • Emile Zhukovsky.

I am NOT going to spoil it for you by giving any details relative to the characters in this book but suffice it to say, Mr. Towles goes to great length to develop each character to the fullest and how those characters interact with Count Rostov.  There is a very surprising ending.  In other words, I did NOT see that coming.

STORYLINE

A Gentleman in Moscow immerses us in another elegantly drawn era with the story of Count Alexander Rostov. When, in 1922, he is deemed an unrepentant aristocrat by a Bolshevik tribunal, the count is sentenced to house arrest in the Metropol, a grand hotel across the street from the Kremlin. Rostov, an indomitable man of erudition and wit, has never worked a day in his life, and must now live in an attic room while some of the most tumultuous decades in Russian history are unfolding outside the hotel’s doors. Unexpectedly, his reduced circumstances provide him a doorway into a much larger world of emotional discovery.  Prior to reading the book, I thought how on Earth could a guy stuck in a hotel for life but that entertaining.  Boy was I wrong about this one.  Mr. Towles displays an ability to develop the characters and situations that are fascinating.   The detail is absolutely grand and the people he meets during his stay are truly interesting and have their own story to tell.

Towles has certainly woven a sophisticated and powerful literary achievement. But what makes this novel so winning is not the generous prose, or the impeccable pace, or the characterization or even the gorgeously realized setting—as eruditely rendered as they are. It’s the author’s voice. The arched eyebrow, the conspiratorial wink, the sly, confiding tone. The piercing irony and the craftiness with which he always seems to know the right nerve to touch, at exactly the right moment, to wound or to outrage most.  The quality of the writing is truly Shakespearian in nature.

In conclusion: You REALLY need to read this book !!!!!!!!

INFECTIOUS DISEASES

April 10, 2020


My wife and I are well into our “senior years”; consequently, we are now “stay-at-home” parents and grandparents until COVID-19 is a thing of the past.  That is, if that’s possible.  We only go out to the grocery store and the pharmacy.  We order from a delivery service if we want to experience something other than a home-cooked meal.  I think most people are doing likewise because it is the most prudent thing to do.  Let’s take a look at the twenty-seven (27) most devastating infectious diseases. 

A VERY BRIEF WORD ABOUT PANDEMIS HISTORY VS DEATHRATE:

Overall, the death rate from infectious diseases dropped from about eight hundred (800) deaths per one hundred thousand (100,000) people in 1900 to forty-six (46) deaths per one hundred thousand (100,000) people in 2014, the study found. The death rate declined almost continuously from 1900 to 1950, except for a spike in deaths in 1918 due to an outbreak of influenza known as the “Spanish flu pandemic.”

The rate has been relatively level since 1950, but there have been some ups and downs. For example, from 1980 to 1995 — around the time of the HIV/AIDS epidemic — the overall death rate from infectious diseases increased from forty-two (42) deaths per one hundred thousand (100,000) people to sixty-three (63) deaths per 100,000 people, the researchers found. [27 Devastating Infectious Diseases.

Many are looking to historic pandemics to find answers about the COVID-19 coronavirus outbreak that has much of the world ground to a halt under quarantine and social distancing mandates. But “public health” wasn’t even a concept before one European crisis forced authorities to act: The bubonic plague or Black Death.

Let’s take a look at several diseases that have plagued the world over the past one hundred years or more.

DISEASES AND PANDEMICS:

The new coronavirusIn COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV”. There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. Using available preliminary data, the median time from onset to clinical recovery for mild cases is approximately 2 weeks and is 3-6 weeks for patients with severe or critical disease.  This is definitely a pandemic with 1,429,516 cases reported, 85,711 deaths and infections in two hundred and twelve (212) countries.  These numbers are as of 9 April 2020 and 1400 hours.

SmallpoxBefore smallpox was eradicated, it was a serious infectious disease caused by the variola virus. It was contagious—meaning, it spread from one person to another. People who had smallpox had a fever and a distinctive, progressive skin rash.  Most people with smallpox recovered, but about 3 out of every 10 people with the disease died. Many smallpox survivors have permanent scars over large areas of their body, especially their faces. Some are left blind. Thanks to the success of vaccination, smallpox was eradicated, and no cases of naturally occurring smallpox have happened since 1977. The last natural outbreak of smallpox in the United States occurred in 1949.

  • Plague– Plague is a zoonotic disease affecting rodents and transmitted by fleas from rodents to other animals and to humans. Direct person-to-person transmission does not occur except in the case of pneumonic plague, when respiratory droplets may transfer the infection from the patient to others in close contact.
  •  Bubonic plague is the form that usually results from the bite of infected fleas. Lymphadenitis develops in the drainage lymph nodes, with the regional lymph nodes most commonly affected. Swelling, pain and suppuration of the lymph nodes produces the characteristic plague buboes.
  • Septicaemic plague may develop from bubonic plague or occur in the absence of lymphadenitis. Dissemination of the infection in the bloodstream results in meningitis, endotoxic shock and disseminated intravascular coagulation.
  • Pneumonic plague may result from secondary infection of the lungs following dissemination of plague bacilli from other body sites. It produces severe pneumonia. Direct infection of others may result from transfer of infection by respiratory droplets, causing primary pulmonary plague in the recipients.  Without prompt and effective treatment, fifty to sixty percent (50–60%)

 of cases of bubonic plague are fatal, while untreated septicaemic and pneumonic plague are invariably fatal.

Malaria– Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2018 an estimated two hundred and twenty-two (228) million cases of malaria occurred worldwide and four hundred and five thousand (405,000) people died, mostly children in the African Region. About two thousand (2,000) cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia.

Influenza Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs. Influenza is commonly called the flu, but it’s not the same as stomach “flu” viruses that cause diarrhea and vomiting.

For most people, influenza resolves on its own. But sometimes, influenza and its complications can be deadly. People at higher risk of developing flu complications include:

  • Young children under age five (5), and especially those under twelve (12) months
  • Adults older than age sixty-five (65)
  • Residents of nursing homes and other long-term care facilities
  • Pregnant women and women up to two weeks postpartum
  • People with weakened immune systems
  • People who have chronic illnesses, such as asthma, heart disease, kidney disease, liver disease and diabetes
  • People who are very obese, with a body mass index (BMI) of forty (40) or higher

Tuberculosis– Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks.  In a person who has a healthy immune system, the body usually fights the infection by walling off (encapsulating) the bacteria into tiny capsules called tubercles.

HIV/AIDS– HIV stands for Human Immunodeficiency Virus. HIV can only infect human beings (H), weakens your immune system by destroying important cells that fight disease and infection (I), and, as a virus, can only reproduce itself by taking over a cell in the body of its host (V). HIV is a lot like other viruses, like those that cause the flu or the common cold, except that normally, your immune system can clear most viruses out of your body. With HIV, our bodies can’t get rid of it. Once you have HIV, you have it for life. The good news? With proper treatment, called antiretroviral therapy (ART, sometimes referred to as high active antiretroviral therapy, or HAART), you can keep the level of HIV in your body low, so it is considered undetectable.

AIDS stands for Acquired Immunodeficiency Syndrome. AIDS is acquired (A) – it’s not something you inherit from your parents. A person acquires AIDS after birth. AIDS involves the body’s immune system (I), which includes all the organs and cells that work to fight off infection or disease. A person with HIV is diagnosed with AIDS when their immune system has reached a certain level of deficiency, or isn’t working the way it should. Lastly, AIDS is a syndrome (S), or a complex illness with a wide range of complications, symptoms, and signs of disease.

Cholera– Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated that close to three million (2.9 million) cases and ninety-five thousand (95,000) deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe. Approximately one in ten percent (10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

Rabies Rabies is a zoonotic disease (a disease that is transmitted from animals to humans), caused by the rabies virus, of the Lyssavirus genus, within the family Rhabdoviridae. Domestic dogs are the most common reservoir of the virus, with more than ninety-nine percent (99%) of human deaths caused by dog-mediated rabies.

The virus is transmitted in the saliva of rabid animals and generally enters the body via infiltration of virus-laden saliva from a rabid animal into a wound (e.g. scratches), or by direct exposure of mucosal surfaces to saliva from an infected animal (e.g. bites). The virus cannot infiltrate intact skin. Once the virus reaches the brain, it further replicates, resulting in presentation of clinical signs from the patient. There are two clinical manifestations of rabies – furious (classical or encephalitic) and paralytic. Furious rabies is the most common form of human rabies, accounting for approximately eighty percent (80%) of cases.

With the exception of Antarctica, rabies is endemic on all continents. Of the tens of thousands of deaths occurring annually due to rabies, ninety-five percent (95%) of cases are reported in Asia and Africa.

Pneumonia– Pneumonia is a common lung infection caused by germs, such as bacteria, viruses, and fungi. It can be a complication of the flu, but other viruses, bacteria and even fungi can cause pneumonia. Anyone can get pneumonia, but some people are more at risk than others. Pneumonia and its symptoms can vary from mild to severe. Treatment depends on the cause of your pneumonia, how severe your symptoms are, and your age and overall health. Most healthy people recover from pneumonia in one to three weeks, but it can be life-threatening. The good news is that pneumonia can be prevented—by getting an annual flu shot (as flu often leads to pneumonia), frequently washing your hands, and for people at high risk, getting a vaccine for pneumococcal pneumonia. Learn about causes and symptoms of pneumonia, how pneumonia is treated, ways to prevent pneumonia and more in this section.

Infectious diarrhea– Diarrhea caused by enteric infections is a major factor in morbidity and mortality worldwide. An estimated two to four (2–4) billion episodes of infectious diarrhea occur each year and are especially prevalent in infants. This review highlights the cellular and molecular mechanisms underlying diarrhea associated with the three classes of infectious agents, i.e., bacteria, viruses and parasites. Several bacterial pathogens have been chosen as model organisms, including Vibrio cholerae as a classical example of secretory diarrhea, Clostridium difficile and Shigella species as agents of inflammatory diarrhea and selected strains of pathogenic Escherichia coli (E. coli) to discuss the recent advances in alteration of epithelial ion absorption. Many of the recent studies addressing epithelial ion transport and barrier function have been carried out using viruses and parasites. Here, we focus on the rapidly developing field of viral diarrhea including rotavirus, norovirus and astrovirus infections. Finally, we discuss Giardia lamblia and Entamoeba histolytica as examples of parasitic diarrhea. Parasites have a greater complexity than the other pathogens and are capable of creating molecules similar to those produced by the host, such as serotonin and PGE2. The underlying mechanisms of infectious diarrhea discussed include alterations in ion transport and tight junctions as well as the virulence factors, which alter these processes either through direct effects or indirectly through inflammation and neurotransmitters.

Ebola– This rare, infectious—and often fatal—disease was discovered in 1976 in the Democratic Republic of Congo (DRC) near the Ebola River. Scientists believe that bats are the most likely carriers of the Ebola virus. Symptoms include the sudden onset of fever, fatigue, muscle pain, headache, and sore throat. This is followed by vomiting, diarrhea, rash, and in some cases, bleeding. People can catch the Ebola virus through close contact with the blood, organs, or other bodily fluids of infected animals. According to the Centers for Disease Control and Prevention, the disease spreads from person to person through direct contact—via broken skin or through the eyes, nose, and mouth—with the blood or body fluids of someone who is sick. People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men can still transmit the virus through their semen for several weeks after recovery from illness.

Variant Creutzfeldt-Jakob disease– Variant Creutzfeldt-Jakob disease (vCJD) is a prion disease that was first described in 1996 in the United Kingdom. There is now strong scientific evidence that the agent responsible for the outbreak of prion disease in cows, bovine spongiform encephalopathy (BSE or ‘mad cow’ disease), is the same agent responsible for the outbreak of vCJD in humans.

Marburg Marburg virus was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany and in Belgrade, Yugoslavia (now Serbia). Thirty-one people became ill, initially laboratory workers followed by several medical personnel and family members who had cared for them. Seven deaths were reported. The first people infected had been exposed to imported African green monkeys or their tissues while conducting research. One additional case was diagnosed retrospectively.

The reservoir host of Marburg virus is the African fruit bat, Rousettus aegyptiacus. Fruit bats infected with Marburg virus do not to show obvious signs of illness. Primates (including humans) can become infected with Marburg virus, and may develop serious disease with high mortality. Further study is needed to determine if other species may also host the virus.

Middle East respiratory syndrome (MERS)– Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About 3 or 4 out of every 10 patients reported with MERS have died.  Health officials first reported the disease in Saudi Arabia in September 2012. Through retrospective (backward-looking) investigations, they later identified that the first known cases of MERS occurred in Jordan in April 2012. So far, all cases of MERS have been linked through travel to, or residence in, countries in and near the Arabian Peninsula. The largest known outbreak of MERS outside the Arabian Peninsula occurred in the Republic of Korea in 2015. The outbreak was associated with a traveler returning from the Arabian Peninsula.

Dengue Dengue is fast emerging pandemic-prone viral disease in many parts of the world. Dengue flourishes in urban poor areas, suburbs and the countryside but also affects more affluent neighborhoods in tropical and subtropical countries.

Dengue is a mosquito-borne viral infection causing a severe flu-like illness and, sometimes causing a potentially lethal complication called severe dengue. The incidence of dengue has increased 30-fold over the last fifty (50) years. Up to fifty to one hundred (50-100) million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk.

Severe dengue (previously known as dengue haemorrhagic fever) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today it affects Asian and Latin American countries and has become a leading cause of hospitalization and death among children and adults in these regions.

Yellow fever Yellow fever is a viral infection transmitted by a bite from infected mosquitoes most commonly found in parts of South America and Africa. When transmitted to humans, the yellow fever virus can damage the liver and other internal organs and be potentially fatal.

The World Health Organization estimates there are 200,000 cases of yellow fever worldwide each year, resulting in thirty thousand (30,000) deaths. Yellow fever appears to be on the rise internationally, due to a decreased immunity to infection among local populations, deforestation, climate change, and high-density urbanization.

Hantaviruses Hantaviruses are a family of viruses spread mainly by rodents and can cause varied disease syndromes in people worldwide.  Infection with any hantavirus can produce hantavirus disease in people. Hantaviruses in the Americas are known as “New World” hantaviruses and may cause hantavirus pulmonary syndrome (HPS). Other hantaviruses, known as “Old World” hantaviruses, are found mostly in Europe and Asia and may cause hemorrhagic fever with renal syndrome (HFRS).

Each hantavirus serotype has a specific rodent host species and is spread to people via aerosolized virus that is shed in urine, feces, and saliva, and less frequently by a bite from an infected host. The most

Anthrax Anthrax is an infectious disease that’s caused by bacteria. It’s very rare in the United States, but it can be very serious.

It usually only affects farm animals like cows and sheep. But it’s possible to become infected if you’re in contact with infected animals or products that come from them. Anthrax has also been found in people who have injected heroin. Others at risk for anthrax include people who work with anthrax in a lab or those exposed to it because of bio-terrorism.   Anthrax isn’t contagious, so you can’t spread it to other people.

MRSA “superbug“– Methicillin-resistant Staphylococcus aureus, or MRSA, is a strain of staph bacteria that is resistant to the antibiotics normally used to treat such infections.

In the 1940s, some sixty (60) years after the discovery of the bacterium S. aureus, doctors began treating staph infections with penicillin. But the overuse and misuse of the drug helped the microbes evolve with resistance to penicillin by the 1950s.

Doctors then started using methicillin to counter the growing problem of penicillin-resistant staph infections, and the new drug quickly became the common treatment for S. aureus, according to the National Institute of Allergy and Infectious Diseases.

In 1961, British scientists discovered MRSA; the first case of this “superbug” in the United States occurred in 1968. Over time, strains of MRSA developed resistances to other penicillin-related antibiotics.

Pertussis Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it’s marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like “whoop. Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded. Deaths associated with whooping cough are rare but most commonly occur in infants. That’s why it’s so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

Tetanus– Tetanus is a serious illness caused by Clostridium bacteria. The bacteria live in soil, saliva, dust, and manure. The bacteria can enter the body through a deep cut, like those you might get from stepping on a nail, or through a burn.   The infection causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw. This makes it impossible to open your mouth or swallow. Tetanus is a medical emergency. You need to get treatment in a hospital.   A vaccine can prevent tetanus. It is given as a part of routine childhood immunization. Adults should get a tetanus shot, or booster, every 10 years. If you get a bad cut or burn, see your doctor – you may need a booster. Immediate and proper wound care can prevent tetanus infection.

Meningitis Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord.  The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck.  Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Some cases of meningitis improve without treatment in a few weeks. Others can be life-threatening and require emergency antibiotic treatment.

Syphilis Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.  After the initial infection, the syphilis bacteria can remain inactive (dormant) in your body for decades before becoming active again. Early syphilis can be cured, sometimes with a single shot (injection) of penicillin. Without treatment, syphilis can severely damage your heart, brain or other organs, and can be life-threatening. Syphilis can also be passed from mothers to unborn children.

SARS Severe acute respiratory syndrome (SARS) is a viral respiratory illness that first emerged in China in November 2002, and later spread through international travel to twenty-nine (29) countries worldwide causing large outbreaks in Hong Kong; Taiwan; Singapore; Hanoi, Vietnam; and Toronto, Canada. According to the World Health Organization (WHO), from November 2002 to July 31, 2003, there were eight thousand ninety-eight (8,098) cases of SARS; of these, seven hundred and seventy-seven (774) died.

On October 1, 2003, the Centers for Disease Control and Prevention (CDC), reported that there were 164 probable and suspect SARS cases in the United States, of which only eight had laboratory evidence of SARS. There were no deaths due to SARS in the US. Most of the U.S. SARS cases were among travelers returning from other parts of the world with SARS. There were 11 suspect and probable SARS cases investigated by the Minnesota Department of Health; many of these individuals had an alternative diagnosis that could explain their symptoms.

Leprosy– Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract and the eyes. Leprosy is known to occur at all ages ranging from early infancy to very old age. Leprosy is curable and early treatment averts most disabilities.

Measles Measles is a very contagious respiratory infection. It causes a total-body skin rash and flu-like symptoms. Measles is rare in the United States thanks to widespread immunization. But millions of cases happen worldwide every year.  Measles (also called rubeola) is caused by a virus , so there’s no specific medical treatment for it. The virus has to run its course. A child who is sick should drink plenty of liquids, get lots of rest, and stay home from school or daycare to prevent spreading the infection

Zika Zika virus is similar to dengue feveryellow fever and West Nile virus. Carried by infected Aedes aegypti mosquitos, Zika is largely transmitted through bites, but can also occur through intrauterine infection.  If a woman is bitten by an infected mosquito and becomes infected, Zika can cross into the placenta and affect the fetus. While anyone can contract Zika, pregnant women are the most at risk due to the potential for fetal microcephaly and other neurologic abnormalities. Sexual transmission of this virus can occur. Transmission has been reported from infected men and women to their sexual partners. The virus can be transmitted through anal, oral or vaginal sex.

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