A comparative analysis yesterday in BMJ Global Health shows that national clinical guidelines for treating COVID-19 vary significantly around the world, and nearly every national guideline (NG) recommends at least one COVID-19 treatment proven not to work.
The authors considered the gold standard for clinical guidelines to be the World Health Organization's (WHO's) 2022 updated guidelines—the 11th version of the WHO guideline.
They looked at NGs for 109 of the 194 WHO member states after the summer of 2022. Of the 85 countries not included in the final analysis, 9 did not have any NGs.
Regionally, Europe had the most countries with easily identifiable guidelines (69.8%), followed by Africa (53.2%). A country's ministry of health published 73.4% of guidelines, while 12.8% of the guidelines were published by a national disease organization.
The 11th WHO guidelines recommend that clinicians categorize disease severity as non-severe, severe, and critical. However, 84.4% of reviewed NGs defined COVID-19 severity differently from the WHO, and 6.4% of the guidelines did not define severity at all.
Just 10 countries (9.2%) had NGs that published severity definitions comparable to the WHO.
Steroids most widely recommended
The WHO guidelines recommend 10 therapeutics or medications, but NGs recommended 1 to 22 therapeutics. The therapies recommended in NGs were graded in 25 (23.8%) of the guidelines assessed. Most (77%; 84) guidelines did not include an assessment of the strength of the therapeutic recommendation.
"The most commonly recommended drugs were corticosteroids; 92% (100/109) of the NGs featured corticosteroids, and 80% (88/109) recommended corticosteroids for the same disease severity as did the WHO," the authors wrote.
Corticosteroids were not recommended in severe disease in nearly 10% of guidelines, however, despite strong evidence of their benefit.
Several countries, especially those in poorer regions, in 2022 continued to recommend treatments that had been disproven and were not recommended by the WHO, including chloroquine, lopinavir–ritonavir, azithromycin, vitamins, and zinc.
Why do NGs differ so much in their treatment guidance for such a widespread and potentially serious infection when all have access to the same information?
"Why do NGs differ so much in their treatment guidance for such a widespread and potentially serious infection when all have access to the same information?" the authors wrote. "Apart from the prohibitive cost of some medications for low-resource settings, we do not have a satisfactory explanation."
One of my favorite things about living in a neighborhood with a lot of young families is the way children make their presence known.
I love the sights and sounds of kids shrieking with joy as they take their first bike and scooter rides of the spring, running through sprinklers in the summer, or gleefully jumping in piles of leaves in the fall. I don’t even mind the sound of teens goofing around on the basketball court — while their blaring music and the endless reverberating thunks against the backboard can get old, it reminds me that they’re having fun and not getting into trouble.
One thing I especially love seeing is posters for kid businesses. Lemonade stands, snow shovelers, lawn mowers, dog walkers (and dog pooper scoopers), babysitters... Kids often have a strong entrepreneurial spirit, and most people enjoy supporting them.
While kids eventually grow out of the card-table-on-the-lawn stage of life, I think it’s a mistake to see this as a sign that entrepreneurial spirit fades with age. Modern zoning rules have put up huge barriers to starting or running a business from home, the place with the lowest barrier to entry and the lowest stakes — the natural jumping-off place to try out a new idea or venture.
Looking around any older neighborhood, you’ll find signs that it used to be normal to have businesses coexisting with residences.
The most obvious example is the “clearly used to be a corner store” house. Here’s one in my neighborhood. Years ago, it was Hart Meat & Grocery Store. Each time I pass by, I daydream a little about it being a small convenience store again, where I could walk for a bag of ice, a Saturday newspaper or a carton of milk. Or an ice cream shop where my kids could walk on their own to get a cone or sundae. Or a small cafe to meet a friend for coffee. The possibilities are endless. Except that it’s no longer zoned for commercial use, so to bring it back to that use, you’d need to apply for rezoning and likely several variances, which would be prohibitively expensive — with no guarantee of the application even being successful!
This house used to be a corner store, a sign of how neighborhoods were once a mix of residential and commercial buildings.
Other home-based businesses operated in ways that left no trace. A couple of years ago, some neighborhood friends outgrew their house and bought a bigger one, one street over. As I was describing the location of their new home to an acquaintance who’d lived here for decades, he mused, “Hmmm… I think that’s the house that used to do Christmas tree sales in their yard.” Say what, now? I looked through old classified ads in a newspaper archive database and discovered this was indeed something people did: set up a tree lot in December, on their own property, right in the middle of their neighborhood. And sure enough, our friends’ new home had been the location of a Christmas tree lot for several decades.
The days of mid-block tree lots and corner stores seem to be over. Over time, zoning has reshaped our neighborhoods and our buying patterns. And we’ve just gotten used to getting our Christmas trees and milk from bigger outfits. What have we lost, though? Maybe a lot.
As a kid, the first place I remember being allowed to go on my own was a small grocery store called Jennifer’s Grocery (though everyone called it Joe’s because Joe was the friendly man behind the counter). It was in a small strip mall with a handful of small units, smack in the middle of a residential area. We’d walk or ride our bikes over to get penny candy or a bag of chips. This strip mall had a few stalls of angle parking out front, but it blended pretty seamlessly into the neighborhood. It was built in the ‘50s, probably right at the tail end of an era where commercial buildings were still incorporated into new neighborhoods (you can see the auto-orientation creeping into its design). Although there’s no longer a grocery store there, the little mall remains and evolves with a variety of different small businesses.
Local businesses can bring neighborhoods together.
In this post from the Lethbridge Historical Society, folks wax nostalgic about the big role that Jennifer’s played in their childhoods. They remembered being sent to the store to pick up a missing supper ingredient, and they remembered the names of the folks who worked there and the other businesses that sat alongside it. “The hub of the neighborhood,” one person categorized it.
There’s just something so special about a place you can walk to — a place that adapts and endures, where you know and are known. It feels like it’s yours. In a piece about the community benefits of walkability, Sarah Kobos captures this sense of familiarity and engagement beautifully:
“As people start to recognize you, the smiles get bigger, and the hellos get friendlier. You start to feel that we’re all in this thing together. Every time it happens, it makes my day. Every time, I feel a part of something bigger and better than myself. Maybe that’s the definition of community.”
That commercial units have been zoned out of existence in older neighborhoods — and never allowed in the first place in newer ones — is a real loss for residents. Kids miss out on opportunities to build independence. People have no choice but to drive to get groceries or anything else they might need, even something as small as a carton of milk. And there are fewer opportunities to just bump into people you know. These seem like little things, but collectively, they make life harder, more expensive and more isolated.
And while people will often point to parking or noise as reasons we should keep commerce out, it’s usually the scale of the operation that is objectionable, not the use. Many of us would be happy to live beside a small coffee shop that folks could walk to; most of us wouldn't want to live next door to a Tim Hortons or Dunkin Donuts drive-through.
Despite the restrictive environment that entrepreneurs find themselves in these days, there are, all sorts of home businesses operating — though many of them are not technically permitted. And even when they are permitted, they’re certainly not encouraged. I tried to find home-based business rules for my city and had to dig through a 400-page zoning bylaw and then a bunch of application forms and web pages to try to make sense of what’s allowed here.
Imagine how many thriving home businesses there could be if we actually encouraged people to make a go of them, rather than creating as much red tape as possible. Chuck Marohn made a good point here:
“Would Bill Gates or Steve Jobs be able to start their multibillion-dollar businesses in their garage today? Not with the zoning restrictions found in most cities. If you can do the business inside the house or an outbuilding and nobody passing by can tell, then there is not a lot of justification for regulating it. We can let entrepreneurs get started by easing up on home occupations.”
I see the rich relationships and connections that grow out of supporting small local businesses in my neighborhood, whether they are artisans, teachers, yoga instructors or beyond. More opportunities for people to make a living, and for the rest of us to support them, can only be a good thing.
Dylan Reid had a great article on spotting (and reviving) the neighborhood corner commercial building. In it, he suggests that “one small nudge… could be to designate all of these former corner shops inside neighborhoods as automatically, as-of-right, eligible to be reconverted to commercial uses.” Even if these buildings didn’t return to being corner shops, this designation would allow other businesses to enter the community. “It’s a change that would be relatively subtle,” Reid explains, “since it would only affect a tiny fraction of the buildings in a neighborhood.”
That would be a great start! I think we can go even further. Ashley Salvador makes a compelling case for permitting accessory commercial units, saying, "Many of today’s urban dwellers want their leisure, consumption, health, and employment needs to be met within close proximity to their home in an affordable, accessible manner.” Accessory commercial units could make this possible.
If it were easier to run a business from home, would every kid with a snow-shoveling hustle or dog-walking gig grow up and keep running a business from home? Not necessarily. But one thing’s for certain: With our current zoning rules, there's a lot of them who’ll never get the chance.
Whether it’s restoring commercial uses within neighborhoods, allowing the construction of accessory commercial units, or easing red tape and restrictions on home-based businesses, there’s so much that cities can do to help entrepreneurs make our neighborhoods more vibrant, walkable and prosperous.
Teaching in the Shimer Great Books Program, I’ve had to stretch myself to teach a lot of things outside my expertise, but the one I’ve found most rewarding — and had the greatest success with — has been music. Reconnecting with classical music while teaching our fine arts course at the independent Shimer was life-changing, permanently altering my listening habits and turning me into a symphony regular. I’ve also learned a lot more about jazz, though I’ve been less drawn to listen to it outside of class. In more recent years, I’ve tried to incorporate more contemporary music to make our music curriculum (now reconfigured so that music is paired with verse and drama rather than with visual art) more accessible. One piece of low-hanging fruit there has been Hamilton, which I am sick to death of but which provides easy fodder for concepts about tragedy, etc. — and the students invariably love it.
More challenging, but much more rewarding, has been Janelle Monae, with whom I feel like I have a very strange relationship. Simply put, she is the first contemporary pop artist I picked up specifically for teaching. As such, even though she has entered my regular rotation, I still have a weirdly detached attitude toward her work — at times she feels almost like a faculty colleague rather than a pop star to me.
I actually first turned to her work because I felt I could kill two birds with one stone. On the one hand, I was teaching a strange gen ed requirement for seniors at North Central that was meant to be something like a “Wicked Problems” course but that I mostly taught as a discussion seminar structured around Peter Frase’s book Four Futures (the “wicked problem” being the intersection between automation and climate change, I guess). I wanted to include some material on Afrofuturism, and what I call “The Janelle Monae Extended Universe” was in many ways exhibit A. For those who are unfamiliar, most of her music videos take place in an allegorical futuristic city known as Metropolis, populated by androids. The first — and in many ways still best — installment is “Many Moons,” which I highly recommend everybody watch at least three times. The video is absolutely jam-packed with stuff, and students still help me pick out fresh details even though I’ve probably screened it in class over 50 times at this point. I can’t imagine how charismatic and confident she had to be to get this made as a woman in her early 20s — a fact I always share with students, as a rare opportunity to make them feel old.
The other stone was in my “Music, Verse, and Drama” class, where I wanted to conclude the semester by exploring music videos as a mode of musical storytelling. So for a few years, I assigned this list of all her Metropolis material (together with a couple framing background videos), culminating in her true video masterpiece, Dirty Computer. Ultimately, I trimmed it down to just Dirty Computer, which is very self-contained and is already a lot to tackle on its own. There are so many angles to approach it — the science fiction framing (and constant visual references), the sexual politics, and of course the relationship between the music and the plot. Sometimes the relation between the musical material and what we’re seeing on screen can feel strained, but she definitely sticks the landing when she turns back one last time to look at the facility she’s escaping (and, implicitly, the viewer’s reality), timed perfectly with the lyrics, “Love me for who I am.” It gets me every time.
I tend to listen almost exclusively to The Archandroid when I’m listening for pleasure, since Electric Lady is much weaker (a typical sophomore slump, plus way too “straight”) and I’m a little burned out on Dirty Computer after watching it so frequently for class. It’s an absolutely amazing piece of work — rich and dense and varied in its style, easily two full careers’ worth of material packed into the double album. At this point, it may be my true desert island disk, because it’s hard to imagine getting sick of it. (Sorry, Radiohead!)
By contrast, my absolute least favorite of her work is the most recent album, The Age of Pleasure. I obviously can’t show the video for the first single, “Lipstick Lover,” in class any time soon, nor would I want to — because, shockingly, no one turns out to be an android! I joked when it first came out that Janelle Monae risked alienating her core audience of middle-aged white sci fi fans, but the truth in that joke is that her exploration of sexuality just does not grab me in the same way as the Metropolis material does. The video feels less sexy than awkward to me, though I wonder if part of that response is the fact that she is a “colleague” and I feel I’m violating our professional boundaries by seeing that side of her.
In retrospect, though, her turn toward a more soft-porn aesthetic in the recent videos highlights and earlier shift between the earlier albums and Dirty Computer, where there is suddenly an explosion of sexually explicit and especially queer content. Where in the earlier music videos dance seemed to be the symbol of freedom (most memorably in “Many Moons,” when she suddenly begins levitating after spending the whole video contriving to keep her feet in contact with the floor), now it’s sexuality that comes to the fore. As someone who also came from a conservative religious upbringing and had to really struggle to figure out what to do with my own sexuality (even though it turned out to be boringly normative), I empathize with the journey I see here, even if I don’t resonate as much with the more recent material.
I also empathize with her sheer productivity, her clear sense that she has to put out whatever she can when she has the chance. She gets a chance to make a music video and she creates a sci-fi epic that you could write a dissertation on. She gets a record contract and she does a double album systematically hitting almost every style in the America pop music canon. She doesn’t just embrace a certain aesthetic, she engages in full-scale world-building. And she does all this while maintaining an acting career and even putting out a book of science fiction (which I am afraid to read because I have heard it isn’t very good and I don’t want it to ruin my image of her). There was recently a lot of online discussion about Sydney Sweeney’s sense that, as someone from a less privileged background, she has to work doubly hard in contemporary Hollywood just to stay afloat. Janelle Monae also comes from a working class background — her father, like mine, was a truck driver — and I can’t help but suspect something like that is going on in her hyper-productivity.
Returning from my weird para-social relationship to the topic of teaching, this is actually the first academic year in a long time when I haven’t taught her work. Another Shimer professor has taken the “Music, Verse, and Drama” course for this year and next, and the weird gen ed requirement has been eliminated. I already worried Janelle Monae was starting to feel “old” to my students, and the fact that she doesn’t seem to be returning to the sci-fi theme means I may need to direct my attention elsewhere the next time I do the Shimer course. So this seemed like the moment to consolidate some of my thoughts on my imaginary friend and colleague, Janelle Monae. She’ll always be an android to me!
Not wrong: every cool thing we hear about outcomes is going to be sacrificed on the altar of shareholder value.
“Nurses know that AI technology and algorithms are owned by corporations that are driven by profit — not a desire to improve patient care conditions or advance the nursing profession. The hospital industry, in cooperation with Silicon Valley and Wall Street, will use AI to further its dangerous effort to displace RNs from the physical care of their patients prioritizing low-cost or free labor over patient needs.”
Log in
