La promesse grippe – The Flu Code

Vinay Gupta published something called the flu code. Here it is in French:

La promesse grippe 0.1Beta, version français – Une service dans l’intérêt publique de L’institute pour efrondnomiques

  1. Si j’ai des signes d’une grippe éventuel, je vais rester chez moi.
  2. Je vais rester à distance des foules quand c’est possible, et je vais toujours porter une masque dans les lieux publiques.
  3. Je vais laver les mains a la porte chaque fois je arrive a ma destination.
  4. Je vais me engager de enseigner ces règles aux autres de protéger tous.

Is This the Big One?

We know that a pandemic is coming. We don’t know when and how. Something’s coming out of Mexico (though the index case might have been someplace else, too soon to tell). Is this the Big One, the pandemic that we are overdue for?

I am gathering information here to make sure I understand it, and how to protect myself and my family.

Avian influenza is influenza type A, subtype H5N1. The porcine influenza found in Mexico is type A, subtype H1N1. Influenza type B is much less dangerous, but is unfortunately not what we are dealing with here. The 1918 pandemic was type A, subtype H1N1 — the same that is circulating in Mexico today. Matching subtypes does not mean that there’s matching virulence, but it’s a clear danger sign.

There are two medecines of interest.

Zanamivir, trade name Relenza (no generics available). A neuraminidase inhibitor. Must be administered by inhaler. Some evidence it is more effective than tamiflu, but little work has been done, for some reason Tamiflu gets all the press.

Oseltamivir, trade name Tamiflu. An orally active neuraminidase inhibitor. It is maintained in huge stockpiles by governments as a hedge against avian flu. Cases are already being treated with it, there is no public info I saw on its effectivness. A friend told me according to info he saw (don’t know if it was public or not) the virus responds to Tamiflu.

Both drugs are effective against Type A and Type B.

Word on the street from Mexico is panicy and points to a long development of the situation and underestimation in public pronouncements. This is expected and normal. The quesiton is what to do about it? Later, there will be finger pointing (or none at all — China and WHO have avoided scrutinty of their massive underreporting of the true impact of SARS, likely 10x or more the official counts). Right now, people have to decide what to do with the early, partial, bad information. One of the courses of action is “nothing out of the ordinary”, which is by default what we are all doing. The fact that Mexico is in full emergency, the USA has just declared an emergency, and the WHO has declared this an event of international concern means it’s probably time to stop the ordinary.

My life is already blessedly empty of large gatherings of people (I’m a geek, we don’t do people). Each day I choose whether to go to the office or not, and maybe now I’ll start to prefer home, until I know more. Perhaps I’ll walk and use taxis instead of the bus, seems like a simple way to reduce exposure to sick people.

Tamiflu is only available in the UK with doctor’s orders, it seems. There are online pharmacies that ask you a bunch of questions, then send the questions to a doctor, who will supposedly “review” the answers, then release the drugs to you for sale. What a sleazy loophole, online pharmacies. I wonder who those doctors are, and how they sleep at night.

Finally, to put it in perspective a bit. The pandemic of 1918 had peak fatalities of less than 25% of each affected community. I can live with odds of 1 in 4, though it’s a bit grim. With modern medicine, the case fatality rate for this outbreak will undoubtedly be much lower, and the attack rate of the virus is likely to be either in the same range as 1918, or lower (why? there’s an upper bound to how virulent a virus can be; humans are not machines, we have huge differences in our biology, and getting sick requires all the biology works just right).

The real problem with pandemic is economic and travel disruption. I think it is likely that there will be some. It’s likely that travel restrictions will come into effect. Hopefully they will not prevent us from receiving our guests for our wedding. But if it happens, it happens. Sad, but the party will go on, at least inside of Switzerland.

Interesting links:

Here’s a typical example of how governments cover up and downplay outbreaks (or just confuse themselves and end up lying on accident). On the front page of Pandemic.gov, the US pandemic stage is listed as 0. When you click on it, you find the definitions (very good information design, I might add). The definitions seem to indicate that the US should either be in phase 0, 1, or 4. But apparently US phase 4 requires WHO to get to phase 6. What’s strange is that the US phases do not take into consideration the possibility that the US could be part of the initial wave of countries as it seems to be. So pretty much life as usual… you prepare and then the plans all go out the window because nature does whatever she wants anyway. 🙂

Update: It was fun to educate myself, but now I’m going back to my regularly scheduled blissful ignorace. Looks to me like smart people are managing a large but not dangerous outbreak correctly, and there’s nothing for me to do but be happy that they are doing their job.

Lemon Custard, or Curd, depending on your skill

I used this recipe to make lemon custard. But I let it get too hot, so it curdled. So Mari got to sample Lemon Curd instead of Lemon Custard as intended. We liked it anyway!

Hint to the reader (i.e. me if I come back to this next time I try it)… you could reasonably start cooking the custard with direct heat, but you should finish it up over a bain marie, to prevent curdification.

Consider serving it with a sprinkling of cacao on top, for color, and for a bit of bitterness to cut the sweet.

Also: that recipe leaves you with 4 egg whites. Nothing to do but make meringues!

The IBM Tax

The IBM tax laid bare, from a promotional spam Amazon sent me:

The hourly prices for Amazon EC2 running IBM are as follows:

  • Amazon EC2 running IBM DB2 Express – starting at $0.38/hour
  • Amazon EC2 running IBM DB2 Workgroup – starting at $1.31/hour
  • Amazon EC2 running IBM Informix Dynamic Server Express – starting at $0.38/hour
  • Amazon EC2 running IBM Informix Dynamic Server Workgroup – starting at $1.31/hour
  • Amazon EC2 running IBM WebSphere sMash – starting at $0.50/hour
  • Amazon EC2 running IBM Lotus Web Content Management – starting at $2.48/hour
  • Amazon EC2 running IBM WebSphere Portal Server and IBM Lotus Web Content Management Server – starting at $6.39/hour

Interesting prices. How could it possibly be that WebSphere + Lotus Web Content Management is worth $6.39 per hour? Who could justify that price? It’s really inconceiveable, though I have to admit I don’t know enough to judge for sure. My bullshit meter is pegged at 11 though, and it’s pretty reliable.

The Economics of being a Hostage

Wow.

Here’s an incredible inside view of the piracy business. What’s incredible is that NPR’s Channa Jaffe Walt managed to get a CEO of a shipping company on the phone and hear the inside story of the negotiations.

Here’s what’s really interesting. The first thing the CEO says is, “I never thought for a moment that I wouldn’t have to pay anything. The only question was how much, and when.” Channa asks him why and he says, “Look, there’s no one to turn to, we’re on our own out there and that’s all there is to it. You pay.”

I found it really interesting to compare that to humanitarian kidnappings, where paying a ransom is theoretically not allowed (though we know it happens sometimes), and even if it does happen it is a very very very last resort. For a shipping company, paying a ransom is the first resort! That’s the difference between water and land, between diplomacy and business. And how much safer and more pleasant it is for the hostages. I’m not making this up: I’ve read excerpts from a book by a former French pirate hostage, and I worked with a former MSF hostage. The hostages of the pirates have it easy, sleeping in their own beds, eating their own food, usually with constant communication to their families, and detention measured in weeks not months. Compare that to the story of Pilar Bauza (7 days sleeping under the stars, walking 100 km, little food and water) or Arjan Erkel (20 months of captivity with almost no communication).

Further, it would be interesting to know what the statistical measures are for survivability and psychological and physical comfort of hostages in the petroleum business versus humanitarians (both on land, but way more money at play for oil workers).

Finally, why is it the pirates manage to safely board ships without killing anyone, but humanitarians are sometimes killed before they are captured and ransomed?

All of which makes me wonder, what would it take, what fundamental change to put humanitarian aid hostages into the same relatively safer category as pirate hostages? Why do we get the shaft? (As usual, follow the money, and there you will find the answer.)

Other really incredible stuff from the story:

  • The ransom payers delivered an electric counter (complimentary, no less!) to try to speed the ship release process. Even so, the pirates counted and/or argued among themselves for 30 hours.
  • They keep timesheets so they know how much to pay each class of pirate!
  • There’s a supposition that the minimum wage for a unskilled guard on a captured boat is USD 1000, twice the average family income in Somalia. The attackers, who board the ship, make many thousands more.
  • The likely payoff for the underwriter is around 200% with a turnaround of less than one year. Try getting that from Wall Street!
  • There’s a delicate balance at work where the holder on the monopoly (the ship) needs to keep the ransoms in check lest they get too high and prompt the ships to defend themselves better such that the pirates lose their monopoly on the commodity.

A long trip in Afghanistan

This is an interesting story by a BBC correspondent, which pulls no punches. Easy to see why he was left feeling bitter.

There are two sides to every story of course, and I’m sure the military folks would tell you about security rules, zero tolerance for violation of force protection imperatives, risk asessments, etc, etc, etc. But that’s all missing the point. When you are doing counterinsurgency work, you have to be close to the people. You have to earn their respect by finding out what earns respect in their culture and then finding a way to do it inside of your own culture. They, in turn, will come to know you and, if you deserve it, you’ll earn their respect in return.

It’s not easy, and it’s not fair: they have the right to reject your cultural assumptions, but you have to understand and take into consideration all of theirs. That’s because you are the guest in their country, and it’s not easy to be the guest. But the nature of counterinsurgency is that you are making yourself a guest (by force no less). So suck it up and be a good guest.

Come on NATO guys, get it together. The Brits learned how to do this in Iraq once (in the early 1900’s). The Americans relearned it. Now it is time to hit the books and re-re-learn the lessons.

PS: Force protection is thinly disguised CYA (Cover Your Ass), which is, in turn, just another form of cowardice. You don’t have to be stupid and get killed, but if you happen to get killed doing something important, then so be it. Life is too short to hide behind “force protection” and not achieve legitimate goals like “safe schools”, “water for kids”, etc. Just do it!

Made me chuckle

I am a Slashdot addict, and one of the reasons are gems like these. The geek sense of humor is omnipresent:

Police in Norfolk, England already have tracking units, The Automatic Vehicle Location System, installed in their cars that allow a control room to track their exact locations. Later this year a similar system will be attached to individual police radios to allow controllers to monitor the position of every frontline officer … the system will allow the force to home in on “shouts” to within yards. The system also lets operators filter a map showing the location of its vehicles and constables to reveal only those with the skills needed for a specific incident, like the closest officer with silver bullets during a werewolf attack.

Tags: whatsayard holycrapbatman itslikeameteryouidiot

On Slashdot, always glance at the tags, sometimes the best stuff goes on in there.