Delaying a month + rewards + comic + potato + pox

(6 minute read)

You may have noticed in my last few Patreon posts, I gave probability estimates like "3 things released in May [80% probability]".

And you may have noticed all my estimates were off.

Welp. In May, I got approximately nothing done. I've been bouncing between friends' couches twice a week whilst traveling, and last-minute rescheduling because of friends having emergencies and/or getting Covid. (Don't worry, my friends are now mostly ok, but, big oof.)

My first instinct was to pause my Patreon for one month... but because I've already paused it for 16 months [Sep 2020–Mar 2022] with that hit in savings, and because many of you told me during my hiatus you wanted to support me anyway, and because "paid time off" is a better norm than "if a bunch of chaotic life stuff pops up I should have my pay docked"... because of all that, I'll keep this Patreon on for the month. That is, you'll be charged tomorrow. (Let me know if you're ok/not ok with that! I can refund a month.)

So, I'm sorry! How To Explain Things Real Good (a mini-talk I gave at Stanford) and Nutshell (the tool for "expandable explanations") will both be delayed by a month.

But! Here's 4 things to tide you over for now:

1️⃣ Patreon Rewards

Hooo-wee it's been 16 months since I updated these, because I was on hiatus.

Wall of Thanks for $2+ backers: https://ncase.me/thanks/ Your names will also appear in the credits of my upcoming talk recording & Nutshell.

Polygon Avatar rewards for $5+ backers: https://ncase.me/polygon-avatars/ Apparently y'all still like this thing.

2️⃣ A Silly Comic

During my burnout-hiatus, I experimented with making a lewd furry Patreon. It turns out it's better as a hobby than side-hustle, so I'm shutting down that other Patreon today. But before I did, I made one silly (safe for work) watercolored comic. Enjoy!

3️⃣ 🥔🥔🥔 Potato 🥔🥔🥔

Very late to signal-boost this, but I'm participating in Slime Mold Time Mold's citizen-science study... to eat (almost) nothing but potato for 28 days!

To sign up, or just learn what/why the heck this is, see their post. [20 minute read, with Appendices]

To read my experience so far (Day 19), see my original tweet-thread, or the unrolled version. [7 min read]

4️⃣ Pox Thoughts

Here's the “What's Nicky Learning?” section!

The following are tentative "prototype" thoughts. But since I have slightly-better-than-layperson knowledge of epidemiology –– (from the Covid-19 explorable I made in collab with an epidemiologist, and yes I know how "I'm not a doctor but I play one on TV" that sounds) –– and since y'all might be nervous about it, I thought I'd share my work-in-progress beliefs on...

the monkeypox.

(Like all prototypes, please constructively critique my mental model! What's insightful, what did I forget to consider, etc? Thanks!)

In short: I'm still deeply worried about the next big pandemic, and it's upsetting how we're doing little to prevent the next one... but I strongly doubt monkeypox is the next one. Health orgs should continue to monitor & contact-trace it, but the rest of us probably (probably) don't have to prepare much.

Here's my (tentative) mental model why:

• The cases so far seem to show almost no aerosol transmission, and yes I know we've heard that before, but for Covid-19, the WHO (and past-me) were stupid. Anyone who looked at Covid's early cases – Diamond Cruise, Washington choir, South Korean call centers – could clearly see it must've been aerosol. Meanwhile, the monkeypox cases look like mostly close prolonged contact/sex.
• The two keys to predicting how controllable an epidemic is [paper] are 1) the reproduction number [Monkeypox R0's is estimated to be ~2.13, paper], and 2) what % of transmissions are pre- or a- symptomatic. (Pre- vs post-symptomatic transmission is why 2003's SARS-Cov-1 was quickly contained, but 2019's SARS-Cov-2 wrecked the world.) You don't need NONE the transmissions to be pre-symptomatic to be containable, just low enough that you can drive R to less than 1. So, how high is monkeypox pre-symptom transmission?
  • The keywords to look out for are "incubation period" (how long until symptoms) and "serial interval" (how long between infector shows symptoms & infectee shows symptoms – this is used to estimate the "generation time", how long it takes for a case to infect someone else)
  • For monkeypox, it's... cutting a bit close for comfort, but it looks like mean incubation period/time-to-symptoms is ~8 days, shorter than the mean serial interval/time-to-infect which is ~9.7 days. [paper] In contrast, the "Classic" version of Covid-19's time-to-symptoms was ~5 days, and its time-to-infect was before that at ~4 days.
  • And sure, we need to think about variance, not just mean – "the average person has one testicle", after all – but eyeballing this, it seems like good ol' fashioned case isolation with contact tracing should be enough to contain this, thanks to the (average) 9.7 – 8 = 1.7 day time you have to isolate a case before they go infectious. And even if you miss that timeframe, contact tracing & isolation should be much easier than Covid's, since it spreads by mostly personal close contact, not aerosols in rooms full of strangers.
• Note that the (current) rise monkeypox case counts is partly caused by better case detection, not only actual rise in cases.
• Even if case isolation + contact tracing isn't enough, we already have a huge stockpiled supply of smallpox vaccine, which is 85% effective against monkeypox. [paper] So we can avoid the months-long lockdowns, and "just" roll that out.

On the other hand:

• "Just" roll that out? Dear god I can imagine a plausible scenario where the CDC / FDA won't roll out the smallpox vaccine because it's only approved for smallpox, not monkeypox, please wait a year while we develop & approve a new vaccine. And health orgs downplay seriousness & meaningful effort to "avoid panic". And politicians deliberately sabotage each others' efforts for the sake of midterms. And the public gets partisan-polarized over it. Again.
• (To be fair, the traditional smallpox ring vaccinations have pretty nasty side-effects... such as occasionally causing *infectious* smallpox. Ideally, I'd like to get one of the newer, safer smallpox vaccines like Jynneos, approved for immune-deficient folks)
• This new monkeypox, apparently, has a weirdly high number of novel mutations. "40 mutations in 4 years" [good tweet thread, good follow-up]. Not necessarily bad for us – most random mutations suck for the organism, and most surviving random mutations are neutral. However, this means I have to be less confident about what previous monkeypoxes can tell us about this pox's pre-symptomatic/aerosol transmission. (And if these mutations aren't random, i.e., they were engineered... well.) 
• Given how I suck at predicting even myself one month in the future... well, add huge error bars to any of my predictions.

But just because something has a small probability, doesn't mean I shouldn't take it seriously; I wear safety belts in cars, because while the probability that I'll crash in this ride is low, the cost of crashing without a belt is way higher than the cost of putting on a belt.

So, here's some *low-cost* stuff I'm personally doing:

1. I stocked up on N95's again. Heck it, they're cheap, and I can save them for wildfires, smog, house renovation, or the next big pandemic.
2. I am committing to getting a smallpox vaccine if/when it's cheaply available for my demographic. (Ideally a safer one like Jynneos.) Because, while I doubt this pox is the next big pox, the Obvious Bio-Terrorism 101 Attack is modifying some pox, so I want to be immune in advance to that whole category of threat.
3. I will not think about monkeypox for 2 weeks, then I'll check the data again. For now, I got other stuff to worry about. Like potato.

Finally: to beat a pox'd horse, the world is really not prepared, or even preparing, for the next big pandemic. The biggest threat, I think, is something engineered. A pre-symptomatic pox, a gain-of-function'd flu, a common cold that makes cyanide, etc. An evolved virus only "wants" to replicate, it isn't trying to kill as many people as possible. But an engineer could.

(My current bet for the Neglected x Important x Tractable solution for preventing the next big pandemic? Indoor air purification. We practically eliminated cholera in the developed world thanks to water purification, maybe we could eliminate airborne disease with indoor air purification. Portable filters & UV-C seem biggest bang-for-back.)

But really: trying to predict if this specific virus will be the next pandemic... feels like waltzing through a golf course in a thunderstorm, and trying to predict if this specific tree we're standing under will be hit by lightning.

Probably not, but oh my god why are we waltzing in a thunderstorm.

————————

And that's all she wrote! Thanks for sticking with me through my burnout-hiatus. I'm earnestly impatient to get back to a healthier, sustainable groove. Hope you found value in the potato-thread, the pox-thoughts, or even the silly comic.

🌞 Have a great summer! 🌞
~ Nicky