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The Science of Superspreading

Bottom line: in order to stop (or realistically, suppress) the COVID-19 pandemic, we need to deal with hot spots of transmission a.k.a superspreading.

These days it seems like everyone and their pet wombat has become a COVID-19 expert overnight. I’m including myself in this category of ‘experts’, because in reality, I’m not an epidemiologist or infectious diseases physician. That’s why I’ve largely refrained from writing about COVID-19, apart from sharing important information every now and then such as this article entitled Should I Wear A Mask In Public All The Time? (published in early April this year).

However, that doesn’t mean we shouldn’t continue to learn about the disease. I strongly believe in educating the public, so that we can make informed decisions about what to do as a society trying to weather a pandemic.

This week, I strongly suggest that you spend a few minutes reading this article on ‘The Science of Superspreading‘. Despite the scary-sounding title, it’s actually really easy to read, and comes with some excellent illustrations in case you’re one of those people who feel faint when confronted with a wall of text.

As shown above, the key takeaway point is that:

Most people don’t infect anyone else. A small percentage of people cause most of the transmission.

For the general public, I think the above point is the most important thing to understand right now. But if you’re a card-carrying member of the Nerd Alert Society, then you might want to start reading about k.

Oh man, we’ve just spent ages trying to understand r, and now you want us to learn a totally different letter of the alphabet?

Err, yeah!

So if R0 (R nought) is the number of people, on average, infected by a single infected person, then k is the measure of dispersion for the disease. It’s a way of asking: does the virus spread in a steady manner or in big bursts? Here’s a really good article by Zeynep Tufekci on how ‘This Overlooked Variable Is the Key to the Pandemic‘.

So what?

If you accept that superspreading is an important feature in COVID-19, then it becomes obvious that we should promote measures that prevent superspreading. This is the rationale for avoiding the three Cs:

  • Crowds
  • Close contacts
  • Closed spaces with poor ventilation

The article also mentions backward contact tracing, but I think that’s more relevant for the authorities. So yeah, that wraps up our lesson for this week. Remember kids, ‘knowing is half the battle’!

Meanwhile…

As I’m writing this, Oxford has just entered Tier 2 of COVID-19 restrictions in the UK. This is probably the least surprising bit of news this week for me, considering the rapid rise in the number of infections here.

I’m not knowledgeable enough to come up with a fool-proof solution for the pandemic, so I don’t envy the authorities who actually have to deal with it. Increasingly though, I see people protesting against the myriad of restrictions imposed on the community. Here’s a picture I took on the 9th of October in the city centre:

COVID-19 protest

Instinctively, I feel like this is not the best response to our current situation (to say the least). But on the other hand, I fully recognise how lucky I am not to have to worry too much about work, health, finances etc. As more and more restrictions come into place, I can’t help but wonder how people will cope psychologically.

So if you’re reading this, I’d like to encourage you to reach out to your loved ones, check on them, make sure they are OK even if you can’t physically be with them. It may not seem like much, but to some people, it may mean the world to them.

Stay safe…

Update:

Thank you Dr Ahmad Munawwar Helmi (over on Facebook) who pointed out this article written by father and daughter team, Dato’ Dr Musa Mohd Nordin and Dr Husna Musa, on the need to think beyond R0 and movement control orders.

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The Value of Failure

Like many others around the world, I waited with bated breath for the outcome of the Ultimate Fighting Championship 254 bout between Khabib “The Eagle” Nurmagomedov and Justin “The Highlight” Gaethje.

True to form, Khabib won the fight alhamdulillah and in a surprise move, announced his retirement saying he had promised his mother that this would be his last fight.

Khabib Nurmagomedov vs Justin Gaethje

I’m not a fan of the UFC, but I always make an exception when Khabib’s name comes up. It’s not so much his prowess in the octagon, but the way he carries himself outside it. This has won him many admirers, including Malaysia’s own Minister in the Prime Minister’s Department, Datuk Dr Zulkifli Mohamad al-Bakri, who wrote about the lessons we can all learn from Khabib’s career, namely:

  1. Obey your parents
  2. Pray to God always
  3. Success is followed by the ‘sujud syukur’ (prostration of gratitude)
  4. Never boast
  5. Retire when you’re at the top
  6. Respected by friends and foes

Learning from failure

One thing that struck me after the victory, however, was this interview with Justin Gaethje. I quote:

Interviewer: You said something to him when he was down on the floor, obviously…very emotional…talk us through it, what did you, what words did you offer him?

Justin: I said, I haven’t had a chance to tell you that I’m so sorry for your Dad’s loss, but you just made your father really proud.

Interviewer: That says a lot about yourself as well, the way that you operate, my man, and it was nice to hear Khabib pay you that compliment as well afterwards…

You really should watch the video of the interview:

How a person carries himself/herself in the aftermath of failure tells you a lot about their true character. I hope more people can learn from this.

Failure is not the end of the line. There’s no shame in failure if you have given it your best. Take it on the chin, or in Justin’s case, wake up from the ‘sweet dream’ after a choke, get right back up and have another go at it. Good luck!

Update:

Instagram post from Khabib. True champion.

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Headington Shark

Location: 2 New High Street, Headington, Oxford

Look, it’s the famous Headington Shark!

You know, if ever your kids have trouble believing that climate change is making the weather more extreme, you could just take them for a stroll around Headington. Just sayin’…

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Times Like These

Imran Idris

It’s times like these you learn to live again
It’s times like these you give and give again
It’s times like these you learn to love again
It’s times like these time and time again…

Looking forward to another week of MRIs and neuropsychological testing. Never thought I’d say this, but I actually miss doing clinical work! Definitely considering starting a Cognitive Neurology Clinic once I’m back in Malaysia.

Have a good week everyone! Stay safe, and look out for each other.

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Dead Office Plant

Dead office plant

Location: Jericho, Oxford

Another (indirect) casualty of COVID-19.

See also:

Winter Coats, Apocalyptic Vibes Greet Workers Returning to Deserted Offices

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A Good Night’s Sleep

Someone asked me the other day if I had any good tips about how to get a good night’s sleep. I’ve written previously about how sleep is crucial for your cognitive abilities, but in truth, the benefits of sleep extend far beyond that. Sleep also helps to:

  • Reduce your cardiovascular risk
  • Prevent diabetes and obesity
  • Enhance the function of the immune system

…amongst many other benefits.

Like many things in life, it is important to get the balance right when it comes to sleep. Too much sleep is detrimental, obviously, but too little sleep can also be harmful. Our culture often glorifies people who can get by with very little sleep, when they are effectively just killing themselves slowly with their so-called ‘productivity’. Bottom line: apart from the quantity of sleep, the quality of sleep also matters.

So, how can we get a good night’s sleep? What brand of sleeping pill should we go out and buy?

The first thing to note is that sleeping pills are very poor treatments for insomnia (the medical term for when you have trouble falling and/or staying asleep). They don’t produce natural sleep; we know this by looking at what happens to your brainwaves when you sleep naturally vs when you are in a drug-induced sleep. Pills mostly work in the short-term only, with a risk of rebound insomnia when you stop treatment. Overall, I’d try my best to avoid sleeping pills if at all possible.

Tips for sleep

So, back to the original question: how do we get a good night’s sleep? For the vast majority of people, the best answer to that question is to learn how to develop good sleeping habits.

Thankfully, the National Institute on Aging has prepared some tips for developing good sleeping habits. I’m going to quote them (in bold text) here because they are excellent:

  • Follow a regular sleep schedule. In other words, go to sleep and get up at the same time each day.
  • Avoid napping in the late afternoon or evening. D’oh!
  • Develop a bedtime routine. Just like your computer needs some time to shut down, you also can benefit from having a ‘shutdown’ routine. It’s difficult to just fall asleep the moment your head hits the pillow. Much better to relax before bedtime in order to prepare you for sleep.
  • Try not to watch television or use your computer, smartphone, or tablet in the bedroom. Stop refreshing your Facebook feeds and read a good book instead.
  • Keep your bedroom at a comfortable temperature. This is an opportunity to practise your diplomacy skills i.e. when trying to reach an agreement with the spouse as to what a ‘comfortable temperature’ is.
  • Use low lighting in the evenings.
  • Exercise at regular times each day. Ideally, not within 2-3 hours of bedtime so that you body has time for its shutdown routine.
  • Avoid eating large meals close to bedtime.
  • Stay away from caffeine late in the day. Caffeine can take up to 8 hours to wear off fully. Nicotine is also a stimulant, so yeah, stop smoking before bedtime. Also, stop smoking during the day. In fact, just stop smoking OK?
  • Remember—alcohol won’t help you sleep. No nightcaps please.

I hope the above information will help you get a good night’s sleep.

Finally, if all else fails, there’s always the audiobook of Samuel L. Jackson reading ‘Go the F**k to Sleep‘. You’re welcome!

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Leuchtturm 1917

The key to happiness is learning to appreciate the little things in life, like this Leuchtturm 1917 notebook that I’ve just bought for a super secret project of mine.

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Train Your Brain

Wouldn’t it be nice to be able to pop a pill and magically become smarter? Of course it would. In the movie Limitless, struggling writer Edward Morra tries a new nootropic drug called NZT-48 and suddenly turns into a genius. Absolutely brilliant, job done, see you later!

Naturally, things are not so straightforward in real life. A recent study by Cohen et al published in Neurology Clinical Practice (DOI: 10.1212/CPJ.0000000000000960) found that many over-the-counter (OTC) cognitive enhancement supplements also contain unapproved drugs. A supplement to supplement your supplement, if you like. The authors conclude by saying that ‘the health effects of consuming untested combinations of unapproved drugs at unpredictable dosages without clinician oversight in supplements is unknown’ (emphasis mine).

Unfortunately, many people still believe in the power of OTC supplements to boost their cognitive abilities. Why is this so? I think it has to do with our desire to shortcut the process to becoming more intelligent. I mean, who’s got the time to read all these books eh? TL;DR…lukis boleh? Etc.

Let’s make it clear then: if you want to be a smart person, the smartest thing you can do right now is to stop buying all these nonsense supplements. None of them have been shown to work, and you might as well donate the money to a more deserving cause.

How To Train Your Brain

So, is there nothing that we can do to train our brains to become smarter?

Of course not. Here are some easy-to-implement suggestions:

1. Get Enough Sleep

In his book ‘Why We Sleep’, neuroscientist Matthew Walker came up with this fictitious advertisement to highlight the benefits of a full night of sleep.

Scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers food cravings.It protects you from cancer and dementia. It wards off colds and the flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You’ll even feel happier, less depressed, and less anxious. Are you interested?

Walker goes on to make the point that if this were a drug, people would be paying exorbitant amounts just to get a small dose into their systems. Unlike the claims made by OTC supplements however, all the above statements about sleep can be backed up by solid evidence.

So, why don’t people promote sleep as a treatment for all these conditions?

My guess is because it’s hard to make money from sleep. You can’t sell it, you can’t buy it for others, and worse still, people who are sleeping tend not to be such excellent consumers. Hard to imagine buying things on Shopee or Lazada while you’re fast asleep!

Bear in mind that we’re talking about good quality sleep here. A full night of sleep begins with your pre-sleep ritual. Do you spend an hour browsing through your Facebook/Instagram feeds, or do you switch off all screens and read a book instead? While you’re sleeping, is your phone still buzzing away with all sorts of useless notifications? These things matter when it comes to determining the quality of your sleep.

2. Healthy Body, Healthy Mind

Apart from getting a full night of sleep, you also need to think about your general physical health. Everyone knows what I mean by that: eat a balanced diet, get enough exercise, stop smoking etc. These measures are not controversial, but if you still want some evidence, check out this recent paper by my colleagues Michele Veldsman and Xin-You Tai in Nature Communications (DOI: 10.1038/s41467-020-18201-5) entitled ‘Cerebrovascular risk factors impact frontoparietal network integrity and executive function in healthy ageing’. One of their key findings is that:

…cerebrovascular risk is associated with reduced cerebral grey matter and white matter integrity within a fronto-parietal brain network underlying executive function.

3. Challenge Your Brain

These days, it is easy to just go through life like a mindless zombie. Many forms of entertainment are effectively infinity pools, designed to suck you in and keep you there for as long as possible. As soon as one YouTube video ends, the next one plays automatically. You can never get to the bottom of your Facebook or Twitter feed thanks to infinity scrolling.

It’s time to break the cycle!

We need to be more mindful about what we feed our minds. Instead of refreshing Instagram for the millionth time, why not try something more cognitively demanding?

Read a good book, solve some Sudoku puzzles, join a really good discussion about current affairs, switch off Google Maps and try to navigate manually, there are endless possibilities for giving your brain a really good challenge.

For Muslims, here’s my personal suggestion: try to memorise the Quran. Whether you get there in the end (i.e. whether you actually manage to memorise all of it) doesn’t really matter. What matters is your effort and ‘istiqamah‘ in doing so. Progress, not perfection. That way, you get to do something cognitively demanding, and spiritually rewarding at the same time.

4. Connect With Others

Last but not least, try to maintain healthy, meaningful connections with others. One of the greatest ironies in today’s world is that we are more connected than ever (thanks to social media) but increasingly becoming more distant from each other.

Most of our relationships are very superficial, reduced to mere ‘Likes’ on Facebook or Instagram. We often know what random celebrities had for breakfast, but don’t even realise that a friend or relative is suffering a serious illness.

How does maintaining healthy relationships make us smarter?

Part of it is the psychological benefit of having a good support network. Part of it is the physical well-being you get from doing various activities together. And a large part of it, I believe, is due to the complex, intricate, delicate nature of human relationships, one that can never be replaced by social media stardom.

It reminds me of this scene from Inception (one of the best movies of all time, by the way) in which Dominick “Dom” Cobb finally makes peace with his guilt over the death of his wife Mal:

Mal: I’m the only thing you do believe in anymore.

Dom: I wish. I wish more than anything, but…I can’t imagine you with all your complexity, all your perfection, all your imperfection. Look at you. You’re just a shade. You’re just a shade of my real wife. And you were the best that I could do, but…I’m sorry, you’re just not good enough.

Inception

I’m not crying, you’re crying. Damn ninjas cutting onions!

So, in summary:

  1. Get enough sleep.
  2. Eat a balanced diet. Get enough exercise. Stop smoking etc.
  3. Do cognitively demanding activities.
  4. Maintain healthy relationships.
  5. Stop buying useless OTC drugs! =)
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Punts At Rest

Punts at rest.

Location: Magdalen Bridge, Oxford

Fancy going punting in the rain? Guess not.

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Questions

From Kottke.org:

The winning entries from the Insight Investment Astronomy Photographer of the Year 2020 competition are here and they are spectacular.

Spectacular doesn’t even begin to describe some of these images!

Here’s my absolute favourite:

This image, entitled ‘Questions’, was taken by New Zealand based photographer Paul Wilson. (Check out his other photos by the way, they are simply mind-blowing!)

Looking at the galaxies above us, one cannot help but wonder how all of this came into existence. All this beauty in the universe, all this majesty, surely it must exist for a reason. I know this is a deeply personal question, one that depends, to a large extent, on your faith and how you view the world around you. For me though, the answer is clear.

The Holy Quran states:

There truly are signs in the creation of the heavens and earth, and in the alternation of night and day, for those with understanding, who remember God standing, sitting, and lying down, who reflect on the creation of the heavens and earth: ‘Our Lord! You have not created all this without purpose—You are far above that!—so protect us from the torment of the Fire.’

Surah Ali-Imran [3:190-191]