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COVID-19: The Current Situation in the UK and June. May 30, 2020

Posted by mwidlake in COVID-19, Perceptions, Private Life, rant, science.
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I’ve not said anything about Covid-19 for much longer than I expected, but really it has been a case of watching the coming peak come and go, pretty much following the pattern of Italy, Spain, Belgium and France. I plan to do a post soon which pulls together the current scientific position, but for now I wanted to record where we are and where my gut feeling (based as ever on reliable scientific sources and not so much on what the daily government updates would like us to think) says we will be in a month or so.

The number of UK recorded deaths where C-19 was present, and detected cases

We’ve not done very well in the UK. If you are based in the UK you may not be aware of the fact that most of Europe think we have,as a nation, been idiots – failing to learn from other countries, late to lock-down, lock-down was not strict enough, too early to open up, our PPE fiasco… I can’t say I can disagree with them. We have one of the highest deaths-per-million-population rates in Europe, exceeded only by Spain and Belgium. But it could have been worse. A lot worse.

I’m truly relieved my predictions in my last post were (for once) too pessimistic. I misjudged when the peak in deaths would be by over a week – it was 9 days earlier than I thought, happening around the 11th April. As a result of coming sooner, the peak was lower than my little model predicted. Even allowing for that, the increase in number of deaths did not mirror the increase in cases (I used the cases pattern as my template for deaths). I think this is because the UK finally started ramping up it’s testing rate. The more testing you do, the more of the real cases you detect, so some of the increase in cases was simply better testing and not continuing spreading. That’s what happens when the source of your metrics changes, your model loses accuracy.

Deaths are directly related to real case numbers, it does not actually matter how many cases you detect. This is part of why case numbers are a much poorer metric for epidemics, whereas deaths are better. The best metric is a random, large sample for those who have had the disease – but we still do not have reliable, large-scale antibody or similar tests to tell us this.

If you look at the actual figures and compare to what I predicted for the peak of deaths, I seem to have been pretty accurate. I said 1,200 to 1,500 around the 20th April and the peak was 1,172 in the 21st April. But I was predicting hospital deaths only. Up until 29th April this was the number reported each day but since then the daily number of deaths reported included community (mostly care home) deaths. The previous figures were altered to reflect this and the graphs to the right are based on these updated figures. Hospital deaths seem to have peaked at 980 on the 11th April, so I was wrong.

I think it is crucial in science and technology (and actually, just in general) that you be honest when you are wrong – even if (like in this case) I could made a fallacious claim to have hit the nail on the head.

The bottom line is, we are well past the first peak and it did not overwhelm the NHS. It got really close and our issues with personal protective equipment was a scandal and must have resulted in more illness and some avoidable deaths to our front-line NHS staff. But, apparently, saying so is Political.

All in all we followed the pattern of European counties that were impacted by Covid-19 before us and implemented similar country-wide lock-downs.

One difference between us and other European countries that have been hit hard is our tail of cases is thicker and longer. We have not been as rigorous in our lock-down as those other countries (e.g we did not have to have written permission to leave or enter an area and children were not utterly forbidden from leaving home, which are just two examples how our lock-down was softer). I know it might not feel like it, but we were not.

What really concerns me is that we are easing lock-down measures so soon in the UK. Our daily new case rate and number of deaths are both still really quite high. The figures always drop over the weekend, especially Sunday and Monday (due to the numbers reported being for the day before). Over the last 3 days (Wed to Fri) we averaged 1998 new cases and 371 deaths per day. If you think Covid-19 has gone away, every single day there are 371 families who sadly know different.

I understand that the economy is important, that unless things are being manufactured, services provided, money earned and spent, that a large part of our society is not functioning. Maybe I don’t really appreciate how important it is as economics has always looked more like a dark art based on greed than anything logical, but some people feel getting back to normal business is critical and the long-term impact of not doing so is potentially as serious as Covid-19.

I also know that not being able to go to places, eat out, have a drink in the pub, meet up with friends in a building or in more than small numbers is frustrating. For many, not seeing your family and loved ones who are not in your home is very upsetting.

I’m sure that parents are desperate for kids to go back to school (partly for education and partly as it turns out kids are a lot of work), couples need a bit of time apart, people are missing their jobs. Nearly all of us have never had to spend so much time with a very small number of other people.

But I’m also sure that what we don’t want is in 4-8 weeks to have to go into the same level of lock-down as we spent most of this spring in. And the next lock-down may be even more draconian as there is a difference now to where we were at the second week of March when we should have locked down first.

SARS-Cov-2 is now endemic and prevalent across the UK. It is everywhere.

At the start of an epidemic the disease is growing in a small number of places, so usually (such as was the case with MERS and SARS) you can contain it by strong isolation and tracking efforts in those areas it occurs, as most of the population are not exposed. This is why you cannot contain seasonal ‘flu epidemics by isolating people, it does not work if it is wide-spread enough. ‘Flu simply flows through the population and it does in some years kill a lot of people.

With Covid-19 right now, If our R(e) – the effective reproduction number – goes above 1 anywhere across the UK, Covid-19 cases will rapidly increase in that area. And with restrictions being lifted across the whole UK and in England especially, I am privately convinced the disease will burst fourth again in many, many places and it is going to go very wrong again. I think the government is being utterly disingenuous about the impact of opening up schools and my friends who are teachers and medics have no doubt this is a significantly more dangerous step than it is being sold as. It might be the right move, but lying about it’s potential impact is not helpful long-term.

Not only are we relaxing social distancing steps too early, but I feel the government has utterly bolloxed up (technical term meaning “done a jolly poor job of”) the messaging. As examples:

  • The very clear “Stay at Home” became the vacuous “Stay Alert”, which no one seems to be able to clearly define and every one seems to have a different interpretation of.
  • We were given contradicting and non-nonsensical rules such as you could see one family member from outside your household in the park, but you could have people come and view your house. So if you want to see your mum & dad at the same time, put your house up for sale and have them view it.
  • Parts of the UK (Wales, Northern Ireland, Scotland) have said they were not consulted on changes, they do not agree with them, and they are doing their own thing. That’s not confusing to people is it?
  • The whole Cummings affair. Dominic Cummings did break the rules, he acted like a selfish idiot, he lied about what he did, he had pathetically stupid excuses (“I drove my child around in a car to test my eyesight” which shows he either does not care at all for other people’s safety or has too low an IQ to be allowed out on his own). The issue is not that one arrogant, self-important person decided the rules do not apply to him. It is that the government fail to understand that not sanctioning him is being interpreted by many to mean they can make up their own minds about which rules apply to them and which they can ignore. Continuing to say “look, get over it” is simply coming across as telling us all to bugger off.

To help steer us through this crisis, we really needed a government with both the mandate to introduce new rules and also the acceptance by most of the population of those rules, and at least acquiescence from the majority to put up with limitations placed upon us. What we have now is a not just the hard-core “we won’t be told what to do” people that would always be a negative factor in limiting the spread of a disease, but a large number of angry, confused, worried people across the country. Almost everyone I personally know in the UK feel angry, confused, worried, and mostly with a progressively declining respect for the government and their advice.

I know I’m not very good at understanding people, it does not come naturally to me. If someone does not think like I do, I can have a devil of a job working out why. But I’m pretty sure that here in the UK a lot of people are going to start saying “to hell with the lock-down rules, everyone else is ignoring them and I’ve not seen anyone die in front of me…”

I went to see my Mum this week. I had to drive 100+ miles to do it. Unlike in Dominic’s case, it’s allowed now and I have no Covid-19 symptoms. I took a mask, I took my own food, we sat in her garden (I got sunburn, so Covid-19 might not get me but skin cancer might). I assured myself she was OK and that her tech will keep working so we can stay in touch. And I felt a little naughty doing it.

But I made a conscious decision to do it now – as I think SARS-CoV-2 is about at it’s lowest prevalence in our population right now (end of May 2020) than it is going to be for months. Admissions and deaths are going down and I expect at least deaths to continue to do so for another week or two. Personally I am deeply worried that in 4 weeks time new cases, hospital admissions, and deaths will be going up again. I don’t want them to be but I’ll be (very happily) surprised if they don’t go up  – what we see in cases & deaths at any point in time is based on the level of spread one or two weeks ago respectively. I suspect that as I type our R(e) number is going up and will exceed 1 this week.

If you don’t agree with me, just keep an eye on what the scientists are saying. Some are already making noises of anxiety as an article on the BBC is already saying today. Scientists tend to make cautious statements such as “we do not think this is wise” or “we feel there is a danger in this choice of action”. It’s a normal person’s equivalent of screaming “Are you bloody idiots?!?”.  Once again, the experts are saying we should do one thing and the government are doing another. It’s not gone too well to ignore the scientists so far.

There is a T-shirt you can get at the moment, which I really must order a dozen of.

“All disaster movies start with someone ignoring a scientist”.

 

 

Friday Philosophy – Concentrating and Keeping Calm. April 3, 2020

Posted by mwidlake in biology, COVID-19, Friday Philosophy, Perceptions, Private Life, science.
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I was talking with a friend this week (via a webcam of course) about how he had been looking & looking at some misbehaving code for days. His team mates had looked too. It was not working and logically it should work. None of them could work it out. The problem turned out to be a small but obvious mistake.

My guesses for UK cases & deaths. Do Not Trust

This of course happens to us all occasionally, but we both agreed that, at the moment, we have the attention spans of a goldfish and are as easily distracted as a dog in squirrel country. I asked around a few other friends and it seems pretty much universal. All of us are making cups of tea and then taking the milk into the lounge & putting the cup of tea in the fridge. Or walking into the kitchen and asking who got the bread out to make lunch. It was you. The cat is wondering why I open the pouch of cat food and then leave it on the worktop and go do my email for 20 minutes. She’s getting annoyed.

Why are we all failing to function? Because we are all worried. This is one of the things anxiety does to us.

The whole COVID-19 thing is stressful – the feeling of being trapped inside, concern for friends and family, the ever growing numbers of infected & dying. I actually think if you are not at all worried then you are either:

  • Not understanding the situation
  • In denial
  • A total sociopath
  • Someone who should not be allowed out alone
  • Have reached a level of Zen calm usually only attainable by old oriental masters/mistresses

I’m by my nature often in camp 3 above, but even I am worried about this and I know it is making me tetchy and less able to focus. I’m struggling to keep my mind on things. Except on COVID-19. I tend to handle things I find unnerving by studying them and I probably spend about 3 or 4 hours a day looking at the latest information and scientific output on COVID-19. However, I note more things to “look at later” than I actually look at, as I am trying to manage my stress.

After an hour I make myself get up, go trim some roses, play a computer game, read a book. Anything to distract me. I’ve even started talking to the other person in the house and my wife is finding that particularly annoying. Sue seems easily annoyed and quite distracted at the moment. I wonder why?

Another way I cope is I talk with people about topics that are causing me stress. If I can’t talk, I write. Thus I wrote this Friday Philosophy – think of yourself as my counsellor.

I’ve seen a lot of social media “memes” about how long ago the 1st of March feels like, when we first started worrying about this. It seems like months ago, yes? To me it seems like a year. I started worrying about this a good while before the 1st March. I think the worry started about early/mid-February. Why? Because I’m a genius of course. {Note, this is called British self-deprecating sarcasm – I’m not a genius!}. No, the reason I picked up on all of this early was that chance primed me to.

I have a background in biology and some of the job roles I have held over my career have been in healthcare and the biological sciences. One role last year was working with a small biotech company working on immunology. So I take an interest in this sort of thing, it’s “my bag”. I was also pretty ill in December with Influenza (and yes, it WAS influenza, type A – I am not “the first case of COVID-19 in the UK”). So I was convalescing at home and took a specific interest in a new illness spreading through China that was influenza-like… And was worrying the hell out of the Chinese authorities who were coming down on it in a way we have not seen before, even with SARS and MERS.

My play spreadsheet.  I should leave this to the experts really

I have to confess, I initially suspected (wrongly, I hasten to add) that this new disease had escaped from a lab. The way it spread, that it seemed to be ‘flu-like, the rapid response by the authorities. I don’t doubt research into modifying diseases goes on – by the UK, China, USA, the Vatican, by every country with a biotech industry. I know we have the tools to directly mess with genomes, I did it myself, crudely, 30 years ago and I know people now who do it now, with considerable accuracy, for medical and other altruistic reasons. However, genetically engineering an organism leaves traces and when COVID-19 was sequenced there was no sign of this and it could be tracked to similar, previously known samples. I might even know some of the people who sequenced it and checked. But, anyway, that suspicion also made me watch.

The rate of spread in Wuhan was as shocking as the authority’s response and then through February the scientific analyses started appearing. The R(0) number (infection rate) and the high case fatality rate were both high. I’m not an epidemiologist but I had been taught the basics of it and I knew what was coming. No, that’s not right, I suspected what was coming, and I was worried. It was when the number of countries with cases started to increase that I felt I knew what was coming. By the end of February I was sure that unless something huge happened to change it, 2-3% of people, everywhere, would be killed. This was going to be like Spanish ‘flu only quicker (as we all travel so much). I became “The Voice Of Doom”.

On 2nd March I recommended to our CEO that UKOUG cancelled our Ireland event (people & organisations were pulling out so it was making it financially untenable anyway, but my major concern was that this was going to explode in the population). Thankfully the rest of the board agreed. I created my tracking spreadsheet about the 5th March. So far it’s been depressingly good at predicting where we are about a week in advance, and not bad for 10 days. I leave it to the experts for anything beyond that. All so depressing so far.

But Something Huge has happened. Governments did take it seriously. Well, most of them. And those who took it seriously soonest and hardest have fared best. The social lock-downs and preparation work that is going on in the UK is going to reduce the impact down dramatically and, more importantly, give us time to try and find solutions. But it still worries me. And I think they could have done it sooner. But most of the world is taking this very seriously – as it is very serious.

Part of me wants to keep watching how COVID-19 develops, and maybe writing more articles on it. I’ve had some really nice feedback on the first two and I want to do a post on where we might go in the coming months and why. But part of me wants to stop as it is making me very anxious and I’m sick of losing my cups of tea, or being stared at hard by the cat, and the wife asking me what the hell am I doing with the spanner and tin of peas.

I can’t easily listen to the government announcements each day as it is obvious, if you look at the scientific data and what medical professionals are saying, that they are simply not being candid. It’s all “we can beat this in the next few weeks” and “we will get you testing kits this month that are utterly reliable” despite the fact that’s going to need a scientific miracle to do that, let alone develop a reliable vaccine. I understand we need to keep positive but I think bullshitting the population now is only going to make telling them anything they will believe in 2 months even harder. In 6 months time when there is still no reliable vaccine and so many people have been wrongly diagnosed and the first few countries have had this rip through them almost uncontrolled, the lack of candid honesty will come back to roost. I worry about that a lot.

So I’m worried and I’m worried I’m going to be worried for months and months and months.

But for now I’m going to go for my daily (local) walk along a path I know will be almost empty of people and relax.

 

* Note, the graph and the spreadsheet are just “decoration”. They are my wild guesses on what may happen and have no reliability at all. Just saying

 

 

 

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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<< COVID-19 Basics. What it is & what it does to us

  COVID-19: What can we do to Reduce Social Distancing >>

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.
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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.

 

 

Postponing Ireland Conference – & Maybe Myself? March 5, 2020

Posted by mwidlake in conference, Presenting, Private Life, science, UKOUG, User Groups.
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As I tweeted a couple of days ago, I never thought I would write something announcing cancelling an event due to a worldwide pandemic. And yet that was what I was asked to do earlier this week (first week of March 2020). It will be interesting to look back at this in the future and judge if it was a wise decision or an over-reaction. At present, I am 100% for Wise Decision.

This week UKOUG decided that, in light of the impacts & concerns around the COVID-19 coronavirus, to postpone this year’s annual Irish conference we hold in Dublin. I thought it would be interesting to some of you to know a little of how we came to that decision.

Firstly, this was a joint decision made by the event committee, the UKOUG board, and the UKOUG senior management. Discussions around the topic of COVID-19 and  had taken place between some of us over the prior 24 hours and the event committee had decided that, in their opinion, there was a strong case to not hold the event at this time. They discussed this with the UKOUG senior management and our CEO decided this deserved an emergency board call. This board call would not just consider the event in Ireland but also our future events, our staff, and our members. (In this post I’m only talking about the Irish event, but enough to say that we are taking steps to protect our staff and consider future events and how they might impact our members & the public, plus how we may replace physical events with remote ones).

Secondly, as you can see above, this was a considered decision and not a knee-jerk reaction.  We had people who live in Ireland involved, we considered feedback we had received from partners/sponsors and also delegates. We talked with the venue. We looked at factual information about COVID-19, it’s communicability & mortality rate (how easily you can be infected and how likely you are to die respectively). In the end the decision was easy as we were all in agreement, we needed to postpone the event.

Thirdly, there were several factors behind the decision to postpone OUG Ireland.

Public Concern

We had several presenters pull out from the event. For most their employing company had banned non-essential (or even all) travel, and some had decided that they personally did not want to risk exposure. A couple of sponsors were in the same situation of being told they could not attend. Further, we had concerned delegates contacting us asking if the event was still on or what steps we were taking. Some cancelled coming, again a mixture of diktat from employer or a personal decision not to attend.

Interestingly, we were getting as many new delegates signing up for the event as dropping out, so obviously some people felt COVID-19 was not an issue.

We knew we had enough speakers in reserve that we could call on to fill agenda holes but we also could see that more and more events were being cancelled across Europe and more companies were announcing travel limitations, so the cancellations were likely to escalate on the run-up to the event. What happens months ahead, no one knows, but for now the public concern is very, very high.

I considered titling this section as FUD – Fear, Uncertainty, & Doubt. But FUD is usually a derogatory term indicating a baseless over-reaction. I think there is a lot of FUD going on in the general public, but people in IT tend to be smarter than average and more balanced. I think it is very reasonable to be concerned to some degree and, as you will see at the end of this piece, the concern will vary depending on your personal circumstances. For some people (e.g those with Asthma or similar decreased lung capacity) there is a significant increased personal risk from this specific illness, it is not always a case of a simple “I’m worried about a pandemic”.

Financial Considerations

With the best will in the world, user groups needs money to put on events. There is a commercial aspect to this. Putting on an event that fails and loses money is a danger. We at UKOUG do insure our major events against Force Majeure, basically events beyond our control, but we are like all user groups in that we walk a tightrope of finance.

Cancelling an event does not always save any money as it has already been paid out. But if a sponsor gets a poor experience in return for their sponsorship £/€/$ they are not happy (and neither are we as the organisers). If delegates come and the event feels like an empty room or the agenda is not what they want, they may not come again. As you can see, it is complex

I have to say that for Ireland we benefit from an excellent relationship with our venue, we have held the event at the Gresham in Dublin for several years and our committee & office know them well. They reduced the potential financial impact on us by offering us flexibility in re-arranging this event.

I make this point as some user groups (and of course, other companies) putting on public events in the near future may find that they have no such flexibility. For them cancelling a conference could actually kill the user group financially or result in individuals losing a lot of money. Did you know that sometimes it is individuals or a very small company that is bank-rolling your usergroup events?

For some user groups the financial consideration will be far more acute than it is for UKOUG.

Public Health

This is not the same as public concern. Public concern is about the actions people take in response to a danger or threat. Public Health is about the actual, real threat.

At present you (yes, you reading this) are almost certainly in more danger of being murdered, killed in a road accident, or dying of normal ‘flu than of dying from COVID-19. And have been all year. And yet none of you stopped living your normal life because of those threats. Most people who will think they have COVID-19 over the next month will actually have either a standard cold or normal influenza. And in fact 90% or so of those who catch COVID-19 will not be that ill. Medical testing is the only sure way of knowing which disease you have had.

But COVID-19 spreads relatively easily via fluid contact – droplets in the air through coughs & sneezes but, more commonly, similar dampness on hard surfaces by people touching their mucous membranes (think eyes, nose, and mouth) and then door handles, surfaces, smart devices. You then touch these surfaces and then your face and you have transmitted the disease to yourself.  Prevention methods are all about constant washing of hands and avoiding touching things. Face masks do diddly squit except if you are in the situation where people might cough in your direction (so medical staff) or to help prevent you coughing the virus out and infecting others. I find it somewhat ironic that in some places so many people have rushed to wear face masks to protect themselves from others but actually it will be doing more to protect others from them.

COVID-19 also has a higher degree or mortality than ‘flu. It stands at about 3.4% at present, compared to 0.1% for standard influenza. I’ve seen arguments that “the real rate is lower as it kills mostly old people or those with underlying conditions”. Well, of COURSE it kills those groups more, that is true for all other diseases. Influenza mostly kills the old, the very young, and the at-risk. That 0.1% is measuring a similar spread of deadliness as the 3.4%. If you get COVID-19 you are something like 30-40 times more likely to die of it than if you get typical influenza. An oddity of COVID-19 is that it does not seem to affect babies and toddlers as much as influenza does. So this new disease is overall more dangerous to adults, especially older adults, than flu than the basic figures indicate…

The mortality rate has increased from around 2% to 3.4% over the last month. Why? Mostly as people are now aware of COVID-19 and deaths will be correctly attributed to it rather than wrongly to other, similar things (like ‘flu). It’s almost certainly not getting more potent. In fact, we might expect the mortality rate to drop as people with a mild version of the disease were probably not being recorded or were being wrongly diagnosed, so the total number of cases would be a lot higher. I expect this figure to drop below 2% for countries with a good health service and no unusually high elderly population.

So what are the chances of holding a user group event and someone infected with the disease coming to the event? Very, very low. The number of known cases outside China are, as a percentage of the population, sod all. But if someone infectious does come to the event? Catching COVID-19 (and in fact a lot of people catching it and it becoming a new source or widespread infection) is quite high.

For those of use who look at project risks it is a very low likelihood/very high impact risk. Something like a hard disk overheating and setting fire to the server. I’ve had that, by the way.

So far the steps taken to keep this disease from spreading are proving effective at slowing it down. But it is spreading. I personally think it is going to get worse before it gets better. Maybe a lot worse, and I am pretty cynical about most “we are doomed” news stories.

Large Oracle user group events are more of a risk than say a big party. Why? A lot of speakers and exhibitors come from geographically distant places, so you are bringing people together from a large area. These people travel a lot and meet a lot of people. It increases the risk. At a party everyone is probably local and if there is no one local with the disease, you are safe. Safer.

This is partly why I was very much in favour of postponing the Irish conference, it had an enhanced risk associated with it as we had an international contingent coming.

What makes me feel qualified to think this? I am not a medic and I am certainly not an epidemiologist (someone who studies disease spread), but I have the advantage of a degree in genetics & zoology and many years of working with the National Health Service and biological academia (some of it on disease and immunology). I am not an expert, but by accident of my history I am better informed than most.

These factors made Ireland too much of a risk, even if the likelihood of something bad happening was actually very low.

Smaller events are less risky and, at present, will go ahead. But all will be reviewed.

 

People want the event

The final factor is that people want the event. Either they do not think the risk is real or they feel that they will be OK anyway as they are young(ish) and healthy or “fate” or whatever. So they will come to the event anyway and cancelling it is “giving in”. Lots of large sporting events are now being cancelled (such as come 5 nations rugby matches) and I am sure a lot of fans are not happy about this. But these are exactly the mass gatherings of disparate people that will really help to spread COVID-19 and create a true epidemic.

In some ways, cancelling a large event could be seen as protecting the ignorant 🙂

 

Maybe Myself?

In the title I mentioned I might need to postpone myself. Why?

At the moment I am an At Risk person. 3 months ago I was in intensive care attached to the most powerful ventilator the NHS uses which does not need the patient to be knocked unconscious and a tube put down into the lungs. In fact, shortly after I was admitted and I was deteriorating, it was expected that I would probably be put into a medical coma and mechanically ventilated. I’m generally fine now – but my lungs are still damaged and recovering. I had influenza & pneumonia. I’ve been asked by a couple of people if I could have actually been a very early COVID-19 case? No. It was not known outside China at the time and lab tests identified the exact strain of influenza I had. If I had been diagnosed with an unknown strain I’d expect the sample would have been re-tested, but this is not the case.

I’m no more likely to catch COVID-19 than any of you, but if I do catch it I am more likely to be at the 3.4% end of things due to the slowly healing lung damage. This is another reason I have paid extra attention to the science behind COVID-19.

I probably should have cancelled my trip to Ireland before the event was postponed, but I was in that last area of consideration. I was not thinking it would effect me and I wanted to go to the event. In the last few days I’ve been advised by people who are clinically qualified that airports & public transport are not a good idea for me. My wife has expressed a desire for me to not give the whole intensive-care-kept-going-by-machines thing a second go as it stressed her. And the cat.

Smaller events I will probably still go to as the risk is lower. And events where everyone is local and there is no signs of the disease there. I really want to go to a meeting in Poland where this will be the case. But to get there I have to go through airports. Full of people from all over the globe. Hmmm.

Personally I am expecting more events, both user groups and generally, to be cancelled. Part of me thinks they should be, the very small risk of a very bad impact is not worth learning a bit more about some software – and you all know how passionate I am about learning.

I think I should be more mindful of the risks myself, but then am I over-reacting?

And I think COVID-19 is going to spread more and kill more people before prevention steps and, eventually, treatment is developed to keep it in check. But I really hope I am wrong on that.

Friday Philosophy – Community Means So Much December 27, 2019

Posted by mwidlake in conference, Friday Philosophy, Perceptions, Private Life, User Groups.
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There have been a few things in the last month that have really brought home to me how much I personally receive from the Community. In my case, my Community is primarily the Oracle User Community – The end users who come together to share knowledge, the Oracle employees who support this, and the companies that support the end users. For most of you reading this, you are part of the Oracle User Community, but most of you will be (I hope) in other communities too through your other interests, be they religious, music, hobbies, sports, charities etc.

My community. I even like some of them 😃

At the start of this month (December 2019) I was at UKOUG’s Techfest2019, our annual December conference which is now focused just on Tech. As “El Presidente” of UKOUG (an unofficial modification of the official title of President, dropped on me by friends with a similar sense of humour as myself). I represent the whole of our membership, be they tech, business applications, or data analytics. But my background is Oracle Technology and so I naturally know more people in that sphere. And I’ve known some of them for over 15 years. There was close to 500 people at the conference on a couple of days and I recognised probably 2/3 of these people, and knew half enough to swap pleasantries. More importantly, a couple of dozen of those people have become good friends.

Conferences, to me, epitomise the community. We exchange knowledge, we learn, but we also have fun and we socialise in a way that I feel you simply can’t via social media. I like nothing more than meeting someone in the flesh that I have only known on-line, having a chat or a coffee or a beer or even a meal. It can really help make that connection that moves acquaintance to friendship (we’ll skip over those rarer occasions when you meet in the flesh and realise they are simply not your cup of tea!).

UKOUG conferences have become a little weird for me over the last few years, due I think to my roles in helping organise parts of the event and now being UKOUG president. I get a lot of positive feedback and personal moral support from people. I’d goes as far as to say I receive genuine affection from some people. I’m told how much they enjoy the event, how much better the coffee is, and sometimes what is not so good about the event (which I need to know), but always in a constructive manner. And people take the piss out of me. Oddly enough, especially with men, you know you are liked when you get good-natured abuse. I get a lot of abuse. In my head it is 95% good-natured 😃.

You had to be there for it to make *any* sense

The downside is I just can’t spend time with all the people I want to spend some time with. I’m getting better at moving about and trying to chat with as many people as I can, but I can only sit down and have a coffee or beer and socially catch up with so many people in the time I have. And not all my time is my own, I have to be President and do things. On that note, I apologise for any mental health issues caused by me taking my clothes off on stage this year…

The care of the community was really brought home to me after Techfest19, when I came down with ‘flu which then ganged up with secondary lung infections and put me in hospital for over a week. I only posted to Facebook (briefly) during this period (I did not want to shout it out over Twitter, which is like talking to the world). For me Facebook is friends & family. Even so, I got so many notes of concern and good wishes. And when I did put up a blog post when I was getting better, I got another burst of support and concern – and that was really nice. If I was not involved in a community, I would not have got that.

But there was another aspect of that show of affection by community that surprised me. My wife Sue is in her own community, that of millinery & hat making. There is not a lot of crossover between that world and the Oracle world! Sue had had the same ‘flu as me but without the extra “fun” I had, and she was having to try and help me in hospital as she struggled to recover herself. And her millinery community gave her so much support and care, which spilled out to include me.  And as Sue has a bit of a foot in the Oracle community also (she has presented at a UKOUG event in her own technical right and has joined me at conferences and met some of my Oracle friends), some of my community reached out to her to check how I was – and how she was coping. That was lovely.

Another aspect of community is the sharing of technical help. I’m a member of the OakTable network and as well as sharing our knowledge with the wider community (we are pretty much all presenters, bloggers, explainers), we help each other. None of us knows the whole Oracle stack or the related tech. During December there were several threads from people you would know as experts going “guys & gals, I’m confused by this” or “I’m seeing X and I suspect Y but I’m just not able to prove it”. And each time people stepped in and helped. Even the big Oracle names need help from the community. So you see, it does not matter if you are brand new to a technical area or lauded as the God of Tuning, everyone at all levels learns from the community.

The Oracle ACEs at Techfest19, core to supporting the Oracle user community

I’m not happy with a lot of things going on in the world at the moment. The UK is becoming more nationalistic, more jingoistic, fundamentally more tribal and distrusting of “them” – foreigners. I hate it. Our right-wing, Conservative government is milking this, encouraging this attitude. You also see it in the US & Trump with his MAGA and his talk of beating other countries with trade embargoes or military might. I know other European countries are seeing a rise in the worst aspects of nationalism and tribal distrust or even hate of “not our tribe”. It really upsets me and makes me worried about where our nations are going.

I think none-tribal communities like the Oracle one, the Millinery one, like most hobby ones, can help dispel this. It’s harder to dislike people from other parts of the world when you engage with them and know, on a personal level, they are the same as “us”, whatever “us” is.

And on my own personal level? I get out of my community five times what I put in.  This month I have received in plenty.

I’d encourage you all to get more involved in your communities and consider joining new ones.  And if you get the chance to physically meet members of your community you only know through screen & smart phone, put the effort in to do so. It can convert acquaintances into real friends and I think most of us would benefit from more friends.

I’m not sure I’ll post again this year, so Happy New Year everyone. And thank you.

 

Philosophy – Treating Illness As A Performance Issue December 24, 2019

Posted by mwidlake in Friday Philosophy, humour, Private Life.
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Firstly, I’m on the mend. This is not a post about “oh woe is me, I am so ill”. But I have been rather ill.  I’ll just give you the highlights: The highs of UKOUG Techfest19 at the start of the month were followed very quickly by me developing full-blown influenza (Type A). After about 5 days of being ill in bed I realised I was fighting for breath just laying there. I analysed the problem and came to the conclusion “something else is very wrong and paracetamol is not the answer”. I was taken into hospital and put on increasingly powerful ventilating machines until they could get enough oxygen into me to keep me (sort of) functioning. I’d developed secondary infections & pneumonia, seriously reducing my lungs’ capacity to exchange oxygen & carbon dioxide. {Update – no, I was not an early, uncrecognised COVID-19 case. If that was so my type of influenza would have almost certainly come up as unknown – the two viruses are quite different}.

Wearing this thing was like being up a hill in a force 8 gale!

A normal oxygen (O2) blood saturation level is 100. Below 90 is a cause for concern. A constant level below 85% is medically deeply worrying as 80% and less is harmful to several organs and confusion/unconsciousness are likely. Below 75% and you are almost certainly unconscious. I do know that when I first got to hospital they could not get me up to 85% and they could not understand how I could still talk and be (mostly) rational. I went from nasal O2 to a face mask to a machine that blew damp, warm O2 up my nose and finally a pressurised face mask. Next step was sedation and full mechanical ventilation – but they did not want to do that. My blood O2 became my main metric and I followed it like a hawk.

So I’m in hospital, very unwell (but not dying {update – at least they didn’t tell me at the time. They told Sue I was seriously ill and would probably be put into a medical coma} ), under excellent care. And I’m almost, but not quite, totally incapacitated. To me it was a bit like I was a computer system with a serious deficiency of CPU power. Or a toy robot with failing batteries. Energy conservation is paramount. So what do you do in this extreme situation? Turn off everything you don’t need turned on, and save energy for things you have to do.

Turning things off was relatively easy. After all, I was connected to a load of monitoring technology and breathing kit so I was not going wandering about. I didn’t move much. If I needed to sit up I was not going to use those stomach muscles, the bed was powered and would move me about. If I wanted something from the table besides me (like a drink) I’d relax, breath deep, get my Blood O2 up –  and then get it. A little rest and then I’d e.g drink or look at the phone.

Some things I had to do (or insisted on doing) and I realised how much energy they took:

Having a poo

It takes a lot more energy to have a poo than you think. I was just about mobile so I was allowed to look after my toilet needs. They would bring me a commode, position it so I could get there still attached to the ventilator keeping me going, remove some of the monitoring (but not all, heart monitor and blood 02 had to stay on) and get me ready to swap to the commode. And then leave me alone for 10 mins. I think at first they hung about by the door listening for a thud, and I had a call button. Getting onto the commode was OK (breath-breath-breath, move, pant for a minute like you just sprinted 100m… relax), but the actual job itself uses more abdominal muscles than you probably every realised. Tiring.

All the monitoring kit was on one arm. The one I normally use to “tidy up” with. Using the other hand was very odd. And again, tiring, I had to take it in stages!

My PICC line. patch in armpit, line along vein almost to my heart.

Post event I would need to rest and let the blood O2 lift back above 90% and then I could shuffle back to the bed and press my button. The nurse would come in, congratulate me, and attach any removed monitoring. I’d lay there and wait for the O2 to get back above 90% and the bloody monitoring machine would stop pinging.

For 3 days this was the hardest thing I did, it was my main exercise…

Eating

Actually chewing & swallowing was easy. But to do that you have to get the food into your mouth. Holding your arms up to eat is hard work! I took to cutting up what I had (if it needed cutting up), having a rest, then eating with one arm, mostly balanced on the table with brief bouts of effort to ferry morsels to my mouth. I was incapable of lifting a pint. Even more incredible – I had no desire to lift a pint!

I’d have a little rest after eating and I found I had to listen carefully to my body about how much to eat. Anything more than about what you would feed a cat in one sitting, and I would lay there, 2 or 3 hours later, conscious of the need to move that food out my stomach and into my gut. Who knew the mechanical side of digesting needed effort.

Washing

You can’t have a shower if you are attached to breathing machines. And I was not able to leave my room anyway as I was an infection risk to other patients (I had ‘flu remember). Plus, at first, no way could I do all that waving arms, applying shower gel and the rest of the business. So it was washing with a bowl, cloths, and lots of towels. If I took it steady I could do this myself, except my back and, oddly enough, my legs. lifting them up was exhausting! Nice nurses did those bits.

Weeing

I’m a man, weeing was not an issue. They give you an endless supply of little bottles with a hole towards the top. So long as you tuck the relevant part into the hole (having sat up using the bed) you just “let go” and pressure does the rest. No energy. The first time is worrying – “what if I miss, what if I fill the bottle”. The bottles are designed to be bigger than a human bladder.

This pushed warm, O2 laden air into my lungs and Was My Friend

However, if you do what I did and then drop the bottle of wee on yourself, do not attempt to sort it out! I did, I stared trying to use a towel and get out the wet spot and I nearly went unconscious as my O2 plummeted from the effort.

What you do do is call the nurse and say “Nurse, I just poured my own wee over myself and I’m wet”. Nurse will remove your wee-covered clothing (a hospital smock), un-plumb you from some machines, move you to a chair, plumb you back in, and then clean up the bed, bedding, floor etc. They don’t either laugh at you or grumble. You just sit there feeling like a pillock.

Nurse will then ask how much you had wee’d. Why? I’m on a high dependency ward, they measure everything. A key thing is fluid in (via saline drips and drinks) and fluid out – blood taken for observations and weeing. I knew I was getting better when the weeing increased compared to drinking. This is because my lungs had swollen with fluid and, as they recovered, they released the fluid. A pair of swollen lungs hold a lot of fluid!

It had been a good wee, I guessed 350ml. It certainly was enough to make me and the bed very wet.

Coughing

Having a good cough (which I did a lot of, of course, what with all the lung issues) would send my blood oxygen plummeting. Again, lots of abdominal muscles and the diaphragm (the sheet of muscle between your lungs and stomach) are used in coughing. If I could, I would build up to a good cough, conserving my strength and getting my O2 up in preparation for a real good go. But if it caught me by surprise, it could drop the blood O2 dramatically. But the good thing was, coughing helped expand the lungs and I recovered quickly and was “better” for half an hour.

Thinking

At rest, your brain uses about 20% of your total energy. This is true even for stupid people like Donald Trump :-). Biologically it’s very interesting that humans have such large brains and put so much energy into it – far more than any other animal (in relation to body size). Our brains makes us different to all other animals, ie “intelligent”, but at a significant energy and nutrients cost.

If my blood O2 dropped too low I would start shutting down. This is why people with breathing difficulties pass out, once blood O2 goes below a certain level, your higher brain functions stop to reduce demand and protect the rest, unconsciousness comes quickly.

Thinking was hard. I’ve never been one for just sitting there “thinking of nothing” but I did an awful lot of that in hospital. It was my brain saving energy.

Socialising was a real drain. I could do the 2 or 3 mins with the nurses or docs when they came to do observations (oh, so many observations in a high dependency ward!) or put drugs in me, take out my bood (Oi! I wanted that blood! I was using it to ship the small amount of O2 I can absorb!). I had to be really on my game when the docs popped in once or twice a day as this was my opportunity to try and ask smart questions like “so we have a diagnosis, what is the prognosis?”. Don’t worry what it means, medics live by it so asking them makes them think you know some of the secrets… Docs don’t tend to tell you much in my experience, unless you can ask pertinent questions and show you understand the answers. They seem to think ignorance (on the part of the patient) is bliss. If I knew when the docs were going to be in, I’d try and have a pre-visit snooze so I was at the top of my game.

Where it was hard was dealing with Mrs Widlake. Mrs Widlake was wonderful, she would ask me what I wanted and the next day she would bring it in, let me know what was going on, if people had been in touch, who was annoying her. And kept me company. It was very important to me.  But after about 1/2 an hour I would start shutting down, the thinking (and talking) reduced my low energy levels. We worked out a solution. She would come in, give me my new book and the bizarre, random items I asked for and chat to me. After 1/2 an hour she would go have a cup of tea in the visitor’s room whilst I zoned out, then came back for more chat. Resource management and time sharing! Sue did not want to leave me alone but after a few days we both accepted that a daily visit in sections, kept to maybe 3 hours, made the best use of the resources available. It was a bit like my batch processing window!

My Nemesis – The Evil pin-Ping-PING machine!

Monitoring

So I was managing my resources and finding out which ones took effort. But like any good system, you need monitoring, real-time feedback. And boy was I monitored! I was on a high dependency/close observation ward. Every hour, every single damned hour all night too, they would come and do blood pressure, record my heart rate and O2, measure my wee, what I had eaten, temperature etc, steal blood.

But the main thing was the machines I was attached up to. They constantly monitored. And pinged. Oh god, did they all bloody Ping. If a chest sensor fell off or I sat on the connector, that machine would ping. If a drip (drug or fluids) ran out, it would Ping. Breathing machine ran out of water? Ping Ping Ping! The ventilator had to up pressure or I moved too much (I duuno why) – Ping Ping Ping.

But the worst, my nemesis (and also my KPI) was the blood O2 monitor. If I dropped below X, usually 86 or 88, it pinged & pinged & pinged. If I dropped below 85 it would up the volume and multi-ping: “ping-Ping-PING! ping-Ping-PING! ping-Ping-PING!”. You could not even cheat it by taking the monitor off, as then it went ping-bloody-crazy. All those tasks I mentioned above that took effort? They all made this blasted machine ping or ping-Ping-PING!

The one biggest challenge to me during my stay was not boredom, not pain (I was lucky, no pain other than what they inflicted on me putting in drains etc, or headaches due to low O2), not fear – it was trying not to go crazy due to the the pinging. I did everything I could to stop the pinging. The only time I really lost it with the nurses was one night as I improved and they changed the warning levels up to 90 and every time, every time I started to fall asleep it bloody ping-Ping-PING’d. I told the nurse to turn the levels back down else I would rip the damn thing off the wall. She said she could not, as she was not qualified to make the decision. “Well find someone who can as, if it does not let me sleep, I will lose my shit”.  It’s the only time I swore at any of the people looking after me. It got turned down.

This is exactly like having OEM monitoring a database and alerting on a KPI such as CPU usage when usage spikes and is actually OK. Just endless, endless false alarms. What the damn things should have done (in my opinion, for me) was only Ping if I was below a limit for over a minute, or went down to critical. Then it should go absolutely crazy.

And it was not just my machines. Other people in the ward had their own pinging machines. They. All. Pinged.

I’m back home now and recovering. I can breath unaided and slowly, slowly I am able to do more without running out of breath. Like have a shower or make my own cup of tea. Give me a month (I’ve been told it’ll take a month) and I should be back to sort-of normal. I won’t be running marathons or using the axe in the garden for a while. I’m still treating myself like an under-resourced computer and dolling out effort where best used. But each day another core comes on line and I can expand the extra effort. I think it’s called getting better.

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

Reviving an iPad and On-Premises lesson 2. July 19, 2019

Posted by mwidlake in Friday Philosophy, humour, Perceptions, Private Life.
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<< Introducing I.T. to an Elderly Relative
<<<< Preparing the device
<<<<<< First Lessons, Frustrations, & Funny Stuff

Unlocking it was not so easy

In my previous post we finished with my mother having bricked her iPad – that is, having turned it onto a useless lump. So I drove up to see her again to sort it out. {BTW if you think I am being a bit mean to my mum – yes I am. But I do love her and in the end the iPad has resulted in us being much more in touch. But I think it helps to share the frustrations of getting someone utterly unused to technology on line}.

The first thing I did was to get Mum to turn it on and put in the password. Martin with an I (not a Y – “as some people spell it like that!”). Mum was, very slowly, putting in the password correctly. And then staring at the screen until it flashed up an error. She had forgotten about pressing DONE. Now, if she’d called me when she had started having trouble… The thing is, that is so true across all of IT support. If only people called up when they first had a problem or did something wrong (like deleted all those rows…). If you call up quickly, there is much more chance the problem will be solved quickly. Anyway, I digress. I now knew what had gone wrong, she may or may not type the password correctly but it was timing out each time. Of course, by this point the iPad would no longer respond to the correct password, it was locked out.

You may not know this but if an iPad is locked out as it thinks it might be stolen (password put in wrongly too many times), you can’t just factory reset it. At least, I could not and google-fu mostly confirmed this. You have to plug it into another device with iTunes on it. And you can’t just plug it into the device you set it up on and refresh it, even if you backed it up to this device. At least, I could not. Maybe I am not very good at this tech lark. You have to download the latest version of the OS to your device, plug the switched off iPad into your device, turn the iPad on and then press certain buttons on it in a given way within a 0.731 second window that occurs at an unspecified time after turning the device on. I don’t know how often I tried to get the sodding iPad into recovery mode and recognised by iTunes, but it sure as hell amused my Mum to watch me try. I then re-set-up the iPad to be the same, simple set-up I had done so before. See post 2 for some hints on that. All the time Mum was making snide comments about “how simple this all is, Martyn!”. I think she was having revenge. Sue was keeping out the way.

After all the issues with “Martin with a Y or I”, I set the pass code to be a number. Yes, it’s less secure but I have the Apple ID details for her account – if she loses the iPad I can either track it or wipe it remotely. But we were up and running again, we had a working iPad and on-premises lesson 2 could begin. I’m not sure either of us was 100% happy about this…

Mum wants 2 main things from “the interweb”. She wants to be able to contact me (and, I presume, her other Son and her daughter-in-law) and she wants to be able to look things up. If she can do the former than I can help, remotely, with the latter.

You need the patience of this person…

So I showed her how to use messenger to contact us again. It’s been a week or so since the last lesson so I knew she would need a reminder. I pointed at one of the various icons and asked her what it looked like “It’s a phone!” So what will it do? “I don’t know, you are supposed to tell me!”. If it looks like a phone, it’s probably… “{blank look}”. You pressed this by accident last week and it made you scream? “Oh, it’s a phone!”. Excellent, we gave it a quick go.

What about this one next to it? What does it look like? “A box and a little box”. Fair point, but it looks a but like a tv camera? She agreed. So, what will it do? “blank look”. You know this one, we tested this with Sue in the kitchen last week… “the kettle?!?”. It was like Star-Trek… “Oh yes, she appeared on the iPad and I could talk to her. It’s just like Star Trek!”. We tried that one too. All good.

OK, let’s re-visit sending messages and using the keyboard. I show her me sending her a couple of messages again. Enter some text, any text. Press the icon to send the message. “Which one”. The one next to the message, it looks like a plane. “Which message?” The one you just typed. “So I press this one {points to the enter key}” No! No, the blue plane one. “This one!” No!!! that is a phone symbol, I explained that one 5 minutes ago and you seem to have no trouble hitting that one despite that it is in utterly the wrong place and no where near the message. “What message?” THE ONE…..The one you just typed, there, the one that says ‘GFRYTSB’. “So I click on your name?” NO! NO! THE FUCKING PLANE! TAP THE FUCKING PLANE!!!!

She taps the plane.

It sends the message “Oh. It did that before. How do I know who it sent it to?” It sent it to the Pope. “Why did it send it to the Pope?” {sigh}. How many people did we set this up for? Me, Sue, Steve, no Pope. But you see my name at the top of the conversation? You know, third child your bore? The name right above all the other messages? It sent it to me.

“But there are three names {moves finger} over here”. THAT IS OVER THERE!!!!!!! You have spent 10 minutes calling me, star- treking me, seeing messages from me, who the hell do you think it sent the message to?!? “Susan?” {I’m losing it…}

OK, send me another message. You know it’s me, my picture and name is above the conversation. Here, look at my screen your picture and name is above *my* conversation and those are the messages you have sent me.

She types something.
and stares at the screen.
And stares at the screen…
And looks at my screen…
And back at her screen…
“It’s not sent! Has it gone to someone else?”
The. Plane. Tap the Plane.
‘Ping’ – “Ohh! you got the message! How does it know where you are?” The bloody computer pixies know. They track everyone in the world. “Can I message anyone in the world?” I lie a little and say no. only the people in the list. “Does it know Steve is in Wales?” Yes. Look, do you ask the phone how it knows where I am? “No, but this is not the phone”.

We exchange a few more messages for practice and then I get her to tap on the other names, to change conversations. She swaps to Sue and Mum sends her a couple of messages. Once again Mum is asking how the computer knows where Sue is. I point out that as Sue is in the room, the iPad can see her – and then realise that was a really stupid thing to say as Mum did not get the joke. “So it CAN’T message Steve if it can’t see him?” No, it can, it can message anyone on her list.”Shall I message him?” No, he lives in Wales, life is hard enough for him already.

It’s time to go home. I make mum turn the iPad off, turn it on, put in the code and send me a message. She’s got it. “What about the internet?” The internet is not ready for you yet Mum, that will be lesson three. Read the book I got you and give it a go if you like. You can’t break… Actually, just wait until I come back over.

I have to say, since then Mum has been able to message me without issue and can turn the iPad on and off with no trouble, so you do get there eventually.

But I do seem to be buying a lot more wine these days…

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.
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<< 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.