My MacBook is back. Apple returned it after a fourth try of finding and fixing the ghost touches haunting my TouchBar. So far no issues… knocking on wood.
Time to put the final touches on a video that should have been finished and posted six weeks ago.
It’s his first summer and he doesn’t know about the coming hardships of winter in the alpine foothills. Right now, there’s food aplenty, warm evenings and nights, beautiful sunrises and sunsets, the sweet smell and taste of flowers everywhere, and a crisp stream passing by his pasture.
Continuing my “water” theme for one more day, this is Aphrodite’s Rock (Πέτρα του Ρωμιού) near Limassol, Cyprus.
Officially, it’s forbidden to climb it but most visitors take a hike up the larger rock next to it (this is Cyprus, where masks don’t protect from viruses but fines and are worn accordingly). According to legend, this is where a nude goddess emerged from the seas to take a bath a few miles north, on the other side of the island. No one ever accused religion of being overly logical.
This is Germany’s highest altitude waterfall. And, yes, I walked up there. Was worth it.
Water Curtain along one of my all-time favorite hikes, the Wutach Gorge.
Limmasol, Cyprus. Geographically in the Middle East, politically part of the European Union, nominally independent, practically Greece, and very much controlled by Russian money.
I’ve held a number of jobs in my life, but none followed me all the way from high school to this day. And don’t get me wrong, each of those jobs made my life richer, better, and my current one more effective. I learned how to cook, how to butcher, and how to painlessly kill an animal for food. I know how to sew my own clothes, how to pilot a boat or ride a motorcycle, how to chop down trees, and how to build a home. I learned how to code (badly), and the differences between RSA and DSA in encryption. Those things help. But they’re not me.
I am just a medic and medicine will always be my first and last love.
I’ve lived in lots of places. The only two that feel somewhat like “home” are Death Valley (and probably, by extension and association with that time in my life, Silicon Valley, definitely NOT San Francisco) and southern Bavaria.
Bavaria is the southernmost part of Germany, sharing its space in the general south with Baden-Württemberg. It’s the alpine state, the beer state, the Octoberfest state, the Siemens and BMW and Max Planck and science, and academia state. It’s also the thing most Americans think of, when they think of Germany: Yodel and Lederhosen. I love it here. And, more to the point, I love that by merely observing people’s reactions to Bavaria, I can determine who is a friend and who is worthless.
And, mostly, I love that out here it doesn’t matter who you are, where you’re from, how you look, whom you shag, or how you vote. Play Schafkopf (a card game), drink your beer, speak Bavarian (at least say “Servus” or “Griasseana” when entering a room and “servus” or “pfiateana” when leaving), have an opinion on 1860 vs. Bayern München, and you belong here.
You should, ideally, also love Pumuckl (a children’s TV show), know who Monaco Franze was, be able to whistle the Erdinger Tune, and know the difference between Semmelknödel (bread dumpling) and Kloß (a potato dumpling).
That might not be for everyone. But for me, this is home.
Sunrise over Castrojeriz, Spain. This is generally an easy day along the Camino Frances, one of the (and the best known) Ways of St. James, pilgrimage routes to Santiago de Compostela in Spain. It starts, however, with a steep incline in the morning before turning into a relaxing days’ walk.
Castrojeriz lies in the Meseta, Spain’s high desert, between Burgos and Leon. It’s a part sometimes skipped by pilgrims for being “boring” and just like the Mountains vs. Beaches question, this one too is a divisive one. Some people love the Meseta, me being one of them, others hate it. But it is here, on dusty roads along cornfields and through small villages and hamlets, that the mind clears and steps into the background for the soul to get its due.
Around campfires in the night and cafés in the day, friendships are forged that can last a lifetime.
Let’s see if I can manage to post a photo a day for a year. Not all photos will have been taken the day I post them, but they all somehow relate to the day at hand.
Today: A picture of the Jacobshorn above Davos, Switzerland. At 2500m, this is a mere hill, comparatively, but it is where I found out about Älplermakronen and fell in love with the country. On the eternal debate of mountains vs. oceans I come down hard on the side of mountains, not liking beaches that much to begin with. Mountains are where the air is fresh and every step gets you one step closer to the stars.
Aerial view of my current or recent location at w3w://swam.split.lemons
I’m in Zurich, Switzerland, for two days. Switzerland is expensive, traditional-yet-modern (every six-farmer town’s cheese shop takes credit card and has a Shopify store1), and clean. The windows are open and I can smell the lake and the mountainous air, despite being quite a ways from the latter and there being a tramway between me and the lake.
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Testing FindPenguins embedding. It’s sadly pretty convoluted from the website, so I am considering just making it a plugin.
It’s funny: MacOS X Monterey Beta 3 broke (it’s a regression) Drafts. Which I rely heavily upon. Yet… no tears. I have gotten so used to using the iPad for everything I do, the Mac might as well not run at all. Sooner or later I’ll have to install DaVinci Resolve and it’s the superior OS for web design, but other than that… yeah.
Aerial view of my current or recent location at w3w://anchors.pipes.shaver
I have arrived in Frankfurt am Main1, ready to take a brief nap and then head out into the night. My hotel is, by choice, in the middle of the city’s largest Red Light District. Located in the Bahnhofsviertel (Train Station Quarter) area, it has resisted persistent, sometimes even violent, efforts at gentrification.
All of Frankfurt is an anachronism in itself, dystopian in a way, but here, in the Bahnhofsviertel Red Light District those tendencies aren’t just put on display for everyone to see, they’re the whole raison d’etre for the area. Homeless and addicts live on the streets below the massive glass-and-steel bunkers housing tens of thousands of bankers and brokers pushing trillions of € and $ and Yen every day, determining the fate of markets and directly affecting the livelihoods of every living being in the world.
Between Gucci shops and luxury car rentals, you find addicts sleeping in the doorway to $400/night hotels and $9000/month luxury condominiums, separated from each other by steel doors and gruff security. Hipsters saunter by, feeling “hipsteria,” the dread one feels if it becomes clear that it might not be possible to visit that new taverna or café before it becomes too common, racing to get a quick Gin & Tonic in before attending the screening of an Art Noir film down the street. And, around the corner, the Harm Reduction and Medical Services program I once worked for.
I knew most people down here.
Pan who was kicked from his home after coming out as trans to his parents and wound up on the streets, eating discarded Doners from trashcans, begging for money and water from Johns passing by. On the street since he was 16, the poison had retarded his aging and puberty enough to keep him in a perpetual state of pseudo-youth until his death by the hands of a drug dealer three years later. I was the only one at his funeral, the small marker next to his paper urn’s final resting place had his deadname on it.
Oliver who either caught his wife cheating or was caught cheating and lost everything in the divorce, his house and car and the kids and access to all but one of his bank accounts with less than a few bucks in it. He came too late to his job, having to walk there, and was fired. He lived in one of the more “luxurious” dwells at the end of the quarter, begging during the day and caring for many of the other homeless in the evenings, getting them appointments with their PO or social worker, or making sure they were seen by us if they looked more seriously ill than usual. He was robbed and killed by a group of juveniles filming the whole thing for Internet clout. And while he lay bleeding on the street, a few stories above him an investment banker shrugged off a multi million $ loss as peanuts. We know this, because both articles appeared in the newspaper the next day, the investment banker on Page One, Oliver in the police blotter section behind the want ads.
The Red Light District, bounded by the train station and skyscrapers.
I knew them all. The ones who fell into sex work, begging, or petty theft. The ones who rented rooms by the day and offered services for money, and the ones who came here, got hooked on drugs, and never left.
It causes a feeling of almost survivor’s guilt in me to have left. Here I am, writing this after emerging from the first class compartment on a train speeding me away from home in the green and quiet parts of the alpine foothills of Bavaria. My $1000+ tablet is connected via 5G to the Internet, thanks to my “Premium” phone contract, and I am drinking coffee. I have an amazing job, received and receive a great education, and I’ll be staying in a hotel tonight that overlooks the Harm Reduction and Medical Services program’s entrance, the street in the perpetual shadow of three massive finance towers reaching into the sky as if to steal even the sun from those less fortunate.
When I left, I vowed to come back. To become a better Street Medic, to help more. To bring medicine, as well as I could, to those who would or could not go to receive it. I have no illusions that many of them will be left. Life expectancies on the street are low, especially for drug users and street sex workers. Violence, bad hygiene, hunger and thirst, drugs, and community acquired diseases are bad enough, but the recent pandemic also led to a shuttering of the bordellos, keeping most of the people who spent a buck or gave a half eaten Doner out of the area. Instead, violence and more death came to the streets.
I come here to remind myself why I am doing this. Why I am spending my days cramming anatomy, physiology, pharmacology, and more. Why I, a man suffering from extreme(!) test anxiety to the point of physical blackouts in front of an easy MCQ, went back to study medicine and research for my PhD.
And I come here to alleviate the survivor’s guilt.
I am not sure the latter will work.
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My prepared talk at last night’s Emergent Response Policies roundtable:
Germany discusses instituting a Case-Fatality Rate instead of general 7-day incidence per 100’000 to decide on further measures. A good move, in my opinion, but not one that will calm either side of the denier/panic debate. With vaccinations reaching 40%+ in many countries, the initial impetus for instituted lockdowns and mask mandates, the need to take strain off the health care system, must be revisited.
The German “Intensivregister” (in German) shows steadily declining cases of ventilated and non-ventilated patients, despite a rise in infections and the rapid emergence of the Delta variant in Europe.
Understanding, that masks are at best infection speed bumps and that only restrictions on event and gathering sizes as well as vaccinations have any hope at curbing health care overload for good, more must be done to educate and inform those who are either misguided about the mechanics and dangers of a vaccination or are on the fence due to other reasons.
We also must put much more effort into ensuring it is understood, that these vaccines do not prevent anyone from becoming infected or infecting others1 but are valuable and needed tools to greatly reduce the incidence of moderate to severe COVID-19, Long COVID, and death in those who are infected. Given the current strains, widespread vaccination coverage could ensure a drop below Influenza morbidity and mortality numbers.
Our current modeling shows a significant drop at 40, 56, 68, and 73 percent vaccinated adults and adolescents above the age of 16 if social distancing rules are maintained below a rate of 56% vaccinated (no large2 public events) and mask requirements are maintained until a full dose +14 day vaccination rate of 68% has been reached. Outdoor mask requirements do not, in observational studies and one review, show much of a reduction in spread but might be useful for other reasons. It has also been shown that even “made unusable” FFP2 masks (e.g. having been cleaned, reused, or used for periods of time exceeding manufacturer specifications) can contribute significantly to pandemic spread reduction3.
Masks show a “small to moderate” effect on individual infection rates per eCDC, but provide a much larger effect on pandemic control.
By contrast, the effect of masks on a pandemic is a population-level outcome where individual-level interventions have an aggregate effect on their community as a system.
In other words, masks in a pandemic behave like highway tortoises (slow drivers in the fast lane): the act of slow driving does not in itself impart a significant effect upon the driver or the cars following directly behind. A chain effect, modellable in in a fluid dynamics simulation, however, shows increasing effects on cars following the initial cohort, down to a predictable traffic jam and total gridlock up to 45 minutes past the initial slow down event.
Masks and social distancing remain therefore important tools in source control (making sure infected and vaccinated individuals do not infect unvaccinated individuals) and pandemic control (“breaking the chain,” slowing the viral spread).
It is, however, imperative to switch our view from overall infection rates to infective events requiring medical intervention and hospitalization, including death, to model further responses. Rather than being the determining factor in response modeling, seven day incidence per 100’000 should become an important factor but not the driving model.
Only Apple would dare selling a 1460mAh battery pack for $100 and actually have people line up to buy it.
Yes, that thing gets an iPhone 12 Pro Max to 50%! But it has magnets man, f’ing magnets!
“[Instagram is] no longer a photo-sharing app or a square photo-sharing app”
… said Instagram boss Mosseri … on Twitter … in a Video. Am I the only one who gets vibes of middle school with all those social media companies spending more time running after whomever is the current popular girl/guy and trying to emulate them as well as they can, rather than becoming an original?
In all fairness, Instagram was never a good photo sharing app. We had phones that took brilliant 4032x3024 pixel images for almost longer than Instagram existed, only to have them (badly) compressed and shrunk to 1024x1024. And so, long after the site killed or drove into irrelevance most of its photo sharing competitors by being the first mobile-first (and, for a long time, mobile-only) offering, it leaves the space to chase after the next summit to climb, mobile short video.
All the more reason to dust off my old Flickr account (proud member since 2004’s Etech pre-pre-pre-launch as a Java based photo “sharing” app, which allowed people to “flick” images from their stash into someone else’s) and use that.
Aerial view of my current or recent location at w3w://party.charcoal.bulk
Another first. I have been resisting the “dark mode” hype for years, now. I don’t feel any eye strain relief and white on black isn’t something I can read as well as black on white. In the past months, however, we have been working on a common framework for COVID-19 data communication and most of my colleagues are dark mode fiends. You can see one of the implementations at Reuters.
So mikka.is will be dark mode for a while. Let’s see if it grows on me.
Last night, I filed my 500th consecutive entry in Day One.
I’ve been journaling since 1989, never skipping more than a day or two between entries, often spending more time agonizing over the analysis of the things that happened than the things themselves. My diary was my first attempt at a “Quantified Self”, with daily stats, weekly tallies, and monthly analyses of my perception and inaccurate recollection of sleep, diet, exercise, and mood.
Roughly a decade later, around the time I moved to the US for good, I switched to an electronic journal. A small Sun Workstation in one of the datacenters at Exodus Communications became a haven of sorts, hosting not only an ever-growing text file of almost daily diary entries1 but also my first blog,
qad.org (the “quintessential art of destruction”), which was nothing more than the same navel gazing, cleansed of deep thoughts about my mental health and lacking the more vivid details of dates, hookups, and work related excitement.
In 2004 I moved the diary to a hidden category on my blog. Instead of using two apps, I now just used the web frontend for both2.
In 2005 I drunkenly agreed to become employee one at WordPress Inc (later Automattic) and bought a MacBook, which added more mobility to the setup but it also was the same year I started to leave dot.com for good, joining Blizzard Entertainment as a Story Developer on World of Warcraft. That could have been a perfect cue to write more, being at Ground Zero for the launch of what would become one of the most successful AAA MMORPG titles on the market, but I spent most of my time playing the game when I wasn’t studying or working for the company making said game.
That changed in 2012 when I not only left the Silicon Valley and all technology-for-money work for good, but Apple named Day One a “Mac App of the Year” or something like this, and so I made the final switch. Day One’s early days were amazing for many reasons: a module called “Publish” allowed me to continue as I had before, writing two entries, one a sanitized version of the other, and publishing one.
This approach ended in 2016 with Day One 2, which took away this functionality (maybe Automattic’s acquisition will restore it), but that was just as well. Facebook and Twitter had effectively killed ego-blogging, dropping visitors to my site from around 6000/week to less than 100. I’d also become active on Quora in 2011, writing answers and stories, which meant I had less and less use for a public blog. And with than, some time in 2016, I stopped blogging in earnest, trying it a few more times over the years, but never really coming back to it. My diary, on the other hand, remained.
The begin of the pandemic in earnest in March last year made it clear, that I had to keep an inventory of my mental health. I’d been struggling with depression off and on since the first days of my first attempt at a medical degree in 1992. Then, as now, the diary helped me in keeping my mind in check, giving me that much needed “reality check” level of self-assessment.
I fully intend to fill the 1000 and beyond. But this milestone, 500 days of continuous journaling, an average of 450 words per day, was worth looking back and celebrating the 32 years of keeping my mind in check and my thoughts accountable.
find, bigger usually didn’t mean less usable. [return]
This morning I woke up late. Which is great, because I’d been sleeping like shit for the past year. Between COVID-19 response and studying, I barely had the time to wind down properly, something that came back to me in short burst-y sleep cycles and frequent naps between shifts. During our finals last year I worked nights, took the test (online), slept for three hours, went back to work, and studied in between. Not by choice, by necessity, as staff in our ward began dropping out with the same burnout I was and am experiencing.
Through all this, and I am loath to admit it, my Oura Ring somewhat helped. No, the “take it easy” prompts weren’t that useful, but tracking a week-to-week state of my body temperature and other factors did assist me with taking the right measures not to burn out.
And then, last week, barely a year after I bought it, it died.
It’s hard to impossible to troubleshoot a closed system like this. I assume it’s not charging anymore, none of the systems in my house can see its Bluetooth connection, so it’s probably dead beyond a restore.
And I miss it. Badly. For the past months, this had become my routine: get up, log into OpenHumans where I was running a private instance aggregating Apple Watch, Oura, Abbot (blood glucose), and other data to see when I was getting too close to the edge of irreversible burnout.
Oura Support has not yet answered my request, which seems to be an issue to some people (others report quick responses, I guess it all depends on their daily form), and I doubt I’ll be able to acquire a replacement before I return to Cyprus for another year of the usual treadmill.
When I purchased the ring, it was without great expectations. But, over the past months, I have become quite dependent on it as one more marker of physical and mental health. Something we all, especially those in direct COVID-19 response, badly need. Maybe there’s something else that will, unobtrusively, sit underneath my gloves or come with me during my hours off… or maybe I have to make do what else I have. But I never though I could miss a piece of plastic and silicon as much as I do.
For the time being, I am making do with AutoSleep, which is a great app (and which Apple tried to sherlock but failed). I’ll miss the body temperature readings1 and I somewhat got used to wearing a ring, but I’ll survive.
Once all this is over, we need to sit down for a good chat about the use of wearables in detecting and preventing health care worker burnout. For now, we’ll fight the remaining fires and take a breather. But then… yes, we need to talk. And we need to have a conversation about acceptable service and presence for companies who manufacture hardware and software that is intended to show health markers. Because, planned and wanted or not, people will use them to stay healthy and sane. And that, whomever you are, whatever “health” product you sell, puts you into a position of increased responsibility. Especially in times like these.
Note: this is an experimental script to pull my Quora answers into micro.blog. Apologies if this spams you.
There is no herd immunity.
The idea of herd immunity comes from things such as Cowpox, which were used to develop the first vaccine (thus the name, from lat. “vaca” for cow) against Smallpox. Smallpox and Cowpox need a lot of time in the body to become infective for others. The same is true for measles, mumps, rubella, and (most importantly) hepatitis. So when you vaccinate someone, that someone might still get infected, but because the virus is murdered by the immune system before the person becomes infective, you actively build a wall against infections.
In Coronaviridae the virus becomes infective around the time the innate immune system acts. That’s the first part of the immune system. Once the adaptive immune system springs into action, you have already been infectious for a day or two. That’s true for vaccinated and unvaccinated people alike. It’s also the reason the vaccine is a vaccine against COVID-19, not SARS-CoV-2, the virus.
In short, IF you are vaccinated, three things happen:
Now, the virus does not differentiate. BUT if you could be vaccinated and refuse to, you do a number of really shitty things:
If you’re vaccinated, you have two days of not feeling 100% and then you’re fine. You might even give it to others who are either vaccinated (good), not vaccinated but could (bad), or can’t be vaccinated. The two latter might develop COVID-19 from the infection.
If you’re not vaccinated you’ll get sick. The chances are now higher than not. You’ll steal treatment options from those who can not be vaccinated. You’ll contribute to the health care climate that pushes nurses and doctors to suicide, divorce, mental trauma, giving up their jobs, and more. You’ll add to the death toll. And, if you don’t die, you’ll have a 10–30% chance of never or for a long time being 100% OK.
The vaccine isn’t for herd immunity. It’s to keep you out of the hospital now and for the next few months, when your Long COVID makes you sick. It’s to save the physicians and nurses. It’s to save the health care system. And it’s to allow us to treat and save those who can not be vaccinated.
By setting “
SEND_DRAFT = True” in the header, your post won’t be posted and instead sent to Drafts for further editing. You can then send the post via Drafts (https://actions.getdrafts.com/a/1Hg).
👨💻Here we go.
🦠 A Grand Jury did not indict the Texas physician who took nine, about to expire, doses of COVID-19 vaccine to give to friends and family instead of discarding them. He remains fired from his job, though. [AP]
🩺 An administrator fired for blowing the whistle on unsafe work practices at her employer’s network won a lawsuit a while back and had to be reinstated. Now the 1st Court of Appeals has held and broadened her protections, meaning whistleblowing will probably become more common (good). [Decision]
🦠 “Type II medical face masks, however, filtered 47% of aerosols, KN95 masks filtered 41%, and FFP2 masks filtered 65%. Face shields did not prevent the inhalation of any aerosols.” [PLOS One]