What is an Encounter? What is a Quest?

[Note that this post may include mild spoilers for the Gold Box games ‘Pool of Radiance’ and ‘Curse of the Azure Bonds’, as well as ‘TES IV: Oblivion’.]

How ‘large’ is a game? How many ‘encounters’ does it have? How many ‘quests’? (And how does the type of encounters & quests affect how large the game feels?)

In an attempt to quantify my feelings, I’m working on ways to measure the ‘size’ of games, and it’s become clear that we need some standard definitions.

Most Computer Role-Playing Games (CRPGs) have the concept of ‘encounters’ and ‘quests’.

‘Encounters’ are generally defined ‘this is who you meet/this is what happens when you go to this place’.

‘Quests’ are generally defined as ‘Someone asks you to go somewhere and do something’.

Encounters are simpler, so we’ll investigate them first.

Many aspects of these definitions are cribbed from the pen and paper language around RPGs, where there will be a map with a numbered encounter key, describing what happens in each location. This visual language has persisted in ‘clue books’ and online hint/walkthroughs, such as this one, from the clue book of one of my favourite CRPGs, ‘Pool of Radiance’:

Map from the clue book for the CRPG Pool of Radiance showing 'Kuto's Well'.  Note the well featured prominently in the center, and the multiple locations possible for some of the encounters.
Map from the clue book for the CRPG Pool of Radiance showing ‘Kuto’s Well’. Note the well featured prominently in the center, and the multiple locations possible for some of the encounters.

In the picture above, you can see 5 numbered encounters, with some of them happening or being able to happen in multiple locations.

In this particular instance, encounter ‘1’ is an encounter with some Kobolds who are trying to sneak away from you, with a chance of occurring each time you enter one of those squares. Encounter ‘2’ is a large multi-wave battle that starts whenever you enter one of those locations (triggering an ambush).

Other similar encounter keys might have a ‘each time you enter one of these locations for the first time, ‘.

So, how do you count the number of ‘encounters’?

Let’s break down the definition of ‘encounter’:
– You go to a place[1]
– You see something/meet someone/meet something

Encounter ‘1’ above triggers when you enter the first place out of a logical set of places that you enter, that probably feels like one encounter for these purposes, as it’s happening in a logical place.

Encounter ‘2’ is similar.

At the opposite end are ‘random encounters’, which are generally used to use up player resources, or to create a sense of urgency, so that players don’t dawdle[2]. These I will generally count, but count separately from ‘placed’ encounters. (Edit: S mentions that random encounters, for example in Pokemon games are often used by the player to ‘grind’ or ‘farm’ XP, to level up their characters outside of the more story-based game content. Interestingly, one could measure how much a game is in the ‘survival horror’ genre by how difficult and resource-consuming random encounters are (cf. System Shock).)

Somewhere are in the middle are random encounters which have a sequence of some sort, but are not tied to any one particular location, such as those in the ‘random’ dungeons in Curse of the Azure bonds:

Map from the clue book for the CRPG Curse of the Azure Bonds, showing the first level of the 'Shadowdale Dungeon'.  Note that 'All encounters are random'
Map from the clue book for the CRPG Curse of the Azure Bonds, showing the first level of the ‘Shadowdale Dungeon’. Note that ‘All encounters are random’

(if you’re interested in the details, please consult Stephen S. Lee’s excellent walkthrough here.)

Game locations designed in this way have the same ‘number’ of encounters, and even though they occur in a defined order, telling a story, the fact that they happen entirely at random, without regard for the location or geography, breaks immersion terribly (at least for me). They tend to feel emptier than other encounters, and (to me), only contribute a fractional amount.

What if a place is different when you go back? Is that a second encounter? I don’t know yet. I’ll have to assess that when I get to examples.

What if you have the same encounter 10 times, with each in an identical but seemingly logical place(such as guard posts)? Is that really 10 encounters? Not really…but it also doesn’t really feel like only one. I posit that it’s somewhere between. I’ve been using a log function internally, probably with base e, as base 10 feels too large and base 2 feels too small, but I could easily see it be something else, where the first few seem ‘real’, but after that they run together much more.

Now, let’s move on to ‘quests’

We can break ‘quests’ down into:
– Someone asks you to do something
– You go somewhere
– You do a thing

Pretty simple, right? This includes all ‘fedex’ fetch quests, escort quests, and even most of the ‘escape from this location’ quests.

The trick is when one of the above is missing, such as when you accidentally find the object of a quest before someone tells you to go looking for it (VLDL has a humorous portrayal of this here). This is generally still defined as the same ‘quest’ in the game notes, as well as in strategy guides, but some (such as S) believe that the ask is required (and without the ask, this is simply ‘world-building’).

Sometimes, no one asks you to do something, but there is still a reward when you do it (such as this quest from Oblivion[3]), or they are happy that you’ve done it (such as the dungeon below Kuto’s Well above, where you get a quest reward for defeating the bandit horde of the notorious Norris the Gray). I would still call those ‘quests’, though. Perhaps there’s a difference between ‘Quests’, which require all three, and ‘quests’, which are ‘whatever the game designer says’. 😀

What if you don’t need to go somewhere? This might just be an encounter, or if it’s particularly involved, it could be an all talking interpersonal drama gaming session (or even a game within a game….)

What if the ‘thing you need to do’ is just getting to the destination? I feel like this one can go either way. Most of the quests in the Oblivion Assassins’ guild have a ‘pre-quest’ which involves getting the assignment. I’m not sure why they did it this way, but it kind of makes sense that an assassins’ guild would want it to be difficult enough to figure out what they were doing, that it might be a quest just to get to the dead drop to find the assignment. However, about half of the locations in Curse of the Azure Bonds are just places that the party has to traverse to get somewhere in order to do something important. To me, this doesn’t really feel like a separate quest (sometimes not even like a separate location), and in a lot of ways makes the game feel smaller.

What do you think? How would you define an ‘encounter’ or a ‘quest’? Do you disagree with any of my definitions above? Let me know in the comments below!

[1] There are variants where encounters can come to you, but that’s usually a different type of story/measurement and is out of scope. This method would probably treat these as one encounter, or you could get really fine-grained and treat that as an entire adventure with ‘locations’ represented by the state of affairs at each step.

[2] There’s also a theory that random encounters are useful because they allow for a differential in stakes between different encounters by having lower-stakes encounters.

[3] I can’t begin to describe how frustrating this quest was, and how difficult it was to do, even with the walkthrough page open beside me. Probably the most ‘realistic’ of the ‘finding something hidden’ quests out there, though.

“How do you feel?”

Spock is the center[1] of Star Trek. Many others have written (or videoed) about this, either about Spock himself (and Leonard Nimoy’s excellent portrayal), or the ‘part-human’ outsider archetype that has been present in every Star Trek show/movie.

Perhaps my favourite Spock scene (or at least the one that I find myself quoting most regularly) is this one from Star Trek IV: The Voyage Home. Shortly after having his katra rejoined with his body, Spock is working through a set of tests of memory and problem solving across numerous disciplines, when, after successfully navigating through and solving myriad technical problems three at a time, he is blocked and stumped by the simple and very ‘human'[2] question: “How do you feel?”

Screenshot of the "How do you feel?" scene from Star Trek IV: The Voyage Home
Screenshot of the “How do you feel?” scene from Star Trek IV: The Voyage Home

I suspect that many other neurodivergent folks also saw a lot of themselves in Spock. Whether it was aspirational (such as his ability to quickly solve problems across disparate disciplines very quickly in critical situations), or because we connected with his ‘outsider’ nature (his slow learning to be more in touch with his human side, or Data’s yearning to be more human), or even because we also wanted to be part of a tightly-knit team, where the science officer would figure out part of the problem, and pass it off to the leader, who would assemble it into action and a solution.

Much of this blog has been about chronicling my journey to better understand myself, from my first post on paying more attention to and bringing out fleeting thoughts, to my entire category ‘Thoughts on Thoughts‘. Through all of this, I continue to search to understand how I feel and why I feel the way I do. In a way, I think[3] that working to understand how one feels is fundamental to the human condition, and we do ourselves a disservice by not investing in investigating ourselves in this way.

There are fundamental questions humans have been asking ourselves since time immemorial: ‘Why are we here?’ and ‘What is our purpose?’. Perhaps a lot of the answers boil down to ‘How do you feel?’

[1] Many of the meanings of ‘center’ are applicable here, whether it’s the logical ‘heart’, or the ‘focus’, the self-insert for an otherwise under-served audience, or even the person or archetype that many plots revolve around, whether it’s solving problems or being put in peril.

[2] This is part of Amanda Grayson (Spock’s mother)’s work to help Spock reattach his human side, now that his katra has been reattached ‘in the Vulcan way.

[3] Or feel?

See the entire scene here:

How do you feel?” (new window)


(inline)

You can also see Spock’s answer to the question at the end of the movie, showing that he now better understands friendship and himself (source for this insight):

I feel fine.” (new window)


(inline)

“Oh, that’s a Fun Failure Mode!”

“Oh, that’s a fun failure mode!” I was talking with a friend of mine recently, and they were talking about a technical problem they were solving[1], specifically about the failure mode that they had seen, and before they could explain their solution, I made the exclamation above.

Failure modes have always fascinated me. I don’t know if that’s a cause of or a result of[2] me going to engineering school[3]. I remember being fascinated (and appalled) by the video and story of ‘Galloping Gertie‘. The torsional twist as a reaction to wind and subsequent failure mode[4] is an image I’ll never forget.

Our undergrad bridge-building course professor[5] seemed to also be very interested in giving us images and experiences of materials actually failing. My favourite was his demontration of the failure characteristics of steel cable. In class, he showed us a diagram similar to this one:

Typical stress vs. strain diagram for a ductile material (e.g. steel).  Shows the linear elastic region, strain hardening, and necking leading ultimately to fracture.  Source: Wikipedia user Nicoguaro
Typical stress vs. strain diagram for a ductile material (e.g. steel). Shows the linear elastic region, strain hardening, and necking leading ultimately to fracture.

Source: Wikipedia user Nicoguaro

Notable parts of this stress-strain diagram include but are not limited to:
– The ‘elastic region’, amounts of stress/force/pressure where the material will stretch but return to its original shape and size[6]
– The ‘strain hardening region’, where the material will adjust and become somewhat stronger. (This may be undesirable)
– The ‘necking region’, where the metal/material starts to lose strength because the atoms can no longer fill in the gaps, causing narrowing of the cross-section (the ‘necking’), eventually leading to fracture, where the material fails

The demonstration included measurements of the deformation of the steel, using a precise length measuring device[7] to provide numerical measurements. Such a device is required, because the deformations we’re talking about are tiny, due to the large Young’s Modulus of steel.

Another demonstration was using a jug of water to break a wooden dowel. The dowel was fixed to a desk, with one end extending (cantilever-style), where the jug was hung at various points. This was intended to show how the torque[8] (of the mass of the hanging water times the distance from the cantilever point) would increase the force, leading to eventual failure of the dowel.

At least that was the intended demonstration. The dowel was so flexible that it bent downwards far enough to minimize the amount of torque/force, preventing it from breaking. So instead, we got to see a failure mode of the intended failure mode instead (and learned something about the resilience of trees!).

Perhaps most memorable was witnessing a failure mode of the professor, who, discontented with his dowel not failing in the experiment, broke it himself over his knee, showing us both the actual failure mode of wooden dowels and how frustration and anger can contribute to engineering failures.

For a great explanation of the different failure modes of different types of materials, especially what it is that makes wood so resilient, I recommend the textbook we used in this course:

The New Science of Strong Materials: Or Why You Don’t Fall through the FloorJ.E. Gordon, Philip Ball (Introduction)

Both of these demonstrations left strong impressions on me. I still remember them more than 25 years later (and I suspect many of my classmates do as well).

Given how visceral and effective these demonstrations were, it would make sense to work out a (reasonably) full set of reasons that engineering[9] projects fail, and create demonstrations and labs based on those, so that the students have those visceral memories to call upon, to warn and inform them.

But what is that set of reasons that engineering projects fail? How do you categorize and teach failure modes systematically?

That’s a question for next time! (Spoiler alert, it will probably involve the ‘swiss-cheese model‘.)

[1] It was a type of problem that I had designed a system to avoid in the past, so it was kind of cool to see an instance of it ‘in the wild’, so to speak.

[2] Or both!

[3] Or growing up with a parent as an engineer

[4] And the poor dog!

[5] Thanks, Prof. Collins!

[6] For those who have been following the news recently, this is one of the reasons that steel is used for pressure vessels such as submarines.

[7] I was originally going to suggest that this was some sort of strain gauge, but if my memory serves me correctly, I remember a dial moving showing deformation. If anyone knows the type of device typically used for such a test, please comment below!

[8] This may have also been the lesson where I learned the second meaning of the phrase ‘Every Couple has its moment‘.

[9] I’m using the word ‘engineering’ here because all of the demos I talked about were related to mechanical engineering/bridge building, but much of this will apply to software engineering as well.

Links to image on Wikimedia Commons, Creative Commons license available there:
Stress/strain curve

S’s note to me, to help me write this post: “Please pick two failure modes and write about them! Then you can add a bonus failure mode, which was you getting overwhelmed by the number of possible failure modes and timing out before writing anything. “

Why do your legs only get wet when you walk? A guide to rain physics and geometry:

So, I was out for my morning walk today, and it started to rain. Luckily, I had planned ahead and brought my umbrella. I opened it up, and was standing there, enjoying the rain…and then I started to walk, and my legs started to get wet. I stopped, my legs stopped getting wet, I started walking, my legs got wet again.

The question is why?

I narrowed the problem down to the following variables:
– Height of the person (technically, the height of the edge of the umbrella)
– Walking speed and wind speed (I’m putting these together for reasons you’ll see later)
– Size and shape of rain droplets (this is to measure terminal velocity)
– S also added ‘size of umbrella’, but I’ll address that in the assumptions section

This is a lot of variables, so let’s make some assumptions:
– The human in question is about 2m tall (accurate within 5%)
– The edge of the umbrella is about 2m from the ground (accurate within 10-15%)
– The edge of the umbrella is about 25-50cm from the front of the leg horizontally
– We count the leg as getting wet as when the rain hits the front of the leg just above the ground
– Length of a step is about 80cm (as per this page)
– Raindrop terminal velocity is about 20m/s, as per this graph:

Graph of 'rain drop terminal speed' vs. 'rain drop radius', from Wired "How Fast Is Falling Rain?", August 29/2011
Graph of ‘rain drop terminal speed’ vs. ‘rain drop radius’, from Wired “How Fast Is Falling Rain?”, August 29/2011

– Wind-speed is negligible, as per this chart from Environment Canada, showing that wind at the time in question (9am) was about 2km/h, from the North:

Table showing weather data for Toronto for 2023-07-25.  Relevant part is showing 'Thunderstorm with light rainshowers' and 'Wind 2km/h, N' at 9am.
Table showing weather data for Toronto for 2023-07-25. Relevant part is showing ‘Thunderstorm with light rainshowers’ and ‘Wind 2km/h, N’ at 9am.

Now on to the math!

We can easily show that with negligible wind, rain falling straight down will not hit the legs.

But assuming 90-degrees from ground vertical legs, what wind-speed would be necessary to rain on them?

At 20m/s, the rain would need to travel 0.25m or 0.5m horizontally as it traveled 2m vertically, or a horizontal wind of about 20m/s * 0.25m/2m = 2.5m/s or 9km/h for 25cm of umbrella overhang to 18km/h for 50cm of umbrella overhang.

So it turns out that the wind-speed was actually really important, as you can see that at other points today, it alone would have made the difference.

Now, what happens when we start walking? There are two factors at play here:
– Walking speed
– Extension of the leg forward out of the protection of the umbrella as you take a step

So we have to add some more assumptions:
– Assuming an average walking speed of about 5.4km/h or 1.5m/s
– Assuming that the toe to toe per step distance is 0.8m (from above), assume that at maximum extension, the tip of the leg is 40cm ahead of the body

Using the wind-speed calculation above, we can see that 1.5m/s of forward motion would only counteract about 1.5m/s / 20m/s * 2m = 15cm of umbrella cover, not enough to make your legs wet.

However, if your leg is 40cm ahead of your body, that would be enough if your umbrella was any reasonable amount off ‘exactly centered’ over the front of your body, and if your leg is 40cm ahead, and your walking speed adds another 15cm, that is enough to counteract even perfect vertical umbrella placement (40cm + 15cm > 50cm).

My experience this morning suggests that either the rain was falling more slowly than 20m/s, I was walking slightly faster than 1.5m/s, or I was resting the umbrella diagonally over my shoulder (most likely). This would have given me the approx. 25cm protection above, and caused my legs to be wet only while I was walking.

How would you calculate this? What would your assumptions be? Have you experienced this? Are you going to test this the next time it rains? Are you as surprised as I am that leg placement and step length are much more important than walking speed (as long as you’re only walking)?

Let me know what you think in the comments!

On the Importance of Encouraging People to ask (Sincere) Questions

Recently, a couple of friends of mine shared the following meme:

Image of text showing a list of 'People also ask' 
suggestions from a Google search answering a question about the movie 
'Oppenheimer'.
Google Search ‘People also ask’:
(circled) ‘Is Oppenheimer based on a true story’
‘Is Einstein in Oppenheimer movie?
Why did Cillian Murphy lose weight for Oppenheimer?’
‘Did Cillian Murphy have to lose weight for Oppeneimer?’
(circled) ‘Is the nuke in Openheimer real?’
(circled) ‘Did they drop a real nuke for Oppenheimer?’

On the face of it, it may seem harmless, poking some fun at people who not only know less than you, but who know less than you consider reasonable (or perhaps even ‘possible’!)[1].

However, this laughing at others can lead to contempt, and a reluctance in the willingness of others to ask questions, due to the loss of psychological safety.

So, why might people laugh at those who know less about a topic than they?

Some describe surprise as a necessary component of laughter. You can be surprised that others know not just less than you know, but even less than you think is possible to know. This cognitive bias causing this surprise is a subset of the ‘Curse of Knowledge‘, perhaps best summed up by this drawing from Rajesh Mathur:

Curse of Knowledge Bias diagram from Rajesh Mathur:
Outer Circle titled 'What you know'
Smaller circle titled 'What you expect them to know'
Smallest circle titled 'What your audience knows'
Curse of Knowledge Bias diagram from Rajesh Mathur:
Outer Circle titled ‘What you know’
Smaller circle titled ‘What you expect them to know’
Smallest circle titled ‘What your audience knows’

Sometimes, however, the laughter is not just about surprise, but also comes from a place of insecurity, the desire (conscious or not) to place one’s self above others. This could also be a trauma response, perhaps to experiences with ‘Sealioning‘, where people will repeatedly throw bad-faith questions into a debate or forum instead of engaging with the argument directly.

Another variant of this occurs often in teachers (and oddly enough, IT professionals), where if you’re continually hearing the same question from many different people, it can feel like ‘they just don’t learn'[2], because each year (or semester or day), you get a new person who hasn’t asked that question yet.

So, why might people be asking questions like this?
– They genuinely don’t know: As shown in the diagram above, the variability in knowledge between humans is vast. Even though you know about Oppenheimer because you’ve read multiple books on the subject[3], others might only have a passing knowledge, or even none, despite his pivotal involvement with the start of the Atomic Age.

– They might be mostly sure, but their experience with the thing made them doubt, or they heard a rumor….and the consequence[4] of their assumption being wrong is so large, the ‘importance x likelihood'[5] equation pushes them to ask the question, humans being loss-averse.

– They’re asking a slightly different question: ‘Is Oppenheimer based on a true story’ could mean a lot of different things. There’s a wide range between how much the movie ‘300‘[6] is based on a true story and how much ‘Oppenheimer‘ is. The question could easily be a rephrasing of “how close is the movie ‘Oppenheimer’ to a ‘true story’?”

– They may have difficulties expressing the specific question they want answered: I think it’s worth mentioning that the ability to ask specific targeted questions into a search engine is a (mostly learned) skill, and like all skills, is subject to privilege and ableist gatekeeping. In fact, one could argue that a large part of the uptake of GPT-like software is their ability to answer peoples’ questions when they are not phrased precisely, helping those who are less able to quickly articulate precise thoughts in written form.
– The search engine could be condensing or de-duplicating the wording of questions asked: On a purely technical note, the search engine has a limited amount of space on the page, and it would make sense that they would condense similar questions into perhaps the simplest and clearest version, making it look like people were very commonly asking a simple question.

Thanks for joining me on this wandering journey. I want to learn (and help others learn) to treat others with more kindness, and it’s important to me to deconstruct all of the reasons behind why I (or others) might be doing this. Thanks for reading!

[1] Having done a bunch of teaching, I was aware of the importance of teaching to different styles of learning, and also to different levels of knowledge, but I remember first hearing about this specific subset of this bias relatively recently, probably in a meme, where an expert in a field says ‘how can they not know about this ?’

[2] See also ‘Endless September‘.

[3] Most of my knowledge and understanding of Oppenheimer is from Feynman.

[4] This consequence can be social, such as ‘why didn’t you know about this?’, or personal, such as ‘I don’t want to change the way I think about this unless I have to’, amongst others.

[5] Humans are generally bad at judging the overall expected value of ‘Low-Probability, High-Impact’ events, which is probably why insurance is a thing, although the reduction in distraction/open-loops is probably worth it.

[6] Yes, I know ‘300’ is based on a graphic novel, that’s part of the point I’m trying to make. I’m specifically mentioning 300 because of the large number of known historical inaccuracies and general problematic-ness. There’s also a huge conversation about ‘The Western Canon’ that is out of scope.

Meetings & Mystics: Some RPG-inspired ideas for Meetings

What if meetings had a ‘hit points bar’, that showed how healthy they are?

Yesterday, S & I were talking about unhealthy & pointless meetings, and S had the following idea:

What if, every time that someone didn’t show up for a meeting[1], that meeting would ‘lose hit points’?

Each meeting has a number of hitpoints, its initial value related to:
– The length of the meeting[2]
– The number of participants
– The ‘importance’ of the meeting organizer or participants[3]

Those hit points change when:
– Each time someone forwards, ‘accepts’, or attends a meeting, the meeting is healed and soothed
– Whenever someone ‘declines’ a meeting, or perhaps worse, no-shows, the meeting is attacked and takes damage
– Whenever someone participates in a meeting, the meeting is bolstered[4]

When hit points decrease below various thresholds:
– The time allocated to the meeting decreases
– The number of people able to attend decreases[5]
– The meeting timeslot moves to a less desirable time[6]
– The meeting becomes less frequent[7]

Note that if any of the above go to zero, the meeting is cancelled

More outlandish ideas
– Meetings can fall asleep (meeting doesn’t happen this week)
– Meetings can be poisoned (meeting loses ‘hit points’ over time)
– Meetings can catch diseases (meeting is at half-length or half bandwidth until ‘healed’), etc…
– People could be given tools or ‘potions’ to heal or harm[8] meetings
– Meetings could be automated and given tools to sort it out amongst themselves, a la ‘Doom as a tool for System Administration’.[9] This logically would lead to:
– Meetings can have ‘classes’ such as ‘tank’ (absorbs damage meant for associated meetings) or ‘healer’ (actively heal associated meetings) or ‘DPS’ (strike back at competing meetings[10]

Some possible wrinkles:
– Some meetings might only ever have a small number attending out of those invited (such as a large Scrum of Scrums), but might be very useful for those who attend, and not a significant distraction for those who do not. We want to retain that usefulness while removing or reducing meetings that don’t have that usefulness…a ‘meeting budget’ [11] might be a way around that
– How does this work with 1:1s? They are generally acknowledged to be vitally important, but how do they fit in? Can one make a personal sacrifice to move ‘hitpoints’ from a 1:1 to a larger meeting when it’s really important?

Closing thoughts, some choice quotes by S:
—S: “Each meeting has a ‘power level’, which determines how many of its attendees it can hold on to….if it loses power, they can peel away & escape?”
—S: “It just occurred to me that the meeting is a monster, not a friend….why is the manager trying to heal the monster?”

[1] (if they weren’t on PTO). Also, when I say ‘meeting’ here, I generally mean ‘meeting series’, as the measurement of the health of a meeting while it is in progress, while very interesting, is a separate topic and out of scope

[2] Longer or larger meetings are not necessarily better, but they might take more effort to completely eliminate, having built up some inertia over time. One could get around this by assigning more ‘hit points’ to the first half hour of a meeting, with progressively fewer per unit of time as it gets longer. Similarly, with the number of attendees; A meeting with 1,000 people might be 500 times more costly than a 1:1, but is it 500 times more important?

[3] The importance of the meeting participants can go either way. If the people who want the meeting are ‘important’, that could be an argument for keeping the meeting. If they show up and don’t participate[4], that could be a clear signal that they should be removed or the meeting is not that important.

[4] Here, ‘participate’ is tricky….If you have a regular meeting where people of ‘importance’ get very useful information by listening, how do you measure that? Scientific talks or status updates between departments might be good examples of this. Also, ‘vigorous participation’ can be difficult to measure, and as ‘engagement’ metrics show, difficult to measure without encouraging loud arguments….One could also use whether video is turned on or not as a sign of engagement, but different organizations may have different cultural norms around this, and there may also be equity issues with this.

This could also lead to meetings being squeezed; When the ‘energy’/’usefulness’ of a meeting (perhaps measured by when people leave or enter) is consistently high all the way through, there is no change….when this decreases for marked sections of the meeting, the meeting ‘health’ decreases until the length of the meeting makes it so that the meeting has a consistently high energy all the way through

[5] IRL, this could be done by reassigning meeting rooms, virtually by restricting the number of simultaneous attendees.
—S: “Each meeting has a ‘power level’, which determines how many of its attendees it can hold on to….if it loses power, they can peel away & escape?”

[6] cf. Star Trek TOS Season 3. Note that this can be complicated by time zone issues

[7] E.g. from every day to 3 times a week, from once a week to once a month. This is already done in an ad hoc way for many types of meetings, for example when a team decides to go from daily to 3/week ‘standups’.

[8] Being able to harm other meetings feels like a very bad idea, but it might lead to fun stories 10 years later

[9] This is where a programmer famously modified the Doom sourcecode to create a world where all the processes on a Linux system would exist as monsters, fighting with the SysAdmin (and each other) through the Doom GUICached link (Sadly the UNM CS server seems to be down right now.) Original Link

[10] If you assign classes and automate meetings ‘interacting’ with each other, you might be able to clear your calendar (or everyone else’s calendar) very quickly….Also, we went back and forth about what each ‘class’ each type of meeting might be, for example, depending on the importance of the meeting, or how reliably it is important (regularly somewhat important like a status meeting, or rarely very important like a ‘these are the code changes going out around the organization’ meeting)

[11] A ‘meeting budget’ might make more explicit the opportunity/social capital cost people incur when arranging meetings (and help alleviate the issue of junior folks not wanting to ‘waste the time’ of senior folks to bring up issues early).

The Power of being ‘Well-Read’

I was reading a random post recently, and came across a mention of ‘Wandel durch Handel‘, in the context of whether embargoes or increased trade are more likely to induce political change.

So, this is not a particularly innovative concept, being an obvious special case of the ‘how much do you engage/meet people where they are vs. set boundaries?’ question.[2]

However, in a debate (or other timing-critical or adversarial conversation) context, you could see how there being a specific name for this specific incarnation of this concept, and your opponent being able to wield it, would lend them an advantage, as you are momentarily confused, perhaps unwilling to ask what they mean, or waiting for context so you could respond appropriately[3].

So, how do you deal with this? One common tactic is to basically ignore what the other speaker is saying, and focus on your prepared talking points. This can be useful in many contexts (not just political contexts), but (I think) a much stronger method is to be better read, to do all[4] the research on the topic at hand.

For the specific case of ‘Wandel durch Handel’ (which I just noticed has a rhyme that kind of rolls off the tongue, at least the way I pronounce German), general knowledge on foreign policy, international trade, or even speaking German, would have made a significant difference to being able to react to the concept. With warning, one could do the specific research/briefing mentioned above, before the interaction with the hostile[5] person.

There are of course many elements of privilege/class/etc. involved in this conversation, not the least of which is “You don’t even know ‘X’?!? You must be uneducated!” All I can say is that there are people with different levels of rhetorical ability and expertise (and ‘expertise’) on all topics, and the Internet is a great help to level the playing field.

Happy learning!

[1] “Wandel durch Handel (WdH, German for “Change through trade”), also known as Wandel durch Annäherung, is a term referring to a political and economic notion, mostly associated with German foreign policy, of increasing trade with authoritarian regimes in an effort to induce political change.”

[2] And also an obvious corollary to the concept of embargoes.

[3] You can see how this is somewhat similar to a ‘Gish Gallop‘, where instead of deploying a large number of arguments of questionable strength, one’s opponent merely throws jargon.

[4] I don’t exaggerate *that* much when I say ‘all’. If a conversation/meeting/presentation is important enough, you can afford to spend a couple of hours on research, and you can probably make it through dozens if not scores of pages/documents on the topic, which should be enough (assuming you already have a general grounding in the subject), to be able to at least converse intelligently about the specific topic in question.

[5] I use the word ‘hostile’ in the sense of ‘opposed goals’, not necessarily that they would be emotionally hostile. They would just be uninterested in working with you on a solution, hence their use of obstructive or adversarial rhetorical techniques.

Why we Still Cannot go back to Normal

tl;dr: Get COVID as few times as you can. Getting COVID the second time is just as likely to kill or disable you as the first time. COVID killed more people in Canada in 2022 than 2020 or 2021, and is disabling many more in an ongoing way. Use masks and better-filtered air to get COVID as few times as you can, and if you do get it, rest up for as long as you can while recovering.

It’s now been more than three years[1] years since COVID-19 entered the world stage, and it’s worth a few minutes to take stock of what we know, where we are, and what we should be doing next.

What is COVID?

COVID is a contagious disease caused by the SARS-CoV-2 virus.

Acute symptoms vary widely, from respiratory such as cough, fever, shortness of breath, and congestion/sputum, to musculo-skeletal with muscle & joint pain, headache and fatigue, to gastro-intestinal with abdominal pain, vomiting and/or diarrhea. Neurological (separate from nasal congestion) loss of taste and smell is perhaps the most well-known distinctive COVID symptom, made famous by online reviews of scented candles.

These acute symptoms also include death, although the exact number is difficult to measure for a number of reasons[2]. The official ‘Case Fatality Rate‘[3] is generally measured to be around 1%, for example by the John Hopkins dashboard. Taking estimated numbers of non-tested and asymptomatic individuals into account, the actual overall ‘Infection Fatality Rate’ is generally calculated to be between 0.5-1% for ‘wild type’ virus. This rate is modified by age, risk factors, variant of interest (Alpha/Delta/Omicron/XBB1.5/etc), and vaccination status.

As I previously reported, based on a study from the University of Toronto, Case Fatality Rates are somewhere between 1.5x and 2x worse for Alpha/Beta/Gamma & Delta variants. Omicron, as I previously reported, is significantly more contagious, but about 0.2x as bad as wild type was in 2020, in the current vaccinated population. XBB1.5, the most recent ‘Variant of Concern’ seems to be replacing Omicron and other variants, but its fatality rate has not been well-measured yet.

In Canada, just over 50000 people have been confirmed to have died of COVID as of Jan 30/2023, representing about a 6% increase in total mortality. The overall death rate from March 2020 to August 2022 was measured to have increased by about an additional 1.6%, or 7.6%. This reduced life expectancy by 0.6 years, the largest single year decline since 1921.

This data from the CDC suggests that vaccination reduces the likelihood of death by about 5x, or about 13x with an up to date relevant (bivalent at time of writing) booster. One would expect this, along with Canada’s vaccination rate of about 80% (and up to date booster rate of about 25%) to be reflected in the numbers above.

COVID is also known to have chronic effects, known as ‘Long COVID‘. ‘Long COVID’ is not yet well defined, and presents with a wide array of symptoms depending on the individual (Nature Paper).

Long COVID effects.  Source: https://www.nature.com/articles/s41579-022-00846-2
Long COVID effects. Source: https://www.nature.com/articles/s41579-022-00846-2

Whether well-defined or not, Long COVID is common, and is still debilitating for many. Estimates range from 10-12% Long COVID incidence for ‘Break Through Infections’ for vaccinated individuals to 10-30% for non-hospitalized cases to 50-70% for hospitalized cases.

The ‘Brain Bank’ study in the UK was lucky enough to have done brain scans before and after COVID infection, and it detected damage to areas of the brain associated with taste and smell, along with measurable cognitive impact, even when COVID cases which required hospitalization were excluded. This suggests that there is damage caused to parts of the brain even by ‘mild’ COVID cases:

Fig. 3: Significant longitudinal differences in cognition. from SARS-CoV-2 is associated with changes in brain structure in UK Biobank.  Shows cognitive impairment by the difference in time required to do a task.
Fig. 3: Significant longitudinal differences in cognition. from SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Shows cognitive impairment by the difference in time required to do a task.

More concerning is this study, which shows that the second COVID infection is just as dangerous as the first. For example, 6 months post-reinfection, all-cause mortality doubled, hospitalization more than tripled, and the likelihood of Long COVID symptoms more than doubled.

COVID Reinfection is just as dangerous or more dangerous than the initial infection.  Source: The COVID 'acute' phase doesn't really end until 90-120 days post-infection. Source: https://www.nature.com/articles/s41591-022-02051-3/figures/3
COVID Reinfection is just as dangerous or more dangerous than the initial infection. Source: The COVID ‘acute’ phase doesn’t really end until 90-120 days post-infection. Source: https://www.nature.com/articles/s41591-022-02051-3/figures/3

Also, while vaccination might help reduce your chance of catching COVID, vaccination status does not seem to substantially decrease your likelihood of developing Long COVID once you do.

So, knowing all of this, what should you do?

1) Get COVID as few times as you can. Each time you get COVID adds to the danger. Some people who seemed fine at first, developed life-altering and debilitating symptoms.

2) Protect yourself like a Billionaire; get and use HEPA filters, and use COVID tests if you must gather: At the Davos World Economic Forum this year, there were stringent and multi-layered anti-COVID precautions, including masking, improved ventilation and filtration, and mandatory testing with immediate revocation of access on positive test.

3) Get as good as mask as you can, and use it whenever you are inside with people. COVID is airborne, and the quality of your mask matters! An N95 is substantially better than a KN-95, which is substantially better than a surgical mask or cloth mask. We recommend this specific N95, as it has good reliable straps, and seems to fit us well. YMMV.

COVID Masking Quality Table
COVID Masking Quality Table

4) Rest! Long COVID seems to have many things in common with Chronic Fatigue Syndrome(ME/CFS). ‘Pacing’, or resting for longer than you might expect, to allow your body to heal has been shown to help in ME/CFS. Also, the data of the after-effects of COVID infection seem to show that the ‘acute’ phase of COVID doesn’t fully pass until somewhere between 90-120 days (3-4 months) post-infection, whereupon people have settled into a new (often worse) ‘normal’:

The COVID 'acute' phase doesn't really end until 90-120 days post-infection. Source: https://www.nature.com/articles/s41591-022-02051-3/figures/3
The COVID ‘acute’ phase doesn’t really end until 90-120 days post-infection. Source: https://www.nature.com/articles/s41591-022-02051-3/figures/3

The end to COVID may still not be in sight yet, but we now have a lot more information about how to protect ourselves from it, and maybe, just maybe lighten the load on our overloaded and buckling healthcare system. It is possible to get back to the low case counts of mid-2021, we just need to work together and make sensible decisions. Stay safe out there.

References:

The best current review on Long COVID: “Long COVID: major findings, mechanisms and recommendations” in Nature Reviews Microbiology, Jan 13, 2023

The best current study on the dangers of reinfections: “Long COVID after breakthrough SARS-CoV-2 infection”, Nature Medicine, 25 May 2022

Some quotes from the above two references:

“The organ damage experienced by patients with long COVID appears durable, and long-term effects remain unknown.”

“Cognitive impairments in long COVID are debilitating, at the same magnitude as intoxication at the UK drink driving limit or 10 years of cognitive ageing73, and may increase over time, with one study finding occurrence in 16% of patients at 2 months after infection and 26% of patients at 12 months after infection74”

“Few people with long COVID demonstrate full recovery, with one study finding that 85% of patients who had symptoms 2 months after the initial infection reported symptoms 1 year after symptom onset143. Future prognosis is uncertain, although diagnoses of ME/CFS and dysautonomia are generally lifelong.”

“The findings highlight the clinical consequences of reinfection and emphasize the importance of preventing reinfection by SARS-CoV-2.”

Other references and links in-line

A final word from r/wallstreetbets and the Bureau of Labor Statistics:

r/ Wall Street Bets drawing trend lines on the Bureau of Labor Statistics chart, showing the greatly increased number of people out sick from work in an ongoing way.
r/ Wall Street Bets drawing trend lines on the Bureau of Labor Statistics chart, showing the greatly increased number of people out sick from work in an ongoing way.

[1] First known case discovered in December 2019, hence the ‘-19’

[2] Reasons why the number of deaths from COVID is difficult to measure include undercounting for reasons such as due to delayed or incomplete reporting of deaths due to institutional overload, delayed annotation of cause of death, and the fact that ‘coroners’ are a profession with inconsistent regulations and training requirements. Overcounting can occur when a person would have died anyway, or COVID is counted as one of a group of causes of death for that person. For this reason, ‘excess deaths’ are typically used in case of pandemic or war.

[3] ‘Case Fatality Rate’ is generally measured as (# of deaths confirmed attributed to COVID)/(# of cases of COVID detected). Incorrect attribution of cause of death can move this number in either direction (although measuring ‘excess deaths’ can help), and reducing the level of testing can lead to this number being overstated (you can look at the ‘test positivity rate’ to get a sense of how under-tested the population is (or how bad the outbreak is)). ‘Case Fatality Rate’ is generally assumed to be an overstatement of the fatality rate, if there are a large number of undiagnosed cases in the population, which are taken into account in the probably more accurate ‘Infection Fatality Rate’.

Historical Atlases

Yesterday, I posted this article about a really cool Pre-Colonial Map of the Philippine Islands, made by a couple high school students (reddit link):

Pre-Colonial Map of the Philippine Islands, made by Maharlikan_ and DeliriumMaps
Pre-Colonial Map of the Philippine Islands, made by Maharlikan_ and DeliriumMaps

In my post, I mentioned that I collect historical atlases, and that my most common complaint was their lack of pre-colonial coverage. J said he wanted to hear about these atlases, so here you go!

I’ve always loved maps and geography; I had a Usborne children’s atlas when I was growing up, I remember learning about European (and world geography) from board games such as Diplomacy, Civilization, and Axis & Allies.

As I mentioned above, I had learned or noticed somewhere that all of these (along with our education in general) was very much from one euro-centric perspective, so when I was looking at historical atlases, I would always look for the one page on each of ‘pre-colonial Americas’ and ‘pre-colonial Sub-Saharan Africa’, and lament the paucity of information there.

Looking back, I know I’ve been collecting them for at least 20 years now, as I have acute memories of searching used book stores in St. Louis circa 2001-2 for atlases not written in English, so I could try to figure out the subject of each of the maps from context only. I remember them (both historical atlases and non-English atlases) being difficult to find at the time, there might be none or only one in each store, and I might already have that one (or it might be mostly copied from other atlases….more on that later!)[1] The atlases that I’m going to list are the ones currently on my shelf. I know I’ve lost a few along the way, either to water damage or other reasons, but my shelf is still quite overflowing with them.

Here’s the shelf in question:

A Shelf of (mostly) Atlases
A Shelf of (mostly) Atlases

From left to right:
– “The Military Atlas of World War I” & “The Military Atlas of World War II” were bargain bin purchases a few years ago. Comprehensive and detailed, but after a while, reading details about just WWI & WWII gets pretty boring (& dark), so I haven’t read these ones through.

– “The Times Complete History of the World“: Probably the best and most comprehensive single historical atlas on the shelf. I’ve owned various versions of this atlas (or similar) over the years. This particular copy is the 8th edition, 2010, starting c. 5 million years ago with human origins. Great bathroom reading.[2]

– “Atlas of World History“, 1997. Looking at this one, I think I got it used much later than that, or at least I never really read it that much. I’m not sure why. It seems to be as comprehensive as the previous one (starting 4 million BCE, covering world civilizations as much as is generally done), but I think the slightly smaller pages and slightly less colourful maps might have dissuaded me (or perhaps I had already read my fill of others by the time I got this one). Looking at it with fresh eyes right now, it might have a fresh perspective, and better/more comprehensive views on non-European parts of the world, so you might want to take a look yourself.

– “The Historical Atlas of the World at War“, 2009: This is an interesting one, looking at world history (well, mostly the European canon) through the lens of warfare, from “Wars of Settlement and Cities”[3], to the “Iraq War” and “The War on Terror”. If you like red/blue battle diagrams and strategic ‘arrows and dates’ diagrams covering all the battles/wars you’ve heard of (and more), this may be the book for you.

– “The New Atlas of World History, Global events at a glance“, 2011: This is another odd one, with a very rigid structure. Every other two-page layout is a timeline page[4], with horizontal categories such as ‘politics & economy’, ‘religion & philosophy’, ‘science & technology’, and ‘arts & architecture’. The atlas tries to stick as closely as possible to regularly-spaced snapshots, long periods up until the advent of history/agriculture (~6000 BCE), every couple thousand or so years from then up until Bronze Age empires (1300 BCE), then every few hundred years or so from then until the fall of Rome (~500 CE), then every hundred years or so until 1492, then every 50 until the industrial revolution (1763), at which point things start to really accelerate. Looking at this one with fresh eyes, I remember that part of why I chose it was that the format of timeline:world map:timeline:world map forced the author to have something to say about all parts of the world in every snapshot, greatly increasing the coverage of areas outside the standard European canon. Similar to many others, this atlas has more to say about the first half of the 20th Century than the second half, perhaps because social change and a retreat from colonialism are not as interesting to people who like writing about warfare. Still a worthwhile addition.

We then skip over a few random D&D books, and a GURPS supplement to perhaps my favourite sci-fi series ever[5], to come to:

– “Encyclopedia of Classic Warfare: Battles throughout history from Megiddo to Waterloo“, 2011: Another one from the bargain bin ($20), it’s a “fully illustrated history of 170 key battles, campaigns, and wars from the ancient Egyptians to the end of the Napoleonic Wars.” It has pretty good world coverage, perhaps mostly limited by records than anything else. Each of the 170 are described in 1-3 pages of your standard ‘red vs. blue arrows’ maps, with maps to show location and key facts for context.

– “D-Day: The First 24 Hours“, 2003: The largest amphibious operation in history. It’s exactly what it says on the cover. It’s a bit much for me, it’s a lot more detail than I need about this (and it’s tiring to read about WWII), but it might have been where I first learned about Hobart’s Funnies.

– “Historical Atlas of Islam“, 2004 (purchased 2007) and “The Routledge Atlas of Jewish History“, 1993: I’m not going to comment on these, other than to say that some time ago, I thought it important to have both of them on my shelf.

Next, we have a couple of the other Usborne children’s books from my youth, perhaps my two favourites, followed by Scott McCloud’s excellent magnum opus ‘Understanding Comics’ which I would recommend to anyone, and its sequel, where he gives suggestions on how to solve some of the issues he raises in the first book.

– “Fighting Techniques of the Medieval World“, 2006: Just what it sounds like. 500-1500 CE, including a chapter on ‘Command and Control’. Looks like it may share some maps with the ‘Encyclopedia of Classic Warfare’ above, but it’s hard to tell because there are only so many ways to draw a ‘red vs. blue’ map, and the two books are quite different otherwise.

– “Journeys of Frodo“, 1981: Almost more of a travelogue than an atlas, this atlas has dozens of hand-drawn maps showing the day-by-day travels of the various members of the fellowship of the ring. I can’t help but think of ‘DM of the Rings‘, a re-imagining of the story if it were a D&D campaign in a world where no one knew Tolkien.

– “The Historical Atlas of Knights & Castles“, 2010: From ‘The Legacy of Rome’ to somewhere in the 14th-16th centuries, this atlas covers what it says on the cover. As you might expect from the cover, it’s covered from a perspective that one would expect from someone who uses the word ‘Christendom’. There is however a chapter on Samurai, as a nod to the rest of the world beyond the heathens and Mongol hordes.

A couple of books from my mis-spent youth in the biological sciences. Voet & Voet, even though it’s by now decades out of date, is still really comprehensive on a lot of things. I learned Biological Sequence Analysis from one of the authors on the eponymous book, ways of thinking that I probably still use today.

– “Transit Maps of the World“, 2015: A more recent addition to my collection. Includes a bunch of the history of this type of representational map. I’ve always loved looking at transit maps (one of my prize souvenirs from our honeymoon is a puzzle of a commuter rail map of Tokyo), and I’ve wanted to for a while do some mathematical analysis of them. Let me know if that’s something you’d like to see.

– “North America: The Historical Geography of a Changing Continent“, 1990 (Current edition link) I don’t remember where or when I picked up this book, but I’ve kept it through multiple purges because of this one graph:

Graph of the cost of different freight methods in the U.S., 1784-1900
Graph of the cost of different freight methods in the U.S., 1784-1900

This may not look like much, but this is the type of graph that shows in a very succinct way the economic pressures that shape societal behaviour. You can see the effects of changes in technology, changes in infrastructure, and wars. This is the kind of data that’s super-difficult to assemble, requiring painstaking assembly[6] from centuries-old records and invoices[7], and yet greatly increases our understanding of the pressures that people of the time were feeling when they made their decisions.

– “The Times History of Europe“, 2001: If you look closely, you’ll see that this atlas shares many maps from the ‘Times Atlas of World History’ above, but focuses more on Europe (Natch). Not much else to say. Pretty Euro-centric, and only has four pages for pre-900 BCE Europe, the same number allocated to ‘The Battle of Salamis’. It also has a strange construction, where it shows a two-page snapshot map from the end of a time period, followed by two pages of smaller maps from during that time period. Just odd choices all around.
We then skip over my collection of landmark genomics and protein structure papers[8], and end up with:

– “Battles that Changed History: Key battles that decided the fate of nations“, 2010: From Megiddo, “the first battle to have been recorded in a methodical manner”, through Salamis, Waterloo, all the way to ‘Iraqi Freedom’, this atlas says it shows ’45 of history’s most significant battles’. The battles are covered in detail, with 8-12 pages for each, many more than other surveys of this kind. There are interesting choices made, however. Half of the battles are after 1800, with four from the Napoleonic wars, and similar numbers from each of the U.S. Civil war and the two World Wars. However, there are only four in total, from all of world history from East of the Fertile Crescent, two of which are from the war in Vietnam. In depth summaries, and a bunch of interesting things to say, but very likely playing to a specific audience.

– “Atlas of Air Warfare“, 2009: “With more than 120 detailed aerial combat maps”. Also from teh bargain bin, this is an atlas that really wants to talk about airplanes. There are two pages of discussion of balloons and zeppelins before it gets right into planes. It does discuss the ongoing use of balloons for observation and other purposes along the way, though. Pretty comprehensive, if you’re interested in planes, or the third dimension in general.

Above the books, you see (from top to bottom), my ‘Optimus Prime’ wall hanging, the classic game ‘Titan‘, recently reprinted, and ‘Serenissima‘[9], a renaissance trading and conflict simulation that I bought because I was sad that Age of Renaissance was out of print. The strangely capped pool noodle to the left is from my ‘Nerf gun wedding’, and is my rendition of a comically large Nerf dart.

There is also one other that didn’t make it onto my ‘oversized’ shelf:

Penguin Atlas of World History, vols. 1 & 2.
Penguin Atlas of World History, vols. 1 & 2.

This atlas (in two volumes) is another interesting oddity. It’s stunningly comprehensive for its small size, seemingly meant to be used as a reference book not just for maps but for much of history by someone who has learned much or most of it in the past, and wants to see how it all fits together.

I’ve always loved its relentless abbreviations:

Just a few of the many abbreviations used in the Penguin Atlas of World History.  Carth. Del. E.
Just a few of the many abbreviations used in the Penguin Atlas of World History. “Carth. Del. E.”

Here you can see them used, even when it’s not necessary to save space:

An ex. of unnec Abr.
An ex. of unnec Abr.

…such as the ‘Vandal Kdm’, or the ‘Ostro.’ or ‘Visi.’ (goths), all abbreviations that would be relatively easily decodeable for someone steeped in the Western canon, but perhaps impenetrable for the average reader.

And that’s all for today! Let me know if you want a more in-depth review of one of these, or anything else you see here. This has been a super-fun trip down memory lane for me. I’m going to go peruse an old atlas now.

[1] You may also be interested in online historical atlases. My favourite is the “Historical Atlas of the 20th Century” by Matthew White, who is working on his second associated book. Please note that a lot of human history is not kind, and he does a lot of research into atrocitology, to try to help understand why humans do the things we do to each other.

[2] When I was avidly reading them, I used to read them in the bathroom. They’re perfect for that, as each two-page spread is self-contained, so you can read it in any number of manageable chunks, depending on how much time you have.

[3] Feels like Civilization all over again, especially the ‘wars of settlement’…

[4] Vaguely reminiscent of perhaps the most famous visual history timeline, “Adams’ Synchronological Chart or Map of History“, which perhaps to continue to best express the classical British conception of history that continues to colour many peoples’ perceptions, whether or not they know it.

[5] David Brin has such wonderful ideas. I recommend starting with his short story ‘Aficionado‘.

[6] For me, this is similar to how when you look at a map in a historical atlas, and think about every dot on the map, and how each of them could easily have been someone’s doctoral thesis or life’s work.

[7] Obligatory. Note that the famous tablet seems to have been only one of many.

[8] Let me know if you want me to talk about these. I’ve been meaning to for a while, but it’s been like 20 years now.

[9] Note that there’s now a second edition. I’ve only ever really played my copy once, and I can’t give a useful review.

Omicron is not so mild…and then there’s Long COVID

Early on in the pandemic, a blogpost came out entitled “Coronavirus: The Hammer and the Dance“. It talked about how, in a pre-vaccine world, to avoid overwhelming our healthcare system, but to allow as much semblance of normalcy as possible, we would need to have successive implementations and releases of various non-pharmaceutical interventions (read: lockdowns, public mask wearing, quarantines, etc.)

As difficult as it was to deal with the reality of that (no matter how much I thought I was mentally prepared for it), it’s perhaps even more tiring now, that in a COVID vaccine world, that with substantial anti-vaccination movements and vaccine hesitancy, and with a new variant (Omicron), that we have to continue this ‘Hammer and Dance’.

A month and a half ago, when I wrote the above, the healthcare system where I live was being overwhelmed. Yesterday (Saturday January 8th), there were no paramedic units available to answer calls. (Toronto Star) (CTV News)

No Paramedic Units available
No Paramedic Units available

More Links.[1]

So, that tells you something about the population-wide effects of Omicron, but population effects are equal to individual effects times overall virulence[2]…and what are the individual effects of Omicron, and how is it different from ‘wild-type’, ‘Alpha’, and ‘Delta’?

(Pre-Omicron) Chart showing COVID variant prevalance over time
(Pre-Omicron) Chart showing COVID variant prevalance over time

Thankfully, a wonderful group from the University of Toronto published a paper on the relative likelihoods of hospitalization, ICU admittance, and death for wildtype, Alpha, and Delta.[3][4]

To put it bluntly, Alpha is about 1.5x more deadly than wild-type, and Delta is another about 1.5x more deadly than Alpha.

On top of this, Alpha is also about 30-50% more transmissible than wild-type, and delta is about 50% more transmissible than Alpha.

All three of these variants have much better outcomes if the patients are vaccinated (about 5x better, according to this paper).

So, what does that mean about Omicron?

According to this article, Omicron is 2.7-3.7 more infectious than Delta among vaccinated & boosted individuals, but about the same as Delta among the unvaccinated, suggesting that some sort of ‘immune evasiveness’ is at play.

This article suggests that: “Compared with patients who had the delta variant, omicron patients had a 53% reduced risk of hospitalization, a 74% reduced risk of ICU admission and a 91% reduced risk of death.” (Original paper)

The following chart bears this out:

Chart showing COVID cases and deaths in Canada from the start of the pandemic until Feb 2022.
Chart showing COVID cases and deaths in Canada from the start of the pandemic until Feb 2022.

Please note that since the Ontario provincial government has made the decision to scale back testing, the above numbers lose accuracy from December 31st, 2021.

Here, on the lower chart, you can clearly see the five peaks[5] of the (so far) five waves of the pandemic (in Canada). The first peak, in early 2020, of (probably) exclusively wild-type, hitting the entirely unvaccinated population hard, then a (relatively) calm 2020 summer, followed by the second peak in late 2020 and early 2021 likely brought on by winter forcing people indoors, relaxation of restrictions, and complacency. Vaccines began to be approved in December, and were rolled out through the first part of 2021, blunting the third wave (mostly Alpha) and the fourth wave (mostly Delta) in the fall and early winter. As you can see, the fifth wave was quite different, with Omicron blazing through the population, multiple times more contagious than Delta, but also less deadly on a per-case basis, but overall leading to a wave about as large as the initial first early 2020 pre-vaccine wave.

COVID is known to increase the likelihood of pulmonary embolism, strokes, and myocardial infarctions (heart attacks).

So, we’ve all heard about the acute COVID symptoms that are included in the above[6], and there have been some issues with people taking a while to recover from these, but more serious, and less talked-about is the phenomenon of ‘Long COVID’ or ‘Post-COVID syndrome‘.

(It’s relevant to note that we only remember the ‘Long Polio’ part of Polio, simply calling it ‘Polio’. It’s entirely possible that COVID will have a similar long-term impact.)

COVID is known to attack the lungs, the heart, the kidneys, and the brain, among other organs.

As a respiratory disease, it is perhaps not unexpected that COVID would attack and damage the lungs. However, much of the attack on organs done by COVID is thought to be because of extracellular expression of ACE-2[7], the doorway that COVID uses to get into cells and multiply.

As far as neurological symptoms, in addition to the above, there are disturbing indications that COVID’s ‘brain fog‘ has disturbing similarities to alzheimer’s.

So, we know that all kinds of things can happen, but how often do they happen? This study, performed in the highly-COVID-tested population Faroe islands, is likely to have included all of the relevant population that contracted COVID (from April to June 2020, so pre-vaccine, all wild type variant). Four months ‘after’ COVID, half of the population studied continued to have at least one symptom (most often fatigue, lost of smell/taste, and/or joint stiffness).

This much larger study of 270,000 people in the U.S. used six months of HMO data, and found that “over 1 in 3 patients had one or more features of long-COVID recorded between 3 and 6 months after a diagnosis of COVID-19. This was significantly higher than after influenza.” In addition, “[f]or 2 in 5 of the patients who had long-COVID features in the 3- to 6-month period, they had no record of any such feature in the previous 3 months.”

This last feature is especially troubling, considering the large number of reinfections that are occurring, for example. the 650,000 in the UK who likely have been infected twice.

Many who currently have Long COVID are terrified of Omicron, as even mild cases of pre-Omicron variants have had the following effects for some, for more than a year afterwards:


“You might have a mild case,” Laurie Bedell, 42, of Pittsburgh, said. “But most people that have long Covid had mild cases.”

She caught the virus in December 2020 and continues to have debilitating pain, fatigue and other symptoms that have transformed her from a healthy, physically active woman to a chronically ill person unable to walk or do any form of exercise for more than 5 to 10 minutes at a time.

“I am terrified,” she said. “I don’t know that I would survive another infection.”

There is currently only anecdotal evidence, but studies are sure to follow, but:


People with long Covid “have good reason to be worried, unfortunately,” said Dr. John Baratta, founder and co-director of the UNC Covid Recovery Clinic in Chapel Hill, North Carolina.

“We have seen people in our clinic who have been reinfected with Covid with the other variants,” he said. “They have new or worsened long Covid symptoms after their reinfection.”

So, what do you do?

First and foremost, get vaccinated and boosted (and if you’re eligible, get your second boost). Vaccines remain effective in reducing the effects of acute COVID, even in the age of Omicron.

Vaccines might also reduce the likelihood of long COVID, but research is still inconclusive and ongoing.

Second, get a good mask. A properly fitted N-95 is substantially better than a cloth, surgical, or even KN-95 mask.

Third, continue to limit the amount of time you spend sharing air with people outside your ‘bubble’. COVID is an airborne disease, and transmits much more easily indoors, where ventilation is poorer. Consider contactless delivery, masked curbside pickup, and socially distanced and/or masked walk’n’talks.

The end to this thing may or may not be in sight, but it’s probably not Omicron, and you want to get Omicron as few times as possible.

Stay safe out there.

[1] This is a heart-breaking first-hand account of what hospital front line workers are going through.

[2] Modulo demographics.

[3] There are limitations on the precision of PCR and the classification of variants, but any study that didn’t do whole genome sequencing would have the same limitations. It increases my confidence in the study that they were very precise about what they were measuring.

[4] thanks, Global News!

[5] Eerily similar to the ‘Hammer and the Dance’ article linked above. But it’s very different living through it.

[6] From Johns Hopkins:


What are symptoms of COVID-19?

The most common symptoms are:

Cough
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
Sore throat
New loss of taste or smell
Diarrhea
Headache
Fatigue
Nausea or vomiting
Congestion or runny nose

Some of these symptoms are very common and can occur due to many conditions other than COVID-19, the disease caused by the coronavirus called SARS CoV-2. If you have any of the symptoms, contact a doctor or other health care provider, who can assess your risk and help you determine the next steps.
Emergency Warning Signs of Severe COVID-19 — When to Call 911

If you or someone in your household is experiencing any of the following symptoms, call 911 or your local emergency room right away and let the operator know that you are calling for someone who might have COVID-19:

Difficulty breathing
Persistent pain or pressure in the chest
New confusion
Inability to wake up or stay awake
Bluish lips or face

There are other possible symptoms of COVID-19. Call your doctor or health care center regarding any symptoms that are severe or concerning to you.

[7] Angiotensin Converting Enzyme 2, a transmembrane protein involved in blood pressure regulation, and extensively studied because of its relation to hypertension.