(CNN) ‘I’m smiling’: Ret. Lt. Gen. Hertling reacts to Putin news.

The news that Putin has fired under-performing generals and taken personal command of tactical decisions has General Hertling in a gleeful mood. I share with him the sentiment that bad news for the Russia is good news for Ukraine. My glee is tempered by the now single pair of hands that now control both conventional operations, and use of WMDs. In the words of CIA, this further heightens unpredictability.  It complicates intelligence work.

History suggests that Putin  is motivated less by high casualties than stalemate. Look at the Donbas map; it contains a de facto Ukraine salient, extending to Severodonetsk, that defies Kremlin military logic.

Russian military minds recall that in World War II, in almost every Soviet  victory, save the great encirclements, the Russians suffered much higher casualties than Germany. The Battle of Kursk, by some measures the largest tank battle in history, was 200 miles from Severodonetsk, so it bears comparison, even if the comparison is faulty.  Here the Soviet forces were defending a salient, which the German forces attempted to reduce.

Then, as now, the Soviet forces had a primitive command structure, which included the motivation of commissars who summarily executed soldiers who abandoned the front. At least one current Russian POW claims the threat still exists. By some counts, Germany lost 165,000; the Soviets lost 863,000. This is celebrated without qualification in Russia.

A more discretionary example. In the Winter War with Finland, Russia ran out of parachute silk. So paratroopers were nailed into barrels, and rolled out of planes into deep snow; 60% survived the drop.

(Euromaidan Press) Russian troops suffer epic fail while attempting to cross river at Bilohorivka.  The bunching of troops has been exemplified as tactical incompetence. While true, it may not have been discretionary. Reports of low morale, which implies fear not neutralized by motivation, may have required the “commissar solution”, threat of summary execution, corralling and pushing masses to the bridges. Those who reached the other side probably bunched up out of fear.

The battlefield balance of terror is now heavily in the favor of Ukraine.

• Does Putin intend to continue the kind of mutual attrition that gave victory to the Soviets in WW2?
• Or does he intend to flip terror to Russian advantage in  the Severodonetsk salient by the use of WMDs ?
• In view of historical  losses that the West has not experienced since WW1, would the inevitable self-inflicted losses of Russian forces to their own WMDs be acceptable to Russia?

Watch the colonels: Power Transition in Russia? Revolution? Part 1

(CNN) ‘I do not have an explanation’: Pentagon official shows video of unidentified object.

This article contains an index into my articles on the subject: (CNN) James Clapper on UFOs; Let’s do Hyperspectral Imaging.

Observations

• The new openness is noteworthy, but not by  itself enough to engender a resolution. Neither is the modest step of sensor calibration.
• Committee members were severely handicapped by the technology gulf. In viewing the spherical ufo of the video clip, Representative Schiff was not sufficiently informed to ask the most obvious question: Was the sphere in absolute motion relative to the earth, or only in motion relative to the fast-moving navy plane? DDNI Scott Bray does not discuss this.
• Technology exists that has application to the problem. See (CNN) James Clapper on UFOs; Let’s do Hyperspectral Imaging. The cost ranges from significant to huge. No one wants to spend.
• If the problem were recast as “target identification”, rather than UFOs, there might be a rationale for funding.
• Moultrie and Bray are truthful and accurate: There are no material samples.

(NY Times) No Longer in Shadows, Pentagon’s U.F.O. Unit Will Make Some Findings Public.  The conclusion of  Eric W. Davis  that some recovered material samples are beyond our technology is the result of compartmentalization of classified technologies.

Retrofitting existing targeting systems with sensors of sufficient breadth and flexibility is not feasible in most cases. It might be considered for external targeting pods, as found on the F-15, the B-52, which has some room for it, and upcoming systems, such as the B-21 Raider.

(CNN) Mass shooting at Buffalo supermarket was a racist hate crime, police say.

The Mourner’s Kaddish:

(Click to enlarge)

The Jewish prayer for the dead.

(CNN) New White House Covid projection puzzles experts and catches some Biden officials off guard. Quoting,

A senior administration official had told CNN on Monday that the 100 million infection number is a moderate one that falls somewhere in the middle of more conservative and extreme projections and is based on an underlying assumption of no additional resources or extra mitigation measures being taken, including new Covid-19 funding from Congress, or dramatic new variants.

This is in line with my own prediction of 1/31/2022, Omicron BA.2; 2022 COVID Forecast; Napkin Calculation #8.  Quoting,

• • Prediction via extrapolation: A peak 9-10 months past 1/22.

…

What of severity? The speculation of Omicron, a Good Thing? is wrong. Omicron infection provides some cross immunity, at terrible cost. Whether faded immunity from Omicron, 9 months hence, reduces severity is an open question, which only a variant can answer.  Mortality will probably decline, due to increased human immune  system experience, but remain at uncomfortable levels.

(Reuters, 5/9/22) Biden says he is worried Putin does not have a way out of Ukraine war. Quoting,

Biden said Putin is a very calculating man and the problem he worries about now is that the Russian leader “doesn’t have a way out right now, and I’m trying to figure out what we do about that.”

Emotionally, I wouldn’t give those Russki bastard monsters anything. At the same time, I tend to think, that by an unproveable counterfactual history, we had a part in creating the monster.  See (2014) Ukraine prediction; an Austrian solution. and (2022) Ukraine; Let’s Make a Deal; Suggestion to Vladimir Putin.

Neutrality is no longer negotiable; Russia is simply too dangerous. We still have to deal with the monster. Joe Biden’s political career has prepared him for this kind of engagement.

I have some ideas. Negotiating positions should not be publicly disclosed, so I will wait a few days before making them public.

Interested parties can contact me in the meantime.

In the Soviet Union that preceded Russia,  power transitions styled after the palace coup. The current situation bears slight resemblance to the description of Crane Brinton’s classic text, The Anatomy of Revolution.  One element makes his list, another has partial resemblance, and one does not:

• A period of  increasing prosperity, followed by sudden reversal. See (BBC) Life in Vladimir Putin’s Russia explained in 10 charts.
• Incompetent use of power. Brinton’s meaning is power  against internal opponents, though it is doubtful that domestic exercise would be sufficient to rescue an unstable power structure.
• There is no sign of involvement of the masses with Brinton’s stereotypical grievances, which might happen if Putin asks more of them by declaration of war, mass mobilization, or sanctions bite very hard.

Some nascent signs imply the future emergence of an  as-yet invisible organized opposition. It follows  Sri Lanka Bombings; Argentine author Jorge Borges, The Approach to Al-Mu’tasim, except that instead of the search for a mastermind, we look for a structure.

(The Hill, 2/11/22) A retired Russian general’s criticism may signal a larger problem for Putin. Quoting,

Retired Russian Colonel-General Leonid Ivashov, the head of the All-Russian Officers Assembly, has gone public with a statement that calls for Russian President Vladimir Putin to resign over the confrontation involving Ukraine.

On 2/11/22, the background of rebellious attitude was black. Since then 12+ generals have been killed. Ivashov represents reservist and retired officers, but there is no social barrier to empathy as might occur with non-commissioned soldiers.

Preceding recruitment, the structure builds by diffusion. One path for diffusion of rebellious sentiment is retired generals–>active generals–>down as far down as colonel.  In the history of military coups and rebellions, the rank of colonel is prominent. A  figure analogous to a “young Turk”, such as Gamal Abdel Nasser, or Muammar Gaddafi, both colonels, might emerge. Not so distant from the foxhole themselves, colonels can relate to and recruit lower ranks. The doughnut fills in.

Given the Soviet tradition of gerontocracy, legitimacy might be beyond the reach of Turks, requiring involvement of more senior figures.  Perhaps, as happened thrice in Soviet history, a diarchy, or triarchy:

• After Stalin’s death: Malenkov, Beria and Molotov.
• After Beria’s death: Khrushchev and  Malenkov.
• After Khrushchev was deposed, Brezhnev and Kosygin.

After Kosygin was pushed out, top leadership collapsed to a single person. The current role of prime minister is strictly subsidiary. Nevertheless, collective leadership, originated by Lenin, has legitimacy in the Russian mind.

Clandestine cell systems are typically part of the activity, but not historically in the Soviet Union, where there was a dynamic based on personal loyalty. If Stalin was poisoned by Beria, which is my view, no cell was documented, no conspirators identified.

• In the arrest of Beria, Khrushchev relied on Marshal Zhukov, who relied on personal loyalty to assemble the force.
• In 1957, Zhukov successfully defended Khrushchev from the Stalinist “Anti-Party Group“, saying “The Army is against this resolution and not even a tank will leave its position without my order!”

Zhukov was uniquely able to defy the otherwise impeccable subordination of the military to the Party. Now it might be less difficult;  the grip of the Kremlin on the armed forces is not what it used to be. The Soviet armed forces were politically uniform in ideology; in the absence of such it is a marketplace for ideas.

Zhukov’s existence was dependent on a degree of personal loyalty that may still exist in segments of Russian society, facilitating actions that in other societies requires a clandestine cell system.

To be continued shortly.

We continue from Ukraine: Nerve Agent Civil Defense Part 3.

The  articles cited so far relate clinical experience, suggesting that the standard of  care may be wrong. There is another type of paper, which attempts to elucidate intricate biochemical mechanisms. See (PubMed) The treatment of Soman poisoning and its perspectives.

Until Novichok came into focus, soman was the odd man out of organophosphate nerve agents. While other agents require time to cement their holds on AChE, soman does so almost instantaneously, so that pralidoxime cannot rip it off. This paper identifies better oxime antidotes, HI-6, HGG-42 and BDB-27.   Yet in this specialty of toxicology, dialog between clinicians who disavow oximes, and biochemists looking for better ones is so notably lacking, each appears unaware of the literature of the other.

Like soman, novichok is/was alleged to bind AChE irreversibly. Why did the Skripals and Navalny survive? The only disclosure about the Skripals conforms to standard treatment, which was not supposed to work. If Porton Down knows more, they’re not saying, for good reason.

Another paper implies something we have to consider. See (PubMed) Release of dopamine, GABA and EAA in rats during intrastriatal perfusion with kainic acid, NMDA and soman: a comparative microdialysis study. The gist: Soman, and other nerve agents, blow up the brain by causing catastrophic levels of neurotransmitters, notably dopamine. Notable, because maybe something can be done about it.

In civil defense, it  has to do with the choice of antihistamine. Quoting from (NIH) Promethazine,

Promethazine…(1)antidopaminergic, (2)antihistamine, and (3)anticholinergic properties. … Promethazine is a direct antagonist at the mesolimbic dopamine receptors and (4)alpha-adrenergic receptors in the brain. Promethazine exhibits its antihistamine effects as an H1-receptor blocker.[12][13]

Note the red numbers. Besides blocking histamine, promethazine has three useful off-target effects, which could save a brain from blowing up. Conversely, diphenylhydramine has been described as making dopamine more potent, which we do not want, or of neutral effect. I’ll leave cyclizine to another time.

In terms of civil defense, the question is: Diphenylhydramine, or something else? There isn’t  data to show that promethazine is clinically better. Diphenylhydramine may be unique in medicine, in the power of a drug that is dirt cheap:

• The most powerful antihistamine known.
• Powerful anticholinergic.
• Possibly competitive with the nerve agent standard of care.
• A bottle of 600 tablets, 25mg, costs $4.49 at Sams Club.
• The only drug with world stocks that might be sufficient to protect a medium size country.

Notably missing is a means to administer by injection. Via the oral route, absorption is delayed by 15 minutes. Blood concentration peaks at about 4 hours. Autoinjectors are better, but unsustainable for repeated exposures. Recall the initial goal:

A civilian in the bulls-eye of a nerve agent munition, who receives the incredibly small lethal dose of a modern nerve agent, cannot be saved by anything other than an antidote kit. Visualize exposure zones as a set of concentric rings surrounding the bulls-eye.  There may be options for the next zone out, LD50, where half of those exposed die, and more distant rings: those who are sickened, and those exposed to the agent after a delay.

If this toxicology specialty had a decent dialog between clinicians and researchers, we might not be swimming in mystery. A comparison for scale. Iodine tablets provide very incomplete protection against nuclear reactor accidents, yet are considered worthwhile.

What is the difference? One is an accident. The other is the intentional work of man.

(CNN) Deaths of 3 Americans at Sandals resort in the Bahamas are under investigation, officials say. Quoting,

“The officers found a Caucasian male slumped against a wall in a bathroom, unresponsive,” the Royal Bahamas Police Force said. “The woman was also unresponsive. Both individuals showed signs of convulsion. The officers examined the bodies and found no signs of trauma.”

Convulsion is a classic sign of organophosphate poisoning. In the tropics, this occurs as the result of aggressive mosquito control, and protection of wood frame structures, using  insecticides not approved for this use in the U.S. This last happened in 2019. (CNN) Colorado couple: We were sickened at same Dominican Republic resort where 3 Americans died.

Malathion, widely used in the U.S., is safe. Bootleg parathion, which approaches sarin in toxicity, would do it.

How ironic, given the current focus.

We continue from Ukraine: Nerve Agent Civil Defense Part 2.

Edit: Corrected link to (MMSL) Antihistamines: Promising Antidotes of Organophosphorus Poisoning.

All small-molecule drugs have off-target effects, a.k.a. side effects. Viewing nerve agents as “evil drugs”, the same is true. The “simple story” of Part 2 applies most directly to sarin, tabun, and VX, but not soman or novichok. How these differences complicate the simple story is at this level mostly, but not entirely a distraction, something to be sorted out by the CW defense establishments.

The challengers have their own simplification,  study of organophosphate pesticide poisoning as a proxy for nerve agents. These pesticides are nerve agents for insects, specialized to insect AChE. They cross-react with human AChE, acting as weaker human nerve agents. Toxicity varies widely. You can drink malathion and get away with it; the active metabolite of parathion is paraoxon, which is 70% as toxic as sarin.

Treatment of parathion poisoning has mostly followed the orthodoxy of the simple story. But there have been  doubters, motivated by poor survival rates with the simple story standard of care. Alternative treatments were  used, based on the off-target anticholinergic effects of  first generation antihistamines, resulting in some papers. There have been so many cases that it has been possible to extract some evidence-based medicine. The principle papers are:

• (MMSL) Antihistamines: Promising Antidotes of Organophosphorus Poisoning.
• (NIH) Protective effects of the antihistamine promethazine against acute paraxon-methyl and dicrotophos toxicity in adult rats.
• (NIH) Efficacy of pralidoxime in organophosphorus poisoning: revisiting the controversy in Indian setting.

Quoting the last,

Results: During the study period, 150 patients were screened following which 120 patients were randomized to either of the treatment arms. Add-on pralidoxime therapy did not offer any appreciable benefit over atropine alone in terms of reducing mortality (18.33% (11/60) versus 13.33% (8/60)) and ventilator requirement (5% (3/60) versus 8.33% (5/60)). However, patients randomized in the add-on pralidoxime arm experienced longer duration of hospital stay (7.02 ± 1.12 days) than those receiving atropine-alone therapy (5.68 ± 1.87 days) (P < 0.001).

This is an astonishing result of evidence based medicine, in strong contradiction to the theory of the simple story. If it transfers to human  nerve agents,  the possibility presents that current orthodox treatment of some or most nerve agents is fundamentally wrong. Which agents, if any, and why, is a mystery.

The  antihistamines are:

• Cyclizine, Marezine, Valoid, Nausicalm,  generic. OTC.
• Diphenylhydramine, the active ingredient of the U.S. (but not EU) formulation of OTC Benadryl, available as a generic.
• Promethazine, by prescription, generic or branded: Phenergan, Promacot.

Some readers may wonder why diazepam (Valium) has been omitted, when it is a frequent adjunct. Atropine is blocked from entry into the brain by the blood brain barrier, but nerve agents penetrate. Untreated, this results in a continual epileptic seizure, with high lethality. Diazepam is an anticonvulsant. Whether diazepam is specific treatment, or merely supportive, is an open question. The antihistamines enter the brain, where they  are specific anticholinergics, possibly replacing diazepam. See (NIH) Diazepam in the treatment of organophosphorus ester pesticide poisoning and (PubMed) The role of diazepam in the treatment of nerve agent poisoning in a civilian population.

Why is atropine the historical choice? Perhaps because it appeared to be the cleaner drug. With the new awareness that nerve agents cause massive release of histamine, resembling the anaphylactic shock of a severe type 1 allergic reaction, anticholinergics that are also antihistamines become desirable.

Optimal treatments, which must be distinct for each agent, are not known.  Since identification of the actual agent is delayed, optimality might not have practical utility.

Takeaway so far: Nerve agent poisoning in humans is so deadly, and experimentation so infeasible, the standard of care may be wrong.

Conclusion follows shortly.

We continue from Ukraine: Nerve Agent Civil Defense Part 1.

Nota bene: This is not medical advice. It is an attempt to make accessible a few papers that are somewhat speculative, so that policymakers can ask intelligent questions of their CW defense establishments, (UK) Defence Science and Technology Laboratory and (U.S.) Edgewood Chemical Biological Center. 

Basics. The nervous system contains cells called neurons. In various forms, neurons are the computing elements of the brain. Neurons in the peripheral nervous system connect all the  functions of the body to the brain, for both conscious and involuntary control, by nerve impulses.

Within a single neuron fiber, which can be feet in length, a nerve impulse propagates in a way resembling an electric pulse aided by chemistry. It  isn’t simple, but is simple compared to when it has to jump from one one neuron to another, across a watery gap called a synapse. The sending neuron spritzes a puff of molecules called neurotransmitters into the gap. In mere milliseconds they are sniffed by receptors on the receiving neuron, which causes a new nerve impulse to start  up in the receptor. There are many neurotransmitters in the brain; the one of interest is acetylcholine.

The spritz of neurotransmitter has to go away before the next spritz, or the system locks up — spasms, convulsions, paralysis, death. The cleanup job is handled by a catalyst molecule that destroys neurotransmitters without damage to itself. In this case, AChE. Each molecule of AChE destroys about 25,000 acetylcholine molecules before it takes a hit, so the body replaces AChE very slowly..

A nerve agent binds to AChE, so that AChE can no longer remove acetylcholine from the synapse. The nervous system locks up; death ensues. This is the simple story, upon which orthodox treatment relies:

• Reduce the activity of the excess acetylcholine, with an anticholinergic medication, such as atropine, which fits into acetylcholine receptors, blocking them.
• Reactivate the AChE, by ripping off the nerve agent, with a class of medications known as oximes. A frequent choice is pralidoxime.

There is a challenge to this recipe, asserting that, while it is well motivated by theory,  it is  incompletely supported by evidence based medicine. It asserts that the simple story neglects other effects of nerve agents, which compete with the simple story for lethality. According to the challenge,

• Treating these other effects may be more important than reactivating AChE, which may not be possible, or which may happen anyway  by mechanisms that are not currently understood.
• Some  OTC medications may work better than atropine as anticholinergics.
• These OTC medications counteract another effect of nerve agents, which resembles a massive, lethal allergic reaction.

I take no position. This is an attempt to make the literature accessible.

This discussion has a lot of big words. Digest this; conclusion follows.