It could be worse. What if you owned a filling station in a deserted border-town?

The NPC Podcast is on the air. The organizers of the National Pharmaceutical Congress are proud to release our new weekly podcast series, hosted by Peter Brenders. Peter's guest this week is Dr. Shafiq Qaadri. Listen here now, or download the episode and play it at your convenience. The NPC Podcast is presented in cooperation with Impres Pharma. (The NPC Podcast is now on Apple iTunes.)

⇒ Issue #78 (In numerology, the number 78 suggests abundance and prosperity.)

⇒ Confirmed Covid cases in Canada as of 07/20: 112,168*

⇒ Confirmed Covid fatalities in Canada as of 07/20: 8,896*

⇒ Worldwide Covid cases as of 07/20: 14,508,892*

⇒ Worldwide Covid fatalities as of 07/20: 606,206*

July 20, 2020—Welcome back to the working week, CurveFlatteners. At the keyboard this morning is Mitch Shannon, not coming to you from the corner of F Street and Peace Portal Drive. 

That intersection is just off Interstate-5 in the verdant border community of Blaine, Washington, where a 59-year-old entrepreneur named Mike Hill just invested US$3.5 million to upgrade his gas station and abutting Starbuck’s franchise. It seemed like a solid bet on the future because there’s no more predictable business proposition in the world then counting on the 2.5 million residents of greater Vancouver to drive the half-hour to Blaine (pop. 5,000) to save serious dough on gas, beer, smokes and groceries while picking up their Amazon packages at the town’s several “Mail Boxes Etcetera” stores.

Then along came Covid. The subsequent closing of the U.S.-Canada border to non-essential travel will continue at least through the end of August, it was recently announced. Automobile border crossings through Blaine were down from the previous year by 97 per cent during June, reports the New York Times (behind a paywall.) The economic effect on communities such as Blaine and individuals such as Mr. Hill has been, in a word, devastating.

And more cultural dominoes keep tumbling, as well. Last week Canada’s federal government put the kibosh on plans to allow visiting MLB teams into Toronto for scheduled play against the Blue Jays, leaving Canada’s hometown heroes without a home. 

Like so many other current developments (see "What I'm Reading Now"), this seems like another case of life imitating art. The plot of Philip Roth’s 1973 satiric fiction, The Great American Novel, uses the identical premise of a major league baseball team, the Ruppert Mundys of the Patriot League, being forced to play every game on the road during the 1941 season. Roth makes this the basis of a lengthy deliberation on human frailty, on the deeper meaning of winning and losing, on belonging to a community and becoming an outcast, on comprehending life and being too slothful and self-absorbed to bother. If you care to understand the underpinnings of world events in 2020, why not seize this moment to turn off cable news, stop reading this newsletter, and download and read a copy of Roth’s fine novel?

Someone who seems unlikely to accept that excellent suggestion is the improbably named Hogan Gidley, a prickly spokesman for the re-election effort of U.S. President Donald Trump. Mr. Gidley explains to a CNN reporter his boss’s position on the shuttered border:  “I’m not sure why you would want to go to Canada when we live in the greatest country on the face of the planet. That’s Donald Trump’s mentality on it.” 

COVID CHRONICLE 07/20/2020

• The practice of medicine often comes down to making the least-bad terrible choice. So it is in the developing world, where doctors must ask which of these two options will lead to a worse outcome: Keep bringing kids into the clinic for routine vaccinations programmes and run the risk of having them infected on-site? Or discontinue vaccinations during the pandemic and hope for the best? It turns out that the dilemma’s not so difficult. Dr. Kaja Abba of the London School of Hygiene and Tropical Medicine modelled a study of 54 African nations that concluded 700,000 children’s lives would be saved by continuing vaccination schedules. 
• Continuing the theme of making the least-bad terrible choice, medical ethicist Mathias Wirth of the University of Bern, Switzerland considered the thorny matter of triage, along with colleagues from German, British and American institutions. Regarding the life-and-death choices clinicians currently make for Covid-19 patients, Prof. Wirth's team recommends increased regional, national and international collaboration among intensive care units. Says he: "There is no real and legitimate triage situation as long as treatment spaces are available elsewhere."
• Researchers from Stanford University School of Medicine report a puzzling case of a volunteer blood donor who was asymptomatic at the time he gave blood and deemed to be clear of Covid-19 symptoms five days after his donation, but whose blood had detectable Covid RNA levels 40 days after his symptoms cleared. Though this is the only reported case, the Stanford group concludes in a report published in the American Journal of Public Health that this incident suggests a potential risk to the safety of public blood supplies. 
• As the fifth month of social distancing rolls along, many may be craving a stiff drink in a convivial setting where everybody knows your name. However, the reopening of indoor taverns has been associated with increases in Covid-19 infection in Quebec, as occurred in the UK, USA and Spain following the resumption of pub life. Last week, the Ontario Medical Association went on record, saying the reopening of bars carries significant risk. Said OMA prexy Dr. Samantha Hill: “When people consume alcohol, inhibitions are lowered, making them much less likely to practise physical distancing, proper masking behaviours and good hand hygiene. Indoor locations with decreased air ventilation present a particularly high risk of transmission.”

STORIES CHRONICLE IS WORKING ON

Senior editor John Evans interviewed researcher Ric Porcyshyn, PhD and Dr. Gary Remington of Toronto’s CAMH on a review of clozapine-associated obsessive-compulsive symptoms and their management. His article will appear in an upcoming Chronicle of Neurology + Psychiatry.

WHAT I’M READING NOW

Dr. Mary L. Trump’s Too Much and Never Enough: How My Family Created the World's Most Dangerous Man (Simon & Schuster, Cdn$37.) Dr. Trump, a psychologist who is the niece of the barking-mad 45th American president, recounts with a clinician’s eye and a real flair for storytelling the family pathology of the Trump (nee Drumpf) clan and the particular circumstances that created one nutso demagogue. If you were seeing this all unfold as a segment of the Dr. Phil show or on the Jerry Springer program, you’d likely chuckle and shake your head. Unfortunately, there’s nothing to laugh at in this tale. Author Trump has succeeded in making her awful family and her daft uncle seem all too explainable, predictable and plausible, and our lives are all the more terrifying for that.

TOMORROW AND TOMORROW

Please use the comments section of the Daily CurveFlattener to let us know what you're up to today and please make a point of checking in via LinkedIn, email, or your favourite connector. Share this newsletter with your colleagues, if you please. Tomorrow, John Evans will be here to take over the editorial chair.