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

Posted by mwidlake in biology, COVID-19, off-topic, science.
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Summary

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I am assuming the  Infection Fatality Rate is 0.5%

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

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

However, 64 Million will not be immune.

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

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

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

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

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

People will become immune to SARS-COV-2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Drawbacks off the COVID-19 Immunity Card

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

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

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

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

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

ID cards by the back door.

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

Criminality

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

Two-Tier Society

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

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

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

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

SARS-COV-2 Could Change

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

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

End Life of the cards

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

 

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

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

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

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

And, I feel it is important to say:

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

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

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

Source of Epidemiological information

ICU beds needed per 100,000 people

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

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

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

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

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

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

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

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

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

Mitigation or Suppression

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

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

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

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

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

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

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

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

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

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

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

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

Delayed impact.

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

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

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

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

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

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

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

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

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

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

Three choices – or is it four?

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

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

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

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

But this Imperial College paper has a solution 4:

Turning social isolation up and down

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

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

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

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

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

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

The “The hammer and the dance” paper…

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

Context is paramount

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

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

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

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

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

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

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

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

Why will social distancing last 18 months?

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

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

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

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

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

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

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

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

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

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

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

Disclaimer

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

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

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

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

 

COVID-19: Information And Outlook March 13, 2020

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

Outlook for the months ahead >>

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.

 

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 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 recenlty, 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.

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 probably 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.

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 predicitons 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.

*****

19/3/20

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

 

  • 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

 

  • 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.

  • 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.

 

 

 

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

Posted by mwidlake in conference, Presenting, Private Life, science, UKOUG, User Groups.
Tags: , , , ,
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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.