Homemade Soups

Continuing to stay home and cook is opening doors for fine cuisine I never thought I could do. Over the past week we have made Italian Minestrone as well as New Orleans Okra Gumbo, two of my favorites. Turns out essentially all soups and maybe even stews start out with a mirepoix (/mɪərˈpwɑː/ meer-PWAH; French pronunciation: ​[miʁˈpwa]) which is a flavor base made from cooked, diced vegetables, usually with butter, oil, or other fat, for a long time on a low heat without coloring or browning, as further cooking, often with the addition of tomato purée, creates a darkened brown mixture called pincage (French: pinçage). In the South, for hundreds of years the fat that has been used is fat back, hamhock, or salt pork, and in New Orleans with the French flair, Lardons which is glorified bacon. So most of the time I use bacon and/or sausage. It is not sautéed or otherwise hard cooked, because the intention is to sweeten the ingredients rather than caramelize them. It is a long-standing cooking technique in French cuisine. I also add heavy doses of garlic as I love garlic but garlic is added later as you can burn it if you cook it long enough. 

When the mirepoix is not precooked, the constituent vegetables may be cut to a larger size, depending on the overall cooking time for the dish. Usually the vegetable mixture is onions, carrots, and celery (either common 'pascal' celery or celeriac), with the traditional ratio being 2:1:1, two parts onion, one part carrot, and one part celery.[1] Mirepoix is the flavor base for a wide variety of Western dishes: stocks, soups, stews and sauces. 

Similar flavor bases include the Italian soffritto, the Spanish and Portuguese sofrito/refogado (braised onions, garlic and tomato), as well as the Turkish variation with tomato paste instead of fresh tomato of the eastern Mediterranean/Balkan region, the German Suppengrün (leeks, carrots and celeriac), the Polish włoszczyzna (leeks, carrots, celery root and parsley root), the Russian/Ukrainian smazhennya or zazharka (onion, carrot and possibly celery, beets or pepper), the United States Cajun/Creole holy trinity (onions, celery, and bell peppers), and possibly the French duxelles (mushrooms and often onion or shallot and herbs, reduced to a paste). 

It really is quite simple and after you have prepared the above you then add further ingredients dependent on what kind of soup you want. For Minestrone the basic addition is Herbs of Provence, diced potatoes, something green, kale, spinach, cabbage, and cooked/washed beans of some kind, and add a cheese rind for further flavor. For Gumbo add Gumbo seasonings and/or home cooked Roux("fried" flour in butter) okra, sausage, shrimp, and/or chicken. And the list goes on and on. YouTube has hundreds of 15 minute or less tutorials dependent on what interests you. Freezing a quart for a rainy days lasts for 3 or 4 months and my experience is the longer you simmer it the better and the second day out of the refrigerator warmed up is even better. 

Updated Covid-19 Recommendations from CDC

 I have included update recommendations from the CDC issued today. We all need to fully comprehend that as each day passes we learn more and more about this virus. I am witnessing lots of people totally misunderstanding this virus and as a result, it is close to spreading out of control. I can assure you the following is accurate: 

1. COVID-19 is HIGHLY contagious and is being spread exponentially primarily by large crowds of people partying not social distancing and not wearing masks. Physicians are just as bad as the general population. This week close to 1/2 of the Anesthesia physicians in a hospital tested positive after an evening party in one of their homes. Talk about not leading by example. You continue to hear about the "R" value which is an indication of the AVERAGE number of people ONE person can infect. My estimation is that it eventually will be calculated at over 10. Seasonal flu is 1 or less. So COVID-19 to me is at least 10X more contagious than seasonal flu. The virus is contagious the first 14 days you have it, after 14 days for the most part people no longer spread it. That is normal and consistent with most viruses that are spread with the initial exposure and COVID-19 is no different from most viruses in that you are spreading them before you know you have them. Once you are sick, you generally no longer are infectious but even that is not 100% dependent on the virus. Ebola for example spreads from dead bodies days after death. 

2. The death rate for seasonal flu hovers around at about 0.2% of the population. As of yesterday the death rate for the USA as a whole was 7% and for Florida was 1.4%. So COVID-19's death rate even with the best-case scenario in Florida is 7X the seasonal flu. 

3. MASKS AND SOCIAL DISTANCING WORK PERIOD. There should be no discussion regarding this. I previously reported studies that said if only 60% of the population wore a mask in public and followed social distancing the virus would go away in weeks. In my opinion, if 100% of the public wore masks and conformed to social distancing the virus would be gone in two weeks. Italy for one has clearly proven it works. Yesterday there were only 5 deaths in Italy. Medical N95 masks are the best but truthfully any mask helps and is better than nothing. Masks, including N95, are now available online at reasonable costs. Seems like everyone is making them now. 

Updated CDC recommendations based on new data are here: 

Patients with confirmed SARS-CoV-2 infection DO NOT need to have two negative tests at least 24 hours apart to return to work, school, or receive medical care. CDC has reported that COVID-19 cases can continue to test positive for up to 12 weeks after their initial positive test, but that they are only potentially infectious to others for about 10 days. 

As such, for most individuals with COVID-19 illness, isolation can be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with the improvement of symptoms (changed from "improvement in respiratory symptoms" to address expanding list of symptoms associated with COVID-19). 

The decision to discontinue isolation for patients with confirmed SARS-CoV-2 infection should be made using a symptom-based strategy, not additional testing: 

· Individuals who had a mild or moderate illness and are not severely immunocompromised can return to work after: 

o At least 10 days have passed since symptoms first appeared and 

o At least 24 hours have passed since last fever without the use of fever-reducing medications and 

o Symptoms (e.g., cough, shortness of breath) have improved 

· Individuals who had severe to critical illness or who are severely immunocompromised can return to work after: 

o At least 20 days have passed since symptoms first appeared 

o At least 24 hours have passed since last fever without the use of fever-reducing medications and 

o Symptoms (e.g., cough, shortness of breath) have improved 

Asymptomatic persons with confirmed COVID-19: 

· Who are not severely immunocompromised can return to work after 

o At least 10 days have passed since the positive laboratory test and the person remains asymptomatic 

· Who are severely immunocompromised can return to work after 

o At least 20 days have passed since the positive laboratory test and the person remains asymptomatic 

o Asymptomatic persons who test positive and later develop symptoms should follow the guidance for symptomatic persons above. 

Definitions of mild to moderate and severe illness, and of severe immunocompromise, as well as more information about the science behind the symptom-based return to work can be found at: https://www.cdc.gov/coronavirus/2019-ncov/community/strategy-discontinue-isolation.html

Please note, the recommendation of 10 days is specifically for those who test positive for the coronavirus and have self-isolated. It does not apply to people who need to quarantine to keep from potentially spreading the virus. The incubation period for the virus is 14 days, so anyone who has been exposed to the virus still needs to quarantine and monitor for symptoms.

How to make some Dough during the pandemic

M. Scott Peck published "The Road Less Traveled" in 1978.  The first line is "Life is difficult".  In the next 20 or so years, Dr. Peck wrote multiple other books developing a philosophy of life that speaks to living a full life with an emphasis on personal growth and many people agree as well as disagree with his philosophies.  In the end, he did not himself follow his own advice.  I bring him up here because one of his comments has guided me for years and it is this.  Like Dr. Peck, I have little to no mechanical abilities and frequently need to hire experts to do "Honey do" handyman jobs around the house as I seem to have no talent for it.  Even though I cook the same could also be said regarding my culinary abilities as my wife will let you know I am very messy and disorganized in the Kitchen.  Dr. Peck addressed this in his books admitting also to a lack of mechanical skills.  But he went on to discuss that was not really true for anyone.  What he discovered was that a lack of mechanical skills, or in my opinion, a lack of culinary skills is all about a lack of patience.  I have discovered the same during the pandemic.  When it comes to cooking or fixing things in truth I have no patience.  I want it fixed now, I want it done now, are we there yet?  The pandemic has given me the time to really get into cooking and understanding excellent food preparation and good cooking requires patience.  You cannot rush it.  When a recipe says to put the food aside to rise or rest there is a valid scientific chemical reason for it and if you rush the process it simply will not work and your food will be mush. 

 For the past 3 months, Clark and I have evolved our cooking and food preparation and have learned a lot.  We would like to pass on some of our new knowledge to you and as my blog is also about food, why not do this?  We have in fact found some valid short cuts that make food preparation easier and are able to open new doors to prepare foods you might not think you could ever do.  At the same time, I will emphasize those steps that do in fact require patience where you need to slow down, smell the roses, and let chemistry do the work it is intended to do.  For the first time in my life these past few months, I have now made homemade bread, biscuits, pizza dough/pizza, and pasta.  Dependent on what you want to make this lesson #1 is all about flour, water, and eggs, the basic ingredients of any dough.

 Up until the Renaissance, all bread products and pasta were made with water mixed with flour.  Somewhere after the 1600s or 1700s eggs were substituted for water and/or added to water.  In general, simple dough is flour and water.  You can find a lot of information regarding what flour is best for what purpose.  Suffice to say at home so far we have used generic all-purpose flour and so far everything has turned out well.  What we have discovered however is the ratio of solids to liquids in making dough is important.  Important enough to where we always measure now the ingredients. 

 Lesson # 1 300 grams of flour mixed with 180 grams of liquid, water, eggs, or water egg combination easily makes a dough ball that is easy to handle and then knead.  Obviously water weighs more than flour so if you mix based on the liquid volume the amount of water and flour as close to the same ballpark but you can look up the conversion.

 Lesson #2 mix any and all flour and any additional solids like salt for example in a food processor and then slowly add the liquid while the food processor is on.  In a very short time, it will make an obvious dough ball.  It is helpful to let the dough ball rest for a minute or two and then restart the food processor and do that 2 or 3 times.  You then remove the dough ball from the processor and it will be sticky but trust me it will be less sticky than if you started out using your hands to mix the flour and liquids. 

 Lesson #3 you do have to knead the dough ball and that is done by putting some flour on a counter to dry the outside of the dough ball a little so it reduces sticking to your hands and then fold and refold the dough ball onto itself.  You do this until the dough ball is smooth to the touch.  Almost every reference we looked at said you can never knead the dough too much.  But in general the best references we found said knead for at least 8 minutes and for all our recipes it worked out fine.

 Lesson #4 here comes the patience part.  After you finish kneading let the dough ball rest.  You just folded it and in a sense beat the crap out of it, it needs time to recover.  Every reference says it needs to rest for 30 minutes minimum.  You either put it in a bowl covered with plastic wrap or just wrap it in plastic wrap, either works.  We just made pizza dough last night and let it rest overnight with no problems.

 At this point, you can make whatever you are making and start cooking.  You cut the dough ball into a size that will meet your needs and the remainder can be wrapped in plastic wrap and frozen in the freezer where it can stay for around 3 months.  You can also put it in the refrigerator to use in the next 4 or 5 days.

 Those are the basics and so far to me easy to follow.  I do recommend you review a few YouTube videos to see how others do it and find the one that works best for you.  With anything, there is a learning curve but it took me only 2 or 3 tries to feel comfortable making anything and I hope it works out well for you.  We now make our own homemade pizza and it has been as good as delivery.  My next article will be making basic soups.

An Update on my Covid-19 Viral Load Article

I am providing in full an article just published that emphasizes why my previous article on viral load is so important. Bottom line the more virus you are exposed to and have in your bloodstream the greater the risk of death. As we speak the recommended behaviors of wearing a mask, social distancing, staying away from crowds, staying our of confined crowded spaces are all designed expressly for the purpose of reducing your exposure and hence your viral load. Why people will not follow these guidelines is beyond me.


Jul 8, 2020

SARS-CoV-2 Viral Load in Hospitalised Patients Correlates With Risk of Intubation, Mortality
By Denise Baez

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load among hospitalized patients is independently associated with the risk of intubation and in-hospital mortality, according to a study published in Clinical Infectious Diseases.

Reed Magleby, MD, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, and colleagues evaluated 678 hospitalized patients with coronavirus disease 2019 (COVID-19) and found that 35% of patients with a high SARS-CoV-2 viral load on admission died, compared with 17.6% of patients with medium viral loads and 6.2% of patients with low viral loads.

The findings suggest that using cycle threshold (Ct) values, which are available when results from reverse transcription-polymerase chain reaction (RT-PCR) assays are reported to clinicians, could identify patients at the highest risk of intubation and death and guide treatment accordingly.

“We found that admission SARS-CoV-2 viral loads, as determined by Ct values that are generated with standard-of-care diagnostic assays, are independently associated with intubation and death among hospitalized patients with COVID-19,” the authors wrote. “These findings highlight the critical role of viral load in SARS-CoV-2 pathogenesis and suggest that Ct values should be reported to assist clinicians in identifying patients at high risk for adverse COVID-19-related outcomes.”

Dr. Magleby and colleagues analyzed data from 678 patients who were hospitalized with COVID-19 between March 30, 2020, and April 30, 2020, at 2 hospitals in New York City. SARS-CoV-2 viral load was assessed using a cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples.

In-hospital mortality was 35% among the 220 patients with a high viral load (Ct <25), 17.6% among the 216 with a medium viral load (Ct 25-30), and 6.2% among the 242 patients with a low viral load (Ct>30). The risk of intubation was also higher in patients with a high viral load (29.1%), compared with those with a medium (20.8%) or low viral load (14.9%).

In a multivariate model that adjusted for age, race, coronary artery disease, congestive heart failure, cerebrovascular disease, hypertension, chronic obstructive pulmonary disease, days of symptoms prior to admission, symptoms upon presentation, initial chest x-ray findings, and level of oxygen support within three hours of arrival to the emergency department, having a high viral load was independently associated with increased risk of in-hospital mortality (adjusted odds ratio [aOR] = 6.05; 95% confidence interval [CI], 2.92-12.52; P< .001) compared with having a low viral load.

The risk of in-hospital mortality was also higher in patients with a medium viral load compared with a low viral load, but this association was not statistically significant (aOR = 2.06; 95% CI, 0.98-4.34; P = .058).

Compared with those with a low viral load, having a high viral load was also independently associated with increased risk of intubation (aOR = 2.73; 95% CI, 1.68-4.44; P < .001). The risk of intubation associated with a medium viral load did not reach statistical significance (aOR = 1.59; 95% CI, 0.96-2.63; P = .07).

Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. Patients with higher viral loads were also more likely to develop myocardial infarction, congestive heart failure, and acute kidney injury requiring hemodialysis.

“While prior studies indicated that viral load correlates with severity of COVID-19 presentation, our study of a larger cohort of hospitalized patients adds to this knowledge base by identifying that admission viral load has important prognostic implications,” the authors wrote. “Reporting
SARS-CoV-2 viral load based on Ct values from admission NP swab samples could, therefore, help identify patients who are at the highest risk of adverse outcomes and who therefore may benefit from more intensive monitoring. Identifying high viral load patients could also be helpful for allocating scarce therapeutic interventions such as antiviral agents.”

The authors noted that additional studies that evaluate viral loads and clinical outcomes among all patients who present to the emergency department are warranted prior to pursuing this strategy clinically.

Reference: https://academic.oup.com/cid/article-pdf/doi/10.1093/cid/ciaa851/33448916/ciaa851.pdf

SOURCE: Clinical Infectious Diseases

Cooking with an Air Fryer

Like everyone else, I am sitting around all day looking for things to do to break the boredom. On TV for a significant portion of my life, I have been bombarded with "infomercials" telling me about the latest and greatest home device that will save me millions of money and minutes of time. On occasion, I succumb to the pressure and buy something. Over the past few years with the advent of Amazon I have developed the habit of looking at online reviews before I buy anything. To my amazement over 90% of the things, I look up to turn out to have a high percentage of negative reviews in which case I don't buy the product, so the actual products I buy are minimal. 

Having all this time on my hands has led me to cook more and a larger variety of foods at home and usually I make a big mess as I am a messy cook. Being from the South I love beyond logic fried foods, especially fried chicken and French fries. So why not try those great foods. Alton Brown has a YouTube video on making fried chicken that seemed simple enough. Unfortunately, it takes quite a lot of time and when it was all said and done the kitchen was covered in grease and oil. Same thing with French Fries. Joel Robuchon has a great recipe but most people do not realize in order to make great fries you actually are supposed to fry them twice meaning twice as much oil and grease on the countertops. 

Over the past year, I have seen ad on ad for an air fryer. Emeril Lagasse has been heavily advertising his Emeril's 360 fryer for a couple of hundred dollars and of course, the ad says you can cook anything with no mess in 10 minutes or less, Right? So I spent close to the past 9 to 10 months researching air fryers. First, an air fryer is nothing more than a convection oven where hot air is circulated constantly around the food at a high temperature. If you read the reviews some are better than others and cheaper than others. They also vary in size as well as some having a Rotisserie. After months of thought, I settled on a Ninja air fryer pictured here. 

It was around $100 and had some of the best reviews and fewest negative reviews. We also have another Ninja product we purchased years ago that has been indestructible. This particular air fryer is one of the smaller ones so the first "con" is you won't be able to prepare a large amount of food for a large family or party. It prepares food for one or two but for us being only two in the household it works well for us. But I will say the main motivation for me was I didn't want to invest money in a larger one only to find out I did not like it so I got a smaller and cheaper one in case I decided to throw it out as a failed experiment. But that didn't happen and I am happy to report the air fryer we have at least is amazing! 

The big "pro" of this air fryer is cooking time is quick and the mess is small to nonexistent and clean up is simple. I'm fairly sure the first thing anyone makes is French fries and I was no exception. Freshly peeled and cut French fries were coated in oil and placed in the fryer and they came out crisp, golden brown, and no preservatives or additives. There is a small learning curve using an air fryer. Things you learn are cook with a higher temp and shorter times and midway through the cooking cycle, you need to pause the fryer and turn or shake the food up a little bit. You also need to preheat the air fryer for 3 or 4 minutes prior to putting your food inside.  So far we have made fried chicken, bread loaves, schnitzel, baked potatoes, fried fish and everything has turned out well and on many occasions as good as you would get if you went out. Our unit also has a roasting button and reheat button which increases the versatility of the unit. So overall we are very pleased with our purchase and for two people we can prepare a really nice meal is generally a half-hour serving fresh foods freshly cooked. What more could you ask for?