The legendary pitcher Yogi Berra said that if you come to a fork on your Pathway – take it.  That was spot on as is usual with Yogi .

The great story teller Lewis Carroll said, from the mouth of the Cheshire cat, that if you don’t know where you’re going any Pathway will take you there.

The question is: Do you know where you’re going?

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Robert Pirsig the philosopher and author of the best selling book, “Zen and the Art of Motorcycle Maintenance”, passed 3 years ago in 2017.

Here is a rare radio interview made and released by the BBC with Pirsig. You get to see his trip companion and late son Chris who was murdered for no apparent reason on a street in San Francisco.

We got lots to learn. Always. Everywhere.

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Dr. Anthony Fauci was in the forefront of research and advancement of healthcare to control HIV/AIDS for four decades.

He was recognized by President George W. Bush with the National Medal of Science!

Nevertheless after 40 years of his dedicated work and leadership there is no vaccine against HIV.  Hundreds of millions of dollars of tax payers money were spent on developing a vaccine to contain the HIV virus.

The question is – what makes it likely that an effective and safe vaccine for SARS-CoV-2 will be developed anytime soon?

Dr. Fauci is relishing the limelight that go with TV cameras.   Do TV appearances make him a better scientist?   Is Dr. Oz your preferred personal cardiac surgeon? Do you want Dr. Sanjay Gupta to do your brain surgery should you need one?

Dr. Anthony Fauci threw an abysmal first pitch to kick off the historic 2020 Major League Baseball season. A Topps baseball card with a masked Fauci mid-pitch just became the bestselling card in the history of ToppsNow, the company’s collection of limited-edition cards.

Yogi Berra said it best: “We made too many wrong mistakes.”

Let the National Institute of Allergy and Infectious Diseases have a new director and new leadership.

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Dr. Anthony Fauci was in the forefront of research and advancement of healthcare to control HIV/AIDS.
He was recognized by president George W. Bush with the National Medal of Science! Nevertheless after his 40 years of dedicated work and leadership there is no vaccine against HIV.

The question is – what makes it so likely that a vaccine for SARS-CoV-2 will be developed anytime soon?

For one thing The National Institute of Allergy and Infectious Disease needs new leadership.

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We don’t know what we don’t know.
Now, pause a moment and think about it.

We don’t know what we don’t know about Corona Viruses

The pandemic caused by SARS-CoV-2 is rolling around the globe.  We don’t know yet how many people are virus carriers or how many patients were infected and subsequently recovered.  Many governments manipulate or suppress their data.

The social, economic and political movement of globalization is now only social a theory of the past.

Historical Uncertainties of SARS-Cov-2
The first outbreak of the corona virus could have happened further south than the  Chinese city of Wuhan as early as September 2019, according to a team of scientists led by the University of Cambridge.  The researchers investigating the virus’ origin analyzed a large number of strains from around the world.

They calculated that the initial outbreak occurred in a window between mid-September or early December, 2019.

An article published in the scientific journal Infection, Genetics and Evolution claim that Covid-19 pandemic might have started in October,  The pathogen, formally known as SARS-CoV-2, is thought to have made the jump from initial host to humans sometime between October 6 and December 11 last year,

“The virus may have mutated into its final ‘human-efficient’ form many months ago, but stayed inside a bat or other animal or even a human for several months without infecting other individuals, ” according to University of Cambridge geneticist Peter Forster.

When the pandemic started to roam around the globe the causative virus was taxonomized as SARS-CoV-2 and being a strain of Corona Virus.  This new strain displays novel and unfamiliar and surprising clinical characteristics.  Everyday new scientific or clinical reports appear that overturn previous factual knowledge and theories.

Below is a partial list of questions and theories that puzzle the scientific community and the political circles, causing social and economical destruction.
The Uncertainty of Origin
The AP news agency reported on 4-30-20  that U.S. intelligence agencies have concluded that the new coronavirus was “not manmade or genetically modified” but say they are still examining whether the origins of the pandemic trace to contact with infected animals or an accident at a Chinese lab.

Where was the SARS-CoV-2 first originated is not known.  It probably no longer matters.

The Uncertainty of Acquired Immunity

The WHO “pushed back against the theory that individuals can only catch the corona virus once, as well as proposals for reopening society that are based on this supposed immunity.” The WHO “said the idea that one-time infection can lead to immunity remains unproven and is thus unreliable as a foundation for the next phase of the world’s response to the pandemic.”

Even the best tests will generate some false positive results (identifying antibodies that don’t actually exist) and some false negatives (missing antibodies that really are there).

One specific concern with antibody tests for SARS-CoV-2:

The tests might pick up antibodies to other types of Corona viruses.

WHO’s Dr. Maria Van Kerkhove said at a briefing: “Right now, we have no evidence that the use of a serologic test can show that an individual is immune or is protected from reinfection,”

As of to-date this question remains open.

Who is a Virus Carrier?

A study from China has found that Corona virus patients discharged from hospital could still carry the virus deep in their lungs, undetected by conventional diagnostic testing methods. The discovery, published in a paper in peer-reviewed journal Cell Research on 2/28/2020, could explain why a growing number of recovered patients had tested positive again.

The same may be true for the viral outbreak on board the USS Kidd. The first sailor began to show symptoms of the virus on April 22, more than 30 days after the ship’s last port visit in Hawaii, according to a status update provided to Congress and reviewed by USNI News. The time between port visits and the first reported case of symptoms have raised questions inside the Navy as to how the virus operates and how long it could exist undetected on a ship.
SARS CoV-2 Has Many Strains

How many?

This is an important question.

Early evidence has shown that Corona virus mutates at the speed of about two mutations per month. Therefore more diversity of it is emerging. All the mutations are collectively called SARS-CoV-2.  But there are many variants

According to, a site that tracks viral genomes across the planet, the virus is mutating 1,000 times faster than influenza viruses and 36,000 times faster than measles.

RNA-based viruses are known to be genetically-unstable, and this one is mutating about 20 times faster than regular RNA viruses.

Initially two strains were identified in China – “S” and “L”.  Hence there is the possibility that the newer L strain is more virulent than its ancestral one.  The divergence from mutation is increasing from less than 2 mutations comparing with its common ancestor in early February to around 12 mutations by early March, according to researchers at

Then, more mutations were discovered.

In June 2020, researchers at Scripps Research, Florida, found that a mutation, known as D614G, stabilized the virus’s spike proteins, which protrude from the viral surface and give the coronavirus its name. The number of functional and intact spikes on each viral particle was about five times higher because of this mutation.

The researchers found that viruses with D614G mutation were more resilient, preserving about five times more functional spike proteins to infect cells than viruses without that mutation.

Does this virus keep acquiring more robust characteristics?

At the beginning of July 2020, Professor Gabriel Leung, Dean of the University of Hong Kong Medical School, said that he believed there were at least 50 to 60 hidden cases in the community of the strain of the virus that had increased its infection rate by 30 per cent due to a DNA mutation.

In another experiment, they found that viruses carrying the D614G mutation infected tissue cells far more efficiently than viruses without the mutation.

Over time, the new Corona virus could possibly mutate to the point that new versions are no longer as recognizable by our immune system as the original version. After all, mutations are probably what allowed the virus to jump from animals to humans.

It’s reasonable to expect that as the Corona virus keeps spreading around the world, it will probably keep changing.  Experts may find new strains.

It’s impossible to predict how those virus changes might affect what happens. But change is just what viruses do.


The Pursuit of A Vaccine and Its Discontents

According to the NY Time Vaccine Tracker, researchers around the world are developing more than 155 vaccines against the Corona virus.  Twenty-three vaccines are in human trials as of, July 13, 2020.

Evidence showed that infected patients who recovered did show high level of antibody.

However, antibody generated from vaccine does equate with fighting off the virus. Some people can have antibody but still be susceptible to the virus. Even if antibody is generated, it doesn’t necessarily confer the same level of immunity.

Recent report from UK in the MedRxiv platform suggests that the antibodies to SARS-CoV-2 in recovered Covid-19 patients last only about 2-3 months.  This is a frustrating piece of news given all the on-going efforts around the world to develop a vaccine that will create human immunity to Corona virus.

Lastly, Moderna Inc., completed a preliminary study in 45 human volunteers with its vaccine.
Adverse events that occurred in more than half the participants included fatigue, chills, headache, myalgia, and pain at the injection site.  Systemic adverse events were more common after the second vaccination, particularly with the highest dose. Three participants (21%) in the highdose group reported one or more severe adverse events.

The only encouraging finding in these results is that all participants developed the antibodies a hoped for.


Ladies and gentlemen – we are living in The New Normal.   We don’t know when another new new normal will emerge. Get used to it.



All details of the scientific source references for research work done and mentioned in this blog are available in my professional page:
Mandy Lender, MD  –  on .

The link is:

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This is a note to myself but feel free to study this report:


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The reason life is bigger than the sciences and arts is because the arts and sciences are an attempt to understand life.

Hot Chips
Told by Dafna Lender

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The coronation of inflation was last week !


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Human Affairs Are Transitional

The proof of the transitory nature of human affairs.

Contagion is transitory.  The outcome is unknown.

If you’re self-isolating, in quarantine, or social distancing due to the Corona Virus, you probably have a lot of questions. These books may help

Find it out here:


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This post is an update and summary on the developing epidemic of Corona Virus Respiratory Disease (COVID-19) in mainland China and world-wide.

Here are the morbidity and mortality numbers updated today – 2-29-20.

  • On 02/29/2020 – a total 86,022 patients diagnosed with the disease. WW.
  • 2,942 patients DIED. 3.4% mortality.  RECOVERED patients –39,801.
  • Sixty-eight (68) cases in the U.S. One patient died. 12 cases in Canada.
  • South Korea – 3150 cases; Japan – 241; Italy – 1,128; Iran 593 cases 43 died. (7.25%)
  • Patients are contagious 14-24 days prior to, OR after showing symptoms.
  • Patients can be symptom free then re-emerge as symptomatic!
  • Significantly, a first case of a dog testing positive for COVID-19 documented.


The Chinese central government is technically the only source for mortality and morbidity information in Mainland China.  The Chinese government is the outside face of the Chinese Communists Party.  The rulers of China report what serves their public relations and political purposes.  More reliable sources for information originate in Hong Kong.  Hong Kong is more open in terms of freer public discourse.

The numbers cited above are mostly from sources in Hong Kong and Taiwan.

Alternative morbidity and mortality data leaked out from sources in Taiwan.  These data claim that there are 154,023 diagnosed patients. There are other sick patients who were not confirmed – 79,808. And, there were 24,589 cases of deaths in Wuhan, Hubei Province.   That brings the death rate from Corona Virus Disease in China to a range of 10- 16%.

Again, the larger numbers are from information leaked in Taiwan. On the other hand the larger numbers of cases and death rate are similar to the result of what epidemiologists predicted based on academic research models.
I have cited the medical sources on-line for these numbers on Facebook page @Lendermedical.

Over fifty countries reported infected patients.

During the last four weeks, while following closely sources including the World Health Organization, the U.S. CDC, and free media outlet observations, I formed some opinions which I share below.

First, the internet is rife with theories of conspiracies.  I ignore those.

Second, governmental sources of information are not objective and untrustworthy sources of data.  The WHO – is a political organization. Its numbers are not to be trusted.  India the second most populous country in the world reported only 3 cases.  Makes no sense.  Indonesia the 4th most populous country reports no disease on its territory.  Seems like a governmental cover-up.

Third, the initial source of the COVID-19 contamination may have been at the Chinese institute of biological research in Wuhan.  A tank of viral soup could have been spilled by error into the sewer system, and hence spread to the environment.

Fourth, viruses are smart and selfish.  Viruses mutate and find their ways to flourish among humans and animals.  It’s called Zoonosis.

Fifth, the incubation time from infection to clinical symptomatology varies.  It was thought that 14 days of absent clinical symptomatology ensures non-contagiousness. This is not the case.  Patients may be diagnosed with Corona Virus Disease, acquire immunity to the virus, then recover and go about their life.  It appears now that recovered patients may be re-infected with the mutated version of the virus and thus keep propagating it.

Sixth, the COVID-19 has affinity to lungs.  It causes lung damage in the form of alveolar pneumonia.  Death ensues in 61% of patients with pneumonia who were admitted to ICU.

Seventh, a vaccine to protect from the virus is months away into the future.

Eighth, it is possible that some currently existing antiviral medications may be beneficial, facilitating patients’ recovery.

In the meantime practicing strict personal hygiene is the best precaution.
Quarantine of sick patients is an effective public health measure.

The basic principles to reduce the general risk of transmission of acute respiratory infections consist of the following:

  1. Avoiding close contact with people suffering from acute respiratory infections.
  2. Frequent hand-washing, especially after direct contact with ill people or their environment.
  3. Avoiding unprotected contact with farm or wild animals.
  4. People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands).
  5. Within healthcare facilities, enhanced standard infection prevention and control practices in hospitals, especially in emergency departments.


Precautionary steps to protect you – as an airline passenger on a flight are:

  1. Avoid sitting near people with symptoms of respiratory illness.
  2. Take a window seat far from the aisle.
  3. Avoid walking around the plane.
  4. Avoid touching items on the plane.
  5. Use hand sanitizer upon returning to your seatafter using the lavatory. Even if you followed hand-washing guidelines, using soap for at least 20 seconds, you may have touched a germ-laden handle or overhead bin afterwards.


I continue to update the morbidity and mortality data on this blogpost as new data is made available.

Visit us on Facebook @Lendermedical  and like our page.
Or enter: Mandy Lender, MD on Facebook.




I continue to update the morbidity and mortality data on this blogpost as new data is made available.

Visit us on Facebook @Lendermedical  and like our page.
Or enter: Mandy Lender, MD on Facebook.

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