== How to prevent the next pandemic == === Bill Gates, 2022, Beaverton Library 614.5924 GAT === https://gatesnotes.com === Background === My first encounters with software were PDP-8 Focal and Fortran at Tektronix and three universities. Then C and Unix at Tektronix. My first "encounter" with Bill Gates was the BASIC software written by Microsoft for the Commodore PET. The PET used a botched version of the IEEE-488 GPIB protocol as a peripheral interface; the Tektronix 4051 graphics workstation implemented GPIB correctly. I wanted to use Tektronix peripherals with the PET, and also an 8 inch floppy drive that I designed a GPIB interface for, but the botched PET firmware wouldn't communicate reliably. So, I read the binary ROM code, and disassembled it into usable 6502 processor source code. There were a few free bytes and inefficiencies in that tightly packed code, I tightened it more and made enough space to fix the GPIB protocol. On a trip to the bay area, I gave my repaired 6502 source and binary (on CPM floppy) to Chuck Peddle at Commodore, along with a commented printed listing. Note that neither the ROM package, nor the code, nor the PET purchase agreement referred to a copyright for that code. Chuck was THRILLED by the listing, and showered me with tchotchkes ... including mechanical blueprints for the PET, but not the schematics, shucky darns. As a leader in the Bay Area hobby computer community, he gave copies of the listing to friends, who copied them for friends, etc. A (9th generation?) copy of my anonymous listing reached Microsoft and Bill Gates. I was told by a Microsoft employee ( a science fiction convention friend ) that Bill Gates threw a carpet-chewing tantrum when he saw the listing ("but it's copyrighted, it says right here in the comments for the source code!") ... but that is probably fiction as well. Anyway, the statute of limitations has expired, Bill Gates has mellowed considerably (thank you Melinda), and I will NOT pay for that old carpet and any long-ago dental repair. That said, I would gladly help Bill Gates stop a pandemic or three. A far better pass-time than dancing paperclip animations and novel-length EULAs and Jeffrey Epstein parties. I very much hope Mr. Gate's motivation is compassion and hope, not past-is-dead guilt or shame or similar handicaps. A vision of health and prosperity for all people, a vision that I share. === The Book Itself === Well written, but it feels mostly ghost-written. As it should be, the mission is to improve global health, not earn authorial fame for Mr. Gates. Another implied mission ''should be'' to convince hundreds of other entrepreneurs like himself to devote the time and resources and vision to help, and create convincing motivations for all eight billion of us, eight billion paths converging towards a plague-free (perhaps someday disease-free) world. (Bill - if you invite ever invite me for dinner, serve veg. COVID happened because wealthy Chinese served raccoon dogs. A few million bucks spent on "better-than-real" fake meat could save millions of future lives, and mega-hectares of nature. Make "super-better" the new luxury meal. Also, [[ https://www.gatesnotes.com/Search?search=Cell%20Biology%20By%20The%20Numbers | gatesnotes ]] does not mention "Cell Biology by the Numbers" 2016 by Milo and Phillips. Fascinating, quantified, beautifully illustrated explanations of MANY things cellular and molecular. You will be engrossed, please do not charge me your hourly rate for the time your irresistable deep dive consumes ). ----- .p10 Nathan Myhrvold worries about lab-engineered bioweapons. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2290382 .p13 [[ https://www.nejm.org/doi/full/10.1056/nejmp1502918 | NEJM The Next Epidemic — Lessons from Ebola ]] 2015 Bill Gates .p13 [[ https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready | TED The next outbreak? We're not ready ]] 2015 Bill Gates . I purchased 1000 surplus/new-in-box 3M N95 masks in 2015, donated MANY in 2020. . 95% of viewers watched this video ''after'' 2019 .p14 [[ https://en.wikipedia.org/wiki/Coalition_for_Epidemic_Preparedness_Innovations | CEPI ]] Coalition for Epidemic Preparednes .p20 2021 White House announced next vaccine 100 day plan .p20 note: vaccine Efficacy:clinical trial Effectiveness:deployed in world .p23 [[ https://vizhub.healthdata.org/gbd-compare | Global Burden of Disease ]], Institute of Health Metrics and Evaluation (IHME) UW Seattle .p24 IHME excess deaths ... not updated after 2021 .p26 COVID success correlates to trust in government .p29 White House refuses help with software .p39 Invest in innovative research, private sector translates to products .p43 analogy to 311K pro and 740K volunteer firefighters in 30K US fire departments, need full time global pandemic response experts .p45 [[ https://goarn.who.int/ | GOARN ]] Global Outbreak Alert and Response Network . related [[ https://depts.washington.edu/einet/about.html | UW EINet ]] .p47 A global epidemic team ( Gates neologism GERM ) would need 3000 full time employees, many skills, $1B/y .p49 1988 to 2021 [[https://www.who.int/ | WHO ]] and [[ https://www.rotary.org/en | Rotary ]] eradicate polio 350K/y -> 5 in 2021 .p53 Early detection [[ https://en.wikipedia.org/wiki/Public_health_emergency_of_international_concern | PHEIC ]] .p57 Disease surveillance: Postal workers in Japan, teachers in Vietnam, US [[ https://en.wikiwhichpedia.org/wiki/Wastewater-based_epidemiology | sewage surveillance ]] .p58 childhood poverty "diarrhea deaths" traced to rotavirus, affordable new vaccine prevented 200K deaths 2010-19 .p59 [[ https://champshealth.org/ | CHAMPS ]] Child Health and Mortality Prevention Service .p59 Minimally Invasive Autopsy .p63 PCR detects lower levels of virus sooner and longer than rapid tests (graph of viral load over time) .p63 pee stick pregnancy test, [[ https://en.wikipedia.org/wiki/Lateral_flow_test | lateral flow immunoassay ]] .p64 [[ https://www.lumiradx.com/us-en/ | LumiraDX ]] .p65 [[ https://www.biosearchtech.com/products/pcr-reagents-kits-and-instruments/pcr-instruments-and-software/array-tape-ultra-high-throughput-platform/nexar | Nexar ]] "from Douglas Scientific", acquired by LGC Biosearch Technologies .p66 Infectious disease experts at [[ https://www.fredhutch.org | Fred Hutchinson Cancer Research Center, Fred Hutch ]] .p66 [[ https://idmod.org/ | Institute for Disease Modelling ]] IDM .p67 Seattle Flu Study 2018, 3 year .p69 phylogenetic tree models influenza spread through community .p79 Hutch [[ https://www.fredhutch.org/en/faculty-lab-directory/bedford-trevor.html | Trevor Bedford ]] and IDM [[ https://www.idmod.org/user/39 | Mike Famulare ]] find closely related COVID cases .p74 March 2020 [[ https://familymedicine.uw.edu/blog/seattle-coronavirus-assessment-network-scan/ | Seattle Coronavirus Assessment Network ]] SCAN .p75 feds order halt in May 2020, policy loosens two weeks later, restart June 46K tests (mostly home) before 2021 .p78 [[ https://www.sacema.org/ | South African Center for Epidemiological Modelling and Surveillance ]] detected and characterized Omicron in late 2021 . and of course, ideologues blamed South Africa for creating Omicron, instead of detecting it arriving from the rest of Africa .p78 [[ https://www.lshtm.ac.uk/ | London School of Hygiene & Tropical Medicine ]] .p80 March 2020 UK epidemiologist [[ https://en.wikipedia.org/wiki/Neil_Ferguson_(epidemiologist) | Neil Ferguson ]] predicts 500K UK and 2M US deaths ''IF'' people do not change their behavior .p81 Out of 30 most recent outbreaks, 3/4 involved nonhuman animals (no cite, '''which''' animals? Insects mostly?) .p84 On Immunity (2014) by Eula Biss, Beaverton Lib 616.079 BIS .p86 NPI Non Pharmaceutical Intervention .p86 "If it looks like you're overreacting, you're probably doing the right thing." Anthony Fauci .p87 1918, Philadelphia locked down 2 weeks after St. Louis, suffered 8x peak death rate .p89 South Africa identified Omicron, consequently sanctioned with a travel ban .p91 Infection Fatality Ratio graph, 0.1% 35, 1% 60, 4.8% 75, 30.4% 95 .p91 school closures reduce disease spread, save teacher's lives, but widen achievement disparities .p92 frequent testing and teacher vaccines first .p93 Future pathogens may be different, necessitating different strategies .p96 2020-2021, flu dropped 99% .p98 Daily testing as effective as school closures .p99 Pre-Omicron, 80% of infections spread from 10% of cases, 70% or cases no spread at all (hence 20% from middle 20%) .101 Airborne COVID lingers longer than expected, low transmission via fomites .103 Open windows good, air filters better .104 more distance better, no magic cutoff at 6 feet .105 1910 Manchurian pneumonic plague, physician Wu Lienteh promotes masks .106 2 infected Missouri hair stylists + 139 clients with masks, no transmission, outside salon, one stylist without mask infected 4. .107 cloth masks stop half, plus surgical masks stop 85%, tight-fitting N95 respirators even better .108 KN95 around ears, N95 around back of head .109 end of 2021, Japan 70ppm excess deaths, US 3200 ppm .113 hydroxychloroquine - green monkeys yes, humans no .114 hospital [[ https://en.wikipedia.org/wiki/Dexamethasone | dexamethasone ]] reduced cytokine storms by 30% .115 monoclonal antibodies mAb, p116 perhaps [[ https://en.wikipedia.org/wiki/Sotrovimab | Sotrovimab ]] .117 [[ https://en.wikipedia.org/wiki/Molnupiravir | Molnupiravir ]] [[ https://en.wikipedia.org/wiki/Nirmatrelvir/ritonavir | Paxlovid ]] .121 [[ https://www.hewatele.org/ | Hewatele ]] swahili abundant air, Kenya Bernard Olayo .126 [[ https://en.wikipedia.org/wiki/James_Lind | James Lind ]] scurvy "clinical trial 1747 .129 [[ https://en.wikipedia.org/wiki/RECOVERY_Trial | RECOVERY Trial ]] in UK .134 [[ https://en.wikipedia.org/wiki/Chinese_hamster_ovary_cell | Chinese hamster ovary (CHO) platform ]], $70 to $120 per patient .138 [[ https://en.wikipedia.org/wiki/Lung-on-a-chip | Lung-on-a-chip]] || || 139 || disease || identified || Vaccine || 50% vaccinated || || || || Whooping cough || 1906 || 1948 || 1986 || || || || Polio || 1908 || 1955 || 1985 || || || || Measles || 1953 || 1963 || 1987 || || || || COVID || 2020 || 2021 || 2022 || .140 Probability of Technical and Regulatory Success, historical average 6% .141 Vaccine initial data June 2020, initial estimates 12 to 18 months .141 Prior best 4 years, [[ https://en.wikipedia.org/wiki/Maurice_Hilleman | Maurice Hilleman ]] [[ https://en.wikipedia.org/wiki/Maurice_Hilleman#Mumps_vaccine | mumps 1967 ]] .144 [[ https://www.gavi.org | Gavi ]] The Vaccine Alliance, from 61 (2016) to 53 (2020) deaths per 1k births (134M/y, 1.1M/y saved) .149 [[ https://en.wikipedia.org/wiki/Universal_coronavirus_vaccine | Universal coronavirus vaccine ]] .150 [[ https://en.wikipedia.org/wiki/Katalin_Karik%C3%B3 | Katalin Karikó ]] mRNA ... perhaps [[ https://www.nobelprize.org/prizes/lists/all-nobel-laureates-in-physiology-or-medicine/ | Nobel soon? ]] .153 2010 "an official at DARPA" funding for mRNA vaccines .154 6 weeks after virus sequencing, Moderna had candidate mRNA vaccine .155 [[ https://en.wikipedia.org/wiki/Viral_vector_vaccine | Viral vector vaccine ]] , J&J / Oxford / AstraZeneca / Covishield (India) .157 [[ https://en.wikipedia.org/wiki/Subunit_vaccine | Subunit vaccine ]] .164 "patent stuff" '''plus''' technique and know-how, generic vaccines not yet .166 [[ https://en.wikipedia.org/wiki/AstraZeneca | AstraZeneca ]] second source deals for 25 factories in 15 countries .168 Gates Foundation pentavalent vaccine .171 Portable coolers 2 to 8℃, standarized vials .172 Pfizer COVID mRNA -70℃ .173 [[ https://ihatepsm.com/blog/auto-disable-ad-syringes | Auto Disable Syringe ]] .175 [[ https://vaxart.com/ | Vaxart ]] oral blocker .177 Zambia [[ https://www.npr.org/sections/goatsandsoda/2020/06/04/865520129/radio-nun-with-a-covid-19-show-we-sisters-are-a-force-to-reckon-with | Sister Astrida Bandha ]] .178 Six areas for development: Universal Vaccines, One and Done, Total Protection, No More Ice Chests, Anyone can give it, Expanded manufacturing .180 Cascadia subduction zone earthquake. 243? year average interval .181 drill tests one part of system, exercise scale from tabletop to full-scale .183 2019 [[ https://en.wikipedia.org/wiki/Crimson_Contagion | Crimson Contagion ]] exercise .185 2001 [[ https://en.wikipedia.org/wiki/Operation_Dark_Winter | Operation Dark Winter ]] 2005 [[ https://en.wikipedia.org/wiki/Atlantic_Storm | Atlantic Storm ]] 2018 [[ https://en.wikipedia.org/wiki/Clade_X | Clade X ]] 2019 [[ https://en.wikipedia.org/wiki/Johns_Hopkins_Center_for_Health_Security#Event_201 | Event 201 ]] .195 [[ https://en.wikipedia.org/wiki/BioWatch | BioWatch urban air sensors ]] considered a flop .199 by end of 2021, more than 17 million excess COIVD deaths .199 2010 to 2019, 24 million childbirth deaths, 19M intestinal, 11M HIV, 7M malaria .202 declining deaths graph, cite is [[ https://desapublications.un.org/publications/world-population-prospects-2019-highlights | World Population Prospects ]] but not in that report .203 20-10-5 %child deaths in 1960 1990 2020 (5 million deaths, still too much) .206 [[ https://ted.com/talks/hans_rosling_the_best_stats_you_ve_ever_seen?language=en | Hans Rosling 2006 The Best Stats You've Ever Seen ]] .207 [[ https://www.theglobalfund.org/en/ | the Global Fund ]] 208 raised $4B for COVID response .209 Pick up $100 bill, absolutely, find owner or give to Gavi .211 graph vaccination and measles eradication in India, 1980s to 2020, second dose rate >80% .211 India 2022/01 1.6 billion COVID vaccinations, 70% of adults two doses .216 written Jan 2022, "by summer 2022 world moving out of acute phase of pandemic." Actually, US huge omicron spike in January, surge in August. .220 1) Better tools 2) GERM team 3) Improve disease surveillance 4) Strengthen Health Systems .231 "The US government ... supported the research that led to the creation of the microchip" . citation needed, it was actually Bell Labs and Texas Instruments and Fairchild .232 [[ https://www.oecd.org/dac/financing-sustainable-development/development-finance-standards/the07odagnitarget-ahistory.htm | 0.7% development funding target .235 Net zero by 2050 .237 Lockdown to "digitization" 2020, ecommerce sales jumped 32% in US .242 Neal Stephenson metaverse 3D avatar meetings / 244 Telehealth / 246 child education (er, who minds the kids?) . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] . [[ | ]] ==== Team ==== . Keith Klugman p04 foundation scientist . Trevor Mundel p14 leads global health . Nathan Myhrvold p10, p193 ==== Others ==== . Larry Brilliant p018 epidemiologist "Outbreaks are inevitable, pandemics are optional" . Anthony Fauci p15 head of NIH, phone call . Bill Foege p06 epidemiologist, CDC former head . David Senser in Michael Lewis [[ https://catalog.wccls.org/polaris/search/title.aspx?ctx=1.1033.0.0.6&pos=1&cn=3884002 | The Premonition ]] (read in late 2021) .