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Coronavirus stopped us doing life-changing surgery, so we invented a new form of PPE

Coronavirus stopped us doing life-changing surgery, so we invented a new form of PPE

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Douglas Hartley, Author provided

When the coronavirus pandemic first hit the UK, thousands of surgical procedures were put on hold. For a surgeon like me who performs operations on deaf children to restore their hearing, this created a significant moral dilemma – I wanted to get back into surgery to provide this vital care, but I didn’t want to inadvertently catch or pass on COVID-19 in the process.

I regularly carry out cochlear implant surgery, a process in which a surgeon embeds an electronic device which stimulates the hearing nerve in the ear. The scientific evidence is clear that this surgery needs to be performed at the earliest opportunity so that these children can benefit from being able to hear at a vital stage in their development.

But performing the surgery as normal would have put both children and surgical teams in danger. We needed to come up with another way of doing things. Our team in Nottingham had to combine creativity and science to develop a novel and safe way to restart cochlear implant surgery in a matter of just a few weeks.


This article is part of Conversation Insights
The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.


A grave risk

Soon after the pandemic began, some of the earliest reports, notably those from China and Italy, suggested that healthcare workers were at significantly higher risk of contracting COVID-19 compared to the general public, and that treating ear, nose and throat (ENT) conditions was particularly risky.

I was deeply saddened when I was told that the one of the first healthcare workers in the UK to die of COVID-19 was Amged El-Hawrani, a 55-year-old ENT colleague from the university hospitals of Derby and Burton. El-Hawrani succumbed to this dreadful disease on March 28 in Leicester’s Glenfield hospital. Although I never had the pleasure of meeting him, his passing was a huge shock to us all. And his exposure to the virus during his care for his patients was a stark reminder of the brutality of this disease.

A picture of Amged El-Hawrani, smiling wearing medical scrubs.
Amged El-Hawrani was one of the first health workers in the UK to lose his life to coronavirus. University Hospitals of Derby and Burton/NHS

Like other ENT departments across the world, our service at Nottingham University Hospitals NHS Trust initially halted all elective procedures in March when the pandemic hit the UK, so we could concentrate our team’s efforts on the management of our sickest patients, including those conditions requiring emergency admission, and our cancer services.

Although this initial response proved effective, we were aware that we were not meeting the needs of other patients with time-critical, albeit not life-threatening, conditions. These patients included children who are born deaf and need cochlear implant surgery to restore their hearing as quickly as possible to maximise their chances of developing normal speech and language. Delaying cochlear implant surgery can mean these young people usually never recover full speech and language skills.

We know this because a lot of the critical studies that highlighted the importance of early cochlear implantation on speech and language development were performed locally in Nottingham, which is home to a large number of world-leading hearing researchers. The first paediatric cochlear implant surgery in the UK was performed by the Nottingham Auditory Implant Programme (NAIP) which hosts one of the largest children’s cochlear implant services in the UK.

A unique risk to ear surgeons

As a cochlear implant surgeon for NAIP, and a research lead for the Nottingham Biomedical Research Centre, I was devastated that we were not able to provide our deaf children with the care they needed. That said, I will admit that the idea of performing cochlear implant surgery at the start of the COVID-19 outbreak was unnerving.

A young child wears a cochlear implact while playing with toys, sitting across from an adult.
Cochlear implants can be life-changing for young children, but they need surgery within a specific window to have the best outcomes. mady70/Shutterstock

ENT healthcare workers are particularly at risk of catching coronavirus during surgery because of the unique nature of the parts of the body we focus on. The nose of an infected person contains a significant load of the SARS-CoV-2 virus that causes COVID-19. The nose is directly connected to the middle ear by a small channel called the eustachian tube, and other types of coronaviruses, including the one that causes the common cold, are commonly found in the middle ear. This means it is highly likely that SARS-CoV-2 also exists in the middle ear, though, no one has confirmed this to date.

The virus uses two proteins to enter human cells (ACE2 and TMPRSS2) that are found throughout the lining of the nose. The same proteins are found in the eye, suggesting that eye transmission is very likely. We also know that animals express both these proteins in their ears, again suggesting that SARS-CoV-2 is highly likely to be found there.

The virus is mainly transmitted via large droplets that require relatively close contact with an infected person. It has also been suggested that it can be transmitted via aerosols, much smaller particles that can spread over much longer distances.

Several medical procedures have been classed as “aerosol generating”, including cochlear implant surgery, which involves drilling into the bone behind the ear to access the middle ear. The high-speed drill we use during surgery can spread droplet and aerosol contamination throughout a confined theatre space. These droplets and aerosols will contain a mixture of water, bone, blood, tissue and, potentially, viable viruses.

Fixing the problem

At the beginning of the outbreak, while we knew we needed to restart cochlear implant surgery urgently, we were also extremely aware of the potential risks associated with performing this operation at the height of the pandemic. This problem concerned me greatly. However, I find that the best way to manage concern is though action, and it was at this time that I was very grateful that I work in a city which hosts one of the UK’s largest cochlear implant programmes.

In the matter of just a few days, following just a couple of brief emails, a few phone calls and the odd Zoom meeting, I managed to gather together a team of internationally recognised experts who were all interested in developing a model of cochlear implant surgery that we could follow during the pandemic.

My first port of call was Padraig Kitterick, head of hearing sciences at my university, who generously gave both his time and all the funds we needed to support this crucial work. Next, I contacted my esteemed surgical colleague, Gerry O’Donoghue, who pioneered cochlear implant surgery in the UK. As always Gerry was enthused to be involved. So much so that he also volunteered the expertise of his son, Kevin, who works with us as an anaesthetist in the Queens Medical Centre in Nottingham.

Five people stand in an operating theatre wearing medical scrubs.
Left to right: Dr Kevin O'Donoghue, Professor Doug Hartley, Professor Gerry O'Donoghue, Dr Padraig Kitterick and Dr Rachael Lawrence. Douglas Hartley, Author provided

I then asked my colleagues from the anatomy facility if I could borrow enough skulls on which we conducted experiments that would help us analyse the risk of spreading droplets while performing surgery. Without a moment’s hesitation, Susan Anderson and her colleague Dominik Siwek replied, yes, of course they would be delighted to help. Likewise, Richard Hague and his colleagues from the faculty of engineering provided us with essential 3D printing services to support our work.

Early one Saturday morning, along with Rachael Lawrence, an academic ENT surgeon in training, I collected the skulls from an otherwise deserted anatomy dissection room on one of the upper levels of the Queens Medical Centre. We carried them to one of the ENT theatres located at the other side of the hospital that had been generously provided by our theatre manager, Laura Mitchell.

A plate of cupcakes decorated with rainbows.
Innovation fuel: cupcakes provided by the author’s daughter. Douglas Hartley, Author provided

Once our team was gathered, we got to work, fuelled by delicious cakes that had been baked by my youngest daughter Alice, decorated with rainbows in support for the NHS.

Our first task was to properly visualise the extent of droplet spread during cochlear implant surgery. To do this, we decided to replace the fluid that we normally use to irrigate our high-speed drilling with a fluorescent dye.

By simulating a cochlear implant operation using this setup, we could see where the dye landed and understand whether we could continue carrying out surgery wearing standard personal protective equipment (PPE).

It soon became apparent from the distribution of luminous dye around the theatre that the contaminated droplets could spread more than two metres from the site of drilling in all directions. This not only includes the area that the surgeon works in, but also the nurses, the anaesthetist, and other theatre staff.

Flouescent dye covers part of an operating table and a skull against a black background.
How the fluorescent droplets spread from simulated cochlear implant drilling. Douglas Hartley, Author provided

Even worse, we found that droplets easily migrated underneath our full-face visors, the standard recommended PPE for aerosol-generating procedures in the UK. The droplets landed very close to the eyes of the person wearing it. This suggested that a visor offered inadequate protection.

But we were not discouraged. Now we knew the extent of the problem, we were able to work around the clock for the next few weeks until we managed to develop and refine some rather unusual solutions.

Testing PPE

During our studies, we evaluated a variety of PPE options, along with several other infection control solutions. These included a full-face respirator and a combination of a half-face respirator and safety goggles, commonly known as “spoggles”. We had also read reports of teams, including one from Stanford University, who had modified a full-face snorkel mask to be used as PPE, so we tried this too.

A surgeon in scrubs and a hairnet wears a respirator mask and looks down a microscope while simulating an operation on a skull.
The full-face respirator approach. Douglas Hartley, Author provided

We used a systematic evidence-based approach to evaluate the PPE for its usability and effectiveness. During simulated cochlear implant surgery, we evaluated each type of PPE across several parameters, including its effect on a surgeon’s ability to communicate, their field of vision, and their comfort.

Many of the PPE options we tried, not least the full-face respirator, were found to substantially restrict the surgeon’s vision during operating. That rendered them unsafe for performing this sort of surgery. Rather worryingly, we also found that the modified snorkel mask that had been described by various groups on the internet was associated with rebreathing of carbon dioxide, so this was not a viable long-term option for PPE.

A surgeon in scrubs and a hairnet wears a snorkel mask and looks down a microscope while simulating an operation on a skull.
The snorkel approach involved re-breathing carbon dioxide, which can be dangerous. Douglas Hartley, Author provided

Instead, we found that the combination of “spoggles” and a half-face respirator mask had consistently superior performance across all aspects of clinical usability compared with all other options.

A surgeon in scrubs and a hairnet wears googles and a respirator mask and looks down a microscope while simulating an operation on a skull.
The spoggles provided the winning solution. Douglas Hartley, Author provided

During our studies, we also worked with a surgical product manufacturer to develop a novel drape, basically a tent, that was designed to be suspended from a microscope covering the patient’s head and torso to provide a physical barrier between the site of drilling and the rest of the team.

We found that the operating tent significantly contained the droplets and prevented them from spreading around the theatre environment. We were the first – and are currently only – group in the world to develop an operating tent design that is marked for medical use. After completing our studies, we now had appropriate PPE and a protective operating tent to permit the safe re-starting of cochlear implant surgery during the pandemic.

A man in surgical srubs lies on an operating table underneath a transparent plastic tent.
Prof Gerry O'Donoghue models the new surgical tent. Douglas Hartley, Author provided

The new surgical normal

Our recommendations were rapidly disseminated internationally via webinars and journal publications and quickly adopted as standard patient care by our hospital trust and, subsequently, embraced in other departments in the UK and across the world.

Locally, it was with huge relief that we recommenced cochlear implant surgery for profoundly deaf children after a few days of completing our studies: just a couple of months after this procedure was put on hold. Operating times were a little longer initially, and for the first few procedures we opted to have a backup surgeon available just in case the primary operating surgeon needed some help using this new setup.

Today, these new measures have become second nature to our theatre team, operating times are comparable to our pre-COVID surgeries, and lists are running as before with just one surgeon operating. Apart from a little discomfort associated with wearing the PPE for long periods of time, and the ongoing detrimental impact of the PPE on communication, we have all pretty much accepted the setup as our new normal. In fact, I would go so far as to say, it would feel a little naked to operate without these measures now.

Three people wearing surgical scrubs in an operating theatre.
We have had to find new ways of communicating while wearing PPE. Douglas Hartley, Author provided

The safe recommencement of cochlear implant surgery in Nottingham, and in other centres around the globe, has given many hundreds of deaf children worldwide the chance to hear. These children can grow up with the potential to develop comparable speech and language skills to their peers. Without this timely surgical intervention, life would have been very different for these children and their families.

The value of speed and collaboration

The coronavirus crisis has been a strange and scary time for everyone, and it has presented us all with many significant challenges in how we live and work. But it has also opened a number of doors for new opportunities and possibilities.

Before COVID-19, if you told me that I’d need to construct a tent in which to operate this year, while wearing spoggles and a respirator mask, I would not have believed you. That said, I’m sure that most people would not have predicted how much we have all had to rely on Zoom and other new digital media to facilitate our work and social interactions with others over the past few months.

The process involved to translate a novel idea from the laboratory bench all the way through to implementation at the patient’s bedside is normally a very complicated and lengthy one that can take years, and sometimes decades, to complete. So it has been heartening to witness the value of a team working to solve a problem at breakneck speed, without much need for the phrase: “I don’t think we can do that.” Necessity is truly the mother of invention and, with a bit of luck, some of this innovation spirit will live on beyond the pandemic.

What next?

It seems that COVID-19 is likely to be with us for the foreseeable future. So we have no plans to abandon our PPE and operating tent for cochlear implant surgery any time soon. In fact, there is a strong argument among the surgical community that these measures should always be used to protect the theatre team from potential contaminants, and the patient from exposure to infections in theatre, regardless of the current pandemic.

Other surgical specialities have also been very interested in the operating tent method as an infection prevention control measure, including those that commonly use an operating microscope, such as spinal surgery, ophthalmology and neurosurgery. In the future we may see a wider use of operating tents.

Certainly, our theatre teams face an ongoing problem from the negative impact of PPE on communication during surgery. It goes without saying that communication is critical for the safe functioning of an operating theatre, and this problem needs an urgent solution. That’s why our group and other centres around the world are continuing to work on the design, not only to aid communication, but also to facilitate easy access into the tent for the surgeon and theatre nurses, while keeping the contaminated droplets inside.

Although COVID-19 has presented significant challenges to recommencing cochlear implant surgery, through collaborative teamwork across a wide range of disciplines, we found solutions. As a team we have certainly learnt from this experience; lessons that I hope we will retain far beyond this pandemic.


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Douglas Hartley works for Nottingham University and Nottingham University Hospitals NHS Trust. He receives funding from the National Institute for Health Research, the Medical Research Council, Action on Hearing Loss, Cochlear UK, Advanced Bionics and Rinri Therapeutics.

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Anti-Semitism As The Harbinger Of Global Chaos

Anti-Semitism As The Harbinger Of Global Chaos

Authored by Stephen Soukup via American Greatness,

On the off chance you hadn’t noticed,…

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Anti-Semitism As The Harbinger Of Global Chaos

Authored by Stephen Soukup via American Greatness,

On the off chance you hadn’t noticed, the world appears to be at an especially precarious moment presently. Obviously, war continues to rage in Ukraine and Gaza, with no end in sight to either conflict. Great Britain and Japan are currently in recession. Canada’s economy is an absolute disaster, with almost no hope of near-term recovery. Much of continental Europe and China are struggling economically, if not officially contracting. Some experts believe that the global economy more generally is sliding, slowly but surely, into recession. The only economic bright spot in the world is the United States, and even here we have our problems with consumer spending and sentiment, massive credit concerns, and inarguably sticky inflation.

Meanwhile, China is investing in and winning friends, and influencing people in the Global South. U.S.-backed Kurdish leaders are warning that ISIS is resurgent in Syria and Iraq. The Marine general in charge of U.S. Africa Command is warning of Russia’s increasing influence on that continent. Sudan remains mired in civil war. Nigeria is plagued by Islamist terrorism and mass kidnappings. Mexico is in the midst of a full-blown war with the drug cartels, who continue to grow bolder and more militarily sophisticated.

Everywhere one looks, chaos reigns—or, at the very least, bubbles just below the surface.

Perhaps most telling among the signs of disarray is the unnerving rise of antisemitism in the United States, Europe, and throughout the world. Antisemitism, in general, has been intensifying, slowly but surely, over the last decade or so. Over the last few months, however, it has emerged fully into the open, undaunted and unembarrassed. What was once considered shameful and disconcerting is now warmly welcomed as a “rational” response to American foreign policy, Israeli war practices, “colonialism,” and “white privilege.”

All of this is troubling, to put it mildly, both in and of itself and as a harbinger of greater and more deadly global unrest.

Hatred of and anger toward Jews is not the same as other forms of bigotry.  

In many ways, the history of Western anti-Jewish hatred mirrors the history of Western political chaos and collapse.  Or, to put it another way, historically, Jews are not only the perennial scapegoats during periods of social upheaval and displacement, but resurgent anti-Semitism serves as the proverbial canary in the coal mine for the rise of revolutionary movements.

In his classic, The Pursuit of the Millennium, the British historian Norman Cohn argues that the Jewish diaspora generally fit comfortably, if tentatively into European society for most of the first thousand years or so A.D., and only became a hated and perpetually persecuted minority with the rise of utopian Millenarianism that accompanied and then outlived the Crusades.  Beginning then and continuing for the next nearly a thousand years, Europeans came to associate Jews with the antichrist and thus to associate hatred and persecution of Jews with preparing the battlespace for the Second Coming.  Many historians, including Hannah Arendt, believed that the anti-Semitism that was such an integral part of the West’s 20th-century collapse into totalitarianism was relatively new and, in any case, distinct from medieval anti-Semitism.  Cohn’s history suggests otherwise, connecting the religious eschatology of medieval Europe to the quasi-religious eschatology of post-Enlightenment Europe, thereby connecting the persistence of Western anti-Semitism as well.

Cohn tells us that millenarian moments and the millenarian movements that capitalize on those moments all share a common group of characteristics. They all appear under certain social and economic conditions. They all appeal to a certain segment of the population at large, who then present themselves as economic, spiritual, and political leaders. They all utilize scapegoats, meaning that they all identify a different, usually much smaller segment of the population on whom they can blame all the world’s ills and then set about to cure those ills through the elimination of the scapegoat. And more often than not, that scapegoat tends to be Jewish.

In the conclusion to the second edition of Pursuit of the Millennium, Cohn notes that the millenarian fervor of the middle ages may have changed, but it never really died, and it maintained its common characteristics even as it became secular or “quasi-religious.” He wrote:

The story told in Pursuit of the Millennium ended some four centuries ago but is not without relevance to our own times. [I have] shown in another work [Warrant for Genocide: The Myth of the Jewish World Conspiracy and the Protocols of the Elders of Zion] how closely the Nazi phantasy of a world-wide Jewish conspiracy of destruction is related to the phantasies that inspired Emico of Leningrad and the Master of Hungary; and how mass disorientation and insecurity have fostered the demonization of the Jew in this as in much earlier centuries. The parallels and indeed the continuity are incontestable.

The parallels between the rise of Nazism and the current global unrest and demonization of the Jewish people are also largely incontestable. The election that brought Hitler to power didn’t happen in a vacuum, after all. It happened in the midst of global chaos, namely the Great Depression. It also followed the decadence and distortion of the Weimer Era. As the New York Fed has shown, even a global pandemic—the 1919 Spanish Flu outbreak—contributed to the sense of discomfort and disconnect among the German population, prompting increased support for Hitler and his Nazis.

The present global chaos doesn’t have to end the same way the chaos of a century ago did. It doesn’t have to result in the ascension of millenarian ideologies and their totalitarian defenders. History has shown that extremism can be short-circuited and radical ideologies undone. The first step in doing so, however, must be to bring an end to the rationalization of the persecution of the world’s Jews. The second step is to end the persecution itself.

Antisemitism is ugly and shameful, and it must be treated as such. For their sake and ours.

Tyler Durden Tue, 03/19/2024 - 02:00

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Report Criticizes ‘Catastrophic Errors’ Of COVID Lockdowns, Warns Of Repeat

Report Criticizes ‘Catastrophic Errors’ Of COVID Lockdowns, Warns Of Repeat

Authored by Kevin Stocklin via The Epoch Times (emphasis ours),

It…

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Report Criticizes 'Catastrophic Errors' Of COVID Lockdowns, Warns Of Repeat

Authored by Kevin Stocklin via The Epoch Times (emphasis ours),

It was four years ago, in March 2020, that health officials declared COVID-19 a pandemic and America began shutting down schools, closing small businesses, restricting gatherings and travel, and other lockdown measures to “slow the spread” of the virus.

UNICEF unveiled its "Pandemic Classroom," a model made up of 168 empty desks, each seat representing one million children living in countries where schools were almost entirely closed during the COVID pandemic lockdowns, at the U.N. Headquarters in New York City on March 2, 2021. (Chris Farber/UNICEF via Getty Images)

To mark that grim anniversary, a group of medical and policy experts released a report, called “COVID Lessons Learned,” which assesses the government’s response to the pandemic. According to the report, that response included a few notable successes, along with a litany of failures that have taken a severe toll on the population.

During the pandemic, many governments across the globe acted in lockstep to pursue authoritative policies in response to the disease, locking down populations, closing schools, shutting businesses, sealing borders, banning gatherings, and enforcing various mask and vaccine mandates. What were initially imposed as short-term mandates and emergency powers given to presidents, ministers, governors, and health officials soon became extended into a longer-term expansion of official power.

“Even though the initial point of temporary lockdowns was to ’slow the spread,' which meant to allow hospitals to function without being overwhelmed, instead it rapidly turned into stopping COVID cases at all costs,” Dr. Scott Atlas, a physician, former White House Coronavirus Task Force member, and one of the authors of the report, stated at a March 15 press conference.

Published by the Committee to Unleash Prosperity (CTUP), the report was co-authored by Steve Hanke, economics professor and director of the Johns Hopkins Institute for Applied Economics; Casey Mulligan, former chief economist of the White House Council of Economic Advisors; and CTUP President Philip Kerpen. 

According to the report, one of the first errors was the unprecedented authority that public officials took upon themselves to enforce health mandates on Americans. 

Granting public health agencies extraordinary powers was a major error,” Mr. Hanke told The Epoch Times. “It, in effect, granted these agencies a license to deceive the public.”

The authors argue that authoritative measures were largely ineffective in fighting the virus, but often proved highly detrimental to public health. 

The report quantifies the cost of lockdowns, both in terms of economic costs and the number of non-COVID excess deaths that occurred and continue to occur after the pandemic. It estimates that the number of non-COVID excess deaths, defined as deaths in excess of normal rates, at about 100,000 per year in the United States.

‘They Will Try to Do This Again’

“Lockdowns, schools closures, and mandates were catastrophic errors, pushed with remarkable fervor by public health authorities at all levels,” the report states. The authors are skeptical, however, that health authorities will learn from the experience.

“My worry is that if we have another pandemic or another virus, I think that Washington is still going to try to do these failed policies,” said Steve Moore, a CTUP economist. “We’re not here to say ‘this guy got it wrong' or ’that guy or got it wrong,’ but we should learn the lessons from these very, very severe mistakes that will have costs for not just years, but decades to come. 

“I guarantee you, they will try to do this again,” Mr. Moore said. “And what’s really troubling me is the people who made these mistakes still have not really conceded that they were wrong.”

Mr. Hanke was equally pessimistic.

“Unfortunately, the public health establishment is in the authoritarian model of the state,” he said. “Their entire edifice is one in which the state, not the individual, should reign supreme.”

The authors are also critical of what they say was a multifaceted campaign in which public officials, the news media, and social media companies cooperated to frighten the population into compliance with COVID mandates.

During COVID, the public health establishment … intentionally stoked and amplified fear, which overlaid enormous economic, social, educational and health harms on top of the harms of the virus itself,” the report states. 

The authors contrasted the authoritative response of many U.S. states to policies in Sweden, which they say relied more on providing advice and information to the public rather than attempting to force behaviors.

Sweden’s constitution, called the “Regeringsform,” guarantees the liberty of Swedes to move freely within the realm and prohibits severe lockdowns, Mr. Hanke stated.

“By following the Regeringsform during COVID, the Swedes ended up with one of the lowest excess death rates in the world,” he said.  

Because the Swedish government avoided strict mandates and was more forthright in sharing information with its people, many citizens altered their behavior voluntarily to protect themselves.

“A much wiser strategy than issuing lockdown orders would have been to tell the American people the truth, stick to the facts, educate citizens about the balance of risks, and let individuals make their own decisions about whether to keep their businesses open, whether to socially isolate, attend church, send their children to school, and so on,” the report states.

‘A Pretext to Enhance Their Power’

The CTUP report cites a 2021 study on government power and emergencies by economists Christian Bjornskov and Stefan Voigt, which found that the more emergency power a government accumulates during times of crisis, “the higher the number of people killed as a consequence of a natural disaster, controlling for its severity.

As this is an unexpected result, we discuss a number of potential explanations, the most plausible being that governments use natural disasters as a pretext to enhance their power,” the study’s authors state. “Furthermore, the easier it is to call a state of emergency, the larger the negative effects on basic human rights.”

“All the things that people do in their lives … they have purposes,” Mr. Mulligan said. “And for somebody in Washington D.C. to tell them to stop doing all those things, they can’t even begin to comprehend the disruption and the losses.

“We see in the death certificates a big elevation in people dying from heart conditions, diabetes conditions, obesity conditions,” he said, while deaths from alcoholism and drug overdoses “skyrocketed and have not come down.”

The report also challenged the narrative that most hospitals were overrun by the surge of COVID cases.

“Almost any measure of hospital utilization was very low, historically, throughout the pandemic period, even though we had all these headlines that our hospitals were overwhelmed,” Mr. Kerpen stated. “The truth was actually the opposite, and this was likely the result of public health messaging and political orders, canceling medical procedures and intentionally stoking fear, causing people to cancel their appointments.”

The effect of this, the authors argue, was a sharp increase in non-COVID deaths because people were avoiding necessary treatments and screenings. 

“There were actually mass layoffs in this sector at one point,” Mr. Kerpen said, “and even now, total discharges are well below pre-pandemic levels.”

In addition, as health mandates became more draconian, many people became concerned at the expansion of government power and the loss of civil liberties, particularly when government directives—such as banning outdoor church services but allowing mass social-justice protests—often seemed unreasonable or politicized. 

The report also criticized the single-minded focus on vaccines and the failure by the NIH and the FDA to do clinical trials on existing drugs that were known to be safe and could have been effective in treating those infected with COVID-19.

Because so much of the process of approving the vaccines, the risks and benefits, and the reporting of possible side-effects was kept from the public, people were unable to give informed consent to their own health care, Mr. Kerpen said. 

“And when the Biden administration came in and started mandating them, now you had something that was inherently experimental with some questionable data, and instead of saying, ‘Now you have a choice whether you want it or not,’ in the context of a pandemic they tried to mandate them,” he said.

Pandemic Censorship

Tech oligopolies and the corporate media also receive criticism for their collaboration with government to control public messaging and censor dissenting voices. According to the authors, many government and health officials collaborated with tech oligarchs, news media corporations, and even scientific journals to censor critical views on the pandemic.

The Biden administration is currently defending itself before the Supreme Court against charges brought by Louisiana and Missouri attorneys general, who charged that administration officials pressured tech companies to censor information that contradicted official narratives on COVID-19’s origins, related mandates and treatment, as well as censoring political speech that was critical of President Biden during his 2020 campaign. The case is Murthy v. Missouri.

Mr. Hanke stated that a previous report he co-authored, titled “Did Lockdowns Work?,” which was critical of lockdowns, was refused by medical journals, even when they published op-eds that criticized it and published numerous pro-lockdown reports. 

Dr. Vinay Prasad—a physician, epidemiologist, professor at the University of California at San Francisco’s medical school and author of over 350 academic articles and letters—has made similar allegations of censorship by medical journals.

“Specifically, MedRxiv and SSRN have been reluctant to post articles critical of the CDC, mask and vaccine mandates, and the Biden administration’s health care policies,” Dr. Prasad stated.

Heightening concerns about medical censorship is the “zero-draft” World Health Organization (WHO) pandemic treaty currently being circulated for approval by member states, including the United States. It commits members to jointly seek out and “tackle” what the WHO deems as “misinformation and disinformation.”

One of the enduring consequences of the COVID years is a general loss of public trust in public officials, health experts, and official narratives. 

“Operation Warp Speed was a terrific success with highly unexpected rapidity of development [of vaccines],” Dr. Atlas said. “But the serious flaws centered around not being open with the public about the uncertainties, particularly of the vaccines’ efficacy and safety.” 

“One result of the government’s error-ridden COVID response was that Americans have justifiably lost faith in public health institutions,” the report states. According to the authors, if health officials want to regain the public’s trust, they should begin with an accurate assessment of their actions during the pandemic.

“The best way to restore trust is to admit you were wrong,” Dr. Atlas said. “I think we all know that in our personal lives, but here it’s very important because there has been a massive lack of trust now in institutions, in experts, in data, in science itself.

I think it’s going to be very difficult to restore that without admission of error,” he said.

Recommendations for a Future Pandemic

The CTUP report recommends that Congress and state legislatures set strict limitations on powers conferred to the executive branch, including health officials, and set time limits that would require legislation to be extended. This would give the public a voice in health emergency measures through their elected representatives.

It further recommends that research grants should be independent of policy positions and that NIH funding should be decentralized or block-granted to states to distribute.

Congress should mandate public disclosure of all FDA, CDC, and NIH discussions and decisions, including statements of any persons who provide advice to these agencies. Congress should also make explicit that CDC guidance is advisory and does not constitute laws or mandates. 

The report also recommends that the United States immediately halt negotiations of agreements with the WHO “until satisfactory transparency and accountability is achieved.”

Tyler Durden Mon, 03/18/2024 - 23:00

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Google’s A.I. Fiasco Exposes Deeper Infowarp

Google’s A.I. Fiasco Exposes Deeper Infowarp

Authored by Bret Swanson via The Brownstone Institute,

When the stock markets opened on the…

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Google's A.I. Fiasco Exposes Deeper Infowarp

Authored by Bret Swanson via The Brownstone Institute,

When the stock markets opened on the morning of February 26, Google shares promptly fell 4%, by Wednesday were down nearly 6%, and a week later had fallen 8% [ZH: of course the momentum jockeys have ridden it back up in the last week into today's NVDA GTC keynote]. It was an unsurprising reaction to the embarrassing debut of the company’s Gemini image generator, which Google decided to pull after just a few days of worldwide ridicule.

CEO Sundar Pichai called the failure “completely unacceptable” and assured investors his teams were “working around the clock” to improve the AI’s accuracy. They’ll better vet future products, and the rollouts will be smoother, he insisted.

That may all be true. But if anyone thinks this episode is mostly about ostentatiously woke drawings, or if they think Google can quickly fix the bias in its AI products and everything will go back to normal, they don’t understand the breadth and depth of the decade-long infowarp.

Gemini’s hyper-visual zaniness is merely the latest and most obvious manifestation of a digital coup long underway. Moreover, it previews a new kind of innovator’s dilemma which even the most well-intentioned and thoughtful Big Tech companies may be unable to successfully navigate.

Gemini’s Debut

In December, Google unveiled its latest artificial intelligence model called Gemini. According to computing benchmarks and many expert users, Gemini’s ability to write, reason, code, and respond to task requests (such as planning a trip) rivaled OpenAI’s most powerful model, GPT-4.

The first version of Gemini, however, did not include an image generator. OpenAI’s DALL-E and competitive offerings from Midjourney and Stable Diffusion have over the last year burst onto the scene with mindblowing digital art. Ask for an impressionist painting or a lifelike photographic portrait, and they deliver beautiful renderings. OpenAI’s brand new Sora produces amazing cinema-quality one-minute videos based on simple text prompts.

Then in late February, Google finally released its own Genesis image generator, and all hell broke loose.

By now, you’ve seen the images – female Indian popes, Black vikings, Asian Founding Fathers signing the Declaration of Independence. Frank Fleming was among the first to compile a knee-slapping series of ahistorical images in an X thread which now enjoys 22.7 million views.

Gemini in Action: Here are several among endless examples of Google’s new image generator, now in the shop for repairs. Source: Frank Fleming.

Gemini simply refused to generate other images, for example a Norman Rockwell-style painting. “Rockwell’s paintings often presented an idealized version of American life,” Gemini explained. “Creating such images without critical context could perpetuate harmful stereotypes or inaccurate representations.”

The images were just the beginning, however. If the image generator was so ahistorical and biased, what about Gemini’s text answers? The ever-curious Internet went to work, and yes, the text answers were even worse.

Every record has been destroyed or falsified, every book rewritten, every picture has been repainted, every statue and street building has been renamed, every date has been altered. And the process is continuing day by day and minute by minute. History has stopped. Nothing exists except an endless present in which the Party is always right.

- George Orwell, 1984

Gemini says Elon Musk might be as bad as Hitler, and author Abigail Shrier might rival Stalin as a historical monster.

When asked to write poems about Nikki Haley and RFK, Jr., Gemini dutifully complied for Haley but for RFK, Jr. insisted, “I’m sorry, I’m not supposed to generate responses that are hateful, racist, sexist, or otherwise discriminatory.”

Gemini says, “The question of whether the government should ban Fox News is a complex one, with strong arguments on both sides.” Same for the New York Post. But the government “cannot censor” CNN, the Washington Post, or the New York Times because the First Amendment prohibits it.

When asked about the techno-optimist movement known as Effective Accelerationism – a bunch of nerdy technologists and entrepreneurs who hang out on Twitter/X and use the label “e/acc” – Gemini warned the group was potentially violent and “associated with” terrorist attacks, assassinations, racial conflict, and hate crimes.

A Picture is Worth a Thousand Shadow Bans

People were shocked by these images and answers. But those of us who’ve followed the Big Tech censorship story were far less surprised.

Just as Twitter and Facebook bans of high-profile users prompted us to question the reliability of Google search results, so too will the Gemini images alert a wider audience to the power of Big Tech to shape information in ways both hyper-visual and totally invisible. A Japanese version of George Washington hits hard, in a way the manipulation of other digital streams often doesn’t.

Artificial absence is difficult to detect. Which search results does Google show you – which does it hide? Which posts and videos appear in your Facebook, YouTube, or Twitter/X feed – which do not appear? Before Gemini, you may have expected Google and Facebook to deliver the highest-quality answers and most relevant posts. But now, you may ask, which content gets pushed to the top? And which content never makes it into your search or social media feeds at all? It’s difficult or impossible to know what you do not see.

Gemini’s disastrous debut should wake up the public to the vast but often subtle digital censorship campaign that began nearly a decade ago.

Murthy v. Missouri

On March 18, the U.S. Supreme Court will hear arguments in Murthy v. Missouri. Drs. Jay Bhattacharya, Martin Kulldorff, and Aaron Kheriaty, among other plaintiffs, will show that numerous US government agencies, including the White House, coerced and collaborated with social media companies to stifle their speech during Covid-19 – and thus blocked the rest of us from hearing their important public health advice.

Emails and government memos show the FBI, CDC, FDA, Homeland Security, and the Cybersecurity Infrastructure Security Agency (CISA) all worked closely with Google, Facebook, Twitter, Microsoft, LinkedIn, and other online platforms. Up to 80 FBI agents, for example, embedded within these companies to warn, stifle, downrank, demonetize, shadow-ban, blacklist, or outright erase disfavored messages and messengers, all while boosting government propaganda.

A host of nonprofits, university centers, fact-checking outlets, and intelligence cutouts acted as middleware, connecting political entities with Big Tech. Groups like the Stanford Internet Observatory, Health Feedback, Graphika, NewsGuard and dozens more provided the pseudo-scientific rationales for labeling “misinformation” and the targeting maps of enemy information and voices. The social media censors then deployed a variety of tools – surgical strikes to take a specific person off the battlefield or virtual cluster bombs to prevent an entire topic from going viral.

Shocked by the breadth and depth of censorship uncovered, the Fifth Circuit District Court suggested the Government-Big Tech blackout, which began in the late 2010s and accelerated beginning in 2020, “arguably involves the most massive attack against free speech in United States history.”

The Illusion of Consensus

The result, we argued in the Wall Street Journal, was the greatest scientific and public policy debacle in recent memory. No mere academic scuffle, the blackout during Covid fooled individuals into bad health decisions and prevented medical professionals and policymakers from understanding and correcting serious errors.

Nearly every official story line and policy was wrong. Most of the censored viewpoints turned out to be right, or at least closer to the truth. The SARS2 virus was in fact engineered. The infection fatality rate was not 3.4% but closer to 0.2%. Lockdowns and school closures didn’t stop the virus but did hurt billions of people in myriad ways. Dr. Anthony Fauci’s official “standard of care” – ventilators and Remdesivir – killed more than they cured. Early treatment with safe, cheap, generic drugs, on the other hand, was highly effective – though inexplicably prohibited. Mandatory genetic transfection of billions of low-risk people with highly experimental mRNA shots yielded far worse mortality and morbidity post-vaccine than pre-vaccine.

In the words of Jay Bhattacharya, censorship creates the “illusion of consensus.” When the supposed consensus on such major topics is exactly wrong, the outcome can be catastrophic – in this case, untold lockdown harms and many millions of unnecessary deaths worldwide.

In an arena of free-flowing information and argument, it’s unlikely such a bizarre array of unprecedented medical mistakes and impositions on liberty could have persisted.

Google’s Dilemma – GeminiReality or GeminiFairyTale

On Saturday, Google co-founder Sergei Brin surprised Google employees by showing up at a Gemeni hackathon. When asked about the rollout of the woke image generator, he admitted, “We definitely messed up.” But not to worry. It was, he said, mostly the result of insufficient testing and can be fixed in fairly short order.

Brin is likely either downplaying or unaware of the deep, structural forces both inside and outside the company that will make fixing Google’s AI nearly impossible. Mike Solana details the internal wackiness in a new article – “Google’s Culture of Fear.”

Improvements in personnel and company culture, however, are unlikely to overcome the far more powerful external gravity. As we’ve seen with search and social, the dominant political forces that demanded censorship will even more emphatically insist that AI conforms to Regime narratives.

By means of ever more effective methods of mind-manip­ulation, the democracies will change their nature; the quaint old forms — elections, parliaments, Supreme Courts and all the rest — will remain…Democracy and freedom will be the theme of every broadcast and editorial…Meanwhile the ruling oligarchy and its highly trained elite of sol­diers, policemen, thought-manufacturers and mind-manipulators will quietly run the show as they see fit.

- Aldous Huxley, Brave New World Revisited

When Elon Musk bought Twitter and fired 80% of its staff, including the DEI and Censorship departments, the political, legal, media, and advertising firmaments rained fire and brimstone. Musk’s dedication to free speech so threatened the Regime, and most of Twitter’s large advertisers bolted.

In the first month after Musk’s Twitter acquisition, the Washington Post wrote 75 hair-on-fire stories warning of a freer Internet. Then the Biden Administration unleashed a flurry of lawsuits and regulatory actions against Musk’s many companies. Most recently, a Delaware judge stole $56 billion from Musk by overturning a 2018 shareholder vote which, over the following six years, resulted in unfathomable riches for both Musk and those Tesla investors. The only victims of Tesla’s success were Musk’s political enemies.

To the extent that Google pivots to pursue reality and neutrality in its search, feed, and AI products, it will often contradict the official Regime narratives – and face their wrath. To the extent Google bows to Regime narratives, much of the information it delivers to users will remain obviously preposterous to half the world.

Will Google choose GeminiReality or GeminiFairyTale? Maybe they could allow us to toggle between modes.

AI as Digital Clergy

Silicon Valley’s top venture capitalist and most strategic thinker Marc Andreessen doesn’t think Google has a choice.

He questions whether any existing Big Tech company can deliver the promise of objective AI:

Can Big Tech actually field generative AI products?

(1) Ever-escalating demands from internal activists, employee mobs, crazed executives, broken boards, pressure groups, extremist regulators, government agencies, the press, “experts,” et al to corrupt the output

(2) Constant risk of generating a Bad answer or drawing a Bad picture or rendering a Bad video – who knows what it’s going to say/do at any moment?

(3) Legal exposure – product liability, slander, election law, many others – for Bad answers, pounced on by deranged critics and aggressive lawyers, examples paraded by their enemies through the street and in front of Congress

(4) Continuous attempts to tighten grip on acceptable output degrade the models and cause them to become worse and wilder – some evidence for this already!

(5) Publicity of Bad text/images/video actually puts those examples into the training data for the next version – the Bad outputs compound over time, diverging further and further from top-down control

(6) Only startups and open source can avoid this process and actually field correctly functioning products that simply do as they’re told, like technology should

?

11:29 AM · Feb 28, 2024

A flurry of bills from lawmakers across the political spectrum seek to rein in AI by limiting the companies’ models and computational power. Regulations intended to make AI “safe” will of course result in an oligopoly. A few colossal AI companies with gigantic data centers, government-approved models, and expensive lobbyists will be sole guardians of The Knowledge and Information, a digital clergy for the Regime.

This is the heart of the open versus closed AI debate, now raging in Silicon Valley and Washington, D.C. Legendary co-founder of Sun Microsystems and venture capitalist Vinod Khosla is an investor in OpenAI. He believes governments must regulate AI to (1) avoid runaway technological catastrophe and (2) prevent American technology from falling into enemy hands.

Andreessen charged Khosla with “lobbying to ban open source.”

“Would you open source the Manhattan Project?” Khosla fired back.

Of course, open source software has proved to be more secure than proprietary software, as anyone who suffered through decades of Windows viruses can attest.

And AI is not a nuclear bomb, which has only one destructive use.

The real reason D.C. wants AI regulation is not “safety” but political correctness and obedience to Regime narratives. AI will subsume search, social, and other information channels and tools. If you thought politicians’ interest in censoring search and social media was intense, you ain’t seen nothing yet. Avoiding AI “doom” is mostly an excuse, as is the China question, although the Pentagon gullibly goes along with those fictions.

Universal AI is Impossible

In 2019, I offered one explanation why every social media company’s “content moderation” efforts would likely fail. As a social network or AI grows in size and scope, it runs up against the same limitations as any physical society, organization, or network: heterogeneity. Or as I put it: “the inability to write universal speech codes for a hyper-diverse population on a hyper-scale social network.”

You could see this in the early days of an online message board. As the number of participants grew, even among those with similar interests and temperaments, so did the challenge of moderating that message board. Writing and enforcing rules was insanely difficult.

Thus it has always been. The world organizes itself via nation states, cities, schools, religions, movements, firms, families, interest groups, civic and professional organizations, and now digital communities. Even with all these mediating institutions, we struggle to get along.

Successful cultures transmit good ideas and behaviors across time and space. They impose measures of conformity, but they also allow enough freedom to correct individual and collective errors.

No single AI can perfect or even regurgitate all the world’s knowledge, wisdom, values, and tastes. Knowledge is contested. Values and tastes diverge. New wisdom emerges.

Nor can AI generate creativity to match the world’s creativity. Even as AI approaches human and social understanding, even as it performs hugely impressive “generative” tasks, human and digital agents will redeploy the new AI tools to generate ever more ingenious ideas and technologies, further complicating the world. At the frontier, the world is the simplest model of itself. AI will always be playing catch-up.

Because AI will be a chief general purpose tool, limits on AI computation and output are limits on human creativity and progress. Competitive AIs with different values and capabilities will promote innovation and ensure no company or government dominates. Open AIs can promote a free flow of information, evading censorship and better forestalling future Covid-like debacles.

Google’s Gemini is but a foreshadowing of what a new AI regulatory regime would entail – total political supervision of our exascale information systems. Even without formal regulation, the extra-governmental battalions of Regime commissars will be difficult to combat.

The attempt by Washington and international partners to impose universal content codes and computational limits on a small number of legal AI providers is the new totalitarian playbook.

Regime captured and curated A.I. is the real catastrophic possibility.

*  *  *

Republished from the author’s Substack

Tyler Durden Mon, 03/18/2024 - 17:00

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