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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

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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.

 

 

 

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

Posted by mwidlake in Friday Philosophy, humour, Private Life.
Tags: , ,
4 comments

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
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<<<<<< 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.
Tags: , , ,
3 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

She Bricked the iPad

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

Next day, no call, no messages.

Next day, no call, no messages.

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

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

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

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

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

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

Preparing A Device for Someone New To I.T. April 26, 2019

Posted by mwidlake in Perceptions, Private Life, Uncategorized.
Tags: , , ,
5 comments

In my previous post I covered what I felt were the main considerations on deciding how to get someone with no real experience of I.T. online, for an example an elderly relative like my mum. In this post I’ll cover setting up the device.  Set-up is actually quite complex and there is a lot of assumed knowledge, like how the keyboard works, what spyware you leave turned on (none!) etc. So I am setting it up for her.  First I’ll just recap the main points on why I decided to use an Apple iPad for my Mum:

Keep the main screen as simple as possible

  • A small tablet – but not too small.
  • Simple, intuitive interface.
  • A Smartphone or iPad mini was too small.
  • PC/laptop ruled out as too complex for her.
  • Apple device as her main potential contacts use Apple devices.
  • A lack of remote access by me was less important than the above considerations.

On of the first things I did was to ask my friends (via Twitter) what they would suggest or had found worked when they had a similar task. Thank you to everyone who replied. If you have further advice, add a comment or contact me and I can update this post. The main suggestions were:

Keep It Simple

Mum has never used a keyboard, never used a smartphone and is not very technically adept. Everything she is learning is almost new to her, from what the enter key does to what an icon is. The closest reference I can use for her is the menu of options on her TV recorder – and she has some pretty bizarre ways of using that (but if it works for her, that’s just fine). So using the device has to be very, very simple. I want the main screen to be simple and non-threatening:

  • Remove every App that is not for something she needs to use (or I need to help).
  • Move any icons I need but she does not (or at least not at first) off the first screen.
  • Be brutal, delete as much as you can –  you can add back anything you later find you need.
  • Only have one app for a given task. Choice in this case is probably just confusion.
  • Include one or two (and only one or two) key things she will want to use.

I’ll just cover some of those bullet points in more detail:

Remove every app not required. My mum has no interest in stocks & shares, in monitoring her health, in maps of where she is (she knows where she is, she does not go anywhere else!). She certainly has no interest in “iTunes Store”, “Photo Booth” or any of the other “free” apps provided by the vendor. They will just be confusing clutter at first.

If there are 2 dozen icons on the screen, Mum will worry about what they all do or what will happen if she clicks the wrong one. And she will click the wrong one. It is a worry we don’t need.

When she first starts, she will struggle to find the right icon – even from a simplified list (and she did). The fewer choices the better.

So I deleted absolutely everything but the half dozen things she needed. If in the coming weeks, months or years she wants anything a deleted apps provides, they can be added back. When she is comfortable with the first lot, I can introduce more.

The very basic “what the buttons do” help sheet

Move Icons I need to the second page. There are some things I need to get the device all set up for her and then tweak it. Two of them are “Settings” and “App Store”. You could argue that “Settings” will have things that Mum might like to change. But she won’t know how and she could mess up things if she changes her settings. So they are moved to the second page – and I told her to leave that page if she ever gets on it! The chances are she will not find the second page of Icons. (I did show her how to get off it, but stressed she call me if in doubt).

I also put a couple of things on the second page that I think she might want to use soon.

Only One Way.  I was advised to provide Mum with e.g. two ways of getting hold of me, in case one fails. Well, no. I do NOT want to have to show her two messaging apps and teach her the differences, I want one method that she can become confident with. It’s part of keeping it simple. Mum will be challenged to learn one interface, if I try and show her a second she will get confused over what works in which app. She can call me on the phone if the new way of communicating is not working, she is happy using a phone (as in just a phone, one that only makes and receives calls).

If Mum decides she does not like the app I choose (e.g. BBC News for, well, news) we can swap later. But right now I pick what I think she will like. And for the sake of simplicity, I chose a set of apps that are from the same provider, so work the same way.

We in the I.T. profession often love that we can swap between programming languages or have 4 or 5 social media apps to choose from. But we live and breath this stuff. This is all new to Mum. When you learnt to drive a  powered vehicle you learnt to drive a car. Or a motorbike. Or maybe even a tractor. You did not learn to use all three at the same time – and also an articulated lorry at the same time!

One or Two things she wants. I got a lot of advice of things to add to make the device fun or interesting, such as games, picture editing, or puzzles. The principle is good – but the reality is you need to think about the person and what they want from the device. And the keeping it simple aspect.

My mum loves jigsaws – but she loves the physical side of them! She has her tables set up, she talks about the manufacture she likes as the pieces fit together so well, she likes to glue together the occasional jigsaw she really likes. Maybe in the future she will look at Jigsaw apps, but right now she wants to keep her physical jigsaws.

What she wants is (1) a way to communicate with me (2) information on cycling and Formula 1 (3) the weather. So I gave her them. Nothing more, I’m keeping it simple. So that is Messenger, BBC sport and BBC weather. BBC news completes her intro to the web.

(Note, I also tried to introduce searching for things on google, but it did not work well – google does not understand “I want to know about him, that cycling chap, the one who’s not got side-burns”. We will come back to google in a month or so).

Make it Big and Bold

I don’t know about you, but the last time I changed my smartphone I got one with a slightly larger screen as I was having to hold the old one further and further away from me so I could focus on it. And I set my new smartphone to have larger Icons.

Add pictures they will like to their social media and the device. Keep personal information to a minimum to protect them.

If you are new to I.T. and you are starting to have issues with vision or hearing, there are options for any device to make it easier to use. Check out the “Ease of Use” or “accessibility” options of the device. Ironically, they are not always the easiest to find. For iPads they are not a main option but under “General”. That’s not very helpful, Apple!

You maybe don’t want to bring up the topic of failing faculties with an older relative – so don’t. Just set up the device to have large icons, big text. and loud messages. Big and Bold.

Also, think of adding pictures and sounds the person will like. I changed the iPad wallpaper for a picture of our cats and when I created her facebook account (hmmm, I’ve not covered that…) I added a background of myself and my brother up some hills and a picture of our last cat as her image. I would have made it a picture of one of her cats but I did not have one. And that will be a nice thing to do with her sometime. The main thrust is use images the person can relate to.

To make the device easier for Mum to use I considered the following:

  • Increase the text size.
  • Increase the icon size.
  • Bold text & increased contrast can help if vision is poor.
  • Set the volume loud and make sure one of the first things you demonstrate is how to increase (and decrease) volume.
  • When you start messaging, send pictures. It’s more interesting.
  • Show them emojis. My mum seemed to really like emojis. Less Tyoing!
  • Put pictures they will like as their wallpaper and social media images.

I think I could have done more in this respect. What I should have done was got pictures from her and scanned them, or looked back in my old photo collection. I could have set the wallpaper to a picture of my Dad (long gone) or of all us kids or something. And any social media you set up for the person, think what pictures you can use for backgrounds and avatars.

 

Reference Material

The online help on tablets etc is pretty good – once you are able to look for it and learn what you can ignore.

For anyone who is really new to technology, reference material is going to need to be a lot more basic.

Keyboards Confuse the Uninitiated

I prepared several sheets of information for my mum, like how to use a keyboard, which I show here. I also did some pictures of the iPad and annotated it – and left space for Mum to add her own notes!

My Mum found these really helpful, especially being able to scribble on them herself (which sometimes was replacing my helpful text with her weird description on what a key did!).

As well as this, I got her one of those “a senior citizen’s guide to the iPad” magazines. They are a good place to go to once the real basics of how to turn the device off and on and how a keyboard works have been learnt. BUT, they have a big drawback – they try and show lots of things in order to address a wide audience, and they usually have a long section at the start about “setting up your device”. I already set it up, Mum does not need it. So, edit the magazine!

I went through the magazine and crossed out in big, thick, black lines the bits she did not need. I also crossed out those sections on an app I had not given her but did a similar thing, and wrote at the start of it “do not read, Mum! Yours works differently!”

 

Random Other Advice

“Tell her not to clean the screen with a brillo pad! :)”
Well, it was a bit of a joke but it leads to a serious point. Explain how to look after the thing. I made the point that she should not get the iPad wet and to dry it immediately if she does spill things on it. And, if she drops it down the loo, take it out immediately, turn it off if it is on and put it somewhere warm – and call me!

“Yes, you can leave it plugged in, it will work for several days between charges. No you can’t damage the screen by tapping it with your finger, but do not use a screwdriver. Hitting it harder will not make it work more.”

We should (and will) get a cover for it so Mum can hold it more easily. Her house is carpeted throughout so dropping it (which she does, but she is close to the ground) is not such an issue.

“tell her how to get rid of Siri when she accidentally starts Siri up.”
I have turned off Siri as much as I can. And this leads on to the general topic of telling the person what they can and should ignore.

I told Mum to ignore prompts she will get (“You have not backed up your device for a week, kittens will die!”) or requests for feedback or surveys; how to shut down advertising boxes; do not respond to anything that ask you to provide information or download anything. And, just because you now have a “computer”, you should still ignore any telephone calls you get offering to help you with your computer problem. They were a hoax before you had a computer, they still are – keep telling them you don’t have a computer.

“Be patient…”
That last one is key. This is all new to them and if you are a regular visitor to my blog you are probably an I.T. expert. It can be very hard for us to understand how new this is for non-I.T. people and we assume knowledge. Like, what the enter key does in different situations and using the shift key (a single press of the shift key is different to a double press – and undoing the ALL CAPS of a double press only take a single press, which my Mum rightly pointed out is not logical!).

My mum really, really did not understand the keyboard very well to start. But touching the screen and dragging things around she took to straight away. I guess different people take to different parts more easily.

Be prepared to be very patient (*) and do not be surprised if some things take them an age to understand and yet other things they seem to get immediately. At some point, probably very early on, they will find out how to do something you don’t know!

(*) as my wife comments (in the comments section) alcohol may be required for post-training de-stress!

Introducing I.T. to an Elderly Relative February 25, 2019

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

Introducing an older person to the connected world can be a challenge. So I thought I would describe my recent experiences in introducing my elderly mother to I.T and the internet. Each such situation will be different of course, depending on the prior experience of the person and the skills you believe they have. I’m going to run through what I think are the main initial considerations. I knew from the start it was going to be a particular challenge with my mother, so I think she is a good example. Hopefully, for many the task will be a little easier…

From cheezburger dot com

Firstly, why are we doing this?

Not everyone has to be on the internet and I knew it was going to be stressful for everyone involved, so the first question to ask is “Is it in the best interest of Uncle Bob to go through this?”

For years my mother has shown very little interest in computers or the internet, and at times she has been quite “Oh, those damn things!” about it all. But over the last 2 or 3 years Mum’s started showing an interest. This has nothing to do with the fact that her youngest son’s whole working life has been in I.T., I think she’s simply started to feel she is missing out as there are so many references on TV programs and the newspaper to things on the internet. “Just go to blingy bong for more information!”. And to her, it really is “blingy bong”.

I think it is vital that the person wants to get online – and this is not a one-week wonder.

Before now my mum had mentioned getting online but then lost interest when the one thing she was interested in disappeared, such as checking the state of play in the Vuelta cycling race as it was not on her TV. Setting someone up on the internet is not cheap and I knew she would insist on paying. You have to organise broadband to the property, buy a device and then spend time in training them. If mum lost interest after a couple of days of trying, it would all be a waste of effort. But she had been constant in mentioning this for a couple of months.

Another reason to get Mum online is so she can stay in touch more easily {am I really sure I want this?!?}. Her hearing is not as good as it was and phone calls are a ‘dedicated, binary activity’. What do I mean by that? Well, when you are on the phone, you have to keep the conversation going and you are doing nothing else, this is your only chance to communicate – dedicated. And when you are not on the phone you are not in contact – Binary (all or nothing).

I think those of us in the technology industry or who grew up in the last… 4 decades maybe take this for granted, but with email, texts, messenger, whatsapp etc you can throw a message or two at people when the need occurs to you, and leave them for the person to pick up. It is a more relaxed way of communicating and, in many ways, more reliable. At present if mum needs me to come over and change light bulbs she needs to call me in the evening. She won’t call me during the day, she is convinced nothing short of death is important enough to call during the day! So she also needs to remember to call and mum is getting worse for that. If she is online she can send me a message when she notices the bulb in hall has blown.

The next step is to assess the capabilities of the person you are helping.

I’ve introduced a few other people (mother-in-law, brother to some degree, relatives of friends) to computers and the internet over the years and the size of the challenge is very much dictated by their skills. I think you need to be honest about how much and how soon people can learn, especially if they are older or have learning needs. It’s great to be surprised by them doing better than you expected, but if they do worse then it can be demoralising for both parties.

My mother-in-law was a retired science teacher, interested in a dozen things, confident, and self-motivated. When she asked me to help her get on the internet I knew it was not going to be too hard.  But something I did not consider is that she had never typed at all (which surprised me, but there you go), so the keyboard was an initial, surprise challenge to the task. Just think about it, you have to explain the “enter” key, the “delete” key, “shift” key, special symbols… But the Mother-in-law was used to using equipment and took to it well. It did mean that the first session was almost totally about introducing her to the keyboard and just a few basics on turning the machine on and off and using email. After that I went on in later sessions to show her the basics of Windows, email, web browsing and she was soon teaching herself. She got a couple of “computes for dummies” and went through them.

Learning skills deteriorate as you age – but each individual is different. Be realistic.

My mother had also never used a typewriter – but she is also not good with technology. Getting her to understand how to use a video player was a task way back when.  It is not that she is no good with mechanical things or controlling them, she was a sewing machinist all her career – but she never moved from a simple sewing machine with just a dozen manually selected stitch patterns to ones which you can program or that have a lot of controls. This might be mean to say, but she struggled with an electronic cat-flap when we installed one for her! {Well, we installed it for the cats to be honest, we do not make Mum enter and exit the house on her hands and knees through a small hole in the door}. My mum has also never had (or wanted) a mobile phone, let alone a smart phone. Apps, widgets, icons, touch screens are all things she has never used.  We were going to have to keep it very, very simple. Mum also lacks focus and retention of details. Lots of repetition would be needed to learn, and only a few things at a time.

Third Question – What hardware?

This is a major consideration. A few years ago if you wanted internet access and email the choice was simply “Mac or PC” and probably came down to what you personally preferred and felt most comfortable supporting.

I realised from the very start that my mum would never cope with a Windows PC or a Mac. I know some people are so Mac-fanboy that they will insist it is “so easy anyone could use them” but no, Macs can have issues and there is a lot of stuff to initially learn to get going. And, like PC’s, they DO go wrong and have issues.

Choice made – will it be the correct one?

I did initially investigate if I could make a Windows PC work for my mum. I can sort out most issues on a PC and so it would be easier for me to support her. You can set Windows up to be simpler for an older person. I was more than happy setting up other older people with a PC in the past, as I’ve mentioned. Another big advantage with a PC would be I could set it up so I could remote access it and help. I live 2.5 hours from Mum, remote access would be a major boon. In another situation I think I would go down that route, set up a Windows laptop, reduce what was available on it, put on the things I felt they would want initially and ensure I had full access to the machine. I could then do interactive “show and tell” sessions. Of course, you have to consider privacy if you have full access to someone’s machine. But I felt I was trying to come up with a solution that was more easy for me rather than more easy for the person I was helping.

My final factor in my decision on what to go for was “the internet”. There is bad stuff on the internet (I don’t mean content so much, what my Mum looks at is up to her and I am under no illusions that when someone gets old they do not become a child to protect. I don’t understand why some people seem to think old people are sweet and innocent! Old people used to be young, wild, risk-taking and randy. They’ve lived a life and learnt about the world and they know what they do and do not like). What bothers me about the internet is viruses, spyware, downloads that screw your system over. No matter how much I would explain to my mum, there was a good chance she would end up clicking on something and downloading some crap that messed up the system or stole her details. Machines that are not Windows PCs suffer from this a lot less.

For a while my mum said she wanted an Alexa or something similar. Something she could ask about Lonnie Donegan’s greatest hits (this is a totally true example). But talking to her she also wanted email and BBC news and sport. Also, I’ve seen people using an Alexa and getting it to understand & do what you want is pretty hit & miss, I could see that really frustrating my Mum. Also I don’t like the damned, nasty, spying, uncontrolled bloody things – they listen all the time and I don’t think it is at all clear what gets send back to the manufacturer, how it is processed, how they use it for sales & marketing.

So, for my mum a tablet was the way to go. It is simpler, much more like using a phone (you know, the mobile phone she has never had!) and has no complication of separate components. Plus it is smaller. I decided on an iPad because:

    • The three people she is most likely to be in contact with already have an iPad mini or iPhone,
    • They are simple. Simple-ish. Well, not too complicated.
    • I felt it was big enough for her to see things on it but not so big as to be in the way.
    • The interface is pretty well designed and swish.
    • They are relatively unaffected by viruses and malware (not impervious though)
    • It will survive being dropped on the carpeted floor of her house many, many, many times.
    • You can’t harm them by just typing things and running apps. {Hmm, I’ll come back to that in a later post…}
    • If she really hated it, I could make use of a new iPad 🙂

The biggest drawback to an iPad is I cannot get remote access. I’ve had a play with one remote viewing tool but it is too complex for Mum to do her part of things, at least initially. If anyone has any suggestions for dead simple remote access to iPads (and I don’t mind paying for such a service) please let me know. I have access to all her passwords and accounts, at least until she is happy taking control, so I can do anything to get access.

I did not make the decision on her hardware on my own though. Having thought through all the above myself, the next time I visited Mum I took an iPad mini and an iPhone and I asked her what she thought she wanted. We talked about Alexas and PCs too. She did not want a PC, she hated the home computer my father had had (it made funny noises in the corner and disturbed her watching “Eastenders”). Even a laptop was too big – her table in the living room must remain dedicated to her jigsaws! Mum felt an iPhone was too small for her. I won’t say I did not lead the conversation a little, but if she had been adamant she wanted just a phone or a laptop, I’d have tried to make it happen.

Decision made, it will be a standard iPad.

Are we all set?

No, not quite. There is one last thing before starting down this route. Getting advice from others on how to do this (which might be why you are reading this). As well as looking around on the internet a little I tweeted out to my community within I.T. to ask for simple advice. After all, many of us are of an age where we have had to deal with helping our older relatives get online. And I got quite a lot of good advice. I love it when the community helps.

A lot of the advice was on how to set up the device. However, I think it best to cover the setting up of the device under a dedicated post. That will be next.

Friday Philosophy – Despair of the Dyslexic Developer and Your Help Please June 1, 2018

Posted by mwidlake in development, Friday Philosophy, Perceptions, Private Life.
Tags: , ,
2 comments

Like a surprisingly large number of people, I’m dyslexic. I’ve mentioned this before, describing how I found out I was dyslexic and also how I think it is sometimes used as an odd sort-of badge of distinction. I am mildly dyslexic, the letters do not try to “merge or run away” from my eye, if I hit a large word I am unfamiliar with I can visually chop it up and get through it. But that is just me. So, today, I want to ask you all, if you are a dyslexic developer or know one, are there any steps you have taken to reduce the impact?

I should mention, neither Jim or Richard are dyslexic as far as I know!

A recent, slightly jokey, conversation on twitter reminded me of the issues I have had in typing the wrong thing (over and over and over again – my usual example is how often I have tried to “shitdwon” an oracle instance). And that in turn reminded me of a more serious conversation I had when at the OUG Ireland conference back in March.

As a developer, I sometimes struggle to spot spelling mistakes or use of the wrong (or missing) punctuation in my code. As my friend JimTheWhyGuy said in the twitter conversation, spotting you had spelt UDPATE wrong. I was telling the audience that I was something of a slow developer, partly due to dyslexia. I can stare at code for ages, especially if I am using a new construct to me, not understanding why I am getting an error. It is often not a syntax problem but a spelling one. I had real problems with the word “partitioning” (and still do) when I started using that feature. – it is a little long and has almost-repeated sections in the middle and I “spin” in the middle if I read it or try to write it. It’s a little too long for my wrists to learn to automatically tap it out.

After the talk a lady came over and asked me if I had any advice on how to reduce the impact of dyslexia when writing code. She’d been diagnosed at school and so had grown up knowing she was dyslexic. (I was not diagnosed as a child, which oddly enough I am still glad about – as I learnt to cope with it in my own way. But I am NOT glad I am dyslexic). I do not know what support and advice she had been given through school, but it was obviously still something that impacted things. All I could come up with were a couple of tricks I use.

One is to copy text into MS Word and see if it highlights anything. You have to teach your version of MS Word (*other word processors with spell checkers are available) that the normal syntax words are real, but all the punctuation and special characters get in the way. Where it does help a lot is reducing the number of errors in specifications & documentation I produce and, now, articles I write. But as I know most of you who come by here have already realised – spelling errors that give another correct word are not picked up by a lot of spell checkers, such as this WordPress site. My blogs are full of missing words, wrong words and other crap.

The other major advance is the use of, Software Development Tools (SDTs – and YES, I spelt SDT wrong first time around writing this!) or Interactive Development Environments (IDEs). These highlight syntax errors (so highlighting typos), allow auto-completion of command words and provide common code constructs. They help, but I’ve never been that good at getting the best out of them. I use SQL*Developer more than the others and it does help.

The final other thing is that I just factor in that it’s going to take me more time to write or read stuff. Like many dyslexics, there is nothing wrong with my comprehension (I went off the scale for reading age when I was 12) but it takes me longer and is more effort.

Looking around on the web about this, there is a lot of stuff, the above point about IDEs being a main one. One common thing is to use different fonts to help stop letters skipping about or moving, but I don’t have that sort of dyslexia so I’ve never looked into that. I was going to review the topic of dyslexic developers more before putting this article together, but reading it all was taking me too long! That and I found the constant “It gave me an advantage” to be bloody annoying.

So, knowing a few of you out there are also dyslexic to some degree or another, have you any tips to share? If you have something to share but do not want to be identified, contact me directly.

I’d really appreciate it, if not for me then for if ever anyone else asks me how I cope as a dyslexic developer.

My main opt-out of course was to move into performance. It’s somehow more “pictorial” in my mind and you write less code…

Friday Philosophy – If I Was a Computer, I Might Be An IBM System 360 April 20, 2018

Posted by mwidlake in Friday Philosophy, Private Life, working.
Tags: ,
4 comments

So today I turn 50. I spent a few minutes looking up what your typical computer looked like then and I decided the IBM System/360 was about right. It was a business machine. Personal computers did not exist then as, well, it was almost the dark ages…

IBM system/360, phot by Dave Ross

{Note, it has been pointed out to me that I should say “If I were a computer”. Seems that even at my age I still have things still to learn properly… I’ll leave it as is to remind myself…}.

Technology changes and we who work with it change. With tech, after a while any individual part (say a specific computer) becomes obsolete and we throw it away. The technology itself changes and we stop using the parts that are superceeded. I don’t remember the last time I used any sort of floppy disc or a Zip Drive. Ironically we still often use a floppy disc icon to identify the Save button.

But us? Do we who work with I.T. become obsolete? Yes. We do so when we stop changing with the times (or “stop working”, but this is not an “I’m old and considering my mortality” type post, you will be relieved to know). I think that if you lose your passion to keep learning something new in computing and/or programming, it’s time to move out of the arena; as, worryingly soon, you are going to become like those old systems that never get updates and you know will be thrown out if they develop a serious flaw or just become too expensive to keep on the payroll – err, I mean plugged in.

I nearly lost interest about 8,10 years ago. I think it was partly that I found myself doing the same things over & over again and having the same stupid arguments (sorry, “discussions”) about how not doing things correctly was going to just make everyone’s life harder in the long run. I don’t mean doing things the same, I mean doing the things that make a good system – ensuring it fits the business need, that it is tested before it gets released, and you do this crazy thing called design. This time it was not that I needed to alter along with the tech, I needed to alter myself a little. I finally realised that, although it was getting worse, the I.T. world has always been a bit like that and part of the trick to this business is simply walking away from places that are too bad and looking for those who are a bit better. I’m lucky to be able to do that moving about (don’t get me wrong, I did have to put effort into it and I think that is where some people go wrong, they seem to almost expect an external agent to make things better for them) but then I’m 50 and still in the business. I’ve seen lots of people simply leave the industry when they could not affect that change.

However, doing a bit of the introverted-navel-gazing that comes with Significant Birthdays, I find it interesting that at 20, 25, 30, 35,… 42 (very significant that one) things have always been changing for me.

When I was born, computers filled a large room. And were yellow.

At 20 I was studying Genetics & Zoology at college and thought I would be a lab scientist. A career in I.T. was not even a consideration.
By 25 I’d taken up computing and I had fallen into this company called Oracle and I reckoned I would be with them for a good while, building systems with Forms, ReportWriter. PL/SQL and whatever came next. Oracle would not last for ever…
When I was 30 I was self employed, touting my services to various companies and mostly doing systems design and performance work.
Come 35 and I was back full-time employed (that was a surprise) working in science organisation (even more of a surprise) using my degree to some, well, degree (an utter surprise). And presenting at Oracle user group conferences.
At 40 I was self-employed again, but now totally focused on performance and and Oracle RDBMS Subject Matter Expert (someone who knows a bit about most of it and most of a bit of it).
42. 42 is a great age. You are the answer to everything…
At 45 I was retired. Except when I was not. OK, I had become a Consultant, doing short jobs for different clients. And doing all this User Group stuff. Me! Antisocial, miserable, slightly-autistic me!
Now at 50, I have to confess I am not keeping on top of the technical details of my chosen sphere the way I probably should, if my career is still in this area. But I’m not doing bad and my “job” is now even more as a presenter and a member of the User Group community. I need new skills for that.

So it keeps changing. Sometimes I chose the change and sometimes changes just dropped on me. But I’ll look at the options as they come up. And if no options are coming up and I am not happy in my job, I go look for options. I won’t say I always choose the best option but, heck, it’s worked OK so far.

I wonder what I’ll be doing at 55 and 60? I just hope I am not stuck in a museum with a “do not touch” sign next to me, like all the remaining IBM System/360s