Coping with the Corona Virus (SARS-CoV-2): Can Glucosamine from Shrimp, Mushrooms, or Other Sources Help Reduce the Danger of Pneumonia?

SARS-CoV-2-COVID-19-virus

Illustration of SARS-CoV-2 virion from the CDC.

Millions of people around the world are worried for China and hope there is soon a full recovery from the dreadful disease, COVID-19. Few things sounds more dreadful than being trapped in a locked-down city where thousands are infected and almost everything is shut down. Pray for the success of Wuhan in conquering this pandemic.

While I expressed my concerns about the severity of these rapidly spreading disease and the impact it is having on so many people, one acquaintance who wishes only to be known as C.T. shared with me some of her tentative findings about the impact of several factors on the death rate of pneumonia found across the world.

Her investigation examined  factors that may affect how severe pneumonia becomes in once healthy patients. I find her proposal interesting and potentially valuable enough that I’d like to invite feedback from experts to see if there is any merit to her thinking. If her work could help alleviate some of the suffering that COVID-19 is causing, and specifically decrease the mortality rate, that would be fantastic. Perhaps there’s nothing there. Intelligent feedback is what I am looking for.

Please note that I am not making any medical claims or suggesting that nutrition or nutritional supplements can directly reduce the risk of coming down with or dying from COVID-19 or pneumonia in general. I am not seeking to spread rumors about the disease (spreading rumors is strictly illegal in China, especially rumors or incorrect information about sensitive issues such as COVID-19 and its management, and I strive to abide by the regulations), but am inviting experts to review a tentative possibility that could be helpful to China and other nations.

C.T.’s hypothesis deals with the possible role of glucosamine and other aspects of nutrition in reducing the risk of pneumonia. Glucosamine is a natural material found in cartilage and in the shells of shrimp, crabs, etc. and the skeletons of marine animals. It is also present in China’s abundant and delicious mushrooms and other fungi (see “Dietary Sources” below). It is an antioxidant that our body can produce, though it is also commonly sold as a dietary supplement said to help treat osteoarthritis and reduce pain in joints (see an overview of reports on glucosamine at ScienceDirect). In what follows, I’ll add some comments to C.T.’s points and  mix a few finds from my searching with some of the things she has found.

The relationship between glucosamine and cartilage health has a reasonable basis (though for relieving pain, as the BBC reports, it’s not clear that glucosamine supplements actually do more than a good, full-strength placebo), and cartilage is present in several vital parts of the lungs, from the trachea through the bronchi. C.T.’s hypothesis is that viral disease may infect chondrocytes, cells that product cartilage, and that our own immune system in response may then attack those cells and lead to tissue damage that allows naturally present bacteria to cause severe infection. But could there be a relationship between glucosamine and pneumonia mortality? C.T. proposes a mechanism involving the SOX-9 protein and its role in driving a “cytokine storm” where dangerous cycles can lead to severe illness. She argues that dietary influences that inhibit or enhance the effect of SOX-9 (i.e., down regulate or up regulate) may help explain significant differences in pneumonia mortality among nations, with tea and perhaps pomegranate juice being likely to up regulate SOX-9 while diets high in shrimp and cartilage may provide the glucosamine that can may regulate SOX-9.  You can see her recent comments on the Coronavirus and the crisis in Wuhan in her post of Jan. 31, 2020, “My two bits about the novel coronavirus from Wuhan,” which points to her earlier post with the key information she wishes to share.

Whether or not C.T.’s proposed mechanisms and dietary considerations are correct, there are peer-reviewed studies suggesting that glucosamine can in fact reduce mortality from respiratory illness.

The scientific literature on glucosamine tends to focus on its role in cartilage formation and in alleviating problems with joints and bones. But there are some surprising finds related to other effects. Here are a few to consider (the first and fourth were pointed out by C.T. in her original work):

1. Griffith A. Bell et al., “Use of glucosamine and chondroitin in relation to mortality,” European Journal of Epidemiology, 27/8 (2012): 593-603; https://www.jstor.org/stable/23272500.

Abstract: Glucosamine and chondroitin are products commonly used by older adults in the US and Europe. There is limited evidence that they have anti-inflammatory properties, which could provide risk reduction of several diseases. However, data on their long-term health effects is lacking. To evaluate whether use of glucosamine and chondroitin are associated with cause-specific and total mortality. Participants (n = 77,510) were members of a cohort study of Washington State (US) residents aged 50-76 years who entered the cohort in 2000-2002 by completing a baseline questionnaire that included questions on glucosamine and chondroitin use. Participants were followed for mortality through 2008 (n = 5,362 deaths). Hazard ratios (HR) for death adjusted for multiple covariates were estimated using Cox models. Current (baseline) glucosamine and chondroitin use were associated with a decreased risk of total mortality compared to never use. The adjusted HR associated with current use of glucosamine (with or without chondroitin) was 0.82 (95 % CI 0.75-0.90) and 0.86 (95 % CI 0.78-0.96) for chondroitin (included in two-thirds of glucosamine supplements). Current use of glucosamine was associated with a significant decreased risk of death from cancer (HR 0.87 95 % CI 0.76-0.98) and with a large risk reduction for death from respiratory diseases (HR 0.59 95 % CI 0.41-0.83). Use of glucosamine with or without chondroitin was associated with reduced total mortality and with reductions of several broad causes of death. Although bias cannot be ruled out, these results suggest that glucosamine may provide some mortality benefit. [For links to references cited by Bell et al., see the Springer page for this article.]

2. Kun-Han Chuang et al., “Attenuation of LPS-induced Lung Inflammation by Glucosamine in Rats,” American Journal of Respiratory Cellular Molelcular Biology, 49/6 (Dec. 2013): 1110-9.

Abstract: Acute inflammation is often observed during acute lung injury (ALI) and acute respiratory distress syndrome. Glucosamine is known to act as an anti-inflammatory molecule. The effects of glucosamine on acute lung inflammation and its associated mechanisms remain unclear. The present study sought to address how glucosamine plays an anti-inflammatory role in acute lung inflammation in vivo and in vitro. Using the LPS intratracheal instillation-elicited rat lung inflammation model, we found that glucosamine attenuated pulmonary edema and polymorphonuclear leukocyte infiltration, as well as the production of TNF-α, IL-1β, cytokine-induced neutrophil chemoattractant (CINC)-1, macrophage inflammatory protein (MIP)-2, and nitric oxide (NO) in the bronchoalveolar lavage fluid (BALF) and in the cultured medium of BALF cells. The expression of TNF-α, IL-1β, IFN-γ, CINC-1, MIP-2, monocyte chemotactic protein-1, and inducible NO synthase (iNOS) in LPS-inflamed lung tissue was also suppressed by glucosamine. Using the rat alveolar epithelial cell line L2, we noted that the cytokine mixture (cytomix)-regulated production and mRNA expression of CINC-1 and MIP-2, NO production, the protein and mRNA expression of iNOS, iNOS mRNA stability, and iNOS promoter activity were all inhibited by glucosamine. Furthermore, glucosamine reduced LPS-mediated NF-κB signaling by decreasing IκB phosphorylation, p65 nuclear translocation, and NF-κB reporter activity. Overexpression of the p65 subunit restored the inhibitory action of glucosamine on cytomix-regulated NO production and iNOS expression. In conclusion, glucosamine appears to act as an anti-inflammatory molecule in LPS-induced lung inflammation, at least in part by targeting the NF-κB signaling pathway.

3. Yuh-Lin Wu et al., “Glucosamine Attenuates Cigarette Smoke-Induced Lung Inflammation by Inhibiting ROS-sensitive Inflammatory Signaling,” Free Radical Biology and Medicine, 69 (April 2014): 208-18; DOI: 10.1016/j.freeradbiomed.2014.01.026.

Abstract

Cigarette smoking causes persistent lung inflammation that is mainly regulated by redox-sensitive pathways. We have reported that cigarette smoke (CS) activates a NADPH oxidase-dependent reactive oxygen species (ROS)-sensitive AMP-activated protein kinase (AMPK) signaling pathway leading to induction of lung inflammation. Glucosamine, a dietary supplement used to treat osteoarthritis, has antioxidant and anti-inflammatory properties. However, whether glucosamine has similar beneficial effects against CS-induced lung inflammation remains unclear. Using a murine model we show that chronic CS exposure for 4 weeks increased lung levels of 4-hydroxynonenal (an oxidative stress biomarker), phospho-AMPK, and macrophage inflammatory protein 2 and induced lung inflammation; all of these CS-induced events were suppressed by chronic treatment with glucosamine. Using human bronchial epithelial cells, we demonstrate that cigarette smoke extract (CSE) sequentially activated NADPH oxidase; increased intracellular levels of ROS; activated AMPK, mitogen-activated protein kinases (MAPKs), nuclear factor-κB (NF-κB), and signal transducer and activator of transcription proteins 3 (STAT3); and induced interleukin-8 (IL-8). Additionally, using a ROS scavenger, a siRNA that targets AMPK, and various pharmacological inhibitors, we identified the signaling cascade that leads to induction of IL-8 by CSE. All these CSE-induced events were inhibited by glucosamine pretreatment. Our findings suggest a novel role for glucosamine in alleviating the oxidative stress and lung inflammation induced by chronic CS exposure in vivo and in suppressing the CSE-induced IL-8 in vitro by inhibiting both the ROS-sensitive NADPH oxidase/AMPK/MAPK signaling pathway and the downstream transcriptional factors NF-κB and STAT3.

4. Jean-Noël Gouze et al., “Exogenous glucosamine globally protects chondrocytes from the arthritogenic effects of IL-1β,” Arthritis Research and Therapy,  8 (2006), article #R173; https://doi.org/10.1186/ar2082. (PDF also available.)

Abstract

The effects of exogenous glucosamine on the biology of articular chondrocytes were determined by examining global transcription patterns under normal culture conditions and following challenge with IL-1β. Chondrocytes isolated from the cartilage of rats were cultured in several flasks either alone or in the presence of 20 mM glucosamine. Six hours later, one-half of the cultures of each group were challenged with 10 ng/ml IL-1β. Fourteen hours after this challenge, RNA was extracted from each culture individually and used to probe microarray chips corresponding to the entire rat genome. Glucosamine alone had no observable stimulatory effect on the transcription of primary cartilage matrix genes, such as aggrecan, collagen type II, or genes involved in glycosaminoglycan synthesis; however, glucosamine proved to be a potent, broad-spectrum inhibitor of IL-1β. Of the 2,813 genes whose transcription was altered by IL-1β stimulation (P < 0.0001), glucosamine significantly blocked the response in 2,055 (~73%). Glucosamine fully protected the chondrocytes from IL-1-induced expression of inflammatory cytokines, chemokines, and growth factors as well as proteins involved in prostaglandin E2 and nitric oxide synthesis. It also blocked the IL-1-induced expression of matrix-specific proteases such as MMP-3, MMP-9, MMP-10, MMP-12, and ADAMTS-1. The concentrations of IL-1 and glucosamine used in these assays were supraphysiological and were not representative of the arthritic joint following oral consumption of glucosamine. They suggest, however, that the potential benefit of glucosamine in osteoarthritis is not related to cartilage matrix biosynthesis, but is more probably related to its ability to globally inhibit the deleterious effects of IL-1β signaling. These results suggest that glucosamine, if administered effectively, may indeed have anti-arthritic properties, but primarily as an anti-inflammatory agent.

In light of these studies, there seems to be reason to believe that glucosamine may be helpful in reducing the mortality of pneumonia. If so, being prepared to have a diet with some glucosamine sources or to have some glucosamine on hand might be reasonable should COVID-19 become a serious threat in your community, or if you are traveling under conditions where you may be exposed to the SARS-CoV-2 virus. Your intelligent feedback on this is welcome — but anonymous trolling comments that I too often tolerate will be deleted here in order to increase the chance of readers finding intelligent comments that help us better understand the issues raised here.

C.T.’s Proposals on Mechanism and Diet

C.T. wrote the following a few days ago:

Hi, Jeff, I know it sounds presumptuous, but I think I figured out which environmental triggers are involved in making it so people exposed to this virus do/do not become symptomatic and how severe the symptoms are.

1) Damage to the hyaline cartilage (by the immune system targeting infected cartilage cells) is much less likely to happen where the diet contains glucosamine (in shrimp paste and cartilage), where there is no exposure to dry and cold air, and where there is not bleach being sprayed in the air (seriously, have Hubei’s bureaucrats never heard of chemical pneumonia?).

2) The cartilage cells, if damaged, think they have to rebuild the hyaline cartilage matrix and so secrete chondroitin sulphate and other cartilage matrix molecules; the gene SOX9 is very instrumental in doing this, but if it is overly active it can cause there to be too many such molecules building up in the lungs. Voila! Viral pneumonia. What gets SOX9 going? EGCG appears to “stimulate exuberant cartilage matrix secretion” (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247298/), and EGCG is THE special molecule in tea leaves. What did the poor people of Wuhan ingest in their apartment quarantines: rice, veggies, legumes, and tea–no meat or shrimp. What else affects SOX9? Turmeric (curcumin decreases SOX9 activity–lucky Thailand), Fluoride (also helps decrease SOX9 activity–lucky India), Pomegranate (increases SOX9–unlucky Iran, where they drink pomegranate juice when sick). This hypothesis holds up even in Italy, where they drink wine and coffee all the time except when they’re trying to lose weight or fight a cold–then they drink green tea. And it utterly refutes all the stupid internet trolls who were going on and on about how “Chinese people have horrible hygiene.”

C.T.’s original post on the relationship between glucosamine and mortality in pneumonia and the possible mechanisms involved is “Glucosamine to protect cartilage during influenza infection,” Petticoat Government, Feb. 5, 2018. Here is an excerpt with the key arguments she makes:

1) The flu infects chondrocytes, the cells in cartilage. They are the only cells in hyaline cartilage, which type of cartilage is coincidentally found in places–joints, rib ends, nose, larynx, trachea, bronchi–that are among the hardest hit by influenza. (https://www.britannica.com/science/cartilage)

2) Influenza-infected chondrocytes don’t seem to actually experience obvious damage until the body’s immune system goes on the attack. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC422866/; http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2567.2003.01621.x/full) [Edited 2/17/2018: Someone pointed out to me that chondrocytes are within an extracellular matrix that has no blood vessels, so other cells, including attacking immune cells, can’t reach them. I looked more into that issue and found a 2015 cartilage transplant study which found that cartilage isn’t as immune-privileged as it used to be believed it was (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522233/). I suspect that chondroblasts–the immature chondrocytes next to the blood-vessel-containing perichondrium–are the first chondrocytes which the immune system cells attack, and then due to their destruction the cartilage matrix becomes compromised; if that compromised state becomes severe enough, immune cells can then gain access to the mature chondrocytes within, as well.]

3) Cytokines are part of the immune system’s attack arsenal. The cytokine IL-1beta is a critical component of lung inflammation during infection with influenza type A H1N1. (http://onlinelibrary.wiley.com/doi/10.1002/jmv.24138/abstracthttps://www.ncbi.nlm.nih.gov/pubmed/27714503)

4) Glucosamine–a natural compound found in cartilage–happens to protect chondrocytes by being a potent inhibitor of IL-1beta. (https://link.springer.com/article/10.1186/ar2082)

5) Damaged cartilage in the trachea/bronchi could allow for more penetrating infection by viruses/bacteria that normally would not be able to do much harm and in that way make flu sufferers much more susceptible to pneumonia. Most of the people who died from the 1918 flu died because “bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.” (https://www.nih.gov/news-events/news-releases/bacterial-pneumonia-caused-most-deaths-1918-influenza-pandemic)

6) People who take glucosamine (it’s a common supplement for arthritis) are much less likely to die of respiratory illnesses than their peers. (https://link.springer.com/article/10.1007/s10654-012-9714-6)

So if you’re worried about influenza, it might be worth it to buy some glucosamine and take it when you’re exposed to influenza so you can protect your hyaline cartilage and thus make yourself less likely to develop pneumonia….

Eat well cooked, or non-manufactured source- glucosamine rich foods (like shrimp) to help the cartilage stay strong, and stay away from tea plant and pomegranate for a second. (Pomegranates are healthy, but are rich in natural SOX9 stimulants… Which is good… But on a viral, over-production level ((what happens with this virus)) you get to much in the lungs too fast, and therefore pneumonia.)

By the way, I have worked with nearly pure EGCG as part of my consumer products research work in the past and was often surprised by how reactive it is. Dissolve a little white EGCG in water and combine with baking soda or other alkaline material and find out what strange, ugly stains you can create on materials such as tissue paper or fabrics after allowing it to sit for a few hours. It has many effects in the body, some clearly positive, but I can imagine that there are situations where this reactive material isn’t helpful. Can it play the role that C.T. suggests? I don’t know, but would like to learn more. Is it possible that giving tea to the ill might not be a good idea? I don’t know, but it may not be helping in Wuhan, though so much of what’s happening there remains opaque. If you have additional useful information, please let me know.

Dietary Sources

C.T. points to shrimp as an important dietary source of glucosamine. I should add that it appears that the glucosamine of shrimp comes from the shell, not the flesh. In Asia, many people eat the shells, or so it seems to me, especially small shrimp where the shell is quite thin and, in fried shrimp, can be tasty and easy to eat. She also mentions gristle, which is commonly consumed, especially chicken gristle. Another source may be soups in which the bones of animals have been stewed for a long period of time. Bone-rich soup, at least in China, especially when stewed long enough to create a white broth, is widely held to be very nutritious and ideal for those who are ill, and probably supplies some glucosamine. I find it delicious, too.

There are also options for vegetarians. Mushrooms contain chitin, the widespread natural polymer found in the shells of shrimp, crabs, insects, etc., and glucosamine is one of the building blocks of chitin and I believe it can be released when digested. See Tao Wu et al., “Chitin and Chitosan–Value-Added Products From Mushroom Waste,” Journal of Agricultural Food Chemistry, 52 /26 (Dec. 29, 2004): 7905-10;  DOI: 10.1021/jf0492565. Also see Pin Zhang et al., “Kinetic Models for Glucosamine Production by Acid Hydrolysis of Chitin in Five Mushrooms,” International Journal of Chemical Engineering, 2020, article ID 5084036 (2020); https://doi.org/10.1155/2020/5084036.

Unfortunately, for those in Wuhan, there are reports that the diet is now necessarily simple and thus there may be less meat (bone and cartilage included) and less shrimp than usual, so the protective effects of glucosamine, if real, may be less available than normal. C.T. worries that the combination of cold, stress, and confinement, coupled with a low-glucosamine and high-tea diet and even the occasional exposure to bleach or other harsh chemicals in the effort to kill the virus in many places might make a perfect storm for elevated pneumonia risk for those infected with the virus. If C.T.’s proposal is correct, then bringing glucosamine or glucosamine-rich foods to Wuhan and other affected areas may be a helpful step to help reduce loss of life.

One of China’s great blessings when it comes to food is the richness of its fungi, with numerous wild and domesticated mushrooms and other fungi that are so delicious. Some are far too expensive for me, but there are many varieties that are relatively inexpensive but very nutritious, especially the black wood ear fungus called mu er (literally wood ear). It’s more expensive than rice or common vegetables like carrots, onions, or cabbage, but it’s still quite cheap and has also been touted for its immune strengthening benefits. I order some much of the time when I’m in Chinese restaurants in China. Perhaps adding this to the diet of the people in Wuhan and other afflicted cities could help?

Is Glucosamine Safe for Those Allergic to Shrimp?

Finally, one important issue is whether those with seafood allergies, including shellfish allergies, should take glucosamine since it is often made from the shells of shrimp. Please consult with your physician and don’t take crazy risks based on random bloggers. However, something to consider as you discuss such matters with competent medical authorities is that several studies suggest that commercially available high-quality glucosamine may not contain the allergens that are harmful to some people. Here are a couple studies to consider:

J. Villacis et al.,  “Do Shrimp-Allergic Individuals Tolerate Shrimp-Derived Glucosamine?,”  Clinical and Experimental Allergy, 36/11 (Nov. 2006): 1457-61;  DOI: 10.1111/j.1365-2222.2006.02590.x.

Abstract

Background: There is concern that shrimp-allergic individuals may react to glucosamine-containing products as shrimp shells are a major source of glucosamine used for human consumption.

Objective: The purpose of this study was to determine whether shrimp-allergic individuals can tolerate therapeutic doses of glucosamine.

Methods: Subjects with a history of shrimp allergy were recruited and tested for both shrimp reactivity via a prick skin test and shrimp-specific IgE by an ImmunoCAP assay. Fifteen subjects with positive skin tests to shrimp and an ImmunoCAP class level of two or greater were selected for a double-blind placebo-controlled food challenge (DBPCFC) using glucosamine-chondroitin tablets containing 1,500 mg of synthetically produced (control) or shrimp-derived glucosamine. Immediate reactions, including changes in peak flow and blood pressure, and delayed reactions (up to 24 h post-challenge) via questionnaire were noted and assessed.

Results: All subjects tolerated 1,500 mg of both shrimp-derived or synthetic glucosamine without incident of an immediate hypersensitivity response. Peak flows and blood pressures remained constant, and no subject had symptoms of a delayed reaction 24 h later.

Conclusion: This study demonstrates that glucosamine supplements from specific manufacturers do not contain clinically relevant levels of shrimp allergen and therefore appear to pose no threat to shrimp-allergic individuals.

Heather C. Gray, et al., “Is glucosamine safe in patients with seafood allergy?,Jounral of Allergy and Clinical Immunology,  114/2 (August 2004) 459–460; DOI: https://doi.org/10.1016/j.jaci.2004.05.050 (PDF also available).

Excerpt:

Six subjects participated in the study. All 6 had a history consistent with a systemic reaction to shellfish. All 6 had positive skin prick test responses to shrimp, crab, lobster, or a combination of these. All 6 had negative skin test responses to the glucosamine extract (Table I) and uneventful oral challenges with glucosamine, with no change in skin, vital signs, or spirometry….

Approximately 600 patients must be recruited to ensure that the chance of rejecting an allergy rate of at least 0.5% is less than 0.05. This pilot study, which indicates that glucosamine is probably safe for patients with shellfish allergy, emphasizes the need for further investigation, with larger studies looking at different shellfish allergens and the consistency of glucosamine formulations.

Further research is needed on this issue and others raised above. If you have other information on the food safety issue or other issues raised here, please share. Thanks!

I welcome your civil, thoughtful feedback.


Other Related Resources:

Theodore M. Brasky, “Use of Glucosamine and Chondroitin and Lung Cancer Risk in the VITamins And Lifestyle (VITAL) Cohort,” Cancer Causes and Control, 22/9 (Sept. 2011): 1333-42.

Jody Braverman, “Nutritional Value of Bone Gristle,” LiveStrong.com, September 30, 2019.

 

Update, 2/28/2020: There’s one study C.T. mentioned suggesting that chondroitin, which is often combined with glucosamine in supplements, can cause pneumonia rather than prevent it, based on a single patient. See Takeshi Satomura et al., “A Case of Drug-induced Pulmonary Disease Considered to be Caused by a Supplement Containing Chondroitin,” The Journal of the Japan Society for Respiratory Endoscopy,  37/2 (2015): 214-18; DOI https://doi.org/10.18907/jjsre.37.2_214.

Abstract 

Drug-induced pulmonary disease can be caused by a variety of drugs including supplements. We examined a case of drug-induced organizing pneumonia induced by a supplement containing chondroitin. Case. An 80-year-old man had been taking supplements for knee pain since early July 2013 and subsequently developed a cough and fever. A chest radiograph demonstrated infiltrative shadows, and he was admitted to our hospital. His condition did not improved with antibiotic treatment and bronchoscopy was performed for diagnostic purposes. A transbronchial lung biopsy specimen showed organizing pneumonia, and the patient’s condition was ameliorated with steroid therapy. We established a diagnosis of drug-induced pulmonary disease based on the results of a lymphocyte stimulation test for a supplement containing chondroitin. Conclusions. We conclude that the use of supplements containing chondroitin may result in drug-induced pulmonary disease.

That single case may not be meaningful, but if you’re concerned and want more glucosamine after consulting with medical personnel, you can just use glucosamine alone or a diet with glucosamine. Chondroitin tends to me relatively more expensive anyway. Consult your physician and don’t rely on bloggers.

By |2020-02-28T13:45:51-07:00February 28th, 2020|Categories: China, Food, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , , , , |0 Comments

Views on the Corona Virus Pandemic in China

As I write, I have been out of China for over 3 weeks and am past the incubation period for the dreaded Corona virus that has been sweeping China. We were away in Vietnam on a  trip just before the Chinese New Year when the pandemic started looking serious, and were able to adapt our plans to stay out of China for a while. It has become a difficult place to be, even for those fortunate enough to avoid the virus.

We hope that the unprecedented efforts to contain the Corona virus in China will bring rapid containment, but the impact of the virus will also bring hardship to millions. The complete lockdown of many large cities like Wuhan can make life very difficult.  Even in  beautiful, modern metropolises like Shanghai and Hangzhou, where relatively few cases of the virus have occurred, life can be difficult. People coming home from travel, like two American friends of mine who just returned to Shanghai from Australia, or a European friend who just got back to Hangzhou from a visit in Shanghai, are finding that strict regulations make them prisoners in their own apartment as the government requires quarantine for travelers. That’s if you are lucky enough to get home at all — my friend in Hangzhou said that she got home just one day before a ban on travelers entering the city went into effect. I don’t know how accurate that is, so I’m just reporting what she understands.

In Shanghai, people returning on Sunday and hoping to start work on Monday are in for disappointment and frustration. It may be one or two weeks before they can go back to work, depending on local rules. After that quarantine period, apartment complexes will only allow you to leave once every other day. Martial law comes with much uncertainty and some hardship, but perhaps this is needed. But hats off to those with the wisdom to have stored basics like food and other supplies to be ready for a time of trouble. People aren’t going hungry as far as I know, but it’s probably much harder to get what you might be used to now.

One man in Shanghai desperately needed to get his new passport that was sent by DHL to Shanghai, but had not been delivered to him for a number of days because DHL was largely shut down due to virus fears. It was only by going to DHL offices and “crying” for hours in front of the building that he finally got the attention of workers there who dug  into a pile of undelivered packages and found his passport, giving him time to get to the airport barely in time. Without that, he would have been in violation of Chinese law with an expired visa. You don’t want to violate visa rules!

Such accounts, though, may pale in comparison to the woes of those who are trapped in places they don’t belong, without resources and friends. Or even local Wuhan residents struggling with the challenges of living life under a lockdown with so much uncertainty, in spite of valiant efforts now to provide support and services. An American trapped in Wuhan did manage to get a seat on a plane out organized by the US government, but the problem was getting to the airport, some 30 miles away from his home. A few weeks ago that would have been easy: just take a taxi. But taxis in Wuhan have been shut down except for a handful dedicated to taking patients to the hospitals, but this requires a complex process of getting approval from the local government committees for each region of town and there’s no chance of getting a ride to the airport. With no feasible way to get to the airport, the man missed the flight and his seat was given to someone else. Fortunately, he had a second passport with Germany, and was able to get on the evacuation flight for Germany, a nation that kindly sent a bus to give German citizens rides to the airport. (Congratulation to those of you who recognize the many virtues of having a second passport. When things go crazy in your home country, it’s nice to have another option.)

In spite of China now going all out to contain the virus, there seems to be international anger toward China and the Chinese people. There are accusations that China did not act quickly enough or is not doing enough. Individual Chinese people are also experiencing blame and anger. Hotels, shops, and restaurants in some areas are turning away Chinese people. Rudeness and xenophobic hysteria abound. As I left Asia a few days ago, after a two-week virus-free exile in Vietnam before I began a business trip to the US for a research project in Minneapolis (I just love the University of Minnesota, by the way!), I read a front-page article in the New York Times on my flight from Hanoi to Seoul and was pained to see further evidence of the worldwide anger toward China. Motoko Rich’s Feb. 1-2, 2020 article, “Global Xenophobia Follows Virus.” See also MarketWatch’s “‘No Chinese allowed’: Racism and fear are now spreading along with the coronavirus” from Feb. 3.  This is a tough time to be Chinese. The video below from a Chinese man in Florence, Italy reminds us of the humanity of those facing prejudice because a virus originated in their country.

Some say there’s a deja vu sense to this virus, which is causing so much hysteria around the globe. But there’s reason for the hysteria: the virus has left China, and now has killed people elsewhere in the world, including (as of Feb. 4) Hong Kong (1 death) and Philippines (1 death), etc., etc., etc., for a total of, well, three deaths so far outside of China. But in China, nearly 500 people have died, so the death toll is on its way to reaching that of the worldwide 2009 influenza pandemic with the H1N1 virus. Well, on its way to some degree, I suppose. The H1N1 virus that started in the Americas spread worldwide and ended up killing over 200,000 people (maybe as many as 500,000). Not 200, not 500, but over 200,000.

Do you recall the the draconian measures taken by the US government to contain that virus in 2009 and 2010? And do you remember the worldwide hostility toward North Americans for that North American virus? The shunning of all things American, the refusal to allow Americans to stay in hotels or enter restaurants, the locking down of New York, Miami, and LA? The martial law, the quarantines, the months of delayed school and the crushing of the US economy? The inability to fly, travel, or even leave your apartment? My memory must be fading, because I don’t remember any of that. I remember encouragement to get flu shots then and warnings about the virus, but not the massive, painful disruption of travel, work, school, and normal life, nor escalation in anti-American sentiment.

China is responding to the crisis by locking down many cities, stranding over 60 million people, with martial-law measures in many other cities with tough regulations forcing many to be quarantined and hindering travel, work, and normal life. There is also the cessation of much public transportation or blockades on roads in and out of many cities, the shutting down of thousands of tourist attractions, delayed operations for millions of employees, delayed school for millions, and so forth. Such extreme measures to contain this virus, and yet there is still international hysteria and blame. Outside of China, two have died, a few hundred are affected. It may get much worse, but right now, it’s noting compared to seasonal bouts of influenza and nothing close to our own H1N1 pandemic that generated hardly any hysteria and resulted in a government response that was not exactly aggressive (I’m not saying it should have been — I really don’t know what should have been done). My point is, do we really need to shun China and be angry at the Chinese people for this one?

Yet the virus has unusually dangerous characteristics and may merit the extreme measures to control it. I’m not sure. But I hope we’ll keep this in perspective relative to the thousands of deaths the US experiences every flu season from related though perhaps less severe viruses. And I pray that we’ll remember China and recognize the great burdens the Chinese people are bearing, and not add to their burdens unnecessarily. Keep China and the Chinese people in your prayers, and thanks to those who are taking steps to help rather than to blame.

By |2020-02-10T12:55:17-07:00February 10th, 2020|Categories: China, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , |0 Comments

Routine Physical Exams in China

If you work for a large company in China, you may be given a routine physical checkup every year through a local Chinese clinic. I’ve been through several versions of this in my years in China. The process can be a bit overwhelming, but it’s certainly efficient.

In these exams, you and many dozens of other people will be herded from one station to another where a “specialist” will perform there duty. Blood test, urine sample reception, eye exam, ear exam, ultrasound inspection of your heart and neck, cardiograph, magic “qi” measurement with electrodes, blood pressure check, etc. It can go pretty quickly and seems very efficient. However, it’s not exactly perfect.

In my last exam at Ciming Clinic on Hongqiao Road near Yili Road, the ear specialist looked into both ears and said all was well. On to the next station. But in reality I had severe ear wax in both ears that was already causing some hearing loss and soon would be causing ringing in one ear. When I had a real ear doctor look at it, he was amazed at how much wax there was. It took two treatments by a good ear doctor at Shanghai East Hospital to get most of it out, and a third treatment by an excellent German specialist at the Gleneagle Clinic at the Tomorrow Center at People’s Square to finish the extraction. How on earth did the Ciming ear specialist not notice and inform me of the problem? I don’t think he even looked when he stuck the ear probe in my ear.

Others have made similar complaints. Basic things are missed. The process is useful for basic indicators, but don’t assume that all is well if the results are positive, or that some of the problems they point to are real. Some of the tests may be unnecessary or even weird, sometimes apparently trying to justify a strange piece of equipment someone acquired. So see a real doctor afterwards to discuss your results and talk about your health. In the mass production operations, generally nobody will ask you basic questions that should be the beginning of a health exam. Good luck!

By |2018-09-26T16:43:30-07:00September 26th, 2018|Categories: China, Consumers, Health, Shanghai, Surviving|Comments Off on Routine Physical Exams in China

Coping with Suicidal Thoughts in Shanghai? Local English- and Chinese-Speaking Resources Can Help

Foreigners living in China can sometimes feel very isolated, which might make depression or other mental health challenges even worse. It’s important to know that if your or a loved one is struggling with suicidal thoughts or the trauma of someone else’s suicide, there are resources to help. One resource is located right here in Shanghai for English speakers: Lifeline Shanghai (China; English only), phone: (021) 62798990. If calling from outside China, use the country code of +86. For Chinese speakers, a resource is HopeLine: 4001619995 (Chinese speakers; 24/7 toll-free access within China).

According to the Lifeline Shanghai website (http://www.lifeline-shanghai.com/):

Lifeline Shanghai serves the English-speaking community with free, confidential, and anonymous emotional support via telephone 10AM to 10PM, 365 days a year. Our helpline offers an emotional support service that respects everyone’s right to be heard, understood, and cared for. Lifeline Shanghai helpline assistants are ready to listen and support, helping you to gain another perspective and connecting you with other support services as needed. Trained volunteers offer emotional support and assist you to clarify options and choices that are right for you. ​

This service is for those with a wide variety of difficulties, not just suicidal thoughts. Appears to be a valuable addition to Shanghai’s expat resources.

Since many of my friends and some of my readers in Shanghai are part of my LDS religious community (The Church of Jesus Christ of Latter-day Saints),  will also mention the excellent resources and list of external resources provided at the Church’s official page, “Suicide Prevention and Ministering Understanding and Healing from the Pain of Suicide” (https://www.lds.org/get-help/suicide/?lang=eng).

Although Shanghai is a prosperous and wonderful place, the problem of suicide is serious. Suicide rates are painfully high and is even a serious problem among children, perhaps due to the high pressure they face in school. See “Child suicides high in Shanghai” at the Christian Science Monitor (an old 2004 article). But suicide rates have been increasing in many parts of the world, including the US. Rates among young girls have actually tripled in recent years, a terrible development. See “Suicide rate triples among young girls: How can we stem the ‘silent epidemic’?,” also from the Christian Science Monitor.

If someone you know is showing signs of suicidal thoughts, take it seriously and lovingly work to support them and get help. Turning to outside expert help may be vitally important.

By |2018-08-17T17:53:13-07:00August 17th, 2018|Categories: Education, Health, Relationships, Religion, Safety, Shanghai, Society, Surviving|Tags: , , , |Comments Off on Coping with Suicidal Thoughts in Shanghai? Local English- and Chinese-Speaking Resources Can Help

A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

A few days ago a grieving mom in Shanghai, a good friend of ours, shared some tragic news with me: her teenage son had pancreatic cancer, one of the worst cancers. Her son was likely to die soon, if the doctor was correct. Only about 20% of pancreatic cancer patients live past 5 years. She was almost overcome with grief and had been crying for a couple of days. But even though she had gone to an expensive hospital that caters to foreign clients, she wasn’t sure she should trust the doctor. The mother called me to see if I knew where she could turn for help. She didn’t know that one of my sons happens to be a doctor treating cancer at a leading US clinic.

I received a photo of the lab report for the boy and sent it to my son. The physical results reported that a scan of internal organs showed no unusual problems indicative of cancer. There were no other symptoms, just a slightly elevated CA-19-9 antigen level, 45 instead of a desired maximum of 37.

My son was greatly disappointed that the doctor would create such needless panic by telling the mom that her son probably had pancreatic cancer. My son explained that the CA-19-9 test is not supposed to be used for diagnosing cancer on its own. Absent other symptoms of cancer, its predictive power for cancer is less than 1%, he said, and when he learned that the son was just a teenager, he said it’s even less likely to be pancreatic cancer because that disease is almost unheard of in young people. The mother’s grief was turned to relief.

I later found scientific publications confirming what my son had said. For example, see K. Umashankar et al., “The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal,” Journal of Gastrointestinal Oncology, 2012 Jun; 3(2): 105–119; doi: 10.3978/j.issn.2078-6891.2011.021:

CA 19-9 serum levels have a sensitivity and specificity of 79-81% and 82-90% respectively for the diagnosis of pancreatic cancer in symptomatic patients; but are not useful as a screening marker because of low positive predictive value (0.5-0.9%).

Other articles indicate that diabetics, such as this young man, can have inflated CA-19-9 values (this applies at least for Type 2 diabetes–I’m not sure if CA-19-9 artifacts from Type 1 diabetes has been investigated), one of many possible alternative causes of elevated CA-19-9 values. Alternative causes for the elevated test result do not appear to have been  considered by the doctor who terrified a mom by declaring that it was probably pancreatic cancer. Again, the test can be useful in tracking the progress of treatment of a known cancer, but should not be used to diagnose cancer in the absence of other evidence, as in this case.




Keep this in mind when you have your physical in China. Don’t panic if a doctor reports that you might have pancreatic cancer based on a blood test result alone. Get a second opinion and understand why that value may be high, but don’t panic. Physical testing here can often include too many unnecessary tests in search of phantom problems that may be listed in your report by people who aren’t necessarily qualified to make such proclamations.

The family still needs to be cautious and follow up on the possible causes of the inflated test result, but it was only slightly elevated unlike the much higher scores that I’ve seen reported in patients who actually do have pancreatic cancer.

I am so grateful that my son was able to help bring peace to a mother who had been crying for a couple of days over the “fake news” she received from a generally good hospital. I suggest that here or anywhere else you should be open to the possibility that some doctors don’t know what they are talking about. And of course, that can apply to what I’ve said here. Do your homework, ask questions, and be cautious about what others declare.

 

By |2018-07-05T22:10:03-07:00June 17th, 2018|Categories: China, Consumers, Education, Health, Safety, Surviving|Tags: , |Comments Off on A Grieving Mom in Shanghai Learns Her Son May Not Have Pancreatic Cancer After All: Misuse of the CA-19-9 Antigen Test

Jimmer, the “Lonely Master,” Might Be Doing Better and Doing More in China than the Deseret News Thinks

In the state of Utah, Salt Lake City’s Deseret News recently carried a touching but slightly downbeat article about China’s most popular basketball player, Jimmer Fredette, the impressive star who once stunned American crowds while playing for Brigham Young University. The article is “Lonely Master: From March Madness to Shanghai, the Unlikely Journey of Jimmer Fredette” by Jesse Hyde, published March 12, 2018. It has a lot of positive things to say about Jimmer and his accomplishments in China, but the general tone of the article is that Jimmer has missed out on his US dreams and thus has settled for something painfully inferior by coming to China, a grim and gritty place. I think there’s another perspective that ought to be considered.

Yes, the CBA is a far weaker competitive field than the NBA, and yes, it is disappointing that his NBA career did not give him the opportunities and satisfaction he sought. But don’t shed too many tears for Jimmer: things might not be as grim as the article implies.

The negative picture painted of China is quite disappointing. It’s a beautiful, exciting place where Jimmer is visible and influential to millions of people in ways that would not be possible in Europe or the US. I have met Jimmer and chatted a few times but don’t know him well nor can I speak for him. But what he is doing here is remarkable and has touched many people. His goodness, his honesty, his humility, and his high standards have also helped him touch people beyond what his athletic skills alone could do. For someone who possibly may have a sense of a mission higher than personal temporal success alone, coming to China brings many opportunities to achieve greater good, while also benefiting from a shorter season and excellent pay. Win/win from my perspective. His presence in China is part of something big, at least in the minds of many of his BYU-related fans here.

One of those fans, a Communist Party official, requested a chance to meet Jimmer last year. I was honored to be part of the little gathering where introductions were made. Jimmer with his characteristic class and humility brought gifts for the Chinese men who had come — framed photos of him as keepsakes. They were thrilled. Before Jimmer showed up, one man in the small group, a business leader in charge of the large complex where we rent some beautiful space to hold LDS services, chattered excitedly about Jimmer and quoted statistics from Jimmer’s games when he was at BYU and in China. Kid in a candy shop when Jimmer arrived. The official had gifts also, a terrific album of Chinese postage stamps. It was a beautiful souvenir for each of the foreigners at this event, which I’m proudly holding in the photo below.

With typical Jimmer class, Jimmer noticed a couple of keenly interested staff members from the little cafe where we met and invited them to get their photos taken also. It was a big day for all of us.

The Deseret News article makes numerous references to the pollution of China and Jimmer’s depressing situation here. The lead paragraph suggests he can’t see much of the skyline in Shanghai due to pollution (yes, we have pollution and some days visibility is noticeably reduced, but we have a lot of beautiful days too and air quality is improving). His apartment is “empty, lonely, a place he just crashes, so devoid of personal effects….” Regarding some reminders of his wife and daughter in his apartment: “Sometimes he needs those reminders. Like when he’s in Shanxi, a gritty industrial city where the gray dust blows from the cement factories and the grime is so thick he could scribble his name on the windows of parked cars.” And when he’s in Shanghai, in spite of the wealth and good food here, “even here, the air carries a slight whiff of chemicals you can almost taste. It’s hard not to want to be somewhere else.”

At this point in reading the article, I wondered if the staff of the Deseret News have ever been in Salt Lake City during the winter months, when the winter inversion traps air in the Salt Lake Valley and leads to painfully high levels of particles, nitrogen oxide, and other pollutants? Of if they have ever been near operations of the massive copper mine that scars the Valley? Or drove through Utah County in the days when the Geneva Steel works were cranking out massive whiffs of chemicals into the air? Or if they have lived near a paper mill in the United States? Shanghai air can get smoggy and is typically worse than most places in the US, but apart from an occasional painter using oil-based paint or a vehicle burning too much oil, as in almost any city, noticeable “whiffs of chemicals” are something I generally don’t experience here, unless those chemicals include the cinnamon aromas coming from Shanghai’s amazing Cinnaswirl bakery with world-class cinnamon rolls, or from the intoxicating smells of any of the hundreds of different cuisines available in Shanghai. OK, we do have stinky tofu, which does have a noticeable smell from its unusual natural chemistry — maybe that’s what the writer encountered here. But you can just take a few steps and be free of that.

China has pollution, certainly. There are spots that are gritty or grimy, just as in America. But it’s also one of the most beautiful and exciting places to live, especially Shanghai. For me personally, my respiratory health during my nearly seven years in Shanghai has been much better than it was in the US, where I would often get bronchitis or other issues in winter. Here it’s been great and I’ve almost never had to miss work due to illness. One or two days for an injury, but my health has been terrific. Part of that is from the food, which is high in fresh produce and generally quite healthy.

Come give China a chance. It’s one of the nicest places in the world, in my opinion. Anyplace is grim when you are away from family, but with such a short playing season, we hope that Jimmer can continue to thrive here and increasingly experience the beauty and wonders of China while here.

As a reminder of the surprising beauty and sometimes even miraculous nature of life in Shanghai, here are images of one of Shanghai’s secrets: its impressive angels rising from the ground to watch over this city. May Jimmer continue to be among them.

Finally, here’s a couple views of one of Jimmer’s favorite Shanghai spots.

Shanghai Disney Castle

The Shanghai Disney Castle

 

Cinderella’s Castle.

 

 

By |2018-03-17T07:24:37-07:00March 16th, 2018|Categories: Business, Career, China, Food, Health, Photography, Relationships, Religion, Restaurants, Safety, Shanghai, Society, Surviving|Comments Off on Jimmer, the “Lonely Master,” Might Be Doing Better and Doing More in China than the Deseret News Thinks

Your Shanghai Apartment and Construction Noise

One of the surprises many foreigners have after moving to Shanghai is how noisy things can be when a big construction project starts. That quiet vacant lot across the street o your building may turn into a volcano of noise that slowly rises one story after another, or the once silent or vacant apartment next to you may become a source of constant pounding and drilling as the owners remodel it over a period of weeks.

Before you select a place, it’s good to look around and see if adjacent lots or buildings look like construction will soon take place. The worse situation is an old vacant building that will be demolished prior to rebuilding. Demolition in China is not a sudden event. It involves endless hours of a giant mechanical woodpecker pounding at stray blocks of cement to break them into tiny chunks. This is one of the most annoying sounds. Much better is the constant grinding sound that occurs when foundations are being dug or poured, for it sort of becomes like white noise that you can sleep through.

Fortunately, Shanghai has strict laws on noise requiring crews to become silent at night, I think by 11 PM, and to stay quiet until about 6:30 AM, giving you a chance to sleep. But these laws apply to ordinary companies and private owners, not to government projects like building a subway. We have a subway site under construction next to our house. Loud grinding and clanking noises will keep going until about midnight and then they are at it again at 3 or 4 in the morning. Pretty much noise all day long. How does one cope?

Make sure you have an apartment where your sleeping quarters will be away from the most likely construction site. That makes a huge difference. Also, consider adding some noise shields over your window at night, like foam board to completely cover the window. Or consider buying a white noise generator to mask the street noise. Ear plugs might also help.

But the real key is knowing what you are in for, as much as you can, before you select your apartment. Then prepare appropriately. Good luck!

By |2018-03-12T16:30:21-07:00March 12th, 2018|Categories: Health, Housing, Shanghai, Society, Surviving|Tags: , , |Comments Off on Your Shanghai Apartment and Construction Noise

Surviving Your Bike Ride in China

Riding a bike is one of the best ways to get around big cities in China. I have my own large Giant bike purchased new for 800 RMB, and I love it. Fast and smooth, but just one gear. That’s fine for Shanghai. Many people ride rental bikes now like Mobikes or the yellow Ofo bike that I sometimes ride (the Mobikes are just too small for me, while the Ofo brand often allows the seat to be raised high enough to make it possible for a tall guy to ride, though not comfortably). I ride my bike most days when going to work in the Hongqiao area of Shanghai. It’s often faster than a taxi and much faster than a bus. You can join the pack of crazy motorcyclists who are not impeded by traffic jams, cutting in and out of obstacles while carefully observing all relevant laws — well, most of the laws of physics, I mean.

Bike riding is fast and convenient, but there are serious dangers. Not as dangerous as a motorcycle, where the higher speed means higher risk, but that higher risk includes collisions with you on your bike, and the results can be nasty. A friend of mine just badly crushed his hand in an accident with a motorcycle while riding his bike. He will need delicate surgery. Another friend was riding across a bridge when she hit a rock and fell from her bike, badly shattering her forearm. Painful surgery and months of recovery were required, but after a year has regained nearly all of her motion. But trust me, you don’t want an accident. Understanding the dangers is critical.

One of the biggest dangers comes from motorcylces and especially their nearly silent electric version, the ebike or electric bike. They can be zooming toward you from behind and you won’t hear them coming. They can be coming in from an angle from the back or side and you won’t hear them coming, unless you listen carefully. More important than listening is looking: you need to frequently make quick glances over your shoulders, especially over your left shoulder where faster approaching vehicles are likely to be coming, but also sometimes over your right shoulder.

Vision Trumps Everything

Peripheral vision is crucial. Frequent glances over your shoulders are vital. Understand that a vehicle may suddenly approach you from any side and any angle. A motorcycle or bike may dart out from an alley or from between parked cars on the side of the road. As you approach an intersection or driveway, someone may suddenly move into your path and it will usually seem that they never even looked your way before entering traffic. It’s amazing that some of them are still alive, but natural selection can be a slow and overly random process. I certainly have not seen any evidence that natural selection has been weeding out insane motorists and cyclists over the years in China. Evolution might work well for some species, but it seems rather inactive for species on the road. Never mind, just focus on not being the one who gets weeded out.

The key is being totally alert and aware of what’s happening in front of you, at your sides, and behind you. Listen carefully for horns, bells, rattling sounds, motors, snorts, cellphone conversations, or other indications of an approaching ghost rider. Watch for signs of motion between stationary cars. Anticipate taxi doors suddenly opening, usually on the right side. Note the protruding nose of a dog getting ready to make a dash for it. Anticipate the craziness of intersections where people may cross your path from all directions. Total alertness and attention is your key to survival.

Here’s the shocking news: for enhanced safety, I’ve given up wearing my helmet. Yes, terrible of me, right? But the statistics globally don’t show that bikers who wear helmets fare better than those who don’t, and in my Shanghai experience, I’ve realized that anything that hinders my peripheral vision or my ability to quickly look over my shoulders increases my risk. Avoiding collisions and falls is the first priority, much better than falling with a touch of added protection. Helmets limit my vision and slow me down when making rapid backward glances. Sayonora.

Alertness is also needed for coping with obstacles on the road. Manhole covers may be moved and the dangerous hole not well marked. Potholes may be large. Bricks or other objects can be in your path. With the rise of rental bikes clogging sidewalks, you will sometimes find a rental bike has been abandoned on the side of the road that partially blocks a bicycle lane. Dangerous! Be  good citizen and move it out of the way, but do this by stopping gradually and with clear signaling of intent. No sudden moves!

Speaking of rental bikes, they add a lot of danger to the scene. Not just because they might be barriers, but because they have brought many new cyclists onto the roads who don’t know much about cycling and safety. And they are slow. They go at about 30-50% of my speed, in part because the wheels are small, and as a result they are constant barriers in front of me I need to weave around. But their riders often don’t ride very well, weaving back and forth as they go. So annoying. Increases the risk for everyone. Be cautious and carefully plan how you can avoid them and get past them as soon as possible. Further, bike renters will often step out onto the road with their bike without even looking at incoming traffic. So clueless. Anticipate their stupidity and be cautious when you see someone standing by a rental bike, possibly getting ready to create a pile-up on his or her first ride.

To Be Safe, Be Predictable

From my experience, a key safety tip is that you need to be predictable. Sudden turns, veering to a side, or a sudden stop can result in disaster. In China, car drivers and motorcyclists constantly forecast where others are going and then plan their sudden weaving in and out or other crazy maneuvers based on forecasting the routes of nearby vehicles. They expect you to just keep going and will time their move based on the forecast. But if you suddenly stop or turn without warning, you may end up where they are about to end up. Bang. Ugly. Notice this when you are in a taxi. Drivers are very aggressive and it all kind of works as long as people are somewhat predictable.

Hand signals aren’t common but are a good idea, especially for left turns against traffic. They aren’t going to stop for you in most cases to let you turn, but the signal lets others know what you are doing so they won’t crash into you.

When you stop, try to do it gradually. Recently I was riding along, thinking I was alone, and saw a person who was on the ground right after an accident between a bike and a motorcycle. I stopped quickly to help and then heard someone right behind me yell as he slammed the brakes of his electric motorcycle to avoid me. I was nearly taken down by that mistake. Be predictable. No sudden moves!

I hope this doesn’t deter you from riding a bike. There are dangers, but if you are alert and cautious, you can manage the risks and enjoy getting around town much faster than going on foot or with public transportation. But do realize that there are risks. Walking and public transportation have much lower risks, so weigh them as alternatives. Very few people have ever needed major surgery after a ride on the subway.

 

By |2018-01-07T19:24:24-07:00January 7th, 2018|Categories: China, Crazy, Health, Safety, Shanghai, Society, Surviving, Travel tips|Tags: , , , , , , , , , |Comments Off on Surviving Your Bike Ride in China

Milk in China: Try the Asahi Brand for Safe, Delicious Fresh Milk

Milk has been a problem for many people in China. Trust of Chinese dairies has been low after some past disasters. Large milk powder companies struggle tend to import the milk they use because of quality control problem among the numerous small dairies that provide milk to large providers. Foreigners who like to use milk tend to buy ultra-high-temperature (UHT) treated milk that does not require refrigeration until it is opened, but the flavor tends to be poor from the heat treatment and nutritional value may be lowered as well.

After struggling with various brands of UHT milk and shying away from Chinese dairies for fresh milk, I finally found a brand of fresh that impresses me: Asahi milk. This is a Japanese company using good Japanese dairy methods on their Chinese dairy. The flavor of the milk is better than anything I remember in the US and tastes like fresh milk I enjoyed in Switzerland long ago. Really delicious. A liter will cost slightly over 20 RMB, about the same price for good quality UHT cartons of milk. But so fresh and delicious. Also, I think, safe and consistent in quality.

Asahi brand whole milk: possibly China's best?v

Asahi brand whole milk: possibly China’s best?

By |2017-10-24T06:52:38-07:00January 21st, 2017|Categories: China, Consumers, Food, Health, Safety, Shopping, Surviving|Tags: , , , |2 Comments

Funny Red Beef in China: Treated with Sodium Nitrite?

I’ve noticed that beef sold in small shops in China is often a bright red color as if very fresh, maybe too fresh. It may have been sitting out for hours or days, and it is still that bright red color, never turning brown as regular beef does. We were buying beef from a local market for quite a while before it hit me that there was something odd about the color. It never turned brown until you cooked it. Finally it hit me that this beef has been treated in some way, probably with sodium nitrite or other chemicals that prevent the normal browning that occurs when beef oxidizes over time.

Some people worry that nitrites might cause cancer, especially when present in meet that is grilled or cooked at high temperature. Whether nitrites are carcinogenic or not, I don’t want chemicals being added to my beef to disguise its age and let old beef look fresh. This might be a good topic for further investigation because I don’t know for sure what is being added and who is doing the treatments, or of they are safe or not. But in the absence of assuring data, the strange absence of browning in some of the been being sold here has given me one more thing to worry about when it comes to meat in China.

Eat meat sparingly. Make sure it’s fresh and from a trustworthy source. Pork and chicken, which are sold in large quantities with high turnover, may be freshest and safest, in my opinion.

By |2017-01-06T21:12:08-07:00January 6th, 2017|Categories: China, Consumers, Food, Health, Restaurants, Safety, Shanghai, Shopping|Tags: , |Comments Off on Funny Red Beef in China: Treated with Sodium Nitrite?

Accident in Shanghai: The Ambulance Never Came

On my way to work each day, I usually walk or ride my bike, but on a rainy night recently, I tried taking a bus. The journey ended up taking longer than just walking. Part of the problem was a busy road (Gubei Road near Gubei’s elegant pedestrian street) was partly blocked by a traffic accident. As the bus drove by the scene, I saw a car and a little motorcycle-powered three-wheeled rig for a restaurant delivery service. There was a woman pacing next to the car talking to someone on a cell phone. And then I saw two feet pointed upwards on the ground. A man was lying on the asphalt near the car that had struck his little vehicle. Cars were passing near him. It was raining on him. Nobody seemed to be looking after the victim, with hundreds of cars steadily moving on both sides. Why was nobody helping?

It seemed beyond my ability to do anything about it, but I got off at the next stop and thought I should at least walk back to the accident site and see if things were OK. I debated internally as I pondered all the things I needed to do and the shear improbability of making a difference because things were probably under control by then. But I felt drawn and so I went back. As I approached the scene, I was relieved to see two police officers had shown up. Things were under control. Still, I crossed the street near them to get a peak at the victim, whom I assumed would now be receiving some kind of help. He was still lying in the same place, rain falling on him, with no protection. Then I realized that, perhaps for the first time ever, I had two umbrellas with me that day. I had grabbed one when I went to work, forgetting that I already had one in the bag I carry. I had two, and since the officers didn’t seem to have any, I could offer them one to help them at least keep the victim dry until an ambulance showed up.

The officer I spoke to recognized that an umbrella would be useful, but he was busy directing traffic and said if I wanted to, I could hold it for the victim. Well, OK, the ambulance would be here any minute and so sure, I could help out a bit. I recognized that people passing by might think that I had been the driver of the vehicle that struck the man, but hoped that I would be doing more good than harm by being the volunteer umbrella holder. The woman driver who had been standing around doing nothing said something like, “Oh, right, good idea” when I started trying to protect the victim. But she didn’t offer to take over that role. I was disappointed that the driver didn’t seem very worried about the delivery man she had struck. He was about 50 years old and had a lot to say about the allegedly reckless driver who struck him while he was driving properly and carefully. Proper driving isn’t all that common here, so I can’t judge who was at fault. He worked for one of Shanghai’s best and healthiest restaurants, Element Fresh, which I would learn provides good health care coverage for their employees.

The man was in pain but it didn’t appear critical, but I was worried about the possibility of internal bleeding and wanted the ambulance to get there ASAP. After about 10 minutes I asked if ambulance was coming. “Yes, I called for one.” After about 20 minutes I asked again and she then said that the ambulance service she called had said all the ambulances were busy and that they would call her when one became free. Huh? I talked to the police and suggested that we should give up on this no-show ambulance and take him to the hospital in a taxi. There were taxis coming by all the time. Why not use one of them?

The police reminded me that moving the man could be dangerous. By then, though, the man was sick of lying on the road and said he was going to sit up, and would we help him. So the police helped him to sit up. And then he said that this was a bad place to be waiting and that he wanted to talk over to the curb where it would be safer and more comfortable, and could we please help him walk over there? So the police helped him as I held my two umbrellas above us, and continued holding both for the man and me as we waited. And waited. I again raised the possibility of a taxi. After about 40 minutes of waiting, the police saw that as a good idea and agreed. So I waved down a taxi and wondered if I would be needed to take the man to the hospital, but was relieved to see that the police arranged for the woman to take the man there and that I would not be needed.

The ambulance never came. A poor man struck by a car laid on the road for perhaps an hour or so waiting for am ambulance that never came. A Taiwanese friend of mine later suggested that the woman may have lied and never called the ambulance because in China it is the person who calls the ambulance that pays for it. Perhaps. But later another friend at lunch shared an even more painful story of a stroke victim he was helping in Shanghai, where it took an hour to get an ambulance and then when they came, the team had rough street people who moved the victim like one moves a bag of potatoes. In any case, in this, one of the most advanced and modern cities in the world, when you need it, the ambulance might not come for a very long time. This is a problem that can happen anywhere, especially in times of crisis, not just in rush hour.

By the way, I was able to reach the man later to check up on him. He’s doing well and is taking a month off from work to recover from the injury to his side. No surgery needed. He was quite upbeat. Element Fresh provides good health care benefits it seems and the responsible driver paid for the medical care. I also was impressed that the leaders at the Element Fresh restaurant at Yili Road/Yanan Road were aware of the man’s situation and care about him and helped me contact him to check on his status. To thank Element Fresh (and more selfishly, to enjoy delicious, healthy dining), my wife and I dined there last night and had a wonderful meal.

More and more, it seems that we need to be increasingly prepared to take care of ourselves and reduce our dependency on others. When it comes to health, we need to be doing more to reduce our future reliance on services that might not be there or whose quality might be far below what we need. Now is the time to exercise, lose weight, stop smoking, eat wisely with plenty of plants in our diet, and to reduce behaviors that put us at risk.

In China, by the way, preparedness also means carrying cash or an ATM card with you so you can pay for medical services. You often won’t be treated until you or somebody pays first.

Another health care tip is to beware surgeons pushing for surgery when it might not be needed.

A couple years ago I had a near-miss with a bad surgeon at a good hospital here who was going to “fix” a knee problem (he said he would repair my meniscus), but after I had checked in for the surgery, a comment from one of the staff about “removing the meniscus” raised my suspicions and I decided to just get up and walk away. I’ve been walking ever since. Had I succumbed to the recommended surgery, I think my mobility might have been impaired.

After I walked away, I called a physical therapist I knew for a second opinion. He said the way to check to see if I really needed surgery would be to go to another reputable hospital and meet with a surgeon there and show them my MRI scan, but tell them that if I needed surgery, I would not do it there so they would have no profit motive to sell their surgery to me. Surgery is the solution for everything in China, he explained, because that’s where the profit is. Something like 70% of all babies born are delivered with C-section. And I suppose a lot of knees get repaired unnecessarily as well.

I took a taxi to another hospital and minutes later was meeting with a surgeon. He checked my knee, looked at the MRI, and said this was not a case where surgery was needed. “Try physical therapy.” I went to that physical therapist and after the first treatment, my problem was significantly reduced, and ten treatments later, I was pretty much back to normal. There is a damaged meniscus, but better damaged one than none at all. I came so close to reducing my long-term mobility, and I remain grateful every day that I can walk or ride. It’s exhilarating to move and to be independent. I will greatly miss this freedom when it is gone or limited someday. But for now, my mobility is one of my most cherished gifts, and I recognize it all the more as a gift since that near miss, and from some accidents that could easily have given me a broken bone or worse, where I am just so grateful to have been able to walk away.

Our health is so precious, and it is up to us to protect it. With the strains on the healthcare system and the increasing difficulty of paying for medical insurance, coupled with the decreasing quality of coverage in many places, it is imperative that we do more to preserve our health and to be able to cope with our problems on our own or with our own resources. We can’t always assume that the help we expect to get will be available. And when we do get it, even from good doctors at good clinics, things can go wrong. Prevention must be our first line of defense. Being prepared to render first aid and take care of basic problems is also vital. For more serious things, doing our own research so we understand the issues can make us less dependent on one person’s opinion and can often increase our ability to guide outcomes in the right direction.

By |2016-11-25T16:54:36-07:00November 25th, 2016|Categories: China, Health, Shanghai|Comments Off on Accident in Shanghai: The Ambulance Never Came

One Nutritional Supplement You Probably Need in China: Vitamin D3

The medical literature tends to suggest that people waste a lot of money on the vitamins and other nutritional supplements they buy. But here in China, there is a vitamin that I think you may need: D3. Vitamin D3 is normally created in our skin by sunlight, but sunlight is sadly lacking in typical Chinese cities because of the air pollution. Even when there is sunlight, there is not much UV light getting through the haze. In the US, people also get some Vitamin D in dairy products since it is routinely added to milk, but I haven’t seen evidence of that being standard in China and dairy products tend to be a much smaller part of one’s diet here.

Lots of people here have lingering colds and coughs. In a couple of cases I know, giving the sufferers regular vitamin D3 helped them get back to normal. D3 is said to play a role in strengthening the immune system and other systems. It’s something we really need in China. You can buy it here, but it’s much more expensive than in the U.S., so I recommend that if you are coming to China for a long time, bring a good supply of Vitamin D3 with you and stay healthy.

By |2016-01-11T17:19:15-07:00January 11th, 2016|Categories: China, Health|Tags: , , , , , |Comments Off on One Nutritional Supplement You Probably Need in China: Vitamin D3