Fear sells

Living in Stockholm is dangerous, at least you can easily get that impression. No, today I’m not going to talk about Covid-19, today I’m going to talk about another danger.

It lurks in the wilderness and jumps on you when you walk by and sucks your blood.

It’s less than 5 mm long.

It’s a tick. 

A tick lurking for a host to come by. Copyright Leroy Baptiste

If you have walked in a forest, especially in the late spring/early summer after rain, you have probably encountered it.

Ticks can transfer diseases. One of them — just like Covid-19 — is a disease for which there is no known cure: Tick-borne encephalitis or TBE. There is, however, a vaccine.

If you live in Stockholm, it is very hard to not know this. Big billboards next to busstops, in the subway, and over super market entrances will remind you every spring and summer.

A flyer I picked up at a local drop-in clinique stating: “TBE-vaccinate yourself against the uninvited guests of the summer. Drop-in, open also evenings and weekends”. Complete with a token-BAME person.

For those of you who don’t live in Stockholm, here are examples from a few infomercial sites:

From https://www.fasting.nu (Pfizer): “One tick bite can be enough — a vaccine exists.”

From https://tbe.se (Healthcare Media): “Lethal tick disease more common than previously known” and “2017: More cases than ever before”.

Plus plenty of pictures of ticks and kids. I’m reminded by the scene in The Truman Show where Truman visits a travel agency to buy a plane ticket and there is a poster of a plane being hit by lightning on the wall behind the sales agent.

Into the sales funnel

Ticks are common also in Denmark and Skåne where I lived before, and while I was taught from childhood to check for ticks and too look out for infection, the danger was Borelia, another tick-borne disease, for which there is a cure (antibiotics, if given early). However, in certain areas, ticks also carry TBE, and one of these areas is the Stockholm region.

So as a good parent, I was naturally fully intended on getting the family vaccinated. Who wouldn’t want their kids to go play in a forest? Which parent doesn’t do their best to protect their kids against the dangers of the world?

First summer in Stockholm came and went without us getting vaccinated (or infected), we were busy doing other things. When life started to calm down — and triggered by the ever present reminders all around — I looked into the practicalities of how to get it done. But there was one thing that was nagging me: Sweden generally provides good public health care, at least for kids, with vaccine programs and regular health checks. So if TBE is so dangerous, why doesn’t Sweden provide the vaccine for free?

So I looked into the facts.

What is the risk of catching TBE?

According to the Swedish health authorities, the number of TBE cases reported per year in the Stockholm region are: 

2017: 146 or 6,32 per 100 000 inhabitants

2018: 116 or 4,94 per 100 000 inhabitants

2019: 98 or 4,12 per 100 000 inhabitants

The numbers I have cited are the cases reported as infected in Sweden. The region of Stockholm contains about 2.3 million people.

For comparison, the number of people who have tested positive with Covid-19 in the Stockholm region so far is above 15 000. However, the vaccine has been around for some time now and I don’t know how many in the Stockholm region has been vaccinated. Maybe we are the last four in the region who hasn’t got our shots?

Checking other sources, here is from CDC: “The overall risk of acquiring TBE for an unvaccinated visitor to a highly endemic area during the TBE virus transmission season has been estimated at 1 case per 10,000 person-months of exposure.”

Also, even if you happen to catch TBE, most cases are mild. Again from CDC: “The European subtype is associated with milder disease, a case-fatality ratio of <2%, and neurologic sequelae in up to 30% of patients. “

Say we are exposed to ticks for one month per year through our behaviour, this puts the odds of someone in the family catching TBE at less than once per 10 000 summers of outdoor activity.

What does the vaccine do?

Vaccines are not miracles, even if they come close. To be fully effective, three doses must be given over one year, with a re-vaccination every 3-5 years. 

From the Swedish Health Authority“After three doses according to the normal time table, almost 100% of the vaccinated is protected for at least three years”

Not bad. Each dose cost around 400 SEK. So the family could be protected for three years for just under 5 000 SEK.

Why doesn’t Sweden provide a free vaccine?

Åland (between Sweden and Finland) provides a free vaccine to its citizens while Sweden has chosen not to do so. In my search to understand why, I found a study by the Swedish Health Authority from December 2018 which clearly examines the costs and benefits for three different vaccine programs.

Essentially doing the same calculations as above, the study concludes that it is not cost effective to provide publicly sponsored vaccination. 

The cost of saving one life-year lands at way above 1 000 000 SEK per year in all of the scenarios. While the study does not put an exact break-even number — as this is essentially a political question — it does state that costs of more than 1 000 000 SEK/year is generally perceived as not cost effective.

This leaves the market open for the commercial actors to convince people like me that what they offer is of value to me. Looking at the dropping number of reported TBE cases for 2019, it looks like they have been very succesful doing this. Or maybe the ticks just didn’t like the hot and dry summers of 2018 and 2019.

My conclusion

My personal risk appetite is definitely higher than 1 per 10 000. So I decided to not get us vaccinated but rely on the well known prevention measures: Wear long trousers and closed footwear when going into the forest, check for ticks when returning home, pay attention also to worn clothes. That saves the family three trips to a clinique and cash for a new iPad. It’s not like we are camping in the archipelago every weekend anyway.

Now after looking into the details, I can safely walk past the infomercials and still feel like a good parent. Of course, if it so happens that one of my kids gets bitten by a tick that causes a serious case of TBE, I will have to live with the consequence of knowing that I — maybe — could have prevented it. Or, hang on, maybe I should buy the kids an insurance, another heavily-marketed product in Sweden…?

Fear sells.

Best of times

It is the best of times, it is the worst of times, … it is a time like any other time.

When Charles Dickens wrote the introduction to a Tale of Two Cities, he was writing a historical novel about the French Revolution. Many times since first reading his gripping story, the first sentence in the book has resonated with me when the present has presented itself from its worst and best sides. Trump, Brexit, and Corona, but also smartphones, drones and internet everywhere.

For me personally, Corona Time has meant lots of quality time with my wife and kids. After the initial disruption and the re-discovering what is valuable, important, meaningful and possible right here, right now, we have enjoyed many great moments.

We live in a beautiful spot with forest and lakes close by, in a suburbia with bike lanes, play grounds, shopping facilities, and still close to nature. A few weeks ago, I took off the supporting wheels on Sofie’s bike at her own request, and soon after she was biking on two wheels. This Sunday, we went to Hågelbyparken, a 3 km ride each way, to enjoy the afternoon sunshine with Sofie biking herself both ways. Saturday on the way back from a car trip to the south tip of Botkyrka, a mother elk and her young kid were grazing in the evening sun right next to the road as we passed by.

It is more than 2 months since I’ve been in the city center of Stockholm and I don’t miss it.

Remnants of fortifications at Skanssundet protecting access to Södertälje from the sea. The fortifications were abandoned by the Swedish garrison shortly before Russian troops arrived and razed the area in 1719. According to local legend, the departing troops should have said: Now you will be rid of us; soon others will come that will hurt more. Copyright Frederik Jensen.

From change comes opportunity

I was laid off from my job a few weeks ago. It’s never fun, but it was the right decision for the company. I was in a strategic position with a short notice period. It was great to get to know the company, but also great now to get to re-invent myself. At work, I had a colleague argue “it has been like that for 15 years, we can’t change that”, while at the same time, outside, people stopped going to concerts, movies, and plays, and stopped visiting relatives and holding parties. A time of change is a time of opportunity, rules are being rewritten.

I’m half way in my professional life, I’ve worked in the space between technology and business for 20 years. I’ve written code, designed libraries, frameworks and tools, I’ve initiated, executed and closed projects. I’ve set up a company to launch a hobby project. I’ve picked up countless new technologies (and vaporised buzzwords) and I’ve worked with lots of smart people. I’ve met my wife at work and we moved to Stockholm to explore new opportunities. 

And still the best is yet to come.

So I’m discovering the job market in Stockholm (again). We hear a lot about the companies that are hit hard by the crisis. But there are winners as well as losers. Plenty of open positions are being posted on LinkedIn, at least the kinds I qualify for. So, to land a good next job, is like playing a game or optimising a process, both of which I enjoy!

Here are some insights I’ve gotten so far:

  • Python & Data Science is hot!
  • LinkedIn Learning does have good quality content!
  • Covid-19 has shown that working full time remote is possible! But companies and recruiters have not yet found out!

Getting into Python and Data Science could be great fun — let me explain why.

Python is huge

I first came upon Python 20 years ago. I was fascinated with the core design principle, the Colombo egg of having white space replacing the semantic meaning of curly braces and semi colons. And then, having learned Matlab at university, it felt very familiar. 

Then I joined SimCorp and became an APL programmer for 10 years. APL is one of the inspirations for Matlab and Python. APL has a run time interpreter and awesome native array support for working with vectors and matrices. The one thing that puts most people off is the non-ascii characters, which certainly impose a learning curve for newcomers. For SimCorp, this meant establishing its own training programme and developing lots of libraries internally.

Now Python has overtaken Java and JavaScript as the most popular programming language (https://www.youtube.com/watch?v=Og847HVwRSI).

I revisited Python last week. I installed Visual Studio Code and took an online training course to brush up on my skills. Some takeaways:

  • Great interfacing capabilities (want to run your own analysis of Covid-19 data? https://covid19api.com)
  • Great libraries for calendar and dates. 
  • Great community of Python lovers.

I also came upon Daniel Ross’ talk from PyCon Sweden 2019 on why Python is huge in finance, well worth half an hour of your time.

Data Science is all around us

Well, what is data science? Beyond the hashtag and buzzword, it is about using domain knowledge and statistical and mathematical models to understand and analyse data. Funny enough, back in my university days, I put together a master program in applied mathematics for myself with courses in numerical analysis, optimisation and data fitting, and a thesis in stochastic calculations. So getting into data science is quite like going back to the roots.

And although I visited the Swedish Workshop on Data Science in October 2019 (https://www.kth.se/en/eecs/om-oss/konferenser-och-event/sweds19), I have a thing or two to catch up on, so I’ve set myself up for a self study of An Introduction to Statistical Learning (http://faculty.marshall.usc.edu/gareth-james/ISL/index.html) and R for Mac (https://cran.r-project.org/bin/macosx/).

The arrival of Covid-19 has popularised modelling and data-driven decision making as never before and correct understanding of a phenomena and the data are crucial for life-and-death decisions these days. In the next Netflix drama, a Data Scientist will be played by cool, young, diverse actor and — in the voice of a prophet — correctly predict the consequences of messing with the laws of nature.

Let me leave you with one final link, an extraordinarily informative presentation of the concepts of epidemiology we now hear every day: https://ncase.me/covid-19.