COVID-19: Don’t Panic, Just Spread That Peanut Butter please

As the shit is hitting the fan (hence the crazy stockpiling of toilet paper), our current pandemic world relies on YOU! Yes, you. Usually people wait for the government and scientists to solve the problem. Now, YOU are the key figure in containing COVID-19.

And I’ll coach you through it.

COVID-19 tip #1: Forget the numbers

The actual numbers don’t mean much in the middle of an epidemic. Tests for COVID-19 are sparse almost everywhere. Who knows how many people are actually infected? South Korea is said to be a dangerous place because they have a lot of infections. But actually; South Korea did a great job testing its population and are one of the few countries where the amount of new infections per day is going down. In other countries it’s still rising every day. (
In countries where they barely test, like the USA, or where they don’t test family members of infected person, like the Netherlands, the numbers might indicate that they have fewer infections than factually would be the case.
Is it safer to go to countries with lower numbers? Or is it more dangerous because people are walking around unaware of their infection and that they are infecting other people?

Numbers are meaningless unless you know the proportion of people that has been tested.

9 infected on a total of 10 tested: bad.

9 infected on a total of 100.000 tested: still bad, but less bad.

COVID-19 tip #2: Think about the implications

Let’s talk about you. You might feel fine. Great. You might think you won’t get sick. Cool, I hope you are right. You might even think that when infected with COVID-19 you will be ok. Well, good for you! Maybe you’ll just have a sore throat. Aaaah. You think you can go to work with a small fever and a cough. Wow, aren’t you a tough one. Or why not bring your kid to the daycare, kids have runny noses all the time. And if you or your kids do get COVID-19, you might be really sick, but you won’t die. What are the chances?

You are ok, you’ll manage, the kids will be fine, so no worries … ERRRRRRRRRRRR (the sound of a game show buzzer indicating that something is wrong).

Who do you meet during the day? Do you bring your children to their grandparents for a day? Do you visit that birthday party? With or without (mild) symptoms you, yes YOU, are a small but very important ‘number’ who influences the implications: the spread of the outbreak.

Think about the implications of your actions and behavior. Think twice, and don’t do what you would normally do.

You want to know why this helps governments, scientists and especially hospitals?

COVID-19 tip# 3: Just Spread the Peanut Butter

You might have seen the picture of this post in newspapers or online. Don’t we all keep refreshing our news feeds in an unhealthy way? But it is important, so I am also going to explain it, my way:

Think of Peanut Butter, imagine that the Peanut Butter is the COVID-19 infected people.

Think of slices of bread, imagine that the slices of bread are the region where you live.

Think of a mouth, imagine that mouth is your regional hospital.

What happens when you feed all the Peanut Butter in the jar to a mouth in one go? The mouth can’t handle it. The mouth can’t swallow the load. Peanut Butter falls on the floor.

What if people with no or mild symptoms infect a huge vulnerable group at the same time? They go the regional hospital. Some end up in an intensive care unit. The hospital in your town will be full quickly, the other ones in the region as well. The hospitals needs to make choices, they save people that have the most chance of survival.
What happens to the Peanut Butter that fell on the floor? It’s gone.

What do people mean with the picture? What do people mean with “flattening the curve”?

Spread the Peanut Butter on the slices of bread. Feed the Peanut Butter bread bite by bite to the mouth.

You are part of this. Together with all your relatives, neighbors and colleagues you hold the knife. The knife represents your actions, the knife represents your behavior.

In an epidemic it’s unavoidable that people get seriously ill. Flattening the curve – or Spreading the Peanut Butter – means that instead of causing many people to be sick at the same time, the people will get sick divided over a longer stretch of time. It is the difference between overloading hospitals which then must choose who lives and dies, and helping the hospitals to manage the outbreak.

You can flatten the curve. Just Spread the Peanut Butter:

– Wash your hands

– Social distancing: Avoid social contacts and crowds unless needed (you need groceries, shopping for a new skirt can wait)

– if you have symptoms, ANY symptoms, even just “a runny nose”, stay home!

– If your child has symptoms, (just a runny nose): keep that child at home. Don’t let it go to school, don’t let it play with friends and definitely don’t send that child to grandparents or other people in the vulnerable group.

Good luck everybody, stay safe!


Illustration: SAM WHITNEY; CDC


COVID-19; is it time to hit the PANIC button?

Say hello to the madness; we are in a pandemic. In my last column I mentioned that the spread outside of China was still rare. Eeeuh, that didn’t age well… Today, three different continents are confronted with outbreaks of the virus, probably others will follow soon. Thousands are infected and a percentage of them have died. Since the virus hit the West it almost seems the world is in panic mode. There is such an overflow of good/vague/bad information surrounding this outbreak that is hard to keep track of it all and put things in perspective.

Luckily, I am here to change that: your very own, Thailand based, Infectious Disease Epidemiologist.

CO-NA-NA, what’s my name?

The issue with a new disease is that it is hard to immediately give it the right name. Some parents might now this feeling, waiting days after a birth to name their kid. The current disease almost changed names more often than Sean Combs, Puff Daddy, P. Diddy, Diddy, Puffy, Fluffy, Duffy, H. Duffy, Hilary Duffy, Hilary Duff did.

Today we call what used to be the “Wuhan-virus”, the “Corona Virus”, the “nCoV” by its WHO approved official name: COVID-19. It stands for “COronaVIrus Disease”-2019 (let’s don’t do a 2020 or 2021 version), the virus itself is called SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).

FACT 1 : COVID-19 (still) not as bad as previous outbreaks

Let’s update the table from the last blog:

Year 2019 2012 2002 2009
Origin country China Saudi Arabia China Mexico
Source Bats Dromedary camels Bats Swines
Number of people infected to date 82.294 2.494 8.096 208.269
Case fatality Susp. 2% 37% 9.6%% 4.20%
Countries with reported infections 57 27 27 175
Countries outside origin with reported deaths 7 16 8 124; MERS-CoV: Middle East Respiratory syndrome; SARS-CoV: Severe Acute Respiratory Syndrome; H1N1: Swine flu

Although COVID-19 seems to be “better” than SARS, MERS and H1N1, it loses the battle in a who-is-a-good-disease competition to seasonal flu. In comparison with the seasonal flu COVID-19 has a higher case-fatality ratio. Seasonal flu has approximately 0.5% mortality rate, COVID-19 currently has a 2% rate (please read FACT 3).  COVID-19 also has a higher reproduction number; seasonal flu infects about 1 to 1.5 other person (tiny persons also count for 1, it is just statistics), COVID-19 appears to infect 1.5-2.5 other person. This means that COVID-19 could spread more widely. Lastly, for seasonal flu we have a vaccine!

FACT 2 : Younger than 50? No reason to panic

(Rest assured: this does not imply the following: Older than 50? Call your local undertaker at 555-…..)

Let me remind you that Coronaviruses have been among us humans for a long time already. Yes, this is a new variant and yes, it is more severe than the previously known ones, but if you look at the figures published by the Centers for Disease Control, China, you can see that if you’re younger than 50 years old, you will be fine.

And even if you do catch the virus, you would probably not even go to see a doctor. Symptoms are fever, dry cough and shortness of breath but range from mild (80% of the cases), severe (14% of the cases) and critically ill (5% of the cases).

Men are at higher risk of dying from COVID-19 than women (rate 3,25 to 1). And people with underlying illnesses like COPD (smoking history), diabetes or a bad working immune system due to medication or old age are also at higher risk [1]. These vulnerable groups are also the people that we usually give the vaccine for seasonal flu. You can see how they are at higher risk of dying from the COVID-19.

Also, <10 years old there have been (to date) no deaths and very few infections reported.

Characteristics Confirmed cases, Deaths, Case fatality
N (%) N (%) rate, %
Overall 44,672 1,023 2.3
Age, years
 0–9 416 (0.9)
 10–19 549 (1.2) 1 (0.1) 0.2
 20–29 3,619 (8.1) 7 (0.7) 0.2
 30–39 7,600 (17.0) 18 (1.8) 0.2
 40–49 8,571 (19.2) 38 (3.7) 0.4
 50–59 10,008 (22.4) 130 (12.7) 1.3
 60–69 8,583 (19.2) 309 (30.2) 3.6
 70–79 3,918 (8.8) 312 (30.5) 8.0
 ≥80 1,408 (3.2) 208 (20.3) 14.8


Just to clarify: these current mortality rates only apply on people of whom it is determined that they have COVID-19 (see again FACT 3). If you don’t have COVID-19: well, don’t text and drive!

FACT 3 You can have the virus and be fine

The symptoms of COVID-19, like I stated above, can be very mild with just some cough and runny nose. Recently, Yan Bai et al. published an interesting article of how even asymptomatic carriers can transmit the virus [3]. This means that you can be infected with COVID-19 and not have any symptoms.
That sheds an interesting light on the 2% mortality rate in FACT 1. If we would test the whole world, we would probably get a higher number of infected persons. Infected persons without even knowing it. This affects the mortality rate: which is deaths from the virus divided by persons infected by the virus. If currently more persons are unknowingly infected the mortality rate could be much lower (as the nominator increases). The absolute number of deaths of course doesn’t change, which is sad, but it might put the severity of the COVID-19 in a different perspective.

Conclusion: during an outbreak it is super difficult to make sense of any of the numbers and to have a complete picture of the outbreak.

FACT 4 Closing an office for 48 hours is pointless

Some companies close their office for two days when an employee is found to have COVID-19. The reason? Intensive cleaning of the office. This does not solve anything!

Yes, the virus can survive long on surfaces, so a good cleaning is very smart. But if after the big cleaning you will re-open the office again you might as well not have bothered. Persons have the disease in them for at least two weeks … spreading it to others … who probably come back to the office on day 3 … you understand where I am heading?

Recently I was in a hotel and at check in they took my temperature and every morning before breakfast they checked me before I could enter the breakfast room. That is a much smarter way to contain the outbreak. That gives us FACT 5.

FACT 5 Do’s and don’ts

Do Don’t
Wash hands regular Go to the current outbreak hotspots
Use desinfecting handgel Go to a place where you are packed with other people with potential bad hygiene
Sneeze and cough in elbow Panic
Read scientific facts Trust Facebook
Think twice before traveling anywhere Panic!!

Do the do’s and stay home when you have any symptoms and you are helping to stop this outbreak.

Well done, stay smart, until a next update!



  1. Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol 2020.
  2. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020[J]. China CDC Weekly, 2020, 2(8): 113-122.
  3. Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA.Published online February 21, 2020. doi:10.1001/jama.2020.2565



The Who’s and What’s of the Wuhan/nCoV virus

The world is in shock, twitter is in meltdown and China looks like the zombie movie World War Z (without Brad Pitt unfortunately). “Facts” and panic are disturbingly intertwined. To provide some guidance, here for all non-medical people (and maybe even some medical) a brief summary of what is going on and how worried you should be.

An old friend presented in a novel way

Coronaviruses have been around us for a long time. The name Corona comes from Greek meaning Crown because of how it looks under the microscope. There are different forms of coronavirus and we’ve known a few already:

– CoV: common cold, super common and mild symptoms

– SARS-CoV: Severe Acute Respiratory Syndrome

– MERS-CoV: Middle East Respiratory syndrome

And now with the new outbreak:

– nCoV: the not so creatively named “novel Coronavirus”

In your life you have been infected with many coronaviruses only not with the dreaded novel, SARS or MERS variant, … just the common cold.

Don’t push the Panic button (… yet)

A little perspective, yes, the world is on high alert but at this moment there is no need to panic yet. I say “yet” because we’re still in the outbreak and who knows what will happen next.

At this moment the majority of the misery is in China. They have the highest number infected and deaths. There was only one country outside China with one death (Hong Kong not counting as separate country…), no other countries have yet reported. If you look at this table you can see how nCoV relates to the other Coronavirus pandemics as well as the H1N1 pandemic.

Year 2019 2012 2002 2009
Origin country China Saudi Arabia China Mexico
Source Bats Dromedary camels Bats Swines
Number of people infected to date 28.276 2.494 8.096 208.269
Case fatality susp 2% 37% 9.6%% 4.20%
Countries with reported infections 25 27 27 175
Countries outside origin with reported deaths 1 16 8 124

You can see that although the infection is spreading fast in China, the spread outside is still rare as well as the number of deaths outside of China. This is all very reassuring for the rest of the world although it doesn’t helpt China much.

This is de guidance of WHO pandemic criteria and you can see we’re currently in phase 4. The big questions is, will we get to phase 5 or 6? In other words: will there be an outbreak of the nCoV in a different country than China? Time will tell…


No hahahatjooo, Do hahahahandhygiene

You never know what happens next so just be cautious. The most important way of prevention of most infectious diseases is hand hygiene. Not just a quick splash of water on your hands but a real soapy two-minute wash and dry your hands after. Do this after visit to the toilet, before eating and after coughing/sneezing and you will be alright. Also please cover your mouth while coughing and sneezing to protect your surroundings. And if you’re sick don’t go to work or a different place where you can infect many others (see also “8 things you though you knew about the flu“).

Facemasks: if it won’t help Spiderman and Batman, it won’t help you

Wearing an ordinary medical facemask, although you look super cool with it, doesn’t help against viruses. Sorry. You would need a special very tight mask that prevents you from even smelling perfume if it was sprayed on your face.

If you do wear a facemask, please put the outside on the outside. It seems a complete “duh” remark but trust me I’ve seen public health professionals getting it wrong. And finally dispose the mask yourself and don’t put others at risk.

Stay safe and keep informed!

For more information:

5 Amazing facts about your skin

Skin comes in the most beautiful spectrum of colors, shininess and textures. We know the beauty of skin in all its forms. We also know how to judge someone by their skin. By color, by scars, by hormones and acne. People get celebrated for their skin. Imagine not having a skin. Weird, isn’t it? Are you still you without your skin? Probably not, you would be a walking musclebag with a serious leakage problem. So why do most people know so little about their skin? There is so much to know.

  1. What is the biggest organ of your body?

Men: reproductive organ is wrong. Women: “feelings” are not an organ. The answer, you’ve guessed it: your skin. Skin is made of multiple layers of hair, nails, nerves and blood vessels. And because of this, it is considered an organ. Not the most spectacular fact, I know, but useful for your next trivia date.

  1. Anti Deadly Diseases Superhero

Your skin is the primary barrier for so many infectious diseases, you have no idea! Many different bacteria on your skin just hang around, not doing any harm. During your day you obtain more and more bacteria, especially on your hands, and still you don’t fall down under that tremendous bacterial load. Only when the barrier is broken – you have a wound, scratched open a mosquito bite or you bit off one of those annoying skin tags next to your nails (never done any of those myself of course) – the bacteria seize the opportunity to slither under your perfect barrier and start to infect. You get a red spot, maybe some pus, but sometimes it can be much more severe. Cellulitis (not the normal dents in the upper legs, but a real skin infection) and erysipelas are severe skin diseases. If you are very unlucky you can develop a heart infection as a result of the lovely necrotizing fasciitis, aka flesh eating bacteria, aka bye bye arms, legs, noses and sex appeal. Protecting your skin from getting these breaks in barrier is very important. If you do have a breach and develop a red spot, clean it thoroughly. If it doesn’t go away or you get fever, you die, no just kidding, but please see a doctor!

  1. Leather face

Due to the melanin (produced by melanocytes) in your skin, your skin can change color. Melanin is a pigment that protects your skin against the sun (see next point) so if exposed to sunlight, your skin will produce more melanin which darkens that part of the skin. If your skin needs to keep producing melanin it will lose its elasticity and give you a leathery look. This ages the skin prematurely.

  1. Skin Cancer: at least you die with a tan

In some parts of the world –  mainly Europe and the USA – being tanned is still considered a beauty ideal. It reminds others that you don’t have to work whole days and that you have money to go to a beach. I hope I am telling you old news, but the sun is dangerous. I still see people on the beach that cover themselves in oil before lying in the sun the entire day in a mini thong. The thong can be dangerous on so many levels, but let me focus on the sun and the dangers of the oily behavior; Skin Cancer. Boom. How does that feel in your leathery face?
There are 3 types of skin cancer:

– Basal cell carcinoma: annoying and can grow, but doesn’t metastasize so not too bad.

– Squamous cell carcinoma: more dangerous and can metastasize, but if caught in time you’ll be fine.

– melanoma: super dangerous and deadly. If caught in time you’re ok,  but if it already spread to lymphnodes or other parts your survival rate drops dramatically to <25%. For the non-mathematicians: if you lie on the beach, comparing thongs with three others, only one person will be able to wear that the thong after 5 years.

Each one of these cancers has growing numbers each year. Mostly due to the sun and, don’t forget, tanning beds!

Getting a sunburn is the worst thing you can ever do to your skin and even though people might respond with “it will be tanned tomorrow” or “it doesn’t hurt”, any form of red coloration of your skin is a sunburn.
Tanning is also never healthy. It can be less harmful when using sunscreen with a high protection factor. Don’t think that when you put this on you will tan slower, that is really really not true. You will only die slower, you will get to live longer. Thank me later. Sunscreen protects against harmful UV radiation which means you can stay in the sun for a longer period of time when putting on a higher SPF (Squishy Peach Fudge).

  1. Beauty and the lying beast of beauty industry

Seriously, so many lies. Let’s tackle some of them.

– you can’t cure wrinkles with crème (but you could try peanut butter), you can’t prevent them with crème there is no such thing as a “facelift in a bottle” or any of that. Don’t fall for it

– you won’t get dry skin if you don’t use soap to wash it. Your skin has a little layer of fat that protects it. Just like your belly, I hear you think, well no. If you use soap you break this fat protection down leaving your skin unprotected. Pretty smart if you think about how cosmetics make you use soap first and then treat the “dry skin” they created by this with expensive cremes.

– putting diamonds in a crème doesn’t make it better. Since this is so small it actually does more harm than good.

– skin serum is exactly the same as crème, you could just as easy put two layers of crème on your face or peanut butter and chocolate paste.

– a more expensive cream is not necessarily better

Please don’t believe everything they tell you. “They” being the cosmetic department of any store. Just put a good SPF on every day and you’ll be fine. Love your skin, check your skin and maybe you will live to see your next of skin.

Outbreak of the measles, SURPRISE? Not really

If you don’t vaccinate your children, they are bound to get infected. And yet, the whole world is amazed by the outbreaks of the measles. News feeds from USA, Europe, Philippines and developing countries have been breaking stories all around. Pictures of sweet little children covered in red spots are collecting likes and dislikes everywhere. But seriously, why the surprise? This is exactly what was to be expected.

It’s real simple action-reaction. We let ignorant parents decide against lifesaving vaccinations (action), the immunization coverage drops in a region, et voilà, an outbreak emerges (reaction). Let me give an example that even the most reluctant anti-vax parent should understand.
If you promise your birthday girl a Frozen themed party, but last-minute you cancel it and you burn the Princess Elsa dress in front of her eyes (action); your kid will cry (reaction).
If you promise her that she will have a healthy life, but you are not vaccinating her; your kid may become deaf, blind, get brain swelling or pneumonia, and these are only the long-term effects of measles. What would she say to her parents when after a life of struggles she gets to celebrate her 18th birthday; ‘thank you and let it go’ in sign language?

One mother asked on Twitter how she could protect her unvaccinated daughter against the measles outbreak in her town. It was a serious question. The mother’s post went viral and luckily for the right reason, she was ridiculed. Something along these lines: ‘don’t worry, just bathe her on the seventh night of full moon in a cocktail of 75% tomato juice, 20% biological bleach, 4% morning pee of a virgin mother, 1% stardust with a hint of basil, while singing Heal the World in B-minor and she’ll be fine …’.

How are people still not understanding how things work? Maybe we should ask Disney to make a movie about it, where no princess is vaccinated, a bad prince causes an epidemic and all the princesses die so there will be no kingdoms and fairytales anymore, only republics, presidents and prime ministers. Wow, certain hit in the cinema’s, expected December 2019 in all Imax theaters in 3D: ‘Beauties and the Measles’.

One more time:

  1. Vaccinations prevent horrible disease outbreaks to emerge (also read: polio, tetanus, rabies)
  2. Vaccinations prevent death in both children and adults
  3. Vaccinations are only useful BEFORE the child/person gets sick
  4. Vaccinations do NOT cause autism (f*cking Wakefield!)
  5. Vaccinations are safe for your children
  6. Not vaccinating your child means that you put the lives of your and other children at risk.

If you disagree with any of these statements than please read my previous blog about the facts about vaccinations. And let me warn you, if we continue down this selfdestructive path, more outbreaks will follow.

Who knows, maybe that’s a good thing. We might get to see ‘Diphtheria and the Seven Dwarfs’ or ‘LEGO Movie 3: It’s a smallpox after all’.

Happy Christmas Diarrhea

The holiday season is upon us with presents, family and lots and lots of food. At least, where I come from, this period is a time where we start eating on Christmas eve and continue until the new year has safely arrived. This sounds all happy and cheerful and festive but there is a possible downside to this long dining and that is: diarrhea.

Gin-Toxin, Bacteria-Cola, White-(Vi)Russian, what’s the difference?

I’ve told you before and I’ll tell you again, it’s very important to know what is actually causing your disease because it influences how you treat it. However, all diarrheal diseases need you to drink a lot (no alcohol you party people, water!) and be the most hygienic person in the world.

Family: caring is sharing

Most diarrheal diseases are caused by viruses like norovirus and rotavirus. Especially in children this can cause severe illness. The history is usually a child that got diarrhea at nursery and then the mother got it, siblings, daddy, etc etc. Really nasty, easy to transmit to others and basically nothing we can do about it but wait the 3-10 days it takes for your body to stop the virus. Keep drinking, don’t put any antidiarrheal medication in you and wash your hands as thoroughly as you can after every toilet visit.

Choose wisely

If you get vomiting and diarrhea within 24 hours after you ate something “bad”, that’s usually a toxin from a bacteria (mostly Staph aureus). A bacteria needs time to settle into your digestive system so it will not cause disease that fast but a toxin is nasty right from the start. The scenario would be something like a nice Christmas dinner with lots of family. There is food on the table which is not entirely cooked through or the Dutch tradition: “gourmetten” where you cook your own food on a miniature stove on the table. The food is on or next to some sort of heating system which is like a nice fireplace for the bacteria to get cosy in front of in your meat (and duplicate like crazy). And then you eat it. Hours later you wake up nauseous, you run to the toilet, you vomit. And again, and again. Sometimes you get the diarrhea immediately in which case you need to decide what to put in the toilet, your vomit or the diarrhea. Choose wisely. After about 24 hours the misery stops and leaves you drained but healthy.

Give yourself an after-Christmas treat

A bacteria takes time, about 3 days give or take, to cause the same symptoms. People think about the past day but can’t name anything about their diet that could have caused this horrible disease. But then you dig deeper and it’s actually three days past Christmas and they remember their big diner, gourmetten, etc. And then you know: this is probably salmonella (or shigella, campylobacter or any other bacterial disease). You can wait till your body clears it by itself or if you have fever you can get some antibiotics. Only three days of antibiotics restores your body.

Lovely readers, I wish you all the best for Christmas and the new year but remember to cook your food all the way through. And if you are one of the many sufferers after the holidays: drink enough and power through. I’ll see you in the new year.

A trip up the penis

Men have been scolded for not knowing a woman’s anatomy by heart, … or fingers. It’s been called ridiculous that the men don’t know the difference between a vagina and a vulva. And granted, I’ve written a blog about this, so the men who don’t know it yet, should read it (again).

Just recently I became aware that the exact opposite also exists; women don’t really know men’s genital anatomy either. True, the basics are covered; often a shrimpy ugly thing, two balls, sometimes a rigid ugly thing, pee exit hole = sperm exit. Enough to get you through a couple of months of dating, but not for any real long-term relationships and genital organs get-togethers. Maybe it’s safe to say that none of us really know our own bodies, let alone the bodies of the opposite sex. We’ve had our trip down the vagina, but now we’re continuing our trip up the penis. Follow me please!

Lesson 1: This is just swell

In the penis there is the urethra and 3 swelling things, of which the names are easy to remember by thinking of that famous movie: Two Corpora Cavernosa share one Corpus Spongiosum. These are essential in getting an erection. During foreplay – yes, surprising fact, some men enjoy foreplay – these cavernosa fill up with blood resulting in an erected penis. Viagra can be a good medicinal fluffer as it causes the blood vessels to dilate but was originally invented to cure heart disease for just the same reason .

Lesson 2: Hang on

Under the penis is the scrotum. It contains the testicles of the man. In most cases this means two balls. In rare cases the scrotum contains one ball, often by not descending, it just didn’t develop, removal after sickness or injury. The medical term is monorchism, not to be confused with monarchism. In super rare case you will find/feel more than two, it is called polyorchidism. These testicles are important, and not to be forgotten (hint hint), because it produces the sperm.

Lesson 3: Just keep swimming

The happy little swimmers of the man are made in the testicles and are cultivated like fine wines and Thanksgiving Turkeys at exactly the correct temperature. Sperms like it just below your normal body temperature. If for example a man decides to go skinny dipping in ice water, the now not so happy swimmers move up the body to get warmer.

Lesson 4: Pro-stay-to, pro-stah-to

When a man ejaculates his sperm shoots through an internal rollercoaster. It slowly crawls up into the body, becoming all excited, and right before it goes into the long super fast straight urethra (where normally urine passes through), it has to visits the mega twisting loop screwer, also known as the prostate. A gland that women don’t have. I repeat: women don’t have a prostate!

The prostate is a gland that is located just below the bladder and circumferences the urethra of a man. You can examine the prostate rectally (or stimulate, not judging). In the prostate the sperm gets the glue that makes it so difficult to wash of, I mean – that makes the sperm so sticky. From there it travels outside with speed of light (why else do men always close their eyes?) or in normal terms approximately 45 km/h and after all that a disappointing amount of approximately 1 teaspoon.

Lesson 5: Relight my fire

It depends on the culture and the times you are living in if you should have a big or a small penis. In ancient Greece it was a sign of eternal youth to have a small penis. This resulted in all those amazing Greek Gods being cut in marble with micro penises. Watching current adult movies makes you belief women are craving for fire extinguisher like monsters. Rest assured boys, chances are you are just average with a length of 4-8 cm which increases to 11-21 cm erected (mean of 14.3), and by a great Evolutionary coincidence, that is just the way women like them. Anyhow, I understand from my anonymous resources that the width might actually be of more importance to the girls. The vagina can’t get any deeper, but it can get wider…

Some men are really unhappy with their penis size and decide to take drastic measures and cut a ligament in their penis and then spend weeks with weights hanging on their penis. This will eventually work and increases the penis length with an astounding … wait for it … 1cm. Totally worth it. Really. Well… Not really. Actually, don’t do it. Well, do it with what you have.

Advanced lessons:

Now, I’ll just mention the following for your own interest to look it up if you want to upgrade your skills… Corona, frenulum and perineum.

Have fun.

Death by Tetanus: it started with a bicycle.

Wednesday 8 am, Moshi, Tanzania
A 26-year old man is brought in. He is severely ill and has difficulty breathing. He can’t open his mouth. The man looks frightened. His mother confirms our suspicions. She tells us that a week ago her son hit a rock with his bicycle and fell. One of the old, rusty spokes poked in his leg and inflicted a wound. This wound healed normally but this morning he became severely ill. This man has tetanus.


Tetanus is an infectious disease caused by the bacteria Clostridium tetani that is characterized by muscle spasms. These spasms can get very severe and cause the classic opisthotonus; the body arches backward and the mouth is in lockjaw. It is fatal in 10% of the cases, mostly due to respiratory failure because of the spasms.

Tetanus can be transmitted by animal bites but also by simple rusty accidents. Bicycle, motorbike and car accidents are very common causes of tetanus and this is the reason that you get a vaccine after you had an accident like this. Because yes, you can get vaccinated against these bacteria. The only problem is that the vaccine needs to be updated every 10 years. If your last vaccination is older, you might need a booster dose. But luckily, if you ever had a vaccine the chances of survival are greater than if you never got any vaccinations.

To try to save patients like this, we normally do four things.

  1. Open the wound from the bicycle accident and surgically remove all possible infected tissue. The bacteria produce toxins that cause the symptoms. So even if the wound looks healed and clean, the toxins still might be present, causing harm. Not easy to convince surgeons to open-up a closed wound but trust me, if you explain the situation, they will help you.
  2. Give antibiotics that kill the bacteria
  3. Give immunoglobulins. This is a special type of medicine where you give immune cells against a disease directly to the patient. We have some diseases where this has a very good effect like rabies and tetanus.
  4. Give him the best supportive care

Wednesday to Friday morning, Moshi, Tanzania

After talking a lot with the surgeons, they opened the wound (step 1: check) and we started the antibiotics (step 2: check).
But now the trouble started. In an earlier post about rabies I mentioned that immunoglobulins are expensive and not always available; Tetanus has the same problem. Unlucky for the man is that we had a similar patient just a few days earlier. We were able to get immunoglobulins from Nairobi, Kenia (close to Moshi) for that patient. It was their last vial. Our 26-old man needed to get his immunoglobulins from Dar-es-Salam. It is in Tanzania, but much further away and thus much more expensive for the family to get it. In other words: they couldn’t get these very important immunoglobulins that might save his life (step 3: no check).

Friday 1.30 pm, Moshi, Tanzania

After two days of supportive therapy (step 4: check) the man is slipping away. We resuscitate for 60 minutes but there is no response. He dies.

It all started with that bicycle. Or did it start much earlier? When he didn’t get the childhood vaccinations? Maybe they were not available, maybe his family never could afford it.

But if you are not yet vaccinated and the vaccinations are available and affordable: get your tetanus shot.

Don’t let a simple bicycle kill you.


Picture: Opisthotonus in a patient suffering from tetanus. Painting by Sir Charles Bell, 1809.

A new hope

It’s been one year since my very first post. Over the past year I have thrown some random topics into the world all related to my true love: infectious diseases (ok, except for husband and children). But we’re a year further now and it’s time to get some more direction in where we need to go in life. Over the year I noticed what interested you most and what I enjoyed writing about most so that combination will be the focus in this brand new year. Drum roll please….

  1. Vaccinations

You probably know by now that I am a huge fan of vaccines. They are wonderful things that prevent so much agony and death that I still don’t understand why this discussion is even starting. But it is.

The religious arguments I sort of understand. However, the reason “god will save my child” always reminds me of this joke. There is a man that just had a shipwreck and he is floating in the big ocean hoping for God to save him. After a while a boat comes up to him and offers to get him aboard. “No thank you”, the man answers, “God will save me”. After a day another boat comes and again the man declines help saying the god will save him. After rejecting the third boat the man drowns. He goes to heaven and upon meeting God he asks, “God, why didn’t you save me?”, God answers “I send you three boats you moron”.

The educated vaccines-are-poison and vaccines-cause-death people I don’t get. Arguments don’t count for them. They stopped listening to science. In this topic I will keep enlightening you about facts about vaccines and the diseases prevented by them.

  1. How your body works

So many times my husband asks me “it hurts here *pointing somewhere on his abdomen* what is there?”. Or tells me “my kidneys and liver are hurting me”. And I just sigh, give him a kiss and a paracetamol and tell him everything will be ok. But honestly, so many people have no idea how their bodies actually work. What is pain? Or itching? What is a spleen and pancreas? Why do you need them? And, probably will attract the most readers, what about sex? How does a penis work? Can you urinate while it’s erected? What is the prostate? How can women ejaculate (need to do some extra research on this…)? Well, all these questions will be answered in this topic.

  1. News

Infectious diseases sometimes hit the news. A big flu epidemic inspired the “8 things you thought you knew about the flu”. Or the whole antibiotic resistance crisis that is on our doorstep. If it’s in the news, it’s nice to know a little bit more about the subject to make sure you are well prepared to impress your co-workers, friends or significant others. In this topic I will discuss something that’s in the news at that moment.

There you have it. Nicely organized three topics that I will alternate to make sure all of you get what you want. You can’t always get what you want, but if you try sometime you find, you get what you need.

Polio: take my breath a-a-ah-hah-ah-way

Breathing. Think about it for a second. You breathe in, you breathe out. No effort. Magical.

You breathe in: to get oxygen in your body and to your brain and muscle tissues, you breathe out; to remove the carbondioxide out of your body. You breathe in, … Breathing is actually for so much more, for speaking, laughing, singing. Without breathing this would all be impossible. Quite extraordinary that you go through life without realizing how amazing this actually is. The only time when you realize it is when it’s not easy. When you get a cold and your nose is blocked. And of course, there are more devastating diseases that turn off the effortlessness of breathing and will challenge you to find new ways of surviving. Let’s go deeper into one of them.  But before I forget: you breathe out.

Joni Mitchell and Neil Young, they can sing right? Donald Sutherland, what a President in the Hunger Games huh? And maybe a real one, President Franklin D. Roosevelt (I say maybe because we’re actually not so sure we agree with the medics from that time). Yes, they all had polio. Challenging them, and their breathing, in ways you can’t imagine.

Poop in your mouth

Polio is a viral infection caused by the poliovirus and can be spread from person to person and fecal-orally. Or in plain English: poop in your mouth. Sounds disgusting? It doesn’t mean you have to literally eat poop. If you don’t wash your hands after you did your number two and subsequently eat a cookie, well done, you completed the fecal-oral route. The cookie is just an example, although we all like those chocolate ones with bigger chunks in them or the one with the pink glazing, instead of cookie you should read: contaminated food or water.

Odin: Whosoever holds this hammer, if he be worthy shall posses the power of thor(ax)

About 1% of polio infections result in severe muscle weakness and the inability to move. This weakness can be quite sudden, occurring over just a matter of hours to days. The muscle weakness usually starts with the legs and could move up to unable the diaphragm. Your diaphragm is a big muscle that separates your thorax from your abdomen. If you breathe in you can either expand your thorax or expand your abdomen (try both of them for a while, I know you want to). Your diaphragm is part of that choice. Without your diaphragm, breathing will be challenging. You will have a high risk of dying. It may even explain the last look of Donald Sutherland in “Invasion of the Body Snatchers”, staring with mouth and eyes fully open.

But it all fairness, it’s ‘only’ the 1%. Most people don’t get the muscle weakness and actually recover fully. Nothing wrong with a bit of drama, ain’t it. I know you want to read about tragedies, deaths and deformities. You are disgu… great, just keep breathing, here we go.

Iron (lung) Man

The most common thing people think about when talking about polio is the iron lung. This is a machine designed to create differences in pressure and thus expanding your thorax, allowing you to breathe. Before mechanical ventilation, this was a great way to keep patients alive if they suffered from any cause of muscle weakness. If you want to see the impact of polio muscle weakness and the iron lung, I can definitely recommend the movie “The sessions”. It’s about sex so that might trigger you to actually go watch it. Oh, and it was nominated for an Oscar and Golden Globe.

“Don’t it always seem to go / That you don’t know what you’ve got / Till it’s gone”

We live in a great world – wars, strange presidents and climate change aside. We live in a world where we can actually prevent diseases like polio. Even the small chance of paralyzes from this devastating disease is flushed away with simple, yet effective, vaccination!

Be grateful that you – yeah you – carelessly decide not to wash your hands – you know who you are – after doing your number two – you must love to eat …, never mind. That we can choose to take a risk for abdominal discomfort by eating on the streets in a developing country (always the best place to eat, honestly). Trust me, without vaccinations, you would think twice. Cause you just might have risked your ability to breathe!

It’s still endemic in Afghanistan and Pakistan and with the ongoing war in Syria, their immunization practices have changed. Luckily in all these countries, the need for vaccination is on everyone’s agenda and still the number of cases is declining. Maybe eventually we can live in a world where Polio is, just like smallpox, a thing of the past.

See, I told you how much you should appreciate your ability to breathe. Now for all those children, mothers, fathers, babies, brothers and sisters that can’t breathe as easily as you can, let’s just focus for one minute. You breathe in, you breathe out. You breathe in, you breathe out. You breathe in, …… There, I got you meditating, I gave you knowledge and you are appreciating what your body can do. You breathe out.




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