Evolving Virulence of COVID-19, Part 1

(NY Times) 72 Hours Inside a Hospital Battling Coronavirus  interviews Dr. Colleen Smith at Elmhurst Hospital in Queens, NYC. The Times is providing COVID coverage free to non-subscribers; this video should be universally viewable. At 4:00 in the video, she says, “What’s getting a little scary now is that the patients we’re getting are much sicker”,… “young people without comorbidity” , that is, underlying health conditions.”

Dr. Smith’s observation is unavoidably subject to confounding factors, a.k.a. “noise.” The swell of sicker patients could be individuals who thought they could tough it out, or are not very aware of how they feel. Still, it’s appropriate to consider that COVID-19 may be gaining virulence in NYC. COVID-19: A Warning.

Plagues of the past were characterized by  virulence that increased in waves. Many mechanisms, including but not limited to, mutation-evolution, are involved. Some of these are understood. Virulence factors are identified features of a pathogen which affect the severity of a disease.

There are huge holes of understanding. Knowledge of how these factors  work at the viral level varies from complete to partial to slight. How they turn on or off is partly, or in a few cases, completely understood. There  is no quantitative understanding that connects biochemical understanding of virulence with epidemiology. Yet the macroscopic viewpoint of epidemiology, with centuries of observation,  has much to say about it.

There is no way to predict the virulence of a  novel virus from viral genes. Understanding has come from the reverse direction: the mechanism of virulence is observed, and then identified in the viral genetics. This is because, despite unraveling of the genetic code, and detailed knowledge of a minority of cellular enzyme systems, most enzyme systems remain a mystery. There are just too many of them.

If you’ve been following the news, you know there is no way to predict R_o, or lethality of COVID, at all. It’s purely observational, depending not just on the pathogen, but the behavior of people, and how they live. It may depend so much on local circumstances to be an invalid concept. Later on, we’ll understand more.

The demand to know the future fuels predictions that have no basis. (CNN) Coronavirus deaths in the US could reach peak in three weeks, epidemiologist says. Of the four authorities, three are doubtful, or subject to misinterpretation in the context of the article. Dr. Stefan Flasche is credible. Quoting,

Dr. Stefan Flasche, a disease modeler at The London School of Hygiene & Tropical Medicine, told CNN by email the peak was influenced by the efficiency of lockdown measures, and “may be anywhere between some time very soon and not for another few months.”

“One scenario is we can indeed reverse the spread as done in China and South Korea, then reach a point to lift the distancing measures,” Flasche said. “But (we may) have to repeat this cycle for a few times because of an inevitable resurgence of cases in the absence of population immunity. In that scenario, we would see multiple peaks in the upcoming 12 months.”

In this vagueness, we have found an honest man. An honest team may be found at (pdf 16 March 2020, Imperial College COVID-19 Response Team) Impact of non-pharmaceutical interventions to reduce COVID-19 mortality and healthcare demand. They are honest because they lay out all of their assumptions, which are unavoidably incorrect. They are predictably wrong, just as the CEP (circular error probable for a gravity bomb) is predictable.

But what is an epidemiologist to do? WHO couldn’t even predict COVID-19 would get out of China, and we now demand detail? Ignored in normal times, this honorable and troubled profession is now belabored with impossible demands. In the press, this includes a hopeful confusion of “peak deaths”, which is a rate, versus cumulative mortality, which most article writers ignore, and looms bleakly in our future.

In China, two variants of COVID-19 have already been identified, Type L and Type S. COVID-19: A Warning. This factor is absent from all the predictions. The epidemiologists have too much on their plates to deal with it.

How do you find an epidemiologist you can trust? Throw him in the snake pit:

The Fortune Cookie (Snake Pit)

My apologies to all epidemiologists. I couldn’t resist it.

To be continued shortly.



Why a COVID Mask Can’t be Sterilized — Electrostatic Electricity

You might think that all there is to a mask are billions of very tiny holes, small enough to admit air, but block particles. This is wrong.

Before the electron microscope was invented in the 1930’s, biologists already knew of infectious agents that could pass through a block of unglazed porcelain. Hence the term, seldom heard these days, filterable virus.

So catching a virus that can pass through porcelain with something that looks like fabric is quite a trick. The secret: electrostatic charge. If on a dry day, you’ve ever had to unpack a box containing packing peanuts, and found that the peanuts tend to stick to you — that’s electrostatic charge.

It turns out that common, nonconducting materials can be so charged. Synthetic fibers can be placed between high voltage plates. When heated, the fibers become electrets, behaving  analogous to magnets, acquiring permanent electric polarization. An electret has a + side and a – side. There are excess electrons on the – side, and a shortage of electrons on the + side. (Don’t be confused by the + and -. It’s an old convention.)

Electret materials are found in most microphones, many furnace filters, and high efficiency masks. Electrets attract and grip most small particles, even if they are small enough to pass through the pores of the mask.

But electrets have a shelf life. The charge in the fibers equalizes in time, at which point the mask behaves like it is made of plain fabric.

This is also why a high efficiency mask cannot be washed. On contact with water, the electret charge leaks around and equalizes. The excess electrons on the – side fill the vacancies on the + side. After washing, the mask is about as good as your scarf.

Your scarf is not totally useless, but it’s not enough for the exposure of a clinical setting.



New Drugs for COVID and Double-Blind Testing, (CNN) Fauci vs. Trump, Part 2

(CNN) Fauci says ‘there isn’t, fundamentally, a difference’ between his view and Trump’s on coronavirus. Quoting,

“I, on the other side, have said I’m not disagreeing with the fact anecdotally they might work, but my job is to prove definitively from a scientific standpoint that they do work,”

There is a disagreement. Fauci may not have ice-water in his veins, and Trump knows the meaning of “Show me the money”, but the two are close to opposite poles. Some philosopher, so obscure I can’t Google him up, said, “Truth is found at the meeting of opposites.” If we were flies on the wall, their differences might sound like that.

Medicine restricts “proof” to double blind testing, which means that neither the physician or the patient know whether the actual treatment, or a placebo, is being received. This avoids prejudice in the observations of the clinician. Even subjective observations of the clinician, like “patient seems stronger”,  have value in a double-blind study.

What of the patients who are harmed? The ethical rationale is that it saves lives in the long run.  Let’s consider a double-blind drug trial which enrolls 1000 patients. Half receive the drug-candidate. Half receive the placebo. Unknown to the experimenters, the drug has one of three actions:

  • Promotes recovery.
  • Has no effect.
  • Harms the patient .

After some period of time, the results are “unblinded.” For the first time, it is possible to see who was getting what, and the likely effects of the drug. Results:

  • If the drug is bad, no more than 500 patients will get hurt.
  • If the drug has no effect, nobody gets hurt.
  • If the drug is good, how many people get hurt?

A double blind trial, with patient consent, is a unique loophole in our legal system, and the exception to the Hippocratic “Do no harm.”  Suppose the drug is one which may have a very long use. For the next 50 years, the drug will be the standard of care.  The double blind method attempts to ensure the maximum benefit for all future patients. It does this by risking the lives of current patients for the benefit of the indefinite future.

Now I’m done extolling the virtues of double-blind testing. It has these disadvantages:

  • It is too slow for a plague situation.
  • It may be sacrificial of people’s lives.
  • Alternatives exist that, sacrificing scientific purity of thought, would likely save more lives.

See (NCBI) Probability, proof, and clinical significance. We live in a world of probabilities. In a study of 1000 patients, there is a possibility that the study results, good, bad, or indifferent, are due to chance. This chance is called P.  Fauci’s acceptable P is probably the conventional choice, 0.05, a 5% chance the study is wrong.

Increasing P means the study can finish sooner, with earlier availability of a drug. This comes with a greater chance the study is wrong and the drug useless or harmful. This is hard to justify if we’re not in a plague situation. But note, compassionate availability of unapproved cancer drugs has been the standard for some years now.

Increasing P can be justified in a plague situation, because of the otherwise certain death of large numbers of patients. It means that regardless of the intent of the drug trial organizers, their choice of P directly affects the survival large numbers of non-study-participants.

This would be evident if a cost/benefit equation, for a drug trial in plague conditions, with the goal of optimizing P, were part of the canon of applied medical statistics. But it’s missing.

The technical resources available to Dr. Fauci could quickly provide the missing equation, minimizing cost by varying P in line  with the current crisis.

My guess: P= 0.25. It shortens the required length of the study, with the likelihood (chance always intrudes) of saving the lives of the large numbers of critically ill who are not study participants.












New Drugs for COVID and Double-Blind Testing, Part 1

Even in this life-and-death situation for so many people, CDC remain staunch in defense of double-blind testing.  Now that several months have passed, politicians, commentators, scientists and doctors have all been humbled. Perhaps there is an opening for non conventional thinking.

Steven Collinson’s editorial,  (CNN) Trump peddles unsubstantiated hope in dark times, politicizes a scientific question. Mr. Collinson would have done better to focus on the medical issues. He chose instead to follow the path of Socrates, an otherwise great thinker who made a great mistake. Socrates declaimed that all he had to know he could learn from “men in the city.” He saw no need for natural science. Socrates was the first thinker to politicize science.

Double blind testing is dear to medicine, because for all but the last 150 years, medicine killed more people than it healed. Double blind testing is ritual purity, because it removes human judgement from the outcome. It would have saved humanity from these deadly treatments:

  • Bloodletting.
  • Purgatives.
  • Roentgen therapy, X-rays as a healing source — not to be confused with legitimate radiation therapy.
  • Thorotrast.
  • Thalidomide in pregnant women.
  • The opioid epidemic.
  • In the 1918 flu epidemic, a massive dose of aspirin, as much as 30 grams in one dose, was frequently prescribed, which by itself would kill the patient.
  • To the above, add the lay healers, swallowing chlorine bleach. Laetrile, and, in many cases, herbs.

Yet during World War I, military surgeons packed wounds with pure sugar, which worked to prevent gangrene. Pure sugar is toxic to bacteria.  Nobody thought of double blind testing while Doctor Sawbones waited.The history of medicine is littered with treatments that worked, yet are forgotten:

The Wikipedia article on Coley’s toxins begins with the statement,

“There is no evidence that Coley’s toxins have any effectiveness in treating cancer, and use of them risks causing serious harm.[4]

The statement is false. It is true is that Coley’s toxins were extremely dangerous, yet acceptable as a personal choice in a time when no alternative treatment, even palliative, was available. If you ignore the opening statement, and read the article without the prejudice of the opening statement, you may conclude that there is a better than even chance that Coley’s toxins did some people some good. The rest faced inevitable death.

Today you have better alternatives, treatments that target the immune system blockade, without risking deadly bacterial infection.

Now refocus on the statement, “”There is no evidence that Coley’s toxins…”  It’s wrong! It is more correct to say, “If someone offers to treat you with Coley’s toxins, run in the other direction.” But somehow, it got dumbed down. Why?

It is an expression of two cultures:

  • Medical culture, which medical practitioners subscribe to, based on science but going beyond science to include paternal responsibility towards the patient and the public.
  • Consumer culture, which accepts the paternal role of professional medicine, with simplification of the truth.

With all this culture, and the very sophisticated statistical methods of research medicine, something is missing: modern decision theory. It’s missing because double-blind testing is the medical equivalent of ritual purity. We need it now.

To be continued shortly.









COVID Vaccines, Medical Ethics, and Manslaughter

I wrote this so long ago, it’s fresh as a daisy. Just substitute “COVID-19” for “Ebola”:

Ebola Vaccines, Medical Ethics, and Manslaughter.

It’s about conflicting values:

  • Purity of the scientific approach, which requires double-blind testing.
  • Fear of legal liability.
  • Saving lives now.

The system rewards adherence to norms. If, like many pandemics of the past, there is a second more deadly wave, the practically impenetrable defense is “We didn’t see it coming.” No good deed goes unpunished.

Health care is the one area of our lives where we accept a level of paternalism that is otherwise unacceptable. You don’t have to be a libertarian to see the value of a partial exception for COVID-19:

Legislation that permits a private individual, and a vaccine company of good scientific repute which has completed favorable Phase 1 trials, to make a contract that limits liability for the many vague and unsubstantiated complaints that can be wrongly blamed on a novel antigen.

If life were a gaming table, our mutual choices, of citizen and vaccine maker, would be:

  • Keep playing.
  • Step away from the table

But it’s not a game, and we can’t step away from this.


U.S. spy agencies India Concerns; COVID-19, the Dangerous Inside-Out Quarantine

This is a short continuation of U.S. spy agencies monitor COVID-19, concerns about India, mainly for people who understand the basics. The primer will come later. We now know that there are at least two strains of COVID-19, which compete by the laws of natural selection.  (Oxford Scientific) On the origin and continuing evolution of SARS-CoV-2. Type L produces severe disease; Type S is comparatively mild.

The following was mentioned in COVID pandemic “could be over by June” Chinese adviser; Third World Reservoir.   Delving deeper,

  • In China, selective pressure towards Type S may have occurred, resulting from stringent quarantine, a reduction of virulence.
  • Yet Type L evolved from Type S, in the direction of greater virulence. It is logical to extend the inference: Early in the Wuhan transmission chain, before quarantines, Type L was selected, with greater virulence.
  • This partly thought and partly real experiment implies that social behavior, particular to a society, strongly affects the competition of Types L and S.

Village India, like Village Pakistan, harbors the remains of tribal culture in the panchayati raj system of local government, dating to 250 AD. Villages contain strong elements of extended family, frequently acting in ways that are officially forbidden by  central governments. Items that occasionally make international news  include honor killings and femicide, with infanticide too common to report.

Now assume that in some village somewhere in the Third World,

  • There are not already circulating corona viruses with enough sero-similarity to provide some immunity.
  • COVID-19  arrives, quickly differentiating into something like Type L and S.
  • The sanitary infrastructure is weak, so isolation is impossible.

How natural selection acts on types L and S depends upon social choices innate to the villages. Types L and S may not even be identified by a village as related diseases. Customs older than recorded history provide the framework for response. Which custom will dominate?

  • The village implements a non selective quarantine, nurses the sick, and disposes of the dead with aseptic funerary rituals. No selective pressure.
  • The severely ill die before expulsion. As with Ebola, preparation of the dead for burial is a major driver. Type L out-competes Type S.
  • Expulsion of the severely ill. Type L-infected dies alone on the road. Possibly selective for Type S.
  • Inside-out reverse quarantine. With leprosy as the precedent, the village nurses the mildly ill and expels the severely  ill. The severely ill person transits to another village, and is taken in by relatives. Type L out propagates Type S.

While the China experience suggests that quarantine allows Type S to out compete Type L, the inside-out reverse quarantine does the opposite. It promotes Type L, of greater virulence.

See COVID-19: A Warning. Other ways in which virulence can be promoted will shortly be discussed.


COVID pandemic “could be over by June” Chinese adviser; Third World Reservoir

(Reuters) Coronavirus pandemic “could be over by June” if countries act, says Chinese adviser. Quoting,

The global coronavirus pandemic could be over by June if countries mobilize to fight it, a senior Chinese medical adviser said on Thursday, as China declared the peak had passed there and new cases in Hubei fell to single digits for the first time.

In the world we live in, this has no chance of happening. Even if everybody rolled up their sleeves and acted correctly within their power, it could not happen. China is unique, the world’s first surveillance state, with capabilities of contact tracing unapproached anywhere else. The acquiescence of China’s citizens to strict measures of control is also unequaled.

The headline of  earlier CNN article, Will the new coronavirus burn out like SARS … or is it here to stay? poses the wrong question. Like many wrong questions, it has no answer:

  • SARS did not burn out. It was contained. Containment was feasible because covert infections were not contagious.
  • Flu strains, and common colds, for which many viruses are responsible, do burn out, by the development of herd immunity.
  • In the absence of public health interventions,  for an historic example, have a look at syphilis. It took about 50 years to convert from a quickly fatal illness to the modern form, which by comparison, is mild.
  • COVID-19 will not burn out in a reasonable time frame, unless you consider 65 weeks reasonable.
  • Although local containment is possible, COVID-19 cannot be contained globally, because of the prevalence of covert infections, asymptomatic and contagious.
  • Containment efforts will prolong the time to “burnout.”
  • Containment efforts are nevertheless required, so healthcare systems are not overwhelmed, and to preserve the fabric of society.

Mi Feng, the spokesman for the National Health Commission quoted in the Reuters article, was not intentionally misleading. He simply omitted context for the rest of the world. Messages of hope frequently do this; they should not be condemned. It is up to us to supply the context.

The estimate of How Long Will the COVID-19 Epidemic Last? Napkin Calculation,  for true “burnout” is 65 weeks. “Burnout”, a word which tells you nothing, happens when enough herd immunity has developed to change the chain of transmission from growing to shrinking. The estimate is crude, but better than hope.

A painful paradox: Intervention, which presently means quarantine and travel restrictions, without other measures, will prolong the 65 weeks. (You may choose your own number, provided you supply justification other than hope). The fastest way to herd immunity is the cruelest, with unjustifiable loss of human life.

This is the way it will happen in most of the world. Like all the plagues of the past, COVID-19 will “burnout”, with the understanding that plagues end when either

  • The concentration of animal vectors has declined.
  • Human depopulation has occurred.
  • Herd immunity has been acquired.

Since Wuhan bats do not mingle with humans like plague rats, this leaves mostly herd immunity. It would take more than the current lethality of COVID-19 to cause the occurrence of natural selection, the “survival of the fittest.” See COVID-19: A Warning.

Now what about the Third World, when herd immunity is acquired, at the expense of great human suffering? COVID-19 will not vanish. Exiting epidemic, It will go underground, persisting as an endemic, mostly mild disease. The Third World will become a disease reservoir.

This presents a problem for a developed country which has exercised effective measures of travel restrictions and quarantine. It means that the population is “naive” with respect to COVID. Having had no exposure, they are as vulnerable as they were before December 2019. Yet constant vigilance is not feasible with a disease that has covert characteristics.  This is constant, imminent catastrophe.

How can the developed countries acquire herd immunity, while avoiding the suffering of the Third World? There are two ways:

  • Spontaneous mutation of COVID-19 to a strain that produces mild disease, which out competes virulent strains. Two strains have already been noted in China. See (Oxford Scientific) On the origin and continuing evolution of SARS-CoV-2. Type L produces severe disease; Type S is comparatively mild.

Although selective pressure towards Type S may have been observed, resulting from stringent quarantine, let’s not rely on it. In fact, it appears that Type L evolved from Type S, in the direction of greater virulence.

  • Ignoring luck, vaccination is the alternative. Even if vaccination programs have limited duration, there is a fascinating potential benefit: the COVID-19 virus may change to become less virulent. The result: herd immunity that endures beyond a vaccination campaign.

We’ll explore how this could happen in the next post.

It is disturbing how little of the $8B appropriation is for vaccine development. This must be corrected, stat!




How Long Will the COVID-19 Epidemic Last? Napkin Calculation

Reference:  (DIVA, pdf) The reproductive number of COVID-19 is higher compared to SARS coronavirus. Contained within the article is a permalink:  http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-168415 . Quoting,

“Teaser:Our review found the average Ro for 2019-nCoV to be 3.28…”

We’re going to do a napkin calculation, closely related to what scientists call a power-of-10 job. There is no claim of accuracy.  Even if we wanted to be sophisticated, there are things in the way of accuracy. The basic reproduction number, R_o, will not be known with any accuracy until this is all history. It’s one of the weaknesses of epidemiology, better at analyzing the past than predicting the future. Nor is there any reason to assume that R_o will be constant with the seasons, and subtle seasonal changes in social behavior.

For this napkin calculation, assume that

  •  The number of people in the U.S. who are infected is actually 10 times the reported figure of 700 as of 6 a.m on 3/10/2020. The number is 7000.
  • Having COVID-19 confers long lasting immunity.
  • R_o, which applies to a population that has never seen COVID-19, is constant.
  • The epidemic is not stopped by other means, such as quarantine, drugs, or vaccination.
  • R_o = 3.78, a little higher than the reference. It is, after all, an estimate.

We want to know R, which unlike R_o takes into account herd immunity. When a  certain percentage, a majority of the population, has had COVID, with or without symptoms, R drops below 1.  Here we go:

  • U.S. population: 327 million
  • Percentage of the population to have experienced COVID, for R to drop below 1:  73.5% = 240 million.
  • The generation time is the average time it takes an infected individual to infect others. Example: If a person is infected on March  1, and infects 4 more people before recovery, at March 7, 14, 21, and 28, the generation time is 17.5 days.
  • If we assume that COVID keeps infecting with R=3.78,  that implies, starting with 7000 infected, 8 generations to reach 240 million.
  • The above is not correct; R decreases as time goes on, so more than 8 generations are required. But for simplicity, to keep it a napkin calculation, let’s go with it.
  • Assume the generations time is three weeks.
  • 8 generations = 24 weeks.
  • Now apply a correction for the gradual decrease of R as the number of people who haven’t had it declines: Multiply the above by the magic number e= 2.71828.
  • This gives 65 weeks till the reproduction number drops below 1.

In  the world of this very rough estimate, the epidemic takes a downturn 65 weeks from present. It assumes  no modifications by medicine and public health, and a lot of mostly avoidable human suffering.

But there you have it. If this were the pre-scientific world of past plagues, and the pathogen had characteristics similar to COVID-19, it would be close to the truth.

Now you can panic. But do it in style.














Turkey’s Erdogan asks Russia to step aside in Syria

(Reuters) Turkey’s Erdogan asks Russia to step aside in Syria.

They will largely do this. The Russians may draw a line on the map, and they may take local action against Turkish deployment beyond that line. If that occurs, it will be the high point of tension, followed by a little freeze, followed by deescalation. This post-conflict pattern has been demonstrated: (BBC) Turkey’s downing of Russian warplane – what we know.

In 2014, when Syria was almost a complete political vacuum, I proposed a reinstatement of the Ottoman Empire, which was dissolved in the aftermath of World War 1, to serve British and French colonial ambitions. Articles: (2014) Turkey & the New Ottoman Empire, and (2016) Turkey in Syria; The New Ottoman Empire; a Brief Note about Cultural Affinity. Additional mentions here.

This colonial redraw is the direct antecedent of today’s map of ethnic conflict, fueled by artificial boundaries that cut across ethnic lines. In some cases, this strategy was intentional, to make these regions more amenable to foreign governance.

Ottoman Syria was a stable component of the empire for 400 years. The semi-representational methods of Ottoman governance, which achieved stability of a multi-ethnic region, remain a marvel to historians, if not a modern aspiration. A reprise in northern Syria, with organic connection to Turkey’s economy, might well have resulted in durable solution. No alternative of the striped-pants brigade has as much life to it.

Turkey’s involvement in Syria reached a high point in the attempt to prevent the recapture of Aleppo. It failed because it was actuated by proxies with insufficient power. Other constraints to greater activity:

  • The tatters of the proclaimed “Zero problems with our neighbors” foreign policy.
  • Sensitivity to war casualties typical of a modern nation.
  • Reluctance or refusal to engage Islamists of any stripe on the battlefield.
  • Turkey’s transition from a member of the Western Alliance to an independent, mini “great power”, which requires a state of balance with Russia.

Russian concerns are a delicate balance of:

The Russians complain, with justification, that Turkey was not acting with effect against terror groups in the Idlib region. The location of Abu Bakr al-Baghdadi at the time of U.S. action was on the edge of Idlib.

There is a tendency for Islamists to cloak themselves within the current political scene. This was demonstrated by Mohamed Morsi, who came to power by popular election, and proceeded by subtle and then less subtle steps to dismantle Egyptian democracy. (That el-Sisi finished the process is not germane here.)

Erdoğan has also subverted Turkish democracy. He began by showing up to chair meetings he had no standing in, and continued (like el-Sisi), with constitutional change that opens the door to further weakening. The huge number of Gülen movement imprisonments goes beyond the modern meaning of sedition; it is an authoritarian clamp-down. (BBC) Reality Check: The numbers behind the crackdown in Turkey.

Subversion of democracy is not a Russian concern. Erdoğan the crypto-Islamist is.  Since 1991, Turkey and Russia have not shared a border. But the intervening states, Armenia, Azerbaijan, and Georgia, are weak and porous. The recent history of the Middle East suggests that the ambition, and potential for Islamic export and aggression  correlate with national transition from secular to Islamist.

If it were necessary to choose a single word to define U.S. foreign policy, it might be one of “preserve”, ‘protect”, or “defend.” For Russia, it would be “if.” Because Russia is a threatened continental power, this leads to complex constructs, that begin with “If Turkey…”.

At the current level of Erdoğan‘s Islamism, the “if”  still allows accommodation of the Turkish occupation. Provided that the remaining terror pockets of Idlib are eliminated, it offers practical advantages to Russia:

  • A reduction of the area of control required of Assad’s overstretched forces.
  • Leverage with Turkey. As an arrangement that lacks the pretense of legitimacy, Turkish occupation is a useful pressure point.
  • Continuance of a Turkey-Russia alliance, in the context of the Russian “if.”

The era of Ottoman collapse is beautifully depicted in the 1988 movie (Youtube) Pascali’s Island, starring Ben Kingsley. It poses the eternal question of the spy: Is anybody listening?