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Finally Getting Broadband – Via 4G! (cable-free, fast-ish internet) February 15, 2021

Posted by mwidlake in Architecture, Hardware, off-topic, Private Life.
Tags: , , ,
2 comments

I live in a field. Well, I live in a house, but it and a few other houses make up a tiny hamlet surrounded by fields. My back garden is itself a small field. It’s nice to live surrounded by countryside, but one of the drawbacks of this rural idyll is our internet connection. Our house is connected to the World Wide Web by a copper telephone line (via a British Telecom service), and it’s not a very good copper telephone line either. I joke that wet, hairy string would be just as useful. Our connection speed is, at best, about 5Mbps download and 0.4Mbps upload. That is not a typo – nought point four megabits a second. My dual ISDN line back in 2003 could just about manage that. At busy times it’s worse – a lot worse – as all the houses in our hamlet contend for whatever bandwidth we have back to civilisation. Evenings & weekends it has almost become a not-service. It is not broadband, it’s narrowband. I pay £23 a month for the wire charge & unlimited calls, another £25 a month for the calls beyond “unlimited” (yeah, tell me) and £30 a month for the narrowband connection. Ouch!

It’s all fields and very little infrastructure…

 

Good BT service.

My neighbours have complained to BT about our internet speed many times over the years and I did also. I was told (and I paraphrase) “you are at the end of a long piece of old copper-wire-based technology and there are not enough people living there for us to care about, so it is not changing”. Which to me utterly sums up my 30 or so years experience of British Telecom, a company I loath with a passion. I asked if I could get a discount for such a shit service and was told I was on their cheapest deal already. “Would I get better service if I paid more?” No. Well, at least they were honest about that.

About 2 years ago a company called Gigaclear came down the road to our little, rural hamlet. They are being paid a lot of money by Essex county council to lay fibre cable to rural locations all over the district. This raised our hopes. Gigaclear dug channels, lay down the ducting, put a green telecommunications box in place by “Joe on the Donkey” (this is the real name of a neighbour’s house) – and went away. They’ve been back a few times since, but the promised super-mega-fast fibre broadband service they touted has not come to fruition. The last two visits have been to check out why they can’t connect anyone. It might partly be that one pair could not even understand that the green box 100 meters away is probably the one that is supposed to service our house, not the one way across two fields that they have not dug a channel from.

 

Bad Weekend BT service

I first realised there was another solution when, forced by evenings & weekends when download speeds dropped to below 1Mbps, I started using my iPhone as a hotspot for my laptop. 5/0.4Mpps was replaced by 15/2.0Mbps. I was soon using my phone to upload pictures to social media and the charity I foster cats for, plus for video conferencing for work & social purposes. If my mobile phone was giving me better connection speed, why in hell was I using an expensive & slower connection from my physical telephone line? One problem was I only have so much download allowance on my mobile phone (10GB). The other was you need to keep the mobile by the computer to tether it. It was not a mobile anymore!

I was then chatting to a neighbour and he said he’d tried a relative’s 4G broadband from EE – EE is about the only phone network we can get a decent signal with here and we use them for our mobile phones – and he was pleasantly surprised at the speed. He said it was expensive though…

As a result of this chat I did a quick check on the EE website. A 4G EE broadband device (basically a box with the electronics for a mobile phone and a router in it) would be cheaper than my current BT solution! £35 a month, no up-front fee, and their advertising blurb claimed 31Mbps on average “in some places”. I had no expectation of getting anything near that sales-pitch speed, but repeated speed test on my EE mobile phone was confirming 15 Mbps download and 2 Mbps upload usually, much better than the BT landline. And the offerings of Gigaclear, should they ever plumb us in, was for 30Mbps for a similar cost to EE 4G broadband, and 100Mbps if you spent more spondoolies. All in all, EE seemed not that expensive really and, as I said, cheaper than sod-all bandwidth with BT!

The last thing I checked was if you could get a physical EE 4G signal booster if your signal was poor. Yes, you can, but from 3rd party companies for about £250-£400. Our EE signal in Widlake Towers is better than any other mobile phone operator but it is never an all-bars signal.

The Change to 4G, cable-free Broadband

I decided it was worth a risk. All I wanted was the speed my iPhone was getting and, if it was poorer, a one-off spend of maybe £300 would help matters. I ordered an EE 4G router and 200GB of data a month. Why so much data? Well, I had never exceeded my 10GB data a month on my mobile phone, I am not what you could call a big data user – I do not download films or live stream stuff. But my connection speed had been so bloody awful for so long I had never even dreamed of downloading 1/2 hour TV programs, let alone whole movies! Maybe I might with a better connection. And I was about to start running training courses for a client. I figured I would bet on the safe side.

My EE 4G router turned up the next day, I was so excited!

It was broken. It would get the 4G signal no trouble but it’s wifi service was unstable, it shut down under load. It was so annoying as for 10 minutes I had FORTY Mbps download and FIFTEEN Mbps upload performance! I count this as mental cruelty, to let me see the sunny uplands of normal 1st world internet access but to then immediately remove it from me…

It was clearly a faulty unit so I was straight on to EE. It took over an hour and a half to contact & talk through the issue with EE but, to be fair, they have a process to go through and they have to make sure the customer is not doing something daft like keeping the router in a basement, and they sent me a replacement unit the very next day.

This is more like it!

It arrived. I plugged it in. It worked. It’s was great! The bandwidth was an order of magnitude better than the old BT router over the fixed telephone cable. Not only that, it also far exceeded both what I had got via my phone and also the estimates of EE. I got over 60Mbps download on average and often above 70 Mbps. The highest I have seen so far is 98Mbps. Upload averages around 14Mpbs and has gone up to 30 Mbps at times – but I have to say I see the peak upload when download is a little depressed. On average I am now getting consistently over 60Mbps download and 10Mbps upload speeds, though sometimes when the local network is busy (mid workday afternoon) I see a little less. “Peak performance” is weekend and evening times, I get fantastic performance, maybe as business users in the area are quieter and few domestic clients are using the 4G network.

So, over 60Mbps download and 10Mbps upload average and sometimes more – I’ll take that! more than 10 times faster download and, well, 30-50 times faster upload then BT over tired copper.

It’s utterly transformed my online experience. I can honestly say that when I see slow internet performance on web pages now I am just as inclined to blame the remote site as my connection. And I can upload pictures & emails in a way I have never been able to before. Until now I was notable to put up short videos of our foster cats to the charity website unless I did it on my phone in the garden, and that was hit-and-miss. Now I can just chuck videos over to them and not worry about it. For me it is a game changer.

My 4G Choice

In the window, catching rays – 4G rays

I had little choice but to go for EE as no other mobile phone company has decent coverage in my area. You may also have only 1 choice but, it you live in an area where many 4G services are available (i.e. you live in a place where other people live!) then look into which is best – not just for speed/cost but also customer service. Many companies are offering wireless 4 and 5G services. Personally I would stick to 4G as 5G is still shiny and new enough to come with a price hike for not-a-lot more total throughput. I’ve always been really pleased with EE customer service. For years I’ve popped over to one of the two local-ish EE shops whenever I have needed to change something or had a problem and they always sort me out quickly. Not only that, on a couple of occasions I’ve suggested I go for a more expensive plan (say to get more roaming data allowance) and they have looked at my historic usages – “Mate, you’ve never been even close to the smaller plan, save yourself £10 a month and take the cheaper one. You can always upgrade”.

I went for EE’s standard 4G Home Router as the only difference I could see with it and their 4G Home Router 2 was the Home Router 2 supported 64 devices not 32, for an extra £50 up front.. Between us Mrs Widlake and I have fewer than 10 devices, let alone over 32…. At the time of writing there is no initial charge for the 4G Home Router, just a £35-£55 monthly charge depending on what data allowance you want £35=100GB, you get an extra 100GB for each additional £5 up to 500GB but then at £55 it becomes unlimited. You can choose between 18 month contract or no contract and an up-front fee, but go look at the website for details, it will have changed by the time you look (I know this as they have introduced a 5G home router between the time I started this blog post an ended it! But I have no 5G signal so of no consideration for me).

In line of sight of the study window

Initially I had the EE 4G home router in the main room of the house so I could fiddle with it if needed, but I soon moved it upstairs to a bedroom where prior tests had shown I got a better 4G signal. (You want as little in the way of building materials and geography between you and the 4G mast, so upstairs by a window is ideal. And in my house the top floor where I put the router is made of wood, straw, mud, & horse shit. Other parts have fully insulated plasterboard which includes a thin metal foil layer to both reflect heat and, unfortunately, block electromagnetic radiation).

Spreading The Network

Another consideration for me was allowing the wifi signal to get to the study. The study is above the garage, a structure covered in black clapperboard which is strangely attached to the neighbour’s house (this is the sort of thing you get with properties hundreds of years old – things just got built). A few years ago when we had the study/garage rebuilt to modern standards we got another company to provide telephone services to the study, to see if it was better than BT. It was. A bit. And it still is. But that company is now part of BT (as is EE to be fair) and is slower than my mobile phone. If the new router reached the study we could stop using BT AND we could stop using this backup supplier (which was cheaper than BT but more limited in some respects). With line-of-sight I hoped the wifi would reach the study. It did  – but it was right at the range limit and the signal would drop :-(. If you moved your laptop or tablet away from the window and clear line-of-site, you lost the Wifi signal from the new 4G broadband router.

I see you (just) router

Well, I had a possible solution to this too.

There are many wifi extenders on the market at many prices, some just use wifi and some use your power cables and others create a mesh. If 30 years in I.T. have taught me anything it is that there is something deficient in my head that means I personally have no affinity for networks. I need simple. I knew I could not use a power cable solution. With these you plug one device in a socket and it communicates over your domestic power lines to a second plugged-in device which provides a wifi service. For historical reasons my study is on a different power circuit to the house, I doubt it would work. I did not want to go to Mesh as I felt (based on experience) I would fuck it up. I just wanted a simple, single WiFi extender.

After a few hours on the internet I came to the conclusion that there was a solution, a relatively old device (first sold in 2016) that might be what I wanted. A TP Link RE450, also known as an AC1750. It was simple and excelled at having a long range. I ordered one for £50 quid.

It came and, following the simple instructions and maybe half an hour of my part-time attention, I had it working and connecting to both the 5 and 2.4 GHz networks of my EE 4G broadband router. I moved the TP Link RE450 over to the study and plugged it in so it had line-of-site to my EE 4G router. The connection light flashed blue and red, which suggested it was not happy – but I worked out that it was happy with the 2.4Ghz connection but not the 5Ghz one. It was right on the edge of it’s range. A bit of fiddling of orientation (hat tip to Mrs W who realised it was better on it’s side) over 2 days, including moving the router a whole 30cm closer, and now both are happy.

The end result is I now have access to the 4G EE broadband router in the study & garage at about 20Mbps download and 12 Mbps upload. I think the limit is the TP Link to EE router connection, which is just down to distance. Bottom line, I now have access to the internet from every part of my house and separate study, and the whole front garden, and the edge of the field opposite the house, and some of the back garden, at speeds substantially faster than my old landline.

British Telecom will be getting a cancellation notice from me by the end of the month (I need to change some email addresses) and the third party service to the study will also be terminated. I will replace a service from BT that was costing me £80 a month and another that was £30 a month with just one at £40 a month, which gives me a much, much better service.

That feels good.

Latest speed test? Done as I completed this post, I recorded 77Mbps download & 30Mbps upload, which I am incredibly pleased with. I don’t expect to get that all the time though.

Speed test the morning I posted this. It will do 🙂

 

Sourdough – Making a Loaf January 19, 2021

Posted by mwidlake in Baking, off-topic, Private Life.
Tags: , ,
4 comments

<<– Creating the Sourdough Starter

Nothing beats fresh, home made bread

Anyone who follows me on Twitter knows I like making sourdough bread. For me, a sourdough loaf is a real treat. I love the combination of a thick, crunchy crust and the soft, strong-flavoured inside. I’ve been asked a few times how I make my bread and I keep saying I will write it up. This blog post is the fulfilment of that promise.

Making sourdough is a longer, more complex baking process than most modern versions of baking bread, but it is actually a very old method of baking and was probably the main method used by the peasant and working classes over the last few hundred years. It takes several hours to make sourdough. I start mine in the evening and bake it in the morning.

Work is stressful (even working in I.T. from home), this pandemic is stressful, baking a nice loaf of bread helps balance that stress.

A key part of the process is that you need a “starter”, a mixture of flour, water, and actively growing yeast. I did a long and detailed post on creating a starter about a month or so ago. If you created a starter then and have been feeding it since, it’s well past time to make a loaf!

Get the Starter Active

If the starter mixture is in the fridge, take it out of the fridge several hours before you are going to use it. If I am making my dough in the evening (my usual method so it can prove overnight) I take the starter out the fridge about noon.

A few hours before you are going to make your dough (usually 6 hours or so for me), mix up 200 grams of strong, white bread flour with tepid water so it is a similar consistency to porridge, add it to the starter and give it a good stir.

This should help get the starter really active and, after a couple of hours, you should see bubbles in the mixture and the volume will increase. I do not seal the jar during this process, I leave it with the lid over the top of the jar but not clipped or screwed down.

Making the Initial Dough

I’ll give you two recipes for making the dough. The first is from a man called Paul Hollywood, who is a very well known and successful baker in the UK. He is one of the judges on “The Great British Bake off“, which is one of the most popular TV programs in the UK. I know the program has been syndicated across the globe, with over 25 countries showing their own version, and a couple showing the UK original. The second recipe is mine, which is derived from Paul Hollywood’s. I increased the size of the loaf as I wanted something to provide sandwiches for 2 people for 2 days and I found a little more salt and a lower percentage of starter gave results I preferred. Less starter seems to give a better final rise to the loaf. Please note – Paul Hollywood is a considerably better baker than I! Perhaps try his recipe first.

This Kenwood Chef is 40 years old!

Paul Hollywood recipe

  • 375g Strong white bread flour
  • 250g sourdough starter
  • 7g salt
  • 130-175 ml tepid water
  • a teaspoon of olive oil

Martin Widlake recipe

  • 500g strong white bread flour
  • 200g sourdough starter
  • 10g salt (but no more!)
  • 7g sugar
  • 200-220ml tepid water
  • a teaspoon of olive oil

 

 

The below is based on my recipe

I have a little plastic jug for measuring the water. Before I put any water in it I put the 10 grams of normal, fine table salt (1). Do not go above 10g of salt in 700g total flour & starter as too much salt inhibits the rise of the loaf. I’m adding about as much salt as you can without this happening.  I also add a teaspoon of sugar (7 grams) as I feel it balances the sour of the loaf and slightly boosts the loaf flavour. Skip this if you like.

I then put 500 grams of strong bread flour into the mixer bowl (see later for some variations to 500g of flour). As I add the flour I also dribble in the salt/sugar mix. This is to help it all mix in evenly. I found that if I just chucked the salt in after all the flour, again the rise could be problematic and the bread seemed to be a bit patchy in it’s flavour. Give the flour with the salt/sugar in a quick swirl with a spoon or something.

I now add 200 grams of sourdough mixture and about 100ml of the tepid water. I do not add it all as I use a food mixer to initially combine my dough. We have a Kenwood Chef that is 40+ years old. To make bread dough in a food mixer you need a dough hook. The one you see in the picture by the recipes is only a few years old, it is coated with Teflon to help the dough to not stick to it.

The mixer can throw little fountains of dry ingredients out of the bowl so I put a towe over the whole thing. If you do this, make absolutely sure the towel is not going to get caught on the dough hook/mixer! With the mixer on it’s lowest setting, I slowly add more of the water to each side of the bowl so that the ingredients combine. I have found that as the dough mixture gets towards the consistency I want, or is damper than I am aiming for, it wraps around the dough hook and no longer mixes! It just wizzes around with the hook.  This is why I added the water slowly and keep about 20-30ml in reserve. Then, when all the ingredients are well mixed but it is not quite forming a single ball, I add the last of the water and keep the mixer running until the dough does wrap around the hook and stay on it. Take it off the hook and make it into a rough ball, as shown In the picture of the mixer.

You can mix it all by hand, which is fun, but your hands get really messy and it takes longer. If you do mix it all by hand, add the water bit by bit until the dough is quite sticky.

I now put a little olive oil, half a teaspoon is all, on a thoroughly cleaned work surface and spread it around  into a 20-30cm circle. I drop the dough in the centre of this and I knead it by hand to finish it off and get a smooth consistency in the dough. Different people like to mix their dough in different ways. I push into it with the heel of my hand, stretching it against the work surface, and then fold it over a little and push into it again. I do this with just the one hand in a regular rhythm of about one one push a second, slowly rotating the dough ball and moving it around so I am working all of the ball. I swap hands occasionally for a full upper-body workout…

Other people slap the dough onto the work surface or throw it down, others squidge it out with both hands and then fold-and-squidge. Do what seems right to you. There are lots of videos on the internet.

The whole aim is to get all the ingredients mixed in smoothly and keep going until the dough is a little elastic. Apparently the best test as to whether you have worked the dough enough is that you can stretch some thin with your fingers and see light coming through it. I don’t do this, it does not seem to work well with my dough, maybe as I do not add enough liquid, maybe because sourdough is a little different. I know it is ready as it…. feels ready. Smooth, not rubbery, but with some stretch to it. Because I use a machine to initially mix and knead the dough I only have to hand knead it for 5 minutes. If you mix the dough by hand then you will need to knead it for 10, 15 minutes. Maybe more.

The whole idea of the kneading is to get some of the protein in the mix, the gluten, to form long chains which give the final loaf it’s structure of a soft and flexible material. If you over knead the dough then the bread will not rise so well and the bread will be rubbery and dense. You don’t want rubbery, dense bread.

Grow my little beauty

Proving the Dough

Once your bread is kneaded to the consistency you want, you have to let it prove – which means left alone to grow. You prove the dough twice.

Use the other half a teaspoon of oil to lightly oil the inside of the mixing bowl. The only reason for the oil is to stop the dough sticking. Put the dough ball into the bowl and cover with clingfilm or similar. I use a clear, plastic shower cap that I can re-use dozens of times as (a) it’s so easy to pop it over the bowl and (b) less plastic waste.

You need to keep the dough at about room temperature – between 18C and 22C – for several hours. Less time if it is warmer, more time if it is cooler. I make my dough about 8-10pm in the evening and leave it overnight, near a radiator that will come on in the morning. This seems to work for my dough.

During the proving stage the yeast in the dough consumes sugars (the sugars come from the starch in the flour being broken down) and they produce carbon dioxide (CO2). this is what makes the dough grow and become soft.

In this first prove of the dough it should doubled to tripled in volume, and become soft and spongey to a light touch. Sticking a finger in it will leave a dent that only partly fills in.

Lightly dust a clean, dry area on your work surface with plain or bread flour and turn the dough out of the bowl it has proved in onto the area. I lightly dust one side of the bowl to stop the dough sticking to it and I ease the dough from the sides and bottom of the bowl with a small, flexible spatula – one of those made of silicon or soft, heat resistant plastic. In the picture above of the dough on the work surface you can see bubbles in it – this is from the CO2.

 

Knocked-back dough ready to go into the banneton

You now need to “knock back” the dough – knead  it all over with your knuckles or, like I do, give it 30 seconds of kneading like you did when you first made the dough. Some instructions tell you to do things like make a ball after knocking it back and  tuck the dough down under the ball and into the bottom of it. I think these are to create little air pockets in the dough that make the large voids you get in posh hippster café sourdough. I don’t want those large voids. I keep the flour dusting to a minimum and push the dough together well to avoid any air gaps or having any folds in the dough which do not “heal” (stick to each other).

Push the dough down into the container

A nicely second-proved dough

You now need to let the dough prove for a second time. I use a “banneton” for this, a special wicker or similar material bowl that is specifically for the final proving of bread. They also impart a nice pattern on the loaf. Dust whatever bowl or banneton you are using well, put the dough into it and push it down firmly. Lightly dust the top and then cover a plastic bag or similar. You want the bag to be above the dough so when it rises it does not contact the bag, as it will stick to it.  I put the showercap I used earlier back over it, with the damp side inwards to stop the top of the bread drying out too much. Put somewhere warm and leave for two hours. If the house is not that warm, I put the oven on and set it to 50C, then turn it off and pop the loaf in that. If you are dead posh you might find your oven has a proving oven compartment or a plate warmer you can use.

After a couple of hours the dough should have risen a little again and have a smooth top. It is now ready to bake

Baking the Bread.

Ready to bake….

A key to getting a good bake where the bread rises evenly and you get a good, strong crust is moisture. You need the atmosphere around the loaf to be damp for the first 20 minutes or so of baking.

I’ve achieved this with two methods – baking in the oven with a tray of water, and using a Dutch Oven.

In the Oven With a Tray of Water.

Pre-heat the oven to 220C and put a shallow tray on the lower shelf.

Heavily dust a baking tray with flour, or flour and semolina (semolina is better at preventing the loaf from sticking, but I find flour on it’s own works just fine and I stopped using the semolina as I’m lazy). Carefully tip the loaf out on the tray and slash the top several times. I have a special, small, gentle serrated knife just for this, it seems to work better than a smooth blade. He’s called Mr Slashy the knife. This scouring allows the crust to expand more easily during the cooking.

 

… but it did not go to plan

Dust lightly with flour and immediately put the loaf into the oven, and put about 500ml of warm water in the shallow tray. This will create steam as the bread cooks.

Cook at 220C for 30 minutes and then turn the oven down to 200C and cook for a further 15-20 minutes. The bread should have risen and turned a lovely golden brown. You can test if it is done by tapping the bottom of the loaf, it should sound hollow. If, like me, you like your bread slightly darker with a stronger crust, extend the higher temperature period from 30 minutes to 35, 40 minutes.

Take the loaf out and move it onto a wire rack to cool.

In the example I show, the loaf is a weird shape. I think this is because, with this loaf, I forgot to put the water in the oven with the loaf, then added cold water to the tray, not warm. As a result there was not enough moisture, the crust formed early and the still-expanding loaf could no longer grow and burst out the side of the crust. If this happens to a lot of your loaves, try scoring more or gently wetting the top and sides of the loaf before the final dust of flour.

It tasted just fine!

In a Dutch Oven.

A Dutch oven is basically a heavy iron or aluminium casserole with a well fitting lid. You bake the bread with the lid on initially to trap moisture. I use an iron casserole dish about 26cm in diameter. The casserole needs to be about 5cm wider than your uncooked loaf, to allow for expansion. If you already have a casserole dish you might need to change your loaf size or the bowl/banneton you prove it in so that the loaf fits!

Pre-heat the oven and the casserole dish to 230C. Yes, 230C. It take about 15 minutes for my casserole to heat up fully.

Take out the casserole and  heavily dust the bottom with flour. You will know it is warm enough as the flour will smoke gently.

As carefully as you can, turn out the loaf into the casserole dish. I turn the banneton upside down and hold the loaf in place with my fingers, shake it slightly until the loaf drops onto my fingers and then I open my fingers to let it drop the 6 inches into the casserole. Do not let your skin touch the casserole dish, it hurts like hell! Slash the top of the loaf several times, again keeping the fingers away from the hot metal.

Take the lid off at 20 minutes

This is the main disadvantage of using a casserole, getting the loaf in and slashing the top is harder and the danger of a nasty burn is ever-present. I have tried turning the loaf out, slashing it and then transferring it to the casserole, but it knocked a fair bit of air out the loaf and reduced the rise.

Cook at 230C for 20 minutes. Remove the lid (the loaf will still be a cream colour) and cook for a further 15-20 mins. Turn the oven down to 160 and cook for a further 15-20 mins. You turn the temperature down more with the casserole as it retains heat for a while.

You might notice my oven says 235 and 165C. My oven temperature is a little cool (I tested with an oven thermometer) so I added 5C. You do get to know your oven when you do baking!

 

 

 

 

 

After 20+15 mins on high, turn down

You loaf should now be dark golden brown. Remove the casserole from the oven. I put a little fan blowing air over the casserole for 5 minutes before I extract the loaf. Using a cloth to protect your fingers, take out the loaf and leave to cool on an a wire rack.

I swapped to the Dutch Oven method as a couple of friends recommended it and the flush of steam from the “oven with a tray” method was making the control panel of my oven go funny. I’ve already had it repaired once.

Having swapped, I think overall the Dutch Oven method gives a better loaf. I have far fewer issues with the loaf rise being uneven and part of the load bursting out the side or the crust “tearing” at the sides.

If I decide to make larger loaves I’ll simply swap to the oven-and-a-tray-of-water method.

 

 

 

Cooling

Once the loaf is out the oven I tend to start losing control of my salivary glands and I am desperate to eat it, so I use a little fan to help it cool in about 1/2 an hour. If you have more will power than I then it takes an hour or so for the loaf to cool naturally.

I love to cut open the loaf and eat it when it is still a little warm. The one disadvantage of this is that the loaf will lose extra moisture as a result of this, so any bread you save until tomorrow will be a little drier. I hardly ever manage to hold off cutting it early for the sake of a better experience tomorrow!

Notice the lack of large voids – perfect for sandwiches

Alterations to the recipe

I sometimes replace 150-200 grams of the white bread flour with spelt or mixed seed flour. It does seem to drop the rise a little though. I have tried adding a little dried bakers yeast to balance this but with limited success.

I have replaced all 500 grams of white bread flour with brown bread flour. It was OK, but despite me generally preferring brown bread,  with sourdough it just does not seem right to me.

I really like adding a teaspoon of smoked, sweet paprika to the mix. This is partly why I put the salt etc in the jug I later user for the water, I put the extra flavour in the jug too and the water washes out any flavouring that has remained in the jug.

Chop up a handful of sundried tomatoes (drained of their oil on kitchen paper as the oil seems to inhibit the rise) and add those with a good squirt (say 25ml) of double strength tomato puree.

 

1) You could use sea salt or Pink Himalayan salt instead of dirt-cheap table salt –  but it’s all the same stuff really, it’s dried out sea and mostly consists of the specific salt compound sodium chloride. The stuff dug out the ground is from a few hundred million years ago and sea salt is usually from drying out current sea water. The problem with salt that is not table salt is it is probably not as fine so it might impede rise more.

 

Sourdough – Creating The “Starter” December 18, 2020

Posted by mwidlake in Baking, off-topic, Private Life.
Tags: ,
2 comments

Making and Baking A Sourdough Loaf –>>

A couple of people have asked me to describe how I create the Sourdough bread that I often tweet about baking. It’s too much for a Facebook post, and waaaay too much for a twitter thread, so I’m putting it here on my blog. This is part one – you need something called a “Sourdough Starter” to make sourdough bread, this is how I create my starter. Part two will describe making an actual loaf of sourdough.

Nothing much beats a sandwich made with home made sourdough

I know this is seriously off-topic for a blog that is supposed to mostly considers Oracle tech & performance, working in Oracle/I.T, and thoughts on IT management & how people work, but let’s face it – the more semi-retired I get the more this blog is becoming somewhere I simply share “stuff”. However, there is a bit of a link. Over the last few years baking bread has been taken up by a surprising number of people in the Oracle Presenting sphere (and this pre-dates the craze for making your own bread that came with Covid-19). One presenter, Jože Senegačnik, even wins national awards for his bread in Slovenia.

What is Sourdough?

Sourdough is a rustic type of bread, usually white, with a dark, thick crust and usually more flavour than a standard loaf of white bread. I know I am biased, but the sourdough bread I make is about the nicest bread I have ever eaten (with perhaps the exception of the bread of some of my other baking friends). It is certainly nicer than your average loaf and better than “normal” bread I have made at home.

Sourdough bread has an open texture (lots of holes), so it is quite light and, at the centre, soft. Sometimes the bread has large voids in it. If you buy sourdough in a shop or it is part of a meal in a café/restaurant (it’s almost always the bread used in posh cafes with your smashed avocado and free range egg for breakfast) it seems to me that the posher the place, the larger the voids. Sometimes a slice of sourdough toast can be more void than bread. It does not need the large voids and, in my opinion, they are detrimental to the bread. You can’t make a sandwich or put anything on the bread without the contents falling through the big holes! It’s fine with soup & stews I suppose, where you are dipping chunks in liquid.

Sourdough is a type of wheat-based bread where instead of using dried yeast or fresh yeast that comes in blocks that look like soft cheese, you use an active, growing “porridge” of yeast. This is a fairly thick mixture of strong bread flour and water, with the yeast growing in it, slowly consuming the flour to produce more yeast.

big voids to lose your topping through…

This “porridge” is called the Starter, and you add it to a mixture of more bread flour, water, and a little salt, to make your bread dough for baking. The starter smells quite strongly, distinctly sour, and I suspect (but am not sure) that sourdough bread is named more for the smell of the starter than the final loaf, which only has a hint of the smell if any at all.

The bread itself also has a distinctive tang to it, not as marked as the smell of the starter mixture, but it is a key part of the flavour.

The crust is an important part of a sourdough loaf. It tends to be thicker, stronger, and (when fresh), well… crustier than normal bread.

The key to it all is the starter, so how do you create and keep your starter?

 

 

The Jar

You need a sealable jar to hold your starter. I use a Kilner jar, as pictured, but a very large jam jar will probably be fine. The jar needs to be able to hold well over a pint/half litre. My jar can hold a litre, which is large enough to generate enough sourdough starter for a good sized loaf but not so large it won’t fit in my fridge (which is important).

Once you have your jar, make sure you have:

  • a packet of white strong bread flour.
  • either some grapes or apples or, if you can manage it, some starter from a friend.
  • at least a week before you want an actual loaf of your own sourdough bread.

I would recommend you use white bread flour as brown or wholemeal (or even seeded) not only provides bits in your mixture where yeast cells would struggle to get to (so might make it more likely for your starter to get infected and “go off”) but as you add quite a bit of starter to the final dough, it’s always going to be partially wholemeal or brown if that is what your starter is based on, no matter what you want.

It has to be strong bread flour. Strong bread flour has a higher percentage of protein, gluten, in it. This is vital to support the texture of bread. Cake is lighter than bread and normal flour that you make cakes out of has less gluten in it.

Sterilise your jar before you use it. Either wash it in really hot water or, preferably, but it in an oven at about 120C for 20, 30 minutes. Let it cool to room temperature before you use it though. You want to sterilise it as the idea is to get a yeast colony growing in the jar that will out-compete bacteria and not-yeast fungi and keep the mixture clean and edible and not poisonous. To begin with there will not be a lot of yeast cells and any bacteria or fungus present could make the mixture bad before the yeast takes hold.

Making the starter

This just needs a little more mixing

Put about 300 grams of the strong white bread flour in the jar and add about 300ml of water, stirring it. you might want to add the water in two or three parts, mixing it well as you go but don’t stir it for minutes. You will hopefully end up with a smooth mixture that is a bit thicker than porridge/wallpaper paste/pesto. Now add a little more water until it *is* the consistency of porridge. Thin enough that it would pour, thickly, but thick enough so that a spoon stuck in it will probably stay in place. Don’t forget to take the spoon out…

Now the tricky bit. Getting the yeast in it. Don’t use baker’s yeast or brewer’s yeast or anything you would buy to make a normal loaf of bread, you want something slower growing and, if possible, local. In some places, at least in the UK, you might have enough yeast in the air to get it going, especially if you live in the countryside near orchards. Leave the jar with the lid open for a few hours and then shut it. A more reliable way to get the yeast is to take the skin off four or five grapes, preferably ones you have had in the house a few days, or some peel (just a couple of long stripes) from an apple, either a locally grown one or one that’s been hanging about in the fruit bowl a few days (but is not rotten!!!). The peel from fruits like this are covered in many yeasts. Use only the peel, not the pulp of the fruit. Chop the peel into little bits and throw it in the mixture and stir.

The yeasts on the skin will get it all going

If you are lucky enough to know someone who already makes sourdough who is local (in which case, why are you reading this?!? Go have a cup of tea with them or a glass of wine and get them to show you how to do all this – relevant covid-19 restrictions allowing of course) then get some off them, about 30ml will be more than enough. I got some from a local bakery a couple of years back who specialised in sourdough. You can even use dried out sourdough, as I did once. I’ll put the little story of that in another post.

The advantage of using some existing starter mix is that it gets going quicker and you an be pretty sure it will work. Getting your starter fully active from scratch using peel or the air can take weeks, a dollop of starter in it’s prime will get you a fully active new starter in days. I swap the jar I keep my starter in every few months, as they can get a bit gungy & crusty, I make the bread/water porridge and chuck in about 200ml of my existing mixture – usually what is left when I am making a loaf. I can use the “new” starter created in this way in a couple of days.

Shut the jar. If you were lucky enough to use existing starter, keep it out at cool room temperature if you are making a loaf in a day or two. Otherwise put it in the fridge.

If you really are starting from fresh, with peel, put the jar somewhere that is “cool room temperature”, that is about 16-18C, not near a radiator or source of heat, not somewhere cold. Hopefully, in a few days you will see little bubbles in the mixture. That means the yeast is growing and releasing carbon dioxide! After about 5 days, whether you see little bubbles or not, take out about a third of the mixture and discard, replace with the same volume of flour/water mix that you removed, give it all a good stir and seal the jar again. Do so again in another 5 days. If you do not see any bubbles by now, it has probably failed. Discard and start again.

A starter in it’s prime, a day after being fed

If the mixture develops any colour other than pale cream/oatmeal (so if it goes green or purple or pink or grey) you now have a jar of poison. Bacteria or fungus have won and out-competed the yeast. If there are spots of grey or other colour on the surface, or fluffy spots, again it is poison. Throw the contents away, sterilise the jar, try again.

Once you have a pale cream/maybe very slightly oatmeal coloured gloop that bubbles a bit you have your starter. Well done. You now have a new pet in your life.

Looking After The Starter

Once you have created the starter you have actually created a living colony – and you have to feed and care for it. If the yeast runs out of food it will go dormant and that opens the door to bacteria or moulds getting a foothold and growing. You have to keep the yeast active and reproducing. To do this you feed it.

Professional bakers who are making a lot of sourdough bread are constantly taking out part of the starter mixture and using it in the dough. An 800 gram loaf will use between 150 and 250 grams of starter depending on how they make the dough. This is replaced with the same volume of flour/water mixture they take out. You can do this yourself, if you are going to make a new loaf every few days you can keep the starter at room temperature and replace what you take out with flour/water mix. The yeast in the remaining starter quickly works through the added mix and new yeast cells grow.

If you are going to make a loaf once a week you can extend this process by putting the starter in the fridge. You take the starter out the fridge a day before you are going to use it. This is so it warms up and becomes more active. If you have space in the jar, you might want to add a bit of extra flour/water mix for the yeast’s breakfast (about 100 grams flour) when you take it out the fridge – I do. You take out about a third of the starter when you make the loaf the next day and replace it with flour/water mix. I leave my jar out for a few hours/overnight after this to let it get going and then you put it back in the fridge.

If you keep your starter for more than a week in the fridge, or 3 or 4 days at room temperature, without using it, you have to feed it. Take out a third of the mixture and discard, replace with water/flour mix that you stir into the starter. So long as you regularly feed the starter it will last pretty much forever, but of course you are simply throwing away flour all the time.

If you are a bad starter owner and you forget about it, it won’t be happy. A layer of fluid will separate out at the top of the mixture and it will go grey. Grey is bad. If this happens, if the fluid and only the very surface of the starter are a light grey, no fluff, you can pour off the fluid and the top third of the starter, feed it, and it might be OK. I’ve brought back starters from grey gloom a few times. However, the starter won’t make a good loaf again until you have fed it a couple of times. If the grey comes back straight away, you best put the poor thing down.

If your starter or anything in the jar goes pink, orange, purple, green, or fluffy, you have let the yeast get too weak and you have grown something new. It might be useful to a microbiologist, it could even contain a new antibiotic unknown to man, but it is far, far more likely to be poison. Throw it away, start again.

When you feed the starter, make sure there is space for it to expand. I keep my jar about half full. When I feed it, the contents expand with the CO2 and then subside. If the jar is too full, there is no space to expand. Also, I suspect my jar leaks every so slightly so no pressure builds up. If your jar is totally sealed you might have issues with it spraying out when you open it. Let me know if you do, photographs of the mess would be appreciated.

The more regularly you use the starter, the better will be the bread you make. When I’ve kept my starter out of the fridge for a week or two and either made a loaf or simply fed the starter every 3 or 4 days, it gets more active and the dough rises more readily when I make a loaf. If I leave the mixture in the fridge for a month, only occasionally feeding it, the first loaf I make from it struggles to rise.

Starters Vary

I’ve occasionally had two starters running at the same time. I once had my home-grown starter and also one seeded from some starter given to me by Jože. I’ve also had a starter that was initiated from a sample from a local baker’s, as I have said, and I’ve created a new starter from scratch when I already had one going. The bread made from different starters have slightly different tastes. And the one I got from Jože was more active than my home grown one. I have to say, I did not notice much difference between the two home grown starters I had. I am sure this is down to a difference in the actual yeasts in the mixture (or not, in the case of my two home-grown ones).

Hmmmmm…. Tasty

I discussed this with a fellow Oracle Presenter Baker and we decided it was highly likely that the actual yeasts in there not only vary with where the seed material came from but also how you keep it. If you keep it in the fridge, yeasts that are more tolerant of cold conditions will survive better, keep the starter at room temperature and those yeasts that reproduce faster in warmer conditions will take over.

Whatever, a loaf of sourdough bread you make from your own starter is a real treat. I’ll describe my baking process in the next post.

 

Friday Philosophy – Is The Problem The Small Things? August 7, 2020

Posted by mwidlake in ethics, Friday Philosophy, off-topic, rant, User Groups.
Tags: , ,
6 comments

Something has been bothering me for a while. In fact, I’d go as far as to say it’s been depressing me. It’s you. Well, many of you.

Well, it’s not MY problem!

What do I mean? Well I’ll give you an example. A week or so ago I went out in the car to get some shopping. A few minutes into the journey, as I go around a gentle bend, I see there is a car coming towards me – on my side of the road. I had to brake to give it space to get back over and I see it has swerved to avoid a branch in the road. As you can see in the picture, it’s not a huge branch, it covers less than one lane. I’m past it now so I go on to the shops and get my stuff.

30 minutes later I’m coming back. And I’m thinking to myself “I bet that branch is still there.” And it is. I can see it from maybe 300 meters back. The two cars in front of me barely slow down and they swerve past it. An oncoming vehicle that *I* can see coming, let alone the two cars in front of me, has to slow down for the swervers like I did. That slight bend means you get a much better warning of the obstacle from the side of the road it is on and as it is on your side, it’s really your responsibility so slow or even briefly stop, but the people in front of me just went for it. They did not care.

I did not swerve. I slowed down. And I put on my hazard lights, and stopped about 20 meters back from the branch. I double checked that no car has appeared behind me and I got out the car. In 20 seconds (including taking the snap), I’ve moved the branch off the road with no danger at all and I’m back to my car.

I know, you would have done the same.

Only no. No, you would not have.

Some of you would like to think you would have stopped and moved the obstacle.

I suspect most of you would claim, if asked, that you would have stopped and moved the branch.

And of course all of you would have slowed to avoid inconveniencing others.

But reality shows that nearly all of you would not.

As I left the scene, I was wondering how many people would have passed that branch in that 30 minutes I knew for sure this small branch had been an obstacle on the road. I’m going to let people going the other way off, as they would have to do a u-turn to come back to it, so how many people would have had to swerve past it?I know that road well, it would have been hmm, 4 or 5 cars a minute going past in one direction – certainly more than 3 cars, less than 10. So well over a hundred drivers would have seen that branch from a distance, most would have been able to safely slow and stop – and yet not one of them had. I have no idea how long the branch had been there, it was not too beaten up so maybe not long, but it could have been a couple of hours. It was easy to avoid – especially if you swerved with little concern for any on-coming traffic…

It turns out I’m the one in a hundred.

Are you thinking “well, it’s not my job to move branches of a road!”

So who’s job is it? And if you could label it as someone’s job (let’s go for someone in the “highways agency”) how do they get to know it needs doing? I don’t know about you but I see dozens of highways agency maintenance people on every journey I do, just cruising around looking for things that need doing. {sarcasm}.

When was the last time you saw something that needed doing in a public place and took the time to think about who should be told, try to contact them, get told to contact someone else, find out it’s not their job but are asked to ring Dave, who you do ring and he says thanks (before making a note to think about it, whilst probably muttering “this is not my job, I’ve got major roadworks to look after”). Hell, it’s easier to stop and move the branch.

Generally in life, in so many situations, I am constantly wondering why someone has not done X (or has done Y). Why don’t you reach for the jar in the shop the old lady can’t quite reach? Why don’t you hold the door? Why did you drop that litter when the bin is JUST THERE! That person  in front of you buying a parking ticket can’t find 10p in their purse to make the correct change? You have loads of 10p pieces… some in your hand already.

This is what is depressing me. Even though nearly everyone likes to think they are the nice person who will do a little for the common good, the reality is that most people won’t when it comes to it – but most people think we all should, and you tell yourselves you do the little things. You are telling yourself now, aren’t you? You are trying to think of the little things you have done for the common good. If you can think of a half dozen in the last month then you really are one of the good guys/gals. If you can only come up with a few…and actually most of them were ages ago… well, sorry but you are the problem.

The strange thing is that, having just insulted you all, as a group you lot are much more likely to be in the 1% than normal. Even though out of the general public not even 1 in 100 people would put in a little effort to move that branch, out of the people reading this, I’d say 10% would. Because I spend a lot of time in the Oracle user community, packed with people who give up their time, knowledge, even their holidays, to speak at conferences, help organise meetings, answer on forums, write blogs, answer questions on twitter, and all that stuff. Many of you reading this are active members of the User Community doing not just small things but often large things for the community. That’s why the community works.

To the rest of you, instead of liking to think you would move the branch or claiming you would (as everyone wants to be thought of as the nice guy/gal) just occasionally move the branch. Or pick that piece of litter up. Or do something small that cost you so little but it just would be nice if someone did it.

No one will thank you.

But you will know you did it. And you are becoming no longer part of the problem but part of the solution. I’m not asking you to give 10% of your salary to charity or give up an important part of your life, just do a bit of the small stuff.

If more of us do it, we will have a better world. If someone had moved that branch soon after it fell, I would not have had to  avoid some swerving dickhead, and the person I saw later would have not had to avoid people who could not even be bothered to slow down or stop briefly. And, in the worst case, that needless accident need not have happened. It really is as simple as spending 1 minute moving a branch.

Don’t be part of the problem, be part of the solution. It’s really, really, really easy.

 

COVID-19: The Coming Peak in the UK & Beyond. April 9, 2020

Posted by mwidlake in biology, COVID-19, off-topic, science.
Tags: , ,
9 comments

<<<<<<Introduction to Covid-19
<<<< Why we had to go into lock-down
<< What we could do to help ease social distancing

The UK government is now talking more in it’s daily briefings about what will come “next”, that is after we have seen the number of diagnosed cases & deaths continue to grow, plateau, and then fall. It will plateau & fall, so long as we all keep staying at home and limiting our social interactions. If we do not, we risk the virus spreading out of control again.

When Will the Peak Be?

My estimates so Do Not Trust At All

First of all, there will be two peaks. First the number of new cases a day will peak and then, about 8 days later, the number of deaths per day will peak. This is because of the average gap between being diagnosed in hospital and succumbing, for those unfortunate enough to do so.

The number of deaths a day looks to me like it will peak around April 20th, at somewhere between 1,200 and 1,500 a day (see below why I think tracking deaths is more reliable than case numbers and why case numbers are a poor metric). We will know that peak is coming as, if the lock-down measures have worked as intend, their effect will result in a plateauing and then drop in new cases during next week ( April 12th-18th). We might be seeing that plateauing already. Deaths will plateau (stay steady) for maybe a longer period than cases due to the fact that the gap between diagnosis and recovery or death is variable. That period will be something like April; 20-27th

If we follow the same “curve” as Italy and Spain,  the number of new cases will slowly start dropping but not as sharply as early models indicated. Deaths will also drop, about 8-10 days later. What happens then I have no idea really, it depends on how well the current social distancing measures work and if people continue to stick to them as spring progresses and people want to escape confinement.

A disproportionate number of deaths in this peak will be from our health services and critical works – people working in shops, bus drivers, refuse collectors, GP’s, teachers – because they are the most exposed. The care industry workers and lower paid people in our society will be hardest hit, which seems monumentally unfair.

The plan of pretty much all national governments so far is the same:

  • Isolation of all people who are non-key workers
  • Slow the spread
  • Expand the respiratory Intensive Care capabilities of the health services as much as possible
  • Look after as many of the wave of people already infected & becoming ill as possible

As I’ve covered in prior blogs, if the government’s measures work we are then we are left “sleeping with the tiger”. The virus is in our population, it will be slowly spreading still, and when social isolation measures relax there is a real risk of the illness and deaths exploding again because most of us are not immune. This is know by all epidemiologists studying this, it is a situation that China, Italy, Spain, and most other countries will face.

The big question is – what comes after the peak?

I’m going to cover three four things:

  1. Why we cannot go on “Cases” the number most often graphed and discussed. We have to go on deaths, and even then there are some confusing factors.
  2. Why the Infection Fatality Rate is key – and we do not know that yet
  3. A “test” or “vaccine” is not a black and white thing, it’s grey, and especially for a Vaccine, it is not coming soon.
  4. How we might manage the period between either a reliable vaccine or herd immunity. Both currently look like at least 18-24 months away.

Why Case Numbers Cannot Be Relied On.

Case Numbers do not tell you as much as you may think

Case numbers (the number of people who have been confirmed as having Covid-19) are the most commonly reported figures, many of us track if things are getting better or worse by them. But they are a very poor indicator really and they certainly cannot be used to compare between countries.

First of all, how are the diagnoses being made? Most countries are using the WHO-approved test or a very similar one, called a PCR test. I won’t go into the details here, I’ll put them in the section of the post on testing, but the test is accurate if done in a laboratory. Why in a lab? because any cross-contamination can give a false positive and if the sample or test chemicals are not kept/handled correctly, can give a false negative.

Not all countries are using just PCR tests. China made some diagnoses based only on symptoms. I’m not sure if other countries are making diagnoses from symptoms only and including them in official figures.

More significantly is who is being tested. In the UK the test was originally only being done on seriously ill patients in hospital. It is now being done on a few NHS staff and certain key people (like Boris Johnson!). In South Korea and Germany, many, many more people were tested, so there will be more cases identified. Add on to that the number of tests a country can do.

In the UK are testing rates have been very poor

In the UK we were limited to a pitifully small number of tests per day, less than 6,000 until March 17th and we only reached 10,000 test a day at the start of April. You cannot detect cases in people you have not tested.

Case numbers will also vary from country to country based on the country’s population! The UK is going to have a lot more cases than Denmark as we have over 10 times as many people.

The final confusion is that even in a single country, what counts as a day for reporting can vary and it can take time for information to be recorded. The UK sees a drop of cases against the prevailing trend on Sunday and Monday. As the cases are for the prior day and it seems like the data is not being as well processed at weekend.

Estimations of how many people really have Covid-19 at any time, as opposed to validated Case numbers, vary wildly. In the UK I doubt we are detecting even 1/3 of cases.

So, all in all, Case Rates are pretty poor as an indicator of how many people are really ill.

Infection Fatality Rate and Tracking Deaths Not Cases.

As I mentioned in my previous post last week, what we really need to know is the Infection Fatality Rate (IFR). This is the percentage of infected people who die. It is not the same as the Case Fatality Rate (CFR), which is the percentage of known cases that die. As the number of known cases is such an unreliable number (see above!) then of course the CFR is going to be rubbish. This is a large part of why the CFR varies so wildly from country to country. France has a CFR of 8.7%, almost as bad as the UK at 10.4%. The US has a CFR of 2.9% (but they will catch up).

As I also covered last week, we cannot calculate the IFR until we know the number of people who have been infected. For that we need a reliable antibody test and one does not exist yet. Yes, they are being sold, but the reliability is poor. Last I knew the UK NHS had reviewed several candidates and none were reliable enough to use.

Scientist have suggested many Infection Fatality rates. I feel 0.5% is a fair estimate. It is vital we know this number with some accuracy as if we have an Infection Fatality Rate we can flip the coin and calculate the number of people who have been infected from the number of people who have died.

IFR * deaths =  number immune

You can go from a graph like the example one I show (either from a model or, after the peak, from real figures) and as you have the number who died (say 20,000 to keep it simple) and the IFR of 0.5% you know that 4 million people (minus the 20,000 who died) had the disease and are now immune.

Of course, once we have a reliable antibody test we can verify the exact value for Infection Fatality Rate and the percentage of the population now immune.  But we only need that information from one country and it can be used, with minor modifications for population age and capacity of the health services, to estimate how many people are immune and thus how many are still at risk from Covid-19. In my example, about 62.5 million people in the UK would still be susceptible to Covid-19. Which is why this will be far from over after this initial peak.

There is one huge caveat in respect of the IFR. If in the UK the NHS is over-run, we will have extra deaths. People who would have survived with treatment die as too many people needed treatment at the same time. This is the whole “flattening the curve” argument, we have to protect the NHS from being over-run to limit this extra, avoidable deaths. In effect the IFR is elevated due to the limitations of the health system.

Countries which do have a poor health service or other aspects of their society that block them from the health service (cultural bias, fear of crippling debt) or more likely to have an elevated IFR, as are countries that allow Covid-19 to run unchecked through their population.

There is another aspect to the IFR and measuring progress of Covid-19 via the death rate. The number of deaths is a more reliable measure. I know that sounds callous, but as we have seen, the Case Number is totally reliant on how you do your testing and there needs to be a huge testing capacity to keep up. Deaths are simpler:

  • There are fewer deaths so fewer tests are needed (to confirm SARS-CoV-2 was present in the deceased, if not already tested).
  • Deaths have to be recorded in a timely manner.
  • Deaths are noticed. There are going to be people who are seriously ill and would be tested if they went to hospital but don’t, they get better and it is not recorded. They are “invisible”. Dead people invariably get noticed.
  • A country that wants to hide the active level of Covid-19 can do so by not testing, under-testing, or not reporting honestly on the tests. It’s not impossible, but it’s hard to cover up a significant increase in the number of deaths.

I stress that is is not a perfect indicator though. There is no clear distinction made as to whether the patient dies of some other illness but SARS-CoV-2 was present; whether the patient was likely to die “soon” anyway – again due to other illnesses; patients who die outside hospitals are not counted in the UK daily figures yet. (If you follow me on Twitter you will have possibly seen me querying the figures last Monday – and people pointing out the reason!)

Reported deaths will also suffer from spikes and dips due to how the reporting is done. The UK and some other countries I checked (France, Italy, Spain) show a dip in all figures, against trend, on Sunday or Monday (or both).

There is a really nice article on all of this this by New Scientist which is itself partly based on this paper by the lancet that gives an IFR of 0.66%

There is also a whole plethora of graphs and information on ourworldindata.org/coronavirus , as well as text explaining in more detail what I have said here. It is well worth a look and you can change which countries appear on the graphs.

 

Test are Not Black And White

There has been a lot of talk in the UK and elsewhere (including the USA), about not doing enough testing. On the other hand their is a constant stream of media reports about quick home tests, both for if you have Covid-19 or have antibodies to SARS-CoV-2 and so are immune. So what is the reality?

A test is only any good if it is reliable as used. For something like a deadly pandemic, it needs to be really reliable. Let me explain why.

Let’s say a company is selling an antibody test and someone uses it, it says they are immune,  and they stop self-isolating. But the test is 75% accurate. 75% sounds good, yes? No. it means 1 in 4 people who take that test and it says they are immune are not –  and they have now gone out, spread the disease to their aunt Mary and she dies. Plus infecting a large number of people and keeping the whole sorry mess going.

{Update – as a friend reminded me, when you are testing for an “unlikely” event, which being immune to C-19 is right now, even a 95% accurate test will give far more false positives than real positives across the whole population – I’ll try and do another blog to explain why}.

And that is if they take the test properly – companies are most likely to give you the best, under-ideal-conditions accuracy rate as they want to sell more kits than Sproggins Pharma selling a similar kit which they claim is 73% accurate.

If you are reading this, you are probably the sort of person who will read the instructions, follow them carefully, not put the swab down on a table,  not let the dog chew it.  And you note the bit on reliability. Most won’t. They will do the test quickly, it says they are immune and they will believe it, especially if the quoted reliability rate is high.

Any home test that can be used by the public has to be both very reliable (less then 5% false positives) and utterly idiot-proof. I’m really concerned that countries that put money first will allow companies to sell tests that do not meet these criteria and it will make the situation a lot, lot worse. It might even result in the pandemic running out of control.

Test For Being Infected – PCR test

PCR stands for Polymerase Chain Reaction. The WHO-approved test for Covid-19 is a PCR test and has been fully described since the end of January. You can even download the details of the test and methods from the WHO page I link to.

A PCR test is a genetic test. A primer is added to the sample to be tested and that primer latches on to a very specific DNA or RNA sequence. A biochemical reaction is then used, called a Polymerase Chain Reaction, to make copies of that DNA/RNA, doubling the number in the sample. These steps are repeated 30 to 40 times to make millions of copies of DNA/RNA. With an old-style PCR test you would then need to run the processed sample through a second process to detect it, like a Southern Blot – you get a square of gel with black lines on it. The PCR test for COVID-19 should be a real-time PCR test. With this the new copies made are attached to a florescent dye so that it can be easily detected as soon as there are enough copies in the sample, say after 30 iterations not the full 40, saving time.

If the original sample contains even just a few pieces of the DNA/RNA you are testing for, you will detect it. The process takes a few hours.

The RNA of the SARS-CoV-2 virus was sequenced (read) back in January and the WHO identified sequences that were unique to the virus, and these are used to make the primers. As I understand it most countries use the WHO identified primers but the USA had some “discussions” between commercial companies over which primers they thought should be used. I won’t suggest there was an element of these commercial companies looking to make a fortune from this, i’m sure it was all about identifying an even more unique RNA sequence to target.

The test has to be done in laboratory conditions. Because the test is so sensitive any cross contamination can give a false positive. e.g the sample taken from a patient was done by someone with COVID-19 themselves or there was SARS-Cov-2 virus in the air from another nearby patient. If a swab is used to get a sample from the back of the throat, it has to be put into a sealed tube as soon as it is used.

If the sample to be tested has not been looked after properly (kept cool, not kept for too long etc) or the chemicals for running the test are similarly not kept in a laboratory environment, you may fail to detect the RNA – a false negative.

Finally, the virus RNA has to be there to be detected. A patient early in their illness may not be shedding virus at a high enough level for the swab to pick up some of it. Once a patient’s own immune system has wiped out the virus (or almost wiped it out) again the swap may not have any or enough virus in it to be detected.

Done right a PCR test is a powerful, incredibly reliable (over 99%) diagnostic tool and is used for detecting many viral diseases, including HIV, Influenza, and MERS.

How a simple yes/no infected test might work

You can probably now understand why creating a PCR test for Covid-19 that can be used at home or in the ward and gives a result in minutes is a bit of a challenge.

Some companies are trying to create a different sort of test. These depend on creating a chemical that will bind to the virus itself, probably one of the viral surface proteins. That chemical or part of it will then react with something else, a marker chemical, to give a visible change, much like a pregnancy test. You put the sample in a well or spot where the detecting chemical is. Fluid is then dragged along the strip carrying the thing to be detected (the virus in this case) and the detecting chemical. Any detecting chemical that did not bind will be left behind. When the fluid goes past the marker chemical, if there is enough detecting chemical, it will change colour. Neat!

Best I know at time of writing, no one has come up with such a test that was reliable. I’m pretty sure someone will, in a few weeks or months. It should be accurate but no where near as sensitive as a PCR test. I must stress, to actually be of use in handling Covid-19 as a nation, the rate of false positive would need to be very low. False negative, though not good for the individual, is nothing like as big a problem in containing the pandemic).

Antibody Test

An Antibody test will show if you have had Covid-19. It will not show if you currently have it, or at least not until the very late stages. This is because it is testing for the natural ability for your immune system, via antibodies, to recognise and attack the SARS-Cov-2 virus.

We desperately need an antibody test as it will allow us to identify people who have had the disease and are now immune. This is vital for 2 reasons:

  1. Someone who is immune does not need to be restricted by social distancing. See my prior post on why this is vital and how we might identify such people.
  2. We can find out how many people have had the disease and compare it to the number of people who have died of the disease and get that very useful Infection Fatality Rate.

Unfortunately, making an antibody test is not easy. Some are in trials and I think the UK government have tried some –  and none have proven trustworthy.

An antibody test is simply not simple. What you need to do is design something that an antibody reacts against, so let me just describe something about antibodies. Before I go any further, I must make it very, very, very clear that of all the biological things I have touched on so far, antibody technology is something my academic background hardly touched on and most of what I know comes from popular science magazines and a few discussions with real experts last year when my work life touched that area.

Your body creates antibodies when it detects something to fight, an invader in our tissues. This is usually a viral or bacterial infection. It also includes cells that “are not our own”, which is why we reject organ transplants unless they are both “matched” to us and we take drugs to dial down our immune response. Our antibodies recognise bits of the invader, in the case of viruses that is (usually) proteins that are in the coat, the outer layer, of viruses. Usually it’s the key proteins, the ones that give them access to our cells. Our immune cells learn to recognise these proteins and attack anything with them on it.

Anyone infected with SARS-Cov-2 who survives (which is, thankfully, most of us) now have antibodies that recognise the virus. There is no guarantee that what Dave’s immune system recognises SATS-CoV-2 by is what Shanti’s immune system does. It will be a bit of the virus, but not necessarily the same bit!

So an antibody test has to include proteins or fragments of proteins that most human immune systems that recognise SARS-Cov-2 will recognise. And as that will potentially vary from person to person…. Oh dear. Thus a good antibody test probably needs to have several proteins or protein fragments in it to work. This is why it is complex.

Again, the tests will come but the first ones will almost certainly not be specific/reliable enough to really trust.

 

Vaccine

The bad news? Despite all the media hype and suggestions in government announcements of creating a vaccination in 18 months (maybe sooner), it is very unlikely. Sorry. It is very, very unlikely. Don’t get me wrong, I would love us to have one right now, or in a month, or even in 6 months. But unless there is a medical miracle, we won’t and by suggesting to everyone that we might, I think the powers that be are storing up a lot of anger, frustration and other issues

A vaccine needs to do something similar to the Antibody test. It needs to contain something that either is part of the virus or looks like part of it. This is usually:

  • An inactivated version of the virus
  • a fragment of the virus
  • One of the key proteins on the virus
  • Rarely, a related virus that is much less harmful (for example cowpox for smallpox vaccine).

The vaccine is administered and the person creates antibodies to it. Now, when the person is exposed to the real virus, the immune system is ready to attack it. Neat!

Influenza Vaccine is often less than 50% effective

Creating vaccines is a long process. You need to come up with something that is safe to administer, prompts our immune systems to create the antibodies, and the antibody reliably attack the virus the vaccine is for – and nothing else! (Occasionally a new vaccine is found to prompt some people’s immune system to attack other things – like the healthy, useful protein the virus actually attacks). And you have to produce a LOT of that thing if you are going to administer it to a large number of people, such as most of the UK population.

The vaccine has to work on most people as you need 60-70% of people to be immune to SAR-CoV-2 get herd immunity from Covid-19 – the higher the better. The influenza vaccine is often much less effective than 50%, especially in older people.

You are giving the vaccine to healthy people and to lots and lots of them. It has to be really, really, really safe. If it seriously harms 1 in a thousand people (which might sound reasonable at first glance, for treating something as bad as Covid-19) – well, that is almost as bad as Covid-19 itself. You would be harming hundreds of thousands of people.

With a drug you use to treat the ill, you can afford for it to be less safe – as you are only giving it to people who are ill (so a smaller number) and they have more to lose. The risk/reward balance is more likely to be positive for a drug. Even if a drug for a life-threatening illness harms 5% of people but cures 50%, it is worth (with informed consent) using it.

We have never, ever created a vaccine in 18 months before. I’m struggling to get a scientific reference as searches are swamped with talk pieces (like this one!) on why it will take a long time. However, this video by an American doctor  Zubin Damnia who does social media about medical matters explains better than I can and this history of vaccines makes it clear at the top it often takes 10 years.

The bottom line is, much though I want to be wrong, the often stated aim of having a suitable vaccine in 18 months or less will need a medical miracle and a huge amount of work.

After The Peak And With No Vaccine – How Do We Cope?

After the peak, most people are still at risk from Covid-19. As I said earlier, if the Infection Fatality Rate is 0.5% then for each person who died there will be 200 people who are now immune, so if there are 20,000 deaths that is 4 million people immune. 6

If there is no vaccine then we have, I think, four options:

  1. Continue social isolation measures as they are to keep the virus from spreading.
  2. Relax isolation a little and let cases creep up but held as steady rate, but within the capacity of the NHS.
  3. Relax isolation quite a bit, monitor number of admissions to ICU (or something similar) and re-impose strict social isolation at  the current level if things start getting worse.
  4. Relax isolation a lot and massively increase testing and case tracking – copying the South Korea/Singapore approach.

Option 1 to hold us all in isolation is, I think, untenable. People will stop doing it and the impact on our economy must be massive. The impact on our society will also be massive, especially if this continues into the next academic year.

I don’t think we can manage option 4 in the UK yet.

So I think we will see an attempt at option 2, relaxing some social isolation rules (such as allowing restaurants to open and small gatherings) but then option 3, tightening social isolation if numbers of new cases start to build.

Option 4 could become a reality in a few months, especially if we can get people to use mobile phone apps to track movements and aid identifying the contacts of people who become ill,  but not everyone has a mobile phone and I think a good percentage of people will not agree to be tracked.

At present, without a vaccine, we will be living with some sort of social until we reach herd immunity, with at the very least 60% of us immune. How long will that take? 60% of the UK population is 40.5 million people. That equates to 202,500 deaths from Covid-19 to get there (remember, see the bit on IFR above).

This current peak of Covid-19 will last about 3 months, from the start of March to the end of May. It remains to be seen if we exceed the NHS expanded capacity. If we allow 20,000 deaths a peak with 4 million people becoming immune each peak, that’s 10 peaks, so 2.5 years.

A better option could well be to aim for a steady rate of new cases and deaths from Covid-19, say 1000 a week. At that rate herd immunity will take just over 200 weeks, 4 years. If we allow 4000 deaths a week than we could be there in a year, but our NHS would have to be handling the many, many thousands of ill patients that would entail.

Of course, in reality, our treatment of Covid-19 patients will get better over time, so fewer people will die from it, but it will still be a horrible thing to go through. And, if we DO get a vaccine sooner rather than later, many of those people will have died needlessly.

So, as you can see, we are in this for a long while.

The expanded health services, better knowledge of what social movement restrictions work, improved testing (including home testing), even my idea of cards for those immune, would all make life easier, it is not all doom and gloom. But I just wish all of what I have put here was being discussed and shared with people (preferably in a shorter form than this blog!) in a clear and constant message. I think if more people understood where we are and what is likely to to happen (or not), we will save ourselves a lot of issues weeks/months/even years down the line.

I honestly don’t know what the answer is – I don’t think anyone does. Which is why all of this talk about an “exit strategy” results in lots of hand waving and no clear plan.

As ever, if you think I’ve got something wrong, you know of a good academic source covering this, or you simply have a comment – let me know.

COVID-19: What Can We Do to Reduce Social Distancing March 27, 2020

Posted by mwidlake in biology, COVID-19, off-topic, science.
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The Coming UK Peak and Beyond >>

Summary

The impact of COVID-19 on our society and our economy is going to be long and hard. I hope I am not the first to come up with this idea, but just in case…

Having everyone on lock-down on and off for months will be hard to maintain. But not everyone will need to be in lock-down. You do not need to be locked down if you are immune.

I think we need to look at having a “COVID-19 Immunity Card” – you get the card to prove that you are probably immune to COVID-19 and that you are no longer a danger to others and are not in danger yourself.

Once you have a card you no longer have to abide by social distancing measures in the same way as those not immune. You are also a known “safe” person who can interact with those who are not. This would be particularly reassuring in the “caring” industries.

The number of people with cards will grow over time due to:

  • People being diagnosed with the disease and recovering – not many yet.
  • People being tested and found to have had the disease (possibly without knowing and have recovered) – coming soon?
  • People who have been vaccinated against it – future group.

There are potentially serous drawbacks to this idea. Such a card would be a source of division for as long as we have them and they would be a huge target for criminal activity, but it could help us “sleep with the tiger” of COVID-19.

It could/would allow our economy, health services, and society function more effectively whilst we are living with COVID-19.

Background – Once we “stop” COVID-19 this time, we have a problem…

The UK, like a growing number of countries, is now in a strong, country-wide, social shut-down. The aim is to suppress COVID-19 (see COVID-19: What’s Going To Happen Now ) i.e. drop the levels of person-to-person transmission (The “R” number) below 1. If each person with COVID_19 infects fewer than 1 other person on average, the spread stops. Quickly. It will take another 2-3 weeks for those already infected or sick (as of the date I am writing this, 27/3/20) to develop the symptoms and possibly need hospital treatment, so between now and mid-April we will see cases continuing to rise rapidly, followed by the number of deaths.

Then, something like Mid-April onwards, new cases will drop and, less slowly, the number of deaths.

COVID-19 will have been stopped. However, it will not have gone away, it will still be in the population. If we relax the social isolation we are currently living under, it will start spreading again and we will have another outbreak. Why? As only a small percentage of the population will be immune to the SARS-COV-2 virus. Governments are giving the impression that we will have “beaten COVID-19!” at this point, when the first peak of cases has come and gone, but the scientific consensus is clear that it will return if we all start living normally again. There are several studies going on at present to model what we can do and how. For example, China is relaxing restrictions and the world-wide epidemiological community is watching. For example, this Imperial College Paper on how China is coming out of strict social distancing is interesting.

I think of this as sleeping with a tiger that we don’t want to wake up.

The Imperial/WHO/MRC paper does cover all of this and suggests a way of relaxing social isolation steps and re-introducing them, over a 2 year period. The chances are, this is all going to go on far longer than most people realise and way longer than any of us want!

Reasoning on why COVID-19 will be with us “until something changes”.

The rest of this post is me being an “Armchair Epidemiologist” – proposing untested ideas with only a tenuous grasp of the true facts. But I thought I would put this out there. Note, there will be a lack of links to any solid references from this point. When you see this in articles discussing scientific ideas, it usually indicates it is a thought experiment.

There is general scientific consensus that, if we had better testing, the Case Fatality Rate would be about 1-2%. Case Fatality Rate (CFR) is the percentage of diagnosed cases that die. What we actually need is the Infection Fatality Rate (IFR) of COVID-19:- Taking into account all people who get the disease (whether they show symptoms or not or were tested or not) what is the percentage of people who die. See the Wikipedia entry on CFR for more details of CFR and IFR.

IFR is being argued about by the scientific community as you have to test a large, random set of people to see how common the disease is and testing by most countries is limited to suspected cases. Thus estimates are being made. The really good news is that the estimates of IFR are a lot lower than CFR. numbers seem to vary from 0.2% to 0.6%. See this pre-print of an article on CFR/IFR  and this paper by Nuffield Primary Care Health Sciences  at Oxford University. I’ll be pessimistic and take 0.5%

I am assuming the  Infection Fatality Rate is 0.5%

The reason we need the Infection Fatality Rate is that we can then calculate the number of infected people from the number of people who died – ONCE number of infection and deaths have reduced to low numbers again. You can’t do this (well, I can’t) when the number of new cases or deaths is increasing.

If 10,000 people die in the peak of cases we are currently enduring, if it is killing 0.5% of people and ICU limits are NOT exceeded, that means 2 million people will be immune once the peak has passed (as 99.5% of that 2 million have it and survive).

However, 64 Million will not be immune.

As has been described, we could now relax social distancing and let businesses and the economy start up to some degree again – but then tighten up social distancing again when cases or ICU admissions rise. We have a series of mini-outbreaks.

We have a population of 66 million. At 2 Million becoming immune in each “Outbreak”, we would need 20 outbreaks to get to a level of people who have had the disease where herd immunity is stopping the disease spreading – 60% or 44 or so million people (but we would still have 22 million susceptible to the disease).

With a peak every 2 months (so no single one exceeds the expanded capabilities of our NHS) getting to 60% immunity would take… several years. This is why all those discussions about getting herd immunity in weeks or months is, frankly, naive. We could only have that happen if we did not control the outbreak.

It might be that we can work out a level of social distancing that allows the economy to keep some semblance of normality and the COVID-19 cases at a level the NHS can keep up with, but that is a very, very fine tightrope to walk.

In any case, if we do not simply let COVID-19 rip through our society (killing more people than it would if controlled, as it vastly overwhelms the health services) we have to sleep with the tiger until we we have another option. But I think there is a way to make sleeping with the tiger more comfortable.

People will become immune to SARS-COV-2

A reliable, widely available test for seeing if someone has had COVID-19 and is now resistant to the  SARS-COV-2 is desperately needed and, I think, will become available soon – in a couple of months, long before a vaccine arrives.

We will then have 2 ways of knowing someone is immune:

  • Those who were tested positive for COVID and survived. They are immune.
  • Those that pass an antibody test. They are probably immune – depending on the reliability of the test. There could be several tests that have different levels of reliability.

These people can be given an “I am immune” card and they will not be limited (at least not so much) in lock downs.

Initially there will only be a hundred thousand people who can have the card, as they have been identified by testing to have had COVID_19,  have got better, and are now immune . But, crucially, a disproportionately high percentage of them will be NHS and first responder workers. This is because those groups are suffering very high exposure to COVID-19, by the very nature of what they do. The ranks of these groups are (and will continue to be) literally decimated by COVID-19. Lots and lots and lots of nurses, doctors, lab staff, cleaners, police, paramedics, GPs are going to be in the first wave getting ill.

Once we have the cheap, reliable antibody test , we can look for the rest of the 2 million.

As you can see, the more testing we do, both for having COVID-19 or for having antibodies against SARS-COV-2, the more people we can give an immunity card.

Over time, especially if we have further outbreaks, the number of people who are immune and are found via the above will increase.

Later, when vaccines are developed, there will be a third group of people we can count as immune:

  • Those who are vaccinated
  • Better still, those who are vaccinated and are latter tested for (and pass) an antibody test.

The first vaccines are likely to not be very effective – think the low end of the level of protection the annul ‘flu vaccines achieve, 20-40%. The antibody tests to confirm you have immune to SARS-COV-2 might also vary. But the details on the card will give which tests and vaccines you have had.

The card will hold details of why the person is immune, what test(s) were used to identify they had the disease, what vaccine(s) they had had, and when these events occurred. Minimal details would be held on the card itself.

A central database would hold the details of vaccination & test efficacy, corroborative information about the person etc.

If the reliability of historical tests or vaccinations change, then the immunity status of the individual may change.

The database of information would of course need to be well secured, kept in more than one place (so that a single IT disaster does not destroy all this key information) and protected. These are technical problems that can be solved.

Drawbacks off the COVID-19 Immunity Card

The cards will need to be very reliable, trusted, and protected from abuse.

Both the data they hold (or link to) and the information about the person the card is for needs to be highly dependable. The data needs to specify which sort of immunity this person has, when they were ill (if they have been) or tested, when any vaccine(s) were administered and when. It may turn out that immunity to SARS-COV-2 will reduce over time (that is, our immune systems “forget” about the disease) and the virus may mutate over time such that it avoids our immune response (whether natural or via vaccine).

The link to the person will need to be reliable, so no one can use a stolen or fake card. Obviously pictures, basic information, etc need to be on the card for a quick check, and information on the card links to a data source that can be used to further check identity and give more detailed information about immunity, such as may be needed if the person is in a medical situation.

It strikes me that this is a perfect use for blockchain. Each card, the data associated with it, when & how it is updates, can be accurately tracked in a way that is very, very hard to fake.

The data and the card should link to nothing else. There would be a temptation to be able cross reference the medical data with socioeconomic data, geographic information, even information about shopping habits to see if there are any correlations between between these factors and how people respond to COVID-19. This would be a nightmare as it introduces questions of consent, privacy, abuse of the data, fear of being spied upon.  Ensuring this card is for one purpose alone, with no link to anything else, would reduce the next drawback.

ID cards by the back door.

This will effectively be introducing ID cards, which some people object to strongly on moral or philosophical grounds. I’m not going to do more than note that this is an issue and observe that many societies have ID cards already. If these cards are kept to this one purpose, it would help make them more acceptable.

Criminality

Of course, as soon as such a valuable thing as a card that allows you to avoid social limitations is available, some people will want one, even though they know they are not immune. Criminals will want to create and sell them, so we need something, probably several things, (again, like a blockchain identifier on the card) to help guard against this. I would also suggest we would want to see strong punishment of individuals who try to use a fake card or get one by deceit. After all, these are probably the same selfish gits who bought all the toilet paper. As for criminals trying to make and sell fake cards, the punishments would be draconian – they would be putting a lot of people at risk.

Two-Tier Society

The cards would by their nature split society. Those who have a card would have more freedom. Those who do not would not.

Some people would never be able to get a card as they are immunocompromised  or similarly unable to be vaccinated.

Human nature says some people would discriminate or persecute people who are not immune if there was a way to identify this. I actually see this as the main reason to not have such a card.

Laws would be required to back up a repeated and strong message about why such discrimination is utterly wrong.

SARS-COV-2 Could Change

We do not yet know how the virus underlying COVID-19 will change over time. It is mutating – but ALL life mutates. We use the mutation to track how SARS-COV-2 has spread across the globe and the mutations, so far, are not known to alter it’s infection rate or how it impacts people (though I think I have seen some suggestions about this on social media that are more trustworthy than general scuttle).

However if it turns out that C-19 becomes C-23 and C-28 etc like Influenzela A, the card scheme still works but you are now stuck with identity cards and potential discrimination against those who are not immune etc.

End Life of the cards

I would want to see an agreed termination point for the cards stated when they are brought in. They or the data they link to will be deleted utterly in 3 years time. This can only be changed by a cross-political-party agreement.

 

That’s my idea. If you have any comments – for, against, highlight things I have wrong – I would love to hear.

COVID-19: What’s Going To Happen Now March 24, 2020

Posted by mwidlake in biology, COVID-19, off-topic, Perceptions, Private Life, science.
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I thought I’d record what the scientific evidence and epidemiological modelling is saying about what is going to happen in respect of COVID-19 in the UK (and, to some extent, elsewhere) over the next weeks and months. As with my intro to COVID-19 this post is mostly “for me”. I’m sharing it but please, please, treat all of this post (not the science I link to!) with some scepticism.

The figures are shocking so I want to spell out right at the start that, if our governments does what it needs to do and does it right (and over the last 2 or 3 weeks the UK government has fallen a tad short on this, but it’s improving) in the end over 99% of us will be OK. If they get it wrong, it’s more like 97% of us will come through this.

And, I feel it is important to say:

90% of even high risk people will also be OK.

I strongly feel that the message is constantly that it is the at-risk people who are dying and not that most people at risk will be OK. Yes, COVID-19 is more of a danger to those over 70 and those with underlying medical conditions, but with the media and government constantly saying “the people who died are old” etc it makes it sound like COVID-19 is a death sentence to them – and it is not.

Yes, I’m quite angry about that that poor messaging.

Source of Epidemiological information

ICU beds needed per 100,000 people

My main source is This paper by Imperial College in collaboration with the World Health Organisation and British Medical Research Council. If you can, please read this paper. It spells out how COVID-19 will spread and what happens when the NHS intensive care unit (ICU) beds are all full. It’s a hard read in two ways.  It is technically dense; and it says things people are still refusing to believe:

  • If we had done nothing and had an infinite number of critical care beds, it would burn through the population of the UK (and all other countries) in 3 months, infecting 81% of people. At that point herd immunity stops it.
  • In the UK 510,000 people would die (COVID-19 kills about 1% of people even with ICU treatment). 2.2M would die in the USA.
  • At the time of publication of the report, the “mitigation” plans by the UK government would have failed to stop even more deaths (more than 1%) as the NHS would have been overwhelmed by the 2nd week of April.
  • At the peak we would have needed 30 times the number of ICU beds we have.
  • The paper does not fully spell this out, but if you need an ICU bed and there is not one, you will almost certainly die. Thus the death rate would be more like 2.3% {Note, that is my figure, I have not spotted it in the report. It is based on 4.4% of the population needing hospitalisation and 30% of them needing critical care, figures that are in the report}. I’ll let you work that out based on the UK population of 66.5 million. OK, it’s about 1.17 million.

These figures are truly scary. They won’t happen now as it shocked our government enough to ramp up the social isolation. If anyone questions why we need the social isolation, give them the figures. If they refuse to believe them,  tell them to read the paper and various articles based on it and point out where they are significantly wrong. If they won’t, thank them for their baseless “opinion”.

The calculation of 510,000 deaths in the UK did not factor in self-isolating naturally, as we all saw people fall ill and die. That would slow down the disease.

However, if the hospital is full to absolute bursting capacity with COVID-19 patients, any person who needs ICU care for other illnesses (cancer, cardiovascular disease, stroke) or accident. How do you fit them in? Deaths for other reasons will increase.

One thing I am not sure of is that in the paper critical care is stated as “invasive mechanical ventilation or ECMO”. If you need just a ventilator and one is not available, I’m pretty sure you would also be likely to die or suffer brain and other organ damage from oxygen deprivation.

As I understand it, this report is what made the UK and other governments take COVID-19 a lot more seriously and really understand the need to implement strict social isolation.

I’d like to say why I put so much trust in this source:

  1. The three organisations behind it are all highly respected (WHO, MRC, and Imperial College)
  2. They state clearly at the top their assumptions – the R number, incubation period, types of social isolation, the percentage of people who will comply with each one.
  3. They created a model that was then verified by running the numbers and seeing if it predicted what had happened in reality to that point.
  4. The subject matter experts I follow have all endorsed this piece of work.

Mitigation or Suppression

The Imperial College report spells out the distinction between Mitigation and Suppression:

Mitigation is where you reduce the R number (the number of people each infected person in turn infects) down from the natural number of around 2.4 but it is still above 1. At this rate the disease continues to spread and the number of cases per day continues to increase, but more slowly. The idea seems to be that it would lead to herd immunity. This was the UK governments aim until Monday 16th March.

Suppression is where you reduce the R number below 1. Within a few weeks the disease is no longer spreading. But it is still there in the population. This is what Wuhan did and Italy is making progress on.

To achieve mitigation the government isolated people infected, asked those who had had contact with them to self isolate, and asked us all to wash our hands and keep a distance and think about working from home. The impact on daily life, business, the economy is minimal. Further steps would be introduced later, like closing universities and schools.

The Imperial college report demonstrated that mitigation was a terrible idea as the number of cases would still explode, but just be delayed a little, and the NHS would be absolutely overwhelmed.

The graph at the top of this article shows the mitigation steps being considered and how it only shifted the curve and did not lower to anywhere like the NHS ICU capacity. It was simply not enough.

Isolation involves the sort of steps most of us would have previously thought only an authoritarian regime like China or North Korea could manage. Schools, universities and non-critical business shut, everyone not doing a critical job made to stay at home except to buy food etc. Basically, Wuhan. And now Italy is doing very similar. As of the 23rd March the UK is following suit.

Most western countries are now implementing many of the steps needed for isolation levels that will suppress COVID-19, but not all the steps needed.

The graph to the right shows the impact of two implementations of Isolation, both implementing several measures but the orange line does not include closing schools and universities. The green line does. The green line keeps the number of cases within the NHS ICU capactiy, the orange does not. That is why schools and universities were closed.

The graph also makes the point about the main problem with Isolation. It is only stopping the virus spreading, it is NOT getting rid of it. Remember, no one is immune unless they have had COVID-19. When the steps to enforce isolation are relaxed, COVID-19 will burst back.

This is potentially the position that China is in. They have locked down Wuhan province tightly and it worked. The number of cases there rocketed even after the lock-down but have since reduced, almost as fast as they increased. China as a whole now have very few new cases. The lock-down is being relaxed as I prepare this post. Epidemiologists expect the number of cases in China to increase again.

The degree to which either mitigation or suppression is enforced obviously impacts society and commerce. The Imperial College report makes the point that they are not addressing those concerns, they are simply saying what social isolation changes will have what effect on COVID_19 spread, deaths, and the ability of the NHS to cope.

Delayed impact.

UK daily cases to March 20th, Italy deaths to March 20.

This next point is being made widely, by both non-scientific observers and the scientific community, but I want to re-iterate it as it is so far being played down by government (which could be changing at the very moment I am typing).

There is no way to avoid the huge increase in COVID-19 cases and deaths that are going to happen in the UK over the next 2-3 weeks. Expect our levels to be the same levels as Italy. In fact, expect them to be 20, 30% higher. This is because the UK government were too slow to lock down and did it in stages when, based on the epidemiology, we should have shut down totally on Monday 16th when the paper I reference was published, or within 2 days to allow for planning.

Up until now COVID-19 has been spreading exponentially (1 person has it, passes it to 2-3 people. They pass it to 4 people who pass it to 8…16…. 32… 64… 128… 256… 512… 1024). This has been seen in the way the number of case had double every 3-4 days, deaths are now following the same pattern.

The two graphs to the right show the number of cases in the UK to the 20th March above, and the number of deaths in Italy to the 20th. They look like the same graph as they sort of are. This is how something grows exponentially when the growth rate is the same – the same as both cases and deaths are caused by the same thing.

(these graphs are from Worldometers – I use this site as I think the John Hopkins site has more incorrect information on it).

Covid-19 takes on average 5.1 days to show symptoms from when you catch it (this can be up to 2 weeks – with all these averages there will be some cases which are two or three times as long). It takes less time, 4.6 days on average, from when you catch it to when you spread it. So you can spread the disease before you get ill. And some people do not get ill (or only very mildly) and spread it. Like “Typhoid Mary”. If you are going to be ill enough to need hospitalisation it takes 5 days from first symptoms for you to deteriorate to that point.. At this point you will be admitted to hospital, tested, and will join the number of confirmed cases. If you are going to die (I know, this sounds really callous) that is another few days. The report does not spell it out but going on the figures they use for time spent in intensive care in the model, about a week.

Add it all together and someone who dies of COVID-19 today caught it 15-20 days ago on average, so the spike will be delayed that much.

Yesterday, 23rd March, almost total lock-down in the UK was announced. Cases and deaths will rise for 20 more days in the UK. Exponentially. To Italy levels, maybe 20-30% higher. Then they will plateau for a few days and drop quickly, depending on how well people respect the social distancing or are forced to. I am expecting over 9,000 will die in this first spike, with a peak number of deaths between 750 and 900 in one day. Sadly my predictions so far have all been correct or a little too optimistic.

That is the reality and that is why we are seeing the actions of our government that have never been seen outside World Wars before.

Three choices – or is it four?

To summarise the above, there were 3 choices available to the UK (and all other countries):

  1. Let COVID-19 burn through the population in 3 months. It would kill 2-3% of the population as the NHS collapsed and also anyone who needed medical treatment during that time would probably not get it. During the 3 months lots of people would have “bad ‘flu”. 80%  of survivors would be resistant to COVID-19 for now.
  2. Mitigate the impact by the measures implemented in stages during mid-March, reduce the impact a little and stretch the curve a little, and have 1.5-2.5% of the population die over 4 months. 70% of survivors {my guess!} would be resistant to COVID-19 for now.
  3. Suppress COVID-19, 10,000 dead and everyone in lock-down until “something changes”, which could be 18 months or more.  A tiny percent, maybe 5% {my guess} resistant to COVID-19.

The UK government chose option 3, after considering 2 for a while (and thus increasing the death count by, hmmm, 3,000 in that first spike).

The “something changes” in option 3 is that scientist create a vaccine for SARS-COV-2, the underlying organism to COVID-19, or we have a quick and reliable immunity test for it that allows those who have survived the disease to move about unrestricted. See further down in this post. Most of us stay in lock-down until “something changes”

But this Imperial College paper has a solution 4:

Turning social isolation up and down

  1. sorry, 4. I can’t get the layout to work. solution 4 is to
    1. suppress.
    2. Let the known bubble of cases come and deal with it.
    3. Once it has passed, relax (not remove!) the Suppression rules to let business and normal life start up again.
    4. Monitor the number of COVID-19 cases coming into ICU.
    5. When it hits a threshold, back to total lockdown and deal with the next bubble.
    6. Repeat.

It is a clever idea. No one wants to stay at home until a vaccine is created in 18 months. Economically, total lock-down until we have a vaccine would be a disaster. So varying the lock-down based on NHS demand indicators would allow some relief from the restrictions. But not back to normal.

Option 4 comes at a cost. More people will die reach time you relax the lock-down, depending on what is allowed. Much of the rest of the paper details this plan and, based on the figures they state at the top of the report in respect of how many people will abide by the rules, what different isolation strategies and key triggers (how many new COVID-19 ICU cases in a week) to increase isolation levels, gives death rates varying from 8,700 to 120,000. This also takes into account a range of R values (how easy it spreads naturally) as there is still some uncertainty about this.

The paper makes one thing clear – we would need to maintain the isolation levels for suppression for 2 years – their cautious estimate of how long it will be until we have a widely available vaccine.

The best case is deaths creep up (after the initial surge we can no longer avoid) with very strong lockdown only relaxed at very low levels of ICU cases and deaths. I personally doubt very strongly that enough people will abide by the rules for long and, as people start ignoring them, others will feel “why should I play by the rules when they don’t”.

I do not have anything like the understanding of human nature needed to predict how people are going to react so I won’t. But the figures being bandied around a few days of keeping UK deaths to 8,000 or less seem utter fantasy to me.

The “The hammer and the dance” paper…

Some of you may have come across “The hammer and the dance”, which is based on a paper by Tomas Pueyo on “Medium”, a home for science papers that have not been verified by anyone. I would not normally look at things here very much but several people have mentioned the paper or even linked to it. If you recognise the term, you will probably recognise the “dance” part as choice 4 above.

Context is paramount

Lots of numbers are being thrown about, but to understand the true impact of COVID-19 those numbers need to be interpreted in light of some general background.

Let’s start with the base rate of mortality. In the UK there were 541,589 deaths in 2018. That give 9.3 deaths per 1,000 residents. See the office for national statistics article for this figure. Over the year that is 1,483 deaths a day, from all causes. People keep on insisting on comparing COVID-19 to influenza. I’ve struggled to get a definitive number of deaths due to Influenza in the UK but it seems to be between 8,000 and 17,000 a year. Let’s take 17,000 as a top estimate, that is 46 a day.

(you may wonder why it is hard to say how many people die of influenza. Well, influenza kills people who are already seriously ill and likely to die anyway, and I believe not every death attributed to influenza is tested for sure to be influenza.

Our key figures are 1,482 deaths by any means a day and 46 a day from influenza, in the UK.

On the 21st March 56 people in the UK died of COVID-19. More than Influenza, about 4% of the daily mortality rate. Bad, but nothing that significant. In Italy, 793 people died of COVID-19 on 21st March (and it looks like that might be the peak). Our figures in the UK for known diagnoses and deaths are following the Italy pattern very closely (for very good scientific reasons) just 2 weeks behind – 15 days to be more precise. In 15 days the death rate for COVID_19 is likely to be very similar to Italy so, despite my hunch the UK peak will be higher, let’s use Italy’s peak number:

  • 50% of the total death rate for everything in the UK.
  • And 17 times the death rate by ‘flu.

So COVID-19 is incredibly serious,  but it could have been worse. It looks like for a period at least, for each country, it will increase the daily death rate by 50% and maybe more. But it is not killing a large percentages of the population.

I’ve seen some scare stories about this disease sending us back to the dark ages as it kills half the population of the world. Rubbish. It might stop the world population growing for a year.

Why will social distancing last 18 months?

No one is naturally immune to COVID-19 until they have had it. Let’s assume that once you have had it you are immune for several years, as you are with many other viral diseases (Influenza A is a special case as changes so fast and in a way that reduces the effectiveness of both vaccines and immunity via exposure).

We could let COVID-19 spread naturally or at least in a contained way – but it will overwhelm our health services as discussed, and 1-3% of us would die.

The other way is to create a vaccine, which gives immunity or partial immunity without having the disease (or maybe a very mild version of it). Vaccination works, it rid us of smallpox totally and, until the loony anti-vaxxer movement got going, it was vastly reducing measles, rubella and many other diseases.

But creating a vaccine that works is hard. Lots of biomedical scientists are working on it and we might get lucky and someone comes up with a very effective vaccine that can be created in bulk, but by lucky we are still talking months. (There is at least one early trial running – but that absolutely does not mean it will be available next month!)

Any vaccine has to be tested, proven effective, and shown not to itself harm.

All of this is why specialist in the field all say “18 months”. It’s a guess based on science and experience. It could take longer, it could be only 12 months, it might be that an initial vaccine is only as effective as the yearly flu vaccine (the flu vaccine generally protects 40-60% of people – see  this oxford university paper).

We can test for if people currently have COVID-19, the test is accurate and relatively cheap. It checks for the RNA of the virus, an established diagnostic practice. Production of the test is being massively increased and improved and we need that so we can better track the disease and accurately identify who has the disease and put them in isolation. In the short term, wider testing will help a lot and those countries that have gone in for huge testing efforts (South Korea and Singapore are examples) have done well in containing COVID-19.

The other tool we really need is a test for immunity, which is usually for the antibodies to a disease. Again, these tests take time to devise. If we could identify those who have had the disease (but were not tested) and are now immune. They would not need to be isolating themselves. A small and growing part of our population could return to normal. But we have no idea when such a tool will be ready, how accurate it is, how cheap it is to do etc.

Finally, scientists need to work out if immunity to COVID-19 is long-lasting, for how long, and if the immunity is strong or weak. We just do not know yet.

Until we have a vaccine (ideally), or the immunity test (it would really help) we have to suppress COVID-19 via social distancing etc.

Basically we are sleeping with a tiger. Best not wake her.

Disclaimer

All of what I put here is based on what is said by experts, scientists, epidemiologists. I’m just pulling some of it together. As I said in the previous blog, I am not an expert in any of this. I’ll make it clear when something is my opinion. I also want to highlight that I only look at sources that I feel are backed by good science. The only information I take from the government is official statistics on cases & deaths. I’m heartened that our government is now taking the spread and impact of COVID-19 more seriously but I remain angry that the experts told them what was coming weeks ago and they were slow to act, putting business concerns before lives.

Any mistakes in this blog post are mine. There are bound to be a couple.

I would love to hear about sources of information you feel are good. I had several excellent sources pointed out to me after my last post, including being corrected on a couple of counts – which I am very happy about.

However, I will probably ignore anything based on rumour or anecdote. Ginger & Garlic are not going to boost your immune system and protect you, quinine is almost certainly not a magic protector. If you have a peer reviewed article in a reputable journal or the support of a respected epidemiologist to back those opinions, then let me know.

 

COVID-19: Information And Outlook March 13, 2020

Posted by mwidlake in biology, COVID-19, off-topic, Private Life, science, Uncategorized.
Tags: , , , ,
11 comments

Outlook for the months ahead >>
Reducing the need for social distancing by knowing who is immune>>>>
The coming UK Peak and Beyond >>>>>>

I decided to put together some information on COVID-19 purely for my own interest – but then decided I might as well put it on a blog post. I’m only going to link to what I feel are reputable sources, nothing from tabloid papers or people promoting conspiracy theories.

If you know of a good site I should include or there is an area I have not touched on that you would like more information on, please feel free to let me know.

Update. At long last, as of the evening of Monday 16th March, the UK government listened to the WHO and other epidemiologists and accepted that draconian measures to suppress COVID-19 (reduce the R rate, the number of people each infected person in turn infects to below 1) rather than mitigate it (reduce the natural R value of 2.4 towards 1 but above 1) will save thousands of lives.

This paper by the Imperial College London in conjunction with the Medical Reaserch Council & WHO is being cited as the root of this change in opinion. It’s a hard read as it is a scientific paper, but it is excellent. It helps make clear many things such as the local spread rate, infection rate, how it transmits between countries. the likely number of real cases as opposed to tested and verified cases. And the simulations match what we have seen to date.

In summary, suppression, such has been managed in South Korea and China, virtually stops the disease for a while. It does not end it. When the measures to suppress it (very strong social control) it will burst out again. There is always a chance it will escaped to areas it is not suppressed and blow up again. But it buys time to work on a vaccine and develop better treatment regimes.

Mitigation slows the spread down. But it continues to spread. An argument was put forward that this will develop “herd immunity” by letting most people get the disease. It means it would be over sooner – but at the cost of hundreds of thousands of lives, just in the UK. The NHS would be utterly swamped during this time.

I’ll move this down into the body of this post later.

{Update 15/4 – I obviously did not move this down as I feel that change of direction was so key}.

 

Firstly, for anyone who does not know me or just stumbles over this page via “Google”, I am not an expert in any of this – I am not a medic, I am not a scientist, and I am certainly not an epidemiologist (someone who studies the transmission of disease). I’m a computer professional with a really old degree in genetics & zoology who has at times worked on systems for the UK National Health Service (NHS), the Human Genome project, and some other scientific organisations.

Secondly, although this is a very serious disease and it is going to continue to have a huge impact,  most people who get it will not be seriously ill. We are not all going to die!

Most people with underlying medical conditions or who are elderly are also going to be fine

The press, at least in the UK, keeps making a huge point that anyone who dies had “Underlying medical conditions” and it is affecting “the old” more. This is true, but the message that comes across is that if you are old or have an underlying medical condition you will die. This is not true.

Even if you are 79 with diabetes and are diagnosed with COVID-19, you have over an 85% chance of being OK, even if you develop the symptoms.

However, the fact that this disease is eventually going to kill tens, hundreds of thousands of people {Update 15/3: 127,000 worldwide so far and that will be an under-estimate , so hundreds of thousands. I’m sure it will hit the million by June. UK it is 13,000 including care homes} is why saying “I’m stronger than this” or “I’m not letting it impact ME!” is, in my opinion, a highly arrogant or stupid approach. Just as wrong is making it the focus of your life. Most of us, around 90-95%, will be mildly ill at most, or not noticeably ill at all. {Caveat – by mildly ill, you may well feel terrible and spend a few days in bed, but that’s like a normal dose of ‘flu.  Take it from someone who has spent a week on ventilators recently, a few days in bed is nothing 🙂 }

Thirdly, though COVID-19 is going to kill quite a few people, the main impact is probably going to be what it does to our health services. It is almost certainly going to over-whelm the health services of most countries, as it has in Italy. Preventative actions, 99% of what we can do, is aimed to spread the load on the health services so that as many people can be treated as best as possible. It is absolutely key that we slow down the rate of cases by not getting together as groups and taking the simple precautions of washing hands well with soap, catching coughs in tissues, things like that. {update 15/4 – THe NHS did an amazing job of preparation. The field hospitals built are not being used very much yet, but the NHS has been sorely tested. Any treatment for other conditions that can be delayed seems to have been deleyed}

This article by The Lancet explains in some detail (maybe too much for general consumption) why social distancing and hand washing are vital to “flattening the hump” and helping the health services cope.

As ever, the best approach is a balance. Personally, I am concerned and I am going to avoid mixing with large numbers of people I do not know. I am actually in an “at risk” category as I was ill with influenza & pneumonia in December, in intensive care getting the sort of treatment bad cases of COVID-19 are getting now. But I am not self-isolating. If I get symptoms, I will self-isolate.

Basics

Names and terms

COVID-19 is the name of the disease. It was first reported in Wuhan in China on the 17th November 2019 but came to general prominence in early 2020 as it spread and infected more people, who then started dying in numbers. The World Health Organisation was informed (WHO).

 

The disease is caused by a virus called SARS-CoV-2. SARS stands for “Severe Acute Respiratory Syndrome” which describes what it does to people. It can cause a serious and sudden problem with breathing, which is when it can be fatal. CoV stands for Coronavirus, which is the type of virus.

It is commonly referred to in the media as “Coronavirus”, which is not a very accurate name. It would be a bit like going to a restaurant and ordering “mammal” (beef, lamb, pork, cat). But the name has stuck and is understood to mean the disease COVID-19 that is worrying everyone at the moment.

This wikipedia article describes the COVID-19 epidemic and this wiipedia article describes the disease itself

What COVID-19 does to you

The virus infects your lungs. It attacks the lining of the alveoli, the little “bags” in the lungs which absorb oxygen and release carbon dioxide. That’s why in mild cases you cough and in serious cases you get short of breath while at rest. If you are sitting quietly but finding you are having to breath hard (as if you have just exercised but you have not), contact the health services immediately. And if you pass out due to not being able to breath, call an ambulance (when you wake up, obviously…).

When the alveoli are infected by the virus they fill with fluid and their linings are damaged. This stops them from absorbing oxygen. All the cells in your body need oxygen, delivered by your blood. In a serious case of COVID-19 you have to breath harder and harder to get that oxygen until you reach a point where you simply cannot breath in and out hard enough.

The treatment is simple. Normal air holds about 20% oxygen, so the medical staff give patients air with extra oxygen in it, or even 100% oxygen, via a mask. If this is not enough a ventilator is used, which is basically a pump or fan that blows the oxygen out under pressure and pushes it into the patient’s lungs. It reduces the effort of breathing also. Ventilators come in increasing powers.

If this is still not enough, the patient is anaesthetised to make them unconscious and a tube is put down the throat (this is called intubation) which is used to push oxygen directly into the lungs. Making patients unconscious also reduces their need for oxygen. If even this is not enough the only final step is to use an artificial lung such as is used in major heart surgery. Hospitals won’t have many (or any!) of those.

In these extreme cases where more and more powerful ventilation is needed then the patient is possibly suffering from something called a Cytokine storm. Basically, the immune system over-reacts and causes damage to other organs like the kidneys.

Normal influenza tends to attack higher in the lungs, so is less dangerous. This is part of the reason COVID-19 is worse than influenza.

This article on how it impacts your lungs is quite technical but very good. The article then goes on to explain how the impact on our health services is a massive concern.

 

What we need to do to slow the spread

COVID-19 can no longer be stopped. To be frank,  it could not be stopped 3 weeks ago. Once enough people were infected with the disease, it became impossible to track them all down by contacting all the people who someone diagnosed with the disease had interacted with. What we could have done is taken the advice of the WHO and the example/evidence of what was coming set by other European countries and locked down earlier. {Update 15/4 – I strongly feel that the government had clear evidence to take each step it took at least a week earlier and it would have saved thousands of lives}.

Two main factors control how quickly a disease spreads:

  • How easily it is passed from one person to another
  • How many people an infected person is in contact with

That second point is not just the people the infected person is physically in a room with. It is, for example, if they cough on a door handle or touch it after coughing into their hand, the live virus will be on the handle. The people who then touch the door handle can be infected.

Washing yours hands with soap and not touching your face is reducing how easily it is passed.

Banning large gatherings reduces how many people are in contact.

Self-isolating will greatly reduce how many people you can infect (or can infect you).

This video describes how exponential growth works  and why reducing gatherings and simply hygiene will slow down the spread of the disease, with COVID-19 as the example.

It also explains how you can tell if things are getting worse or could be getting better. It is to do with the “inflection point”, when the number of new cases starts to drop. Until that happens, it’s going to get worse. This is a significant part on what epidemiologists look at in respect of how a current illness is spreading. In the UK, Spain, US, pretty much all countries where you cannot control the population, the rate of spread is staying high and the numbers of new cases and deaths is growing exponentially. This is what makes COVID-19 such a problem and why scientists worried back in January. It spreads really well and sometimes before symptoms show, which is why we all need to wash our hands, keep away from large gatherings, cover our coughs. You might feel fine, you could be spreading this.

Why washing with soap is the best protection

A virus is piece of RNA (very similar to DNA) covered in a coat of fat – called a lipid layer. Soap dissolves fat. That is why soap is so good at destroying viruses like COVID-19. Alcohol can do the same but it needs to be strong alcohol (70% or more) and works best if it also contains a soap or detergent.

The antibacterial chemicals in antibacterial cleaner do nothing to viruses. Bacteria are totally different to viruses, Bacteria are much more complex.

This twitter thread explains in some detail how soap destroys viruses

 

Monitoring (probably what most people are staring at)

The below are links to pages with info that is updated regularly.

****

Update, 19/3. The data on number of cases coming out for the UK has become less unreliable. The official Public Health England page is not being update until later and later in the day – and it is for figures for the previous day. Worldometers figures do not match the Public Health England figures for most of the last 2 weeks now, except the last 3 days. I think the official figures get corrected but worldometers is not picking up those corrections.

I still check both but I use the official public health England figures for my own trending.

Some days, most annoyingly for me the 16th March, have a figure for new cases that is not at all in line with those before and after. In fact, I think unbelievably different.

****

I tend to go to this worldometers  site as it is updated quicker than the official UK one.  On Friday 13th in the evening it showed an increase in the day’s total and the 11th death before the official UK site did. However, it does not seem to be corrected in retrospect like the official UK one is (I am not sure if that is good or bad)

This is the UK government page that tracks UK COVID-19 cases . It is designed for PC. For mobile phones go to this entry point and pick the option Note that it is a day behind. Information is gathered as-of 9am in the morning and is usually published at around 2pm. {this is now more like 6pm in the evening)

{update 24/3 I removed the link to John Hopkins as their figures consistently fail to match the UK government figures in any way, or the worldometers numbers – which are more consistent between them. Also, a JH person was tweeting how it was THE BEST source and did not reply to two response pointing out it is flawed. It might look nice but it is a poor source of data.}

Lots of people have shared the John Hopkins institute site, but I find information drops off it or the list of countries on the left do not match what is highlighted on the map, so I don’t it.

This page is a global view.  I have to confess, I have not looked at it in a couple of days, but it has lots of interesting information

 

Why certain diseases make things worse

As has been widely shared, a lot of people dying “have underlying medical conditions” or are old. I want to stress that people who are old or have these conditions (and even both)  will most likely recover. But it is true that if you have cardiovascular disease, diabetes, high blood pressure and several other conditions, you are at higher risk. The advice is to maintain your treatment and to keep as fit and healthy as you can. If you can exercise, do so!

If you are generally in poor health or have a debilitating condition, all disease are going to impact you more. Especially anything that reduces your lung function or blood supply as the virus makes you ill by reducing how much oxygen is absorbed by your lungs and taken to e.g. your brain and liver by the blood. Maybe now is a good time to stop smoking if you do!

I could not understand the increased diabetes risk. A suggested answer is very technical, but it might be to do with the levels of ACE & ACE2 proteins you have. COVID-19 seems to enter cells by using our own ACE2 proteins, but it is unknown if this is a genuine link or not.

This “The Lancet” article describes  suggests why diabetes and hypertension make you more susceptible to COVID 19. It’s short but quite technical. To balance that, the European Society of Cardiology claim there is no link (thank you David Harper for that).

This does highlight that COVID-19 is a new disease, most focus is on understanding and treating it and details like this will become clearer over time.

I should stress, never stop taking medicine based on social media guff – including this page! Even *IF* there is a link between drug X and COVID-19 susceptibility, you are taking drug X for a good reason and that reason has not disappeared. If the potential impact is large, it will be obvious to medics who will highlight it as an issue.

What facilities do the UK have to treat COVID-19?

According to announcements by the government on how well prepared we are in the UK for the “peak” of cases (which we are no where near yet):

Apparently in the UK we have 4,000 intensive care beds and “more are being made available” but there seems to be no detail on that.

We have 5,000 ventilators. The government is asking other companies to make them.

Update 19/3 the UK government is talking to companies about the details of making more ventilators and I know of at least one company that is offering to make many more. The issues is that there are stringent tests for suppliers of medical equipment and of the equipment itself. Any equipment used for medical purposes has to be built in a clean environment.

5 hospitals are stated as having ECMO equipment (Extra-corporeal Membrane Oxygenation machines) available for treating COVID-19 patients. These can re-oxygenate blood in the the same way the lungs do. They are massive and complex and they won’t be able to build extra ones for months – and of course every country will want them.

These figures are oddly “round” which suggests they are estimates or guesses. As the only real treatment for COVID-19 is extra oxygen and ventilating patients, then treatment will again be limited by the equipment we have or can be made. I’m no expert on equipment manufacture, I’ve seen no information on how easy it would be to ramp up production but I do know that when our Prime Minister asked companies that don’t make them to swap production to them the answer was “give us a full specification and a set of patterns and we *might* be able to). Medical equipment has to work, no company is going to want to “give it a go” and, if the machines don’t work or break down or harm the patient, face being sued into bankruptcy once this is over.

 

There is no vaccine and there is no known drug treatment that has anything but sketchy “it seems it might help” evidence.

Vaccines take years to develop normally. This can be fast-tracked by reducing the level of testing and precautions, but that means risking creating an ineffective vaccine at best or even killing more people. On the plus side, scientists already have targets for creating a vaccine – the RNA of COVID-19 has been sequenced (read), we know some of the proteins involved, it looks like the main target to infect cells is known (ACE2). The trick is to develop something that looks like one of those elements and that prompts the human immune system to develop antibodies against it (without harming the human) that then attacks the COVID-19 virus (without attacking anything else in the human) and that can be created in huge amounts (there are a huge number of humans).

There is no existing drug that seems to work very well. Existing antiviral treatments are being tested. Anything with any hope at all are being tested. If they worked well, we’d probably know already and the international medical community would be making it known. ANYthing you see on the internet about a miracle cure or “In India they have discovered that vitamin C, Ibuprofen and Tamiflu taken in large quantities together cures 76% of cases” is utter bullshit. Spreading this bullshit on social media is extremely not-helpful as some people will believe it and start demanding a treatment that does not work.

Medics and scientists will continue to work and they will get something eventually, but almost certainly not in the next few months. Sorry.

There appears to be no natural immunity

Like most viruses that attack us, the only way to be immune to it is to either catch the disease and get better, or be given a vaccine (which, in effect, is the same to the body as getting the disease but without most of the illness).  This means that, given how well COVID-19 spreads, we will all get this eventually until herd immunity slows it right down. At that point, everyone who has not had it will still be at risk of getting COVID-19 if they meet someone with the disease.

Bottom line, until a vaccine is created and everyone takes it, COVID-19 will continue to spread until most people have had it. The key thing is to try to slow it down so that our medical services can cope with the number of people it makes seriously ill.

 

Predictions

Before reading any of this, remember – I am not an expert! I’m a computer programmer with a smattering of some relevant experience.

However, about 3 weeks ago I felt I knew what was coming and I’ve spent the last 2 weeks being “the voice of doom”. Sadly I think I have been mostly right. So I thought I’d put somewhere how I think some things are going to play out.

I’m not trying to scare people. Well, sort of I am. I want people to be aware that it is going to be bad for a while, that as nations and individuals we need to take the right, simple actions. And that governments will lie to you about some of this stuff. Look for scientific/medical information.

(predictions made on 13th March 2020)

  • In the UK we will have about 250-350 new cases on Monday 16th March.
  • By the weekend of the 21st/22nd we will see 1000 new cases a day in the UK.
  • Numbers of deaths will “take off” around the 18th March and will double about every 3 days for at least 2 weeks.
  • Deaths as a percentage of known cases in the UK will be between 0.8% and 1.8% by the end of the month and will escalate.
  • The rate of new cases will stop growing so fast, but the rate of deaths will continue to grow as a faster rate. This is due to 2 factors – (1) the delay from getting ill to dying is on average a week or so (2) the UK is no longer testing everyone, buggering up the figures.

****

Update 19/3 – how did I do prediction-wise. Well, on the 16th March there were officially 152 new cases. But on the 15th there were 330, and 407 on the 17th. So I was wrong in both directions! On the actual date, I overestimated. But for the 3 days around the 15th and going on the trend, I had underestimated. I was not pessimistic enough.

The deaths did take of in the middle of this week – 16,33, and 41 for the 17th, 18, &19th March.

And we are well on track to hit 1,000 new cases by the weekend, but given the ever changing information on who is being tested, I’m not sure that confirmed cases is very accurate. I think the percentage death rate will have to be increased to take into account the lack of testing.

So, sadly, I seem to be still predicting quite well what is happening. BTW I base my predictions by stealing the work of proper, real scientists and mostly ignoring the UK government. I’m not doing anything more “clever” than choosing my sources and a simple spreadsheet.

Update 21/3. We hit over 1,000 cases – 1,035 today. So “my” prediction (really I just use a simple calculation based on the work of the real epidemiologist) is sadly spot on.

Deaths reported, 56. It’s taken off but not doubling every 3 days. It will.

Update 15/4 – Death rates did indeed double every three days – actually 3.3.

23/3       54
26/3       115
29/3       209
1/4        563!
4/4        708

Thankfully, the various distancing measures started to slow the rate in the first week of April, as self isolating and then pub etc closures kicked in

As predicated,  the slowdown of new cases predicates the slow down of deaths, but the UK’s poor testing numbers make this connection weaker and weaker

*****

19/3/20

  • Daily deaths in the UK due to COVID-19 will exceed a thousand in the first week of April.

Update 15/4 – thankfully I was wrong, but we hit 980 on the 8/4. If we include the 10% of care home deaths missing from the figures, we did hit 1,000

  • I’m not so sure about this one – I think we will have a slowdown of new UK cases in about a month and than after a gap of about a month  it will take off again.

 

  • COVID-19 will reach every country by April

Update 15/4 – pretty much true

  • China will have a second wave of infections in a month or two.

I think this because although they managed to control the first outbreak (by taking measures most western countries would not entertain), the virus has not spread through the rest of the population and it will get re-introduced from another location.

Update 15/4 – I’m not sure on this. Their figures are really good at them moment. They have shut down and quarantined another area but there has not been a second large outbreak we know of.

  • This is going to hit the USA very hard indeed.

This is because:

They initially had little capacity for testing (it is still poor despite political promises – and they have been having a damned argument about which commercial company gets to set up a new, Invented In America test to make a few people very rich indeed)

Their health service is far more about making a profit than treating people, so ill people will not get treated (or tested!);

The percentage death rate is going to look terrible, maybe 3 or 4%, as the number of cases actually tested will be low (if they “guess” at the infected numbers this might not happen);

Ill people will not self isolate as most US employees have little or no sickness pay.

Update 15/4 – The US has been really badly hit and when it took off, it took off large. I think a large part of this is because President Trump was a bloody moron and spent weeks downplaying this. As he likes to say “it’s all on tape” – he claimed this would be finished by Easter, was not as bad as ‘flu etc. The only thing he can claim to have done (and has done so repeatedly) was to stop flights from China. But he was advised then it was not going to have any impact as it had spread. And was already in the US.

I think it will continue to hit the US really hard, not just for the reasons I cited before, but because the president seems determined to do exactly the wrong things to contain this, such  as “opening for business” very soon and sacking anyone who disagrees with him.

I was wrong on the % death rate as they have massively increased testing, which was an amazing achievement.

 

 

Friday Philosophy – Brexit July 26, 2019

Posted by mwidlake in Friday Philosophy, off-topic, Private Life.
Tags: , ,
3 comments

I don’t really do politics on this blog, it’s often just too damned divisive. But not only am I angry (and vicariously ashamed) of Brexit but I have a strong suspicion of how things are going to go from now…

I’ll lay my cards on the table first. I did not vote for Brexit. Like the vast majority of people I get on well with in the UK, I wanted to remain part of Europe. Half of my anger with Brexit is that I feel there should never have been a public vote in the first place, for three main reasons:

  1. It has been heavily speculated that the issue of us remaining part of Europe was offered as a public vote as the Conservative party wanted to shut down the growing popularity of the more right-wing, xenophobic parties such as UKIP. Thus it was a waste of time, money, and effort to prove a point that I think could have been done in other ways. There was never any expectation by the people who instigated the referendum that a large percentage of the population would vote for leaving…
  2. Whether we are better off being within the EU and what we lose/gain from it is a very complex issue. I’d say 99% of the population knew nothing like enough about it to make a sensible decision. I think I understood more about the influence of the EU on us than the majority of people in the UK. This comes from me having an interest in environmental matters, workers rights, health & safety, and control of big business. An awful lot of our legislation in these areas came from the EU and were good for the majority and poor for the rich and powerful. However, I don’t think I had enough knowledge to make an informed decision, it was more a gut decision. And the political fight over the vote was almost devoid of sense, reason, even honesty, and was more a campaign based on fear, uncertainty, and doubt. It was a vote by the ill-informed on the ill-defined.
  3. The final reason is that our media and politicians have used the EU as a “distant enemy” to blame or ridicule for decades. It’s almost a national hobby. We had stupid stuff like claims the EU said we had to sell straight bananas or that barmaids would have to completely cover their bosoms. Neither were true. But there has been a consistent blaming of the EU for things that UK politicians thought would be unpopular or that the tabloids felt they could sell copy on due to outrage. It’s just like how businesses blame “the computer system” for anything that goes wrong (“Computer says No! – *cough* “) whereas in fact it’s often nothing to do with the computer system. Thus the EU already had an unfair bad press due to all this political cowardice and media tripe. In many respects, we reaped the crop grown from the seeds of our own stupidity.

Anyway, we had the vote, it was really tight, it gave “the wrong” result. And it seems that far more people have swap from “let’s leave” to “let’s stay” than the other way around, when they got a better understanding of the impact – but we are not getting a second vote. That is despite 6 million plus people signing a petition for a second vote and the biggest public protest march we have ever had in this country.

So what do I think will happen from here on in?

Something I have expected to happen for a couple of years now, but has not really, is an attempt by UK politicians to start trying to blame the EU itself for the mess the UK are in. Basically to start saying “Well, we could leave the EU and it would all be fine – but the EU are being mean to us! The EU won’t let us do X or let us have Y! Because they hate us now and they are not being fair!!!”. We are going to see an escalating number of occurrences where the Conservatives will tell us that the EU negotiators have blocked an utterly reasonable suggestion or are making demands that threaten our sovereignty, or are trying to control us. They will announce that the EU is trying to stop us being the great nation we know we are. I fear that Boris will start turning to Trump to be our best friend in the playground.  

From what I have seen so far, I think the rest of the EU have basically been “You want to leave? Are you mad? OK, if you wish, off you go. But I’m sorry, if you are leaving the club you no longer get the club discount at the shops, you no longer have access to the club house, and you don’t get any say in the club rules. And yes, you do have to pay your outstanding club membership until you actually leave.” Which is all very, very reasonable and, if tables were turned, it is what we in the UK would be doing.

I predict that from here until Boris and the Tories do whatever they do in respect of our fundamentally xenophobic “we are still a mighty empire and are too good for you” walking off in a huff, more and more they are going to try and blame the innocent party, the EU. We are going to hear endless stuff about how they won’t be reasonable in negotiations and are bullying us. I don’t think the EU will do that, but really it’s what we actually deserve for our childish behaviour.

End of Rant

First Lessons, Frustrations, & Funny Stuff – Introducing the iPad To My Mum July 12, 2019

Posted by mwidlake in Friday Philosophy, Knowledge, off-topic, Perceptions, Private Life.
Tags: , , ,
3 comments

<< Introducing I.T. to an Elderly Relative
<<<< Preparing the device

So, you are are helping an elderly relative or someone else who knows nothing at all about keyboards, icons, internet, or web browsing to get going with I.T. You have set up the device for them, now you need to introduce them to it. This is where it gets… interesting.

As I describe in earlier posts, I bought an iPad for my mum and set it up in a nice, simple way for her. I knew there was nothing she could do to actually break the iPad, it would just be a little confusing and possibly quite a frustrating process showing her how to use it. I was wrong. On all counts.

To do this I drove up to see my mum for the day, taking along the current Mrs Widlake for emotional support. Having arrived and set up the new router we had got from British Telecom (that’s a whole other story of woe) I sat Mum down and showed her the iPad, the on/off button, the volume buttons and the Home button. I got her to turn the device off and on, I pulled up some things on the internet to show her videos & music and got her to turn the volume up and down, and showed her how you touch the screen to do things. I told Mum about plugging it in and the icon that shows how much charge it has. All was going OK. I showed her the keyboard…

“Ohh, that’s complex!” No it’s not, there is one key per letter and some special keys. “Why can’t it have 9 numbered buttons and you just press 3 twice for H?” Because it is not 1995 anymore and this is much easier. I open Messenger for her, start a conversation to me and get her to type, yes you guessed it, ‘Hello World’. “I can’t find the ‘L'”. That’s OK, just take your time…

Mum is punching her finger on the screen as if she is killing cockroaches. You just need to tap it mother “I am!”. More softly (bash bash bash). No, gently (bash bash). If I poked your cat that hard she’d bite me, imagine you are touching the cat (bash bash bash). Mum, the screen is glass – if you hit it like that it will break and cut your finger off! That worked.. sort of (thud thud thud). 2 minutes and liberal use of the delete key later (her aim is poor) we get ‘Hello World’. Great! Well, you are sending the message to me, look that’s my name and a little picture of me! Say ‘Hello Martin’ – “Hello Martin” says Mum. Nooo, type it. “Where’s the L key?” Same place as before, just take your time…

When Mum is looking for a key she hovers her finger over the keyboard, waves it over one area, goes to another area and waves it over that – and then back to the first area… and repeats. Half of the keyboard has some sort of exclusion field around it. Mum, just look along each row until you find the letter you want. “I was!” No, you looked there and then there, 3 times. Trust me, just work along each row. She does.. “There it is! I knew it was there!”. Hmmm

After about 10 minutes of this random messaging (it felt like an hour but my wife, sniggering on the sofa, said it was 10 minutes) I get Mum to practice logging into the device. This, after all, is a vital step.

I tell her the password is my name. I decided on my name as she (probably) won’t forget it and it is more secure than a number that she will remember. “With a Y or an I?” Huh? “Martin with a Y or an I?” What did you name me? “Martin”. With a Y or an I? “Well, an I of course.” Well it’s with a bloody I then! “Some people spell it different…”. Why would I set your password to my name but spelt the wrong way? It’s an I you silly old Moo. (yes, it’s getting to me).

She types Marti.. “There is no N key”. It’s there. “Oh yes”. I tell her to press DONE. She does, the home screen comes on. I get her to turn it off and put in her password again. “What is my password?” Martin. “I just typed that”. Yes, we are practising. “OK – (thud thud thud… thud….)”. The N key is there, Mum (thud). And DONE… (thud) “I’m in!”. Excellent. Now do it again so you have done it without any help.

(thud thud thud….thud…..) “The N key has gone!” – It’s…  {breathes a little…} there! “Oh yes! I knew that!” But she does press DONE on her own.

Now do it again. “Why?” Because I need to know you can do it easily. (thud thud…thud thud…….) “Where…” It’s there! There! THERE!!! You’ve pressed it 4 times in the last 2 minutes, it’s ALWAYS there, it does not bloody move!!! IT’S THERE!!!! I can feel veins throbbing at my temples…

Sue pipes up “Shall I make us all a cup of tea and we can go look at the fish in the pond?” She’s a saint.

After a break and some calming down, we go through it all again (with fewer issues and less swearing) and I show Mum ‘Messenger’ again and how she can communicate with me. I show her how to type a message and send it and how to call me and we do a few trials and she seems OK with that. She keeps forgetting to press the plane icon “why is it a blue arrow?” It’s like a plane, you send the message. “It looks like an arrow”. OK, it’s an arrow, you are firing the message to me wherever I am. “How does it know where you are?” Magic Pixies.

By now we are both getting really annoyed with each other but she can turn the device on, log in, use the keyboard (well, sort of) and she can message me. That is enough for day one – and I need alcohol in a way that is slightly worrying.

We drive home and later that evening we get a message off my mum. It’s almost indecipherable as she has forgotten where the delete key is, and she does not seem to understand that she can check what she has typed, but it’s sort-of a success. I started to reply about where the delete key is, but something in my head steps in and quietly suggests to me that remote support for my confused mother after all the wine I consumed is probably a poor idea. I send a brief “we got home” message – and a picture of a cat.

Next day she calls me on Messenger. Hi Mum, how are you? “{small scream} – is that you, Martin?” Yes, you called me. “No I didn’t!” Err, yes you did. “I didn’t, I sent you a message”. Did you press the blue arrow. “Yes!”. The one next to the text you typed “No, the one at the top of the screen”…. At the top of the screen?… Does it look a bit like a telephone? “Yes!” That would be the telephone then. “Oh! How do I send this message?” After I end the call mother, press the blue arrow. 30 seconds later my phone rings. Hi Mum… “(smaller scream) – it did it again!” So, why do you think it did it again? “I pressed the wrong key?” Yes.

Over the next few hours I get a few messages (no more calls) and slowly the random strings slowly become things I can understand. We are getting there.

She Bricked the iPad

Next day she calls me on Messenger… Hi Mum? “{small scream…}”  We repeat the previous day. Typing is better.

Next day, no call, no messages.

Next day, no call, no messages.

Next day, the phone (real phone) goes “I’ve broken it, it won’t work!” Hello Mum. OK, what is broken. “It’s broken, it won’t let me in! It won’t accept my password”. OK pick up the device tell me what you are doing… We work through it, she is entering the password (with an I not a Y, I checked) and “it’s not working” is actually she is getting a message saying the device is disabled. I ask Mum if maybe, perhaps, she got the password wrong a few times and it asked her to wait 5 minutes before trying again? “No, I got my password right – but it would not let me in and after a few times it said that!”. OK… So, leave it alone for an hour and try again. “I did that yesterday!” I’m getting a bad feeling about this… ” And after I tried it, it told me to wait again… and it still could not remember my password and then I left it all day and now it says it’s disabled and needs to be plugged in. I plugged it in!”

I explain that she has actually done the one thing that can brick(*) an iPad. She has repeatedly got the password wrong enough times and persistently enough to cause it to believe it is stolen. It is useless to her. It needs to be plugged into a computer and reset. *sigh*. I asked her why she did not call me when “it forgot her password”. She did not want to bother me…

So now I had to organise a day to drive over there, factory reset the damned thing, and set it up again. And I was going to change her password to a simple number.

It had not been a little confusing, it had been utterly baffling.  I had not found it quite frustrating, I had been turned into a swearing lunatic. And she had indeed broken the iPad.

I rang my Brother. I told him the inheritance is all his – I am adopted.

(*) Brick – turn an electronic device into something as responsive and useful as a house brick.