Tired of respiratory viruses this winter? Not so fast. Norovirus has entered the room.

Norovirus—a virus that causes stomach cramping, intense episodes of vomiting and diarrhea, and sometimes fevers—is taking off in the Northern Hemisphere. If we had a storm system for viruses, this might be deemed a sh… you get it.

What’s happening right now?

Norovirus outbreaks happen any time of the year, but their seasonal pattern is remarkably consistent, peaking in February and March. We don’t really know what is driving this consistency.

People don’t typically go to the doctor for norovirus (they wait it out), so the CDC reports data from specific outbreak investigations in 14 states. This won’t tell us how many people are infected in the U.S.; rather, it tells us the trend. We are currently on trend with last year. But December and January have been less than exciting compared to pre-pandemic years (gray shaded areas). Unfortunately data is lagged.

Another monitoring system—percent positivity reported in some states—shows a slightly different, more up-to-date story. We have already passed last year’s peak. This may mean we will get a bigger wave than usual.

Trends in the U.S. are consistent with England where norovirus is 66% higher than normal, but within historical range. Norovirus activity in people ages 65+, though, are at levels that “haven’t been seen in over a decade”.

There is good news: the virus has not significantly mutated. This is what typically drives previously bad norovirus seasons in the States. The increase in cases now may be driven by typical winter behaviors combined with less population immunity due to the pandemic, like we saw with RSV.

How high will this peak be? We don’t know. But, in pre-pandemic times, we could expect 19-21 million people infected, ~100,000 hospitalizations, and ~900 deaths throughout a season.

How does it spread?

Norovirus is very infectious. On average, one infected person will infect 2-7 other people.

For one, it can live on surfaces for weeks. It’s spread through the fecal to oral route so transmission avenues include:

• Direct contact. 6 in 10 infections are through direct contact, like shaking hands or touching door handles, and then putting your hand in your mouth.

• Indirectly, like through foods. An infected person can touch food with bare hands that have viral particles on them. You can ingest the food and then get sick.

• Aerosolized. If someone throws up in a toilet, for example, viral particles can become aerosoled after flushing. This isn’t the main route of transmission.

Second, people only need a few viral particles to get sick. Once the virus enters the body, norovirus hijacks your cells and turns them into viral factories. It latches on, specifically, to cells in your gut causing less than wonderful symptoms. Before 2018, we didn’t know why norovirus chose the gut, but a new study found it’s because our gut is home to one rare type of cell (tuft cells).

Third, this virus spreads pre-symptomatically and up to 2 weeks after symptoms resolve. In other words, you can spread it even if you don’t have symptoms.

Who is at risk?

Three out of four norovirus outbreaks occur in nursing homes. Restaurants and schools follow. Cruise ship outbreaks usually make the news, but only account for 1% of outbreaks.

Children under 5 years old and adults aged 85 years and older are more likely to have an outpatient or emergency department visit than people of other ages. Of those who die, 90% are persons aged 65 years and older.

How to protect yourself?

It’s tough.

There are no vaccines. Some are under development, but they’re tricky to make because noroviruses constantly mutate and are very diverse.

They’re also one of the hardest viruses to kill because they have a stable coating called a capsid. This means:

• Washing hands needs to be thorough. It takes about 30 seconds of vigorous washing and rubbing with hot water and soap. And you must get it all, even under nails.

• Quick application of hand sanitizer usually won’t get rid of it.

• Bleach-based products on surfaces are the best.

If someone brings it home, to daycare, or to nursing homes, it’s hard to avoid. Some things that can help:

• If you’re infected, don’t prepare food.

• Use the longest dishwasher or laundry cycle. It can stick to plates even after being washed at restaurants, especially with sticky substances like cheese. Hand washing dishes doesn’t work as well because the water doesn’t get warm enough to kill the virus.

• Consider linens contaminated.

• Clean surfaces, like doorknobs, thoroughly.

If you get sick, the good news is that it only lasts 24-48 hours. But stay home at least two days after symptoms lift. Also, stay hydrated.

Bottom line

Norovirus is on the rise. Ten percent of the population should expect to get sick, but there are things we can do to reduce risk.

I’m optimistic April will be a much calmer time for viruses. We’re almost there.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:

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Thanks to systemic and deliberate underfunding, NHS Emergency departments are now a vision of hell.

By George Monbiot, published in the Guardian 11^th January 2023

You have to see it to believe it. A few days after Christmas, I hit my head on a scaffolding bolt. There was lots of blood and pain down the right side of my face and into my neck. I thought I could live with it, but the following day I noticed a black floater in my right eye. When, after several hours, it had failed to clear, I phoned 111. They told me to travel immediately to the emergency department at my local hospital. They booked me in for 9pm, my expected arrival time.

I naively imagined I would be seen then. But when I arrived, there were 16 ambulances waiting to offload their patients. The waiting room was a vision of hell. All the chairs were occupied. Sick people leaned against the walls. Many of the patients, from babies to the extremely aged, looked dangerously unwell. And yet, for all of us, the wait went on and on.

I was seen by a doctor at 3am. During those six hours, I witnessed two things that distressed me more than my own injury. A man with what appeared to be cardiac symptoms collapsed on to the floor, possibly from a heart attack. A toddler was screaming “it hurts, it hurts!” for almost three hours without a break. It was devastating to hear.

When I was called by a nurse, halfway through my wait, I asked whether this was an especially busy night. “Oh no,” she told me, “this is quite a quiet one. Most nights recently have been worse.” Nothing I saw was the fault of the staff, who were working at a frantic pace to manage an impossible load. They looked exhausted. What I witnessed were the extraordinary but now normal effects of 13 years of austerity. Hospitals across the country appear to be approaching a tipping point.

Last week I spoke to an accident and emergency consultant at a London teaching hospital. She told me that several of the nurses there are now dependent on food banks. Junior doctors with massive student debts are paid £14 an hour. Yet every day they must carry unbearable loads and make morally corrosive decisions, as they decide whom to prioritise among people with immediate needs. Very long waits ensure that “frustrated and frightened patients are being seen by exhausted, demoralised health workers”. Verbal and physical aggression is commonplace. Unsurprisingly, staff are leaving in droves, and she can’t fill the vacant places.

There must come a point at which those who remain can no longer cope, and will be forced out as the mental, physical and moral pressure becomes too great. What happens then? Don’t ask the government. It denies the very existence of the crisis.

A recent study suggests that the death rate rises by 8% among people who have to wait more than six hours for transfer from emergency departments. One estimate suggests that delays in emergency care are killing between 300 and 500 people a week in England. This is to say nothing of the millions of lost hours and the infections circulating in tightly packed waiting rooms. The government’s NHS “savings” are the mother of all false economies.

With one breath, the government claims to have vanquished Covid so effectively that it no longer needs to publish the infection rate. With the next, it blames the Covid pandemic for the pressure on the NHS. While it’s true that Covid and flu are aggravating factors, the real cause runs much deeper: years of systemic underfunding.

The cumulative NHS funding gap since 2010 is more than £200bn. What this means, as the recent book NHS Under Siege by John Lister and Jacky Davis explains, is the difference between the money the service would have received if funding levels prior to 2010 had been sustained, and the money it has received since. For all New Labour’s flaws, it followed the globally accepted rule that to keep pace with an ageing population and technological change a modern health system requires an annual 4% real terms increase in funding. When the Tories reject the idea of “endlessly putting in more and more money”, they reject the idea of sustaining a functional service.

Since 2010, almost 9,000 general and acute beds have been lost in England. Of these, 5,000 were closed in March 2020 for the sake of social distancing and infection control. They have never reopened, because the NHS does not have the money required to reorganise its buildings. While the Organisation for Economic Co-operation and Development (OECD) average is five beds per 1,000 people, the UK has 2.4. In September 2021, the Royal College of Emergency Medicine warned that the NHS had a deficit of 15,000 beds for emergency care. But nothing was done.

The beds crisis is compounded by a parallel disaster: the privatisation and defunding of social care that began under the Tories in the 1990s. Because the social care system is now in permanent crisis, lacking funding, staff and places, an average of 13,000 NHS beds are occupied by patients who could otherwise leave.

Amid all the reorganisations, deorganisations, swerves and U-turns, there have been two consistent policies across the past 13 years: underfunding of the NHS and overfunding of the private sector.

In the same month that the government closed 5,000 NHS beds, it block-booked all 8,000 beds in England’s private hospitals, and covered their entire operating costs. In return, these hospitals were required to do … nothing. It was free money. Rather than relieving the pandemic pressure, the 187 private hospitals treated, between them, a grand total of eight Covid patients a day. And, perhaps because they were now being paid merely for existing, they greatly reduced the other NHS-funded procedures they handled.

In 2021, through a scarcely noticed policy that seems to me just as scandalous as its corrupt PPE deals, the government extended these payments for doing nothing for a further four years, with a new “framework contract” for private hospitals. The expected cost is £10bn.

Even when they do treat patients, transferring NHS services to private hospitals does not increase capacity. It diverts the money that would have been spent in the public sector to a less efficient and more costly service. Private hospitals don’t train their own doctors and nurses. They cannot offer more services without sucking staff out of the NHS.

I’m fine, by the way. By the time the doctor saw me, my symptoms had cleared. But the NHS is bleeding out in the government’s waiting room, hoping for a call that never comes.

www.monbiot.com

A lot of people have been asking for an explainer on what is going on with Southwest Airlines and the massive meltdown that has occurred. I’m almost at a loss for words: Southwest is the largest US domestic airline. They serve 23 of the top 25 markets in the US. One of my friends is currently stranded with his cat in Las Vegas, and Southwest can’t get him back home until *checks notes* 2023.

When it suits them Southwest says, in effect, “we’re a small carrier serving small places, the rules shouldn’t really apply to us” (whether it’s safety or anything else) but the reality is that they’re a major airline. They should be considered as such, and treated accordingly.

However, Southwest is highly unusual. Their IT is almost entirely homegrown, with software they built themselves. It’s creaky and antiquated – you’ll observe this if you watch their schedules. They’re irregularly and manually loaded into the system. The majority of airlines use standardized reservations systems like Sabre, Amadeus, etc. which integrate well with other standardized tools. While Southwest has kinda sorta migrated to Amadeus, they only support limited integrations in specific circumstances.

Other airlines (apart from Allegiant, Southwest, Spirit, Frontier and a couple others like Avelo and Breeze) have relationships with airport hotels so they can issue vouchers to stranded passengers and crew. They also work with each other in a system called “interlining” where they take each other’s passengers to avoid total systemic meltdowns like these. For example, when Delta melted down in the past, American and United have bailed them out (and vice-versa). In this case, it’s the week between Christmas and New Year, and there are no seats on other airlines to book their passengers into. Even if there were, there is no interline agreement. So Southwest behaves like an ultra low cost carrier (where you expect poor service and paid a fare to match, rather than the above-market fares Southwest often charges), basically says “see you next week” and dumps you wherever they left you.

So, about aircraft positioning and crew scheduling – Southwest is essentially a short and medium haul airline. They mostly don’t do long haul services except for Hawaii. Southwest turns aircraft quickly, in less than 30 minutes. They have higher aircraft utilization than any other major US airline. They often run their crews on tight loops where they’re out from home and back the same day so they can save money on accommodating crews who overnight away from their home base. This is all really clever and it works really well until it doesn’t.

So when Southwest melted down due to weather events, they didn’t have nearly the number of rooms reserved that they needed for their own crew, and it was Christmas so hotels were full. Crews often did not get rooms. They just got dumped like passengers at airports. At least there are crew break rooms at most airports, but it’s not very comfortable. Major airlines usually have enough hotel relationships to be able to work something out (American has had some issues too) but Southwest does not.

The airline now has a problem where they need to figure out where all of their crews are (lacking accommodations, some have found their own way home), and where their planes are, and whether either are where they need to be, and basically redo their entire crew and aircraft scheduling plan for the whole airline. The only real way they have to do this (because of the way they operate and their limited IT capabilities) is to stop for an entire day and set to work inventorying their assets and crews and then build out entirely new trips for everyone.

However, they were also just really mean to everyone who works for them, and who knows what that will do for the motivation of their employees. They effectively required employees to come to work sick, making others sick just before they’re most needed to recover the operation. Given Southwest’s checkered past with safety, will they pressure employees to work when they really aren’t fit to fly? I personally hope the FAA is watching.

Anyway, how does Southwest fix this? Just like in IT security, every time there is a high profile problem, there is a vendor promising to magically fix everything with AI. Unfortunately, just like in IT security, the problem space is also very complicated and AI is not good at solving most of these problems. One way they could handle it is already proven, it’s just expensive: holding crews and aircraft in reserve to recover from irregular operations. Qantas successfully does this.

A week ago, Qantas had an A380 unexpectedly land in Azerbaijan. They thought there might be a fire in the cargo bay so they landed in Baku. It turned out there was a real problem with the aircraft and it couldn’t be promptly repaired in Azerbaijan, a country which doesn’t frequently see A380s. So, Qantas sent a rescue flight, something that Southwest has repeatedly proven they lack the capability to do. Because Qantas plans ahead for emergencies (and they absorb the expense of doing so), they were effectively able to recover their operation.

To be fair, it’s not just Southwest who does their route planning this way. You see the same sort of problems with Flair Airlines in Canada. They’re an extreme example but fairly representative. Flair serves 34 destinations with 24 aircraft. You can imagine the follow-on impact if any flight, on any leg, has a problem. So why would an airline do this? It seems crazy, right? Well, it’s a question of incentives.

This holiday season could have worked out really well for Southwest, had everything gone according to (a very aggressive) plan. Southwest did their route planning the same way that most American companies do supply chain planning: “just in time” with no slack or contingency planning. If it all melts down, they simply dump the problem on their customers. Southwest, after all, legally has no responsibility to practically anyone except for their shareholders. They are covered by their Contract of Carriage and US Department of Transportation rules (which are lasseiz-faire at best).

You didn’t get home for Christmas? You got stranded in Las Vegas for a week? Well, dear consumer, Southwest won’t help you, the government won’t help you, nobody will compensate you for the losses you suffered, and you also can’t sue because the federal government has given airlines a liability shield along with endless taxpayer bailouts. If you don’t like it, you’re looking at one middle finger from the federal government, and another from Southwest.

One last piece of airline trivia before I leave you all to digest this post. American Airlines cancelled less than 1% of its schedule yesterday. Southwest cancelled over 70% of its schedule. Southwest will likely (successfully) claim that under the Contract of Carriage, they do not have to pay for stranded passengers’ hotels. Keep this in mind any time that politicians show up saying that every problem will be fixed with tort reform to keep evil class action lawyers from driving up costs.

What’s the fix? Liability. Airlines are actually run by really smart people. They’re just allowed to optimize for only one thing: shareholder returns. As it turns out, this hasn’t worked out any better for essential services like airlines than it has for any other sector of the US economy. We need to be OK with the idea that corporations have obligations other than shareholder value, and those obligations extend for longer than this quarter’s earnings call. Create damages which aren’t excluded from class action liability, and airlines will suddenly become extremely interested in reliability (as well as extremely interested in a DOT-regulated standard for weather delays and disruptions).

I don’t personally think re-regulating is the solution, as many pundits have proposed. Instead, financial accountability is the solution. The US should just copy EU 261 from the European Union. It has worked very well to improve airline reliability in Europe because there are actual financial penalties paid to consumers. There have still been occasional meltdowns, but far smaller scale than the largest domestic passenger airline in the US entirely collapsing for multiple days.

Some people will say that this will drive up costs, making flying more expensive. With respect, I observe that you can routinely fly over 1,500 miles within Europe for under 22 euros:

It’s long past the time that airlines should get a free pass (if they ever should have). Real, financial penalties are a market-based solution to encourage airlines to improve reliability. Organizations respond to incentives, and the federal government must create the right ones.

Those of you who are regular listeners of the show will know that I got kinda obsessed with the epic saga of Sam Bankman-Fried and FTX, the massive crypto exchange that just collapsed and nuked like, $30 billion of funny money and probably like $8 billion real dollars.

As soon as the company collapsed stories started to filter out about FTX’s sister company, Alameda Research, which apparently gambled away the client funds that went missing in a manner likely to result in prison time for several people. The financial press seemed particularly fascinated by Caroline Ellison, the 28-year-old CEO of the company, on-again-off-again polyamorous lover of Sam Bankman-Fried, and Harry Potter devotee.

I’m not particularly interested in finance or the nitty gritty of Crypto, but I am endlessly entertained by the way the mainstream press rode the dicks of the people who ran FTX and Alameda. The short of it is that FTX and Alameda were big gambling platforms, in which nerds in their late 20s with delusions of grandeur bet on what are called “shitcoins” while giving interviews about effective altruism and claiming that all of this was being done in the service of charity.

The way the tech press fell for this is fascinating, but today we’re going to look at some of the ideology that helped inspire the greatest disaster in crypto history. And to tell that story, we need to look back at Caroline Ellison, and her obsession with Harry Potter.

I think the first reporting on this I saw was from the totally legit reporting platform “efinancialcareers.com”, which simply noted:

“Before joining Alameda as a trader in March 2018, Ellison spent 19 months as a junior trader at Jane Street after graduating from Stanford University with a bachelor's degree in mathematics in 2016. In a podcast two years ago, Ellison explained that Jane Street was her first job out of college. A diehard mathematician and Harry Potter fan born of two economists, Ellison she hadn't wanted to go into trading but "just didn't really know what to do" with her life.”

A Forbes article, published November 18th, provided more information, claiming Ellison was a “Harry Potterhead”, and that her parents first started reading the books to her when she was three years old.

But if Caroline were just obsessed with the normal Harry Potter series, I would not be writing about it.

Her old Tumblr existed under the name “WorldOptimisation”. Gawker revealed this for an article in which they also noted she was heavily into fan fiction. Several folks on Twitter pointed out that the phrase “World Optimisation” has its origin in another piece of fan-fiction, an epic re-write of the first Harry Potter book called Harry Potter and the Methods of Rationality.

If you are a normal, decent, well-socialized human being, you probably have not heard about Harry Potter and the Methods of Rationality. Actually explaining what this thing is will have to happen in several different stages. But I should start by telling you this re-write of the first Harry Potter book is around 660,000 words long.

The entire Lord of the Rings series, including The Hobbit, comes in at a little less than 580,000 words.

About ten years ago, when the first chapters of Rationalist Harry Potter were posted by a guy name Eliezer Yudkowsky, it was quickly heralded by a weird number of mainstream media figures as a work of brilliance. Legal scholar William Baude, writing for the Washington Post, called it "one of my favorite books written this millennium" in 2015. In 2021, Joe Biden appointed him to the Presidential Commission on the Supreme Court.

Ben Wikler, Chair of the Wisconsin Democratic Party, called Rationalist Harry Potter "the #1 fan fiction series of all time," in The Guardian. David Whelan, writing for Vice, called it “curiously mind-altering” and we’re going to come back to that Vice article in a second because it is very silly. All these guys are very silly.

(William Baude (left) and Ben Wikler (right), two normal dudes who wrote articles about a 600,000 word Harry Potter fanfic and went on to high-powered jobs in the Democratic establishment. This is very funny, as is the fact that Will’s Wikipedia picture seems to have been screencapped during a Skype call while Ben got the best head-shot J.C. Penney could provide.)

First: what is Rationalist Harry Potter about? The story itself is an alternate version of Harry Potter history, where Aunt Petunia’s sister receives the magic equivalent of elective surgery (via her sister Lily) which makes her hot, so she marries an Oxford professor instead of Vernon Dursley. Lily and James still get murdered by Voldemort, so Hot-Petunia and Oxford guy raise Harry, who is also a supergenius in this story.

When Rational Harry Potter he gets his invitation to Hogwarts and learns that magic is real he decides to apply the scientific method to understanding and manipulating the arcane arts. That’s actually not a bad premise for a fan-fiction, or even a work of original satire inspired by the Harry Potter series. Let me assure you that Eliezer Yudkowsky does nothing cool with this idea beyond introducing it.

In a broader sense, the “story” of Rational Harry Potter has very little to do with what the book is about: Rationalism.

Rationalism is a school of thought dedicated to encouraging people to act more rationally, using reason instead of subjective experience to navigate the world. “But Robert,” I hear you cry, “people’s opinions about what the ‘rational’ choice is in different situations can vary wildly, and the scientific method simply doesn’t apply to many of the most important decisions human beings have to make in life.”

Yes, that’s true, but in another, more important way, it’s false, because the world’s sole arbiter of Rationality is Eliezer Yudkowsky, a man who spent five years writing a Harry Potter fanfic so long the audiobook for it clocks in at 500 hours.

In interviews, Eliezer has claimed Rational Harry Potter was written to push the rational skills he promoted in his online community, LessWrong. LessWrong is now sorta defunct, but at its height it was basically a weird little online cult dedicated to Yudkowsky’s teachings. We’ll talk about him more in a bit, but Rational Harry Potter was basically conceived as an advertisement for LessWrong and it worked spectacularly well in that task.

Reading Rational Harry Potter is supposed to equip you with skills to act less irrationally and gain the kind of super-powers the bad sort of psych nerds think you get from reading enough neuroscience abstracts. Here’s how David Whelan explained it in that Vice article I promised we’d return to:

“All those times in the original where Harry grieved over his dead parents or said precisely the wrong thing to Cho Chang to get in her pants, turns out he was acting irrationally.

This new Potter, though, doesn't. He's basically the Jesus Christ of Rational Thought. He owns this book. He hits Voldemort out of the fucking park with a bunt while scratching his ass with his foot. And—here's the kicker—if you start copying him—that is, making rational decisions that overcome cognitive biases—you, too, can make life your bitch.”

First off, none of this is actually true. While Eliezer’s Harry Potter is obsessed with rationalist thought experiments and Bayes’s Theorem, he very rarely solves any problems via logic and intelligence. Instead he gets a time-turner (Harry Potter time machine) right away and then uses time travel to solve nearly all of his problems. I have read roughly 100,000 words of this stupid thing, along with a chapter-by-chapter review by an actual scientist. If you’re the kind of person who learns useful life lessons from Rational Harry Potter, you’re probably multi-billion dollar fraudster Caroline Ellison.

Speaking of which, remember when I said her Tumblr name “WorldOptimization”, was a reference to Rational Harry Potter? It comes from this line, spoken Eliezer’s 11-year-old protagonist:

"World domination is such an ugly phrase. I prefer to call it world optimization."

Rational Harry Potter spends a mind-numbing portion of the book’s total length discussing his desire to take over the world once his rationalist skills allow him to hack magic. He is not depicted as being a bad guy for wanting this.

World domination is a background theme that runs through the whole online rationalist community. In February of 2021 Caroline Ellison posted a list of “cute boy things” that, not by coincidence, describes the protagonist of Yudkowsky’s fanfic perfectly:

There’s a lot more here because the story of Rational Harry Potter, and the community around it, eventually ties into Peter Thiel, Elon Musk, and some of the worst science-fiction I’ve ever read in my life. And if you want to learn more about all that, I’ll be going into much more depth on it with Margaret Killjoy, in an upcoming live episode of Behind the Bastards.

You can buy a ticket now! The show is December 8th, at 6PM PST, and will also conclude a live Q&A afterwards! If you can’t make that time, you can still buy a ticket and watch the replay for whole week. So if you found this article interesting, or you just like Behind the Bastards and think seeing my face during an episode would be neat for some reason, book today!

Back in September of 2014, as the alt-right began to bubble up from the cracks left by Gamergate, Peter Thiel published an article in Wired magazine. It was titled, “You Should Run Your Startup Like a Cult. Here’s How.” The article that followed was, mostly, quite milquetoast, a few thousand words on motivating tech workers excerpted from Peter’s recent book, ‘Zero to One’. There are however some noteworthy lines, like this one:

“In the most intense kind of organization, members abandon the outside world and hang out only with other members. We have a word for such organizations: cults. Cultures of total dedication look crazy from the outside. But entrepreneurs should take cultures of extreme dedication seriously.”

Peter goes on to express his distaste for companies like Accenture, a consulting firm with a rapid turnover of employees who have “no long-term connection” to each other whatsoever. He then provides this…interesting graph:

It’s probably worth noting here that ‘Zero to One’ was co-written by Blake Masters, who this year ran for one of Arizona’s Senate seats backed by a pile of Thiel-bucks. He starred in a famously off-putting ad in which he fired a suppressed pistol into the water after repeatedly fawning about the fact that the firearm was made in Germany. Masters lost badly (by around 5%) to Mark Kelly, an actual astronaut.

Masters blamed gun violence on “black people, frankly” and expressed a belief that gay marriage should be banned (he attended his own boss, Peter’s, wedding). The fact that Thiel thought this serial-killer-ass-looking dude:

…could win an election, might suggest that he wasn’t entirely off base when he compared the working environment at his companies to a cult. You have to be living in a very specific reality tunnel, one far detached from your fellow man, to think Blake Masters was ever a good candidate. If Thiel is, in fact, a cult leader, this kind of detachment makes sense. A defining characteristic of cult leaders is that they all wind up floating in their own alternate reality.

There is one more line in that article I find interesting:

“The best startups might be considered slightly less extreme kinds of cults. The biggest difference is that cults tend to be fanatically wrong about something important. People at a successful startup are fanatically right about something those outside it have missed.”

Peter Thiel is, of course, an avowed monarchist who spends oodles of cash bankrolling fascist causes. It would be foolish to assume this article expressed 100% of his honest feelings. But that paragraph above is interesting to me because it is basically never true. I want you to think through the great tech enterprises of our day and tell me how many fit that description.

When I look at the annals of successful tech unicorns, I don’t often see people who were “right” about something “those outside” missed. Instead, I see people who succeeded in building little cults around their products in the tech press, and out of their customers. When Google blew up, it’s not because they were “right” about the need for a search engine, something the rest of the world ignored. It’s because they were the first to do a good job of building something everyone knew was necessary. The ‘Don’t Be Evil’ stuff, the legendary perks and corporate culture (anyone remember ‘The Internship?’) that all came later, grafted onto the scaffolding of a bafflingly useful tool.

Speaking of tools!

You can see variations of the same story with Microsoft, with Apple, with Mozilla and Facebook and so on. This started to become much less true in the oughts, as the overnight start-up sensations became companies like Uber, Theranos, various Crypto scams or one of those services that littered downtown city streets with hundreds of rentable scooters. For these companies, the central service was either an outright con, or fundamentally unprofitable.

Everyone inside Uber knew they were running against the clock on whether or not they could get self-driving cars to work before the VC funding ran out. They were not, by and large, deluded about the reality of what it would actually take to make the company profitable. What mattered wasn’t so much whether or not they could get the tech to work, it was whether they could keep people convinced they could long enough to cash out.

‘Keep the con going long enough to cash out’ is the central operating tenet of Silicon Valley, and the best way to do that is to build a cult, a closed information loop that creates a separate reality tunnel so the people shoveling cash at the project never guess that failure is possible. Every collapsed Crypto exchange and shitcoin is a variation of this story.

But cults need cult leaders. And that’s where the billionaires come in.

Tesla brought Elon Musk the bulk of his fortune, and though the company was founded on the back of some very cool technology, it became a household name off the back of Elon Musk’s fame. It didn’t matter that Tesla, the company, only achieved profitability by selling carbon credits, a form of climate indulgence, to other car companies. Musk was going to save the world, or at least take us to Mars.

Elon Musk was a good enough confidence man that Tesla stock wound up overvalued by around $1 trillion. But along the way he made the calamitous mistake of believing in his own bullshit. Friends and business partners who knew him in more rational days will point out that he’s become surrounded by yes-men and sycophants, as his wealth has allowed him to gradually elide the discomfort of ever being challenged.

A version of this happens to every person who makes enough money. Wealth and power can impact the brain in ways that mirror brain damage, causing a loss of impulse control and compassion for other people. And that’s just the case for folks who wind up normal-ass rich, without millions of weirdos worshipping them as the techno-messiah.

The evidence is all there. Think of the time, in 2018, he tweeted himself into a $40 million dollar settlement with the SEC just so he could make a “420” joke. Or the time he grew so enraged that he couldn’t make himself the center of a story about a bunch of starving children stuck in a cave that he accused one of the rescuers of pedophilia. These are the actions of a man who has grown enraptured by the myth of his own importance.

When I read stories now, of Twitter employees shitcanned for criticizing Elon in private slack chats, I can’t help but think of L. Ron Hubbard living on the high seas in a fleet of cruise ships with his most dedicated followers. Whenever someone would ‘fail’ him, he’d have his other followers fling them over the side of the boat and into the ocean.

As I was writing this essay, a tweet from the ‘Whole Mars Catalog’ (a major Tesla stan) hit my timeline:

Whole Mars Catalog @WholeMarsBlog

If you're trying Tesla Full Self-Driving Beta for the first time, it's important to remember that it will at some point randomly try to kill you. This is a when, not an if. As such you must keep your hand on the wheel and be ready to takeover at any time. You must pay attention

6:57 PM ∙ Nov 22, 2022

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1,475Likes136Retweets

I finished Season 2 of The Vow recently, and it struck me that there’s at least a little Keith Raniere in Elon. The need for his followers to prove their devotion to the ‘smartest man on earth’ by taking on incredible risk is, at least, similar.

It’s possible that the cult of Elon Musk has been irreparably damaged by his acquisition of Twitter. The naked preference he’s showed members of the far-right, including unrepentant fascists and anti-Semites, has turned off a lot of former casual believers. Every cult leader has a point at which they fall too far into the reality tunnel they’ve carved for their cultists.. What happens after this point varies (L. Ron Hubbard disappeared to write incomprehensible books in the desert, Keith Raniere went to prison, etc) but there is always a moment of collapse.

This brings me to the story of perhaps the greatest billionaire cult leader in history: Steve Jobs. The co-founder of Apple had an enviable library of successes. His company invented the personal computer, and when he was eventually forced out as CEO, he helped found Pixar, then came back to Apple and presided over the release of the iPod, iPhone and iPad. All of these devices were built by other men, of course, but Jobs made them part of his vision of our future.

In books about Apple, a term you’ll here again and again is “reality distortion field”. Because I’m a lazy man, I’ll refer you to Wikipedia here:

This is interesting to me in part because Steve Jobs is still the most successful example of the “visionary tech founder” archetype. His ability to distort reality, manipulate geniuses like Wozniak, and convince investors and shareholders to believe in his vision of the future remains unequaled.

Steve, in the years where he was most powerful, had much more self-control and discipline than Elon Musk. He ran a famously tight shop. Leaks from Apple were rare, and he communicated with the public almost exclusively through speeches more choreographed than a musical from the 1950s. Yet Steve, too, fell victim to his reality distortion field.

In 2003, during a CT scan to check for kidney stones, doctors saw a “shadow” on Steve’s pancreas. Further tests showed that it was cancerous. The good news was that the specific kind of pancreatic cancer he had was rare, and treatable. Given that he could afford the very best doctors on earth, his prognosis was good (at least, ‘good’ for pancreatic cancer).

But Steve refused surgery. For nine months he resorted to his own concocted list of radical dietary changes and alternative medical treatments. He told his biographer, Walter Isaacson: “I didn’t want my body to be opened…I didn’t want to be violated in that way.”

The people who loved Jobs attempted to puncture his reality tunnel during this period, and convince him to treat his cancer. But he would not listen. As Walter Isaacson, later told CBS:

"I think that he kind of felt that if you ignore something, if you don't want something to exist, you can have magical thinking. And it had worked for him in the past.”

It remains a central tenet of my own personal belief system that there is no such thing as a genius. Tests that seek to show intelligence rarely show more than the skill at solve a particular kind of puzzle. But the grand mythology of the tech industry is built around a fantasy of hyper-competent, Randian gods and goddesses, holding up candles to light the way for us poor, blinkered fools stuck in the dark.

The reality is that billionaires are fools as often as the rest of us; nearly 100% of the time. A man like Elon Musk can throw away fortunes to fuel his ego, but eventually his flights of fantasy will lead him out into open sky, with no ground beneath him. Gravity will do the rest.

The dreaded and much anticipated triple-demic is finally here—for the first time RSV, flu, and COVID-19 are rising together. And it’s not looking pretty. Here is the current state of affairs.

Overall

Every Friday the CDC updates their “influenza-like illness (ILI)” data. This is a database in which providers tally patients that presented with ILI—a fever and a cough and/or sore throat—at their office. So these numbers include everything (flu, RSV, COVID-19, etc.) and are a general indication of the climate of respiratory of health in the United States.

Last Friday Twitter covered my reaction to the latest data pretty clearly: Holy crap. There are a lot of sick people in the United States right now.

This level is truly unprecedented; we’ve never seen such high levels of ILI activity at this time of year. The map above is typically green (see below for this time in previous years). In fact, notice that before 2019, we didn’t even have the dark red/purple colors.

Yesterday, the CDC Director said: “hospitalizations are the highest now than they have been in the past decade.” This is truly concerning given a backdrop of burnt out healthcare workers and low staff levels.

While ILI surveillance gives us a picture of symptoms overall, we do have some (imperfect) surveillance for specific diseases.

RSV

RSV continues to rise. We may be seeing the first signs of peaking on a national level (bottom right graph). This is expected given that test positivity rates have already clearly peaked (bottom left graph). There are certainly regional differences, as the South has clearly peaked (at least so far—Thanksgiving activity may change this) and West hasn’t slowed down yet.

Flu

Flu cases are increasing and increasing fast. Flu hospitalizations are lagged (much like COVID-19) but increasing. Flu season outbreaks typically start in schools (hitting healthy children). Then the virus takes time to get to older adults. We expect hospitalizations to continue to rise in weeks to come.

In Canada, hospitalizations by age are clearly tracked. The highest risk for hospitalization is in those under 4 years old and those over 65 years. This likely reflects U.S. patterns, too.

As Inside Medicine reported, for the first time during the pandemic, flu hospitalizations overtook COVID-19 hospitalizations last week. This may be a one-off occurrence since COVID-19 hospitalizations are increasing now, too, but it is noteworthy.

We don’t know if this will be the “worst flu season we’ve ever seen.” The Southern Hemisphere (Australia specifically) had a high number of flu cases but moderate levels of hospitalizations. Epidemiologists are crossing our fingers that this is what the Northern Hemisphere will see, too.

COVID-19

COVID-19 is on the rise across the globe due to the combination of seasonal changes, behaviors changes, and the variant soup. In the U.S., all signs point to the beginning of a wave. For example, SARS-CoV-2 in wastewater is rapidly increasing across all regions.

One major concern is the rapid rise in hospitalizations among older adults, which has exponentially increased 28% in the past two weeks. In many states, like California, the rate of hospitalizations is higher than the BA.5 wave, BA.2 wave, and/or Delta wave.

This is partly (or wholly) due to abysmal vaccination rates—only 1 in 3 adults over the age of 65+ have their fall COVID-19 booster. A public health failure. Without a recent booster, many people are technically vaccinated but not protected. I appreciated a recent U.K. public health campaign displaying the best messaging I’ve seen thus far.

Thanksgiving was 1.5 weeks ago, and because of it, many social networks expanded, providing new opportunities for viruses to spread. For COVID-19, it takes about ~2 weeks to see the epidemiological impact of holidays. The recent COVID-19 uptick may be partially explained by a “Thanksgiving effect,” although we are seeing an uptick in other countries that don’t celebrate Thanksgiving. I expect Thanksgiving will springboard us into more RSV and flu, too, but this surveillance is delayed.

Bottom line

This viral season is like no other. I’m running out of adjectives to describe it. (Unprecedented. Worrisome. A pain. Exhausting.) Unfortunately, we don’t know how long this will last or how bad it will get. I’m especially concerned for hospital systems, kids under 5, and adults over the age of 65, as they are at highest risk.

There’s a lot we can do: mask, test before seeing loved ones, get that airflow moving, stay home when you’re sick. The least you can do for a healthy season is get a flu and fall COVID-19 booster. If you haven’t gotten one yet, it’s never too late.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:

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