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Strobist: AB800 with gridded HOBD-W overhead. AB800 with gridded 60X30 softbox camera left. AB800 with gridded 7 inch reflector to rear. AB800 with Softlighter II to rear Triggered by Cybersync.

 

 

it is better to die of myocardial than becoming Sushi...

NORITA 66, NORITAR 80mm F2, f/16 1/250, 2023/07/28 14:19, KODAK PORTRA 400, 現像：桜カメラ

 

NORITA 66と角島大橋と写真投稿休載のお知らせ

この写真は紹介するかどうか結構迷った。

僕は基本的には観光地はあまり紹介しない。深い意味はないけれど、単純に地元で気に入った風景などを写真に撮っているだけだからだ。千畳敷は観光地でもあるけれど、僕にとってはちょっとしたスイーツを食べる日常の場所でしかない。薄曇りだったので日頃写真などでは見慣れた角島大橋ではないのでまあいいかという気にもなった。僕は単なる天邪鬼なのかもしれない。薄雲というか靄があったようで、水平線も目で見た感じだとわかりにくく、遠くはぼやけ霞んでいた。平日ではあったがすでに夏休みの方も多かったようで、それなりに人出があった。

 

　●

 

本来、この投稿は先週の月曜日に長門に帰還してから行うつもりで準備したものだ。あいにく、僕は最後の投稿後、心筋梗塞に襲われ救急車を手配し病院で手術を受けた。色々あったが全部をすっとばすと、先程点滴を外すことができた。正直、今後もさほど楽観を許す訳ではないがいますぐ死ぬということもおそらくないだろう。そのため、ようやく気力が出てきてこれを公開している。今後の復活は未定だ。復活しなかった場合は、僕が亡くなったかあるいは写真の投稿に飽きたということだろう。とはいっても、僕はすでに数日前から、CONTAX TVS、PORTRA 400で東京の病院の12階から観た風景を撮ったりしている。飽きることはおそらくないのだろうと思う。できなくなることはあるとしても。また、再開できる時を楽しみにしている。あなたもそうであると僕は嬉しい。

 

I originally prepared this post with the intention of doing so after my return to Nagato last Monday. Unfortunately, after my last post, I suffered a myocardial infarction and had to go to the hospital for an ambulance and underwent surgery. After all that happened, I was able to get the IV removed a short while ago. To be honest, I am not very optimistic about the future, but I am not sure that I am going to die right now. So, I finally have the energy to publish this. I have not yet decided whether I will revive it in the future. If I don't revive it, it will probably mean that I am dead or that I have had enough of posting photos. However, I have already been taking pictures of the view from the 12th floor of a hospital in Tokyo with my CONTAX TVS and PORTRA 400 for a few days now. I don't think I will ever get tired of it. Even though there will be times when I will not be able to do so. I am looking forward to the time when I will be able to do it again. I am happy if you are too.

 

Translated with DeepL

A Remarkable Curriculum Vitae

 

BRUNO and his twin sister HELLA, (mother Kessie, father Max, both born in the wild), were born in Zoo Munich (Tierpark Hellabrunn) in February 18, 1969.

Orangutan twins are most seldom. As their mother Kessi did not know how to raise two babies at the same time, the twins had only one chance to survive - and that was intensive care in a hospital for neonatals (Munich-Schwabing) ! Bruno was so weak that he had to be raised in an incubator for some time. They both survived and were well and after 10 months of intensive care they could move back into the zoo. Bruno, became the clan chef of the Munich Orang Utan Group and proud father of 31 offsprings. His three youngest ones were born in 2016 and 2017 (TP Hellabrunn/Munich Zoo).

After two myocardial infarctions Bruno had revovered and was closely monitored by the vets. But in the last days his health conditions deteriorated and after he had shown clear signs that he could not and did not want to live any longer the ethical commission of the zoo decided to let him go ……

 

Bruno died July 19, 2018 at the age of 49 years and he will be missed by his numerous friends

 

Taken in TP Hellabrunn/Munich Zoo

Canon EOS 450D EF70-300mm f/4-5.6L IS USM

f/5.0

1/200

200 mm

ISO 400

 

Dedicated to C.F. (ILYWAMHASAM)

It is the season of slip, slide, and fall.

Of dead car batteries and doors that are frozen shut.

Of slippery, ice covered roads.

Of summer tired cars trying to navigate snow covered roads.

Of zero visibility due to white outs.

Of emergency road closures due to multiple vehicle accidents.

Of sickness, influenza, and colds.

Of frostbite and runny noses and potential hypothermia.

Of snow shovelling induced myocardial infarction (heart attacks.)

Of frostbite and runny noses.

Of Seasonal Affective Disorder which can last 4-5 months.

Of cold, bitter, dark days.

Of people who think -40 degrees is great weather for out door activities.

 

Those that are happy to hibernate for four months, I say hello, for you are kindred souls.

 

Explore.

Recently shown in the POSI+TIVE MAGAZINE website feature, A Life in Pictures.

Wednesday morning we walked 3800m using our clockwise route over Mt. Tolmie. Got the heartrate up to 140bpm at times so that's cool.

 

That's what Victoria's foremost heart specialist told me after my MI (that's a myocardial infarction to you lay people) in 2000:

 

"All you have to do is get out twice a week and get your heartrate up to 120bpm for twenty-minutes."

 

That's what we've been doing these past 16 years.

Walsall, New Art Gallery

The gallery's permanent collection has over 3500 works, and has also acquired contemporary works. This colourful but rather gruesome piece is by Polly Morgan, a taxidermy sculpture entitled Myocardial Infarction (otherwise known as a heart attack).

Vladimir Semyonovich Vysotsky (Russian: Владимир Семёнович Высоцкий, IPA: [vlɐˈdʲimʲɪr sʲɪˈmʲɵnəvʲɪtɕ vɨˈsotskʲɪj]; 25 January 1938 – 25 July 1980), was a Soviet singer-songwriter, poet, and actor who had an immense and enduring effect on Soviet culture. He became widely known for his unique singing style and for his lyrics, which featured social and political commentary in often humorous street-jargon. He was also a prominent stage- and screen-actor. Though the official Soviet cultural establishment largely ignored his work, he was remarkably popular during his lifetime, and to this day exerts significant influence on many of Russia's musicians and actors.

 

Vysotsky was born in Moscow at the 3rd Meshchanskaya St. (61/2) maternity hospital. His father, Semyon Volfovich (Vladimirovich) (1915–1997), was a colonel in the Soviet army, originally from Kiev. Vladimir's mother, Nina Maksimovna, (née Seryogina, 1912–2003) was Russian, and worked as a German language translator.[3] Vysotsky's family lived in a Moscow communal flat in harsh conditions, and had serious financial difficulties. When Vladimir was 10 months old, Nina had to return to her office in the Transcript bureau of the Soviet Ministry of Geodesy and Cartography (engaged in making German maps available for the Soviet military) so as to help her husband earn their family's living.

 

Vladimir's theatrical inclinations became obvious at an early age, and were supported by his paternal grandmother Dora Bronshteyn, a theater fan. The boy used to recite poems, standing on a chair and "flinging hair backwards, like a real poet," often using in his public speeches expressions he could hardly have heard at home. Once, at the age of two, when he had tired of the family's guests' poetry requests, he, according to his mother, sat himself under the New-year tree with a frustrated air about him and sighed: "You silly tossers! Give a child some respite!" His sense of humor was extraordinary, but often baffling for people around him. A three-year-old could jeer his father in a bathroom with unexpected poetic improvisation ("Now look what's here before us / Our goat's to shave himself!") or appall unwanted guests with some street folk song, promptly steering them away. Vysotsky remembered those first three years of his life in the autobiographical Ballad of Childhood (Баллада о детстве, 1975), one of his best-known songs.

 

As World War II broke out, Semyon Vysotsky, a military reserve officer, joined the Soviet army and went to fight the Nazis. Nina and Vladimir were evacuated to the village of Vorontsovka, in Orenburg Oblast where the boy had to spend six days a week in a kindergarten and his mother worked for twelve hours a day in a chemical factory. In 1943, both returned to their Moscow apartment at 1st Meschanskaya St., 126. In September 1945, Vladimir joined the 1st class of the 273rd Moscow Rostokino region School.

 

In December 1946, Vysotsky's parents divorced. From 1947 to 1949, Vladimir lived with Semyon Vladimirovich (then an army Major) and his Armenian wife, Yevgenya Stepanovna Liholatova, whom the boy called "aunt Zhenya", at a military base in Eberswalde in the Soviet-occupied zone of Germany (later East Germany). "We decided that our son would stay with me. Vladimir came to stay with me in January 1947, and my second wife, Yevgenia, became Vladimir's second mother for many years to come. They had much in common and liked each other, which made me really happy," Semyon Vysotsky later remembered. Here living conditions, compared to those of Nina's communal Moscow flat, were infinitely better; the family occupied the whole floor of a two-storeyed house, and the boy had a room to himself for the first time in his life. In 1949 along with his stepmother Vladimir returned to Moscow. There he joined the 5th class of the Moscow 128th School and settled at Bolshoy Karetny [ru], 15 (where they had to themselves two rooms of a four-roomed flat), with "auntie Zhenya" (who was just 28 at the time), a woman of great kindness and warmth whom he later remembered as his second mother. In 1953 Vysotsky, now much interested in theater and cinema, joined the Drama courses led by Vladimir Bogomolov.[7] "No one in my family has had anything to do with arts, no actors or directors were there among them. But my mother admired theater and from the earliest age... each and every Saturday I've been taken up with her to watch one play or the other. And all of this, it probably stayed with me," he later reminisced. The same year he received his first ever guitar, a birthday present from Nina Maksimovna; a close friend, bard and a future well-known Soviet pop lyricist Igor Kokhanovsky taught him basic chords. In 1955 Vladimir re-settled into his mother's new home at 1st Meshchanskaya, 76. In June of the same year he graduated from school with five A's.

 

In 1955, Vladimir enrolled into the Moscow State University of Civil Engineering, but dropped out after just one semester to pursue an acting career. In June 1956 he joined Boris Vershilov's class at the Moscow Art Theatre Studio-Institute. It was there that he met the 3rd course student Iza Zhukova who four years later became his wife; soon the two lovers settled at the 1st Meschanskaya flat, in a common room, shielded off by a folding screen. It was also in the Studio that Vysotsky met Bulat Okudzhava for the first time, an already popular underground bard. He was even more impressed by his Russian literature teacher Andrey Sinyavsky who along with his wife often invited students to his home to stage improvised disputes and concerts. In 1958 Vysotsky's got his first Moscow Art Theatre role: that of Porfiry Petrovich in Dostoyevsky's Crime and Punishment. In 1959 he was cast in his first cinema role, that of student Petya in Vasily Ordynsky's The Yearlings (Сверстницы). On 20 June 1960, Vysotsky graduated from the MAT theater institute and joined the Moscow Pushkin Drama Theatre (led by Boris Ravenskikh at the time) where he spent (with intervals) almost three troubled years. These were marred by numerous administrative sanctions, due to "lack of discipline" and occasional drunken sprees which were a reaction, mainly, to the lack of serious roles and his inability to realise his artistic potential. A short stint in 1962 at the Moscow Theater of Miniatures (administered at the time by Vladimir Polyakov) ended with him being fired, officially "for a total lack of sense of humour."

 

Vysotsky's second and third films, Dima Gorin's Career and 713 Requests Permission to Land, were interesting only for the fact that in both he had to be beaten up (in the first case by Aleksandr Demyanenko). "That was the way cinema greeted me," he later jokingly remarked. In 1961, Vysotsky wrote his first ever proper song, called "Tattoo" (Татуировка), which started a long and colourful cycle of artfully stylized criminal underworld romantic stories, full of undercurrents and witty social comments. In June 1963, while shooting Penalty Kick (directed by Veniamin Dorman and starring Mikhail Pugovkin), Vysotsky used the Gorky Film Studio to record an hour-long reel-to-reel cassette of his own songs; copies of it quickly spread and the author's name became known in Moscow and elsewhere (although many of these songs were often being referred to as either "traditional" or "anonymous"). Just several months later Riga-based chess grandmaster Mikhail Tal was heard praising the author of "Bolshoy Karetny" (Большой Каретный) and Anna Akhmatova (in a conversation with Joseph Brodsky) was quoting Vysotsky's number "I was the soul of a bad company..." taking it apparently for some brilliant piece of anonymous street folklore. In October 1964 Vysotsky recorded in chronological order 48 of his own songs, his first self-made Complete works of... compilation, which boosted his popularity as a new Moscow folk underground star.

 

In 1964, director Yuri Lyubimov invited Vysotsky to join the newly created Taganka Theatre. "'I've written some songs of my own. Won't you listen?' – he asked. I agreed to listen to just one of them, expecting our meeting to last for no more than five minutes. Instead I ended up listening to him for an entire 1.5 hours," Lyubimov remembered years later of this first audition. On 19 September 1964, Vysotsky debuted in Bertolt Brecht's The Good Person of Szechwan as the Second God (not to count two minor roles). A month later he came on stage as a dragoon captain (Bela's father) in Lermontov's A Hero of Our Time. It was in Taganka that Vysotsky started to sing on stage; the War theme becoming prominent in his musical repertoire. In 1965 Vysotsky appeared in the experimental Poet and Theater (Поэт и Театр, February) show, based on Andrey Voznesensky's work and then Ten Days that Shook the World (after John Reed's book, April) and was commissioned by Lyubimov to write songs exclusively for Taganka's new World War II play. The Fallen and the Living (Павшие и Живые), premiered in October 1965, featured Vysotsky's "Stars" (Звёзды), "The Soldiers of Heeresgruppe Mitte" (Солдаты группы "Центр") and "Penal Battalions" (Штрафные батальоны), the striking examples of a completely new kind of a war song, never heard in his country before. As veteran screenwriter Nikolay Erdman put it (in conversation with Lyubimov), "Professionally, I can well understand how Mayakovsky or Seryozha Yesenin were doing it. How Volodya Vysotsky does it is totally beyond me." With his songs – in effect, miniature theatrical dramatizations (usually with a protagonist and full of dialogues), Vysotsky instantly achieved such level of credibility that real life former prisoners, war veterans, boxers, footballers refused to believe that the author himself had never served his time in prisons and labor camps, or fought in the War, or been a boxing/football professional. After the second of the two concerts at the Leningrad Molecular Physics institute (that was his actual debut as a solo musical performer) Vysotsky left a note for his fans in a journal which ended with words: "Now that you've heard all these songs, please, don't you make a mistake of mixing me with my characters, I am not like them at all. With love, Vysotsky, 20 April 1965, XX c." Excuses of this kind he had to make throughout his performing career. At least one of Vysotsky's song themes – that of alcoholic abuse – was worryingly autobiographical, though. By the time his breakthrough came in 1967, he'd suffered several physical breakdowns and once was sent (by Taganka's boss) to a rehabilitation clinic, a visit he on several occasions repeated since.

 

Brecht's Life of Galileo (premiered on 17 May 1966), transformed by Lyubimov into a powerful allegory of Soviet intelligentsia's set of moral and intellectual dilemmas, brought Vysotsky his first leading theater role (along with some fitness lessons: he had to perform numerous acrobatic tricks on stage). Press reaction was mixed, some reviewers disliked the actor's overt emotionalism, but it was for the first time ever that Vysotsky's name appeared in Soviet papers. Film directors now were treating him with respect. Viktor Turov's war film I Come from the Childhood where Vysotsky got his first ever "serious" (neither comical, nor villainous) role in cinema, featured two of his songs: a spontaneous piece called "When It's Cold" (Холода) and a dark, Unknown soldier theme-inspired classic "Common Graves" (На братских могилах), sung behind the screen by the legendary Mark Bernes.

 

Stanislav Govorukhin and Boris Durov's The Vertical (1967), a mountain climbing drama, starring Vysotsky (as Volodya the radioman), brought him all-round recognition and fame. Four of the numbers used in the film (including "Song of a Friend [fi]" (Песня о друге), released in 1968 by the Soviet recording industry monopolist Melodiya disc to become an unofficial hit) were written literally on the spot, nearby Elbrus, inspired by professional climbers' tales and one curious hotel bar conversation with a German guest who 25 years ago happened to climb these very mountains in a capacity of an Edelweiss division fighter. Another 1967 film, Kira Muratova's Brief Encounters featured Vysotsky as the geologist Maxim (paste-bearded again) with a now trademark off-the-cuff musical piece, a melancholy improvisation called "Things to Do" (Дела). All the while Vysotsky continued working hard at Taganka, with another important role under his belt (that of Mayakovsky or, rather one of the latter character's five different versions) in the experimental piece called Listen! (Послушайте!), and now regularly gave semi-official concerts where audiences greeted him as a cult hero.

 

In the end of 1967 Vysotsky got another pivotal theater role, that of Khlopusha [ru] in Pugachov (a play based on a poem by Sergei Yesenin), often described as one of Taganka's finest. "He put into his performance all the things that he excelled at and, on the other hand, it was Pugachyov that made him discover his own potential," – Soviet critic Natalya Krymova wrote years later. Several weeks after the premiere, infuriated by the actor's increasing unreliability triggered by worsening drinking problems, Lyubimov fired him – only to let him back again several months later (and thus begin the humiliating sacked-then-pardoned routine which continued for years). In June 1968 a Vysotsky-slagging campaign was launched in the Soviet press. First Sovetskaya Rossiya commented on the "epidemic spread of immoral, smutty songs," allegedly promoting "criminal world values, alcoholism, vice and immorality" and condemned their author for "sowing seeds of evil." Then Komsomolskaya Pravda linked Vysotsky with black market dealers selling his tapes somewhere in Siberia. Composer Dmitry Kabalevsky speaking from the Union of Soviet Composers' Committee tribune criticised the Soviet radio for giving an ideologically dubious, "low-life product" like "Song of a Friend" (Песня о друге) an unwarranted airplay. Playwright Alexander Stein who in his Last Parade play used several of Vysotsky's songs, was chastised by a Ministry of Culture official for "providing a tribune for this anti-Soviet scum." The phraseology prompted commentators in the West to make parallels between Vysotsky and Mikhail Zoschenko, another Soviet author who'd been officially labeled "scum" some 20 years ago.

 

Two of Vysotsky's 1968 films, Gennady Poloka's Intervention (premiered in May 1987) where he was cast as Brodsky, a dodgy even if highly artistic character, and Yevgeny Karelov's Two Comrades Were Serving (a gun-toting White Army officer Brusentsov who in the course of the film shoots his friend, his horse, Oleg Yankovsky's good guy character and, finally himself) – were severely censored, first of them shelved for twenty years. At least four of Vysotsky's 1968 songs, "Save Our Souls" (Спасите наши души), "The Wolfhunt" (Охота на волков), "Gypsy Variations" (Моя цыганская) and "The Steam-bath in White" (Банька по-белому), were hailed later as masterpieces. It was at this point that 'proper' love songs started to appear in Vysotsky's repertoire, documenting the beginning of his passionate love affair with French actress Marina Vlady.

 

In 1969 Vysotsky starred in two films: The Master of Taiga where he played a villainous Siberian timber-floating brigadier, and more entertaining Dangerous Tour. The latter was criticized in the Soviet press for taking a farcical approach to the subject of the Bolshevik underground activities but for a wider Soviet audience this was an important opportunity to enjoy the charismatic actor's presence on big screen. In 1970, after visiting the dislodged Soviet leader Nikita Khrushchev at his dacha and having a lengthy conversation with him, Vysotsky embarked on a massive and by Soviet standards dangerously commercial concert tour in Soviet Central Asia and then brought Marina Vlady to director Viktor Turov's place so as to investigate her Belarusian roots. The pair finally wed on 1 December 1970 (causing furore among the Moscow cultural and political elite) and spent a honeymoon in Georgia. This was the highly productive period for Vysotsky, resulting in numerous new songs, including the anthemic "I Hate" (Я не люблю), sentimental "Lyricale" (Лирическая) and dramatic war epics "He Didn't Return from the Battle" (Он не вернулся из боя) and "The Earth Song" (Песня о Земле) among many others.

 

In 1971 a drinking spree-related nervous breakdown brought Vysotsky to the Moscow Kashchenko clinic [ru]. By this time he has been suffering from alcoholism. Many of his songs from this period deal, either directly or metaphorically, with alcoholism and insanity. Partially recovered (due to the encouraging presence of Marina Vladi), Vysotsky embarked on a successful Ukrainian concert tour and wrote a cluster of new songs. On 29 November 1971 Taganka's Hamlet premiered, a groundbreaking Lyubimov's production with Vysotsky in the leading role, that of a lone intellectual rebel, rising to fight the cruel state machine.

 

Also in 1971 Vysotsky was invited to play the lead in The Sannikov Land, the screen adaptation of Vladimir Obruchev's science fiction,[47] which he wrote several songs for, but was suddenly dropped for the reason of his face "being too scandalously recognisable" as a state official put it. One of the songs written for the film, a doom-laden epic allegory "Capricious Horses" (Кони привередливые), became one of the singer's signature tunes. Two of Vysotsky's 1972 film roles were somewhat meditative: an anonymous American journalist in The Fourth One and the "righteous guy" von Koren in The Bad Good Man (based on Anton Chekov's Duel). The latter brought Vysotsky the Best Male Role prize at the V Taormina Film Fest. This philosophical slant rubbed off onto some of his new works of the time: "A Singer at the Microphone" (Певец у микрофона), "The Tightrope Walker" (Канатоходец), two new war songs ("We Spin the Earth", "Black Pea-Coats") and "The Grief" (Беда), a folkish girl's lament, later recorded by Marina Vladi and subsequently covered by several female performers. Popular proved to be his 1972 humorous songs: "Mishka Shifman" (Мишка Шифман), satirizing the leaving-for-Israel routine, "Victim of the Television" which ridiculed the concept of "political consciousness," and "The Honour of the Chess Crown" (Честь шахматной короны) about an ever-fearless "simple Soviet man" challenging the much feared American champion Bobby Fischer to a match.

 

In 1972 he stepped up in Soviet Estonian TV where he presented his songs and gave an interview. The name of the show was "Young Man from Taganka" (Noormees Tagankalt).

 

In April 1973 Vysotsky visited Poland and France. Predictable problems concerning the official permission were sorted after the French Communist Party leader Georges Marchais made a personal phone call to Leonid Brezhnev who, according to Marina Vlady's memoirs, rather sympathized with the stellar couple. Having found on return a potentially dangerous lawsuit brought against him (concerning some unsanctioned concerts in Siberia the year before), Vysotsky wrote a defiant letter to the Minister of Culture Pyotr Demichev. As a result, he was granted the status of a philharmonic artist, 11.5 roubles per concert now guaranteed. Still the 900 rubles fine had to be paid according to the court verdict, which was a substantial sum, considering his monthly salary at the theater was 110 rubles. That year Vysotsky wrote some thirty songs for "Alice in Wonderland," an audioplay where he himself has been given several minor roles. His best known songs of 1973 included "The Others' Track" (Чужая колея), "The Flight Interrupted" (Прерванный полёт) and "The Monument", all pondering on his achievements and legacy.

 

In 1974 Melodiya released the 7" EP, featuring four of Vysotsky's war songs ("He Never Returned From the Battle", "The New Times Song", "Common Graves", and "The Earth Song") which represented a tiny portion of his creative work, owned by millions on tape. In September of that year Vysotsky received his first state award, the Honorary Diploma of the Uzbek SSR following a tour with fellow actors from the Taganka Theatre in Uzbekistan. A year later he was granted the USSR Union of Cinematographers' membership. This meant he was not an "anti-Soviet scum" now, rather an unlikely link between the official Soviet cinema elite and the "progressive-thinking artists of the West." More films followed, among them The Only Road (a Soviet-Yugoslav joint venture, premiered on 10 January 1975 in Belgrade) and a science fiction movie The Flight of Mr. McKinley (1975). Out of nine ballads that he wrote for the latter only two have made it into the soundtrack. This was the height of his popularity, when, as described in Vlady's book about her husband, walking down the street on a summer night, one could hear Vysotsky's recognizable voice coming literally from every open window. Among the songs written at the time, were humorous "The Instruction before the Trip Abroad", lyrical "Of the Dead Pilot" and philosophical "The Strange House". In 1975 Vysotsky made his third trip to France where he rather riskily visited his former tutor (and now a celebrated dissident emigre) Andrey Sinyavsky. Artist Mikhail Shemyakin, his new Paris friend (or a "bottle-sharer", in Vladi's terms), recorded Vysotsky in his home studio. After a brief stay in England Vysotsky crossed the ocean and made his first Mexican concerts in April. Back in Moscow, there were changes at Taganka: Lyubimov went to Milan's La Scala on a contract and Anatoly Efros has been brought in, a director of radically different approach. His project, Chekhov's The Cherry Orchard, caused a sensation. Critics praised Alla Demidova (as Ranevskaya) and Vysotsky (as Lopakhin) powerful interplay, some describing it as one of the most dazzling in the history of the Soviet theater. Lyubimov, who disliked the piece, accused Efros of giving his actors "the stardom malaise." The 1976 Taganka's visit to Bulgaria resulted in Vysotskys's interview there being filmed and 15 songs recorded by Balkanton record label. On return Lyubimov made a move which many thought outrageous: declaring himself "unable to work with this Mr. Vysotsky anymore" he gave the role of Hamlet to Valery Zolotukhin, the latter's best friend. That was the time, reportedly, when stressed out Vysotsky started taking amphetamines.

 

Another Belorussian voyage completed, Marina and Vladimir went for France and from there (without any official permission given, or asked for) flew to the North America. In New York Vysotsky met, among other people, Mikhail Baryshnikov and Joseph Brodsky. In a televised one-hour interview with Dan Rather he stressed he was "not a dissident, just an artist, who's never had any intentions to leave his country where people loved him and his songs." At home this unauthorized venture into the Western world bore no repercussions: by this time Soviet authorities were divided as regards the "Vysotsky controversy" up to the highest level; while Mikhail Suslov detested the bard, Brezhnev loved him to such an extent that once, while in hospital, asked him to perform live in his daughter Galina's home, listening to this concert on the telephone. In 1976 appeared "The Domes", "The Rope" and the "Medieval" cycle, including "The Ballad of Love".

 

In September Vysotsky with Taganka made a trip to Yugoslavia where Hamlet won the annual BITEF festival's first prize, and then to Hungary for a two-week concert tour. Back in Moscow Lyubimov's production of The Master & Margarita featured Vysotsky as Ivan Bezdomny; a modest role, somewhat recompensed by an important Svidrigailov slot in Yury Karyakin's take on Dostoevsky's Crime and Punishment. Vysotsky's new songs of this period include "The History of Illness" cycle concerning his health problems, humorous "Why Did the Savages Eat Captain Cook", the metaphorical "Ballad of the Truth and the Lie", as well as "Two Fates", the chilling story of a self-absorbed alcoholic hunted by two malevolent witches, his two-faced destiny. In 1977 Vysotsky's health deteriorated (heart, kidneys, liver failures, jaw infection and nervous breakdown) to such an extent that in April he found himself in Moscow clinic's reanimation center in the state of physical and mental collapse.

 

In 1977 Vysotsky made an unlikely appearance in New York City on the American television show 60 Minutes, which falsely stated that Vysotsky had spent time in the Soviet prison system, the Gulag. That year saw the release of three Vysotsky's LPs in France (including the one that had been recorded by RCA in Canada the previous year); arranged and accompanied by guitarist Kostya Kazansky, the singer for the first time ever enjoyed the relatively sophisticated musical background. In August he performed in Hollywood before members of New York City film cast and (according to Vladi) was greeted warmly by the likes of Liza Minnelli and Robert De Niro. Some more concerts in Los Angeles were followed by the appearance at the French Communist paper L’Humanité annual event. In December Taganka left for France, its Hamlet (Vysotsky back in the lead) gaining fine reviews.

 

1978 started with the March–April series of concerts in Moscow and Ukraine. In May Vysotsky embarked upon a new major film project: The Meeting Place Cannot Be Changed (Место встречи изменить нельзя) about two detectives fighting crime in late 1940s Russia, directed by Stanislav Govorukhin. The film (premiered on 11 November 1978 on the Soviet Central TV) presented Vysotsky as Zheglov, a ruthless and charismatic cop teaching his milder partner Sharapov (actor Vladimir Konkin) his art of crime-solving. Vysotsky also became engaged in Taganka's Genre-seeking show (performing some of his own songs) and played Aleksander Blok in Anatoly Efros' The Lady Stranger (Незнакомка) radio play (premiered on air on 10 July 1979 and later released as a double LP).

 

In November 1978 Vysotsky took part in the underground censorship-defying literary project Metropolis, inspired and organized by Vasily Aksenov. In January 1979 Vysotsky again visited America with highly successful series of concerts. That was the point (according to biographer Vladimir Novikov) when a glimpse of new, clean life of a respectable international actor and performer all but made Vysotsky seriously reconsider his priorities. What followed though, was a return to the self-destructive theater and concert tours schedule, personal doctor Anatoly Fedotov now not only his companion, but part of Taganka's crew. "Who was this Anatoly? Just a man who in every possible situation would try to provide drugs. And he did provide. In such moments Volodya trusted him totally," Oksana Afanasyeva, Vysotsky's Moscow girlfriend (who was near him for most of the last year of his life and, on occasion, herself served as a drug courier) remembered. In July 1979, after a series of Central Asia concerts, Vysotsky collapsed, experienced clinical death and was resuscitated by Fedotov (who injected caffeine into the heart directly), colleague and close friend Vsevolod Abdulov helping with heart massage. In January 1980 Vysotsky asked Lyubimov for a year's leave. "Up to you, but on condition that Hamlet is yours," was the answer. The songwriting showed signs of slowing down, as Vysotsky began switching from songs to more conventional poetry. Still, of nearly 800 poems by Vysotsky only one has been published in the Soviet Union while he was alive. Not a single performance or interview was broadcast by the Soviet television in his lifetime.

 

In May 1979, being in a practice studio of the MSU Faculty of Journalism, Vysotsky recorded a video letter to American actor and film producer Warren Beatty, looking for both a personal meeting with Beatty and an opportunity to get a role in Reds film, to be produced and directed by the latter. While recording, Vysotsky made a few attempts to speak English, trying to overcome the language barrier. This video letter never reached Beatty. It was broadcast for the first time more than three decades later, on the night of 24 January 2013 (local time) by Rossiya 1 channel, along with records of TV channels of Italy, Mexico, Poland, USA and from private collections, in Vladimir Vysotsky. A letter to Warren Beatty film by Alexander Kovanovsky and Igor Rakhmanov. While recording this video, Vysotsky had a rare opportunity to perform for a camera, being still unable to do it with Soviet television.

 

On 22 January 1980, Vysotsky entered the Moscow Ostankino TV Center to record his one and only studio concert for the Soviet television. What proved to be an exhausting affair (his concentration lacking, he had to plod through several takes for each song) was premiered on the Soviet TV eight years later. The last six months of his life saw Vysotsky appearing on stage sporadically, fueled by heavy dosages of drugs and alcohol. His performances were often erratic. Occasionally Vysotsky paid visits to Sklifosofsky [ru] institute's ER unit, but would not hear of Marina Vlady's suggestions for him to take long-term rehabilitation course in a Western clinic. Yet he kept writing, mostly poetry and even prose, but songs as well. The last song he performed was the agonizing "My Sorrow, My Anguish" and his final poem, written one week prior to his death was "A Letter to Marina": "I'm less than fifty, but the time is short / By you and God protected, life and limb / I have a song or two to sing before the Lord / I have a way to make my peace with him."

 

Although several theories of the ultimate cause of the singer's death persist to this day, given what is now known about cardiovascular disease, it seems likely that by the time of his death Vysotsky had an advanced coronary condition brought about by years of tobacco, alcohol and drug abuse, as well as his grueling work schedule and the stress of the constant harassment by the government. Towards the end, most of Vysotsky's closest friends had become aware of the ominous signs and were convinced that his demise was only a matter of time. Clear evidence of this can be seen in a video ostensibly shot by the Japanese NHK channel only months before Vysotsky's death, where he appears visibly unwell, breathing heavily and slurring his speech. Accounts by Vysotsky's close friends and colleagues concerning his last hours were compiled in the book by V. Perevozchikov.

 

Vysotsky suffered from alcoholism for most of his life. Sometime around 1977, he started using amphetamines and other prescription narcotics in an attempt to counteract the debilitating hangovers and eventually to rid himself of alcohol addiction. While these attempts were partially successful, he ended up trading alcoholism for a severe drug dependency that was fast spiralling out of control. He was reduced to begging some of his close friends in the medical profession for supplies of drugs, often using his acting skills to collapse in a medical office and imitate a seizure or some other condition requiring a painkiller injection. On 25 July 1979 (a year to the day before his death) he suffered a cardiac arrest and was clinically dead for several minutes during a concert tour of Soviet Uzbekistan, after injecting himself with a wrong kind of painkiller he had previously obtained from a dentist's office.

 

Fully aware of the dangers of his condition, Vysotsky made several attempts to cure himself of his addiction. He underwent an experimental (and ultimately discredited) blood purification procedure offered by a leading drug rehabilitation specialist in Moscow. He also went to an isolated retreat in France with his wife Marina in the spring of 1980 as a way of forcefully depriving himself of any access to drugs. After these attempts failed, Vysotsky returned to Moscow to find his life in an increasingly stressful state of disarray. He had been a defendant in two criminal trials, one for a car wreck he had caused some months earlier, and one for an alleged conspiracy to sell unauthorized concert tickets (he eventually received a suspended sentence and a probation in the first case, and the charges in the second were dismissed, although several of his co-defendants were found guilty). He also unsuccessfully fought the film studio authorities for the rights to direct a movie called The Green Phaeton. Relations with his wife Marina were deteriorating, and he was torn between his loyalty to her and his love for his mistress Oksana Afanasyeva. He had also developed severe inflammation in one of his legs, making his concert performances extremely challenging.

 

In a final desperate attempt to overcome his drug addiction, partially prompted by his inability to obtain drugs through his usual channels (the authorities had imposed a strict monitoring of the medical institutions to prevent illicit drug distribution during the 1980 Olympics), he relapsed into alcohol and went on a prolonged drinking binge (apparently consuming copious amounts of champagne due to a prevalent misconception at the time that it was better than vodka at countering the effects of drug withdrawal).

 

On 3 July 1980, Vysotsky gave a performance at a suburban Moscow concert hall. One of the stage managers recalls that he looked visibly unhealthy ("gray-faced", as she puts it) and complained of not feeling too good, while another says she was surprised by his request for champagne before the start of the show, as he had always been known for completely abstaining from drink before his concerts. On 16 July Vysotsky gave his last public concert in Kaliningrad. On 18 July, Vysotsky played Hamlet for the last time at the Taganka Theatre. From around 21 July, several of his close friends were on a round-the-clock watch at his apartment, carefully monitoring his alcohol intake and hoping against all odds that his drug dependency would soon be overcome and they would then be able to bring him back from the brink. The effects of drug withdrawal were clearly getting the better of him, as he got increasingly restless, moaned and screamed in pain, and at times fell into memory lapses, failing to recognize at first some of his visitors, including his son Arkadiy. At one point, Vysotsky's personal physician A. Fedotov (the same doctor who had brought him back from clinical death a year earlier in Uzbekistan) attempted to sedate him, inadvertently causing asphyxiation from which he was barely saved. On 24 July, Vysotsky told his mother that he thought he was going to die that day, and then made similar remarks to a few of the friends present at the apartment, who begged him to stop such talk and keep his spirits up. But soon thereafter, Oksana Afanasyeva saw him clench his chest several times, which led her to suspect that he was genuinely suffering from a cardiovascular condition. She informed Fedotov of this but was told not to worry, as he was going to monitor Vysotsky's condition all night. In the evening, after drinking relatively small amounts of alcohol, the moaning and groaning Vysotsky was sedated by Fedotov, who then sat down on the couch next to him but fell asleep. Fedotov awoke in the early hours of 25 July to an unusual silence and found Vysotsky dead in his bed with his eyes wide open, apparently of a myocardial infarction, as he later certified. This was contradicted by Fedotov's colleagues, Sklifosovsky Emergency Medical Institute physicians L. Sul'povar and S. Scherbakov (who had demanded the actor's immediate hospitalization on 23 July but were allegedly rebuffed by Fedotov), who insisted that Fedotov's incompetent sedation combined with alcohol was what killed Vysotsky. An autopsy was prevented by Vysotsky's parents (who were eager to have their son's drug addiction remain secret), so the true cause of death remains unknown.

 

No official announcement of the actor's death was made, only a brief obituary appeared in the Moscow newspaper Vechernyaya Moskva, and a note informing of Vysotsky's death and cancellation of the Hamlet performance was put out at the entrance to the Taganka Theatre (the story goes that not a single ticket holder took advantage of the refund offer). Despite this, by the end of the day, millions had learned of Vysotsky's death. On 28 July, he lay in state at the Taganka Theatre. After a mourning ceremony involving an unauthorized mass gathering of unprecedented scale, Vysotsky was buried at the Vagankovskoye Cemetery in Moscow. The attendance at the Olympic events dropped noticeably on that day, as scores of spectators left to attend the funeral. Tens of thousands of people lined the streets to catch a glimpse of his coffin.

 

According to author Valery Perevozchikov part of the blame for his death lay with the group of associates who surrounded him in the last years of his life. This inner circle were all people under the influence of his strong character, combined with a material interest in the large sums of money his concerts earned. This list included Valerii Yankelovich, manager of the Taganka Theatre and prime organiser of his non-sanctioned concerts; Anatoly Fedotov, his personal doctor; Vadim Tumanov, gold prospector (and personal friend) from Siberia; Oksana Afanasyeva (later Yarmolnik), his mistress the last three years of his life; Ivan Bortnik, a fellow actor; and Leonid Sul'povar, a department head at the Sklifosovski hospital who was responsible for much of the supply of drugs.

 

Vysotsky's associates had all put in efforts to supply his drug habit, which kept him going in the last years of his life. Under their influence, he was able to continue to perform all over the country, up to a week before his death. Due to illegal (i.e. non-state-sanctioned) sales of tickets and other underground methods, these concerts pulled in sums of money unimaginable in Soviet times, when almost everyone received nearly the same small salary. The payouts and gathering of money were a constant source of danger, and Yankelovich and others were needed to organise them.

 

Some money went to Vysotsky, the rest was distributed amongst this circle. At first this was a reasonable return on their efforts; however, as his addiction progressed and his body developed resistance, the frequency and amount of drugs needed to keep Vysotsky going became unmanageable. This culminated at the time of the Moscow Olympics which coincided with the last days of his life, when supplies of drugs were monitored more strictly than usual, and some of the doctors involved in supplying Vysotsky were already behind bars (normally the doctors had to account for every ampule, thus drugs were transferred to an empty container, while the patients received a substitute or placebo instead). In the last few days Vysotsky became uncontrollable, his shouting could be heard all over the apartment building on Malaya Gruzinskaya St. where he lived amongst VIP's. Several days before his death, in a state of stupor he went on a high speed drive around Moscow in an attempt to obtain drugs and alcohol – when many high-ranking people saw him. This increased the likelihood of him being forcibly admitted to the hospital, and the consequent danger to the circle supplying his habit. As his state of health declined, and it became obvious that he might die, his associates gathered to decide what to do with him. They came up with no firm decision. They did not want him admitted officially, as his drug addiction would become public and they would fall under suspicion, although some of them admitted that any ordinary person in his condition would have been admitted immediately.

 

On Vysotsky's death his associates and relatives put in much effort to prevent a post-mortem being carried out. This despite the fairly unusual circumstances: he died aged 42 under heavy sedation with an improvised cocktail of sedatives and stimulants, including the toxic chloral hydrate, provided by his personal doctor who had been supplying him with narcotics the previous three years. This doctor, being the only one present at his side when death occurred, had a few days earlier been seen to display elementary negligence in treating the sedated Vysotsky. On the night of his death, Arkadii Vysotsky (his son), who tried to visit his father in his apartment, was rudely refused entry by Yankelovich, even though there was a lack of people able to care for him. Subsequently, the Soviet police commenced a manslaughter investigation which was dropped due to the absence of evidence taken at the time of death.

 

Vysotsky's first wife was Iza Zhukova. They met in 1956, being both MAT theater institute students, lived for some time at Vysotsky's mother's flat in Moscow, after her graduation (Iza was 2 years older) spent months in different cities (her – in Kiev, then Rostov) and finally married on 25 April 1960.

 

He met his second wife Lyudmila Abramova in 1961, while shooting the film 713 Requests Permission to Land. They married in 1965 and had two sons, Arkady (born 1962) and Nikita (born 1964).

 

While still married to Lyudmila Abramova, Vysotsky began a romantic relationship with Tatyana Ivanenko, a Taganka actress, then, in 1967 fell in love with Marina Vlady, a French actress of Russian descent, who was working at Mosfilm on a joint Soviet-French production at that time. Marina had been married before and had three children, while Vladimir had two. They were married in 1969. For 10 years the two maintained a long-distance relationship as Marina compromised her career in France to spend more time in Moscow, and Vladimir's friends pulled strings for him to be allowed to travel abroad to stay with his wife. Marina eventually joined the Communist Party of France, which essentially gave her an unlimited-entry visa into the Soviet Union, and provided Vladimir with some immunity against prosecution by the government, which was becoming weary of his covertly anti-Soviet lyrics and his odds-defying popularity with the masses. The problems of his long-distance relationship with Vlady inspired several of Vysotsky's songs.

 

In the autumn of 1981 Vysotsky's first collection of poetry was officially published in the USSR, called The Nerve (Нерв). Its first edition (25,000 copies) was sold out instantly. In 1982 the second one followed (100,000), then the 3rd (1988, 200,000), followed in the 1990s by several more. The material for it was compiled by Robert Rozhdestvensky, an officially laurelled Soviet poet. Also in 1981 Yuri Lyubimov staged at Taganka a new music and poetry production called Vladimir Vysotsky which was promptly banned and officially premiered on 25 January 1989.

 

In 1982 the motion picture The Ballad of the Valiant Knight Ivanhoe was produced in the Soviet Union and in 1983 the movie was released to the public. Four songs by Vysotsky were featured in the film.

 

In 1986 the official Vysotsky poetic heritage committee was formed (with Robert Rozhdestvensky at the helm, theater critic Natalya Krymova being both the instigator and the organizer). Despite some opposition from the conservatives (Yegor Ligachev was the latter's political leader, Stanislav Kunyaev of Nash Sovremennik represented its literary flank) Vysotsky was rewarded posthumously with the USSR State Prize. The official formula – "for creating the character of Zheglov and artistic achievements as a singer-songwriter" was much derided from both the left and the right. In 1988 the Selected Works of... (edited by N. Krymova) compilation was published, preceded by I Will Surely Return... (Я, конечно, вернусь...) book of fellow actors' memoirs and Vysotsky's verses, some published for the first time. In 1990 two volumes of extensive The Works of... were published, financed by the late poet's father Semyon Vysotsky. Even more ambitious publication series, self-proclaimed "the first ever academical edition" (the latter assertion being dismissed by sceptics) compiled and edited by Sergey Zhiltsov, were published in Tula (1994–1998, 5 volumes), Germany (1994, 7 volumes) and Moscow (1997, 4 volumes).

 

In 1989 the official Vysotsky Museum opened in Moscow, with the magazine of its own called Vagant (edited by Sergey Zaitsev) devoted entirely to Vysotsky's legacy. In 1996 it became an independent publication and was closed in 2002.

 

In the years to come, Vysotsky's grave became a site of pilgrimage for several generations of his fans, the youngest of whom were born after his death. His tombstone also became the subject of controversy, as his widow had wished for a simple abstract slab, while his parents insisted on a realistic gilded statue. Although probably too solemn to have inspired Vysotsky himself, the statue is believed by some to be full of metaphors and symbols reminiscent of the singer's life.

 

In 1995 in Moscow the Vysotsky monument was officially opened at Strastnoy Boulevard, by the Petrovsky Gates. Among those present were the bard's parents, two of his sons, first wife Iza, renown poets Yevtushenko and Voznesensky. "Vysotsky had always been telling the truth. Only once he was wrong when he sang in one of his songs: 'They will never erect me a monument in a square like that by Petrovskye Vorota'", Mayor of Moscow Yuri Luzhkov said in his speech.[95] A further monument to Vysotsky was erected in 2014 at Rostov-on-Don.

 

In October 2004, a monument to Vysotsky was erected in the Montenegrin capital of Podgorica, near the Millennium Bridge. His son, Nikita Vysotsky, attended the unveiling. The statue was designed by Russian sculptor Alexander Taratinov, who also designed a monument to Alexander Pushkin in Podgorica. The bronze statue shows Vysotsky standing on a pedestal, with his one hand raised and the other holding a guitar. Next to the figure lies a bronze skull – a reference to Vysotsky's monumental lead performances in Shakespeare's Hamlet. On the pedestal the last lines from a poem of Vysotsky's, dedicated to Montenegro, are carved.

 

The Vysotsky business center & semi-skyscraper was officially opened in Yekaterinburg, in 2011. It is the tallest building in Russia outside of Moscow, has 54 floors, total height: 188.3 m (618 ft). On the third floor of the business center is the Vysotsky Museum. Behind the building is a bronze sculpture of Vladimir Vysotsky and his third wife, a French actress Marina Vlady.

 

In 2011 a controversial movie Vysotsky. Thank You For Being Alive was released, script written by his son, Nikita Vysotsky. The actor Sergey Bezrukov portrayed Vysotsky, using a combination of a mask and CGI effects. The film tells about Vysotsky's illegal underground performances, problems with KGB and drugs, and subsequent clinical death in 1979.

 

Shortly after Vysotsky's death, many Russian bards started writing songs and poems about his life and death. The best known are Yuri Vizbor's "Letter to Vysotsky" (1982) and Bulat Okudzhava's "About Volodya Vysotsky" (1980). In Poland, Jacek Kaczmarski based some of his songs on those of Vysotsky, such as his first song (1977) was based on "The Wolfhunt", and dedicated to his memory the song "Epitafium dla Włodzimierza Wysockiego" ("Epitaph for Vladimir Vysotsky").

 

Every year on Vysotsky's birthday festivals are held throughout Russia and in many communities throughout the world, especially in Europe. Vysotsky's impact in Russia is often compared to that of Wolf Biermann in Germany, Bob Dylan in America, or Georges Brassens and Jacques Brel in France.

 

The asteroid 2374 Vladvysotskij, discovered by Lyudmila Zhuravleva, was named after Vysotsky.

 

During the Annual Q&A Event Direct Line with Vladimir Putin, Alexey Venediktov asked Putin to name a street in Moscow after the singer Vladimir Vysotsky, who, though considered one of the greatest Russian artists, has no street named after him in Moscow almost 30 years after his death. Venediktov stated a Russian law that allowed the President to do so and promote a law suggestion to name a street by decree. Putin answered that he would talk to Mayor of Moscow and would solve this problem. In July 2015 former Upper and Lower Tagansky Dead-ends (Верхний и Нижний Таганские тупики) in Moscow were reorganized into Vladimir Vysotsky Street.

 

The Sata Kieli Cultural Association, [Finland], organizes the annual International Vladimir Vysotsky Festival (Vysotski Fest), where Vysotsky's singers from different countries perform in Helsinki and other Finnish cities. They sing Vysotsky in different languages and in different arrangements.

 

Two brothers and singers from Finland, Mika and Turkka Mali, over the course of their more than 30-year musical career, have translated into Finnish, recorded and on numerous occasions publicly performed songs of Vladimir Vysotsky.

 

Throughout his lengthy musical career, Jaromír Nohavica, a famed Czech singer, translated and performed numerous songs of Vladimir Vysotsky, most notably Песня о друге (Píseň o příteli – Song about a friend).

 

The Museum of Vladimir Vysotsky in Koszalin dedicated to Vladimir Vysotsky was founded by Marlena Zimna (1969–2016) in May 1994, in her apartment, in the city of Koszalin, in Poland. Since then the museum has collected over 19,500 exhibits from different countries and currently holds Vladimir Vysotsky' personal items, autographs, drawings, letters, photographs and a large library containing unique film footage, vinyl records, CDs and DVDs. A special place in the collection holds a Vladimir Vysotsky's guitar, on which he played at a concert in Casablanca in April 1976. Vladimir Vysotsky presented this guitar to Moroccan journalist Hassan El-Sayed together with an autograph (an extract from Vladimir Vysotsky's song "What Happened in Africa"), written in Russian right on the guitar.

 

In January 2023, a monument to the outstanding actor, singer and poet Vladimir Vysotsky was unveiled in Yuzhno-Sakhalinsk, in the square near the Rodina House of Culture. Author Vladimir Chebotarev.

 

After her husband's death, urged by her friend Simone Signoret, Marina Vlady wrote a book called The Aborted Flight about her years together with Vysotsky. The book paid tribute to Vladimir's talent and rich persona, yet was uncompromising in its depiction of his addictions and the problems that they caused in their marriage. Written in French (and published in France in 1987), it was translated into Russian in tandem by Vlady and a professional translator and came out in 1989 in the USSR. Totally credible from the specialists' point of view, the book caused controversy, among other things, by shocking revelations about the difficult father-and-son relationship (or rather, the lack of any), implying that Vysotsky-senior (while his son was alive) was deeply ashamed of him and his songs which he deemed "anti-Soviet" and reported his own son to the KGB. Also in 1989 another important book of memoirs was published in the USSR, providing a bulk of priceless material for the host of future biographers, Alla Demidova's Vladimir Vysotsky, the One I Know and Love. Among other publications of note were Valery Zolotukhin's Vysotsky's Secret (2000), a series of Valery Perevozchikov's books (His Dying Hour, The Unknown Vysotsky and others) containing detailed accounts and interviews dealing with the bard's life's major controversies (the mystery surrounding his death, the truth behind Vysotsky Sr.'s alleged KGB reports, the true nature of Vladimir Vysotsky's relations with his mother Nina's second husband Georgy Bartosh etc.), Iza Zhukova's Short Happiness for a Lifetime and the late bard's sister-in-law Irena Vysotskaya's My Brother Vysotsky. The Beginnings (both 2005).

 

A group of enthusiasts has created a non-profit project – the mobile application "Vysotsky"

 

The multifaceted talent of Vysotsky is often described by the term "bard" (бард) that Vysotsky has never been enthusiastic about. He thought of himself mainly as an actor and poet rather than a singer, and once remarked, "I do not belong to what people call bards or minstrels or whatever." With the advent of portable tape-recorders in the Soviet Union, Vysotsky's music became available to the masses in the form of home-made reel-to-reel audio tape recordings (later on cassette tapes).

 

Vysotsky accompanied himself on a Russian seven-string guitar, with a raspy voice singing ballads of love, peace, war, everyday Soviet life and of the human condition. He was largely perceived as the voice of honesty, at times sarcastically jabbing at the Soviet government, which made him a target for surveillance and threats. In France, he has been compared with Georges Brassens; in Russia, however, he was more frequently compared with Joe Dassin, partly because they were the same age and died in the same year, although their ideologies, biographies, and musical styles are very different. Vysotsky's lyrics and style greatly influenced Jacek Kaczmarski, a Polish songwriter and singer who touched on similar themes.

 

The songs – over 600 of them – were written about almost any imaginable theme. The earliest were blatnaya pesnya ("outlaw songs"). These songs were based either on the life of the common people in Moscow or on life in the crime people, sometimes in Gulag. Vysotsky slowly grew out of this phase and started singing more serious, though often satirical, songs. Many of these songs were about war. These war songs were not written to glorify war, but rather to expose the listener to the emotions of those in extreme, life-threatening situations. Most Soviet veterans would say that Vysotsky's war songs described the truth of war far more accurately than more official "patriotic" songs.

 

Nearly all of Vysotsky's songs are in the first person, although he is almost never the narrator. When singing his criminal songs, he would adopt the accent and intonation of a Moscow thief, and when singing war songs, he would sing from the point of view of a soldier. In many of his philosophical songs, he adopted the role of inanimate objects. This created some confusion about Vysotsky's background, especially during the early years when information could not be passed around very easily. Using his acting talent, the poet played his role so well that until told otherwise, many of his fans believed that he was, indeed, a criminal or war veteran. Vysotsky's father said that "War veterans thought the author of the songs to be one of them, as if he had participated in the war together with them." The same could be said about mountain climbers; on multiple occasions, Vysotsky was sent pictures of mountain climbers' graves with quotes from his lyrics etched on the tombstones.

 

Not being officially recognized as a poet and singer, Vysotsky performed wherever and whenever he could – in the theater (where he worked), at universities, in private apartments, village clubs, and in the open air. It was not unusual for him to give several concerts in one day. He used to sleep little, using the night hours to write. With few exceptions, he wasn't allowed to publish his recordings with "Melodiya", which held a monopoly on the Soviet music industry. His songs were passed on through amateur, fairly low quality recordings on vinyl discs and magnetic tape, resulting in his immense popularity. Cosmonauts even took his music on cassette into orbit.

 

Musically, virtually all of Vysotsky's songs were written in a minor key, and tended to employ from three to seven chords. Vysotsky composed his songs and played them exclusively on the Russian seven string guitar, often tuned a tone or a tone-and-a-half below the traditional Russian "Open G major" tuning. This guitar, with its specific Russian tuning, makes a slight yet notable difference in chord voicings than the standard tuned six string Spanish (classical) guitar, and it became a staple of his sound. Because Vysotsky tuned down a tone and a half, his strings had less tension, which also colored the sound.

 

His earliest songs were usually written in C minor (with the guitar tuned a tone down from DGBDGBD to CFACFAC)

 

Songs written in this key include "Stars" (Zvyozdy), "My friend left for Magadan" (Moy drug uyekhal v Magadan), and most of his "outlaw songs".

 

At around 1970, Vysotsky began writing and playing exclusively in A minor (guitar tuned to CFACFAC), which he continued doing until his death.

 

Vysotsky used his fingers instead of a pick to pluck and strum, as was the tradition with Russian guitar playing. He used a variety of finger picking and strumming techniques. One of his favorite was to play an alternating bass with his thumb as he plucked or strummed with his other fingers.

 

Often, Vysotsky would neglect to check the tuning of his guitar, which is particularly noticeable on earlier recordings. According to some accounts, Vysotsky would get upset when friends would attempt to tune his guitar, leading some to believe that he preferred to play slightly out of tune as a stylistic choice. Much of this is also attributable to the fact that a guitar that is tuned down more than 1 whole step (Vysotsky would sometimes tune as much as 2 and a half steps down) is prone to intonation problems.

 

Vysotsky had a unique singing style. He had an unusual habit of elongating consonants instead of vowels in his songs. So when a syllable is sung for a prolonged period of time, he would elongate the consonant instead of the vowel in that syllable.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[8] The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.[9][10] As of 26 April 2020, more than 2.89 million cases have been reported across 185 countries and territories, resulting in more than 203,000 deaths. More than 822,000 people have recovered.[7]

 

Common symptoms include fever, cough, fatigue, shortness of breath and loss of smell.[5][11][12] While the majority of cases result in mild symptoms, some progress to viral pneumonia, multi-organ failure, or cytokine storm.[13][9][14] More concerning symptoms include difficulty breathing, persistent chest pain, confusion, difficulty waking, and bluish skin.[5] The time from exposure to onset of symptoms is typically around five days but may range from two to fourteen days.[5][15]

 

The virus is primarily spread between people during close contact,[a] often via small droplets produced by coughing,[b] sneezing, or talking.[6][16][18] The droplets usually fall to the ground or onto surfaces rather than remaining in the air over long distances.[6][19][20] People may also become infected by touching a contaminated surface and then touching their face.[6][16] In experimental settings, the virus may survive on surfaces for up to 72 hours.[21][22][23] It is most contagious during the first three days after the onset of symptoms, although spread may be possible before symptoms appear and in later stages of the disease.[24] The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab.[25] Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using it for routine screening.[26][27]

 

Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), covering coughs, and keeping unwashed hands away from the face.[28][29] In addition, the use of a face covering is recommended for those who suspect they have the virus and their caregivers.[30][31] Recommendations for face covering use by the general public vary, with some authorities recommending against their use, some recommending their use, and others requiring their use.[32][31][33] Currently, there is not enough evidence for or against the use of masks (medical or other) in healthy individuals in the wider community.[6] Also masks purchased by the public may impact availability for health care providers.

 

Currently, there is no vaccine or specific antiviral treatment for COVID-19.[6] Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.[34] The World Health Organization (WHO) declared the 2019–20 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC)[35][36] on 30 January 2020 and a pandemic on 11 March 2020.[10] Local transmission of the disease has occurred in most countries across all six WHO regions.[37]

 

File:En.Wikipedia-VideoWiki-Coronavirus disease 2019.webm

Video summary (script)

 

Contents

1Signs and symptoms

2Cause

2.1Transmission

2.2Virology

3Pathophysiology

3.1Immunopathology

4Diagnosis

4.1Pathology

5Prevention

6Management

6.1Medications

6.2Protective equipment

6.3Mechanical ventilation

6.4Acute respiratory distress syndrome

6.5Experimental treatment

6.6Information technology

6.7Psychological support

7Prognosis

7.1Reinfection

8History

9Epidemiology

9.1Infection fatality rate

9.2Sex differences

10Society and culture

10.1Name

10.2Misinformation

10.3Protests

11Other animals

12Research

12.1Vaccine

12.2Medications

12.3Anti-cytokine storm

12.4Passive antibodies

13See also

14Notes

15References

16External links

16.1Health agencies

16.2Directories

16.3Medical journals

Signs and symptoms

Symptom[4]Range

Fever83–99%

Cough59–82%

Loss of Appetite40–84%

Fatigue44–70%

Shortness of breath31–40%

Coughing up sputum28–33%

Loss of smell15[38] to 30%[12][39]

Muscle aches and pains11–35%

Fever is the most common symptom, although some older people and those with other health problems experience fever later in the disease.[4][40] In one study, 44% of people had fever when they presented to the hospital, while 89% went on to develop fever at some point during their hospitalization.[4][41]

 

Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum production, and muscle and joint pains.[4][5][42][43] Symptoms such as nausea, vomiting and diarrhoea have been observed in varying percentages.[44][45][46] Less common symptoms include sneezing, runny nose, or sore throat.[47]

 

More serious symptoms include difficulty breathing, persistent chest pain or pressure, confusion, difficulty waking, and bluish face or lips. Immediate medical attention is advised if these symptoms are present.[5][48]

 

In some, the disease may progress to pneumonia, multi-organ failure, and death.[9][14] In those who develop severe symptoms, time from symptom onset to needing mechanical ventilation is typically eight days.[4] Some cases in China initially presented with only chest tightness and palpitations.[49]

 

Loss of smell was identified as a common symptom of COVID‑19 in March 2020,[12][39] although perhaps not as common as initially reported.[38] A decreased sense of smell and/or disturbances in taste have also been reported.[50] Estimates for loss of smell range from 15%[38] to 30%.[12][39]

 

As is common with infections, there is a delay between the moment a person is first infected and the time he or she develops symptoms. This is called the incubation period. The incubation period for COVID‑19 is typically five to six days but may range from two to 14 days,[51][52] although 97.5% of people who develop symptoms will do so within 11.5 days of infection.[53]

 

A minority of cases do not develop noticeable symptoms at any point in time.[54][55] These asymptomatic carriers tend not to get tested, and their role in transmission is not yet fully known.[56][57] However, preliminary evidence suggests they may contribute to the spread of the disease.[58][59] In March 2020, the Korea Centers for Disease Control and Prevention (KCDC) reported that 20% of confirmed cases remained asymptomatic during their hospital stay.[59][60]

 

A number of neurological symptoms has been reported including seizures, stroke, encephalitis and Guillain-Barre syndrome.[61] Cardiovascular related complications may include heart failure, irregular electrical activity, blood clots, and heart inflammation.[62]

 

Cause

See also: Severe acute respiratory syndrome coronavirus 2

Transmission

Cough/sneeze droplets visualised in dark background using Tyndall scattering

Respiratory droplets produced when a man is sneezing visualised using Tyndall scattering

File:COVID19 in numbers- R0, the case fatality rate and why we need to flatten the curve.webm

A video discussing the basic reproduction number and case fatality rate in the context of the pandemic

Some details about how the disease is spread are still being determined.[16][18] The WHO and the U.S. Centers for Disease Control and Prevention (CDC) say it is primarily spread during close contact and by small droplets produced when people cough, sneeze or talk;[6][16] with close contact being within approximately 1–2 m (3–7 ft).[6][63] Both sputum and saliva can carry large viral loads.[64] Loud talking releases more droplets than normal talking.[65] A study in Singapore found that an uncovered cough can lead to droplets travelling up to 4.5 metres (15 feet).[66] An article published in March 2020 argued that advice on droplet distance might be based on 1930s research which ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough or sneeze can travel up to 8.2 metres (27 feet).[17]

  

Respiratory droplets may also be produced while breathing out, including when talking. Though the virus is not generally airborne,[6][67] the National Academy of Sciences has suggested that bioaerosol transmission may be possible.[68] In one study cited, air collectors positioned in the hallway outside of people's rooms yielded samples positive for viral RNA but finding infectious virus has proven elusive.[68] The droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.[16] Some medical procedures such as intubation and cardiopulmonary resuscitation (CPR) may cause respiratory secretions to be aerosolised and thus result in an airborne spread.[67] Initial studies suggested a doubling time of the number of infected persons of 6–7 days and a basic reproduction number (R0 ) of 2.2–2.7, but a study published on April 7, 2020, calculated a much higher median R0 value of 5.7 in Wuhan.[69]

 

It may also spread when one touches a contaminated surface, known as fomite transmission, and then touches one's eyes, nose or mouth.[6] While there are concerns it may spread via faeces, this risk is believed to be low.[6][16]

 

The virus is most contagious when people are symptomatic; though spread is may be possible before symptoms emerge and from those who never develop symptoms.[6][70] A portion of individuals with coronavirus lack symptoms.[71] The European Centre for Disease Prevention and Control (ECDC) says while it is not entirely clear how easily the disease spreads, one person generally infects two or three others.[18]

 

The virus survives for hours to days on surfaces.[6][18] Specifically, the virus was found to be detectable for one day on cardboard, for up to three days on plastic (polypropylene) and stainless steel (AISI 304), and for up to four hours on 99% copper.[21][23] This, however, varies depending on the humidity and temperature.[72][73] Surfaces may be decontaminated with many solutions (with one minute of exposure to the product achieving a 4 or more log reduction (99.99% reduction)), including 78–95% ethanol (alcohol used in spirits), 70–100% 2-propanol (isopropyl alcohol), the combination of 45% 2-propanol with 30% 1-propanol, 0.21% sodium hypochlorite (bleach), 0.5% hydrogen peroxide, or 0.23–7.5% povidone-iodine. Soap and detergent are also effective if correctly used; soap products degrade the virus' fatty protective layer, deactivating it, as well as freeing them from the skin and other surfaces.[74] Other solutions, such as benzalkonium chloride and chlorhexidine gluconate (a surgical disinfectant), are less effective.[75]

 

In a Hong Kong study, saliva samples were taken a median of two days after the start of hospitalization. In five of six patients, the first sample showed the highest viral load, and the sixth patient showed the highest viral load on the second day tested.[64]

 

Virology

Main article: Severe acute respiratory syndrome coronavirus 2

 

Illustration of SARSr-CoV virion

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus, first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[76] All features of the novel SARS-CoV-2 virus occur in related coronaviruses in nature.[77] Outside the human body, the virus is killed by household soap, which bursts its protective bubble.[26]

 

SARS-CoV-2 is closely related to the original SARS-CoV.[78] It is thought to have a zoonotic origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[47] In February 2020, Chinese researchers found that there is only one amino acid difference in the binding domain of the S protein between the coronaviruses from pangolins and those from humans; however, whole-genome comparison to date found that at most 92% of genetic material was shared between pangolin coronavirus and SARS-CoV-2, which is insufficient to prove pangolins to be the intermediate host.[79]

 

Pathophysiology

The lungs are the organs most affected by COVID‑19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell.[80] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and some have suggested that decreasing ACE2 activity might be protective,[81][82] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective and these hypotheses need to be tested.[83] As the alveolar disease progresses, respiratory failure might develop and death may follow.[82]

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[84] as well as endothelial cells and enterocytes of the small intestine.[85]

 

ACE2 is present in the brain, and there is growing evidence of neurological manifestations in people with COVID‑19. It is not certain if the virus can directly infect the brain by crossing the barriers that separate the circulation of the brain and the general circulation. Other coronaviruses are able to infect the brain via a synaptic route to the respiratory centre in the medulla, through mechanoreceptors like pulmonary stretch receptors and chemoreceptors (primarily central chemoreceptors) within the lungs.[medical citation needed] It is possible that dysfunction within the respiratory centre further worsens the ARDS seen in COVID‑19 patients. Common neurological presentations include a loss of smell, headaches, nausea, and vomiting. Encephalopathy has been noted to occur in some patients (and confirmed with imaging), with some reports of detection of the virus after cerebrospinal fluid assays although the presence of oligoclonal bands seems to be a common denominator in these patients.[86]

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[87] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[88] and is more frequent in severe disease.[89] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.[87] ACE2 receptors are highly expressed in the heart and are involved in heart function.[87][90] A high incidence of thrombosis (31%) and venous thromboembolism (25%) have been found in ICU patients with COVID‑19 infections and may be related to poor prognosis.[91][92] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in patients infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside with the presentation of viral pneumonia.[93]

 

Another common cause of death is complications related to the kidneys[93]—SARS-CoV-2 directly infects kidney cells, as confirmed in post-mortem studies. Acute kidney injury is a common complication and cause of death; this is more significant in patients with already compromised kidney function, especially in people with pre-existing chronic conditions such as hypertension and diabetes which specifically cause nephropathy in the long run.[94]

 

Autopsies of people who died of COVID‑19 have found diffuse alveolar damage (DAD), and lymphocyte-containing inflammatory infiltrates within the lung.[95]

 

Immunopathology

Although SARS-COV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, patients with severe COVID‑19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[96]

 

Additionally, people with COVID‑19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.[97]

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in COVID‑19 patients.[98] Lymphocytic infiltrates have also been reported at autopsy.[95]

 

Diagnosis

Main article: COVID-19 testing

 

Demonstration of a nasopharyngeal swab for COVID-19 testing

 

CDC rRT-PCR test kit for COVID-19[99]

The WHO has published several testing protocols for the disease.[100] The standard method of testing is real-time reverse transcription polymerase chain reaction (rRT-PCR).[101] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[25][102] Results are generally available within a few hours to two days.[103][104] Blood tests can be used, but these require two blood samples taken two weeks apart, and the results have little immediate value.[105] Chinese scientists were able to isolate a strain of the coronavirus and publish the genetic sequence so laboratories across the world could independently develop polymerase chain reaction (PCR) tests to detect infection by the virus.[9][106][107] As of 4 April 2020, antibody tests (which may detect active infections and whether a person had been infected in the past) were in development, but not yet widely used.[108][109][110] The Chinese experience with testing has shown the accuracy is only 60 to 70%.[111] The FDA in the United States approved the first point-of-care test on 21 March 2020 for use at the end of that month.[112]

 

Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for detecting infections based upon clinical features and epidemiological risk. These involved identifying people who had at least two of the following symptoms in addition to a history of travel to Wuhan or contact with other infected people: fever, imaging features of pneumonia, normal or reduced white blood cell count, or reduced lymphocyte count.[113]

 

A study asked hospitalised COVID‑19 patients to cough into a sterile container, thus producing a saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has the potential of being quicker than a swab and involving less risk to health care workers (collection at home or in the car).[64]

 

Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.[26][27] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[26] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[26][114]

 

In late 2019, WHO assigned the emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID‑19 without lab-confirmed SARS-CoV-2 infection.[115]

  

Typical CT imaging findings

 

CT imaging of rapid progression stage

Pathology

Few data are available about microscopic lesions and the pathophysiology of COVID‑19.[116][117] The main pathological findings at autopsy are:

 

Macroscopy: pleurisy, pericarditis, lung consolidation and pulmonary oedema

Four types of severity of viral pneumonia can be observed:

minor pneumonia: minor serous exudation, minor fibrin exudation

mild pneumonia: pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

severe pneumonia: diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

healing pneumonia: organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL[118]

Blood: disseminated intravascular coagulation (DIC);[119] leukoerythroblastic reaction[120]

Liver: microvesicular steatosis

Prevention

See also: 2019–20 coronavirus pandemic § Prevention, flatten the curve, and workplace hazard controls for COVID-19

 

Progressively stronger mitigation efforts to reduce the number of active cases at any given time—known as "flattening the curve"—allows healthcare services to better manage the same volume of patients.[121][122][123] Likewise, progressively greater increases in healthcare capacity—called raising the line—such as by increasing bed count, personnel, and equipment, helps to meet increased demand.[124]

 

Mitigation attempts that are inadequate in strictness or duration—such as premature relaxation of distancing rules or stay-at-home orders—can allow a resurgence after the initial surge and mitigation.[122][125]

Preventive measures to reduce the chances of infection include staying at home, avoiding crowded places, keeping distance from others, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[126][127][128] The CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available.[126] Proper hand hygiene after any cough or sneeze is encouraged.[126] The CDC has recommended the use of cloth face coverings in public settings where other social distancing measures are difficult to maintain, in part to limit transmission by asymptomatic individuals.[129] The U.S. National Institutes of Health guidelines do not recommend any medication for prevention of COVID‑19, before or after exposure to the SARS-CoV-2 virus, outside of the setting of a clinical trial.[130]

 

Social distancing strategies aim to reduce contact of infected persons with large groups by closing schools and workplaces, restricting travel, and cancelling large public gatherings.[131] Distancing guidelines also include that people stay at least 6 feet (1.8 m) apart.[132] There is no medication known to be effective at preventing COVID‑19.[133] After the implementation of social distancing and stay-at-home orders, many regions have been able to sustain an effective transmission rate ("Rt") of less than one, meaning the disease is in remission in those areas.[134]

 

As a vaccine is not expected until 2021 at the earliest,[135] a key part of managing COVID‑19 is trying to decrease the epidemic peak, known as "flattening the curve".[122] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.[122][125]

 

According to the WHO, the use of masks is recommended only if a person is coughing or sneezing or when one is taking care of someone with a suspected infection.[136] For the European Centre for Disease Prevention and Control (ECDC) face masks "... could be considered especially when visiting busy closed spaces ..." but "... only as a complementary measure ..."[137] Several countries have recommended that healthy individuals wear face masks or cloth face coverings (like scarves or bandanas) at least in certain public settings, including China,[138] Hong Kong,[139] Spain,[140] Italy (Lombardy region),[141] and the United States.[129]

 

Those diagnosed with COVID‑19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[30][142] The CDC also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose, coughing or sneezing. It further recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[126]

 

For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.[143]

  

Prevention efforts are multiplicative, with effects far beyond that of a single spread. Each avoided case leads to more avoided cases down the line, which in turn can stop the outbreak in its tracks.

 

File:COVID19 W ENG.ogv

Handwashing instructions

Management

People are managed with supportive care, which may include fluid therapy, oxygen support, and supporting other affected vital organs.[144][145][146] The CDC recommends that those who suspect they carry the virus wear a simple face mask.[30] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[41][147] Personal hygiene and a healthy lifestyle and diet have been recommended to improve immunity.[148] Supportive treatments may be useful in those with mild symptoms at the early stage of infection.[149]

 

The WHO, the Chinese National Health Commission, and the United States' National Institutes of Health have published recommendations for taking care of people who are hospitalised with COVID‑19.[130][150][151] Intensivists and pulmonologists in the U.S. have compiled treatment recommendations from various agencies into a free resource, the IBCC.[152][153]

 

Medications

See also: Coronavirus disease 2019 § Research

As of April 2020, there is no specific treatment for COVID‑19.[6][133] Research is, however, ongoing. For symptoms, some medical professionals recommend paracetamol (acetaminophen) over ibuprofen for first-line use.[154][155][156] The WHO and NIH do not oppose the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for symptoms,[130][157] and the FDA says currently there is no evidence that NSAIDs worsen COVID‑19 symptoms.[158]

 

While theoretical concerns have been raised about ACE inhibitors and angiotensin receptor blockers, as of 19 March 2020, these are not sufficient to justify stopping these medications.[130][159][160][161] Steroids, such as methylprednisolone, are not recommended unless the disease is complicated by acute respiratory distress syndrome.[162][163]

 

Medications to prevent blood clotting have been suggested for treatment,[91] and anticoagulant therapy with low molecular weight heparin appears to be associated with better outcomes in severe COVID‐19 showing signs of coagulopathy (elevated D-dimer).[164]

 

Protective equipment

See also: COVID-19 related shortages

 

The CDC recommends four steps to putting on personal protective equipment (PPE).[165]

Precautions must be taken to minimise the risk of virus transmission, especially in healthcare settings when performing procedures that can generate aerosols, such as intubation or hand ventilation.[166] For healthcare professionals caring for people with COVID‑19, the CDC recommends placing the person in an Airborne Infection Isolation Room (AIIR) in addition to using standard precautions, contact precautions, and airborne precautions.[167]

 

The CDC outlines the guidelines for the use of personal protective equipment (PPE) during the pandemic. The recommended gear is a PPE gown, respirator or facemask, eye protection, and medical gloves.[168][169]

 

When available, respirators (instead of facemasks) are preferred.[170] N95 respirators are approved for industrial settings but the FDA has authorised the masks for use under an Emergency Use Authorisation (EUA). They are designed to protect from airborne particles like dust but effectiveness against a specific biological agent is not guaranteed for off-label uses.[171] When masks are not available, the CDC recommends using face shields or, as a last resort, homemade masks.[172]

 

Mechanical ventilation

Most cases of COVID‑19 are not severe enough to require mechanical ventilation or alternatives, but a percentage of cases are.[173][174] The type of respiratory support for individuals with COVID‑19 related respiratory failure is being actively studied for people in the hospital, with some evidence that intubation can be avoided with a high flow nasal cannula or bi-level positive airway pressure.[175] Whether either of these two leads to the same benefit for people who are critically ill is not known.[176] Some doctors prefer staying with invasive mechanical ventilation when available because this technique limits the spread of aerosol particles compared to a high flow nasal cannula.[173]

 

Severe cases are most common in older adults (those older than 60 years,[173] and especially those older than 80 years).[177] Many developed countries do not have enough hospital beds per capita, which limits a health system's capacity to handle a sudden spike in the number of COVID‑19 cases severe enough to require hospitalisation.[178] This limited capacity is a significant driver behind calls to flatten the curve.[178] One study in China found 5% were admitted to intensive care units, 2.3% needed mechanical support of ventilation, and 1.4% died.[41] In China, approximately 30% of people in hospital with COVID‑19 are eventually admitted to ICU.[4]

 

Acute respiratory distress syndrome

Main article: Acute respiratory distress syndrome

Mechanical ventilation becomes more complex as acute respiratory distress syndrome (ARDS) develops in COVID‑19 and oxygenation becomes increasingly difficult.[179] Ventilators capable of pressure control modes and high PEEP[180] are needed to maximise oxygen delivery while minimising the risk of ventilator-associated lung injury and pneumothorax.[181] High PEEP may not be available on older ventilators.

 

Options for ARDS[179]

TherapyRecommendations

High-flow nasal oxygenFor SpO2 <93%. May prevent the need for intubation and ventilation

Tidal volume6mL per kg and can be reduced to 4mL/kg

Plateau airway pressureKeep below 30 cmH2O if possible (high respiratory rate (35 per minute) may be required)

Positive end-expiratory pressureModerate to high levels

Prone positioningFor worsening oxygenation

Fluid managementGoal is a negative balance of 0.5–1.0L per day

AntibioticsFor secondary bacterial infections

GlucocorticoidsNot recommended

Experimental treatment

See also: § Research

Research into potential treatments started in January 2020,[182] and several antiviral drugs are in clinical trials.[183][184] Remdesivir appears to be the most promising.[133] Although new medications may take until 2021 to develop,[185] several of the medications being tested are already approved for other uses or are already in advanced testing.[186] Antiviral medication may be tried in people with severe disease.[144] The WHO recommended volunteers take part in trials of the effectiveness and safety of potential treatments.[187]

 

The FDA has granted temporary authorisation to convalescent plasma as an experimental treatment in cases where the person's life is seriously or immediately threatened. It has not undergone the clinical studies needed to show it is safe and effective for the disease.[188][189][190]

 

Information technology

See also: Contact tracing and Government by algorithm

In February 2020, China launched a mobile app to deal with the disease outbreak.[191] Users are asked to enter their name and ID number. The app can detect 'close contact' using surveillance data and therefore a potential risk of infection. Every user can also check the status of three other users. If a potential risk is detected, the app not only recommends self-quarantine, it also alerts local health officials.[192]

 

Big data analytics on cellphone data, facial recognition technology, mobile phone tracking, and artificial intelligence are used to track infected people and people whom they contacted in South Korea, Taiwan, and Singapore.[193][194] In March 2020, the Israeli government enabled security agencies to track mobile phone data of people supposed to have coronavirus. The measure was taken to enforce quarantine and protect those who may come into contact with infected citizens.[195] Also in March 2020, Deutsche Telekom shared aggregated phone location data with the German federal government agency, Robert Koch Institute, to research and prevent the spread of the virus.[196] Russia deployed facial recognition technology to detect quarantine breakers.[197] Italian regional health commissioner Giulio Gallera said he has been informed by mobile phone operators that "40% of people are continuing to move around anyway".[198] German government conducted a 48 hours weekend hackathon with more than 42.000 participants.[199][200] Two million people in the UK used an app developed in March 2020 by King's College London and Zoe to track people with COVID‑19 symptoms.[201] Also, the president of Estonia, Kersti Kaljulaid, made a global call for creative solutions against the spread of coronavirus.[202]

 

Psychological support

See also: Mental health during the 2019–20 coronavirus pandemic

Individuals may experience distress from quarantine, travel restrictions, side effects of treatment, or fear of the infection itself. To address these concerns, the National Health Commission of China published a national guideline for psychological crisis intervention on 27 January 2020.[203][204]

 

The Lancet published a 14-page call for action focusing on the UK and stated conditions were such that a range of mental health issues was likely to become more common. BBC quoted Rory O'Connor in saying, "Increased social isolation, loneliness, health anxiety, stress and an economic downturn are a perfect storm to harm people's mental health and wellbeing."[205][206]

 

Prognosis

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The severity of diagnosed cases in China

The severity of diagnosed COVID-19 cases in China[207]

Case fatality rates for COVID-19 by age by country.

Case fatality rates by age group:

China, as of 11 February 2020[208]

South Korea, as of 15 April 2020[209]

Spain, as of 24 April 2020[210]

Italy, as of 23 April 2020[211]

Case fatality rate depending on other health problems

Case fatality rate in China depending on other health problems. Data through 11 February 2020.[208]

Case fatality rate by country and number of cases

The number of deaths vs total cases by country and approximate case fatality rate[212]

The severity of COVID‑19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[47]

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years, and 4% aged 10-19 years.[22] They are likely to have milder symptoms and a lower chance of severe disease than adults; in those younger than 50 years, the risk of death is less than 0.5%, while in those older than 70 it is more than 8%.[213][214][215] Pregnant women may be at higher risk for severe infection with COVID-19 based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[216][217] In China, children acquired infections mainly through close contact with their parents or other family members who lived in Wuhan or had traveled there.[213]

 

In some people, COVID‑19 may affect the lungs causing pneumonia. In those most severely affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing respiratory failure, septic shock, or multi-organ failure.[218][219] Complications associated with COVID‑19 include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting abnormalities, specifically an increase in prothrombin time, have been described in 6% of those admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.[220] Approximately 20-30% of people who present with COVID‑19 demonstrate elevated liver enzymes (transaminases).[133] Liver injury as shown by blood markers of liver damage is frequently seen in severe cases.[221]

 

Some studies have found that the neutrophil to lymphocyte ratio (NLR) may be helpful in early screening for severe illness.[222]

 

Most of those who die of COVID‑19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[223] The Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available for review, 97.2% of sampled patients had at least one comorbidity with the average patient having 2.7 diseases.[224] According to the same report, the median time between the onset of symptoms and death was ten days, with five being spent hospitalised. However, patients transferred to an ICU had a median time of seven days between hospitalisation and death.[224] In a study of early cases, the median time from exhibiting initial symptoms to death was 14 days, with a full range of six to 41 days.[225] In a study by the National Health Commission (NHC) of China, men had a death rate of 2.8% while women had a death rate of 1.7%.[226] Histopathological examinations of post-mortem lung samples show diffuse alveolar damage with cellular fibromyxoid exudates in both lungs. Viral cytopathic changes were observed in the pneumocytes. The lung picture resembled acute respiratory distress syndrome (ARDS).[47] In 11.8% of the deaths reported by the National Health Commission of China, heart damage was noted by elevated levels of troponin or cardiac arrest.[49] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[227]

 

The availability of medical resources and the socioeconomics of a region may also affect mortality.[228] Estimates of the mortality from the condition vary because of those regional differences,[229] but also because of methodological difficulties. The under-counting of mild cases can cause the mortality rate to be overestimated.[230] However, the fact that deaths are the result of cases contracted in the past can mean the current mortality rate is underestimated.[231][232] Smokers were 1.4 times more likely to have severe symptoms of COVID‑19 and approximately 2.4 times more likely to require intensive care or die compared to non-smokers.[233]

 

Concerns have been raised about long-term sequelae of the disease. The Hong Kong Hospital Authority found a drop of 20% to 30% in lung capacity in some people who recovered from the disease, and lung scans suggested organ damage.[234] This may also lead to post-intensive care syndrome following recovery.[235]

 

Case fatality rates (%) by age and country

Age0–910–1920–2930–3940–4950–5960–6970–7980-8990+

China as of 11 February[208]0.00.20.20.20.41.33.68.014.8

Denmark as of 25 April[236]0.24.515.524.940.7

Italy as of 23 April[211]0.20.00.10.40.92.610.024.930.826.1

Netherlands as of 17 April[237]0.00.30.10.20.51.57.623.230.029.3

Portugal as of 24 April[238]0.00.00.00.00.30.62.88.516.5

S. Korea as of 15 April[209]0.00.00.00.10.20.72.59.722.2

Spain as of 24 April[210]0.30.40.30.30.61.34.413.220.320.1

Switzerland as of 25 April[239]0.90.00.00.10.00.52.710.124.0

Case fatality rates (%) by age in the United States

Age0–1920–4445–5455–6465–7475–8485+

United States as of 16 March[240]0.00.1–0.20.5–0.81.4–2.62.7–4.94.3–10.510.4–27.3

Note: The lower bound includes all cases. The upper bound excludes cases that were missing data.

Estimate of infection fatality rates and probability of severe disease course (%) by age based on cases from China[241]

0–910–1920–2930–3940–4950–5960–6970–7980+

Severe disease0.0

(0.0–0.0)0.04

(0.02–0.08)1.0

(0.62–2.1)3.4

(2.0–7.0)4.3

(2.5–8.7)8.2

(4.9–17)11

(7.0–24)17

(9.9–34)18

(11–38)

Death0.0016

(0.00016–0.025)0.0070

(0.0015–0.050)0.031

(0.014–0.092)0.084

(0.041–0.19)0.16

(0.076–0.32)0.60

(0.34–1.3)1.9

(1.1–3.9)4.3

(2.5–8.4)7.8

(3.8–13)

Total infection fatality rate is estimated to be 0.66% (0.39–1.3). Infection fatality rate is fatality per all infected individuals, regardless of whether they were diagnosed or had any symptoms. Numbers in parentheses are 95% credible intervals for the estimates.

Reinfection

As of March 2020, it was unknown if past infection provides effective and long-term immunity in people who recover from the disease.[242] Immunity is seen as likely, based on the behaviour of other coronaviruses,[243] but cases in which recovery from COVID‑19 have been followed by positive tests for coronavirus at a later date have been reported.[244][245][246][247] These cases are believed to be worsening of a lingering infection rather than re-infection.[247]

 

History

Main article: Timeline of the 2019–20 coronavirus pandemic

The virus is thought to be natural and has an animal origin,[77] through spillover infection.[248] The actual origin is unknown, but by December 2019 the spread of infection was almost entirely driven by human-to-human transmission.[208][249] A study of the first 41 cases of confirmed COVID‑19, published in January 2020 in The Lancet, revealed the earliest date of onset of symptoms as 1 December 2019.[250][251][252] Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019.[253] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[254][255]

 

Epidemiology

Main article: 2019–20 coronavirus pandemic

Several measures are commonly used to quantify mortality.[256] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.[257]

 

The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 7.0% (203,044/2,899,830) as of 26 April 2020.[7] The number varies by region.[258]

 

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed individuals who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected individuals (diagnosed and undiagnosed) who die from a disease. These statistics are not time-bound and follow a specific population from infection through case resolution. Many academics have attempted to calculate these numbers for specific populations.[259]

  

Total confirmed cases over time

 

Total deaths over time

 

Total confirmed cases of COVID‑19 per million people, 10 April 2020[260]

 

Total confirmed deaths due to COVID‑19 per million people, 10 April 2020[261]

Infection fatality rate

Our World in Data states that as of March 25, 2020, the infection fatality rate (IFR) cannot be accurately calculated.[262] In February, the World Health Organization estimated the IFR at 0.94%, with a confidence interval between 0.37 percent to 2.9 percent.[263] The University of Oxford Centre for Evidence-Based Medicine (CEBM) estimated a global CFR of 0.72 percent and IFR of 0.1 percent to 0.36 percent.[264] According to CEBM, random antibody testing in Germany suggested an IFR of 0.37 percent there.[264] Firm lower limits to local infection fatality rates were established, such as in Bergamo province, where 0.57% of the population has died, leading to a minimum IFR of 0.57% in the province. This population fatality rate (PFR) minimum increases as more people get infected and run through their disease.[265][266] Similarly, as of April 22 in the New York City area, there were 15,411 deaths confirmed from COVID-19, and 19,200 excess deaths.[267] Very recently, the first results of antibody testing have come in, but there are no valid scientific reports based on them available yet. A Bloomberg Opinion piece provides a survey.[268][269]

 

Sex differences

Main article: Gendered impact of the 2019–20 coronavirus pandemic

The impact of the pandemic and its mortality rate are different for men and women.[270] Mortality is higher in men in studies conducted in China and Italy.[271][272][273] The highest risk for men is in their 50s, with the gap between men and women closing only at 90.[273] In China, the death rate was 2.8 percent for men and 1.7 percent for women.[273] The exact reasons for this sex-difference are not known, but genetic and behavioural factors could be a reason.[270] Sex-based immunological differences, a lower prevalence of smoking in women, and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men.[273] In Europe, of those infected with COVID‑19, 57% were men; of those infected with COVID‑19 who also died, 72% were men.[274] As of April 2020, the U.S. government is not tracking sex-related data of COVID‑19 infections.[275] Research has shown that viral illnesses like Ebola, HIV, influenza, and SARS affect men and women differently.[275] A higher percentage of health workers, particularly nurses, are women, and they have a higher chance of being exposed to the virus.[276] School closures, lockdowns, and reduced access to healthcare following the 2019–20 coronavirus pandemic may differentially affect the genders and possibly exaggerate existing gender disparity.[270][277]

 

Society and culture

Name

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",[278][279][280] with the disease sometimes called "Wuhan pneumonia".[281][282] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[283] Middle East Respiratory Syndrome, and Zika virus.[284]

 

In January 2020, the World Health Organisation recommended 2019-nCov[285] and 2019-nCoV acute respiratory disease[286] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species or groups of people in disease and virus names to prevent social stigma.[287][288][289]

 

The official names COVID‑19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.[290] WHO chief Tedros Adhanom Ghebreyesus explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019).[291] The WHO additionally uses "the COVID‑19 virus" and "the virus responsible for COVID‑19" in public communications.[290] Both the disease and virus are commonly referred to as "coronavirus" in the media and public discourse.

 

Misinformation

Main article: Misinformation related to the 2019–20 coronavirus pandemic

After the initial outbreak of COVID‑19, conspiracy theories, misinformation, and disinformation emerged regarding the origin, scale, prevention, treatment, and other aspects of the disease and rapidly spread online.[292][293][294][295]

 

Protests

Beginning April 17, 2020, news media began reporting on a wave of demonstrations protesting against state-mandated quarantine restrictions in in Michigan, Ohio, and Kentucky.[296][297]

 

Other animals

Humans appear to be capable of spreading the virus to some other animals. A domestic cat in Liège, Belgium, tested positive after it started showing symptoms (diarrhoea, vomiting, shortness of breath) a week later than its owner, who was also positive.[298] Tigers at the Bronx Zoo in New York, United States, tested positive for the virus and showed symptoms of COVID‑19, including a dry cough and loss of appetite.[299]

 

A study on domesticated animals inoculated with the virus found that cats and ferrets appear to be "highly susceptible" to the disease, while dogs appear to be less susceptible, with lower levels of viral replication. The study failed to find evidence of viral replication in pigs, ducks, and chickens.[300]

 

Research

Main article: COVID-19 drug development

No medication or vaccine is approved to treat the disease.[186] International research on vaccines and medicines in COVID‑19 is underway by government organisations, academic groups, and industry researchers.[301][302] In March, the World Health Organisation initiated the "SOLIDARITY Trial" to assess the treatment effects of four existing antiviral compounds with the most promise of efficacy.[303]

 

Vaccine

Main article: COVID-19 vaccine

There is no available vaccine, but various agencies are actively developing vaccine candidates. Previous work on SARS-CoV is being used because both SARS-CoV and SARS-CoV-2 use the ACE2 receptor to enter human cells.[304] Three vaccination strategies are being investigated. First, researchers aim to build a whole virus vaccine. The use of such a virus, be it inactive or dead, aims to elicit a prompt immune response of the human body to a new infection with COVID‑19. A second strategy, subunit vaccines, aims to create a vaccine that sensitises the immune system to certain subunits of the virus. In the case of SARS-CoV-2, such research focuses on the S-spike protein that helps the virus intrude the ACE2 enzyme receptor. A third strategy is that of the nucleic acid vaccines (DNA or RNA vaccines, a novel technique for creating a vaccination). Experimental vaccines from any of these strategies would have to be tested for safety and efficacy.[305]

 

On 16 March 2020, the first clinical trial of a vaccine started with four volunteers in Seattle, United States. The vaccine contains a harmless genetic code copied from the virus that causes the disease.[306]

 

Antibody-dependent enhancement has been suggested as a potential challenge for vaccine development for SARS-COV-2, but this is controversial.[307]

 

Medications

Main article: COVID-19 drug repurposing research

At least 29 phase II–IV efficacy trials in COVID‑19 were concluded in March 2020 or scheduled to provide results in April from hospitals in China.[308][309] There are more than 300 active clinical trials underway as of April 2020.[133] Seven trials were evaluating already approved treatments, including four studies on hydroxychloroquine or chloroquine.[309] Repurposed antiviral drugs make up most of the Chinese research, with nine phase III trials on remdesivir across several countries due to report by the end of April.[308][309] Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.[309]

 

The COVID‑19 Clinical Research Coalition has goals to 1) facilitate rapid reviews of clinical trial proposals by ethics committees and national regulatory agencies, 2) fast-track approvals for the candidate therapeutic compounds, 3) ensure standardised and rapid analysis of emerging efficacy and safety data and 4) facilitate sharing of clinical trial outcomes before publication.[310][311]

 

Several existing medications are being evaluated for the treatment of COVID‑19,[186] including remdesivir, chloroquine, hydroxychloroquine, lopinavir/ritonavir, and lopinavir/ritonavir combined with interferon beta.[303][312] There is tentative evidence for efficacy by remdesivir, as of March 2020.[313][314] Clinical improvement was observed in patients treated with compassionate-use remdesivir.[315] Remdesivir inhibits SARS-CoV-2 in vitro.[316] Phase III clinical trials are underway in the U.S., China, and Italy.[186][308][317]

 

In 2020, a trial found that lopinavir/ritonavir was ineffective in the treatment of severe illness.[318] Nitazoxanide has been recommended for further in vivo study after demonstrating low concentration inhibition of SARS-CoV-2.[316]

 

There are mixed results as of 3 April 2020 as to the effectiveness of hydroxychloroquine as a treatment for COVID‑19, with some studies showing little or no improvement.[319][320] The studies of chloroquine and hydroxychloroquine with or without azithromycin have major limitations that have prevented the medical community from embracing these therapies without further study.[133]

 

Oseltamivir does not inhibit SARS-CoV-2 in vitro and has no known role in COVID‑19 treatment.[133]

 

Anti-cytokine storm

Cytokine release syndrome (CRS) can be a complication in the later stages of severe COVID‑19. There is preliminary evidence that hydroxychloroquine may have anti-cytokine storm properties.[321]

 

Tocilizumab has been included in treatment guidelines by China's National Health Commission after a small study was completed.[322][323] It is undergoing a phase 2 non-randomised trial at the national level in Italy after showing positive results in people with severe disease.[324][325] Combined with a serum ferritin blood test to identify cytokine storms, it is meant to counter such developments, which are thought to be the cause of death in some affected people.[326][327][328] The interleukin-6 receptor antagonist was approved by the FDA to undergo a phase III clinical trial assessing the medication's impact on COVID‑19 based on retrospective case studies for the treatment of steroid-refractory cytokine release syndrome induced by a different cause, CAR T cell therapy, in 2017.[329] To date, there is no randomised, controlled evidence that tocilizumab is an efficacious treatment for CRS. Prophylactic tocilizumab has been shown to increase serum IL-6 levels by saturating the IL-6R, driving IL-6 across the blood-brain barrier, and exacerbating neurotoxicity while having no impact on the incidence of CRS.[330]

 

Lenzilumab, an anti-GM-CSF monoclonal antibody, is protective in murine models for CAR T cell-induced CRS and neurotoxicity and is a viable therapeutic option due to the observed increase of pathogenic GM-CSF secreting T-cells in hospitalised patients with COVID‑19.[331]

 

The Feinstein Institute of Northwell Health announced in March a study on "a human antibody that may prevent the activity" of IL-6.[332]

 

Passive antibodies

Transferring purified and concentrated antibodies produced by the immune systems of those who have recovered from COVID‑19 to people who need them is being investigated as a non-vaccine method of passive immunisation.[333] This strategy was tried for SARS with inconclusive results.[333] Viral neutralisation is the anticipated mechanism of action by which passive antibody therapy can mediate defence against SARS-CoV-2. Other mechanisms, however, such as antibody-dependent cellular cytotoxicity and/or phagocytosis, may be possible.[333] Other forms of passive antibody therapy, for example, using manufactured monoclonal antibodies, are in development.[333] Production of convalescent serum, which consists of the liquid portion of the blood from recovered patients and contains antibodies specific to this virus, could be increased for quicker deployment.[334]

  

en.wikipedia.org/wiki/Coronavirus_disease_2019

Vladimir Semyonovich Vysotsky (Russian: Владимир Семёнович Высоцкий, IPA: [vlɐˈdʲimʲɪr sʲɪˈmʲɵnəvʲɪtɕ vɨˈsotskʲɪj]; 25 January 1938 – 25 July 1980), was a Soviet singer-songwriter, poet, and actor who had an immense and enduring effect on Soviet culture. He became widely known for his unique singing style and for his lyrics, which featured social and political commentary in often humorous street-jargon. He was also a prominent stage- and screen-actor. Though the official Soviet cultural establishment largely ignored his work, he was remarkably popular during his lifetime, and to this day exerts significant influence on many of Russia's musicians and actors.

 

Vysotsky was born in Moscow at the 3rd Meshchanskaya St. (61/2) maternity hospital. His father, Semyon Volfovich (Vladimirovich) (1915–1997), was a colonel in the Soviet army, originally from Kiev. Vladimir's mother, Nina Maksimovna, (née Seryogina, 1912–2003) was Russian, and worked as a German language translator.[3] Vysotsky's family lived in a Moscow communal flat in harsh conditions, and had serious financial difficulties. When Vladimir was 10 months old, Nina had to return to her office in the Transcript bureau of the Soviet Ministry of Geodesy and Cartography (engaged in making German maps available for the Soviet military) so as to help her husband earn their family's living.

 

Vladimir's theatrical inclinations became obvious at an early age, and were supported by his paternal grandmother Dora Bronshteyn, a theater fan. The boy used to recite poems, standing on a chair and "flinging hair backwards, like a real poet," often using in his public speeches expressions he could hardly have heard at home. Once, at the age of two, when he had tired of the family's guests' poetry requests, he, according to his mother, sat himself under the New-year tree with a frustrated air about him and sighed: "You silly tossers! Give a child some respite!" His sense of humor was extraordinary, but often baffling for people around him. A three-year-old could jeer his father in a bathroom with unexpected poetic improvisation ("Now look what's here before us / Our goat's to shave himself!") or appall unwanted guests with some street folk song, promptly steering them away. Vysotsky remembered those first three years of his life in the autobiographical Ballad of Childhood (Баллада о детстве, 1975), one of his best-known songs.

 

As World War II broke out, Semyon Vysotsky, a military reserve officer, joined the Soviet army and went to fight the Nazis. Nina and Vladimir were evacuated to the village of Vorontsovka, in Orenburg Oblast where the boy had to spend six days a week in a kindergarten and his mother worked for twelve hours a day in a chemical factory. In 1943, both returned to their Moscow apartment at 1st Meschanskaya St., 126. In September 1945, Vladimir joined the 1st class of the 273rd Moscow Rostokino region School.

 

In December 1946, Vysotsky's parents divorced. From 1947 to 1949, Vladimir lived with Semyon Vladimirovich (then an army Major) and his Armenian wife, Yevgenya Stepanovna Liholatova, whom the boy called "aunt Zhenya", at a military base in Eberswalde in the Soviet-occupied zone of Germany (later East Germany). "We decided that our son would stay with me. Vladimir came to stay with me in January 1947, and my second wife, Yevgenia, became Vladimir's second mother for many years to come. They had much in common and liked each other, which made me really happy," Semyon Vysotsky later remembered. Here living conditions, compared to those of Nina's communal Moscow flat, were infinitely better; the family occupied the whole floor of a two-storeyed house, and the boy had a room to himself for the first time in his life. In 1949 along with his stepmother Vladimir returned to Moscow. There he joined the 5th class of the Moscow 128th School and settled at Bolshoy Karetny [ru], 15 (where they had to themselves two rooms of a four-roomed flat), with "auntie Zhenya" (who was just 28 at the time), a woman of great kindness and warmth whom he later remembered as his second mother. In 1953 Vysotsky, now much interested in theater and cinema, joined the Drama courses led by Vladimir Bogomolov.[7] "No one in my family has had anything to do with arts, no actors or directors were there among them. But my mother admired theater and from the earliest age... each and every Saturday I've been taken up with her to watch one play or the other. And all of this, it probably stayed with me," he later reminisced. The same year he received his first ever guitar, a birthday present from Nina Maksimovna; a close friend, bard and a future well-known Soviet pop lyricist Igor Kokhanovsky taught him basic chords. In 1955 Vladimir re-settled into his mother's new home at 1st Meshchanskaya, 76. In June of the same year he graduated from school with five A's.

 

In 1955, Vladimir enrolled into the Moscow State University of Civil Engineering, but dropped out after just one semester to pursue an acting career. In June 1956 he joined Boris Vershilov's class at the Moscow Art Theatre Studio-Institute. It was there that he met the 3rd course student Iza Zhukova who four years later became his wife; soon the two lovers settled at the 1st Meschanskaya flat, in a common room, shielded off by a folding screen. It was also in the Studio that Vysotsky met Bulat Okudzhava for the first time, an already popular underground bard. He was even more impressed by his Russian literature teacher Andrey Sinyavsky who along with his wife often invited students to his home to stage improvised disputes and concerts. In 1958 Vysotsky's got his first Moscow Art Theatre role: that of Porfiry Petrovich in Dostoyevsky's Crime and Punishment. In 1959 he was cast in his first cinema role, that of student Petya in Vasily Ordynsky's The Yearlings (Сверстницы). On 20 June 1960, Vysotsky graduated from the MAT theater institute and joined the Moscow Pushkin Drama Theatre (led by Boris Ravenskikh at the time) where he spent (with intervals) almost three troubled years. These were marred by numerous administrative sanctions, due to "lack of discipline" and occasional drunken sprees which were a reaction, mainly, to the lack of serious roles and his inability to realise his artistic potential. A short stint in 1962 at the Moscow Theater of Miniatures (administered at the time by Vladimir Polyakov) ended with him being fired, officially "for a total lack of sense of humour."

 

Vysotsky's second and third films, Dima Gorin's Career and 713 Requests Permission to Land, were interesting only for the fact that in both he had to be beaten up (in the first case by Aleksandr Demyanenko). "That was the way cinema greeted me," he later jokingly remarked. In 1961, Vysotsky wrote his first ever proper song, called "Tattoo" (Татуировка), which started a long and colourful cycle of artfully stylized criminal underworld romantic stories, full of undercurrents and witty social comments. In June 1963, while shooting Penalty Kick (directed by Veniamin Dorman and starring Mikhail Pugovkin), Vysotsky used the Gorky Film Studio to record an hour-long reel-to-reel cassette of his own songs; copies of it quickly spread and the author's name became known in Moscow and elsewhere (although many of these songs were often being referred to as either "traditional" or "anonymous"). Just several months later Riga-based chess grandmaster Mikhail Tal was heard praising the author of "Bolshoy Karetny" (Большой Каретный) and Anna Akhmatova (in a conversation with Joseph Brodsky) was quoting Vysotsky's number "I was the soul of a bad company..." taking it apparently for some brilliant piece of anonymous street folklore. In October 1964 Vysotsky recorded in chronological order 48 of his own songs, his first self-made Complete works of... compilation, which boosted his popularity as a new Moscow folk underground star.

 

In 1964, director Yuri Lyubimov invited Vysotsky to join the newly created Taganka Theatre. "'I've written some songs of my own. Won't you listen?' – he asked. I agreed to listen to just one of them, expecting our meeting to last for no more than five minutes. Instead I ended up listening to him for an entire 1.5 hours," Lyubimov remembered years later of this first audition. On 19 September 1964, Vysotsky debuted in Bertolt Brecht's The Good Person of Szechwan as the Second God (not to count two minor roles). A month later he came on stage as a dragoon captain (Bela's father) in Lermontov's A Hero of Our Time. It was in Taganka that Vysotsky started to sing on stage; the War theme becoming prominent in his musical repertoire. In 1965 Vysotsky appeared in the experimental Poet and Theater (Поэт и Театр, February) show, based on Andrey Voznesensky's work and then Ten Days that Shook the World (after John Reed's book, April) and was commissioned by Lyubimov to write songs exclusively for Taganka's new World War II play. The Fallen and the Living (Павшие и Живые), premiered in October 1965, featured Vysotsky's "Stars" (Звёзды), "The Soldiers of Heeresgruppe Mitte" (Солдаты группы "Центр") and "Penal Battalions" (Штрафные батальоны), the striking examples of a completely new kind of a war song, never heard in his country before. As veteran screenwriter Nikolay Erdman put it (in conversation with Lyubimov), "Professionally, I can well understand how Mayakovsky or Seryozha Yesenin were doing it. How Volodya Vysotsky does it is totally beyond me." With his songs – in effect, miniature theatrical dramatizations (usually with a protagonist and full of dialogues), Vysotsky instantly achieved such level of credibility that real life former prisoners, war veterans, boxers, footballers refused to believe that the author himself had never served his time in prisons and labor camps, or fought in the War, or been a boxing/football professional. After the second of the two concerts at the Leningrad Molecular Physics institute (that was his actual debut as a solo musical performer) Vysotsky left a note for his fans in a journal which ended with words: "Now that you've heard all these songs, please, don't you make a mistake of mixing me with my characters, I am not like them at all. With love, Vysotsky, 20 April 1965, XX c." Excuses of this kind he had to make throughout his performing career. At least one of Vysotsky's song themes – that of alcoholic abuse – was worryingly autobiographical, though. By the time his breakthrough came in 1967, he'd suffered several physical breakdowns and once was sent (by Taganka's boss) to a rehabilitation clinic, a visit he on several occasions repeated since.

 

Brecht's Life of Galileo (premiered on 17 May 1966), transformed by Lyubimov into a powerful allegory of Soviet intelligentsia's set of moral and intellectual dilemmas, brought Vysotsky his first leading theater role (along with some fitness lessons: he had to perform numerous acrobatic tricks on stage). Press reaction was mixed, some reviewers disliked the actor's overt emotionalism, but it was for the first time ever that Vysotsky's name appeared in Soviet papers. Film directors now were treating him with respect. Viktor Turov's war film I Come from the Childhood where Vysotsky got his first ever "serious" (neither comical, nor villainous) role in cinema, featured two of his songs: a spontaneous piece called "When It's Cold" (Холода) and a dark, Unknown soldier theme-inspired classic "Common Graves" (На братских могилах), sung behind the screen by the legendary Mark Bernes.

 

Stanislav Govorukhin and Boris Durov's The Vertical (1967), a mountain climbing drama, starring Vysotsky (as Volodya the radioman), brought him all-round recognition and fame. Four of the numbers used in the film (including "Song of a Friend [fi]" (Песня о друге), released in 1968 by the Soviet recording industry monopolist Melodiya disc to become an unofficial hit) were written literally on the spot, nearby Elbrus, inspired by professional climbers' tales and one curious hotel bar conversation with a German guest who 25 years ago happened to climb these very mountains in a capacity of an Edelweiss division fighter. Another 1967 film, Kira Muratova's Brief Encounters featured Vysotsky as the geologist Maxim (paste-bearded again) with a now trademark off-the-cuff musical piece, a melancholy improvisation called "Things to Do" (Дела). All the while Vysotsky continued working hard at Taganka, with another important role under his belt (that of Mayakovsky or, rather one of the latter character's five different versions) in the experimental piece called Listen! (Послушайте!), and now regularly gave semi-official concerts where audiences greeted him as a cult hero.

 

In the end of 1967 Vysotsky got another pivotal theater role, that of Khlopusha [ru] in Pugachov (a play based on a poem by Sergei Yesenin), often described as one of Taganka's finest. "He put into his performance all the things that he excelled at and, on the other hand, it was Pugachyov that made him discover his own potential," – Soviet critic Natalya Krymova wrote years later. Several weeks after the premiere, infuriated by the actor's increasing unreliability triggered by worsening drinking problems, Lyubimov fired him – only to let him back again several months later (and thus begin the humiliating sacked-then-pardoned routine which continued for years). In June 1968 a Vysotsky-slagging campaign was launched in the Soviet press. First Sovetskaya Rossiya commented on the "epidemic spread of immoral, smutty songs," allegedly promoting "criminal world values, alcoholism, vice and immorality" and condemned their author for "sowing seeds of evil." Then Komsomolskaya Pravda linked Vysotsky with black market dealers selling his tapes somewhere in Siberia. Composer Dmitry Kabalevsky speaking from the Union of Soviet Composers' Committee tribune criticised the Soviet radio for giving an ideologically dubious, "low-life product" like "Song of a Friend" (Песня о друге) an unwarranted airplay. Playwright Alexander Stein who in his Last Parade play used several of Vysotsky's songs, was chastised by a Ministry of Culture official for "providing a tribune for this anti-Soviet scum." The phraseology prompted commentators in the West to make parallels between Vysotsky and Mikhail Zoschenko, another Soviet author who'd been officially labeled "scum" some 20 years ago.

 

Two of Vysotsky's 1968 films, Gennady Poloka's Intervention (premiered in May 1987) where he was cast as Brodsky, a dodgy even if highly artistic character, and Yevgeny Karelov's Two Comrades Were Serving (a gun-toting White Army officer Brusentsov who in the course of the film shoots his friend, his horse, Oleg Yankovsky's good guy character and, finally himself) – were severely censored, first of them shelved for twenty years. At least four of Vysotsky's 1968 songs, "Save Our Souls" (Спасите наши души), "The Wolfhunt" (Охота на волков), "Gypsy Variations" (Моя цыганская) and "The Steam-bath in White" (Банька по-белому), were hailed later as masterpieces. It was at this point that 'proper' love songs started to appear in Vysotsky's repertoire, documenting the beginning of his passionate love affair with French actress Marina Vlady.

 

In 1969 Vysotsky starred in two films: The Master of Taiga where he played a villainous Siberian timber-floating brigadier, and more entertaining Dangerous Tour. The latter was criticized in the Soviet press for taking a farcical approach to the subject of the Bolshevik underground activities but for a wider Soviet audience this was an important opportunity to enjoy the charismatic actor's presence on big screen. In 1970, after visiting the dislodged Soviet leader Nikita Khrushchev at his dacha and having a lengthy conversation with him, Vysotsky embarked on a massive and by Soviet standards dangerously commercial concert tour in Soviet Central Asia and then brought Marina Vlady to director Viktor Turov's place so as to investigate her Belarusian roots. The pair finally wed on 1 December 1970 (causing furore among the Moscow cultural and political elite) and spent a honeymoon in Georgia. This was the highly productive period for Vysotsky, resulting in numerous new songs, including the anthemic "I Hate" (Я не люблю), sentimental "Lyricale" (Лирическая) and dramatic war epics "He Didn't Return from the Battle" (Он не вернулся из боя) and "The Earth Song" (Песня о Земле) among many others.

 

In 1971 a drinking spree-related nervous breakdown brought Vysotsky to the Moscow Kashchenko clinic [ru]. By this time he has been suffering from alcoholism. Many of his songs from this period deal, either directly or metaphorically, with alcoholism and insanity. Partially recovered (due to the encouraging presence of Marina Vladi), Vysotsky embarked on a successful Ukrainian concert tour and wrote a cluster of new songs. On 29 November 1971 Taganka's Hamlet premiered, a groundbreaking Lyubimov's production with Vysotsky in the leading role, that of a lone intellectual rebel, rising to fight the cruel state machine.

 

Also in 1971 Vysotsky was invited to play the lead in The Sannikov Land, the screen adaptation of Vladimir Obruchev's science fiction,[47] which he wrote several songs for, but was suddenly dropped for the reason of his face "being too scandalously recognisable" as a state official put it. One of the songs written for the film, a doom-laden epic allegory "Capricious Horses" (Кони привередливые), became one of the singer's signature tunes. Two of Vysotsky's 1972 film roles were somewhat meditative: an anonymous American journalist in The Fourth One and the "righteous guy" von Koren in The Bad Good Man (based on Anton Chekov's Duel). The latter brought Vysotsky the Best Male Role prize at the V Taormina Film Fest. This philosophical slant rubbed off onto some of his new works of the time: "A Singer at the Microphone" (Певец у микрофона), "The Tightrope Walker" (Канатоходец), two new war songs ("We Spin the Earth", "Black Pea-Coats") and "The Grief" (Беда), a folkish girl's lament, later recorded by Marina Vladi and subsequently covered by several female performers. Popular proved to be his 1972 humorous songs: "Mishka Shifman" (Мишка Шифман), satirizing the leaving-for-Israel routine, "Victim of the Television" which ridiculed the concept of "political consciousness," and "The Honour of the Chess Crown" (Честь шахматной короны) about an ever-fearless "simple Soviet man" challenging the much feared American champion Bobby Fischer to a match.

 

In 1972 he stepped up in Soviet Estonian TV where he presented his songs and gave an interview. The name of the show was "Young Man from Taganka" (Noormees Tagankalt).

 

In April 1973 Vysotsky visited Poland and France. Predictable problems concerning the official permission were sorted after the French Communist Party leader Georges Marchais made a personal phone call to Leonid Brezhnev who, according to Marina Vlady's memoirs, rather sympathized with the stellar couple. Having found on return a potentially dangerous lawsuit brought against him (concerning some unsanctioned concerts in Siberia the year before), Vysotsky wrote a defiant letter to the Minister of Culture Pyotr Demichev. As a result, he was granted the status of a philharmonic artist, 11.5 roubles per concert now guaranteed. Still the 900 rubles fine had to be paid according to the court verdict, which was a substantial sum, considering his monthly salary at the theater was 110 rubles. That year Vysotsky wrote some thirty songs for "Alice in Wonderland," an audioplay where he himself has been given several minor roles. His best known songs of 1973 included "The Others' Track" (Чужая колея), "The Flight Interrupted" (Прерванный полёт) and "The Monument", all pondering on his achievements and legacy.

 

In 1974 Melodiya released the 7" EP, featuring four of Vysotsky's war songs ("He Never Returned From the Battle", "The New Times Song", "Common Graves", and "The Earth Song") which represented a tiny portion of his creative work, owned by millions on tape. In September of that year Vysotsky received his first state award, the Honorary Diploma of the Uzbek SSR following a tour with fellow actors from the Taganka Theatre in Uzbekistan. A year later he was granted the USSR Union of Cinematographers' membership. This meant he was not an "anti-Soviet scum" now, rather an unlikely link between the official Soviet cinema elite and the "progressive-thinking artists of the West." More films followed, among them The Only Road (a Soviet-Yugoslav joint venture, premiered on 10 January 1975 in Belgrade) and a science fiction movie The Flight of Mr. McKinley (1975). Out of nine ballads that he wrote for the latter only two have made it into the soundtrack. This was the height of his popularity, when, as described in Vlady's book about her husband, walking down the street on a summer night, one could hear Vysotsky's recognizable voice coming literally from every open window. Among the songs written at the time, were humorous "The Instruction before the Trip Abroad", lyrical "Of the Dead Pilot" and philosophical "The Strange House". In 1975 Vysotsky made his third trip to France where he rather riskily visited his former tutor (and now a celebrated dissident emigre) Andrey Sinyavsky. Artist Mikhail Shemyakin, his new Paris friend (or a "bottle-sharer", in Vladi's terms), recorded Vysotsky in his home studio. After a brief stay in England Vysotsky crossed the ocean and made his first Mexican concerts in April. Back in Moscow, there were changes at Taganka: Lyubimov went to Milan's La Scala on a contract and Anatoly Efros has been brought in, a director of radically different approach. His project, Chekhov's The Cherry Orchard, caused a sensation. Critics praised Alla Demidova (as Ranevskaya) and Vysotsky (as Lopakhin) powerful interplay, some describing it as one of the most dazzling in the history of the Soviet theater. Lyubimov, who disliked the piece, accused Efros of giving his actors "the stardom malaise." The 1976 Taganka's visit to Bulgaria resulted in Vysotskys's interview there being filmed and 15 songs recorded by Balkanton record label. On return Lyubimov made a move which many thought outrageous: declaring himself "unable to work with this Mr. Vysotsky anymore" he gave the role of Hamlet to Valery Zolotukhin, the latter's best friend. That was the time, reportedly, when stressed out Vysotsky started taking amphetamines.

 

Another Belorussian voyage completed, Marina and Vladimir went for France and from there (without any official permission given, or asked for) flew to the North America. In New York Vysotsky met, among other people, Mikhail Baryshnikov and Joseph Brodsky. In a televised one-hour interview with Dan Rather he stressed he was "not a dissident, just an artist, who's never had any intentions to leave his country where people loved him and his songs." At home this unauthorized venture into the Western world bore no repercussions: by this time Soviet authorities were divided as regards the "Vysotsky controversy" up to the highest level; while Mikhail Suslov detested the bard, Brezhnev loved him to such an extent that once, while in hospital, asked him to perform live in his daughter Galina's home, listening to this concert on the telephone. In 1976 appeared "The Domes", "The Rope" and the "Medieval" cycle, including "The Ballad of Love".

 

In September Vysotsky with Taganka made a trip to Yugoslavia where Hamlet won the annual BITEF festival's first prize, and then to Hungary for a two-week concert tour. Back in Moscow Lyubimov's production of The Master & Margarita featured Vysotsky as Ivan Bezdomny; a modest role, somewhat recompensed by an important Svidrigailov slot in Yury Karyakin's take on Dostoevsky's Crime and Punishment. Vysotsky's new songs of this period include "The History of Illness" cycle concerning his health problems, humorous "Why Did the Savages Eat Captain Cook", the metaphorical "Ballad of the Truth and the Lie", as well as "Two Fates", the chilling story of a self-absorbed alcoholic hunted by two malevolent witches, his two-faced destiny. In 1977 Vysotsky's health deteriorated (heart, kidneys, liver failures, jaw infection and nervous breakdown) to such an extent that in April he found himself in Moscow clinic's reanimation center in the state of physical and mental collapse.

 

In 1977 Vysotsky made an unlikely appearance in New York City on the American television show 60 Minutes, which falsely stated that Vysotsky had spent time in the Soviet prison system, the Gulag. That year saw the release of three Vysotsky's LPs in France (including the one that had been recorded by RCA in Canada the previous year); arranged and accompanied by guitarist Kostya Kazansky, the singer for the first time ever enjoyed the relatively sophisticated musical background. In August he performed in Hollywood before members of New York City film cast and (according to Vladi) was greeted warmly by the likes of Liza Minnelli and Robert De Niro. Some more concerts in Los Angeles were followed by the appearance at the French Communist paper L’Humanité annual event. In December Taganka left for France, its Hamlet (Vysotsky back in the lead) gaining fine reviews.

 

1978 started with the March–April series of concerts in Moscow and Ukraine. In May Vysotsky embarked upon a new major film project: The Meeting Place Cannot Be Changed (Место встречи изменить нельзя) about two detectives fighting crime in late 1940s Russia, directed by Stanislav Govorukhin. The film (premiered on 11 November 1978 on the Soviet Central TV) presented Vysotsky as Zheglov, a ruthless and charismatic cop teaching his milder partner Sharapov (actor Vladimir Konkin) his art of crime-solving. Vysotsky also became engaged in Taganka's Genre-seeking show (performing some of his own songs) and played Aleksander Blok in Anatoly Efros' The Lady Stranger (Незнакомка) radio play (premiered on air on 10 July 1979 and later released as a double LP).

 

In November 1978 Vysotsky took part in the underground censorship-defying literary project Metropolis, inspired and organized by Vasily Aksenov. In January 1979 Vysotsky again visited America with highly successful series of concerts. That was the point (according to biographer Vladimir Novikov) when a glimpse of new, clean life of a respectable international actor and performer all but made Vysotsky seriously reconsider his priorities. What followed though, was a return to the self-destructive theater and concert tours schedule, personal doctor Anatoly Fedotov now not only his companion, but part of Taganka's crew. "Who was this Anatoly? Just a man who in every possible situation would try to provide drugs. And he did provide. In such moments Volodya trusted him totally," Oksana Afanasyeva, Vysotsky's Moscow girlfriend (who was near him for most of the last year of his life and, on occasion, herself served as a drug courier) remembered. In July 1979, after a series of Central Asia concerts, Vysotsky collapsed, experienced clinical death and was resuscitated by Fedotov (who injected caffeine into the heart directly), colleague and close friend Vsevolod Abdulov helping with heart massage. In January 1980 Vysotsky asked Lyubimov for a year's leave. "Up to you, but on condition that Hamlet is yours," was the answer. The songwriting showed signs of slowing down, as Vysotsky began switching from songs to more conventional poetry. Still, of nearly 800 poems by Vysotsky only one has been published in the Soviet Union while he was alive. Not a single performance or interview was broadcast by the Soviet television in his lifetime.

 

In May 1979, being in a practice studio of the MSU Faculty of Journalism, Vysotsky recorded a video letter to American actor and film producer Warren Beatty, looking for both a personal meeting with Beatty and an opportunity to get a role in Reds film, to be produced and directed by the latter. While recording, Vysotsky made a few attempts to speak English, trying to overcome the language barrier. This video letter never reached Beatty. It was broadcast for the first time more than three decades later, on the night of 24 January 2013 (local time) by Rossiya 1 channel, along with records of TV channels of Italy, Mexico, Poland, USA and from private collections, in Vladimir Vysotsky. A letter to Warren Beatty film by Alexander Kovanovsky and Igor Rakhmanov. While recording this video, Vysotsky had a rare opportunity to perform for a camera, being still unable to do it with Soviet television.

 

On 22 January 1980, Vysotsky entered the Moscow Ostankino TV Center to record his one and only studio concert for the Soviet television. What proved to be an exhausting affair (his concentration lacking, he had to plod through several takes for each song) was premiered on the Soviet TV eight years later. The last six months of his life saw Vysotsky appearing on stage sporadically, fueled by heavy dosages of drugs and alcohol. His performances were often erratic. Occasionally Vysotsky paid visits to Sklifosofsky [ru] institute's ER unit, but would not hear of Marina Vlady's suggestions for him to take long-term rehabilitation course in a Western clinic. Yet he kept writing, mostly poetry and even prose, but songs as well. The last song he performed was the agonizing "My Sorrow, My Anguish" and his final poem, written one week prior to his death was "A Letter to Marina": "I'm less than fifty, but the time is short / By you and God protected, life and limb / I have a song or two to sing before the Lord / I have a way to make my peace with him."

 

Although several theories of the ultimate cause of the singer's death persist to this day, given what is now known about cardiovascular disease, it seems likely that by the time of his death Vysotsky had an advanced coronary condition brought about by years of tobacco, alcohol and drug abuse, as well as his grueling work schedule and the stress of the constant harassment by the government. Towards the end, most of Vysotsky's closest friends had become aware of the ominous signs and were convinced that his demise was only a matter of time. Clear evidence of this can be seen in a video ostensibly shot by the Japanese NHK channel only months before Vysotsky's death, where he appears visibly unwell, breathing heavily and slurring his speech. Accounts by Vysotsky's close friends and colleagues concerning his last hours were compiled in the book by V. Perevozchikov.

 

Vysotsky suffered from alcoholism for most of his life. Sometime around 1977, he started using amphetamines and other prescription narcotics in an attempt to counteract the debilitating hangovers and eventually to rid himself of alcohol addiction. While these attempts were partially successful, he ended up trading alcoholism for a severe drug dependency that was fast spiralling out of control. He was reduced to begging some of his close friends in the medical profession for supplies of drugs, often using his acting skills to collapse in a medical office and imitate a seizure or some other condition requiring a painkiller injection. On 25 July 1979 (a year to the day before his death) he suffered a cardiac arrest and was clinically dead for several minutes during a concert tour of Soviet Uzbekistan, after injecting himself with a wrong kind of painkiller he had previously obtained from a dentist's office.

 

Fully aware of the dangers of his condition, Vysotsky made several attempts to cure himself of his addiction. He underwent an experimental (and ultimately discredited) blood purification procedure offered by a leading drug rehabilitation specialist in Moscow. He also went to an isolated retreat in France with his wife Marina in the spring of 1980 as a way of forcefully depriving himself of any access to drugs. After these attempts failed, Vysotsky returned to Moscow to find his life in an increasingly stressful state of disarray. He had been a defendant in two criminal trials, one for a car wreck he had caused some months earlier, and one for an alleged conspiracy to sell unauthorized concert tickets (he eventually received a suspended sentence and a probation in the first case, and the charges in the second were dismissed, although several of his co-defendants were found guilty). He also unsuccessfully fought the film studio authorities for the rights to direct a movie called The Green Phaeton. Relations with his wife Marina were deteriorating, and he was torn between his loyalty to her and his love for his mistress Oksana Afanasyeva. He had also developed severe inflammation in one of his legs, making his concert performances extremely challenging.

 

In a final desperate attempt to overcome his drug addiction, partially prompted by his inability to obtain drugs through his usual channels (the authorities had imposed a strict monitoring of the medical institutions to prevent illicit drug distribution during the 1980 Olympics), he relapsed into alcohol and went on a prolonged drinking binge (apparently consuming copious amounts of champagne due to a prevalent misconception at the time that it was better than vodka at countering the effects of drug withdrawal).

 

On 3 July 1980, Vysotsky gave a performance at a suburban Moscow concert hall. One of the stage managers recalls that he looked visibly unhealthy ("gray-faced", as she puts it) and complained of not feeling too good, while another says she was surprised by his request for champagne before the start of the show, as he had always been known for completely abstaining from drink before his concerts. On 16 July Vysotsky gave his last public concert in Kaliningrad. On 18 July, Vysotsky played Hamlet for the last time at the Taganka Theatre. From around 21 July, several of his close friends were on a round-the-clock watch at his apartment, carefully monitoring his alcohol intake and hoping against all odds that his drug dependency would soon be overcome and they would then be able to bring him back from the brink. The effects of drug withdrawal were clearly getting the better of him, as he got increasingly restless, moaned and screamed in pain, and at times fell into memory lapses, failing to recognize at first some of his visitors, including his son Arkadiy. At one point, Vysotsky's personal physician A. Fedotov (the same doctor who had brought him back from clinical death a year earlier in Uzbekistan) attempted to sedate him, inadvertently causing asphyxiation from which he was barely saved. On 24 July, Vysotsky told his mother that he thought he was going to die that day, and then made similar remarks to a few of the friends present at the apartment, who begged him to stop such talk and keep his spirits up. But soon thereafter, Oksana Afanasyeva saw him clench his chest several times, which led her to suspect that he was genuinely suffering from a cardiovascular condition. She informed Fedotov of this but was told not to worry, as he was going to monitor Vysotsky's condition all night. In the evening, after drinking relatively small amounts of alcohol, the moaning and groaning Vysotsky was sedated by Fedotov, who then sat down on the couch next to him but fell asleep. Fedotov awoke in the early hours of 25 July to an unusual silence and found Vysotsky dead in his bed with his eyes wide open, apparently of a myocardial infarction, as he later certified. This was contradicted by Fedotov's colleagues, Sklifosovsky Emergency Medical Institute physicians L. Sul'povar and S. Scherbakov (who had demanded the actor's immediate hospitalization on 23 July but were allegedly rebuffed by Fedotov), who insisted that Fedotov's incompetent sedation combined with alcohol was what killed Vysotsky. An autopsy was prevented by Vysotsky's parents (who were eager to have their son's drug addiction remain secret), so the true cause of death remains unknown.

 

No official announcement of the actor's death was made, only a brief obituary appeared in the Moscow newspaper Vechernyaya Moskva, and a note informing of Vysotsky's death and cancellation of the Hamlet performance was put out at the entrance to the Taganka Theatre (the story goes that not a single ticket holder took advantage of the refund offer). Despite this, by the end of the day, millions had learned of Vysotsky's death. On 28 July, he lay in state at the Taganka Theatre. After a mourning ceremony involving an unauthorized mass gathering of unprecedented scale, Vysotsky was buried at the Vagankovskoye Cemetery in Moscow. The attendance at the Olympic events dropped noticeably on that day, as scores of spectators left to attend the funeral. Tens of thousands of people lined the streets to catch a glimpse of his coffin.

 

According to author Valery Perevozchikov part of the blame for his death lay with the group of associates who surrounded him in the last years of his life. This inner circle were all people under the influence of his strong character, combined with a material interest in the large sums of money his concerts earned. This list included Valerii Yankelovich, manager of the Taganka Theatre and prime organiser of his non-sanctioned concerts; Anatoly Fedotov, his personal doctor; Vadim Tumanov, gold prospector (and personal friend) from Siberia; Oksana Afanasyeva (later Yarmolnik), his mistress the last three years of his life; Ivan Bortnik, a fellow actor; and Leonid Sul'povar, a department head at the Sklifosovski hospital who was responsible for much of the supply of drugs.

 

Vysotsky's associates had all put in efforts to supply his drug habit, which kept him going in the last years of his life. Under their influence, he was able to continue to perform all over the country, up to a week before his death. Due to illegal (i.e. non-state-sanctioned) sales of tickets and other underground methods, these concerts pulled in sums of money unimaginable in Soviet times, when almost everyone received nearly the same small salary. The payouts and gathering of money were a constant source of danger, and Yankelovich and others were needed to organise them.

 

Some money went to Vysotsky, the rest was distributed amongst this circle. At first this was a reasonable return on their efforts; however, as his addiction progressed and his body developed resistance, the frequency and amount of drugs needed to keep Vysotsky going became unmanageable. This culminated at the time of the Moscow Olympics which coincided with the last days of his life, when supplies of drugs were monitored more strictly than usual, and some of the doctors involved in supplying Vysotsky were already behind bars (normally the doctors had to account for every ampule, thus drugs were transferred to an empty container, while the patients received a substitute or placebo instead). In the last few days Vysotsky became uncontrollable, his shouting could be heard all over the apartment building on Malaya Gruzinskaya St. where he lived amongst VIP's. Several days before his death, in a state of stupor he went on a high speed drive around Moscow in an attempt to obtain drugs and alcohol – when many high-ranking people saw him. This increased the likelihood of him being forcibly admitted to the hospital, and the consequent danger to the circle supplying his habit. As his state of health declined, and it became obvious that he might die, his associates gathered to decide what to do with him. They came up with no firm decision. They did not want him admitted officially, as his drug addiction would become public and they would fall under suspicion, although some of them admitted that any ordinary person in his condition would have been admitted immediately.

 

On Vysotsky's death his associates and relatives put in much effort to prevent a post-mortem being carried out. This despite the fairly unusual circumstances: he died aged 42 under heavy sedation with an improvised cocktail of sedatives and stimulants, including the toxic chloral hydrate, provided by his personal doctor who had been supplying him with narcotics the previous three years. This doctor, being the only one present at his side when death occurred, had a few days earlier been seen to display elementary negligence in treating the sedated Vysotsky. On the night of his death, Arkadii Vysotsky (his son), who tried to visit his father in his apartment, was rudely refused entry by Yankelovich, even though there was a lack of people able to care for him. Subsequently, the Soviet police commenced a manslaughter investigation which was dropped due to the absence of evidence taken at the time of death.

 

Vysotsky's first wife was Iza Zhukova. They met in 1956, being both MAT theater institute students, lived for some time at Vysotsky's mother's flat in Moscow, after her graduation (Iza was 2 years older) spent months in different cities (her – in Kiev, then Rostov) and finally married on 25 April 1960.

 

He met his second wife Lyudmila Abramova in 1961, while shooting the film 713 Requests Permission to Land. They married in 1965 and had two sons, Arkady (born 1962) and Nikita (born 1964).

 

While still married to Lyudmila Abramova, Vysotsky began a romantic relationship with Tatyana Ivanenko, a Taganka actress, then, in 1967 fell in love with Marina Vlady, a French actress of Russian descent, who was working at Mosfilm on a joint Soviet-French production at that time. Marina had been married before and had three children, while Vladimir had two. They were married in 1969. For 10 years the two maintained a long-distance relationship as Marina compromised her career in France to spend more time in Moscow, and Vladimir's friends pulled strings for him to be allowed to travel abroad to stay with his wife. Marina eventually joined the Communist Party of France, which essentially gave her an unlimited-entry visa into the Soviet Union, and provided Vladimir with some immunity against prosecution by the government, which was becoming weary of his covertly anti-Soviet lyrics and his odds-defying popularity with the masses. The problems of his long-distance relationship with Vlady inspired several of Vysotsky's songs.

 

In the autumn of 1981 Vysotsky's first collection of poetry was officially published in the USSR, called The Nerve (Нерв). Its first edition (25,000 copies) was sold out instantly. In 1982 the second one followed (100,000), then the 3rd (1988, 200,000), followed in the 1990s by several more. The material for it was compiled by Robert Rozhdestvensky, an officially laurelled Soviet poet. Also in 1981 Yuri Lyubimov staged at Taganka a new music and poetry production called Vladimir Vysotsky which was promptly banned and officially premiered on 25 January 1989.

 

In 1982 the motion picture The Ballad of the Valiant Knight Ivanhoe was produced in the Soviet Union and in 1983 the movie was released to the public. Four songs by Vysotsky were featured in the film.

 

In 1986 the official Vysotsky poetic heritage committee was formed (with Robert Rozhdestvensky at the helm, theater critic Natalya Krymova being both the instigator and the organizer). Despite some opposition from the conservatives (Yegor Ligachev was the latter's political leader, Stanislav Kunyaev of Nash Sovremennik represented its literary flank) Vysotsky was rewarded posthumously with the USSR State Prize. The official formula – "for creating the character of Zheglov and artistic achievements as a singer-songwriter" was much derided from both the left and the right. In 1988 the Selected Works of... (edited by N. Krymova) compilation was published, preceded by I Will Surely Return... (Я, конечно, вернусь...) book of fellow actors' memoirs and Vysotsky's verses, some published for the first time. In 1990 two volumes of extensive The Works of... were published, financed by the late poet's father Semyon Vysotsky. Even more ambitious publication series, self-proclaimed "the first ever academical edition" (the latter assertion being dismissed by sceptics) compiled and edited by Sergey Zhiltsov, were published in Tula (1994–1998, 5 volumes), Germany (1994, 7 volumes) and Moscow (1997, 4 volumes).

 

In 1989 the official Vysotsky Museum opened in Moscow, with the magazine of its own called Vagant (edited by Sergey Zaitsev) devoted entirely to Vysotsky's legacy. In 1996 it became an independent publication and was closed in 2002.

 

In the years to come, Vysotsky's grave became a site of pilgrimage for several generations of his fans, the youngest of whom were born after his death. His tombstone also became the subject of controversy, as his widow had wished for a simple abstract slab, while his parents insisted on a realistic gilded statue. Although probably too solemn to have inspired Vysotsky himself, the statue is believed by some to be full of metaphors and symbols reminiscent of the singer's life.

 

In 1995 in Moscow the Vysotsky monument was officially opened at Strastnoy Boulevard, by the Petrovsky Gates. Among those present were the bard's parents, two of his sons, first wife Iza, renown poets Yevtushenko and Voznesensky. "Vysotsky had always been telling the truth. Only once he was wrong when he sang in one of his songs: 'They will never erect me a monument in a square like that by Petrovskye Vorota'", Mayor of Moscow Yuri Luzhkov said in his speech.[95] A further monument to Vysotsky was erected in 2014 at Rostov-on-Don.

 

In October 2004, a monument to Vysotsky was erected in the Montenegrin capital of Podgorica, near the Millennium Bridge. His son, Nikita Vysotsky, attended the unveiling. The statue was designed by Russian sculptor Alexander Taratinov, who also designed a monument to Alexander Pushkin in Podgorica. The bronze statue shows Vysotsky standing on a pedestal, with his one hand raised and the other holding a guitar. Next to the figure lies a bronze skull – a reference to Vysotsky's monumental lead performances in Shakespeare's Hamlet. On the pedestal the last lines from a poem of Vysotsky's, dedicated to Montenegro, are carved.

 

The Vysotsky business center & semi-skyscraper was officially opened in Yekaterinburg, in 2011. It is the tallest building in Russia outside of Moscow, has 54 floors, total height: 188.3 m (618 ft). On the third floor of the business center is the Vysotsky Museum. Behind the building is a bronze sculpture of Vladimir Vysotsky and his third wife, a French actress Marina Vlady.

 

In 2011 a controversial movie Vysotsky. Thank You For Being Alive was released, script written by his son, Nikita Vysotsky. The actor Sergey Bezrukov portrayed Vysotsky, using a combination of a mask and CGI effects. The film tells about Vysotsky's illegal underground performances, problems with KGB and drugs, and subsequent clinical death in 1979.

 

Shortly after Vysotsky's death, many Russian bards started writing songs and poems about his life and death. The best known are Yuri Vizbor's "Letter to Vysotsky" (1982) and Bulat Okudzhava's "About Volodya Vysotsky" (1980). In Poland, Jacek Kaczmarski based some of his songs on those of Vysotsky, such as his first song (1977) was based on "The Wolfhunt", and dedicated to his memory the song "Epitafium dla Włodzimierza Wysockiego" ("Epitaph for Vladimir Vysotsky").

 

Every year on Vysotsky's birthday festivals are held throughout Russia and in many communities throughout the world, especially in Europe. Vysotsky's impact in Russia is often compared to that of Wolf Biermann in Germany, Bob Dylan in America, or Georges Brassens and Jacques Brel in France.

 

The asteroid 2374 Vladvysotskij, discovered by Lyudmila Zhuravleva, was named after Vysotsky.

 

During the Annual Q&A Event Direct Line with Vladimir Putin, Alexey Venediktov asked Putin to name a street in Moscow after the singer Vladimir Vysotsky, who, though considered one of the greatest Russian artists, has no street named after him in Moscow almost 30 years after his death. Venediktov stated a Russian law that allowed the President to do so and promote a law suggestion to name a street by decree. Putin answered that he would talk to Mayor of Moscow and would solve this problem. In July 2015 former Upper and Lower Tagansky Dead-ends (Верхний и Нижний Таганские тупики) in Moscow were reorganized into Vladimir Vysotsky Street.

 

The Sata Kieli Cultural Association, [Finland], organizes the annual International Vladimir Vysotsky Festival (Vysotski Fest), where Vysotsky's singers from different countries perform in Helsinki and other Finnish cities. They sing Vysotsky in different languages and in different arrangements.

 

Two brothers and singers from Finland, Mika and Turkka Mali, over the course of their more than 30-year musical career, have translated into Finnish, recorded and on numerous occasions publicly performed songs of Vladimir Vysotsky.

 

Throughout his lengthy musical career, Jaromír Nohavica, a famed Czech singer, translated and performed numerous songs of Vladimir Vysotsky, most notably Песня о друге (Píseň o příteli – Song about a friend).

 

The Museum of Vladimir Vysotsky in Koszalin dedicated to Vladimir Vysotsky was founded by Marlena Zimna (1969–2016) in May 1994, in her apartment, in the city of Koszalin, in Poland. Since then the museum has collected over 19,500 exhibits from different countries and currently holds Vladimir Vysotsky' personal items, autographs, drawings, letters, photographs and a large library containing unique film footage, vinyl records, CDs and DVDs. A special place in the collection holds a Vladimir Vysotsky's guitar, on which he played at a concert in Casablanca in April 1976. Vladimir Vysotsky presented this guitar to Moroccan journalist Hassan El-Sayed together with an autograph (an extract from Vladimir Vysotsky's song "What Happened in Africa"), written in Russian right on the guitar.

 

In January 2023, a monument to the outstanding actor, singer and poet Vladimir Vysotsky was unveiled in Yuzhno-Sakhalinsk, in the square near the Rodina House of Culture. Author Vladimir Chebotarev.

 

After her husband's death, urged by her friend Simone Signoret, Marina Vlady wrote a book called The Aborted Flight about her years together with Vysotsky. The book paid tribute to Vladimir's talent and rich persona, yet was uncompromising in its depiction of his addictions and the problems that they caused in their marriage. Written in French (and published in France in 1987), it was translated into Russian in tandem by Vlady and a professional translator and came out in 1989 in the USSR. Totally credible from the specialists' point of view, the book caused controversy, among other things, by shocking revelations about the difficult father-and-son relationship (or rather, the lack of any), implying that Vysotsky-senior (while his son was alive) was deeply ashamed of him and his songs which he deemed "anti-Soviet" and reported his own son to the KGB. Also in 1989 another important book of memoirs was published in the USSR, providing a bulk of priceless material for the host of future biographers, Alla Demidova's Vladimir Vysotsky, the One I Know and Love. Among other publications of note were Valery Zolotukhin's Vysotsky's Secret (2000), a series of Valery Perevozchikov's books (His Dying Hour, The Unknown Vysotsky and others) containing detailed accounts and interviews dealing with the bard's life's major controversies (the mystery surrounding his death, the truth behind Vysotsky Sr.'s alleged KGB reports, the true nature of Vladimir Vysotsky's relations with his mother Nina's second husband Georgy Bartosh etc.), Iza Zhukova's Short Happiness for a Lifetime and the late bard's sister-in-law Irena Vysotskaya's My Brother Vysotsky. The Beginnings (both 2005).

 

A group of enthusiasts has created a non-profit project – the mobile application "Vysotsky"

 

The multifaceted talent of Vysotsky is often described by the term "bard" (бард) that Vysotsky has never been enthusiastic about. He thought of himself mainly as an actor and poet rather than a singer, and once remarked, "I do not belong to what people call bards or minstrels or whatever." With the advent of portable tape-recorders in the Soviet Union, Vysotsky's music became available to the masses in the form of home-made reel-to-reel audio tape recordings (later on cassette tapes).

 

Vysotsky accompanied himself on a Russian seven-string guitar, with a raspy voice singing ballads of love, peace, war, everyday Soviet life and of the human condition. He was largely perceived as the voice of honesty, at times sarcastically jabbing at the Soviet government, which made him a target for surveillance and threats. In France, he has been compared with Georges Brassens; in Russia, however, he was more frequently compared with Joe Dassin, partly because they were the same age and died in the same year, although their ideologies, biographies, and musical styles are very different. Vysotsky's lyrics and style greatly influenced Jacek Kaczmarski, a Polish songwriter and singer who touched on similar themes.

 

The songs – over 600 of them – were written about almost any imaginable theme. The earliest were blatnaya pesnya ("outlaw songs"). These songs were based either on the life of the common people in Moscow or on life in the crime people, sometimes in Gulag. Vysotsky slowly grew out of this phase and started singing more serious, though often satirical, songs. Many of these songs were about war. These war songs were not written to glorify war, but rather to expose the listener to the emotions of those in extreme, life-threatening situations. Most Soviet veterans would say that Vysotsky's war songs described the truth of war far more accurately than more official "patriotic" songs.

 

Nearly all of Vysotsky's songs are in the first person, although he is almost never the narrator. When singing his criminal songs, he would adopt the accent and intonation of a Moscow thief, and when singing war songs, he would sing from the point of view of a soldier. In many of his philosophical songs, he adopted the role of inanimate objects. This created some confusion about Vysotsky's background, especially during the early years when information could not be passed around very easily. Using his acting talent, the poet played his role so well that until told otherwise, many of his fans believed that he was, indeed, a criminal or war veteran. Vysotsky's father said that "War veterans thought the author of the songs to be one of them, as if he had participated in the war together with them." The same could be said about mountain climbers; on multiple occasions, Vysotsky was sent pictures of mountain climbers' graves with quotes from his lyrics etched on the tombstones.

 

Not being officially recognized as a poet and singer, Vysotsky performed wherever and whenever he could – in the theater (where he worked), at universities, in private apartments, village clubs, and in the open air. It was not unusual for him to give several concerts in one day. He used to sleep little, using the night hours to write. With few exceptions, he wasn't allowed to publish his recordings with "Melodiya", which held a monopoly on the Soviet music industry. His songs were passed on through amateur, fairly low quality recordings on vinyl discs and magnetic tape, resulting in his immense popularity. Cosmonauts even took his music on cassette into orbit.

 

Musically, virtually all of Vysotsky's songs were written in a minor key, and tended to employ from three to seven chords. Vysotsky composed his songs and played them exclusively on the Russian seven string guitar, often tuned a tone or a tone-and-a-half below the traditional Russian "Open G major" tuning. This guitar, with its specific Russian tuning, makes a slight yet notable difference in chord voicings than the standard tuned six string Spanish (classical) guitar, and it became a staple of his sound. Because Vysotsky tuned down a tone and a half, his strings had less tension, which also colored the sound.

 

His earliest songs were usually written in C minor (with the guitar tuned a tone down from DGBDGBD to CFACFAC)

 

Songs written in this key include "Stars" (Zvyozdy), "My friend left for Magadan" (Moy drug uyekhal v Magadan), and most of his "outlaw songs".

 

At around 1970, Vysotsky began writing and playing exclusively in A minor (guitar tuned to CFACFAC), which he continued doing until his death.

 

Vysotsky used his fingers instead of a pick to pluck and strum, as was the tradition with Russian guitar playing. He used a variety of finger picking and strumming techniques. One of his favorite was to play an alternating bass with his thumb as he plucked or strummed with his other fingers.

 

Often, Vysotsky would neglect to check the tuning of his guitar, which is particularly noticeable on earlier recordings. According to some accounts, Vysotsky would get upset when friends would attempt to tune his guitar, leading some to believe that he preferred to play slightly out of tune as a stylistic choice. Much of this is also attributable to the fact that a guitar that is tuned down more than 1 whole step (Vysotsky would sometimes tune as much as 2 and a half steps down) is prone to intonation problems.

 

Vysotsky had a unique singing style. He had an unusual habit of elongating consonants instead of vowels in his songs. So when a syllable is sung for a prolonged period of time, he would elongate the consonant instead of the vowel in that syllable.

Night.

single exposure as shot, no lens

The Family Hotel features a mural by famous Australian painter, Clifton Pugh.

 

Clifton Pugh:

 

Clifton Ernest Pugh (1924 - 1990), artist, was born on the 17th of December 1924 at Richmond, Melbourne, youngest of three sons of English-born Thomas Owen Pugh, assistant mechanical engineer, and his wife, Adelaide-born Violet Ogden, née Cooke. His maternal grandfather was the astronomer W. E. Cooke. Clif attended state schools at Frankston, Auburn, Briar Hill, and Eltham in Victoria, Taringa in Queensland, and Ivanhoe Grammar School in Melbourne in 1939, leaving school at 14.

 

Working as a junior in a newspaper office and at an aircraft factory, Pugh took evening classes in cartoon drawing at Swinburne Technical College in 1940. In 1942 he attended evening classes in life-drawing at the Australian School of Arts and Crafts, Adelaide, marking the beginning of a sustained interest in working from the model.

 

Pugh was conscripted into the Citizen Military Forces on the 10th of February 1943 and transferred to the Australian Imperial Force in April. After training in New South Wales and Queensland, he served in New Guinea in 1944 - 1945 with the 2/2nd Battalion and in Japan in 1946 - 1947 at the headquarters of the 34th Brigade. He was discharged in May 1947.

 

On the 20th of September 1947 Pugh married June Heather Rogasch, a stenographer, in the Church of Christ, Camberwell, Melbourne. They separated two years later. He attended the National Gallery School of Victoria (1948 - 1952) under the Commonwealth Reconstruction Training Scheme. The dark hue of Pugh’s oeuvre can be traced to the palette of his teacher, the Meldrum School portraitist (Sir) William Dargie.

 

In the 1950s Pugh first came to notice with depictions of indigenous flora and fauna in an interpretive, figurative style. His bush scenes struck a dramatic contrast, particularly with those of the Heidelberg School, for their denial of the sentimental in favour of harsh realism. His landscapes were innovative for their employment of a relatively loose brushstroke and layering of paint that imitated the disordered character of the Australian bush. A typical work is ‘Meeting of the Apostle Birds’ (1958), in which birds of the Cottles Bridge area, northeast of Melbourne, where he spent his adult life, are arranged in an artificial pattern over the detritus of the bush floor. In ‘A Feral Cat’ (1957) the introduced animal dominates the composition, emphasising its threat to native fauna.

 

Pugh held his first major one-man show in March 1957 at the Victorian Artists’ Society. He became a vocal member of the Antipodeans, a group established in 1959 to defend figurative art. Other members were his artist friends, John Brack, Bob Dickerson, Arthur Boyd, David Boyd, Charles Blackman, John Perceval, and the art historian, Bernard Smith. Their exhibition at the VAS in August 1959 inspired several later reconstructions of the original show. Pugh received leading coverage in British newspapers in an exhibition of prominent Australian artists at the Whitechapel Gallery in London in 1961. He married Marlene Lorraine Harvey, ceramicist and naturalist, his de facto wife of seventeen years and mother of his two sons, Shane and Dailan, at the Registrar-General’s Office, Sydney on the 23rd of June 1965. They were separated shortly afterwards.

 

Pugh was an Archibald prize winner: Rupert Henderson (1965), Sir John McEwen (1971), and Gough Whitlam (1972). Other portrait subjects ranged from his family to Australian political leaders and Prince Philip, the Duke of Edinburgh. He married his second de facto wife (1970 - 1980) Judith Ley, a writer who had changed her name to Pugh six years earlier, at the Kensington Registry Office, London, on the 29th of June 1976, with former Prime Minister Gough Whitlam attending as a witness. Adriane Strampp, who was to become an artist in her own right, was his de facto wife from 1980 to 1985.

 

Pugh was chairman (1972) of the Victorian Australian Labor Party arts advisory committee and member (1973 - 1974) of the Australian Council for the Arts. He attracted much media attention, for his outspoken comments on political issues, his bohemian lifestyle and unconventional bush home. The house he built of mud brick and recycled materials called Dunmoochin was notable for its quirky architecture, objets d’art and paintings by those he knew and admired. The Dunmoochin Artists’ Society, a community comprising potters and painters, was established from the early 1950s to further conservation, as well as art and craft issues. He was appointed AO in 1985. The Dunmoochin house was destroyed by fire in 2001 and replaced under the auspices of the Dunmoochin Foundation by two studios providing temporary accommodation for those interested in art or environmental matters.

 

Survived by his sons, Pugh died of acute myocardial infarction on the 14th of October 1990 at Prahran, Melbourne, and was cremated. His work is represented in most Australian public galleries and many overseas collections.

 

Source: Australian Dictionary Of Biography.

Flowers from Sainsbury's to cheer me up. I had a heart attack on the 8th of August 2017. Everything seems fine now but I have to rest for 6 weeks. Thank God for the NHS

Well, tagged again ... this time by lovely Ray :))

Rules of the game are to post a pic of yourself prior age 10.

 

On this photo you can see the reason for my crucified soul:

My mom thought it would be a cute idea for carnival to dress me up

like Little Red Riding Hood while I wanted to be a cool redskin ...

Just one look at my facial expression and guess if I was happy with my suit!

My lucky big bro got a cowboy's dressage, and my poor little bro had

to bear that damn stupid clown's hat which wasn't better than my costume ;))

 

Sorry for being late or even missing to watch all of your busy and inspiring

pictures. There's much work atm, over this my dad had a myocardial infarction

last week. He's feeling fine again since my brother reacted pretty fast and

drove him to the hospital. Now he's back at home, and my siblings and I

are rotating to watch and take care about him.

 

Congrats to my precious friend Spiff who celebrates his birthday

at today's earth day. Looking forward to his visual dedication ...

Just the best out of everything to you, my dear :))

Today I was cleaning up around the house and picked up my favourite pair of Danner leather work boots. They are scuffed up, faded, malodorous, and have a dampness that I haven't been able to shake for many years. The soles have no useful treads on them, the zippers no longer zip, yet they mould to my high arched feet magically. They are simply, perfect. I have been issued newer, shinier, drier boots but continued to wear this pair.

 

These Danner work boots have taken me to many strange places; crack houses, mansions, raves, the bowels of malls, french fry factories, homeless shelters, hyperbaric chambers, native reservations, and sewer treatment plants. Not to mention all the regular places a Paramedic goes on a daily basis; nursing homes, ER's, ICU's, Cath Labs, malls, urgent care centres, low income housing projects, schools, apartment complexes etc.

 

I think back to the countless hours of work I've done in these boots, both early day shifts and seemingly endless night shifts. On the bad side; shootings, stabbings, motorcycle and automobile collisions, suicides, overdoses, industrial accidents, drownings in bath tubs...the list goes on and on. On the good side; delivering babies, successful cardiac arrests, and diagnosing and treating acute myocardial infarctions (heart attacks) in the field and transporting patients directly to surgery (Cath Lab).

 

Where I am going with this is simply that my Danner work boots have officially reached the end of their working life. If they were human they would be in a vegetative state. Before I pull the plug, I thought I'd give her one last hurrah.

 

Strobist Info: Nikon D200, ISO 100, f/4, 1/250 sec, Alien Bee 800 at 1/4 power, 10 degree grid flying above the boots.

 

See more on the blog. www.mariostrim.com

  

Digitalis purpurea, the foxglove or common foxglove, is a toxic species of flowering plant in the plantain family Plantaginaceae, native to, and also widespread throughout most of temperate Europe. It has also naturalized in parts of North America, as well as some other temperate regions. The plant is a popular garden subject, with many cultivars available. It is the original source of the medicine digoxin, a medicine for the human heart (also called digitalis or digitalin). This biennial plant grows as a rosette of leaves in the first year after sowing, before flowering and then dying in the second year (i.e. it is monocarpic). It generally produces enough seeds, however, so that new plants will continue to grow in a garden setting.

 

Description

Digitalis purpurea is an herbaceous biennial or short-lived perennial plant. The leaves are spirally arranged, simple, 10–35 cm (3.9–13.8 in) long and 5–12 cm (2–5 in) broad, and are covered with gray-white pubescent and glandular hairs, imparting a woolly texture. The foliage forms a tight rosette at ground level in the first year.

 

The flowering stem develops in the second year, typically 1–2 m (3.3–6.6 ft) tall, sometimes longer. The flowers are arranged in a showy, terminal, elongated cluster, and each flower is tubular and pendent. The flowers are typically purple, but some plants, especially those under cultivation, may be pink, rose, yellow, or white. The inside surface of the flower tube is heavily spotted. The flowering period is early summer, sometimes with additional flower stems developing later in the season. The plant is frequented by bees, which climb right inside the flower tube to gain the nectar within.

 

The fruit is a capsule which splits open at maturity to release the numerous tiny 0.1-0.2 mm seeds.

 

Distribution

Native range

Digitalis purpurea has a native range that spans across several countries in Western Europe and North Africa. In Western Europe, it is native to Belgium, Czech Republic, France, Germany, Ireland, Portugal, Spain, Sweden and the United Kingdom. In North Africa the species can be found in Morocco. Additionally, it occurs naturally on the islands of Corsica and Sardinia.

 

Introduced range

Digitalis purpurea has been introduced throughout the world into countries and continents outside of their natural range. Due to introductions the species has expanded its range further into Europe and Africa as well as colonizing continents outside of their natural range such as Asia, North America, South America and Oceania.

 

Digitalis purpurea has been introduced extensively throughout Europe into: Austria, the Baltic States, Belarus, Denmark, Hungary, the Netherlands, Poland, Réunion, and Ukraine. It has also found its way to the Azores, the Canary Islands, Central European Russia, Madeira, and the Sakhalin and Kuril Islands.

 

In North America, it has been introduced into more than twenty states of the United States, such as: Arkansas, California, Connecticut, Idaho, Maine, Maryland, Massachusetts, Michigan, Montana, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Vermont, Washington, West Virginia, Wisconsin, and Wyoming. In Canada, it has been introduced to multiple provinces, including: British Columbia, New Brunswick, Newfoundland, Nova Scotia, Ontario, and Québec.

 

In South America, Digitalis purpurea has been introduced into Argentina, specifically in the regions of Northeast, Northwest, and South. It has also been introduced to Bolivia, Brazil (specifically the South and Southeast regions), Chile (Central region), Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Jamaica, Mexico (Central, Gulf, Northeast, Southeast, and Southwest regions), Peru, Uruguay, and Venezuela.

 

Digitalis purpurea has been introduced to various regions in Asia, including China (specifically South-Central and Southeast regions), Korea, and Vietnam. In Africa, it has been introduced to Malawi and Zimbabwe. Furthermore, it has been introduced to the island nations of New Zealand, both the North and South Islands. It is also an established weed across multiple locations in Tasmania, Australia.

 

Subspecies and hybrids

Digitalis purpurea subsp. purpurea – most of Europe and Macaronesia and widely introduced to other parts of the world.

Digitalis purpurea subsp. amandiana (Samp.) P.A.Hinz – northern Portugal (specifically around the Douro Basin).

Digitalis purpurea subsp. mauretanica (Humbert & Maire) A.M.Romo – Morocco.

Digitalis purpurea subsp. toletana (Font Quer) P.A.Hinz – central Spain.

Digitalis × fulva Lindl. 1821 (hybrid formula: D. grandiflora × purpurea).

 

A single flower of Digitalis purpurea

Digitalis purpurea subsp. mariana is a synonym for D. mariana subsp. mariana, and D. purpurea subsp. heywoodii is a synonym for D. mariana subsp. heywoodii.

 

D. dubia, a name used for populations of foxglove growing among calciferous rocks on shady cliff faces on the island of Majorca, is now considered a synonym of D. minor, but until recently it had been either considered to be a valid species (i.e. in the Flora Europaea (1976), and the Euro+Med Plantbase (2011)), as well as classified as D. purpurea subsp. dubia in 1922, or Digitalis purpurea f. dubia by Spanish taxonomists in 1983.

 

Ecology

Digitalis purpurea grows in acidic soils, in partial sunlight to deep shade, in a range of habitats, including open woods, woodland clearings, moorland and heath margins, sea-cliffs, rocky mountain slopes and hedge banks. It is commonly found and readily colonises sites where the ground has been disturbed, such as recently cleared woodland, or where the vegetation has been burnt. It also colonises areas of land that have been disturbed by clear-felling and by construction projects, being among the first wildflowers to reappear, often in large quantities. Foxgloves are eurytopic plants, as their seeds germinate when exposed to light; for this reason, they are generally absent from shaded areas, such as within woodlands.

 

D. purpurea is most successful in humus-rich soil, but it can succeed in any soil that isn't too wet nor too dry; either way, the common foxglove only needs a small amount of soil for survival.

 

Larvae of the foxglove pug (Eupithecia pulchellata), a moth, consume the flowers of the common foxglove for food. The caterpillars of this moth crawl into the newly opening flowers, one caterpillar to a flower. It then spins a silken web over the mouth of the flower, sealing it, and then proceeds to feed on the stamens and developing seeds. When the other uninfected flowers fall off, the corolla of the infected flowers remain on the plant, and the caterpillar then pupates in the flower. The species is uncommon, it has been recorded in Britain, Germany, Switzerland and Austria. Other species of Lepidoptera have been recorded eating the leaves, including Mellicta athalia and Xestia ashworthii in Britain, Eurodryas aurinia in Romania, and Mellicta deione in Portugal.

 

Genetics

The colours of the petals of the Digitalis purpurea are known to be determined by at least three genes that interact with each other.

 

The M gene determines the production of a purple pigment, a type of anthocyanin. The m gene does not produce this pigment. The D gene is an enhancer of the M gene, and leads it to produce a large amount of the pigment. The d gene does not enhance the M gene, and only a small amount of pigment is produced. Lastly, the W gene causes the pigment be deposited only in some spots, while the w gene allows the pigment to be spread all over the flower.

 

This combination leads to four phenotypes:

M/_; W/_; _/_ = a white flower with purple spots;

m/m; _/_; _/_ = an albino flower with yellow spots;

M/_; w/w; d/d = a light purple flower;

M/_; w/w; D/_ = a dark purple flower.

 

Cultivation

The plant is a popular ornamental, providing height and colour in late spring and early summer. Cultivated forms often show flowers completely surrounding the central spike, in contrast to the wild form, where the flowers only appear on one side. Numerous cultivars have been developed with a range of colours. Seeds are frequently sold as a mixture (e.g. Excelsior hybrids, in shades of white, pink and purple). Some strains are easily grown by the novice gardener, while others are more challenging. They may also be purchased as potted plants in the spring.

 

Digitalis purpurea is hardy down to −15 °C (5 °F) (USDA zones 4–9).

 

Award of garden merit

The following selections have gained the Royal Horticultural Society's Award of Garden Merit:

Camelot Series:

'Camelot Cream'

'Camelot Lavender'

'Camelot Rose'

'Camelot White'

Dalmatian Series:

'Dalmatian Crème'

'Dalmatian Peach'

'Dalmatian Purple'

'Dalmatian White'

D. purpurea f. alba

'Martina'

'Pam's Choice'

'The Shirley' (Gloxinioides group)

Digitalis × mertonensis (the strawberry foxglove)

 

Toxicity

Due to the presence of the cardiac glycoside digitoxin, the leaves, flowers and seeds of this plant are all poisonous to humans and some animals and can be fatal if ingested.

 

The main toxins in Digitalis spp. are the two chemically similar cardiac glycosides: digitoxin and digoxin. Like other cardiac glycosides, these toxins exert their effects by inhibiting the ATPase activity of a complex of transmembrane proteins that form the sodium potassium ATPase pump, (Na+/K+-ATPase). Inhibition of the Na+/K+-ATPase in turn causes a rise not only in intracellular Na+, but also in calcium, which in turn results in increased force of myocardial muscle contractions.[citation needed] In other words, at precisely the right dosage, Digitalis toxin can cause the heart to beat more strongly. However, digitoxin, digoxin and several other cardiac glycosides, such as ouabain, are known to have steep dose-response curves, i.e., minute increases in the dosage of these drugs can make the difference between an ineffective dose and a fatal one.

 

Symptoms of Digitalis poisoning include a low pulse rate, nausea, vomiting, and uncoordinated contractions of different parts of the heart, leading to cardiac arrest and finally death.

 

Medicinal use

Extracted from the leaves, this same cardiac glycoside digitoxin is used as a medication for heart failure. Its clinical use was pioneered by William Withering, who recognized it "reduced dropsy", increased urine flow, and had a powerful effect on the heart. During World War II, County Herb Committees were established to collect medicinal herbs when German blockades created shortages; this included Digitalis purpurea which was used to regulate heartbeat.

Fifteen years ago after experiencing chest pains (probably a panic attack) I wore one of these for 24 hours, took a selfie, and posted it to Flickr: flic.kr/p/5uq1YX

 

Here we go again. No chest pain this time, but I've had weeks of lightheadedness and debilitating fatigue. Today a stress test found irregularities, so I have been referred for a myocardial perfusion study. That's where they inject a chemical tracer so they can observe blood flow through the heart. Meanwhile, I have to wear the holter for 72 hours.

 

Project 365, 2023 Edition: Day 234/365

 

Thank you to everyone who visits, faves, and comments.

Medical researches from the University of Manitoba found that sub zero temperatures are linked to an increased risk of heart attack. Analyzing 1,487 adults diagnosed with acute myocardial infarction (MI) in Winnipeg from July 2008 to December 2013 correlating MI with local snowfall and temperature records from Environment Canada database. The strongest predictor of acute MI (27% increased risk) was a daily high of less than 0 degree celcius. With every drop of 1 degree celcius the risk goes up .8% demonstrating a clear linear trend. However snowfall had no independent association with MI risk.

Historical evidence of the effects of cold weather on the incidence of MI dates back to Hippocrates in 430 BC. Factors influenced by cold temperatures include cardiac workload, coronary resistance, blood pressure and cholesterol.

Vladimir Semyonovich Vysotsky (Russian: Владимир Семёнович Высоцкий, IPA: [vlɐˈdʲimʲɪr sʲɪˈmʲɵnəvʲɪtɕ vɨˈsotskʲɪj]; 25 January 1938 – 25 July 1980), was a Soviet singer-songwriter, poet, and actor who had an immense and enduring effect on Soviet culture. He became widely known for his unique singing style and for his lyrics, which featured social and political commentary in often humorous street-jargon. He was also a prominent stage- and screen-actor. Though the official Soviet cultural establishment largely ignored his work, he was remarkably popular during his lifetime, and to this day exerts significant influence on many of Russia's musicians and actors.

 

Vysotsky was born in Moscow at the 3rd Meshchanskaya St. (61/2) maternity hospital. His father, Semyon Volfovich (Vladimirovich) (1915–1997), was a colonel in the Soviet army, originally from Kiev. Vladimir's mother, Nina Maksimovna, (née Seryogina, 1912–2003) was Russian, and worked as a German language translator.[3] Vysotsky's family lived in a Moscow communal flat in harsh conditions, and had serious financial difficulties. When Vladimir was 10 months old, Nina had to return to her office in the Transcript bureau of the Soviet Ministry of Geodesy and Cartography (engaged in making German maps available for the Soviet military) so as to help her husband earn their family's living.

 

Vladimir's theatrical inclinations became obvious at an early age, and were supported by his paternal grandmother Dora Bronshteyn, a theater fan. The boy used to recite poems, standing on a chair and "flinging hair backwards, like a real poet," often using in his public speeches expressions he could hardly have heard at home. Once, at the age of two, when he had tired of the family's guests' poetry requests, he, according to his mother, sat himself under the New-year tree with a frustrated air about him and sighed: "You silly tossers! Give a child some respite!" His sense of humor was extraordinary, but often baffling for people around him. A three-year-old could jeer his father in a bathroom with unexpected poetic improvisation ("Now look what's here before us / Our goat's to shave himself!") or appall unwanted guests with some street folk song, promptly steering them away. Vysotsky remembered those first three years of his life in the autobiographical Ballad of Childhood (Баллада о детстве, 1975), one of his best-known songs.

 

As World War II broke out, Semyon Vysotsky, a military reserve officer, joined the Soviet army and went to fight the Nazis. Nina and Vladimir were evacuated to the village of Vorontsovka, in Orenburg Oblast where the boy had to spend six days a week in a kindergarten and his mother worked for twelve hours a day in a chemical factory. In 1943, both returned to their Moscow apartment at 1st Meschanskaya St., 126. In September 1945, Vladimir joined the 1st class of the 273rd Moscow Rostokino region School.

 

In December 1946, Vysotsky's parents divorced. From 1947 to 1949, Vladimir lived with Semyon Vladimirovich (then an army Major) and his Armenian wife, Yevgenya Stepanovna Liholatova, whom the boy called "aunt Zhenya", at a military base in Eberswalde in the Soviet-occupied zone of Germany (later East Germany). "We decided that our son would stay with me. Vladimir came to stay with me in January 1947, and my second wife, Yevgenia, became Vladimir's second mother for many years to come. They had much in common and liked each other, which made me really happy," Semyon Vysotsky later remembered. Here living conditions, compared to those of Nina's communal Moscow flat, were infinitely better; the family occupied the whole floor of a two-storeyed house, and the boy had a room to himself for the first time in his life. In 1949 along with his stepmother Vladimir returned to Moscow. There he joined the 5th class of the Moscow 128th School and settled at Bolshoy Karetny [ru], 15 (where they had to themselves two rooms of a four-roomed flat), with "auntie Zhenya" (who was just 28 at the time), a woman of great kindness and warmth whom he later remembered as his second mother. In 1953 Vysotsky, now much interested in theater and cinema, joined the Drama courses led by Vladimir Bogomolov.[7] "No one in my family has had anything to do with arts, no actors or directors were there among them. But my mother admired theater and from the earliest age... each and every Saturday I've been taken up with her to watch one play or the other. And all of this, it probably stayed with me," he later reminisced. The same year he received his first ever guitar, a birthday present from Nina Maksimovna; a close friend, bard and a future well-known Soviet pop lyricist Igor Kokhanovsky taught him basic chords. In 1955 Vladimir re-settled into his mother's new home at 1st Meshchanskaya, 76. In June of the same year he graduated from school with five A's.

 

In 1955, Vladimir enrolled into the Moscow State University of Civil Engineering, but dropped out after just one semester to pursue an acting career. In June 1956 he joined Boris Vershilov's class at the Moscow Art Theatre Studio-Institute. It was there that he met the 3rd course student Iza Zhukova who four years later became his wife; soon the two lovers settled at the 1st Meschanskaya flat, in a common room, shielded off by a folding screen. It was also in the Studio that Vysotsky met Bulat Okudzhava for the first time, an already popular underground bard. He was even more impressed by his Russian literature teacher Andrey Sinyavsky who along with his wife often invited students to his home to stage improvised disputes and concerts. In 1958 Vysotsky's got his first Moscow Art Theatre role: that of Porfiry Petrovich in Dostoyevsky's Crime and Punishment. In 1959 he was cast in his first cinema role, that of student Petya in Vasily Ordynsky's The Yearlings (Сверстницы). On 20 June 1960, Vysotsky graduated from the MAT theater institute and joined the Moscow Pushkin Drama Theatre (led by Boris Ravenskikh at the time) where he spent (with intervals) almost three troubled years. These were marred by numerous administrative sanctions, due to "lack of discipline" and occasional drunken sprees which were a reaction, mainly, to the lack of serious roles and his inability to realise his artistic potential. A short stint in 1962 at the Moscow Theater of Miniatures (administered at the time by Vladimir Polyakov) ended with him being fired, officially "for a total lack of sense of humour."

 

Vysotsky's second and third films, Dima Gorin's Career and 713 Requests Permission to Land, were interesting only for the fact that in both he had to be beaten up (in the first case by Aleksandr Demyanenko). "That was the way cinema greeted me," he later jokingly remarked. In 1961, Vysotsky wrote his first ever proper song, called "Tattoo" (Татуировка), which started a long and colourful cycle of artfully stylized criminal underworld romantic stories, full of undercurrents and witty social comments. In June 1963, while shooting Penalty Kick (directed by Veniamin Dorman and starring Mikhail Pugovkin), Vysotsky used the Gorky Film Studio to record an hour-long reel-to-reel cassette of his own songs; copies of it quickly spread and the author's name became known in Moscow and elsewhere (although many of these songs were often being referred to as either "traditional" or "anonymous"). Just several months later Riga-based chess grandmaster Mikhail Tal was heard praising the author of "Bolshoy Karetny" (Большой Каретный) and Anna Akhmatova (in a conversation with Joseph Brodsky) was quoting Vysotsky's number "I was the soul of a bad company..." taking it apparently for some brilliant piece of anonymous street folklore. In October 1964 Vysotsky recorded in chronological order 48 of his own songs, his first self-made Complete works of... compilation, which boosted his popularity as a new Moscow folk underground star.

 

In 1964, director Yuri Lyubimov invited Vysotsky to join the newly created Taganka Theatre. "'I've written some songs of my own. Won't you listen?' – he asked. I agreed to listen to just one of them, expecting our meeting to last for no more than five minutes. Instead I ended up listening to him for an entire 1.5 hours," Lyubimov remembered years later of this first audition. On 19 September 1964, Vysotsky debuted in Bertolt Brecht's The Good Person of Szechwan as the Second God (not to count two minor roles). A month later he came on stage as a dragoon captain (Bela's father) in Lermontov's A Hero of Our Time. It was in Taganka that Vysotsky started to sing on stage; the War theme becoming prominent in his musical repertoire. In 1965 Vysotsky appeared in the experimental Poet and Theater (Поэт и Театр, February) show, based on Andrey Voznesensky's work and then Ten Days that Shook the World (after John Reed's book, April) and was commissioned by Lyubimov to write songs exclusively for Taganka's new World War II play. The Fallen and the Living (Павшие и Живые), premiered in October 1965, featured Vysotsky's "Stars" (Звёзды), "The Soldiers of Heeresgruppe Mitte" (Солдаты группы "Центр") and "Penal Battalions" (Штрафные батальоны), the striking examples of a completely new kind of a war song, never heard in his country before. As veteran screenwriter Nikolay Erdman put it (in conversation with Lyubimov), "Professionally, I can well understand how Mayakovsky or Seryozha Yesenin were doing it. How Volodya Vysotsky does it is totally beyond me." With his songs – in effect, miniature theatrical dramatizations (usually with a protagonist and full of dialogues), Vysotsky instantly achieved such level of credibility that real life former prisoners, war veterans, boxers, footballers refused to believe that the author himself had never served his time in prisons and labor camps, or fought in the War, or been a boxing/football professional. After the second of the two concerts at the Leningrad Molecular Physics institute (that was his actual debut as a solo musical performer) Vysotsky left a note for his fans in a journal which ended with words: "Now that you've heard all these songs, please, don't you make a mistake of mixing me with my characters, I am not like them at all. With love, Vysotsky, 20 April 1965, XX c." Excuses of this kind he had to make throughout his performing career. At least one of Vysotsky's song themes – that of alcoholic abuse – was worryingly autobiographical, though. By the time his breakthrough came in 1967, he'd suffered several physical breakdowns and once was sent (by Taganka's boss) to a rehabilitation clinic, a visit he on several occasions repeated since.

 

Brecht's Life of Galileo (premiered on 17 May 1966), transformed by Lyubimov into a powerful allegory of Soviet intelligentsia's set of moral and intellectual dilemmas, brought Vysotsky his first leading theater role (along with some fitness lessons: he had to perform numerous acrobatic tricks on stage). Press reaction was mixed, some reviewers disliked the actor's overt emotionalism, but it was for the first time ever that Vysotsky's name appeared in Soviet papers. Film directors now were treating him with respect. Viktor Turov's war film I Come from the Childhood where Vysotsky got his first ever "serious" (neither comical, nor villainous) role in cinema, featured two of his songs: a spontaneous piece called "When It's Cold" (Холода) and a dark, Unknown soldier theme-inspired classic "Common Graves" (На братских могилах), sung behind the screen by the legendary Mark Bernes.

 

Stanislav Govorukhin and Boris Durov's The Vertical (1967), a mountain climbing drama, starring Vysotsky (as Volodya the radioman), brought him all-round recognition and fame. Four of the numbers used in the film (including "Song of a Friend [fi]" (Песня о друге), released in 1968 by the Soviet recording industry monopolist Melodiya disc to become an unofficial hit) were written literally on the spot, nearby Elbrus, inspired by professional climbers' tales and one curious hotel bar conversation with a German guest who 25 years ago happened to climb these very mountains in a capacity of an Edelweiss division fighter. Another 1967 film, Kira Muratova's Brief Encounters featured Vysotsky as the geologist Maxim (paste-bearded again) with a now trademark off-the-cuff musical piece, a melancholy improvisation called "Things to Do" (Дела). All the while Vysotsky continued working hard at Taganka, with another important role under his belt (that of Mayakovsky or, rather one of the latter character's five different versions) in the experimental piece called Listen! (Послушайте!), and now regularly gave semi-official concerts where audiences greeted him as a cult hero.

 

In the end of 1967 Vysotsky got another pivotal theater role, that of Khlopusha [ru] in Pugachov (a play based on a poem by Sergei Yesenin), often described as one of Taganka's finest. "He put into his performance all the things that he excelled at and, on the other hand, it was Pugachyov that made him discover his own potential," – Soviet critic Natalya Krymova wrote years later. Several weeks after the premiere, infuriated by the actor's increasing unreliability triggered by worsening drinking problems, Lyubimov fired him – only to let him back again several months later (and thus begin the humiliating sacked-then-pardoned routine which continued for years). In June 1968 a Vysotsky-slagging campaign was launched in the Soviet press. First Sovetskaya Rossiya commented on the "epidemic spread of immoral, smutty songs," allegedly promoting "criminal world values, alcoholism, vice and immorality" and condemned their author for "sowing seeds of evil." Then Komsomolskaya Pravda linked Vysotsky with black market dealers selling his tapes somewhere in Siberia. Composer Dmitry Kabalevsky speaking from the Union of Soviet Composers' Committee tribune criticised the Soviet radio for giving an ideologically dubious, "low-life product" like "Song of a Friend" (Песня о друге) an unwarranted airplay. Playwright Alexander Stein who in his Last Parade play used several of Vysotsky's songs, was chastised by a Ministry of Culture official for "providing a tribune for this anti-Soviet scum." The phraseology prompted commentators in the West to make parallels between Vysotsky and Mikhail Zoschenko, another Soviet author who'd been officially labeled "scum" some 20 years ago.

 

Two of Vysotsky's 1968 films, Gennady Poloka's Intervention (premiered in May 1987) where he was cast as Brodsky, a dodgy even if highly artistic character, and Yevgeny Karelov's Two Comrades Were Serving (a gun-toting White Army officer Brusentsov who in the course of the film shoots his friend, his horse, Oleg Yankovsky's good guy character and, finally himself) – were severely censored, first of them shelved for twenty years. At least four of Vysotsky's 1968 songs, "Save Our Souls" (Спасите наши души), "The Wolfhunt" (Охота на волков), "Gypsy Variations" (Моя цыганская) and "The Steam-bath in White" (Банька по-белому), were hailed later as masterpieces. It was at this point that 'proper' love songs started to appear in Vysotsky's repertoire, documenting the beginning of his passionate love affair with French actress Marina Vlady.

 

In 1969 Vysotsky starred in two films: The Master of Taiga where he played a villainous Siberian timber-floating brigadier, and more entertaining Dangerous Tour. The latter was criticized in the Soviet press for taking a farcical approach to the subject of the Bolshevik underground activities but for a wider Soviet audience this was an important opportunity to enjoy the charismatic actor's presence on big screen. In 1970, after visiting the dislodged Soviet leader Nikita Khrushchev at his dacha and having a lengthy conversation with him, Vysotsky embarked on a massive and by Soviet standards dangerously commercial concert tour in Soviet Central Asia and then brought Marina Vlady to director Viktor Turov's place so as to investigate her Belarusian roots. The pair finally wed on 1 December 1970 (causing furore among the Moscow cultural and political elite) and spent a honeymoon in Georgia. This was the highly productive period for Vysotsky, resulting in numerous new songs, including the anthemic "I Hate" (Я не люблю), sentimental "Lyricale" (Лирическая) and dramatic war epics "He Didn't Return from the Battle" (Он не вернулся из боя) and "The Earth Song" (Песня о Земле) among many others.

 

In 1971 a drinking spree-related nervous breakdown brought Vysotsky to the Moscow Kashchenko clinic [ru]. By this time he has been suffering from alcoholism. Many of his songs from this period deal, either directly or metaphorically, with alcoholism and insanity. Partially recovered (due to the encouraging presence of Marina Vladi), Vysotsky embarked on a successful Ukrainian concert tour and wrote a cluster of new songs. On 29 November 1971 Taganka's Hamlet premiered, a groundbreaking Lyubimov's production with Vysotsky in the leading role, that of a lone intellectual rebel, rising to fight the cruel state machine.

 

Also in 1971 Vysotsky was invited to play the lead in The Sannikov Land, the screen adaptation of Vladimir Obruchev's science fiction,[47] which he wrote several songs for, but was suddenly dropped for the reason of his face "being too scandalously recognisable" as a state official put it. One of the songs written for the film, a doom-laden epic allegory "Capricious Horses" (Кони привередливые), became one of the singer's signature tunes. Two of Vysotsky's 1972 film roles were somewhat meditative: an anonymous American journalist in The Fourth One and the "righteous guy" von Koren in The Bad Good Man (based on Anton Chekov's Duel). The latter brought Vysotsky the Best Male Role prize at the V Taormina Film Fest. This philosophical slant rubbed off onto some of his new works of the time: "A Singer at the Microphone" (Певец у микрофона), "The Tightrope Walker" (Канатоходец), two new war songs ("We Spin the Earth", "Black Pea-Coats") and "The Grief" (Беда), a folkish girl's lament, later recorded by Marina Vladi and subsequently covered by several female performers. Popular proved to be his 1972 humorous songs: "Mishka Shifman" (Мишка Шифман), satirizing the leaving-for-Israel routine, "Victim of the Television" which ridiculed the concept of "political consciousness," and "The Honour of the Chess Crown" (Честь шахматной короны) about an ever-fearless "simple Soviet man" challenging the much feared American champion Bobby Fischer to a match.

 

In 1972 he stepped up in Soviet Estonian TV where he presented his songs and gave an interview. The name of the show was "Young Man from Taganka" (Noormees Tagankalt).

 

In April 1973 Vysotsky visited Poland and France. Predictable problems concerning the official permission were sorted after the French Communist Party leader Georges Marchais made a personal phone call to Leonid Brezhnev who, according to Marina Vlady's memoirs, rather sympathized with the stellar couple. Having found on return a potentially dangerous lawsuit brought against him (concerning some unsanctioned concerts in Siberia the year before), Vysotsky wrote a defiant letter to the Minister of Culture Pyotr Demichev. As a result, he was granted the status of a philharmonic artist, 11.5 roubles per concert now guaranteed. Still the 900 rubles fine had to be paid according to the court verdict, which was a substantial sum, considering his monthly salary at the theater was 110 rubles. That year Vysotsky wrote some thirty songs for "Alice in Wonderland," an audioplay where he himself has been given several minor roles. His best known songs of 1973 included "The Others' Track" (Чужая колея), "The Flight Interrupted" (Прерванный полёт) and "The Monument", all pondering on his achievements and legacy.

 

In 1974 Melodiya released the 7" EP, featuring four of Vysotsky's war songs ("He Never Returned From the Battle", "The New Times Song", "Common Graves", and "The Earth Song") which represented a tiny portion of his creative work, owned by millions on tape. In September of that year Vysotsky received his first state award, the Honorary Diploma of the Uzbek SSR following a tour with fellow actors from the Taganka Theatre in Uzbekistan. A year later he was granted the USSR Union of Cinematographers' membership. This meant he was not an "anti-Soviet scum" now, rather an unlikely link between the official Soviet cinema elite and the "progressive-thinking artists of the West." More films followed, among them The Only Road (a Soviet-Yugoslav joint venture, premiered on 10 January 1975 in Belgrade) and a science fiction movie The Flight of Mr. McKinley (1975). Out of nine ballads that he wrote for the latter only two have made it into the soundtrack. This was the height of his popularity, when, as described in Vlady's book about her husband, walking down the street on a summer night, one could hear Vysotsky's recognizable voice coming literally from every open window. Among the songs written at the time, were humorous "The Instruction before the Trip Abroad", lyrical "Of the Dead Pilot" and philosophical "The Strange House". In 1975 Vysotsky made his third trip to France where he rather riskily visited his former tutor (and now a celebrated dissident emigre) Andrey Sinyavsky. Artist Mikhail Shemyakin, his new Paris friend (or a "bottle-sharer", in Vladi's terms), recorded Vysotsky in his home studio. After a brief stay in England Vysotsky crossed the ocean and made his first Mexican concerts in April. Back in Moscow, there were changes at Taganka: Lyubimov went to Milan's La Scala on a contract and Anatoly Efros has been brought in, a director of radically different approach. His project, Chekhov's The Cherry Orchard, caused a sensation. Critics praised Alla Demidova (as Ranevskaya) and Vysotsky (as Lopakhin) powerful interplay, some describing it as one of the most dazzling in the history of the Soviet theater. Lyubimov, who disliked the piece, accused Efros of giving his actors "the stardom malaise." The 1976 Taganka's visit to Bulgaria resulted in Vysotskys's interview there being filmed and 15 songs recorded by Balkanton record label. On return Lyubimov made a move which many thought outrageous: declaring himself "unable to work with this Mr. Vysotsky anymore" he gave the role of Hamlet to Valery Zolotukhin, the latter's best friend. That was the time, reportedly, when stressed out Vysotsky started taking amphetamines.

 

Another Belorussian voyage completed, Marina and Vladimir went for France and from there (without any official permission given, or asked for) flew to the North America. In New York Vysotsky met, among other people, Mikhail Baryshnikov and Joseph Brodsky. In a televised one-hour interview with Dan Rather he stressed he was "not a dissident, just an artist, who's never had any intentions to leave his country where people loved him and his songs." At home this unauthorized venture into the Western world bore no repercussions: by this time Soviet authorities were divided as regards the "Vysotsky controversy" up to the highest level; while Mikhail Suslov detested the bard, Brezhnev loved him to such an extent that once, while in hospital, asked him to perform live in his daughter Galina's home, listening to this concert on the telephone. In 1976 appeared "The Domes", "The Rope" and the "Medieval" cycle, including "The Ballad of Love".

 

In September Vysotsky with Taganka made a trip to Yugoslavia where Hamlet won the annual BITEF festival's first prize, and then to Hungary for a two-week concert tour. Back in Moscow Lyubimov's production of The Master & Margarita featured Vysotsky as Ivan Bezdomny; a modest role, somewhat recompensed by an important Svidrigailov slot in Yury Karyakin's take on Dostoevsky's Crime and Punishment. Vysotsky's new songs of this period include "The History of Illness" cycle concerning his health problems, humorous "Why Did the Savages Eat Captain Cook", the metaphorical "Ballad of the Truth and the Lie", as well as "Two Fates", the chilling story of a self-absorbed alcoholic hunted by two malevolent witches, his two-faced destiny. In 1977 Vysotsky's health deteriorated (heart, kidneys, liver failures, jaw infection and nervous breakdown) to such an extent that in April he found himself in Moscow clinic's reanimation center in the state of physical and mental collapse.

 

In 1977 Vysotsky made an unlikely appearance in New York City on the American television show 60 Minutes, which falsely stated that Vysotsky had spent time in the Soviet prison system, the Gulag. That year saw the release of three Vysotsky's LPs in France (including the one that had been recorded by RCA in Canada the previous year); arranged and accompanied by guitarist Kostya Kazansky, the singer for the first time ever enjoyed the relatively sophisticated musical background. In August he performed in Hollywood before members of New York City film cast and (according to Vladi) was greeted warmly by the likes of Liza Minnelli and Robert De Niro. Some more concerts in Los Angeles were followed by the appearance at the French Communist paper L’Humanité annual event. In December Taganka left for France, its Hamlet (Vysotsky back in the lead) gaining fine reviews.

 

1978 started with the March–April series of concerts in Moscow and Ukraine. In May Vysotsky embarked upon a new major film project: The Meeting Place Cannot Be Changed (Место встречи изменить нельзя) about two detectives fighting crime in late 1940s Russia, directed by Stanislav Govorukhin. The film (premiered on 11 November 1978 on the Soviet Central TV) presented Vysotsky as Zheglov, a ruthless and charismatic cop teaching his milder partner Sharapov (actor Vladimir Konkin) his art of crime-solving. Vysotsky also became engaged in Taganka's Genre-seeking show (performing some of his own songs) and played Aleksander Blok in Anatoly Efros' The Lady Stranger (Незнакомка) radio play (premiered on air on 10 July 1979 and later released as a double LP).

 

In November 1978 Vysotsky took part in the underground censorship-defying literary project Metropolis, inspired and organized by Vasily Aksenov. In January 1979 Vysotsky again visited America with highly successful series of concerts. That was the point (according to biographer Vladimir Novikov) when a glimpse of new, clean life of a respectable international actor and performer all but made Vysotsky seriously reconsider his priorities. What followed though, was a return to the self-destructive theater and concert tours schedule, personal doctor Anatoly Fedotov now not only his companion, but part of Taganka's crew. "Who was this Anatoly? Just a man who in every possible situation would try to provide drugs. And he did provide. In such moments Volodya trusted him totally," Oksana Afanasyeva, Vysotsky's Moscow girlfriend (who was near him for most of the last year of his life and, on occasion, herself served as a drug courier) remembered. In July 1979, after a series of Central Asia concerts, Vysotsky collapsed, experienced clinical death and was resuscitated by Fedotov (who injected caffeine into the heart directly), colleague and close friend Vsevolod Abdulov helping with heart massage. In January 1980 Vysotsky asked Lyubimov for a year's leave. "Up to you, but on condition that Hamlet is yours," was the answer. The songwriting showed signs of slowing down, as Vysotsky began switching from songs to more conventional poetry. Still, of nearly 800 poems by Vysotsky only one has been published in the Soviet Union while he was alive. Not a single performance or interview was broadcast by the Soviet television in his lifetime.

 

In May 1979, being in a practice studio of the MSU Faculty of Journalism, Vysotsky recorded a video letter to American actor and film producer Warren Beatty, looking for both a personal meeting with Beatty and an opportunity to get a role in Reds film, to be produced and directed by the latter. While recording, Vysotsky made a few attempts to speak English, trying to overcome the language barrier. This video letter never reached Beatty. It was broadcast for the first time more than three decades later, on the night of 24 January 2013 (local time) by Rossiya 1 channel, along with records of TV channels of Italy, Mexico, Poland, USA and from private collections, in Vladimir Vysotsky. A letter to Warren Beatty film by Alexander Kovanovsky and Igor Rakhmanov. While recording this video, Vysotsky had a rare opportunity to perform for a camera, being still unable to do it with Soviet television.

 

On 22 January 1980, Vysotsky entered the Moscow Ostankino TV Center to record his one and only studio concert for the Soviet television. What proved to be an exhausting affair (his concentration lacking, he had to plod through several takes for each song) was premiered on the Soviet TV eight years later. The last six months of his life saw Vysotsky appearing on stage sporadically, fueled by heavy dosages of drugs and alcohol. His performances were often erratic. Occasionally Vysotsky paid visits to Sklifosofsky [ru] institute's ER unit, but would not hear of Marina Vlady's suggestions for him to take long-term rehabilitation course in a Western clinic. Yet he kept writing, mostly poetry and even prose, but songs as well. The last song he performed was the agonizing "My Sorrow, My Anguish" and his final poem, written one week prior to his death was "A Letter to Marina": "I'm less than fifty, but the time is short / By you and God protected, life and limb / I have a song or two to sing before the Lord / I have a way to make my peace with him."

 

Although several theories of the ultimate cause of the singer's death persist to this day, given what is now known about cardiovascular disease, it seems likely that by the time of his death Vysotsky had an advanced coronary condition brought about by years of tobacco, alcohol and drug abuse, as well as his grueling work schedule and the stress of the constant harassment by the government. Towards the end, most of Vysotsky's closest friends had become aware of the ominous signs and were convinced that his demise was only a matter of time. Clear evidence of this can be seen in a video ostensibly shot by the Japanese NHK channel only months before Vysotsky's death, where he appears visibly unwell, breathing heavily and slurring his speech. Accounts by Vysotsky's close friends and colleagues concerning his last hours were compiled in the book by V. Perevozchikov.

 

Vysotsky suffered from alcoholism for most of his life. Sometime around 1977, he started using amphetamines and other prescription narcotics in an attempt to counteract the debilitating hangovers and eventually to rid himself of alcohol addiction. While these attempts were partially successful, he ended up trading alcoholism for a severe drug dependency that was fast spiralling out of control. He was reduced to begging some of his close friends in the medical profession for supplies of drugs, often using his acting skills to collapse in a medical office and imitate a seizure or some other condition requiring a painkiller injection. On 25 July 1979 (a year to the day before his death) he suffered a cardiac arrest and was clinically dead for several minutes during a concert tour of Soviet Uzbekistan, after injecting himself with a wrong kind of painkiller he had previously obtained from a dentist's office.

 

Fully aware of the dangers of his condition, Vysotsky made several attempts to cure himself of his addiction. He underwent an experimental (and ultimately discredited) blood purification procedure offered by a leading drug rehabilitation specialist in Moscow. He also went to an isolated retreat in France with his wife Marina in the spring of 1980 as a way of forcefully depriving himself of any access to drugs. After these attempts failed, Vysotsky returned to Moscow to find his life in an increasingly stressful state of disarray. He had been a defendant in two criminal trials, one for a car wreck he had caused some months earlier, and one for an alleged conspiracy to sell unauthorized concert tickets (he eventually received a suspended sentence and a probation in the first case, and the charges in the second were dismissed, although several of his co-defendants were found guilty). He also unsuccessfully fought the film studio authorities for the rights to direct a movie called The Green Phaeton. Relations with his wife Marina were deteriorating, and he was torn between his loyalty to her and his love for his mistress Oksana Afanasyeva. He had also developed severe inflammation in one of his legs, making his concert performances extremely challenging.

 

In a final desperate attempt to overcome his drug addiction, partially prompted by his inability to obtain drugs through his usual channels (the authorities had imposed a strict monitoring of the medical institutions to prevent illicit drug distribution during the 1980 Olympics), he relapsed into alcohol and went on a prolonged drinking binge (apparently consuming copious amounts of champagne due to a prevalent misconception at the time that it was better than vodka at countering the effects of drug withdrawal).

 

On 3 July 1980, Vysotsky gave a performance at a suburban Moscow concert hall. One of the stage managers recalls that he looked visibly unhealthy ("gray-faced", as she puts it) and complained of not feeling too good, while another says she was surprised by his request for champagne before the start of the show, as he had always been known for completely abstaining from drink before his concerts. On 16 July Vysotsky gave his last public concert in Kaliningrad. On 18 July, Vysotsky played Hamlet for the last time at the Taganka Theatre. From around 21 July, several of his close friends were on a round-the-clock watch at his apartment, carefully monitoring his alcohol intake and hoping against all odds that his drug dependency would soon be overcome and they would then be able to bring him back from the brink. The effects of drug withdrawal were clearly getting the better of him, as he got increasingly restless, moaned and screamed in pain, and at times fell into memory lapses, failing to recognize at first some of his visitors, including his son Arkadiy. At one point, Vysotsky's personal physician A. Fedotov (the same doctor who had brought him back from clinical death a year earlier in Uzbekistan) attempted to sedate him, inadvertently causing asphyxiation from which he was barely saved. On 24 July, Vysotsky told his mother that he thought he was going to die that day, and then made similar remarks to a few of the friends present at the apartment, who begged him to stop such talk and keep his spirits up. But soon thereafter, Oksana Afanasyeva saw him clench his chest several times, which led her to suspect that he was genuinely suffering from a cardiovascular condition. She informed Fedotov of this but was told not to worry, as he was going to monitor Vysotsky's condition all night. In the evening, after drinking relatively small amounts of alcohol, the moaning and groaning Vysotsky was sedated by Fedotov, who then sat down on the couch next to him but fell asleep. Fedotov awoke in the early hours of 25 July to an unusual silence and found Vysotsky dead in his bed with his eyes wide open, apparently of a myocardial infarction, as he later certified. This was contradicted by Fedotov's colleagues, Sklifosovsky Emergency Medical Institute physicians L. Sul'povar and S. Scherbakov (who had demanded the actor's immediate hospitalization on 23 July but were allegedly rebuffed by Fedotov), who insisted that Fedotov's incompetent sedation combined with alcohol was what killed Vysotsky. An autopsy was prevented by Vysotsky's parents (who were eager to have their son's drug addiction remain secret), so the true cause of death remains unknown.

 

No official announcement of the actor's death was made, only a brief obituary appeared in the Moscow newspaper Vechernyaya Moskva, and a note informing of Vysotsky's death and cancellation of the Hamlet performance was put out at the entrance to the Taganka Theatre (the story goes that not a single ticket holder took advantage of the refund offer). Despite this, by the end of the day, millions had learned of Vysotsky's death. On 28 July, he lay in state at the Taganka Theatre. After a mourning ceremony involving an unauthorized mass gathering of unprecedented scale, Vysotsky was buried at the Vagankovskoye Cemetery in Moscow. The attendance at the Olympic events dropped noticeably on that day, as scores of spectators left to attend the funeral. Tens of thousands of people lined the streets to catch a glimpse of his coffin.

 

According to author Valery Perevozchikov part of the blame for his death lay with the group of associates who surrounded him in the last years of his life. This inner circle were all people under the influence of his strong character, combined with a material interest in the large sums of money his concerts earned. This list included Valerii Yankelovich, manager of the Taganka Theatre and prime organiser of his non-sanctioned concerts; Anatoly Fedotov, his personal doctor; Vadim Tumanov, gold prospector (and personal friend) from Siberia; Oksana Afanasyeva (later Yarmolnik), his mistress the last three years of his life; Ivan Bortnik, a fellow actor; and Leonid Sul'povar, a department head at the Sklifosovski hospital who was responsible for much of the supply of drugs.

 

Vysotsky's associates had all put in efforts to supply his drug habit, which kept him going in the last years of his life. Under their influence, he was able to continue to perform all over the country, up to a week before his death. Due to illegal (i.e. non-state-sanctioned) sales of tickets and other underground methods, these concerts pulled in sums of money unimaginable in Soviet times, when almost everyone received nearly the same small salary. The payouts and gathering of money were a constant source of danger, and Yankelovich and others were needed to organise them.

 

Some money went to Vysotsky, the rest was distributed amongst this circle. At first this was a reasonable return on their efforts; however, as his addiction progressed and his body developed resistance, the frequency and amount of drugs needed to keep Vysotsky going became unmanageable. This culminated at the time of the Moscow Olympics which coincided with the last days of his life, when supplies of drugs were monitored more strictly than usual, and some of the doctors involved in supplying Vysotsky were already behind bars (normally the doctors had to account for every ampule, thus drugs were transferred to an empty container, while the patients received a substitute or placebo instead). In the last few days Vysotsky became uncontrollable, his shouting could be heard all over the apartment building on Malaya Gruzinskaya St. where he lived amongst VIP's. Several days before his death, in a state of stupor he went on a high speed drive around Moscow in an attempt to obtain drugs and alcohol – when many high-ranking people saw him. This increased the likelihood of him being forcibly admitted to the hospital, and the consequent danger to the circle supplying his habit. As his state of health declined, and it became obvious that he might die, his associates gathered to decide what to do with him. They came up with no firm decision. They did not want him admitted officially, as his drug addiction would become public and they would fall under suspicion, although some of them admitted that any ordinary person in his condition would have been admitted immediately.

 

On Vysotsky's death his associates and relatives put in much effort to prevent a post-mortem being carried out. This despite the fairly unusual circumstances: he died aged 42 under heavy sedation with an improvised cocktail of sedatives and stimulants, including the toxic chloral hydrate, provided by his personal doctor who had been supplying him with narcotics the previous three years. This doctor, being the only one present at his side when death occurred, had a few days earlier been seen to display elementary negligence in treating the sedated Vysotsky. On the night of his death, Arkadii Vysotsky (his son), who tried to visit his father in his apartment, was rudely refused entry by Yankelovich, even though there was a lack of people able to care for him. Subsequently, the Soviet police commenced a manslaughter investigation which was dropped due to the absence of evidence taken at the time of death.

 

Vysotsky's first wife was Iza Zhukova. They met in 1956, being both MAT theater institute students, lived for some time at Vysotsky's mother's flat in Moscow, after her graduation (Iza was 2 years older) spent months in different cities (her – in Kiev, then Rostov) and finally married on 25 April 1960.

 

He met his second wife Lyudmila Abramova in 1961, while shooting the film 713 Requests Permission to Land. They married in 1965 and had two sons, Arkady (born 1962) and Nikita (born 1964).

 

While still married to Lyudmila Abramova, Vysotsky began a romantic relationship with Tatyana Ivanenko, a Taganka actress, then, in 1967 fell in love with Marina Vlady, a French actress of Russian descent, who was working at Mosfilm on a joint Soviet-French production at that time. Marina had been married before and had three children, while Vladimir had two. They were married in 1969. For 10 years the two maintained a long-distance relationship as Marina compromised her career in France to spend more time in Moscow, and Vladimir's friends pulled strings for him to be allowed to travel abroad to stay with his wife. Marina eventually joined the Communist Party of France, which essentially gave her an unlimited-entry visa into the Soviet Union, and provided Vladimir with some immunity against prosecution by the government, which was becoming weary of his covertly anti-Soviet lyrics and his odds-defying popularity with the masses. The problems of his long-distance relationship with Vlady inspired several of Vysotsky's songs.

 

In the autumn of 1981 Vysotsky's first collection of poetry was officially published in the USSR, called The Nerve (Нерв). Its first edition (25,000 copies) was sold out instantly. In 1982 the second one followed (100,000), then the 3rd (1988, 200,000), followed in the 1990s by several more. The material for it was compiled by Robert Rozhdestvensky, an officially laurelled Soviet poet. Also in 1981 Yuri Lyubimov staged at Taganka a new music and poetry production called Vladimir Vysotsky which was promptly banned and officially premiered on 25 January 1989.

 

In 1982 the motion picture The Ballad of the Valiant Knight Ivanhoe was produced in the Soviet Union and in 1983 the movie was released to the public. Four songs by Vysotsky were featured in the film.

 

In 1986 the official Vysotsky poetic heritage committee was formed (with Robert Rozhdestvensky at the helm, theater critic Natalya Krymova being both the instigator and the organizer). Despite some opposition from the conservatives (Yegor Ligachev was the latter's political leader, Stanislav Kunyaev of Nash Sovremennik represented its literary flank) Vysotsky was rewarded posthumously with the USSR State Prize. The official formula – "for creating the character of Zheglov and artistic achievements as a singer-songwriter" was much derided from both the left and the right. In 1988 the Selected Works of... (edited by N. Krymova) compilation was published, preceded by I Will Surely Return... (Я, конечно, вернусь...) book of fellow actors' memoirs and Vysotsky's verses, some published for the first time. In 1990 two volumes of extensive The Works of... were published, financed by the late poet's father Semyon Vysotsky. Even more ambitious publication series, self-proclaimed "the first ever academical edition" (the latter assertion being dismissed by sceptics) compiled and edited by Sergey Zhiltsov, were published in Tula (1994–1998, 5 volumes), Germany (1994, 7 volumes) and Moscow (1997, 4 volumes).

 

In 1989 the official Vysotsky Museum opened in Moscow, with the magazine of its own called Vagant (edited by Sergey Zaitsev) devoted entirely to Vysotsky's legacy. In 1996 it became an independent publication and was closed in 2002.

 

In the years to come, Vysotsky's grave became a site of pilgrimage for several generations of his fans, the youngest of whom were born after his death. His tombstone also became the subject of controversy, as his widow had wished for a simple abstract slab, while his parents insisted on a realistic gilded statue. Although probably too solemn to have inspired Vysotsky himself, the statue is believed by some to be full of metaphors and symbols reminiscent of the singer's life.

 

In 1995 in Moscow the Vysotsky monument was officially opened at Strastnoy Boulevard, by the Petrovsky Gates. Among those present were the bard's parents, two of his sons, first wife Iza, renown poets Yevtushenko and Voznesensky. "Vysotsky had always been telling the truth. Only once he was wrong when he sang in one of his songs: 'They will never erect me a monument in a square like that by Petrovskye Vorota'", Mayor of Moscow Yuri Luzhkov said in his speech.[95] A further monument to Vysotsky was erected in 2014 at Rostov-on-Don.

 

In October 2004, a monument to Vysotsky was erected in the Montenegrin capital of Podgorica, near the Millennium Bridge. His son, Nikita Vysotsky, attended the unveiling. The statue was designed by Russian sculptor Alexander Taratinov, who also designed a monument to Alexander Pushkin in Podgorica. The bronze statue shows Vysotsky standing on a pedestal, with his one hand raised and the other holding a guitar. Next to the figure lies a bronze skull – a reference to Vysotsky's monumental lead performances in Shakespeare's Hamlet. On the pedestal the last lines from a poem of Vysotsky's, dedicated to Montenegro, are carved.

 

The Vysotsky business center & semi-skyscraper was officially opened in Yekaterinburg, in 2011. It is the tallest building in Russia outside of Moscow, has 54 floors, total height: 188.3 m (618 ft). On the third floor of the business center is the Vysotsky Museum. Behind the building is a bronze sculpture of Vladimir Vysotsky and his third wife, a French actress Marina Vlady.

 

In 2011 a controversial movie Vysotsky. Thank You For Being Alive was released, script written by his son, Nikita Vysotsky. The actor Sergey Bezrukov portrayed Vysotsky, using a combination of a mask and CGI effects. The film tells about Vysotsky's illegal underground performances, problems with KGB and drugs, and subsequent clinical death in 1979.

 

Shortly after Vysotsky's death, many Russian bards started writing songs and poems about his life and death. The best known are Yuri Vizbor's "Letter to Vysotsky" (1982) and Bulat Okudzhava's "About Volodya Vysotsky" (1980). In Poland, Jacek Kaczmarski based some of his songs on those of Vysotsky, such as his first song (1977) was based on "The Wolfhunt", and dedicated to his memory the song "Epitafium dla Włodzimierza Wysockiego" ("Epitaph for Vladimir Vysotsky").

 

Every year on Vysotsky's birthday festivals are held throughout Russia and in many communities throughout the world, especially in Europe. Vysotsky's impact in Russia is often compared to that of Wolf Biermann in Germany, Bob Dylan in America, or Georges Brassens and Jacques Brel in France.

 

The asteroid 2374 Vladvysotskij, discovered by Lyudmila Zhuravleva, was named after Vysotsky.

 

During the Annual Q&A Event Direct Line with Vladimir Putin, Alexey Venediktov asked Putin to name a street in Moscow after the singer Vladimir Vysotsky, who, though considered one of the greatest Russian artists, has no street named after him in Moscow almost 30 years after his death. Venediktov stated a Russian law that allowed the President to do so and promote a law suggestion to name a street by decree. Putin answered that he would talk to Mayor of Moscow and would solve this problem. In July 2015 former Upper and Lower Tagansky Dead-ends (Верхний и Нижний Таганские тупики) in Moscow were reorganized into Vladimir Vysotsky Street.

 

The Sata Kieli Cultural Association, [Finland], organizes the annual International Vladimir Vysotsky Festival (Vysotski Fest), where Vysotsky's singers from different countries perform in Helsinki and other Finnish cities. They sing Vysotsky in different languages and in different arrangements.

 

Two brothers and singers from Finland, Mika and Turkka Mali, over the course of their more than 30-year musical career, have translated into Finnish, recorded and on numerous occasions publicly performed songs of Vladimir Vysotsky.

 

Throughout his lengthy musical career, Jaromír Nohavica, a famed Czech singer, translated and performed numerous songs of Vladimir Vysotsky, most notably Песня о друге (Píseň o příteli – Song about a friend).

 

The Museum of Vladimir Vysotsky in Koszalin dedicated to Vladimir Vysotsky was founded by Marlena Zimna (1969–2016) in May 1994, in her apartment, in the city of Koszalin, in Poland. Since then the museum has collected over 19,500 exhibits from different countries and currently holds Vladimir Vysotsky' personal items, autographs, drawings, letters, photographs and a large library containing unique film footage, vinyl records, CDs and DVDs. A special place in the collection holds a Vladimir Vysotsky's guitar, on which he played at a concert in Casablanca in April 1976. Vladimir Vysotsky presented this guitar to Moroccan journalist Hassan El-Sayed together with an autograph (an extract from Vladimir Vysotsky's song "What Happened in Africa"), written in Russian right on the guitar.

 

In January 2023, a monument to the outstanding actor, singer and poet Vladimir Vysotsky was unveiled in Yuzhno-Sakhalinsk, in the square near the Rodina House of Culture. Author Vladimir Chebotarev.

 

After her husband's death, urged by her friend Simone Signoret, Marina Vlady wrote a book called The Aborted Flight about her years together with Vysotsky. The book paid tribute to Vladimir's talent and rich persona, yet was uncompromising in its depiction of his addictions and the problems that they caused in their marriage. Written in French (and published in France in 1987), it was translated into Russian in tandem by Vlady and a professional translator and came out in 1989 in the USSR. Totally credible from the specialists' point of view, the book caused controversy, among other things, by shocking revelations about the difficult father-and-son relationship (or rather, the lack of any), implying that Vysotsky-senior (while his son was alive) was deeply ashamed of him and his songs which he deemed "anti-Soviet" and reported his own son to the KGB. Also in 1989 another important book of memoirs was published in the USSR, providing a bulk of priceless material for the host of future biographers, Alla Demidova's Vladimir Vysotsky, the One I Know and Love. Among other publications of note were Valery Zolotukhin's Vysotsky's Secret (2000), a series of Valery Perevozchikov's books (His Dying Hour, The Unknown Vysotsky and others) containing detailed accounts and interviews dealing with the bard's life's major controversies (the mystery surrounding his death, the truth behind Vysotsky Sr.'s alleged KGB reports, the true nature of Vladimir Vysotsky's relations with his mother Nina's second husband Georgy Bartosh etc.), Iza Zhukova's Short Happiness for a Lifetime and the late bard's sister-in-law Irena Vysotskaya's My Brother Vysotsky. The Beginnings (both 2005).

 

A group of enthusiasts has created a non-profit project – the mobile application "Vysotsky"

 

The multifaceted talent of Vysotsky is often described by the term "bard" (бард) that Vysotsky has never been enthusiastic about. He thought of himself mainly as an actor and poet rather than a singer, and once remarked, "I do not belong to what people call bards or minstrels or whatever." With the advent of portable tape-recorders in the Soviet Union, Vysotsky's music became available to the masses in the form of home-made reel-to-reel audio tape recordings (later on cassette tapes).

 

Vysotsky accompanied himself on a Russian seven-string guitar, with a raspy voice singing ballads of love, peace, war, everyday Soviet life and of the human condition. He was largely perceived as the voice of honesty, at times sarcastically jabbing at the Soviet government, which made him a target for surveillance and threats. In France, he has been compared with Georges Brassens; in Russia, however, he was more frequently compared with Joe Dassin, partly because they were the same age and died in the same year, although their ideologies, biographies, and musical styles are very different. Vysotsky's lyrics and style greatly influenced Jacek Kaczmarski, a Polish songwriter and singer who touched on similar themes.

 

The songs – over 600 of them – were written about almost any imaginable theme. The earliest were blatnaya pesnya ("outlaw songs"). These songs were based either on the life of the common people in Moscow or on life in the crime people, sometimes in Gulag. Vysotsky slowly grew out of this phase and started singing more serious, though often satirical, songs. Many of these songs were about war. These war songs were not written to glorify war, but rather to expose the listener to the emotions of those in extreme, life-threatening situations. Most Soviet veterans would say that Vysotsky's war songs described the truth of war far more accurately than more official "patriotic" songs.

 

Nearly all of Vysotsky's songs are in the first person, although he is almost never the narrator. When singing his criminal songs, he would adopt the accent and intonation of a Moscow thief, and when singing war songs, he would sing from the point of view of a soldier. In many of his philosophical songs, he adopted the role of inanimate objects. This created some confusion about Vysotsky's background, especially during the early years when information could not be passed around very easily. Using his acting talent, the poet played his role so well that until told otherwise, many of his fans believed that he was, indeed, a criminal or war veteran. Vysotsky's father said that "War veterans thought the author of the songs to be one of them, as if he had participated in the war together with them." The same could be said about mountain climbers; on multiple occasions, Vysotsky was sent pictures of mountain climbers' graves with quotes from his lyrics etched on the tombstones.

 

Not being officially recognized as a poet and singer, Vysotsky performed wherever and whenever he could – in the theater (where he worked), at universities, in private apartments, village clubs, and in the open air. It was not unusual for him to give several concerts in one day. He used to sleep little, using the night hours to write. With few exceptions, he wasn't allowed to publish his recordings with "Melodiya", which held a monopoly on the Soviet music industry. His songs were passed on through amateur, fairly low quality recordings on vinyl discs and magnetic tape, resulting in his immense popularity. Cosmonauts even took his music on cassette into orbit.

 

Musically, virtually all of Vysotsky's songs were written in a minor key, and tended to employ from three to seven chords. Vysotsky composed his songs and played them exclusively on the Russian seven string guitar, often tuned a tone or a tone-and-a-half below the traditional Russian "Open G major" tuning. This guitar, with its specific Russian tuning, makes a slight yet notable difference in chord voicings than the standard tuned six string Spanish (classical) guitar, and it became a staple of his sound. Because Vysotsky tuned down a tone and a half, his strings had less tension, which also colored the sound.

 

His earliest songs were usually written in C minor (with the guitar tuned a tone down from DGBDGBD to CFACFAC)

 

Songs written in this key include "Stars" (Zvyozdy), "My friend left for Magadan" (Moy drug uyekhal v Magadan), and most of his "outlaw songs".

 

At around 1970, Vysotsky began writing and playing exclusively in A minor (guitar tuned to CFACFAC), which he continued doing until his death.

 

Vysotsky used his fingers instead of a pick to pluck and strum, as was the tradition with Russian guitar playing. He used a variety of finger picking and strumming techniques. One of his favorite was to play an alternating bass with his thumb as he plucked or strummed with his other fingers.

 

Often, Vysotsky would neglect to check the tuning of his guitar, which is particularly noticeable on earlier recordings. According to some accounts, Vysotsky would get upset when friends would attempt to tune his guitar, leading some to believe that he preferred to play slightly out of tune as a stylistic choice. Much of this is also attributable to the fact that a guitar that is tuned down more than 1 whole step (Vysotsky would sometimes tune as much as 2 and a half steps down) is prone to intonation problems.

 

Vysotsky had a unique singing style. He had an unusual habit of elongating consonants instead of vowels in his songs. So when a syllable is sung for a prolonged period of time, he would elongate the consonant instead of the vowel in that syllable.

 

The Vladimir Semyonovich Vysotsky Statue is a prominent monument located in Voronezh, Russian Federation, dedicated to the legendary Russian singer-songwriter, actor, and poet Vladimir Semyonovich Vysotsky. This statue stands as a tribute to Vysotsky's immense contributions to Russian culture and his enduring legacy.

 

Vladimir Vysotsky was born on January 25, 1938, in Moscow, Russia. He quickly gained recognition for his unique artistic style, characterized by his powerful voice, poetic lyrics, and charismatic stage presence. Vysotsky's songs captured the essence of the Soviet era, addressing social issues, human emotions, and political satire. His music resonated deeply with the masses, and he became an iconic figure in Russian popular culture.

 

The idea of erecting a statue in Voronezh to honor Vladimir Vysotsky was conceived to commemorate his connection to the city. Vysotsky had a special relationship with Voronezh, as he spent a significant portion of his early career performing in local theaters and interacting with the local artistic community. The statue serves as a reminder of this bond and celebrates his artistic contributions.

 

The Vysotsky Statue was unveiled on November 18, 2009, in front of the Voronezh Academic Drama Theater, where Vysotsky performed numerous times. The monument was created by renowned Russian sculptor Grigory Pototsky. Standing at approximately 5 meters tall, the bronze statue captures Vysotsky in a dynamic pose, holding a guitar and singing passionately.

 

The sculpture depicts Vysotsky in mid-performance, capturing his energy and intensity on stage. The attention to detail in the statue is remarkable, with intricate facial features, flowing hair, and realistic clothing. The sculptor aimed to convey Vysotsky's passion and charisma through the artwork, and the statue successfully embodies these qualities.

 

The location of the statue, in front of the Voronezh Academic Drama Theater, is significant. It symbolizes Vysotsky's strong ties to the theater and his impact on the performing arts. The statue serves as a meeting point for admirers of Vysotsky's work, attracting locals and tourists alike. It has become an iconic landmark in Voronezh, attracting visitors who come to pay their respects and celebrate Vysotsky's artistic legacy.

 

The statue's unveiling was accompanied by a grand ceremony, attended by government officials, artists, and Vysotsky's fans. The event highlighted the significance of Vysotsky's artistic contributions and celebrated his enduring influen

Flowers from Sainsbury's to cheer me up. I had a heart attack on the 8th of August 2017. Everything seems fine now but I have to rest for 6 weeks. Thank God for the NHS

en.wikipedia.org/wiki/Digitalis_purpurea

  

Digitalis purpurea (foxglove, common foxglove, purple foxglove or lady's glove) is a species of flowering plant in the genus Digitalis, in the family Plantaginaceae, native and widespread throughout most of temperate Europe. It is also naturalised in parts of North America and some other temperate regions. The plants are well known as the original source of the heart medicine digoxin (also called digitalis or digitalin).

  

Description

  

Digitalis purpurea is an herbaceous biennial or short-lived perennial plant. The leaves are spirally arranged, simple, 10–35 cm long and 5–12 cm broad, and are covered with gray-white pubescent and glandular hairs, imparting a woolly texture. The foliage forms a tight rosette at ground level in the first year.

 

The flowering stem develops in the second year, typically 1 to 2 m tall, sometimes longer. The flowers are arranged in a showy, terminal, elongated cluster, and each flower is tubular and pendent. The flowers are typically purple, but some plants, especially those under cultivation, may be pink, rose, yellow, or white. The inside surface of the flower tube is heavily spotted. The flowering period is early summer, sometimes with additional flower stems developing later in the season. The plant is frequented by bees, which climb right inside the flower tube to gain the nectar within.

 

The fruit is a capsule which splits open at maturity to release the numerous tiny (0.1-0.2 mm) seeds.

  

Subspecies

  

The three subspecies of Digitalis purpurea are:

 

D. p. subsp. purpurea – most of Europe

D. p. subsp. heywoodii – Iberia

D. p. subsp. mariana – Iberia

  

Hybrids

  

Digitalis x fulva, Lindl. 1821 (hybrid formula: Digitalis grandiflora Mill. × Digitalis purpurea L.).

  

Toxicity

  

Due to the presence of the cardiac glycoside digitoxin, the leaves, flowers and seeds of this plant are all poisonous to humans and some animals and can be fatal if ingested.

 

Extracted from the leaves, this same compound, whose clinical use was pioneered as digitalis by William Withering, is used as a medication for heart failure. He recognized it "reduced dropsy", increased urine flow and had a powerful effect on the heart. Unlike the purified pharmacological forms, extracts of this plant did not frequently cause intoxication because they induced nausea and vomiting within minutes of ingestion, preventing the patient from consuming more.

 

The main toxins in Digitalis spp. are the two chemically similar cardiac glycosides: digitoxin and digoxin. Like other cardiac glycosides, these toxins exert their effects by inhibiting the ATPase activity of a complex of transmembrane proteins that form the sodium potassium ATPase pump, (Na+/K+-ATPase). Inhibition of the Na+/K+-ATPase in turn causes a rise not only in intracellular Na+, but also in calcium, which in turn results in increased force of myocardial muscle contractions. In other words, at precisely the right dosage, Digitalis toxin can cause the heart to beat more strongly. However, digitoxin, digoxin and several other cardiac glycosides, such as ouabain, are known to have steep dose-response curves, i.e., minute increases in the dosage of these drugs can make the difference between an ineffective dose and a fatal one.

 

Symptoms of Digitalis poisoning include a low pulse rate, nausea, vomiting, and uncoordinated contractions of different parts of the heart, leading to cardiac arrest and finally death.

  

Cultivation

  

The plant is popular as a garden subject, and numerous cultivars have been developed with a range of colours from white through pink to purple, such as "Dalmatian Purple". Cultivated forms often show flowers completely surrounding the central spike, in contrast to the wild form, where the flowers only appear on one side. D. purpurea is easily grown from seed or purchased as potted plants in the spring. The following selections have gained the Royal Horticultural Society's Award of Garden Merit:

'The Shirley'[2]

'Excelsior group'[3]

D. purpurea f. alba[4]

 

Digitalis purpurea is hardy to zones 4-9.[5]

  

Uses

  

Digoxigenin (DIG) is a steroid found exclusively in the flowers and leaves of the plants Digitalis purpurea and Digitalis lanata. It is used as a molecular probe to detect DNA or RNA. It can easily be attached to nucleotides by chemical modifications. DIG molecules are often linked to uridine nucleotides; DIG-labeled uridine (DIG-U) can then be incorporated into RNA probes via in vitro transcription. Once hybridisation occurs in situ, RNA probes with the incorporated DIG-U can be detected with anti-DIG antibodies conjugated to alkaline phosphatase. To reveal the hybridised transcripts, alkaline phosphatase can be reacted with a chromogen to produce a coloured precipitate.

  

In literature and music

  

This plant inspired a famous poem by the Italian poet Giovanni Pascoli titled "Digitale Purpurea". It also inspired the Italian industrial metal band Digitalis Purpurea.

 

The pomegranate bush (seen just below the oranges) and the lantana bush were planted by birds...

 

Fruit of the Seville Orange (aka Marmalade Orange) tree is very bitter. The juice can be used as a substitute for lemon juice. The trees are grown in Spain and exported to England for the famous English Marmalade. Israeli Marmalade is also excellent.

__________________________________________________

Here is an article in Wikipedia:

 

Bitter orange, Seville orange, sour orange, bigarade orange, or marmalade orange refers to a citrus tree (Citrus × aurantium) and its fruit. It is a hybrid between Citrus maxima (pomelo) and Citrus reticulata (mandarin).

 

[2] Many varieties of bitter orange are used for their essential oil, and are found in perfume, used as a flavoring or as a solvent. The Seville orange variety is used in the production of marmalade.

 

Bitter orange is also employed in herbal medicine as a stimulant and appetite suppressant, due to its active ingredient, synephrine.[3][4]

 

Bitter orange supplements have been linked to a number of serious side effects and deaths, and consumer groups advocate that people avoid using the fruit medically.[5]

 

Varieties

Citrus x aurantium subsp. amara is a spiny evergreen tree native to southern Vietnam, but widely cultivated. It is used as grafting stock for citrus trees, in marmalade, and in liqueur such as triple sec, Grand Marnier and Curaçao. It is also cultivated for the essential oil expressed from the fruit, and for neroli oil and orange flower water, which are distilled from the flowers.

 

Seville orange (or bigarade) is a widely known, particularly tart orange which is now grown throughout the Mediterranean region.

 

It has a thick, dimpled skin, and is prized for making marmalade, being higher in pectin than the sweet orange, and therefore giving a better set and a higher yield.

 

It is also used in compotes and for orange-flavored liqueurs. Once a year, oranges of this variety are collected from trees in Seville and shipped to Britain to be used in marmalade.[6]

 

However, the fruit is rarely consumed locally in Andalusia.[7]

Chinotto, from the myrtle-leaved orange tree, C. aurantium var. myrtifolia, is used for the namesake Italian soda beverage.[8] This is sometimes considered a separate species.

Daidai, C. aurantium var. daidai, is used in Chinese medicine and Japanese New Year celebrations. The aromatic flowers are added to tea.[9]

 

Wild Florida sour orange is found near small streams in generally secluded and wooded parts of Florida and the Bahamas. It was introduced to the area from Spain.[9]

 

Bergamot orange is probably a bitter orange and limetta hybrid; it is cultivated in Italy for the production of bergamot oil, a component of many brands of perfume and tea, especially Earl Grey tea.

 

Uses

 

Bitter oranges

This orange is used as a rootstock in groves of sweet orange.[9] The fruit and leaves make lather and can be used as soap.[9] The hard white or light yellow wood is used in woodworking and made into baseball bats in Cuba.[9]

 

Cooking

The unripe fruit, called narthangai, is commonly used in Southern Indian cuisine, especially in Tamil cuisine. It is pickled by cutting it into spirals and stuffing it with salt. The pickle is usually consumed with yoghurt rice thayir sadam. The fresh fruit is also used frequently in pachadis. The juice from the ripe fruit is also used as a marinade for meat in Nicaraguan, Cuban, Dominican and Haitian cooking, as it was in Peruvian Ceviche until the 1960s. The peel can be used in the production of bitters. In Yucatán (Mexico), it is a main ingredient of the cochinita pibil.

 

The Belgian Witbier (white beer) is made from wheat spiced with the peel of the bitter orange. The Finnish and Swedish use bitter orange peel in gingerbread (pepparkakor), some Christmas bread and in mämmi. It is also used in the Nordic mulled wine glögg. In Greece and Cyprus, the nerántzi or kitrómilon, respectively, is one of the most prized fruits used for spoon sweets, and the C. aurantium tree (nerantziá or kitromiliá) is a popular ornamental tree. Throughout Iran (commonly known as narenj), the juice is popularly used as a salad dressing, souring agent in stews and pickles or as a marinade. The blossoms are collected fresh to make a prized sweet-smelling aromatic jam ("Bitter orange blossom jam" Morabba Bahar-Narendj), or added to brewing tea. In Turkey, juice of the ripe fruits can be used as salad dressing, especially in Çukurova region.

 

Herbal stimulant

The extract of bitter orange (and bitter orange peel) has been marketed as dietary supplement purported to act as a weight-loss aid and appetite suppressant. Bitter orange contains the tyramine metabolites N-methyltyramine, octopamine and synephrine,[10] substances similar to epinephrine, which act on the α1 adrenergic receptor to constrict blood vessels and increase blood pressure and heart rate.[11][12] p-Synephrine alone or in combination with caffeine or other substances has been shown to modestly increase weight loss in several low-quality clinical trials.[13] Following bans on the herbal stimulant ephedra in the U.S., Canada, and elsewhere, bitter orange has been substituted into "ephedra-free" herbal weight-loss products by dietary supplement manufacturers.[14]

 

Like most dietary supplement ingredients, bitter orange has not undergone formal safety testing, but it is believed to cause the same spectrum of adverse events as ephedra.[15] Case reports have linked bitter orange supplements to strokes,[16][17] angina,[10] and ischemic colitis.[18] The U.S. National Center for Complementary and Alternative Medicine found that "there is currently little evidence that bitter orange is safer to use than ephedra."[4]

 

My Note: The following sentence means I cannot take this dietary supplement, since I take statins and cannot eat grapefruit!!

Bitter orange may have serious drug interactions with drugs such as statins in a similar way to grapefruit.[19]

 

Following an incident in which a healthy young man suffered a myocardial infarction (heart attack) linked to bitter orange, a case study found that dietary supplement manufacturers had replaced ephedra with its analogs from bitter orange.[20]

  

IMG_3886 - Version 2

Walsall, New Art Gallery

Vladimir Semyonovich Vysotsky 25 January 1938 – 25 July 1980, was a Soviet singer-songwriter, poet, and actor who had an immense and enduring effect on Soviet culture. He became widely known for his unique singing style and for his lyrics, which featured social and political commentary in often humorous street-jargon. He was also a prominent stage- and screen-actor. Though the official Soviet cultural establishment largely ignored his work, he was remarkably popular during his lifetime, and to this day exerts significant influence on many of Russia's musicians and actors.

 

Vysotsky was born in Moscow at the 3rd Meshchanskaya St. (61/2) maternity hospital. His father, Semyon Volfovich (Vladimirovich) (1915–1997), was a colonel in the Soviet army, originally from Kiev. Vladimir's mother, Nina Maksimovna, (née Seryogina, 1912–2003) was Russian, and worked as a German language translator.[3] Vysotsky's family lived in a Moscow communal flat in harsh conditions, and had serious financial difficulties. When Vladimir was 10 months old, Nina had to return to her office in the Transcript bureau of the Soviet Ministry of Geodesy and Cartography (engaged in making German maps available for the Soviet military) so as to help her husband earn their family's living.

 

Vladimir's theatrical inclinations became obvious at an early age, and were supported by his paternal grandmother Dora Bronshteyn, a theater fan. The boy used to recite poems, standing on a chair and "flinging hair backwards, like a real poet," often using in his public speeches expressions he could hardly have heard at home. Once, at the age of two, when he had tired of the family's guests' poetry requests, he, according to his mother, sat himself under the New-year tree with a frustrated air about him and sighed: "You silly tossers! Give a child some respite!" His sense of humor was extraordinary, but often baffling for people around him. A three-year-old could jeer his father in a bathroom with unexpected poetic improvisation ("Now look what's here before us / Our goat's to shave himself!") or appall unwanted guests with some street folk song, promptly steering them away. Vysotsky remembered those first three years of his life in the autobiographical Ballad of Childhood (Баллада о детстве, 1975), one of his best-known songs.

 

As World War II broke out, Semyon Vysotsky, a military reserve officer, joined the Soviet army and went to fight the Nazis. Nina and Vladimir were evacuated to the village of Vorontsovka, in Orenburg Oblast where the boy had to spend six days a week in a kindergarten and his mother worked for twelve hours a day in a chemical factory. In 1943, both returned to their Moscow apartment at 1st Meschanskaya St., 126. In September 1945, Vladimir joined the 1st class of the 273rd Moscow Rostokino region School.

 

In December 1946, Vysotsky's parents divorced. From 1947 to 1949, Vladimir lived with Semyon Vladimirovich (then an army Major) and his Armenian wife, Yevgenya Stepanovna Liholatova, whom the boy called "aunt Zhenya", at a military base in Eberswalde in the Soviet-occupied zone of Germany (later East Germany). "We decided that our son would stay with me. Vladimir came to stay with me in January 1947, and my second wife, Yevgenia, became Vladimir's second mother for many years to come. They had much in common and liked each other, which made me really happy," Semyon Vysotsky later remembered. Here living conditions, compared to those of Nina's communal Moscow flat, were infinitely better; the family occupied the whole floor of a two-storeyed house, and the boy had a room to himself for the first time in his life. In 1949 along with his stepmother Vladimir returned to Moscow. There he joined the 5th class of the Moscow 128th School and settled at Bolshoy Karetny [ru], 15 (where they had to themselves two rooms of a four-roomed flat), with "auntie Zhenya" (who was just 28 at the time), a woman of great kindness and warmth whom he later remembered as his second mother. In 1953 Vysotsky, now much interested in theater and cinema, joined the Drama courses led by Vladimir Bogomolov.[7] "No one in my family has had anything to do with arts, no actors or directors were there among them. But my mother admired theater and from the earliest age... each and every Saturday I've been taken up with her to watch one play or the other. And all of this, it probably stayed with me," he later reminisced. The same year he received his first ever guitar, a birthday present from Nina Maksimovna; a close friend, bard and a future well-known Soviet pop lyricist Igor Kokhanovsky taught him basic chords. In 1955 Vladimir re-settled into his mother's new home at 1st Meshchanskaya, 76. In June of the same year he graduated from school with five A's.

 

In 1955, Vladimir enrolled into the Moscow State University of Civil Engineering, but dropped out after just one semester to pursue an acting career. In June 1956 he joined Boris Vershilov's class at the Moscow Art Theatre Studio-Institute. It was there that he met the 3rd course student Iza Zhukova who four years later became his wife; soon the two lovers settled at the 1st Meschanskaya flat, in a common room, shielded off by a folding screen. It was also in the Studio that Vysotsky met Bulat Okudzhava for the first time, an already popular underground bard. He was even more impressed by his Russian literature teacher Andrey Sinyavsky who along with his wife often invited students to his home to stage improvised disputes and concerts. In 1958 Vysotsky's got his first Moscow Art Theatre role: that of Porfiry Petrovich in Dostoyevsky's Crime and Punishment. In 1959 he was cast in his first cinema role, that of student Petya in Vasily Ordynsky's The Yearlings (Сверстницы). On 20 June 1960, Vysotsky graduated from the MAT theater institute and joined the Moscow Pushkin Drama Theatre (led by Boris Ravenskikh at the time) where he spent (with intervals) almost three troubled years. These were marred by numerous administrative sanctions, due to "lack of discipline" and occasional drunken sprees which were a reaction, mainly, to the lack of serious roles and his inability to realise his artistic potential. A short stint in 1962 at the Moscow Theater of Miniatures (administered at the time by Vladimir Polyakov) ended with him being fired, officially "for a total lack of sense of humour."

 

Vysotsky's second and third films, Dima Gorin's Career and 713 Requests Permission to Land, were interesting only for the fact that in both he had to be beaten up (in the first case by Aleksandr Demyanenko). "That was the way cinema greeted me," he later jokingly remarked. In 1961, Vysotsky wrote his first ever proper song, called "Tattoo" (Татуировка), which started a long and colourful cycle of artfully stylized criminal underworld romantic stories, full of undercurrents and witty social comments. In June 1963, while shooting Penalty Kick (directed by Veniamin Dorman and starring Mikhail Pugovkin), Vysotsky used the Gorky Film Studio to record an hour-long reel-to-reel cassette of his own songs; copies of it quickly spread and the author's name became known in Moscow and elsewhere (although many of these songs were often being referred to as either "traditional" or "anonymous"). Just several months later Riga-based chess grandmaster Mikhail Tal was heard praising the author of "Bolshoy Karetny" (Большой Каретный) and Anna Akhmatova (in a conversation with Joseph Brodsky) was quoting Vysotsky's number "I was the soul of a bad company..." taking it apparently for some brilliant piece of anonymous street folklore. In October 1964 Vysotsky recorded in chronological order 48 of his own songs, his first self-made Complete works of... compilation, which boosted his popularity as a new Moscow folk underground star.

 

In 1964, director Yuri Lyubimov invited Vysotsky to join the newly created Taganka Theatre. "'I've written some songs of my own. Won't you listen?' – he asked. I agreed to listen to just one of them, expecting our meeting to last for no more than five minutes. Instead I ended up listening to him for an entire 1.5 hours," Lyubimov remembered years later of this first audition. On 19 September 1964, Vysotsky debuted in Bertolt Brecht's The Good Person of Szechwan as the Second God (not to count two minor roles). A month later he came on stage as a dragoon captain (Bela's father) in Lermontov's A Hero of Our Time. It was in Taganka that Vysotsky started to sing on stage; the War theme becoming prominent in his musical repertoire. In 1965 Vysotsky appeared in the experimental Poet and Theater (Поэт и Театр, February) show, based on Andrey Voznesensky's work and then Ten Days that Shook the World (after John Reed's book, April) and was commissioned by Lyubimov to write songs exclusively for Taganka's new World War II play. The Fallen and the Living (Павшие и Живые), premiered in October 1965, featured Vysotsky's "Stars" (Звёзды), "The Soldiers of Heeresgruppe Mitte" (Солдаты группы "Центр") and "Penal Battalions" (Штрафные батальоны), the striking examples of a completely new kind of a war song, never heard in his country before. As veteran screenwriter Nikolay Erdman put it (in conversation with Lyubimov), "Professionally, I can well understand how Mayakovsky or Seryozha Yesenin were doing it. How Volodya Vysotsky does it is totally beyond me." With his songs – in effect, miniature theatrical dramatizations (usually with a protagonist and full of dialogues), Vysotsky instantly achieved such level of credibility that real life former prisoners, war veterans, boxers, footballers refused to believe that the author himself had never served his time in prisons and labor camps, or fought in the War, or been a boxing/football professional. After the second of the two concerts at the Leningrad Molecular Physics institute (that was his actual debut as a solo musical performer) Vysotsky left a note for his fans in a journal which ended with words: "Now that you've heard all these songs, please, don't you make a mistake of mixing me with my characters, I am not like them at all. With love, Vysotsky, 20 April 1965, XX c." Excuses of this kind he had to make throughout his performing career. At least one of Vysotsky's song themes – that of alcoholic abuse – was worryingly autobiographical, though. By the time his breakthrough came in 1967, he'd suffered several physical breakdowns and once was sent (by Taganka's boss) to a rehabilitation clinic, a visit he on several occasions repeated since.

 

Brecht's Life of Galileo (premiered on 17 May 1966), transformed by Lyubimov into a powerful allegory of Soviet intelligentsia's set of moral and intellectual dilemmas, brought Vysotsky his first leading theater role (along with some fitness lessons: he had to perform numerous acrobatic tricks on stage). Press reaction was mixed, some reviewers disliked the actor's overt emotionalism, but it was for the first time ever that Vysotsky's name appeared in Soviet papers. Film directors now were treating him with respect. Viktor Turov's war film I Come from the Childhood where Vysotsky got his first ever "serious" (neither comical, nor villainous) role in cinema, featured two of his songs: a spontaneous piece called "When It's Cold" (Холода) and a dark, Unknown soldier theme-inspired classic "Common Graves" (На братских могилах), sung behind the screen by the legendary Mark Bernes.

 

Stanislav Govorukhin and Boris Durov's The Vertical (1967), a mountain climbing drama, starring Vysotsky (as Volodya the radioman), brought him all-round recognition and fame. Four of the numbers used in the film (including "Song of a Friend [fi]" (Песня о друге), released in 1968 by the Soviet recording industry monopolist Melodiya disc to become an unofficial hit) were written literally on the spot, nearby Elbrus, inspired by professional climbers' tales and one curious hotel bar conversation with a German guest who 25 years ago happened to climb these very mountains in a capacity of an Edelweiss division fighter. Another 1967 film, Kira Muratova's Brief Encounters featured Vysotsky as the geologist Maxim (paste-bearded again) with a now trademark off-the-cuff musical piece, a melancholy improvisation called "Things to Do" (Дела). All the while Vysotsky continued working hard at Taganka, with another important role under his belt (that of Mayakovsky or, rather one of the latter character's five different versions) in the experimental piece called Listen! (Послушайте!), and now regularly gave semi-official concerts where audiences greeted him as a cult hero.

 

In the end of 1967 Vysotsky got another pivotal theater role, that of Khlopusha [ru] in Pugachov (a play based on a poem by Sergei Yesenin), often described as one of Taganka's finest. "He put into his performance all the things that he excelled at and, on the other hand, it was Pugachyov that made him discover his own potential," – Soviet critic Natalya Krymova wrote years later. Several weeks after the premiere, infuriated by the actor's increasing unreliability triggered by worsening drinking problems, Lyubimov fired him – only to let him back again several months later (and thus begin the humiliating sacked-then-pardoned routine which continued for years). In June 1968 a Vysotsky-slagging campaign was launched in the Soviet press. First Sovetskaya Rossiya commented on the "epidemic spread of immoral, smutty songs," allegedly promoting "criminal world values, alcoholism, vice and immorality" and condemned their author for "sowing seeds of evil." Then Komsomolskaya Pravda linked Vysotsky with black market dealers selling his tapes somewhere in Siberia. Composer Dmitry Kabalevsky speaking from the Union of Soviet Composers' Committee tribune criticised the Soviet radio for giving an ideologically dubious, "low-life product" like "Song of a Friend" (Песня о друге) an unwarranted airplay. Playwright Alexander Stein who in his Last Parade play used several of Vysotsky's songs, was chastised by a Ministry of Culture official for "providing a tribune for this anti-Soviet scum." The phraseology prompted commentators in the West to make parallels between Vysotsky and Mikhail Zoschenko, another Soviet author who'd been officially labeled "scum" some 20 years ago.

 

Two of Vysotsky's 1968 films, Gennady Poloka's Intervention (premiered in May 1987) where he was cast as Brodsky, a dodgy even if highly artistic character, and Yevgeny Karelov's Two Comrades Were Serving (a gun-toting White Army officer Brusentsov who in the course of the film shoots his friend, his horse, Oleg Yankovsky's good guy character and, finally himself) – were severely censored, first of them shelved for twenty years. At least four of Vysotsky's 1968 songs, "Save Our Souls" (Спасите наши души), "The Wolfhunt" (Охота на волков), "Gypsy Variations" (Моя цыганская) and "The Steam-bath in White" (Банька по-белому), were hailed later as masterpieces. It was at this point that 'proper' love songs started to appear in Vysotsky's repertoire, documenting the beginning of his passionate love affair with French actress Marina Vlady.

 

In 1969 Vysotsky starred in two films: The Master of Taiga where he played a villainous Siberian timber-floating brigadier, and more entertaining Dangerous Tour. The latter was criticized in the Soviet press for taking a farcical approach to the subject of the Bolshevik underground activities but for a wider Soviet audience this was an important opportunity to enjoy the charismatic actor's presence on big screen. In 1970, after visiting the dislodged Soviet leader Nikita Khrushchev at his dacha and having a lengthy conversation with him, Vysotsky embarked on a massive and by Soviet standards dangerously commercial concert tour in Soviet Central Asia and then brought Marina Vlady to director Viktor Turov's place so as to investigate her Belarusian roots. The pair finally wed on 1 December 1970 (causing furore among the Moscow cultural and political elite) and spent a honeymoon in Georgia. This was the highly productive period for Vysotsky, resulting in numerous new songs, including the anthemic "I Hate" (Я не люблю), sentimental "Lyricale" (Лирическая) and dramatic war epics "He Didn't Return from the Battle" (Он не вернулся из боя) and "The Earth Song" (Песня о Земле) among many others.

 

In 1971 a drinking spree-related nervous breakdown brought Vysotsky to the Moscow Kashchenko clinic [ru]. By this time he has been suffering from alcoholism. Many of his songs from this period deal, either directly or metaphorically, with alcoholism and insanity. Partially recovered (due to the encouraging presence of Marina Vladi), Vysotsky embarked on a successful Ukrainian concert tour and wrote a cluster of new songs. On 29 November 1971 Taganka's Hamlet premiered, a groundbreaking Lyubimov's production with Vysotsky in the leading role, that of a lone intellectual rebel, rising to fight the cruel state machine.

 

Also in 1971 Vysotsky was invited to play the lead in The Sannikov Land, the screen adaptation of Vladimir Obruchev's science fiction,[47] which he wrote several songs for, but was suddenly dropped for the reason of his face "being too scandalously recognisable" as a state official put it. One of the songs written for the film, a doom-laden epic allegory "Capricious Horses" (Кони привередливые), became one of the singer's signature tunes. Two of Vysotsky's 1972 film roles were somewhat meditative: an anonymous American journalist in The Fourth One and the "righteous guy" von Koren in The Bad Good Man (based on Anton Chekov's Duel). The latter brought Vysotsky the Best Male Role prize at the V Taormina Film Fest. This philosophical slant rubbed off onto some of his new works of the time: "A Singer at the Microphone" (Певец у микрофона), "The Tightrope Walker" (Канатоходец), two new war songs ("We Spin the Earth", "Black Pea-Coats") and "The Grief" (Беда), a folkish girl's lament, later recorded by Marina Vladi and subsequently covered by several female performers. Popular proved to be his 1972 humorous songs: "Mishka Shifman" (Мишка Шифман), satirizing the leaving-for-Israel routine, "Victim of the Television" which ridiculed the concept of "political consciousness," and "The Honour of the Chess Crown" (Честь шахматной короны) about an ever-fearless "simple Soviet man" challenging the much feared American champion Bobby Fischer to a match.

 

In 1972 he stepped up in Soviet Estonian TV where he presented his songs and gave an interview. The name of the show was "Young Man from Taganka" (Noormees Tagankalt).

 

In April 1973 Vysotsky visited Poland and France. Predictable problems concerning the official permission were sorted after the French Communist Party leader Georges Marchais made a personal phone call to Leonid Brezhnev who, according to Marina Vlady's memoirs, rather sympathized with the stellar couple. Having found on return a potentially dangerous lawsuit brought against him (concerning some unsanctioned concerts in Siberia the year before), Vysotsky wrote a defiant letter to the Minister of Culture Pyotr Demichev. As a result, he was granted the status of a philharmonic artist, 11.5 roubles per concert now guaranteed. Still the 900 rubles fine had to be paid according to the court verdict, which was a substantial sum, considering his monthly salary at the theater was 110 rubles. That year Vysotsky wrote some thirty songs for "Alice in Wonderland," an audioplay where he himself has been given several minor roles. His best known songs of 1973 included "The Others' Track" (Чужая колея), "The Flight Interrupted" (Прерванный полёт) and "The Monument", all pondering on his achievements and legacy.

 

In 1974 Melodiya released the 7" EP, featuring four of Vysotsky's war songs ("He Never Returned From the Battle", "The New Times Song", "Common Graves", and "The Earth Song") which represented a tiny portion of his creative work, owned by millions on tape. In September of that year Vysotsky received his first state award, the Honorary Diploma of the Uzbek SSR following a tour with fellow actors from the Taganka Theatre in Uzbekistan. A year later he was granted the USSR Union of Cinematographers' membership. This meant he was not an "anti-Soviet scum" now, rather an unlikely link between the official Soviet cinema elite and the "progressive-thinking artists of the West." More films followed, among them The Only Road (a Soviet-Yugoslav joint venture, premiered on 10 January 1975 in Belgrade) and a science fiction movie The Flight of Mr. McKinley (1975). Out of nine ballads that he wrote for the latter only two have made it into the soundtrack. This was the height of his popularity, when, as described in Vlady's book about her husband, walking down the street on a summer night, one could hear Vysotsky's recognizable voice coming literally from every open window. Among the songs written at the time, were humorous "The Instruction before the Trip Abroad", lyrical "Of the Dead Pilot" and philosophical "The Strange House". In 1975 Vysotsky made his third trip to France where he rather riskily visited his former tutor (and now a celebrated dissident emigre) Andrey Sinyavsky. Artist Mikhail Shemyakin, his new Paris friend (or a "bottle-sharer", in Vladi's terms), recorded Vysotsky in his home studio. After a brief stay in England Vysotsky crossed the ocean and made his first Mexican concerts in April. Back in Moscow, there were changes at Taganka: Lyubimov went to Milan's La Scala on a contract and Anatoly Efros has been brought in, a director of radically different approach. His project, Chekhov's The Cherry Orchard, caused a sensation. Critics praised Alla Demidova (as Ranevskaya) and Vysotsky (as Lopakhin) powerful interplay, some describing it as one of the most dazzling in the history of the Soviet theater. Lyubimov, who disliked the piece, accused Efros of giving his actors "the stardom malaise." The 1976 Taganka's visit to Bulgaria resulted in Vysotskys's interview there being filmed and 15 songs recorded by Balkanton record label. On return Lyubimov made a move which many thought outrageous: declaring himself "unable to work with this Mr. Vysotsky anymore" he gave the role of Hamlet to Valery Zolotukhin, the latter's best friend. That was the time, reportedly, when stressed out Vysotsky started taking amphetamines.

 

Another Belorussian voyage completed, Marina and Vladimir went for France and from there (without any official permission given, or asked for) flew to the North America. In New York Vysotsky met, among other people, Mikhail Baryshnikov and Joseph Brodsky. In a televised one-hour interview with Dan Rather he stressed he was "not a dissident, just an artist, who's never had any intentions to leave his country where people loved him and his songs." At home this unauthorized venture into the Western world bore no repercussions: by this time Soviet authorities were divided as regards the "Vysotsky controversy" up to the highest level; while Mikhail Suslov detested the bard, Brezhnev loved him to such an extent that once, while in hospital, asked him to perform live in his daughter Galina's home, listening to this concert on the telephone. In 1976 appeared "The Domes", "The Rope" and the "Medieval" cycle, including "The Ballad of Love".

 

In September Vysotsky with Taganka made a trip to Yugoslavia where Hamlet won the annual BITEF festival's first prize, and then to Hungary for a two-week concert tour. Back in Moscow Lyubimov's production of The Master & Margarita featured Vysotsky as Ivan Bezdomny; a modest role, somewhat recompensed by an important Svidrigailov slot in Yury Karyakin's take on Dostoevsky's Crime and Punishment. Vysotsky's new songs of this period include "The History of Illness" cycle concerning his health problems, humorous "Why Did the Savages Eat Captain Cook", the metaphorical "Ballad of the Truth and the Lie", as well as "Two Fates", the chilling story of a self-absorbed alcoholic hunted by two malevolent witches, his two-faced destiny. In 1977 Vysotsky's health deteriorated (heart, kidneys, liver failures, jaw infection and nervous breakdown) to such an extent that in April he found himself in Moscow clinic's reanimation center in the state of physical and mental collapse.

 

In 1977 Vysotsky made an unlikely appearance in New York City on the American television show 60 Minutes, which falsely stated that Vysotsky had spent time in the Soviet prison system, the Gulag. That year saw the release of three Vysotsky's LPs in France (including the one that had been recorded by RCA in Canada the previous year); arranged and accompanied by guitarist Kostya Kazansky, the singer for the first time ever enjoyed the relatively sophisticated musical background. In August he performed in Hollywood before members of New York City film cast and (according to Vladi) was greeted warmly by the likes of Liza Minnelli and Robert De Niro. Some more concerts in Los Angeles were followed by the appearance at the French Communist paper L’Humanité annual event. In December Taganka left for France, its Hamlet (Vysotsky back in the lead) gaining fine reviews.

 

1978 started with the March–April series of concerts in Moscow and Ukraine. In May Vysotsky embarked upon a new major film project: The Meeting Place Cannot Be Changed (Место встречи изменить нельзя) about two detectives fighting crime in late 1940s Russia, directed by Stanislav Govorukhin. The film (premiered on 11 November 1978 on the Soviet Central TV) presented Vysotsky as Zheglov, a ruthless and charismatic cop teaching his milder partner Sharapov (actor Vladimir Konkin) his art of crime-solving. Vysotsky also became engaged in Taganka's Genre-seeking show (performing some of his own songs) and played Aleksander Blok in Anatoly Efros' The Lady Stranger (Незнакомка) radio play (premiered on air on 10 July 1979 and later released as a double LP).

 

In November 1978 Vysotsky took part in the underground censorship-defying literary project Metropolis, inspired and organized by Vasily Aksenov. In January 1979 Vysotsky again visited America with highly successful series of concerts. That was the point (according to biographer Vladimir Novikov) when a glimpse of new, clean life of a respectable international actor and performer all but made Vysotsky seriously reconsider his priorities. What followed though, was a return to the self-destructive theater and concert tours schedule, personal doctor Anatoly Fedotov now not only his companion, but part of Taganka's crew. "Who was this Anatoly? Just a man who in every possible situation would try to provide drugs. And he did provide. In such moments Volodya trusted him totally," Oksana Afanasyeva, Vysotsky's Moscow girlfriend (who was near him for most of the last year of his life and, on occasion, herself served as a drug courier) remembered. In July 1979, after a series of Central Asia concerts, Vysotsky collapsed, experienced clinical death and was resuscitated by Fedotov (who injected caffeine into the heart directly), colleague and close friend Vsevolod Abdulov helping with heart massage. In January 1980 Vysotsky asked Lyubimov for a year's leave. "Up to you, but on condition that Hamlet is yours," was the answer. The songwriting showed signs of slowing down, as Vysotsky began switching from songs to more conventional poetry. Still, of nearly 800 poems by Vysotsky only one has been published in the Soviet Union while he was alive. Not a single performance or interview was broadcast by the Soviet television in his lifetime.

 

In May 1979, being in a practice studio of the MSU Faculty of Journalism, Vysotsky recorded a video letter to American actor and film producer Warren Beatty, looking for both a personal meeting with Beatty and an opportunity to get a role in Reds film, to be produced and directed by the latter. While recording, Vysotsky made a few attempts to speak English, trying to overcome the language barrier. This video letter never reached Beatty. It was broadcast for the first time more than three decades later, on the night of 24 January 2013 (local time) by Rossiya 1 channel, along with records of TV channels of Italy, Mexico, Poland, USA and from private collections, in Vladimir Vysotsky. A letter to Warren Beatty film by Alexander Kovanovsky and Igor Rakhmanov. While recording this video, Vysotsky had a rare opportunity to perform for a camera, being still unable to do it with Soviet television.

 

On 22 January 1980, Vysotsky entered the Moscow Ostankino TV Center to record his one and only studio concert for the Soviet television. What proved to be an exhausting affair (his concentration lacking, he had to plod through several takes for each song) was premiered on the Soviet TV eight years later. The last six months of his life saw Vysotsky appearing on stage sporadically, fueled by heavy dosages of drugs and alcohol. His performances were often erratic. Occasionally Vysotsky paid visits to Sklifosofsky [ru] institute's ER unit, but would not hear of Marina Vlady's suggestions for him to take long-term rehabilitation course in a Western clinic. Yet he kept writing, mostly poetry and even prose, but songs as well. The last song he performed was the agonizing "My Sorrow, My Anguish" and his final poem, written one week prior to his death was "A Letter to Marina": "I'm less than fifty, but the time is short / By you and God protected, life and limb / I have a song or two to sing before the Lord / I have a way to make my peace with him."

 

Although several theories of the ultimate cause of the singer's death persist to this day, given what is now known about cardiovascular disease, it seems likely that by the time of his death Vysotsky had an advanced coronary condition brought about by years of tobacco, alcohol and drug abuse, as well as his grueling work schedule and the stress of the constant harassment by the government. Towards the end, most of Vysotsky's closest friends had become aware of the ominous signs and were convinced that his demise was only a matter of time. Clear evidence of this can be seen in a video ostensibly shot by the Japanese NHK channel only months before Vysotsky's death, where he appears visibly unwell, breathing heavily and slurring his speech. Accounts by Vysotsky's close friends and colleagues concerning his last hours were compiled in the book by V. Perevozchikov.

 

Vysotsky suffered from alcoholism for most of his life. Sometime around 1977, he started using amphetamines and other prescription narcotics in an attempt to counteract the debilitating hangovers and eventually to rid himself of alcohol addiction. While these attempts were partially successful, he ended up trading alcoholism for a severe drug dependency that was fast spiralling out of control. He was reduced to begging some of his close friends in the medical profession for supplies of drugs, often using his acting skills to collapse in a medical office and imitate a seizure or some other condition requiring a painkiller injection. On 25 July 1979 (a year to the day before his death) he suffered a cardiac arrest and was clinically dead for several minutes during a concert tour of Soviet Uzbekistan, after injecting himself with a wrong kind of painkiller he had previously obtained from a dentist's office.

 

Fully aware of the dangers of his condition, Vysotsky made several attempts to cure himself of his addiction. He underwent an experimental (and ultimately discredited) blood purification procedure offered by a leading drug rehabilitation specialist in Moscow. He also went to an isolated retreat in France with his wife Marina in the spring of 1980 as a way of forcefully depriving himself of any access to drugs. After these attempts failed, Vysotsky returned to Moscow to find his life in an increasingly stressful state of disarray. He had been a defendant in two criminal trials, one for a car wreck he had caused some months earlier, and one for an alleged conspiracy to sell unauthorized concert tickets (he eventually received a suspended sentence and a probation in the first case, and the charges in the second were dismissed, although several of his co-defendants were found guilty). He also unsuccessfully fought the film studio authorities for the rights to direct a movie called The Green Phaeton. Relations with his wife Marina were deteriorating, and he was torn between his loyalty to her and his love for his mistress Oksana Afanasyeva. He had also developed severe inflammation in one of his legs, making his concert performances extremely challenging.

 

In a final desperate attempt to overcome his drug addiction, partially prompted by his inability to obtain drugs through his usual channels (the authorities had imposed a strict monitoring of the medical institutions to prevent illicit drug distribution during the 1980 Olympics), he relapsed into alcohol and went on a prolonged drinking binge (apparently consuming copious amounts of champagne due to a prevalent misconception at the time that it was better than vodka at countering the effects of drug withdrawal).

 

On 3 July 1980, Vysotsky gave a performance at a suburban Moscow concert hall. One of the stage managers recalls that he looked visibly unhealthy ("gray-faced", as she puts it) and complained of not feeling too good, while another says she was surprised by his request for champagne before the start of the show, as he had always been known for completely abstaining from drink before his concerts. On 16 July Vysotsky gave his last public concert in Kaliningrad. On 18 July, Vysotsky played Hamlet for the last time at the Taganka Theatre. From around 21 July, several of his close friends were on a round-the-clock watch at his apartment, carefully monitoring his alcohol intake and hoping against all odds that his drug dependency would soon be overcome and they would then be able to bring him back from the brink. The effects of drug withdrawal were clearly getting the better of him, as he got increasingly restless, moaned and screamed in pain, and at times fell into memory lapses, failing to recognize at first some of his visitors, including his son Arkadiy. At one point, Vysotsky's personal physician A. Fedotov (the same doctor who had brought him back from clinical death a year earlier in Uzbekistan) attempted to sedate him, inadvertently causing asphyxiation from which he was barely saved. On 24 July, Vysotsky told his mother that he thought he was going to die that day, and then made similar remarks to a few of the friends present at the apartment, who begged him to stop such talk and keep his spirits up. But soon thereafter, Oksana Afanasyeva saw him clench his chest several times, which led her to suspect that he was genuinely suffering from a cardiovascular condition. She informed Fedotov of this but was told not to worry, as he was going to monitor Vysotsky's condition all night. In the evening, after drinking relatively small amounts of alcohol, the moaning and groaning Vysotsky was sedated by Fedotov, who then sat down on the couch next to him but fell asleep. Fedotov awoke in the early hours of 25 July to an unusual silence and found Vysotsky dead in his bed with his eyes wide open, apparently of a myocardial infarction, as he later certified. This was contradicted by Fedotov's colleagues, Sklifosovsky Emergency Medical Institute physicians L. Sul'povar and S. Scherbakov (who had demanded the actor's immediate hospitalization on 23 July but were allegedly rebuffed by Fedotov), who insisted that Fedotov's incompetent sedation combined with alcohol was what killed Vysotsky. An autopsy was prevented by Vysotsky's parents (who were eager to have their son's drug addiction remain secret), so the true cause of death remains unknown.

 

No official announcement of the actor's death was made, only a brief obituary appeared in the Moscow newspaper Vechernyaya Moskva, and a note informing of Vysotsky's death and cancellation of the Hamlet performance was put out at the entrance to the Taganka Theatre (the story goes that not a single ticket holder took advantage of the refund offer). Despite this, by the end of the day, millions had learned of Vysotsky's death. On 28 July, he lay in state at the Taganka Theatre. After a mourning ceremony involving an unauthorized mass gathering of unprecedented scale, Vysotsky was buried at the Vagankovskoye Cemetery in Moscow. The attendance at the Olympic events dropped noticeably on that day, as scores of spectators left to attend the funeral. Tens of thousands of people lined the streets to catch a glimpse of his coffin.

 

According to author Valery Perevozchikov part of the blame for his death lay with the group of associates who surrounded him in the last years of his life. This inner circle were all people under the influence of his strong character, combined with a material interest in the large sums of money his concerts earned. This list included Valerii Yankelovich, manager of the Taganka Theatre and prime organiser of his non-sanctioned concerts; Anatoly Fedotov, his personal doctor; Vadim Tumanov, gold prospector (and personal friend) from Siberia; Oksana Afanasyeva (later Yarmolnik), his mistress the last three years of his life; Ivan Bortnik, a fellow actor; and Leonid Sul'povar, a department head at the Sklifosovski hospital who was responsible for much of the supply of drugs.

 

Vysotsky's associates had all put in efforts to supply his drug habit, which kept him going in the last years of his life. Under their influence, he was able to continue to perform all over the country, up to a week before his death. Due to illegal (i.e. non-state-sanctioned) sales of tickets and other underground methods, these concerts pulled in sums of money unimaginable in Soviet times, when almost everyone received nearly the same small salary. The payouts and gathering of money were a constant source of danger, and Yankelovich and others were needed to organise them.

 

Some money went to Vysotsky, the rest was distributed amongst this circle. At first this was a reasonable return on their efforts; however, as his addiction progressed and his body developed resistance, the frequency and amount of drugs needed to keep Vysotsky going became unmanageable. This culminated at the time of the Moscow Olympics which coincided with the last days of his life, when supplies of drugs were monitored more strictly than usual, and some of the doctors involved in supplying Vysotsky were already behind bars (normally the doctors had to account for every ampule, thus drugs were transferred to an empty container, while the patients received a substitute or placebo instead). In the last few days Vysotsky became uncontrollable, his shouting could be heard all over the apartment building on Malaya Gruzinskaya St. where he lived amongst VIP's. Several days before his death, in a state of stupor he went on a high speed drive around Moscow in an attempt to obtain drugs and alcohol – when many high-ranking people saw him. This increased the likelihood of him being forcibly admitted to the hospital, and the consequent danger to the circle supplying his habit. As his state of health declined, and it became obvious that he might die, his associates gathered to decide what to do with him. They came up with no firm decision. They did not want him admitted officially, as his drug addiction would become public and they would fall under suspicion, although some of them admitted that any ordinary person in his condition would have been admitted immediately.

 

On Vysotsky's death his associates and relatives put in much effort to prevent a post-mortem being carried out. This despite the fairly unusual circumstances: he died aged 42 under heavy sedation with an improvised cocktail of sedatives and stimulants, including the toxic chloral hydrate, provided by his personal doctor who had been supplying him with narcotics the previous three years. This doctor, being the only one present at his side when death occurred, had a few days earlier been seen to display elementary negligence in treating the sedated Vysotsky. On the night of his death, Arkadii Vysotsky (his son), who tried to visit his father in his apartment, was rudely refused entry by Yankelovich, even though there was a lack of people able to care for him. Subsequently, the Soviet police commenced a manslaughter investigation which was dropped due to the absence of evidence taken at the time of death.

 

Vysotsky's first wife was Iza Zhukova. They met in 1956, being both MAT theater institute students, lived for some time at Vysotsky's mother's flat in Moscow, after her graduation (Iza was 2 years older) spent months in different cities (her – in Kiev, then Rostov) and finally married on 25 April 1960.

 

He met his second wife Lyudmila Abramova in 1961, while shooting the film 713 Requests Permission to Land. They married in 1965 and had two sons, Arkady (born 1962) and Nikita (born 1964).

 

While still married to Lyudmila Abramova, Vysotsky began a romantic relationship with Tatyana Ivanenko, a Taganka actress, then, in 1967 fell in love with Marina Vlady, a French actress of Russian descent, who was working at Mosfilm on a joint Soviet-French production at that time. Marina had been married before and had three children, while Vladimir had two. They were married in 1969. For 10 years the two maintained a long-distance relationship as Marina compromised her career in France to spend more time in Moscow, and Vladimir's friends pulled strings for him to be allowed to travel abroad to stay with his wife. Marina eventually joined the Communist Party of France, which essentially gave her an unlimited-entry visa into the Soviet Union, and provided Vladimir with some immunity against prosecution by the government, which was becoming weary of his covertly anti-Soviet lyrics and his odds-defying popularity with the masses. The problems of his long-distance relationship with Vlady inspired several of Vysotsky's songs.

 

In the autumn of 1981 Vysotsky's first collection of poetry was officially published in the USSR, called The Nerve (Нерв). Its first edition (25,000 copies) was sold out instantly. In 1982 the second one followed (100,000), then the 3rd (1988, 200,000), followed in the 1990s by several more. The material for it was compiled by Robert Rozhdestvensky, an officially laurelled Soviet poet. Also in 1981 Yuri Lyubimov staged at Taganka a new music and poetry production called Vladimir Vysotsky which was promptly banned and officially premiered on 25 January 1989.

 

In 1982 the motion picture The Ballad of the Valiant Knight Ivanhoe was produced in the Soviet Union and in 1983 the movie was released to the public. Four songs by Vysotsky were featured in the film.

 

In 1986 the official Vysotsky poetic heritage committee was formed (with Robert Rozhdestvensky at the helm, theater critic Natalya Krymova being both the instigator and the organizer). Despite some opposition from the conservatives (Yegor Ligachev was the latter's political leader, Stanislav Kunyaev of Nash Sovremennik represented its literary flank) Vysotsky was rewarded posthumously with the USSR State Prize. The official formula – "for creating the character of Zheglov and artistic achievements as a singer-songwriter" was much derided from both the left and the right. In 1988 the Selected Works of... (edited by N. Krymova) compilation was published, preceded by I Will Surely Return... (Я, конечно, вернусь...) book of fellow actors' memoirs and Vysotsky's verses, some published for the first time. In 1990 two volumes of extensive The Works of... were published, financed by the late poet's father Semyon Vysotsky. Even more ambitious publication series, self-proclaimed "the first ever academical edition" (the latter assertion being dismissed by sceptics) compiled and edited by Sergey Zhiltsov, were published in Tula (1994–1998, 5 volumes), Germany (1994, 7 volumes) and Moscow (1997, 4 volumes).

 

In 1989 the official Vysotsky Museum opened in Moscow, with the magazine of its own called Vagant (edited by Sergey Zaitsev) devoted entirely to Vysotsky's legacy. In 1996 it became an independent publication and was closed in 2002.

 

In the years to come, Vysotsky's grave became a site of pilgrimage for several generations of his fans, the youngest of whom were born after his death. His tombstone also became the subject of controversy, as his widow had wished for a simple abstract slab, while his parents insisted on a realistic gilded statue. Although probably too solemn to have inspired Vysotsky himself, the statue is believed by some to be full of metaphors and symbols reminiscent of the singer's life.

 

In 1995 in Moscow the Vysotsky monument was officially opened at Strastnoy Boulevard, by the Petrovsky Gates. Among those present were the bard's parents, two of his sons, first wife Iza, renown poets Yevtushenko and Voznesensky. "Vysotsky had always been telling the truth. Only once he was wrong when he sang in one of his songs: 'They will never erect me a monument in a square like that by Petrovskye Vorota'", Mayor of Moscow Yuri Luzhkov said in his speech.[95] A further monument to Vysotsky was erected in 2014 at Rostov-on-Don.

 

In October 2004, a monument to Vysotsky was erected in the Montenegrin capital of Podgorica, near the Millennium Bridge. His son, Nikita Vysotsky, attended the unveiling. The statue was designed by Russian sculptor Alexander Taratinov, who also designed a monument to Alexander Pushkin in Podgorica. The bronze statue shows Vysotsky standing on a pedestal, with his one hand raised and the other holding a guitar. Next to the figure lies a bronze skull – a reference to Vysotsky's monumental lead performances in Shakespeare's Hamlet. On the pedestal the last lines from a poem of Vysotsky's, dedicated to Montenegro, are carved.

 

The Vysotsky business center & semi-skyscraper was officially opened in Yekaterinburg, in 2011. It is the tallest building in Russia outside of Moscow, has 54 floors, total height: 188.3 m (618 ft). On the third floor of the business center is the Vysotsky Museum. Behind the building is a bronze sculpture of Vladimir Vysotsky and his third wife, a French actress Marina Vlady.

 

In 2011 a controversial movie Vysotsky. Thank You For Being Alive was released, script written by his son, Nikita Vysotsky. The actor Sergey Bezrukov portrayed Vysotsky, using a combination of a mask and CGI effects. The film tells about Vysotsky's illegal underground performances, problems with KGB and drugs, and subsequent clinical death in 1979.

 

Shortly after Vysotsky's death, many Russian bards started writing songs and poems about his life and death. The best known are Yuri Vizbor's "Letter to Vysotsky" (1982) and Bulat Okudzhava's "About Volodya Vysotsky" (1980). In Poland, Jacek Kaczmarski based some of his songs on those of Vysotsky, such as his first song (1977) was based on "The Wolfhunt", and dedicated to his memory the song "Epitafium dla Włodzimierza Wysockiego" ("Epitaph for Vladimir Vysotsky").

 

Every year on Vysotsky's birthday festivals are held throughout Russia and in many communities throughout the world, especially in Europe. Vysotsky's impact in Russia is often compared to that of Wolf Biermann in Germany, Bob Dylan in America, or Georges Brassens and Jacques Brel in France.

 

The asteroid 2374 Vladvysotskij, discovered by Lyudmila Zhuravleva, was named after Vysotsky.

 

During the Annual Q&A Event Direct Line with Vladimir Putin, Alexey Venediktov asked Putin to name a street in Moscow after the singer Vladimir Vysotsky, who, though considered one of the greatest Russian artists, has no street named after him in Moscow almost 30 years after his death. Venediktov stated a Russian law that allowed the President to do so and promote a law suggestion to name a street by decree. Putin answered that he would talk to Mayor of Moscow and would solve this problem. In July 2015 former Upper and Lower Tagansky Dead-ends (Верхний и Нижний Таганские тупики) in Moscow were reorganized into Vladimir Vysotsky Street.

 

The Sata Kieli Cultural Association, [Finland], organizes the annual International Vladimir Vysotsky Festival (Vysotski Fest), where Vysotsky's singers from different countries perform in Helsinki and other Finnish cities. They sing Vysotsky in different languages and in different arrangements.

 

Two brothers and singers from Finland, Mika and Turkka Mali, over the course of their more than 30-year musical career, have translated into Finnish, recorded and on numerous occasions publicly performed songs of Vladimir Vysotsky.

 

Throughout his lengthy musical career, Jaromír Nohavica, a famed Czech singer, translated and performed numerous songs of Vladimir Vysotsky, most notably Песня о друге (Píseň o příteli – Song about a friend).

 

The Museum of Vladimir Vysotsky in Koszalin dedicated to Vladimir Vysotsky was founded by Marlena Zimna (1969–2016) in May 1994, in her apartment, in the city of Koszalin, in Poland. Since then the museum has collected over 19,500 exhibits from different countries and currently holds Vladimir Vysotsky' personal items, autographs, drawings, letters, photographs and a large library containing unique film footage, vinyl records, CDs and DVDs. A special place in the collection holds a Vladimir Vysotsky's guitar, on which he played at a concert in Casablanca in April 1976. Vladimir Vysotsky presented this guitar to Moroccan journalist Hassan El-Sayed together with an autograph (an extract from Vladimir Vysotsky's song "What Happened in Africa"), written in Russian right on the guitar.

 

In January 2023, a monument to the outstanding actor, singer and poet Vladimir Vysotsky was unveiled in Yuzhno-Sakhalinsk, in the square near the Rodina House of Culture. Author Vladimir Chebotarev.

 

After her husband's death, urged by her friend Simone Signoret, Marina Vlady wrote a book called The Aborted Flight about her years together with Vysotsky. The book paid tribute to Vladimir's talent and rich persona, yet was uncompromising in its depiction of his addictions and the problems that they caused in their marriage. Written in French (and published in France in 1987), it was translated into Russian in tandem by Vlady and a professional translator and came out in 1989 in the USSR. Totally credible from the specialists' point of view, the book caused controversy, among other things, by shocking revelations about the difficult father-and-son relationship (or rather, the lack of any), implying that Vysotsky-senior (while his son was alive) was deeply ashamed of him and his songs which he deemed "anti-Soviet" and reported his own son to the KGB. Also in 1989 another important book of memoirs was published in the USSR, providing a bulk of priceless material for the host of future biographers, Alla Demidova's Vladimir Vysotsky, the One I Know and Love. Among other publications of note were Valery Zolotukhin's Vysotsky's Secret (2000), a series of Valery Perevozchikov's books (His Dying Hour, The Unknown Vysotsky and others) containing detailed accounts and interviews dealing with the bard's life's major controversies (the mystery surrounding his death, the truth behind Vysotsky Sr.'s alleged KGB reports, the true nature of Vladimir Vysotsky's relations with his mother Nina's second husband Georgy Bartosh etc.), Iza Zhukova's Short Happiness for a Lifetime and the late bard's sister-in-law Irena Vysotskaya's My Brother Vysotsky. The Beginnings (both 2005).

 

A group of enthusiasts has created a non-profit project – the mobile application "Vysotsky"

 

The multifaceted talent of Vysotsky is often described by the term "bard" (бард) that Vysotsky has never been enthusiastic about. He thought of himself mainly as an actor and poet rather than a singer, and once remarked, "I do not belong to what people call bards or minstrels or whatever." With the advent of portable tape-recorders in the Soviet Union, Vysotsky's music became available to the masses in the form of home-made reel-to-reel audio tape recordings (later on cassette tapes).

 

Vysotsky accompanied himself on a Russian seven-string guitar, with a raspy voice singing ballads of love, peace, war, everyday Soviet life and of the human condition. He was largely perceived as the voice of honesty, at times sarcastically jabbing at the Soviet government, which made him a target for surveillance and threats. In France, he has been compared with Georges Brassens; in Russia, however, he was more frequently compared with Joe Dassin, partly because they were the same age and died in the same year, although their ideologies, biographies, and musical styles are very different. Vysotsky's lyrics and style greatly influenced Jacek Kaczmarski, a Polish songwriter and singer who touched on similar themes.

 

The songs – over 600 of them – were written about almost any imaginable theme. The earliest were blatnaya pesnya ("outlaw songs"). These songs were based either on the life of the common people in Moscow or on life in the crime people, sometimes in Gulag. Vysotsky slowly grew out of this phase and started singing more serious, though often satirical, songs. Many of these songs were about war. These war songs were not written to glorify war, but rather to expose the listener to the emotions of those in extreme, life-threatening situations. Most Soviet veterans would say that Vysotsky's war songs described the truth of war far more accurately than more official "patriotic" songs.

 

Nearly all of Vysotsky's songs are in the first person, although he is almost never the narrator. When singing his criminal songs, he would adopt the accent and intonation of a Moscow thief, and when singing war songs, he would sing from the point of view of a soldier. In many of his philosophical songs, he adopted the role of inanimate objects. This created some confusion about Vysotsky's background, especially during the early years when information could not be passed around very easily. Using his acting talent, the poet played his role so well that until told otherwise, many of his fans believed that he was, indeed, a criminal or war veteran. Vysotsky's father said that "War veterans thought the author of the songs to be one of them, as if he had participated in the war together with them." The same could be said about mountain climbers; on multiple occasions, Vysotsky was sent pictures of mountain climbers' graves with quotes from his lyrics etched on the tombstones.

 

Not being officially recognized as a poet and singer, Vysotsky performed wherever and whenever he could – in the theater (where he worked), at universities, in private apartments, village clubs, and in the open air. It was not unusual for him to give several concerts in one day. He used to sleep little, using the night hours to write. With few exceptions, he wasn't allowed to publish his recordings with "Melodiya", which held a monopoly on the Soviet music industry. His songs were passed on through amateur, fairly low quality recordings on vinyl discs and magnetic tape, resulting in his immense popularity. Cosmonauts even took his music on cassette into orbit.

 

Musically, virtually all of Vysotsky's songs were written in a minor key, and tended to employ from three to seven chords. Vysotsky composed his songs and played them exclusively on the Russian seven string guitar, often tuned a tone or a tone-and-a-half below the traditional Russian "Open G major" tuning. This guitar, with its specific Russian tuning, makes a slight yet notable difference in chord voicings than the standard tuned six string Spanish (classical) guitar, and it became a staple of his sound. Because Vysotsky tuned down a tone and a half, his strings had less tension, which also colored the sound.

 

His earliest songs were usually written in C minor (with the guitar tuned a tone down from DGBDGBD to CFACFAC)

 

Songs written in this key include "Stars" (Zvyozdy), "My friend left for Magadan" (Moy drug uyekhal v Magadan), and most of his "outlaw songs".

 

At around 1970, Vysotsky began writing and playing exclusively in A minor (guitar tuned to CFACFAC), which he continued doing until his death.

 

Vysotsky used his fingers instead of a pick to pluck and strum, as was the tradition with Russian guitar playing. He used a variety of finger picking and strumming techniques. One of his favorite was to play an alternating bass with his thumb as he plucked or strummed with his other fingers.

 

Often, Vysotsky would neglect to check the tuning of his guitar, which is particularly noticeable on earlier recordings. According to some accounts, Vysotsky would get upset when friends would attempt to tune his guitar, leading some to believe that he preferred to play slightly out of tune as a stylistic choice. Much of this is also attributable to the fact that a guitar that is tuned down more than 1 whole step (Vysotsky would sometimes tune as much as 2 and a half steps down) is prone to intonation problems.

 

Vysotsky had a unique singing style. He had an unusual habit of elongating consonants instead of vowels in his songs. So when a syllable is sung for a prolonged period of time, he would elongate the consonant instead of the vowel in that syllable.

Smoking as few as 3 cigarettes a day for women (or 3 grams of tobacco in another form) significantly increases the risk of having a myocardial infarction or dying from some other cause. These risks were roughly 1½ times greater in women than in men. The findings together with similar results from other studies, reinforces the fallacy of "cutting down" as an escape from the dangers of smoking.

 

Source:

[ The Copenhagen City Heart Study. E. Prescott, H. Scharling, M. Osler, et al., J Epidemiol Community Health, 2002, vol. 56, pp. 702--706 ]

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Keep healthy this winter by including plenty of these 5 foods in your diet.

 

 

Although there are fewer foods that are in season in winter than in summer, winter boasts some surprising health superstars. Here are 5 of the healthiest winter foods you should be eating.

Pomegranates

Chances are you’ve tasted pomegranates in their newly popular juice form. And from a heart-health perspective, that’s probably a good thing. Pomegranate juice is rich in antioxidants (more so than other fruit juices)—just a cup daily might help to keep free radicals from oxidizing “bad” LDL cholesterol, according to a preliminary study in theAmerican Journal of Clinical Nutrition. Oxidized LDL contributes to plaque buildup in the arteries. Another study showed that drinking pomegranate juice might improve blood flow to the heart in people with myocardial ischemia, a serious condition in which the heart’s oxygen supply is compromised because the arteries leading to it are blocked.

 

 

Dark Leafy Greens

[caption id="attachment_363" align="alignleft" width="300"] Eat your greens ~ spinach, broccoli, curly lettuce and asparagus. Healthy eating.[/caption]

 

Dark leafy greens, such as kale, chard and collards, thrive in the chill of winter when the rest of the produce section looks bleak. In fact, a frost can take away the bitterness of kale. These greens are particularly rich in vitamins A, C and K. Collards, mustard greens and escarole are also excellent sources of folate, important for women of childbearing age.

Citrus

[caption id="attachment_362" align="alignright" width="300"] Citrus fruit[/caption]

 

Citrus fruits, including lemons, limes, oranges and grapefruit, are at their juiciest in the wintertime and can add sunshine to the dreary winter. Citrus fruits are loaded with vitamin C—one medium orange delivers more than 100 percent of your daily dose. As Karen Ansel, M.S., R.D., writes in the January/February 2012 issue of EatingWell Magazine, citrus fruits are also rich sources of flavonoids. The predominant flavonoid in these fruits—hesperidin—is credited with boosting “good” HDL cholesterol and lowering “bad” LDL cholesterol and triglycerides.

Potatoes

Potatoes sometimes get a bad rap for being a white starch, thrown into the same category as white rice or white bread. But unlike those other starches, which have indeed been stripped of healthful nutrients, potatoes are a whole food that contain several beneficial nutrients. They are an excellent source of two immunity boosters—vitamins C and B6, delivering 25% and 29% of your daily needs per medium potato, respectively. They are also a good source of folate, which is especially important for women of childbearing age, and they deliver fiber (4 grams in a medium potato; women need 25 grams daily and men need 38 grams). If you can find purple potatoes, you’ll get an added health boon—they are rich in anthocyanins—antioxidants that are linked to a host of health benefits, from lowering cancer and heart disease risk to quelling inflammation.

Winter Squash

There are many varieties of winter squash—including butternut, acorn, delicata and spaghetti squash—and they are all excellent choices in the winter. One cup of cooked winter squash has few calories (around 80) but is high in both vitamin A (214 percent of the recommended daily value) and vitamin C (33 percent), as well as being a good source of vitamins B6 and K, potassium and folate.

Not looking or feeling too bad following my heart attack 10 days ago. Feeling lucky and also thankful for the NHS

Taxus cuspidata, the Japanese yew or spreading yew, is a member of the genus Taxus, native to Japan, Korea, northeast China and the extreme southeast of Russia.

 

It is an evergreen tree or large shrub growing to 10–18 m tall, with a trunk up to 60 cm diameter. The leaves are lanceolate, flat, dark green, 1–3 cm long and 2–3 mm broad, arranged spirally on the stem, but with the leaf bases twisted to align the leaves in two flattish rows either side of the stem except on erect leading shoots where the spiral arrangement is more obvious.

 

The seed cones are highly modified, each cone containing a single seed 4–8 mm long partly surrounded by a modified scale which develops into a soft, bright red berry-like structure called an aril, 8–12 mm long and wide and open at the end. The arils are mature 6–9 months after pollination. Individual trees from Sikhote-Alin are known to have been 1,000 years old.

 

Uses

It is widely grown in eastern Asia and eastern North America as an ornamental plant.

 

Toxicity

The molecular structure of taxine B

The entire yew bush, except the aril (the red flesh of the berry covering the seed), is toxic due to a group of chemicals called taxine alkaloids. Their cardiotoxicity is well known and act via calcium and sodium channel antagonism, causing an increase in cytoplasmic calcium currents of the myocardial cells. The seeds contains the highest concentrations of these alkaloids. If any leaves or seeds of the plant are ingested, urgent medical advice is recommended, as well as observation for at least 6 hours after the point of ingestion. The most cardiotoxic taxine is Taxine B followed by Taxine A; Taxine B also happens to be the most common alkaloid in the Taxus species. Yew poisonings are relatively common in both domestic and wild animals who consume the plant accidentally. The taxine alkaloids are absorbed quickly from the intestine and in high enough quantities can cause death due to general cardiac failure, cardiac arrest, or respiratory failure. Taxines are also absorbed efficiently via the skin and Taxus species should thus be handled with care and preferably with gloves. Taxus baccata leaves contain approximately 5 mg of taxines per 1g of leaves. The estimated (i.e. not by any means a fact) lethal dose (LDmin) of Taxus baccata leaves is 3.0-6.5 mg/kg body weight for humans There is currently no known antidotes for yew poisoning, but drugs such as atropine have been used to treat the symptoms. Taxine remains in the plant all year, with maximal concentrations appearing during the winter. Dried yew plant material retains its toxicity for several months and even increases its toxicity as the water is removed, fallen leaves are also toxic. Although poisoning usually occurs when leaves of yew trees are eaten, in at least one case a victim inhaled sawdust from a yew tree.

 

The following book made it clear that it is very difficult to measure taxine alkaloids and that this is a major reason as to why different studies show different results. Minimum lethal dose, oral LDmin for many different animals were tested:

 

Chicken 82.5 mg/kg

Cow 10.0 mg/kg

Dog 11.5 mg/kg

Goat 60.0 mg/kg

Horse 1.0–2.0 mg/kg

Pig 3.5 mg/kg

Sheep 12.5 mg/kg

Several studies have found taxine LD50 values under 20 mg/kg in mice and rats.

 

For symptoms of human toxicity see Taxine alkaloids

 

Male and monoecious yews in this genus release toxic pollen, which can cause the mild symptoms see Taxine alkaloids. The pollen are also a trigger for asthma. These pollen grains are only 15 microns in size, and can easily pass through most window screens.

I love this brainy, sexy Canadian... ;-)

For the record, I did not have one at the State Fair this year, but I am curious how they tasted. I assume the Fried PB&J was well received as the line was 15-20 deep at all times.

French postcard in the Les Vedettes de Cinéma Series, by A.N., Paris, no. 11. Photo: Universal Film Company. Perhaps this card is for The Shark Master (Fred Leroy Granville, 1921) which evolves in the South Seas.

 

Frank Mayo (1889–1963) was an American actor, who appeared in 310 films between 1911 and 1949.

 

Born in New York, Frank Mayo was the grandson of 19th-century theater actor Frank M. Mayo and made his theater debut at age 6 in his grandfather's play Davy Crockett. Mayo was first credited in film in the 1911 short film The Thumb Print (1911), by the Vitagraph Studios, along with Earle Williams, Maurice Costello and Florence Turner. He later acted in The Lure of the Windigo (Selig, 1914) and acted at the Balboa Amusement Company in such films as The Love Liar (1915), The Rim of the Desert (1915), The Adventures of a Madcap (1915) and in the series The Red Circle (1915), alongside Ruth Roland. Meanwhile, Mayo directed a single film, The Lost Bracelet (Lubin, 1916).

 

He signed to World Films in 1918, and acted in several World Film films throughout the 1918 and 1919. For Universal Pictures Mayo starred between 1919 and 1923 in some 25 features including The Girl in Number 29 (1920), The Red Lane (1920), Hitchin 'Posts (1920), The Shark Master (1921), and Out of the Silent North (1922). In 1923 he moved over to Goldwyn Pictures where he starred in e.g. Souls for Sale (Rupert Hughes, Goldwyn 1923) and Wild Oranges (King Vidor, Goldwyn 1924), after which he acted for First National and a whole string of smaller companies, as in The Triflers (Louis Gasnier, Bud Schulberg productions 1924) and Then Came the Woman (David Hartford, David Hartford Productions 1926). After 1927 he had a big gap in film acting and started again in 1930 when the sound film had set in. However, his glory days as film star were over, and he had now to satisfy with supporting parts at most and more often he had uncredited parts. Until 1949 Mayo acted but almost only in uncredited parts,

 

Frank Mayo's first wife, Joyce Eleanor Mayo, told in 1920 that her husband had deserted his marriage in 1919 after “six years of marriage”, i.e. from 193 onward. Afterward, Frank married actress Dagmar Godowsky in Tijuana, Mexico in 1921. Frank married Dagmar four days after an emergency proceeding to divorce Joyce Eleanor Mayo, but California law did not allow new marriage until a final sentence was reached one year after the injunction was granted, which eventually characterized the case as bigamy. In March 1925, Dagmar Godowsky appointed Anna Luther as co-responsible in a lawsuit that initiated the divorce proceedings after alleging to have discovered Luther with her husband in Mayo's apartment. The marriage was annulled in August 1928, based on the fact that Mayo had another wife. In 1963 Mayo died in Laguna Beach, California of acute myocardial infarction, and was buried in the Forest Lawn Memorial Park (Hollywood Hills).

 

Sources, English and Portuguese Wikipedia, IMDB.

 

A Couple Of Things You Might Not Recognize About What Your Means

If you have your blood pressure level checked, you’ll get two numbers, the top number will be your systolic pressure and the bottom one is your diastolic pressure. The systolic pressure will be the force of your blood within...

 

bengkuang.com/what-exactly-do-you-know-regarding-your-blo...

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA

The KOM League

Flash Report

For the week of

July 10 thru 16, 2016

 

Somehow another Flash Report was prepared this week in spite of what is going on in this crazy world. Writing these reports may be my way of coping with the whole sordid mess. If the events seen on TV and carried on the Internet depress you maybe you can take a few moments and scan this report which covers a wide range of topics that go as far back as 1881. If you don’t have the time or inclination to peruse this edition I direct your attention to the last story in this report and the historical photo that you will only see by clicking here: www.flickr.com/photos/60428361@N07/28138983596/

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Bartlesville Pirate passes away

 

www.legacy.com/obituaries/kansascity/obituary.aspx?n=PAUL...

 

Paul Frederick Monteil, Jr., 87, Lee's Summit, Mo., died peacefully in his sleep June 29, 2016. Paul was born in Kansas City, Mo., on Oct. 28, 1928, to Paul F. Monteil, Sr. and Alice Burke Monteil. Paul was preceded in death by parents, daughter, Rita Monteil and son, Joe Monteil. He is survived by his wife of 64 years, Eileen Halpin Monteil of the home, children and spouses, Marilyn Bernard (Marc) of Mitchell, SD, Patty Monteil- Mendicino (John) of Warson Woods, Mo., Paul Monteil III (Chris Hernandez) of Kansas City, Katie Carroll-Monteil (John) of Hong Kong, and Jim Monteil (Shelley) of Lee's Summit. He is also survived by his grandchildren, Brianna and Paul Bernard, Abby and Riley Monteil, and Emma Carroll-Monteil, and his in-laws, nieces and nephew.

Coach Monteil was best known for pacing the sidelines of football fields, mostly at O'Hara High School where he won the 1980 Missouri 3A state championship. Over 20 seasons he coached the Celtics to a 144-76-1 record. At O'Hara he also coached golf and basketball, and served as a teacher and athletic director. The school honored Paul in 2001 by naming its stadium "Paul Monteil Stadium." He was selected to Hall of Fames for the Missouri Football Coaches (1997) and the Greater Kansas City Football Coaches Association (2015), and named Western Missouri Coach of the Year (1980). But it was baseball that blessed Paul's early life.

He was a pro prospect as a second baseman, playing two seasons of minor league professional baseball in the Pittsburgh Pirates organization. More importantly, he met his wife Eileen after a baseball game. Paul was associated with Catholic schools his entire life, as a student and athlete at Blessed Sacrament, Rockhurst High School and College, and as a teacher and coach at De La Salle and O'Hara High School. The Monteil family lived on Booth Avenue, where their backyard overlooked the O'Hara practice field. The family could watch practices from the kitchen window, as well as enjoy beautiful sunsets. Paul and Eileen married on Sept. 8, 1951.

Paul worked at the family store, Monteil's Market, while starting a family with Eileen. His 50-year coaching career began in 1947 at De La Salle, assisting Godfrey Kobets. In 1960 he became a full time social studies teacher and head baseball coach. He was part of a close-knit group of coaches at De La Salle, friendships he valued his entire life. In 1967 Paul moved to O'Hara High School, where he taught and coached until his retirement in 1995. Paul had a close relationship with the Christian Brothers at both De La Salle and O'Hara, and was named an affiliate Christian Brother in 1982. Off the field, Paul enjoyed golfing, chocolate milkshakes, reading Westerns, watching the Chiefs and Royals, and spending weekends at the family cabin at Lake of the Ozarks. We are happy to report that even in his last days Paul retained his customary and beloved "twinkle in his eye" orneriness. As a coach he was known for motivating his teams with his fiery competitiveness. He was a humble leader who gave the credit for the team's success to his players and assistant coaches while always accepting the blame for losses. As a teacher his students enjoyed getting his class off track by getting him to tell stories about working in the grocery store and driving a Brink's truck. As an educator and coach, Paul had a great influence on the lives of his students, players, assistant coaches, and fellow educators. And we know he is reunited in Heaven with his children, Rita and Joe. In lieu of flowers, the family suggests donations to St. Regis or O'Hara schools. Visitation will be at 9:30 a.m. Tuesday, July 5, followed by a Mass of Christian Burial at Noon at St. Regis Catholic Church, 8941 James A. Reed Road, Kansas City, MO 64138. Burial will be in Mt. Olivet Cemetery. Offer condolences online at mcgilleystatelinechapel.com Arr.: McGilley State Line Chapel, 12301 State Line Rd., Kansas City, MO 64145 (816) 942-6180. M

Published in Kansas City Star on July 3, 2016

 

Ed comment:

 

Paul Monteil was found early in the process to identify former KOM leaguers. The newspapers of that era referred to him as “Sonny: Monteil a 19 year-old shortstop from Kansas City, Kansas. (The newspaper had the wrong state.) His career began in 1948 when he played for both New Iberia, LA of the Evangeline and Bartlesville, OK of the KOM leagues. He was limited to 11 games at shortstop that year for Bartlesville due them having an all-star shortstop by the name of Calvin Frazer.

 

In 1949 Monteil was back with Bartlesville for limited action and was then sent to Mt. Vernon, Ill. of the Mississippi Ohio Valley league. His primary reason for not staying with Bartlesville was due to the aforementioned Calvin Frazer.

 

Monteil was a member of the 1948 Bartlesville Pirates who had two other players with the nickname of “Sonny.” The others were Rolf Harald Moeller and Salvatore Raymond Catalano. For sure Bartlesville was “Sonnier” than any other team in KOM history and may have set the all-time professional baseball record for the most guys by that nickname on any team. With the passing of Monteil all the Sonny’s are gone. Catalano died in 1980 in Brooklyn, New York and Moeller did likewise in 2004 in Loomis, California.

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Another Kansas City reader who didn’t fare well. Subtitle: What happens in Las Vegas doesn’t stay in Las Vegas.

 

John: We just got back from a week in Las Vegas. While there, my wallet and phone were stolen and while at the police department reporting it, I passed out and was taken by ambulance to the hospital. After several labs and cardiology testing were complete, I had an angiogram that revealed a 95% blockage on the right side and now have a 'stint' souvenir from Las Vegas. Hospital stay: 4 nights and 5 days and the food was good! We have had to cancel our credit cards, changed a few bank accounts around, get a new driver’s license, medical cards and should be receiving my replacement phone today. What a VaCa!

 

I leave on AMTRAK Friday July 1 and come back Saturday July 9. Will be with sister in Fort Worth to visit her and other Texas family that I have not seen in 2.5 years. This has been planned for almost 2 months. I feel good and am going. Hope all is well on your end. Jim

 

Ed note:

 

That note was from fellow former batboy—Jim Jay. He was the Kansas City A’s batboy back in the 1956-57 era. So, he knows what hard times are in baseball circles. That experience probably toughened him up for his Vegas trip. He is proof that whatever happens in Vegas doesn’t stay there. He got out ASAP.

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Carthage Cubs of 1951

 

In the last couple of issues of the Flash Report some names have been shared of guys who were on the Carthage Cubs roster in 1950. There was a method in my madness or else it was a slow week and I was attempting to find something to write.

 

Over the years I have made a point that many guys who contributed to the league in some form or another were never recognized. The term “less thans” has been applied to those who appeared as position players in less than 10 games or pitchers who threw less than 45 innings. However, the document from which that information was gleaned “The Official Baseball Guide,” published by the Sporting News, didn’t use the term “less thans” they were more positive. You might have guessed I’m not in love with the negative terminology used currently.

 

In 24 years of research I believe there were 1,588, plus or minus less than a dozen, young men to don a KOM league uniform for a regular season game. If you were to go back to the Baseball Guides for the years the KOM league operated you’d see roughly 930 names. The difference in the numbers was that roughly 650 players didn’t meet the 10 games played or 45 innings pitched plateau.

 

Often I have speculated as to the number of young men who showed up for spring training or during the regular season who didn’t see any game action. The only two documents I have to gauge the “non-players” are the official files of the 1946-47 Miami Blues/Owls and the 1950-51 Carthage Cubs.

 

With the KOM league operating with both independent as well as major league affiliated teams many players “passed in the night.” The independent teams included Miami, Chanute and Iola at various times while both Chanute and Iola had major league affiliation at times. Both Chanute and Miami were farm clubs of the Topeka Owls at different times.

 

During the seven year history of the league there were either six or eight teams comprising it. In total there were 50 teams covering that span. In that period the complete rosters for an entire season ranged between 24 and 50 individuals. Some wags called the KOM the “Keep on Moving league.” For most of each season the rosters were limited to 15. At the start and end of the season the teams could carry additional players.

 

Going back to the numbers cited of former KOM leaguers I would conservatively estimate that the 50 teams in league history had 15 players in the spring or added during the season that didn’t play in a single game. That would mean another 750 players who thought they had a chance at playing professional baseball. So, what I have done with the 1950 Carthage Cubs in previous reports and what is contained in the following article is an attempt to document the breadth of the outreach of a Class D operation.

 

Owners for independent teams advertised in local newspapers and even The Sporting News for players to try out for their club. One KOM newspaper even wrote, in 1950, that Iola and Chanute were advertising on bulletin boards in Kansas City post offices for players. Of course, that is where the FBI’s 10 MOST WANTED criminals were featured.

__________________________________________________________________

1951 Carthage Cubs

 

The regular season roster for this team included the following individuals for whom I have biographical information that is available but not included in this report: Living members from that team are: Ernie Aiken, Water Babcock, Fred Bade, Wayne Baker, Bill Bauernfeind, George Beck, Don Biebel, Len Bourdet, J. J. Conroy, Richard Gintert, Tom Kordas, John Mudd, Bernie Tomicki, Orville Jacobs and Leonard Van de Hey. One other guy, who was batboy for that team, wrote this article and I assume he is still with us. I’ll check that out with my wife.

 

Last First Middle

Aiken Ernest William

Anderson Donald Edward

Babcock Walter Edward

Bade Frederick H.

Baker Nolan Wayne

Bauernfeind William S.

Beck George John

Biebel Donald Floyd

Bourdet Malcolm Leonard

Coffman Burton Laverne

Conroy JosephJames

Eastburn William Ellsworth

Gintert Richard Earle

Handzo Jr.John G.

Hicks Gary Benton

Jacobs Orville Mayburn

Koehler Walter Theodore

Kordas Thomas George

Lovely Jr. Vernon Scott

McClure Jr. Leonard Stephen "Bud"

McMichael Robert James

Millan Bruce E.

Milster Jack Harland

Mudd John David

Oxford Russell Charles

Paddock Thomas Edward

Reitz Albert Joseph (Manager)

Sorensen Jr .Leroy Stephen

Straub Stanton Wayne

Tomicki Bernard John

Tompkins Burton A.

Vandehey Leonard Elmer

Ward Norman Dale

Zimmer Duane Eugene

 

Young men who showed up for spring training or joined team later but never saw game action

 

***

Jack Garrett

All that is known is that he was a pitcher who Carthage spent $78 on for transportation to join the club. No evidence he ever signed a contract. He didn’t get any money for transportation home.

 

***

Jack Clayton Jean

Born: 10/11/1933 Atlantic, IA (Lived in Adair, IA when signed by Cubs)

Died: 2/ 20/1997 Colorado Springs, Colo.

Reported 6/6/1951

Disabled list 7/3/1951—Injury listed as pulled leg muscle.

Roomed with Fred Bade at 428 Sycamore St. while with Carthage. That was contained in official Carthage records on Aug. 3, 1951.

1952 Blackwell, OK

.

***

Robert Westgate (No middle name)

Born: 2/5/1932 Chicago, Ill.

Died: 12/27/1980 Hobart, Ind.

Graduate of Foreman High School in Chicago--1950

Played for Sioux Falls, SD until 7/30/1951

Reported 8/1/1951 to Carthage

Placed on disabled list and never pitched for Carthage. He had turned his ankle while with Sioux Falls three days before they sent him to Carthage “thinking” he was okay. 1952 on rosters at Topeka, Janesville, Wis. and Blackwell. Okla.

Served in U. S. Army from 10/8/1952 to 9/9/1954

Occupation: Worked for Rockford Life Ins. Company in Hobart, Ind.

Death certificate shows he died of a massive myocardial infarction at St. Mary’s Med. Center in Hobart, Ind.

Warning: If anyone attempts to follow the life of Robert Westgate on Ancestry.com there is a Jack Anderson who has the mirror image life of Westgate. In fact, those names are intertwined to the point that Robert Westgate had two sons and those sons are also shown as sons of Jack Anderson. My conclusion—Ancestry.com doesn’t always have the correct information. Or else Westgate had an alias of Jack Anderson.

 

***

Frank Henry Bendlage—Ft. Madison, IA

Born: 4 Oct 1932- Fort Madison, Lee, Iowa, USA

Death: 21 Jul 2002 - Fort Madison, Lee, Iowa, USA

CPL US ARMY KOREA

Cemetery: Oakland Cemetery 40th St & Ave L Fort Madison, IA

www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=110951...

 

***

William E. Hurr—Forsyth, Mont.

Birth Date: 1/8/1932

Marriage Date: 23 Aug 1951

Marriage Place: Lame Deer, Rosebud, Montana

Current residence: Billings, Mt

 

****

Jacob Henry Jacobsen—Homer, Neb.

Birth : 11/1/1931 Homer, Neb.

Death: 1/2/1992 Riverside, CA.

Had played with Carthage in 1950.

Jacobsen sent a letter in 1951 asking to be released from his professional contract and Carthage sent their response to “Jacob Jackson.” They wanted a share of his bonus money before granting a release.

 

****

Donald P. Annen—Madison, WI

Born: 7/26/1926 Madison, WI

Had been with Carthage in 1950 and left town with Topeka after spring training at Carthage.

Occupation: Fireman with City of Madison

Still resides in Madison, WI and used to read these reports until he got tired of seeing how many of his former teammates were being reported as having passed away.

 

***

Robert James Lowrey—Lafayette, Ind.

Born: 2/14/1932—St. Vincent’s Hosp. Lafayette, Ind.

Died: 5/27/1996 Lafayette, Ind. St. Vincent’s Hospital

Find –A-Grave site: www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=742456...

First Marriage: Lucille Lietchy 3/9/1963

Second Marriage: Georgia Anna Melboom 2/15/1968

Robert was a Purdue Univ. graduate.

Occupation: Insurance Agent for Western Southern

Great Internet documentation on him from birth to death certificate.

 

***

Parker Dean Pyatt—Granville, Ill.

Born: 11/02/1931 Granville, Ill.

Died: 8/26/1984 Las Vegas, NV

Occupation at time of death—farmer

Burial: Granville Cemetery Putnam County Illinois, USA--Plot: Block A, Lot 26, Grave 2

Find-A-Grave citation--http://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=42320815

Place of Residence: Las Vegas, Clark County, Nevada

Funeral Director: Gary R. Davis, Davis Paradise Valley Funeral Home, Las Vegas, Nevada, and Dysart Funeral Chapel, Granville, Illinois

Married Beverly J. Scott

Source: State of Nevada Burial Permit

Family links: Parents: Roy Pyatt (____ - 1963)

Arlyne Kathryn Matson Pyatt (1908 - 1988)

 

***

Charles Louis Yerbic—Dunfermline, Ill.

Born: June 21, 1932 Dunfermline, Ill.

Released by Carthage May 1, 1951

Died: December 21, 2005 Grand Junction, Colo.

Served in U. S. Navy 1952-1956

 

Ed comment:

 

Contact was first made with Charles Yerbic, around 1994, when I was writing my first book about the KOM league. He told of pitching the last pre-season exhibition games for Carthage against the Alba, MO Aces an amateur team that once gave all the Boyer brothers a chance to hone their baseball skills. Carthage won that game 5-3 but Yerbic was cut the next day.

 

There was great anticipation on the part of Yerbic’s family, so much so that on January 22nd, 1951 his older brother (by 14 years) wrote the following on the letterhead of KGRH Broadcasting Company in Fayetteville, Ark. to the Carthage Chamber of Commerce. “This is to express my interest in subscribing to your local newspaper for a period of three (3) months. This special interest is brought about by the fact that my younger brother, CHARLES YERBIC is due to report to your baseball club this spring, having been given a contact with the Chicago Cubs. I would very much like to follow his activities and progress with your local club. Whatever you can do in this regard, I would appreciate very much. Very truly yours, Stephen L. Starwyck.”

 

That letter now raises a couple of questions. First, did Starwyck have to pay for the paper since his younger brother didn’t make the team? Secondly, was Starwyck Stephen’s radio name or was he and Yerbic step brothers? Well, I didn’t want to leave that question unanswered.

(Obituary: STARWYCK, Capt. Stephen Louis was born Dec. 19, 1918 and went home to the Lord on Dec. 7, 2011. Born to the late Katherine and Kazamir Starcevich in Kirksville, MO, he graduated from Lewiston High School in 1936 and enlisted in the Navy in August of the same year. After 11 years of straight sea duty which involved major engagements, he immediately accepted appointment in the Naval Reserve where he rose to the rank of Captain) In tracking the Starcevich family it is obvious the Austrian family descendants changed the spelling of the last to Starwyck. Kazamir Starcevich died in 1929 leaving his wife Katherine a widow. Charles Yerbic’s father married the former Katherine Starcevich/Starwyck around 1930. That is the brief story.

 

Obituary:

This link contains the only photo of Yerbic I ever saw. www.legacy.com/obituaries/gjsentinel/obituary.aspx?n=char...

 

Charles L. Yerbic (Chuck) peacefully passed away at St. Mary's Hospital on December 21st after a short illness. A Mass will be held at St. Joseph Catholic Church at 10 a.m., Tuesday, December 27th in Grand Junction. The son of James and Katherine Yerbic, Chuck was born and raised in Dunfermline, Illinois. He served in the Navy for two years then attended the University of Oklahoma before graduating from Central State College with a Bachelor's degree in business. He and his wife of 39 years, Patricia Yerbic raised six sons of whom they were both very proud. He worked for General Motors for several years in Oklahoma City, Oklahoma and owned and managed Yerbic Motors in Greeley, Colorado. Chuck loved spending time with his family and traveling, and he showed a fine example of leadership and inspiration. He is preceded in death by his parents, six brothers, three sisters, his wife Patricia, and his adult son Rick. Survivors include sons: Chip (and daughter-in-law Karina), Kip, Mike, Mark (and daughter-in-law Gail) and Jim; grandchildren: Jemeleh, Landon, Lyndsay, Turner and Gregory. He is also survived by his very dear friend, Giselle Roberts. Chuck will be greatly missed and remembered with love forever. Memorial contributions can be made to St. Joseph Catholic Church, 230 N. 3rd St., Grand Junction, CO 81501. Published in The Daily Sentinel on Dec. 25, 2005

 

***

Richard S. Ziegler—Affinity, W. VA.

Born: 1931 Affinity, WVA—small mining town in the Appalachian Coal fields. See this link: www.coalcampusa.com/sowv/gulf/affinity/affinity.htm

Last known address Charles Town, WVA. (Not to be confused with Charleston)

Had played with Springfield, Ill. and Spindale, NC in 1950.

Have placed a telephone call to him and left message.

 

***

Hugh Alan Wolf—Indianapolis, Ind.

Born: 6/26/1931 Indianapolis St. Vincent’s Hospital

Graduate: Broad Ripple High School 1949 played on undefeated high school baseball team.

Wolf’s father sent a letter to the Cubs asking that they release his son so he could play amateur ball in Indianapolis.

Released by Chicago Cubs May 16, 1951

Attended Butler University in Indianapolis

Last known whereabouts: Carmel, Ind. in 1993.

 

***

Emil Borgini—Mt. Clare, Ill. (Carthage office files listed him as Fred )

Born: 11/27/1929 Mt. Clare, Ill.

Death: Feb. 27, 2003 Springfield, Sangamon County, Illinois

 

Obituary:

 

Emil Borgini, 73, of Mount Clare died Thursday, Feb. 27, 2003, at Memorial Medical Center. He was born Nov. 27, 1929, in Mount Clare, the son of Virgil and Helen Chelli Borgini. He married Ethel Taylor in 1951 in Gillespie. Mr. Borgini, a 1947 graduate of Benld Township High School, received a bachelor's degree from Blackburn College and a master's degree from Southern Illinois University of Edwardsville. He was a catcher for the Chicago Cubs from 1948-51. He was U.S. Navy veteran of the Korean War. Following his military service, he was a catcher for the Chicago Cubs minor league organization in 1953. He retired as a high school teacher for Benld High School, were he coached basketball. He also had been a high school teacher and principal for Gillespie High School, where he also was the baseball coach and an assistant football coach, and had been the unit district superintendent. He was a member of Benld Lions Club, Benld Owls, VFW Post 4547 of Gillespie and was an adult driver education instructor. He was a board member of Macoupin County Housing Authority, Community Memorial Hospital in Staunton and Gillespie-Benld Area Ambulance Service. Survivors: wife, Ethel; a son, Don (wife, Kathy) Borgini of Carlinville; a daughter, Lynn Borgini of Chicago; two grandchildren; mother, Helen Borgini of Mount Clare; and a brother, Fred Borgini of Haddonfield, N.J. Services: 10:30 a.m. Monday, Kravanya Funeral Home, Gillespie, the Rev. Donna Snyder officiating. Burial: Gillespie City Cemetery.

___________________________________________________________________________

***

Robert Edward Schnabel—Eola, Ill. (In a recent report it was indicated he might still be alive.)

Born: June 16, 1932 Eola, Ill.

Died: November 30, 2010 Eola, Ill

Graduated St. Rita of Cascia High School –Chicago

Basketball photo in high school yearbook stated he was “long-limbed, 6’3” center who was willing to learn and always improving.

Also in spring training with Carthage in 1950

Graduate of DePaul Univ. 1952 with B. S. Degree in Chemistry.

Joined the U. S. Air Force after college and attained rank of Sergeant First Class

Find –A Grave:

www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=137663...

 

***

William Lacy Garten—Hinton, W. Va

Obituary: This provides all the pertinent information.

William Lacy "Bill" Garten, 79 of Hinton died Friday morning May 2, 2008 in Summers County A.R.H. in Hinton following a lengthy illness.

 

Born June 9, 1928 at Garten in Fayette County, he was the son of the late Lacy A. & Randolph Myers Garten.

 

Mr. Garten was a 1945 graduate of Fayetteville High School, lettering in football, basketball & track. He participated in the 1945 North-South Football Game. He was awarded a basketball scholarship by West Virginia University and attended the school until transferring to Concord College in 1946. He lettered in football, basketball & baseball at Concord and was selected All Conference in football in 1949.

 

In 1950, Bill signed a baseball contract with the Chicago Cubs, and played in the Appalachian & Western Carolina Leagues. He was drafted into the U.S. Army in 1952 and served his country in the Korean Conflict. Upon his release in 1954, he started his teaching career at Hinton High School and was assistant football coach and head basketball and baseball coach at Hinton from 1955-1956. In 1957, he was named head football, basketball and baseball coach a Hinton High. He also served as track coach for 2 years. His accomplishments as football coach consisted of leading the Bobcats to the state finals in 1963, losing to Ceredo-Kenova, and winning the state class AA football championship in 1968, defeating Oceana 9-0. He retired as football coach after the 1978 season. He taught social studies and physical education for 30 years at Hinton High, retiring in 1985. His impact and guidance on young student athletes was immeasurable. In 2001, Summers County High School, which succeeded Hinton High School, renamed their football stadium, Garten Stadium, in honor of Coach Garten.

 

He was an avid outdoorsman and enjoyed hunting grouse, turkey & deer. He also loved fishing for trout, bass & channel cats. He was a member of the Benevolent & Protective Order of Elks, serving as Past Exalted Ruler, the Veterans of Foreign Wars, Willow Wood Country Club & the Retired Teachers Associations. Bill was also a member of the Hinton First Presbyterian Church.

 

Survivors include his wife of 58 years, Elaine Bradley Garten. One son, Bill & wife Luci Garten of Nashville, TN. One daughter, Sally Garten of Barger Springs. One granddaughter, Lacy Garten.

 

Memorial services will be held at 11:00 a.m. Wednesday May 7, 2008 at Hinton First Presbyterian Church with Rev. Dr. Barbara Romfo officiating. Private interment will be in Restwood Memorial Gardens in Hinton.

 

***

James Kenneth Grubb

Born: 12/3/1926 Kankakee, Ill

Died: 1/8/1960 Chicago, Ill

Married Shirley Jean Alexander at Edwardsville, Ill. in 1950. She lived until 2007.

Paris, Ill begged Carthage to release Grubb to them in the spring of 1951 and they did and he won 15 games for them.

Having died just short of his 34th birthday raises a question I can’t answer. Maybe someone out there knows the details of his death. (Ed note: That is a subtle hint to baseball necrologist, Jack Morris to work his magic on “My Heritage.”)

 

***

Nicholas C. Agnos—Rochelle, Ill.

Born: 10/20/1930 Rochelle, Ill.

Baseball career: Played for Danville, Ill., Janesville, WI, Monroe, LA, and Carlsbad, NM between the years 1951 to 1956.

Current location. Still living with his wife, Connie, in Rochelle, Ill.

 

***

Jacob J. “Jake” Dwyer (This is the only information I could find or this man)

Mr. Dwyer may have been from Lacrosse, Wisc. but I can’t state that without reservation. So, I won’t.

In a letter from Lee Newman, President of the Carthage Baseball Assn., to Jack Sheehan of the Chicago Cubs, on July 9, 1951, it stated that C. J. Dwyer was owed money for spring training expenses. That letter also expressed the Carthage Baseball club’s regret that Don Anderson had been released as manager that same day. Newman expressed the sentiment Anderson was an honest man and they hoped the Cubs would find another place for him in the organization.

____________________________________________________________________________

KOM league supervisor of umpires 1950

 

For a long time I’ve wanted to write an article about a very popular figure in baseball circles in Southwest Missouri.

 

Up to 1950 the supervisor of umpires for the KOM league was Ward Elmer Mohs a postal worker from Tulsa, OK. Stories about the things Mohs endured as an umpire is the stuff of which reams are written. But, this segment is dedicated to his successor.

 

With the start of the 1950 season, league president E. L. Dale called on Joplin, Mo. baseball legend, Joe Becker to fill the role vacated by Mohs.

 

No one could have been more qualified for the head of umpires than a man born August 3, 1881 in Stupferich, Baden Germany. Joseph Jacob Becker was his name. By the turn of the 20th century the Becker’s had migrated to the United States. Of his six brothers and sisters they were all born in Chicago between the years 1886 and 1896.

 

On October 1, 1901 Becker married Wilhelmina Nicolei in Chicago. He began raising a family there where he had three sons and one daughter between 1902 and 1908. By the time he registered for the draft in 1917 he was 37 years of age and listed his occupation as a printer for the Chicago Daily News. That was his winter job. The other job started in 1911 when he took on a career in umpiring. In documentation from The Sporting News umpire cards this is a brief summary of his career:

1911-12-13-- Umpire in the Wisconsin State Illinois league

1914-15—Umpire Western Canada league

1916—Three I league

1920-1921—Western league

1922-23-24-25-26-27-28-Pacific Coast league

1929-30—International league.

 

Between the years 1908 and 1921 his wife, Wilhelmina passed away. On April 4, 1921 he married Daisy Harnish. In 1930 the Federal Census showed him as divorced and living at the Keystone Hotel in Joplin, MO. He worked as a proof reader for the Joplin Globe and scouted for the Brooklyn Dodgers from 1930 through 1935. In 1936 he was hired as the business manager of the Western Assn. Joplin Miners club. He held that position through the 1940 season.

 

In 1941 Becker still worked for the Joplin Globe and scouted for the Boston Red Sox. In 1942 the New York Yankees hired him in a similar role. With WW II in full swing there wasn’t much scouting going on in 1943 so he spent most of his energy working for the Globe. In 1944 the Red Sox again hired him to be their scout in the four state area of Southwest Missouri, Northeast Arkansas, Northwest Oklahoma and Southeast Kansas. That job lasted until 1949.

 

One of the recommendations Becker made to the Red Sox began in earnest, in 1948. Becker knew every baseball person in his area and was a great friend of Barney Barnett of Baxter Springs, Kansas. When Barney formed his first version of the Baxter Springs Whiz Kids, in 1944, they didn’t have uniforms. Becker, from his role as the business manager of the Joplin Miners, a couple of years earlier knew where the Miners old uniforms were stored. They were the home uniforms of the 1939 New York Yankees that had been sent to Joplin for the Miners to wear in 1941-42. Becker obtained the uniforms and gave them to Barnett who outfitted his team of young men in uniforms that were many sizes too large for them but at least they had uniforms. I have a photo of those young men in those Yankee/Miner uniforms as they posed in front of Barnett’s home in 1944. I may have to dig that out sometime and put it on Flickr. When Barnett was through with those uniforms they were claimed by a mining team called “The Bar Hill Miners.”

Note: A day later I dug up the first Whiz Kid photo and to see it you’ll have to visit this site: www.flickr.com/photos/60428361@N07/28138983596/ All the players are wearing Yankee uniforms with the exception of Ben Craig. Craig is the man mentioned in a Flash Report, a couple of weeks ago, who wants his ashes scattered in the Kansas City, KS area. If you missed that story or want to see it again, let me know. These are the Whiz Kids in the photo that is attached to this report on the Flickr site. Photo was taken in front of the home of Barney Barnett in Baxter Springs, Kansas—June 22, 1944

Left to right: Bill Crow, Sonny Helms, Charles “Frog” Heavin, Dean Cannon, Calvin Mischler, Cecil Crow, Barney Barnett, Guy Crow-Kneeling-batboy, Ben Craig, Jack Moore, Dick Barnett, Bob (Bocky) Myers and Elmer Weaver. (The only living members from that photo are Charles Heavin and Ben Craig. Craig was the only Whiz Kid not wearing a New York Yankee jersey. For historical perspective this team predated Mickey Mantle joining them by three years.)

 

To make a long story even more so, Becker hung out at Baxter Springs to the point that if you ever see a photo, like one of the 1947 versions of the Whiz Kids and an older gentleman in the back row wearing a light colored hat, that was Becker. Over and over he called the Red Sox front office telling them about the Baxter Springs shortstop and that they should allow him to offer Mickey Mantle’s dad enough money in order to make Mantle the property of the Red Sox. But, there was no interest in him by the “Bean-Towners.”

 

By virtue of the KOM league hiring Becker, in 1950, as their supervisor of umpires, which basically ended his scouting and active umpiring career. He had some decisions to make such as recommending the firing of Davey Crockett, that year, for changing his calls on two occasions and causing havoc that league president E. L. Dale didn’t want.

 

Becker lived another seven years following his season as head of KOM umpires. He was involved in the social life of Joplin as well as other things. Age the age of 72, in 1953, he was involved in an automobile accident , in Joplin, and it occurred when he ran a stop sign and hit another car. Four years later he passed away on Christmas Eve.

 

When he passed away the old ballpark in Joplin was still called, Miner’s Park. However, under the urging of local baseball enthusiasts such as former big leaguers Ferrell Anderson and Al Gerheauser, the ballpark was named Joe Becker Stadium. Having the ballpark named after him was quite an accomplishment for Joplin was also called “home” by Charles Evard “Gabby” Street. www.google.com/webhp?sourceid=chrome-instant&ion=1&am...

 

There were many baseball people who confused Joe Becker of Joplin with Joe Becker of St. Louis. When the Duluth Dukes experienced their bus crash in 1948 many thought that the Joe Becker Jr. who was in that crash was from Joplin. Joe Becker, from Joplin had a son but he was born in 1904 and never played professional baseball.

______________________________________________________________

I'm done!!!

 

Flowers from Sainsbury's to cheer me up. I had a heart attack on the 8th of August 2017. Everything seems fine now but I have to rest for 6 weeks. Thank God for the NHS

Explored [5dmk2, 50mm f1.4, CS3]

This is the last of my “medical series” (for now). This fellow is a cardiologist with a sense of humour (which is quite rare). So, here is a joke which he may enjoy if he sees this:

In a car garage, where a famous heart surgeon was waiting for the service manager to take a look at his Mercedes, there was a loud mouthed mechanic who was removing the cylinder heads from the motor of a car. He saw the surgeon waiting and lured him into an argument.

 

He asked the doc after straightening up and wiping his hands on a rag, "Look at this car i'm working on. I also open hearts, take valves out, grind them, put in new parts, and when I finish this baby will purr like a kitten. So how come you get the big bucks, when you and I are doing basically the same work?"

 

The surgeon very calmly leaned over and whispered to the loudmouth mechanic, "Try doing it with the engine running."

 

[Side note: this picture really made me appreciate the 5dmk2's low light capabilities, very impressive. This was 1/125 at f2.2, ISO 800, no flash]

Metamfetamin kan brukas

Bipacksedel

Information till förskrivare

Diskutera här påFlickr om metamfetamin alltid behöver vara bra eller dåligt, eller om det finns mera nyanserade sätt att se på det hela.

  

Metamfetamin kan missbrukas och

-Metamfetamin kan missbrukas: se konsekvenserna

och missbruket ökar snabbt. Speciellt farligt för personer med ADHD då missbruk av metamfetamin reglerar ned densiteten på dopaminreceptorerna.

 

Metamfetamin - the faces of meth

Klassiker om vad som händer med metamfetaminmissbrukaren, åldrandet och tänderna. Blicken, huden och ödesränderna.

 

Meth större hjärna med mindre innehåll

Vad som händer i hjärnan hos Meth missbrukare, hjärnan växer på grund av att den svullnar och densiteten på dopaminreceptorerna regleras ned. Men också att metamfetamin rätt använt kan vara bra samt varför. Skillnaden mellan enantiomererna hur hur otroligt olika de verkar.

 

Metamfetamin & ADHD + Hel dokumentär

Hel dokumentärfilm från National Geographic om världens farligaste drog: Metamfetamin,

 

Den här dokumentären kanske om inte annat kan förklara lite av varför Metamfetamin fått det rykte som det har, vilka konsekvenserna av ett missbruk blir osv. Ãven om dokumentären inte alls förklarar att personer med ADHD löper en ökad risk att fastna i ett metamfetaminmissbruk och att det på sikt kommer att göra problemen mycket värre tack vare att höga doser reglerar ned antalet och densiteten på dopamin receptorerna. Så att det som frälser dig också kommer att döda dig har kanske aldrig varit sannare än här.

 

Metamfetamin de direkta & indirekta skadeverkningarna

-Se Oprahshow nedan om metamfetaminmissbruk

-ohämmad sex med främlingar och sambanden

 

Fler och fler rapporter kommer om metamfetamin eller crystal meth som en del föredrar att kalla det men skadeverkningarna av ett missbruk direkt säger kanske inte så mycket om de indirekta skadeverkningarna av missbruket, vilket varit väldigt vanligt och utbrett i vissa kretsar i bland annat New York.

    

Marknadsföringen av Meth amfetamin till gravida

Den Pengakåta pillerindustrin har genom åren haft en rad smaklösheter för sig förutom att dölja resultat som talar till sitt preparats nackdel så manipuleras och har det manipulerats en hel del igenom åren. En speciellt intressant grupp att kränga "de nya supervetenskapliga" produkterna till har varit kvinnor, ofta med någon skavank som medicinjättarna inte alls varit sena med att marknadsföra med vetenskap som täckmantel. Det kan vara den feta kvinnan, den okåta kvinnan, den otacksamma kvinnan eller bara kvinnan som inte hinner med att städa rent i hemmet. Eller varför inte suggan som blivit på smällen och fettnat till? Behöver inte hon lite metamfetamin?

 

så här farligt lever användarna

 

Metamfetamin utbrett i hela skåne

 

ny dödsdrog sprider ut sig

 

DN Metamfetamin 1 2 3

 

SvD 1 2 3 4 5

 

Sydsvenskan 1 2 3

  

Produktbeskrivning på Engelska

 

METH

Teratogenic effects: Pregnancy Category C. Methamphetamine has been shown to have teratogenic and embryocidal effects in mammals given high multiples of the human dose. There are no adequate and well-controlled studies in pregnant women. METH tablets should

not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Nonteratogenic effects: Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation and significant lassitude.

  

Usage in Nursing Mothers: Amphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.

Pediatric Use: Safety and effectiveness for use as an anorectic agent in children below the age of 12 years have not been established. Long-term effects of methamphetamine in children have not been established (see WARNINGS). Drug treatment is not indicated in all cases of the behavioral syndrome characterized by moderate to severe distractibility, short attention span, hyperactivity, emotional lability and impulsivity. It should be considered only in light of the complete history and evaluation of the child. The decision to prescribe METH tablets should depend on the physicianâs assessment of the chronicity and severity of the childâs symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics. When these symptoms are associated with acute stress reactions, treatment with METH tablets is usually not indicated. Clinical experience suggests that in psychotic children, administration of METH tablets may exacerbate symptoms of behavior disturbance and thought disorder. Amphetamines have been reported to exacerbate motor and phonic tics and Touretteâs syndrome. Therefore, clinical evaluation for tics and Touretteâs syndrome in children and their families should precede use of stimulant medications.

  

ADVERSE REACTIONS

The following are adverse reactions in decreasing order of severity within each category that have been reported: Cardiovascular: Elevation of blood pressure, tachycardia and palpitation. Fatal cardiorespiratory arrest has been reported, mostly in the context of abuse/misuse. Central Nervous System: Psychotic episodes have been rarely

eported at recommended doses. Dizziness, dysphoria, overstimulation, euphoria, insomnia, tremor, restlessness and headache. Exacerbation of motor and phonic tics and Touretteâs syndrome. Gastrointestinal: Diarrhea, constipation, dryness of mouth, unpleasant taste and other gastrointestinal disturbances.

Hypersensitivity: Urticaria.

Endocrine: Impotence and changes in libido.

Miscellaneous: Suppression of growth has been reported with the

long-term use of stimulants in children (see WARNINGS).

DRUG ABUSE AND DEPENDENCE

Controlled Substance: METH tablets are subject to control under

DEA schedule II.

  

Abuse: Methamphetamine has been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to many times that recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with methamphetamine include

severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis often clinically indistinguishable from schizophrenia. Abuse and/or misuse of methamphetamine have resulted in death. Fatal cardiorespiratory arrest has been reported in the context of abuse and/or misuse of methamphetamine.

 

OVERDOSAGE depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. Emergence of New Psychotic or Manic Symptoms: Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of

treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlledstudies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.

Aggression: Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility. There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued. Visual Disturbance Difficulties with accommodation and blurring of vision have been reported with stimulant treatment.

 

PRECAUTIONS

General: METH tablets should be used with caution in patients with even mild hypertension. Methamphetamine should not be used to combat fatigue or to replace rest in normal persons. Prescribing and dispensing of methamphetamine should be limited to the smallest amount that is feasible at one time in order to minimize the possibility of overdosage. Information for Patients: The patient should be informed that methamphetamine may impair the ability to engage in potentially hazardous activities, such as, operating machinery or driving a motor vehicle.

 

The patient should be cautioned not to increase dosage, except on advice of the physician. Prescribers or other health professionals should inform patients, their families and their caregivers about the benefits and risks associated with treatment with methamphetamine and should counsel them it its appropriate use. A patient Medication Guide is available for METH. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have.

 

Drug Interactions: Insulin requirements in diabetes mellitus may be altered in association with the use of methamphetamine and the concomitant dietary regimen. Methamphetamine may decrease the hypotensive effect of guanethidine. METH should not be used concurrently with monoamine oxidase inhibitors (see CONTRAINDICATIONS). Concurrent administration of tricyclic antidepressants and indirect- acting sympathomimetic amines such as the amphetamines, should be closely supervised and dosage carefully adjusted. Phenothiazines are reported in the literature to antagonize the CNS stimulant action of the amphetamines.

  

INDICATIONS AND USAGE

Attention Deficit Disorder with Hyperactivity: METH tablets are indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children over 6 years of age with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or may not be warranted. Exogenous Obesity: as a short-term (i.e., a few weeks) adjunct in a regimen of weight reduction based on caloric restriction, for patients in whom obesity is refractory to alternative therapy, e.g., repeated diets, group programs, and other drugs. The limited usefulness of METH tablets (see CLINICAL PHARMACOLOGY) should be weighed against possible risks inherent in use of the drug, such as those described below.

  

CONTRAINDICATIONS

METH tablets are contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors; hypertensive crisis may result. It is also contraindicated in patients with glaucoma, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism or known hypersensitivity or idiosyncrasy to sympathomimetic amines. Methamphetamine should not be given to patients who are in an agitated state or who have a history of drug abuse.

  

WARNINGS

Tolerance to the anorectic effect usually develops within a few weeks. When this occurs, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued (see DRUG ABUSE AND DEPENDENCE).

Serious Cardiovascular Events

Sudden Death and Pre existing Structural Cardiac Abnormalities

or Other Serious Heart Problems:

Children and Adolescents: Sudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a

stimulant drug.

Adults: Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD. Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs. Hypertension and other Cardiovascular Conditions: Stimulant medications cause a modest increase in average blood pressure (about 2-4 mmHg) and average heart rate (about 3-6 bpm), and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia. Assessing Cardiovascular Status in Patients being Treated with Stimulant Medications: Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g., electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.

Psychiatric Adverse Events

Pre-existing Psychosis:

Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder. Bipolar Illness: Particular care should be taken in using stimulants to treat ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in suchpatients. Prior to initiating treatment with a stimulant,

 

METH®

Methamphetamine

Hydrochloride

Tablets, USP only

 

DESCRIPTION

METH® (methamphetamine hydrochloride tablets, USP), chemically known as (S)-N,α-dimethylbenzeneethanamine hydrochloride, is a member of the amphetamine group of sympathomimetic amines. It has the following structural formula:

 

CLINICAL PHARMACOLOGY

Methamphetamine is a sympathomimetic amine with CNS stimulant activity. Peripheral actions include elevation of systolic and diastolic blood pressures and weak bronchodilator and respiratory stimulant action. Drugs of this class used in obesity are commonly known as âanorecticsâ or âanorexigenicsâ. It has not been established, however, that the action of such drugs in treating obesity is primarily one of appetite suppression. Other central nervous system actions, or metabolic effects, may be involved, for example. Adult obese subjects instructed in dietary management and treated with âanorecticâ drugs, lose more weight on the average than those treated with placebo and diet, as determined in relatively short-term clinical trials.

The magnitude of increased weight loss of drug-treated patients over placebo-treated patients is only a fraction of a pound a week. The rate of weight loss is greatest in the first weeks of therapy for both drug and placebo subjects and tends to decrease in succeeding weeks. The origins of the increased weight loss due to the various possible drug effects are not established. The amount of weight loss associated with the use of an âanorecticâ drug varies from trial to trial, and the increased weight loss appears to be related in part to variables other than the drug prescribed, such as the physician-investigator, the population treated, and the diet prescribed. Studies do not permit conclusions as to the relative importance of the drug and non-drug factors on weight loss.

  

The natural history of obesity is measured in years, whereas the studies cited are restricted to a few weeks duration; thus, the total impact of drug-induced weight loss over that of diet alone must be considered clinically limited. The mechanism of action involved in producing the beneficial behavioral changes seen in hyperkinetic children receiving methamphetamine is unknown. In humans, methamphetamine is rapidly absorbed from the gastrointestinal tract. The primary site of metabolism is in the liver by aromatic hydroxylation, N-dealkylation and deamination. At least seven metabolites have been identified in the urine. The biological half-life has been reported in the range of 4 to 5 hours. Excretion occurs primarily in the urine and is dependent on urine pH. Alkaline urine will significantly increase the drug half-life. Approximately 62% of an oral dose is eliminated in the urine within the first 24 hours with about one-third as intact drug and the remainder as metabolites.

  

METHAMPHETAMINE HAS A HIGH POTENTIAL FOR

ABUSE. IT SHOULD THUS BE TRIED ONLY IN

CLINICAL PHARMACOLOGY. HAVE A NICE DAY.

 

Bara metylfenidat rekommenderas av de europeiska kontrollmyndigheterna för behandling av ADHD

  

Flowers from Sainsbury's to cheer me up. I had a heart attack on the 8th of August 2017. Everything seems fine now but I have to rest for 6 weeks. Thank God for the NHS

The Postcard

 

A postally unused Croydon Series postcard that was published by W.A. Field of South Norwood, London S.E.

 

Although the card was not posted, someone has used a pen to write on the divided back:

 

"14.9.06.

Dear Stan,

This is a part of the

wonderful London

Road. It starts somewhere

at the bridges, and comes

through Kennington, Brixton,

Streatham, Norbury, Thornton

Heath, Croydon, Purley and

heaps more until it gets to

Brighton!

Of course, it is called by the

names of the places it goes

through up above. It begins

to be London Road at Norbury,

and somewhere lower down

it changes to the Brighton

Road.

Love,

Nell".

 

David Henry Goodsall

 

So what else happened on the day that Nell wrote the card?

 

Well, Friday the 14th. September 1906 was not a good day for David Henry Goodsall, because on that day he died in London having suffered a myocardial infarction.

 

David, who was born in Gravesend on the 4th. January 1843, was an English surgeon who is best remembered for devising Goodsall's Rule.

 

David was educated at St. Ann's School. His father had decided to study medicine, but died while he was a student at St. Bartholomew's Hospital, as a result of a wound sustained while performing a post mortem examination.

 

As a result, David Goodsall's fees at St. Bartholomew's were waived, as his father's wound was inflicted by a member of staff, and he studied medicine there from 1865.

 

He became house surgeon at St Mark's Hospital in 1870, a Fellow of the Royal College of Surgeons in 1872, and full surgeon in 1888.

 

Goodsall's Rule

 

David developed an interest in rectal surgery, writing a chapter in 'Diseases of the Anus and Rectum' in which Goodsall's Rule is described.

 

When you are searching for a fistula tract’s opening in the anal canal (as you do), the Goodsall Rule is a great help.

 

If anyone's interested, Goodsall's Rule of 1900 is as follows:

 

'An external opening anterior to a transverse

line drawn across the anal verge is associated

with a straight radial tract into the canal.

However an external opening posterior to the

transverse line follows a curved fistulous tract

to the posterior midline rectal lumen.

Horseshoe fistulas occasionally are associated

with anterior and posterior openings in the anal

canal'.

 

So now you know.

Flowers from Sainsbury's to cheer me up. I had a heart attack on the 8th of August 2017. Everything seems fine now but I have to rest for 6 weeks. Thank God for the NHS

The Postcard

 

A Sussex Series postcard published by F. Douglas Miller.

 

The card was posted in Worthing on Monday the 22nd. September 1919 to:

 

Miss P. Elliott,

16, Kenilworth Road,

Anerley,

London S.E.

 

The somewhat confusing pencilled message on the divided back of the card was as follows:

 

"Dear P,

Your terminological

inexactitude or something

scandalous we said when

no letter arrived from today.

I suppose you are having

such a good time that you

have forgotten us.

Anyway we are enjoying

ourselves.

Love, Dad".

 

Storrington

 

Storrington is a small town in the Horsham District of West Sussex. It lies at the foot of the north side of the South Downs. As of 2006 it had a population of around 4,600. It has one main shopping street (High Street).

 

The History of Storrington

 

Storrington is listed in the Domesday Book as 'Estorchestone', meaning a place well-known for storks. A charter to hold a regular market on Wednesdays was granted by Henry IV in 1400, together with permissions for three fairs during the year, on Mayday, Wednesday of Whit week and the Feast of Martin on the 11th. November.

 

Tanning and blacksmithing were important industries, and only in the 20th. century did these roles fade away. Rabbit breeding was another significant industry, reflected in a number of local place names including 'The Warren', 'Warren Hill', 'Sullington Warren' and 'Warren Croft'.

 

This working/small industry background has however, left little behind architecturally. Nikolaus Pevsner noted only the small door in Browns Lane, the church, and the Dominican convent known as the Abbey to be historically significant.

 

'The Cricket Match'

 

Storrington is thinly disguised as the home of the home team in Hugh de Sélincourt's 1924 novel 'The Cricket Match', complete with chestnut trees and duck pond (in the photograph). In later editions a cartoon map of the village is used as end pages.

 

Storrington Landmarks

 

St Joseph's Hall in Greyfriars Lane is a Grade II listed former residence of the Bishop of Arundel and Brighton. It was built as a private house for US businessman George Trotter in 1910, and then sold to a French religious order, the Norbertines. In 1956 it was used by Vincent and Nona Byrne as a home for refugees from the Hungarian uprising.

 

Parham Park, towards Pulborough, is a country house with rolling parkland containing a large herd of maintained deer. There is also the private Edwin Lutyens-built Little Thakeham nearby.

 

Twinning

 

Storrington is twinned with the commune of Villerest in the Loire department of central France.

 

Frederick Douglas Miller

 

www.sussexpostcards.info have provided a wealth of fascinating information about Frederick Douglas Miller, some of which is recorded below:

 

Frederick Douglas Miller was a photographer who was based in Boltro Road, Haywards Heath by 1899, and later at Worthing.

 

F. Douglas Miller, as he usually signed himself, was an unusually gifted photographer. In addition to making studio portraits, he published an extensive range of postcard views of Sussex, producing many memorable images not just of towns and villages but also the countryside, which many contemporary photographers ignored.

 

Miller was born on the 6th. December 1874, in the village of Brede, north of Hastings. His parents moved to Hove, then Burgess Hill before finally settling in Haywards Heath in 1880. By 1891 at the age of 16 Douglas was already working as a photographer's apprentice.

 

By 1900, Douglas had established The Mid-Sussex Photographic Studio at 16 Boltro Road in Haywards Heath. Advertising in the 1899 Kelly's Directory he offered to execute "photos in any size and newest styling" and to undertake "copying and enlarging".

 

He also stated that he was available to photograph "garden parties" and perform "outdoor work generally". Douglas started postcard publishing soon after the new century began, and quickly built up a thriving business.

 

Frederick Douglas Miller's Family Background

 

Douglas Miller's parents, Matilda Goldsmith and Frederick Miller (or Fred Miller, as he was usually called), married in Eastbourne on the 4th. March 1874. Fred Miller was a professional photographer, as was his father, Edward Miller.

 

Fred Miller began his working life "in service". The 1871 census records that he was employed as a footman by a Mr and Mrs Brodie, who lived in Compton Street, Eastbourne.

 

Fred Miller was active from the late 1870's to 1902 or later, exhibiting at the Royal Academy, Royal Society of British Artists and elsewhere. Brighton and Hove Museums have four of his watercolours as well as two ink drawings. Two excellent paintings by Miller hang in Cuckfield Museum, and many others are in private collections. Douglas Miller reproduced several of his father's paintings as picture postcards.

 

Fred Miller's artistic skill and enthusiasm was inherited Douglas and his brothers. His interest in photography was presumably an important influence on Douglas Miller's decision to become a professional photographer.

 

Fred died of heart failure on the 26th. June 1917 in the Royal Sussex County Hospital in Brighton after a bowel operation.

 

F. Douglas Miller - The Early Years at Haywards Heath

 

By 1903 Douglas Miller had moved his studio to the opposite side of Boltro Road, to Number 9, presumably because it offered him more space or better illumination.

 

Although running his photographic business must have kept Douglas Miller busy, he found time to give occasional illustrated talks. Thus, early in 1908 at a Congregational Church Social he lectured on "The Capabilities of the Camera", illustrating his talk with lantern slide studies of children, wild and domesticated animals, calm and rough seas, high diving, high jumping and steeple chasing. It is not recorded how many of these photographs he took himself.

 

Douglas Miller ran the Boltro Road studio until February 1916, when he sold out to Ebenezer (William) Pannell, who already (by 1913) had a photographer's business in Perrymount Road in Haywards Heath.

 

It is not known for certain why Douglas Miller decided to sell his studio in Haywards Heath. One suspects that he sold up because of business worries. The Great War had a most damaging effect on the photographic trade throughout the country. Orders for photographs slumped, and by 1916 the national mood was one of deep pessimism as the news from the Western Front became ever bleaker and the death toll rose steadily.

 

The reduced trade almost certainly meant that Haywards Heath was oversupplied with studio photographers, as, besides Miller, there was Harry Tullett, Ebenezer Pannell and Bertram Tugwell (and perhaps others), all competing for business. Miller probably saw the writing on the wall, and decided that it would be prudent to sell the studio, taking his postcard business elsewhere. What Pannell offered him may never be known, but Miller may have had to sell for quite a modest price.

 

F. Douglas Miller - The Worthing Years

 

Having given up the studio, Douglas Miller and his wife Kate moved to Worthing, where they remained for the rest of their lives.

 

While living at Worthing, Douglas Miller does not seem to have carried out any trade or profession other than postcard publishing, which he appears to have abandoned after only a few years.

 

There is no evidence that he set up a new studio or worked for any of the established photographers in the town. Directories always list him as a 'private resident', which suggests that he was at least semi-retired, living off investments.

 

Douglas's wife, who had been suffering from bronchitis, died of a heart attack in a Hove nursing home on the 19th. March 1959, aged 83. A niece registered the death, perhaps because Douglas was too frail to take charge. Miller was admitted to Southlands Hospital in Shoreham-by-Sea, where he died of myocardial degeneration on the 7th. June 1961.

 

Neither the Worthing Gazette nor the Worthing Herald published an obituary of Douglas. It was a strangely muted end for a man who had done so much to record the Sussex scene in the Golden Age of Postcards.

 

Douglas Miller's Postcards

 

The first postcards of Sussex that Douglas Miller produced have undivided backs, which may indicate that they date from before 1902, when Post Office regulations were relaxed to allow correspondence to share the reverse side of cards with the address.

 

The earliest known postmarks, however, date from the summer of 1903. By the end of 1904, postmarks establish that Miller was selling cards over a wide area of Sussex, for example at Ardingly, Billingshurst, Clayton, Lewes and Rottingdean. Judging from a big increase in the number of postmarks, he greatly stepped up his output of cards during 1905, and enlarged his sales area very considerably.

 

Miller chose a highly distinctive format for his cards. Until 1917 almost all the cards had a wide, some would say overgenerous, white border below the picture, and no border on the other three sides of the card.

 

Some cards were left untitled, but most had titles that were individually handwritten in ink in copperplate script on the left (less commonly the right) side of the border. At first Miller used scarlet ink, but he soon switched to writing the titles in Indian ink.

 

The earliest cards were anonymous, but by April 1904 he began embossing his cards in the lower right corner: "F. DOUGLAS MILLER, HAYWARDS HEATH". Few of the other leading postcard publishers in Sussex took the trouble to emboss their cards.

 

Miller or an assistant would have had to emboss each card separately, then write the title, leaving enough time for the ink to dry. He persisted with this expensive and time-consuming procedure for many years. His competitors were doubtless able to produce their cards more cheaply.

 

In the summer of 1916 Miller started to emboss his cards 'F. DOUGLAS MILLER, THE SUSSEX SERIES', leaving out all reference to Haywards Heath. This change in labelling coincided with his selling his studio and moving to Worthing.

 

The new series continued with the broad border and handwritten captions for about a year, and then the cards were redesigned with a narrower border and the captions repositioned within the picture space. The elegant copper-plate script was abandoned, and instead the captions were written directly on the negatives in small, blocky capitals.

 

The captions often looked untidy and ragged, spoiling the appearance of the cards. Often the captions included a serial number, e.g. 'KINGSTON 10'. Some Sussex Series views were new, but most were simply reissues of earlier cards.

 

From 1921 onwards the cards appeared in un-embossed form, without any indication of the publisher. Perhaps Miller decided that it was no longer worth the extra effort to put his name on the cards. Perhaps he was no longer publishing them, having sold the negatives on to someone else. Many of the un-embossed cards of Mid Sussex are stamped on the back in red ink:

H.J. COMBRIDGE, STATIONER, BURGESS HILL.

Combridge is known to have acquired Homewood's postcard publishing business in 1919, and it would have been a logical step for him to take over the work of distributing Miller's cards as well.

 

Postmark evidence suggests that sales of the un-embossed cards petered out by about 1925. However, starting in about 1927, some of Miller's cards of the Lewes area, Danehill, Storrington, Amberley and other places were reissued in sepia with three-digit serial numbers and neat printed titles, whose wording often differed from that on the earlier cards.

 

Douglas Miller's Sales Area

 

Miller's postcards cover a large area of Sussex from the Arun valley in the west to the Cuckmere valley in the east, and from Rottingdean on the coast northwards to Danehill, Horsted Keynes, Crawley and Billingshurst.

 

Miller also produced a range of cards of Ecclesbourne Glen and Fairlight Glen, on the coast near Hastings, which were sold at a kiosk on the coast path at Fairlight Glen, and very probably also at the café at the top of the Glen.

 

Miller published only limited numbers of cards of Brighton and other big towns, concentrating instead on recording smaller towns and villages, as well as the countryside. Many of his street scenes are remarkably devoid of people, and look as if they may have been taken early in the morning, perhaps on Sundays. Possibly he used long exposures and feared that moving people would blur the negatives.

 

Miller was evidently fond of trees, and took many pictures of tree-lined roads and forest paths. Water also held a special fascination for him, as shown by numerous cards of lakes and rivers, and even small ponds. He also seems to have liked open country, especially heathland and downland. Windmills and watermills were other enthusiasms. Unlike many of his contemporaries, he published a variety of winter views, including snow scenes. He was visibly more in tune with nature than many of his rivals.

 

A high proportion of the towns and villages that Miller depicted on his cards had their own railway stations, which suggests that his usual practice was to travel by train wherever possible. His Haywards Heath home was close to the station so the train would have been a convenient form of transport for him. Miller often took his bicycle with him on the train so that he could travel onwards having arrived at a suitable station. The bicycle in question can be seen in a number of the postcard views, propped up against a fence, wall or tree.

 

Other locations that Miller visited, such as Mount Caburn and Mount Harry near Lewes, would not have been accessible on a bicycle and could only have been reached on foot. Unlike many of his contemporaries, Miller took evident delight in exploring the more remote parts of the Sussex countryside, which makes his decision to move to central Worthing all the more surprising.

 

Miller's photographs are often exasperatingly difficult to date, especially the countryside views. The town photographs provide rather more clues, but await detailed research. It is already clear, however, that the photographs span a period of at least 30 years, in contrast to the postcards, which were issued over a period of only about 20 years

 

Although some of Miller's views of streets in towns and villages show pedestrians, cyclists and horse-drawn carts, very few show motorcars. Many of the postcard pioneers went to some trouble to make their views look modern by photographing cars.

 

Either the Miller photographs were taken a few years earlier than those of many of his contemporaries, or he had a rooted dislike of cars. It is perhaps significant that he was not averse to recording road accidents. Like several other Sussex photographers he was on hand to photograph the wreckage of the Vanguard coach at Handcross in July 1906. He also issued two postcard views of a motorcar accident at Slough Green near Cuckfield in January 1908.

 

In 1904 or 1905 Miller published a postcard view looking up Church Lane in Lewes, with Malling Mill in the distance. After the Mill burnt down on September 8, 1908, he re-photographed Church Lane, and issued a replacement card, but without the Mill the view lost much of its charm, and the card sold fewer copies than its predecessor.

 

On the 3rd. July 1909, the Hon. C. S. Rolls (of Rolls Royce fame) made a balloon ascent from the Hospital Field at Haywards Heath in connection with a meeting of the Sussex County Automobile Club. The Club members then pursued the balloon by car as it was carried by the breeze 25 miles across country to Paddock Wood, where Rolls made a bumpy landing in a farmer's field. The first three competitors to reach Rolls in their cars were awarded prizes. Miller photographed the start of the ascent, the first ever at Haywards Heath, and also many of the cars of Club members parked in Queens Road, issuing a total of at least seven different postcards commemorating the Club meeting.

 

Miller seems to have done very little photography after the First World War. He did, however, publish a card of the War Memorial at Bolney, which is likely to have been erected in 1920 or 1921. He also photographed the Lych Gate at Cowfold, which is said to have been erected as a war memorial. It appears, therefore, that he was still adding to his range of cards even at the start of the 1920s.

 

Robin Gandy

 

So what else happened on the day that the card was posted?

 

Well, the 22nd. September 1919 marked the birth in Rotherfield Peppard, Oxfordshire of Robin Oliver Gandy.

 

Robin was a British mathematician and logician. He was a friend, student, and associate of Alan Turing, having been supervised by Turing during his PhD at the University of Cambridge, where they worked together.

 

Robin Gandy - The Early Years

 

Robin was the son of Thomas Hall Gandy (1876–1948) and Ida Caroline née Hony (1885–1977) and great-great-grandson of the architect and artist Joseph Gandy (1771–1843).

 

Educated at Abbotsholme School, Gandy took two years of the Mathematical Tripos at King's College, Cambridge, before enlisting for military service in 1940.

 

During World War II he worked on radio intercept equipment at Hanslope Park, where Alan Turing was working on a speech encipherment project, and he became one of Turing's lifelong friends and associates.

 

In 1946, he completed Part III of the Mathematical Tripos, then began studying for a PhD under Turing's supervision. He completed his thesis, 'On Axiomatic Systems in Mathematics and Theories in Physics', in 1952. He was a member of the Cambridge Apostles, an intellectual society of the University.

 

Robin Gandy's Career and Research

 

Gandy held positions at the University of Leicester, the University of Leeds, and the University of Manchester. He was a visiting associate professor at Stanford University from 1966 to 1967, and held a similar position at the University of California, Los Angeles in 1968. In 1969, he moved to Wolfson College, Oxford, where he became Reader in Mathematical Logic.

 

Robin Gandy is known for his work in recursion theory. His contributions include the Spector–Gandy theorem, the Gandy Stage Comparison theorem, and the Gandy Selection Theorem. He also made a significant contribution to the understanding of the Church—Turing thesis, and his generalisation of the Turing machine is called a Gandy machine.

 

The Death of Robin Gandy

 

Robin died at the age of 76 in Oxford on the 20th, November 1995.

 

The Legacy of Robin Gandy

 

The Robin Gandy Buildings, a pair of accommodation blocks at Wolfson College, Oxford, are named after Gandy. A one-day centenary Gandy Colloquium was held on the 22nd. February 2020 at the College in Gandy's honour, including contributions by some of his students.

What are the benefits and advantages of Virgin Coconut Oil to Your Health ?

 

Why drink Virgin Coconut Oil? (Must read) Sinusitis & Alergy, Chronic Tiredness & Asthma

Protection from disease Dandruff and hair fall

Advantages of VCO & Metabolism and Energy Remove excess fat- Obesity

Remedial, Substance digestion and absorption Prostate Enlargement, Ulcer and constipation

Mother's milk & MCFA,pregnancy & Your baby Acute myocardial infarction deterrent

Anti aging, Scars on skin elasticity, Protect & treat skin High blood & Diabetes

Cracked heel, Accident wound, wound and sore Cancer , AIDS Treatment & other Researches

         

Prof.Dr.Mary G.Enig Director, Nutritional Science Division,

Enig Associates, Inc. 11120 New Hampshire Avenue

500 Silver Spring, MD 20904-2633 U.S.

 

"Coconut oil is the important and beneficial food for 21st century . With the availability of clinical and scientific information of its healthy qualities of antimicrobial virgin coconut oil particularly and coconut oil in generally, makes it very attractive."

    

“Virgin Coconut Oil is most salutary oil in the world"

 

Dr. Bruce Fife (Doctor Naturopati – USA)

   

" Virgin Coconut Oil has anti virus, anti bacteria, anti fungus and anti natural parasite characteristics can control a variety of diseases "

 

Dr. John J. Kabara (Universiti Michigan –USA)

   

" Virgin coconut oil stand strong alone as the most salutary oil that you can use. It contains nutritional value and research treasure that is really valuable. I really indeed want you make virgin coconut oil as part of your daily nutrition's plan "

Dr. Mark Atkinson, Holistic Medical Physician

 

MBBS Bsc (Hons) FRIPHH FCMA BETD SAC DIP

 

(Clinical Nutrition)

     

Dr Joseph Mercola

(Author of Total Health Programand Rachael Droege)

  

6 ways for your

 

skin to really look young

   

1-Control from excessive exposure to sunlight.

2-Avoid from practicing a 'yo-yo diet'.

3-Use Virgin Coconut Oil

Using virgin coconut oil as a lotion is the ideal method to control your skin's youthfulness. It does not only prevent the formation of harmful free radicals, but it also act to protect it from free radical. In fact it is also capable of sustaining the skin from whitehead and other skin problem due to aging factor and excessive exposure to sunlight.

Virgin coconut oil is capable of strengthening the 'connective' tissue of the skin, thereby helping to stop the skin from slack and wrinkle. It contains certain elements that is capable of restoring damaged skin or preventing the skin from contracting a disease.

Virgin coconut oil not only give temporary relief to the skin, but it also helps to restore and improve the skin, and that cannot be done by any other types of lotion. It functioned to r5estore the youthfulness of your skin by removing the external dead skin cells. Virgin coconut oil will penetrate deep into the underlayer skin and will reinforce that layer of tissue. Finally your skin will be soft and healthy.

If you want the maximum restorative effect, you must choose those oil that is genuinely of high quality, free from chemicals, no bleaching and non hydrogenated. All these are available in virgin coconut oil.

4-Rest your face muscles

5-Take plenty of Omega-3.

6-Avoid smoking.

         

Hj.Ishak Basiran

(Mechanical Engineer)

M.Director Desaku Maju Marketing, Desaku Trading, Mudah Niaga & Teknologi Desa Hijau Sdn Bhd.

Dr.AH.Bambang Setiaji, MSc

(Expert Virgin Coconut oil Nusantara)

Lecturer Fakulti Kimia Matematik dan Ilmu Pengetahuan Alam Universiti Gadjah Mada Indonesia

             

Everyday drink Virgin Coconut Oil @ Black Seed Oil @ Honey- What you will get?

 

Relieve breathing– dilute phlegm and cleanse the respiratory tract and throat.

  

Ease defecation and urination – overcome constipation & uncomfortable urination and remove toxin through excrement.

  

Increase the metabolism rate on the whole body cells– Virgin coconut oil will be diffused on as the energy component inside the body – your body will consider stronger.

  

In the ileum and colon, it destroys the harmful organism like viruses, bacteria, fungi and protozoan (worm). The digestion will achieve maximum level.

  

Reduce the condition of being easily hungry – when the digestion achieves maximum level, the body will gain more nutrition and energy.

  

Therefore the body weight is controlled – don't need to eat much and often.

  

Reduce body fat – the body weight decreases to suit the person's body.

 

Not easily infected by diseases – with the strengthening of the body immunity system.

  

Reduce the stickiness of the blood platelet – the stickiness of the platelet is the contributing factor of the plaque formation in the blood vessel.

  

Reduce the risk of heart attack and high blood pressure – avoid the formation of plaque in the blood vessel especially the blood vessel to the heart.

 

Speeds up the process of repairing the damaged cells – restore the flexibility, tenderness and fineness of skin.

  

THE LONG TERM EFFECT ON THE BODY FOR CONSUMING VIRGIN COCONUT OIL

 

Reduce the cholesterol level – it does not contain cholesterol. Therefore it is the best alternative to other oils that have high high cholesterol level.

 

Control diabetes - the pancreas is more efficient to secrete insulin while the cell work more efficiently to diffuse the needed sugar.

 

Overcome degenerative disease and old age problem - the natural anti oxidant in virgin coconut oil is the free radical formation obstructer.

 

Does not increase the stickiness level of platelet in the blood – overcome plaque formation in the vessel which is the factor of heart attack.

 

The body is more resistant to diseases because VCO has anti virus, anti bacteria, anti fungus and anti protozoan agents.

 

Restore the flexibility, softness of skin – it speeds up the process of building new cells, besides protecting it from ultra violet radiation.

 

Stimulate new hair growth and guard against dandruff –the hair cell will gain adequate energy and nutrients for maximum growth.

 

Prevent allergy – virgin coconut oil acts as an anti histamine agent.

 

Prevent the risk of cancer disease – virgin coconut oil destroys the presence of any pathogen. Therefore leucocytes can act maximally destroy the cancer cells, because the leucocytes is not capable of attacking the pathogen organisms.

 

Overcome snoring – because the respiratory tract and uvula will be flexible and elastic due to the existence of new cells.

    

As a Source of Food, Energy and Health

   

VIRGIN COCONUT OIL

 

Ø Does not burden the pancreas

 

Ø Medium Chain Fatty Acid (MCFA – easily digested)

 

Ø Digested by only the saliva enzyme and in stomach (very good for those who have digestive disorder, metabolic problem, premature infant that the body system is under growth.

 

Ø Transmitted to the liver producing maximum energy.

 

Ø Produce instant energy. It can pass through the membrane cell of mitochondria without the enzyme.

 

Ø Cells become efficient.

 

Ø Act to prevent the formation of free radical.

 

Ø The poisonous trans fatty acid that destroy the body system is not produced.

 

Ø No cholesterol.

 

Ø Contain about 45-55 % of lauric acid.

 

Ø Have antivirus, antibacterial, antifungal, anti protozoan properties.

 

Ø On skin, it acts as the additional shield against the dangerous ultra violet (UV) radiation (longer skin's youthfulness) and prevent from the bacterial infection (prevent skin disease infection) besides speeding up the formation of new cells (flexibility and softness of skin is more obvious.

 

Ø Acts as anti cancer and anti histamine (prevent allergy).

 

Ø Increase metabolism. (Cells have more energy, makethem more efficient).

 

Ø Improve endurance.

 

Ø Improve the digestive system. (will not easily get hungry, no need to eat much and the body weight is controlled naturally).

 

Ø Improve the digestion of vitamins and minerals (good for old folks).

  

VEGETABLE OIL

 

Ø Burdening to the pancreas.

 

Ø Long Chain Fatty Acid ( only certain LCFA can be digested)

 

Ø Need pancreatic enzyme and various enzymes to be broken down into small units.

 

Ø It needs specific enzyme to enable it to permeate mitochondria membrane cell - thus it generates energy slower than Virgin Coconut Oil.

 

Ø Cells not efficient.

 

Ø Free radical is easily formed.

 

Ø It is being processed through deodorization, bleaching, dehydrogenation, which in the process, produces trans fatty acid that is known to be harmful to the human body.

 

Ø Contain cholesterol.

 

Ø Almost no beneficial acid.

             

ACUTE MYOCARDIAL INFARCTION PREVENTION

 

As explain earlier, coconut oil does not increase the blood cholesterol level or triglyceride level or excessive blood clot. It even stimulate the metabolism, thereby lowering the cholesterol level. Research result from 1970 to 1980 showed that coconut oil is good for the heart although at that time the unsaturated fat is blamed for increasing the risk of myocardial infarction. It is proven that taking coconut oil greatly influence towards the decline in the risk of myocardial infarction compared with other edible oil. Coconut oil can also reduce the accumulation of body fat, increasing lifespan, lessen blood clot formation, reduce free radicals in the cells, reduce the cholesterol level in the blood and heart, adding antioxidant in the cells and reduce the possibility of acute myocardial infarction of the society. By consuming coconut oil the risk of heart attack can be reduced.

 

Based on this evidence coconut oil therefore is good for the heart or at least harmless to the heart. However it is a fact that coconut oil is not only harmless but play an important role in fighting against acute myocardial infarction. Because of its extraordinary role, it is expected to become a new weapon in fighting against acute myocardial infarction.

   

ACUTE MYOCARDIAL INFARCTION AND HYPERTENSION

 

To understand how coconut oil can help prevent acute myocardial infarction, we must possess the basic knowledge of how a heart disease develop. Acute myocardial infarction is caused by the hardening of the arteries (atherosclerosis) that happened as a result of plaque formation. Most people say atherosclerosis is caused by too much cholesterol in the blood. This idea call cholesterol hypothesis or lipid from acute myocardial infarction. Presently this idea still is widely spread in popular media by the Soya bean industries, in fact this theory is already obsolete, with the clinical observation and academic research it had been displaced by the response to injury hypothesis.

 

What causes the formation of plaque and atherosclerosis to develop? Generally it is always thought that hardening of the vein is usually associated with cholesterol. However cholesterol does not only stay freely in the blood vessels but can settle abruptly anywhere in the vessel. Cholesterol is used by the body to patch and repair wounds on the wall of blood vessels. In fact cholesterol is not really required for the formation of plaque in the atherosclerosis. Contrary to popular belief, the key component of blood vessel plaque is not cholesterol but protein especially the network of wounds. Several blood vessels that suffer atherosclerosis contain a small amount of cholesterol or none at all. According to response to injury hypothesis, part of the atherosclerosis develop as a result of wound on the inner wall of the blood vessel. Wound can happen due several reasons such as poisoning, free radicals, virus or bacteria. If the cause of the wound is not removed, it will cause further damage and as long as the complication and inflammation continue, the network will continue developing. Blood coagulant protein called platelets circulate freely in the blood. When it meets the wound it will become sticky and stick with one another in the damaged network to facilitate remedy. This is how blood clot is form. Wound from whatever source will trigger the platelet to coagulate and the cells in the blood vessel will release element to stimulate the growth of muscle cells in the wall. A complex combination of network wound, platelet, calcium, cholesterol and triglyceride work together to cure the wound. Therefore from the fiber network, it is clear that not only cholesterol that form the basic element in plaque. Calcium accumulation in plaque caused the hardening of blood vessel and this is the characteristic of atherosclerosis.

 

Contrary to popular belief, plaque does not only stick to the internal wall along the blood vessel just like mud does in the garden hose. But plaque grow inside the wall of a blood vessel, and it is part of the wall. The wall of a blood vessel is surrounded by a layer of strong muscle fiber coiling around it to prevent the plaque from spreading. Because plaques grow and developed, but it is unable to propagate outwards, it therefore presses inwards and close the vessel passage, narrowing down the bloodstream and restricting the blood flow.

 

Platelets gather around the wound to form blood clot. It seals the vent of the damage tube. But if the blood is inclined to clot, it will finally obstruct the blood flow. Finally the vessel narrowed down by the plaque will because clog by the blood clot and this in turn will stop the blood flow. If this happen to the coronary vessel it is known as heart attack. If it happened to carotid vessel going to the brain, the result is what is called stroke. Atherosclerosis cause acute myocardial infarction and other cardiovascular interference.

     

PROSTATE ENLARGEMENT

  

Generally adult male has risk in attack prostate disruption during his life. Most common prostate disruption is benign prostaic hyperplasia (BHP) or prostate enlargement. Almost 50% old man among 40-59 year and 90% people those aged between 70-80 year stricken phenomenon BHP. The disease distributed when someone ageing. Is known that lifestyle plays a vital role happened this BHP, and it make main problem in western country. Man who lives in developed country who are less advanced where local food production and consumption usually has been undisturbed by this disease. Yet disease actual cause BHP this not yet leak. Theory most popular concentrate to male hormone dihydrostestosterone (DHT) as his cause. Believed that when we ageing greater testerone are transformed into collected DHT in prostate. Affairs this resulted prostate grow, and it pressing urethra, (fund whereby urine flowing) and bladder until cause often urinate and interference urinate, especially at night, this situation often in knit with gland inflammation. Although it is not cancer ailment, but that potential as upholder happen this disease, (cancer).

 

Medical that reasonable to BHP is by prevent change testerone become DHT. Finasteride is a medicine function by this way and has proven effective. Herb medication popular and are believed get prevent poisonous influence DHT's formation that excess is saw palmetto. This subtropical climate can found in American region South-East. Indian's person indigenous Florida and his early people use berries and this crop as medicine people to cure disruption reproduction, or vessel disease urinate and influenza. To woman are used to mother's milk and defuse menstruation painful.

 

Present research that saw palmetto berries powerfully effective in lessen disruption BHP. Relatively proscar (BHP's drug that many formulation), saw palmetto more effective in defuse prostate phenomenon. Lot of scrutiny have pointed out that saw palmetto powerfully effective almost 90% to menstrual period among week 4 to week 6 . Instead proscar only effective in defuse his phenomenon less 37% after drug taking during per years. Convince that saw palmetto had no side effects. Instead proscar may cause impotency, desire decline (libido) sexual and disabled birth. Saw palmetto have solicited his reputation among the physicians alternative health and conventional as a effective medication to BPH. It make a herb has been admitted by conventional medication as secure and effective.

 

Medication influences saw palmetto can be found especially from fat tamarind in berry. Attract to be observed that saw palmetto make cluster palm and berries and it make among coconut species. Obtain many fat tamarind to saw palmetto berries make similar MCFA with MCFA in coconut. Dr Jon Kabara, biochemist fat (lipid), declared that fat tamarind saw palmetto barriers cope pursue formation DHT hormone. Then be also with fat tamarind to coconut oil. A conclusion is necessarily equal coconut oil effective it even more effective in preventing and cure BPH like extract saw palmetto.

         

DIABETES DISEASE. (DIABETES)

 

Among a number of modern society diseases is diabetes. This disease have increased less from a century ago to the need serious attention. Now diabetes become sixth-largest killer in America. Diabetes does not just cause death but can cause other disease such as kidney pain, acute myocardial infarction, high-blood-pressure, stroke, cataract, nerve damage, hearing loss and blindness. Calculated that 45% risky inhabitants this disease (diabetes).

 

By easier diabetes are disease that related with sugar inside the body in whose know as blood sugar or blood glucose. Every cell inside body should get glucose to spur metabolic. Cell use glucose to strengthen growth process and recovery. When eat food, digestive system change a lot of food become glucose then free in bloodstream. Hormone insulin, issued by gland pancreas, arrange glucose from the blood to be channeled into the cell until operational as fuel. If cell not get glucose total that sufficient cell will become 'hunger' and finally will die. To this moment, network and organs of the body will suffer damage. That is really happened to the diabetes patient.

   

There are two types diabetes, namely diabetes type I and diabetes type II. Diabetes type I sometimes considered as diabetes youth, namely diabetes which had been dependent insulin. Diabetes this type is ordinary originated during child and it is because by incapacity pancreas to issue total insulin needed by person. While diabetes type II also known as diabetes who do not rely to insulin. Diabetes this kind only occurred when person already adult and it happen because cell not able to absorb normal rate insulin issued by pancreas. In these circumstances insulin may regard as key to a key mango to singles door. Insulin with role as key, open mango key (enter into the cell) and then open the gate to facilitate glucose enter. If his mango's key make from material that are not quality and it damage, key is no longer function, door will not be able to open. This happens to sufferer diabetes tipe II. Insulin available cannot longer open the gate because his mango's key damaged. To both type diabetes this glucose level in the blood increase whereas his cell malfunction.

 

To diabetes tipe I pancreas not able to produce insulin rate that adequate to deliver glucose ply to all cells inside body. The treatment is with make insulin injection once or more a day with sugar low nutrition table that the tight. Was reported that around 90% sufferer diabetes have been from tipe II and 85% from it caused by obesity. This both tipe diabetes, diet very important whether to patient that stay to the moment disease start though in his handling. While type of food eaten also really influence patient either it enhance or protect

 

A interesting facts, persons that stay in the archipelago Pacific who practice traditional diet never reportedly catch diabetes ill. Yet when them leave his natural food and replace him with westernized food, all manner type of disease come, and in about is diabetes. For example what that happened in Nautu Island people in South-pacific. During their centuries just rely to food based upon on banana, tuber and coconut.

 

Yet after being found in their earth phosphate patching his revenue bring to prosperity and their changing lifestyles, majority of the population replace banana, tuber and coconut with food from fine powder, sugar and vegetable oil that while his process already experienced many modify. Consequently emerge disease have never seem before it like diabetes and others. Reportedly World Health Organization (WHO), almost half Nautu's Island urban population that age 30-64 years get diabetes disease.

 

Doctors have successfully helped patients to operate diabetes with organize patient practice low-fat diet, high carbohydrate. Through diet they get limit fat intake until 30% calorie. Complex carbohydrates as perfect grain and vegetables comprise from 50% to 60% calorie. Medium carbohydrate as fine powder and sugar should avoid. This is because carbohydrate pay tension that not duly to pancreas and this will increase in blood sugar to level that jeopardizes. Reason to fat reduction and also sweet food are gaining body weight reduction. This is because body weight problem is main cause diabetes. In addition other reason to low-fat diet is reduce the acute myocardial infarction risk that general effect from diabetes illness.

 

Lastly, researchers has shown that flute vegetable oil excessive recruitment cause disease diabetes. This matter was strengthen with a proof study to on animal where it have successfully raised diabetes with only feeding fat content poly unsaturated fat that substantial. Then with only limiting fat intake, that animals has undergone remedial from his disease (diabetes). In a conclusion powerfully effective low-fat diet in the handling diabetes.

 

Latest suggestion is lessen or limit all fats. Unsaturated mono fat as olive oil, subtly influence diabetes, then approved use at reasonable rates. Yet because all fats including high olive oil caloric content, then his recruitment not are encouraged. However seem unsaturated poly oil classified oil as problem occur. This scrutiny shows that when unsaturated poly fat from diet enclose in cellular arrangement, cell ability to get disturbed glucose. In other words 'mango key' to cell open the gate supply glucose to be entered aggravate his state when too much unsaturated poly oil in take in food. Then insulin not afford open the gate. Unsaturated poly fat oxidizable easily and destroyed by free radicals. With all type of fat, including unsaturated poly oil, used as obstacle hedge supply membrane cell. Unsaturated poly fat oxidizable in membrane cell can influence by detrimental his cellular function, including his ability in permit hormone, glucose and other substance to flow into and outwards his cell. Then thereof, diet high to vegetable unsaturated poly oil distillation increase diabetes. Diet low to oil will help dispel his symptom because all fat potential to increase body weight. Then would be excellent to avoiding him.

 

In this regard still there fat which can be eaten by diabetes sufferer without foreboding. The fat is coconut oil. Coconut oil not cause diabetes and it get help arrange blood sugar, felled at lessen influence diabetes. Nautu's people take many coconut oil during several generations and was never found diabetes, yet when they replace with eating from other oil his result is disaster.

 

Attractive one item of coconut oil not claim enzyme production insulin from pancreas. With reduction to process inside the body during lunch time, whereas insulin was still being taken out with many, then would facilitate organs of the body function more efficient. Coconut oil also help give energy to cell because it have been absorbed easily without need enzyme or insulin. Coconut oil has proven can improve secretion insulin and blood glucose. Coconut oil to improving food and improve action and insulin capacity send glucose repeat among cell, when compared with other oil.

 

In Journal of the Indian Medicine Association reports that diabetes type II in India have increased when person neglect oil traditional, because more selective vegetable unsaturated poly oil that has promoted “good for the heart”. The authors having commentary on the relationship between unsaturated poly oil with diabetes and organize enhance consumption coconut oil as method to prevent diabetes.

 

A diabetes consequence are diminished energy that related with incapacity cell to get glucose that is required. Without glucose to strengthen cellular activity, metabolic becomes slow and all body fell weak.

 

Athletic were organized as a method to help diabetes sufferer operate in blood sugar. The reason why beneficial athletic is that it enhance metabolic. Faster metabolic amount will stimulate insulin production increase that is required and enhance glucose absorption in cells. Therefore it can help diabetes sufferer type I though diabetes sufferer type II.

 

Coconut oil can also increase metabolic amount that cause body fire more calories that mean will add body weight reduction. Therefore decrease body weight can do with only increasing coconut oil into the food. MCFA to coconut oil mail directly to heart are transformed into energy instead of inside the body as fat network.

 

Diabetes sufferer as good it avoiding consumption all fats, except coconut oil, because it get help stabilize blood glucose rate and help lessen excess body weight. Not extreme if reputedly that coconut oil is as good oil it eaten diabetes sufferer.

     

Ulcer and Constipation

  

Some of the ulcers are usually caused by Herpes virus simplex type 2. It will attack when the person's immunity is low such as during fever, cold, diabetes, when menstruating, stress and others, while constipation is caused by lack water, fiber, drug/chemical reaction, incorrect toilet habit, cancer of the intestine, after operation or pregnancy.

 

Generally by taking Virgin Coconut Oil it will ease the pain, besides reducing inflammation and swelling of the ulcer sufferer. The high content of lauric and capric acid in virgin coconut oil (with antimicrobial characteristics) help to enhance the body's resistance besides acting as an antibiotic in the body. For those suffering from constipation, Virgin Coconut Oil can ease the bowel and help to treat internal wound such as pile.

 

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Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

 

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). Older people are more likely to have severe symptoms. At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[ Around 20% of those people will remain asymptomatic throughout infection, and the rest will develop symptoms later on, becoming pre-symptomatic rather than asymptomatic and therefore having a higher risk of transmitting the virus to others. Some people continue to experience a range of effects—known as long COVID—for months after recovery, and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person. Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission. The exact route of transmission is rarely proven conclusively, but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases. Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by reverse transcription loop-mediated isothermal amplification (RT-LAMP) from a nasopharyngeal swab.

 

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

 

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

 

SIGNS AND SYSTOMS

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties. People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.

 

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction). At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time. These asymptomatic carriers tend not to get tested and can spread the disease. Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.

 

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days. Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.

Most people recover from the acute phase of the disease. However, some people continue to experience a range of effects for months after recovery—named long COVID—and damage to organs has been observed. Multi-year studies are underway to further investigate the long-term effects of the disease.

 

CAUSE

TRANSMISSION

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes. A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person. During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.

 

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols. Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation. The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts. Airborne transmission is able to particularly occur indoors, in high risk locations such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated. It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.

 

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact. A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads. The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.

 

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.

 

The number of people generally infected by one infected person varies. Coronavirus disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location. There is a major role of "super-spreading events", where many people are infected by one person.

 

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear. People remain infectious in moderate cases for 7–12 days, and up to two weeks in severe cases. In October 2020, medical scientists reported evidence of reinfection in one person.

 

VIROLOGY

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan. All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.

 

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.

 

SARS-CoV-2 is closely related to the original SARS-CoV. It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13). The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV. The structure of the M protein resembles the sugar transporter SemiSWEET.

 

The many thousands of SARS-CoV-2 variants are grouped into clades. Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).

 

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.

 

SARS-CoV-2 VARIANTS

Three known variants of SARS-CoV-2 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).

 

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant ‘VUI – 202012/01’ (the first Variant Under Investigation in December 2020) transmits more easily than other strains.

 

PATHOPHYSIOLOGY

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs). The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs. The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell. The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective, though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective. As the alveolar disease progresses, respiratory failure might develop and death may follow.

 

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed. SARS-CoV-2 could cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain. The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.

 

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium as well as endothelial cells and enterocytes of the small intestine.

 

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system. An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China, and is more frequent in severe disease. Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart. ACE2 receptors are highly expressed in the heart and are involved in heart function. A high incidence of thrombosis and venous thromboembolism have been found people transferred to Intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis. Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia. Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains – without detected SARS-CoV-2 – and the olfactory bulbs from those who have died from COVID-19.

 

Another common cause of death is complications related to the kidneys. Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.

 

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.

 

IMMUNOPATHOLOGY

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon-γ inducible protein 10 (IP-10), monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein 1-α (MIP-1α), and tumour necrosis factor-α (TNF-α) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.

 

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.

 

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 . Lymphocytic infiltrates have also been reported at autopsy.

 

VIRAL AND HOST FACTORS

VIRUS PROTEINS

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.

 

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope. The N and E protein are accessory proteins that interfere with the host's immune response.

 

HOST FACTORS

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.

 

The virus' effect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.

 

HOST CYTOKINE RESPONSE

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm. Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.

 

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.

 

DIAGNOSIS

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions. Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.

 

VIRAL TESTING

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests, which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used. Results are generally available within hours. The WHO has published several testing protocols for the disease.

 

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.

 

The University of Oxford's CEBM has pointed to mounting evidence that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing" On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."

 

IMAGING

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening. Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection. Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses. Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.

 

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases. Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19. A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.

Coding

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.

 

PATHOLOGY

The main pathological findings at autopsy are:

 

Macroscopy: pericarditis, lung consolidation and pulmonary oedema

Lung findings:

minor serous exudation, minor fibrin exudation

pulmonary oedema, pneumocyte hyperplasia, large atypical pneumocytes, interstitial inflammation with lymphocytic infiltration and multinucleated giant cell formation

diffuse alveolar damage (DAD) with diffuse alveolar exudates. DAD is the cause of acute respiratory distress syndrome (ARDS) and severe hypoxemia.

organisation of exudates in alveolar cavities and pulmonary interstitial fibrosis

plasmocytosis in BAL

Blood: disseminated intravascular coagulation (DIC); leukoerythroblastic reaction

Liver: microvesicular steatosis

 

PREVENTION

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.

 

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.

 

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA. It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries. Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial. Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve". This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.

 

VACCINE

A COVID‑19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus causing coronavirus disease 2019 (COVID‑19). Prior to the COVID‑19 pandemic, there was an established body of knowledge about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which enabled accelerated development of various vaccine technologies during early 2020. On 10 January 2020, the SARS-CoV-2 genetic sequence data was shared through GISAID, and by 19 March, the global pharmaceutical industry announced a major commitment to address COVID-19.

 

In Phase III trials, several COVID‑19 vaccines have demonstrated efficacy as high as 95% in preventing symptomatic COVID‑19 infections. As of March 2021, 12 vaccines were authorized by at least one national regulatory authority for public use: two RNA vaccines (the Pfizer–BioNTech vaccine and the Moderna vaccine), four conventional inactivated vaccines (BBIBP-CorV, CoronaVac, Covaxin, and CoviVac), four viral vector vaccines (Sputnik V, the Oxford–AstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and two protein subunit vaccines (EpiVacCorona and RBD-Dimer). In total, as of March 2021, 308 vaccine candidates were in various stages of development, with 73 in clinical research, including 24 in Phase I trials, 33 in Phase I–II trials, and 16 in Phase III development.

Many countries have implemented phased distribution plans that prioritize those at highest risk of complications, such as the elderly, and those at high risk of exposure and transmission, such as healthcare workers. As of 17 March 2021, 400.22 million doses of COVID‑19 vaccine have been administered worldwide based on official reports from national health agencies. AstraZeneca-Oxford anticipates producing 3 billion doses in 2021, Pfizer-BioNTech 1.3 billion doses, and Sputnik V, Sinopharm, Sinovac, and Johnson & Johnson 1 billion doses each. Moderna targets producing 600 million doses and Convidicea 500 million doses in 2021. By December 2020, more than 10 billion vaccine doses had been preordered by countries, with about half of the doses purchased by high-income countries comprising 14% of the world's population.

 

SOCIAL DISTANCING

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others. Many governments are now mandating or recommending social distancing in regions affected by the outbreak.

 

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing. In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.

 

SELF-ISOLATION

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation. Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups. Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.

Face masks and respiratory hygiene

 

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing. Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing. A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection. But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

 

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease. When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.

 

HAND-WASHING AND HYGIENE

Thorough hand hygiene after any cough or sneeze is required. The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose. The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available. For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.

 

SURFACE CLEANING

After being expelled from the body, coronaviruses can survive on surfaces for hours to days. If a person touches the dirty surface, they may deposit the virus at the eyes, nose, or mouth where it can enter the body cause infection. Current evidence indicates that contact with infected surfaces is not the main driver of Covid-19, leading to recommendations for optimised disinfection procedures to avoid issues such as the increase of antimicrobial resistance through the use of inappropriate cleaning products and processes. Deep cleaning and other surface sanitation has been criticized as hygiene theater, giving a false sense of security against something primarily spread through the air.

 

The amount of time that the virus can survive depends significantly on the type of surface, the temperature, and the humidity. Coronaviruses die very quickly when exposed to the UV light in sunlight. Like other enveloped viruses, SARS-CoV-2 survives longest when the temperature is at room temperature or lower, and when the relative humidity is low (<50%).

 

On many surfaces, including as glass, some types of plastic, stainless steel, and skin, the virus can remain infective for several days indoors at room temperature, or even about a week under ideal conditions. On some surfaces, including cotton fabric and copper, the virus usually dies after a few hours. As a general rule of thumb, the virus dies faster on porous surfaces than on non-porous surfaces.

However, this rule is not absolute, and of the many surfaces tested, two with the longest survival times are N95 respirator masks and surgical masks, both of which are considered porous surfaces.

 

Surfaces may be decontaminated with 62–71 percent ethanol, 50–100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.2–7.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used. The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected. A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.

 

VENTILATION AND AIR FILTRATION

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.

 

HEALTHY DIET AND LIFESTYLE

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.

 

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms. This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.

 

TREATMENT

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus. Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.

 

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. Good personal hygiene and a healthy diet are also recommended. The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.

 

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.

Several experimental treatments are being actively studied in clinical trials. Others were thought to be promising early in the pandemic, such as hydroxychloroquine and lopinavir/ritonavir, but later research found them to be ineffective or even harmful. Despite ongoing research, there is still not enough high-quality evidence to recommend so-called early treatment. Nevertheless, in the United States, two monoclonal antibody-based therapies are available for early use in cases thought to be at high risk of progression to severe disease. The antiviral remdesivir is available in the U.S., Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for people needing mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy.

 

PROGNOSIS

The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. The Italian Istituto Superiore di Sanità reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.

 

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[191][192] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath. On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs – including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".

 

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.

 

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers, air pollution is similarly associated with risk factors, and pre-existing heart and lung diseases and also obesity contributes to an increased health risk of COVID-19.

 

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2. One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.

See also: Impact of the COVID-19 pandemic on children

 

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 10–19 years. They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.

 

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19. Genetic screening is able to detect interferon effector genes.

 

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.

 

COMPLICATIONS

Complications may include pneumonia, acute respiratory distress syndrome (ARDS), multi-organ failure, septic shock, and death. Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots. Approximately 20–30% of people who present with COVID-19 have elevated liver enzymes, reflecting liver injury.

 

Neurologic manifestations include seizure, stroke, encephalitis, and Guillain–Barré syndrome (which includes loss of motor functions). Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal. In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.

 

LONGER-TERM EFFECTS

Some early studies suggest that that 10 to 20% of people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems, including fatigue and shortness of breath. About 5-10% of patients admitted to hospital progress to severe or critical disease, including pneumonia and acute respiratory failure.

 

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[228] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.

 

People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis. Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.

 

IMMUNITY

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production, just as with most other infections. Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease. The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4-fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms. Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common. Some other coronaviruses circulating in people are capable of reinfection after roughly a year. Nonetheless, on 3 March 2021, scientists reported that a much more contagious Covid-19 variant, Lineage P.1, first detected in Japan, and subsequently found in Brazil, as well as in several places in the United States, may be associated with Covid-19 disease reinfection after recovery from an earlier Covid-19 infection.

 

MORTALITY

Several measures are commonly used to quantify mortality. These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health. The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.

 

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,685,770/121,585,388) as of 18 March 2021. The number varies by region. The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

 

INFECTION FATALITY RATE

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk. This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.

 

CURRENT ESTIMATES

A December 2020 systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy. That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. These results were also highlighted in a December 2020 report issued by the WHO.

 

EARLIER ESTIMATES OF IFR

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[ On 2 July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%. In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.5–1%. Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10 July, in New York City, with a population of 8.4 million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).Antibody testing in New York City suggested an IFR of ~0.9%,[258] and ~1.4%. In Bergamo province, 0.6% of the population has died. In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.

 

SEX DIFFERENCES

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy. The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women. Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders. One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors. Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men. In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men. As of April 2020, the US government is not tracking sex-related data of COVID-19 infections. Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.

 

ETHNIC DIFFERENCES

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups. Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death. Similar issues affect Native American and Latino communities. According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults. The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water. Leaders have called for efforts to research and address the disparities. In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background. More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease. The findings are from Professor Svante Pääbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet. This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.

 

COMORBIDITIES

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease. According to March data from the United States, 89% of those hospitalised had preexisting conditions. The Italian Istituto Superiore di Sanità reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases. According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), Ischemic Heart Disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

 

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis. Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes. When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms. COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.

 

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3 million additional TB cases and 1.4 million TB related deaths by 2025.

 

NAME

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus", with the disease sometimes called "Wuhan pneumonia". In the past, many diseases have been named after geographical locations, such as the Spanish flu, Middle East Respiratory Syndrome, and Zika virus. In January 2020, the WHO recommended 2019-nCov and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma. The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020. Tedros Adhanom explained: CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019). The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.

 

HISTORY

The virus is thought to be natural and of an animal origin, through spillover infection. There are several theories about where the first case (the so-called patient zero) originated. Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019. Evidence suggests that it descends from a coronavirus that infects wild bats, and spread to humans through an intermediary wildlife host.

 

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1 December 2019.Official publications from the WHO reported the earliest onset of symptoms as 8 December 2019. Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020. According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020 George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but that it was not the site of the initial outbreak.[ Traces of the virus have been found in wastewater samples that were collected in Milan and Turin, Italy, on 18 December 2019.

 

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission. The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December, and at least 266 by 31 December. On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus. A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December. On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. The Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause" that same evening. Eight of these doctors, including Li Wenliang (punished on 3 January), were later admonished by the police for spreading false rumours and another, Ai Fen, was reprimanded by her superiors for raising the alarm.

 

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases—enough to trigger an investigation.

 

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days. In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange. On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen. Later official data shows 6,174 people had already developed symptoms by then, and more may have been infected. A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential". On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern. By this time, the outbreak spread by a factor of 100 to 200 times.

 

Italy had its first confirmed cases on 31 January 2020, two tourists from China. As of 13 March 2020 the WHO considered Europe the active centre of the pandemic. Italy overtook China as the country with the most deaths on 19 March 2020. By 26 March the United States had overtaken China and Italy with the highest number of confirmed cases in the world. Research on coronavirus genomes indicates the majority of COVID-19 cases in New York came from European travellers, rather than directly from China or any other Asian country. Retesting of prior samples found a person in France who had the virus on 27 December 2019, and a person in the United States who died from the disease on 6 February 2020.

 

After 55 days without a locally transmitted case, Beijing reported a new COVID-19 case on 11 June 2020 which was followed by two more cases on 12 June. By 15 June there were 79 cases officially confirmed, most of them were people that went to Xinfadi Wholesale Market.

 

RT-PCR testing of untreated wastewater samples from Brazil and Italy have suggested detection of SARS-CoV-2 as early as November and December 2019, respectively, but the methods of such sewage studies have not been optimised, many have not been peer reviewed, details are often missing, and there is a risk of false positives due to contamination or if only one gene target is detected. A September 2020 review journal article said, "The possibility that the COVID-19 infection had already spread to Europe at the end of last year is now indicated by abundant, even if partially circumstantial, evidence", including pneumonia case numbers and radiology in France and Italy in November and December.

 

MISINFORMATION

After the initial outbreak of COVID-19, misinformation and disinformation regarding the origin, scale, prevention, treatment, and other aspects of the disease rapidly spread online.

 

In September 2020, the U.S. CDC published preliminary estimates of the risk of death by age groups in the United States, but those estimates were widely misreported and misunderstood.

 

OTHER ANIMALS

Humans appear to be capable of spreading the virus to some other animals, a type of disease transmission referred to as zooanthroponosis.

 

Some pets, especially cats and ferrets, can catch this virus from infected humans. Symptoms in cats include respiratory (such as a cough) and digestive symptoms. Cats can spread the virus to other cats, and may be able to spread the virus to humans, but cat-to-human transmission of SARS-CoV-2 has not been proven. Compared to cats, dogs are less susceptible to this infection. Behaviors which increase the risk of transmission include kissing, licking, and petting the animal.

 

The virus does not appear to be able to infect pigs, ducks, or chickens at all.[ Mice, rats, and rabbits, if they can be infected at all, are unlikely to be involved in spreading the virus.

 

Tigers and lions in zoos have become infected as a result of contact with infected humans. As expected, monkeys and great ape species such as orangutans can also be infected with the COVID-19 virus.

 

Minks, which are in the same family as ferrets, have been infected. Minks may be asymptomatic, and can also spread the virus to humans. Multiple countries have identified infected animals in mink farms. Denmark, a major producer of mink pelts, ordered the slaughter of all minks over fears of viral mutations. A vaccine for mink and other animals is being researched.

 

RESEARCH

International research on vaccines and medicines in COVID-19 is underway by government organisations, academic groups, and industry researchers. The CDC has classified it to require a BSL3 grade laboratory. There has been a great deal of COVID-19 research, involving accelerated research processes and publishing shortcuts to meet the global demand.

 

As of December 2020, hundreds of clinical trials have been undertaken, with research happening on every continent except Antarctica. As of November 2020, more than 200 possible treatments had been studied in humans so far.

Transmission and prevention research

Modelling research has been conducted with several objectives, including predictions of the dynamics of transmission, diagnosis and prognosis of infection, estimation of the impact of interventions, or allocation of resources. Modelling studies are mostly based on epidemiological models, estimating the number of infected people over time under given conditions. Several other types of models have been developed and used during the COVID-19 including computational fluid dynamics models to study the flow physics of COVID-19, retrofits of crowd movement models to study occupant exposure, mobility-data based models to investigate transmission, or the use of macroeconomic models to assess the economic impact of the pandemic. Further, conceptual frameworks from crisis management research have been applied to better understand the effects of COVID-19 on organizations worldwide.

 

TREATMENT-RELATED RESEARCH

Repurposed antiviral drugs make up most of the research into COVID-19 treatments. Other candidates in trials include vasodilators, corticosteroids, immune therapies, lipoic acid, bevacizumab, and recombinant angiotensin-converting enzyme 2.

 

In March 2020, the World Health Organization (WHO) initiated the Solidarity trial to assess the treatment effects of some promising drugs: an experimental drug called remdesivir; anti-malarial drugs chloroquine and hydroxychloroquine; two anti-HIV drugs, lopinavir/ritonavir; and interferon-beta. More than 300 active clinical trials were underway as of April 2020.

 

Research on the antimalarial drugs hydroxychloroquine and chloroquine showed that they were ineffective at best, and that they may reduce the antiviral activity of remdesivir. By May 2020, France, Italy, and Belgium had banned the use of hydroxychloroquine as a COVID-19 treatment.

 

In June, initial results from the randomised RECOVERY Trial in the United Kingdom showed that dexamethasone reduced mortality by one third for people who are critically ill on ventilators and one fifth for those receiving supplemental oxygen. Because this is a well-tested and widely available treatment, it was welcomed by the WHO, which is in the process of updating treatment guidelines to include dexamethasone and other steroids. Based on those preliminary results, dexamethasone treatment has been recommended by the NIH for patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen but not in patients with COVID-19 who do not require supplemental oxygen.

 

In September 2020, the WHO released updated guidance on using corticosteroids for COVID-19. The WHO recommends systemic corticosteroids rather than no systemic corticosteroids for the treatment of people with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence). The WHO suggests not to use corticosteroids in the treatment of people with non-severe COVID-19 (conditional recommendation, based on low certainty evidence). The updated guidance was based on a meta-analysis of clinical trials of critically ill COVID-19 patients.

 

WIKIPEDIA