Crunching the numbers

The one problem with being a scientist for many years is that you can take the scientist out of science but you can’t take science out of the scientist. It’s in their nature. When I left research science, I didn’t cease to be a scientist.

I still have a scientists instincts, motivations, thoughts and ideas. I cannot leave a piece of data alone without thinking of alternative analyses or different ways of looking at the same. Like all scientists, when I look at data I think “what if…”.

Like so many others I have watched this unfolding catastrophe with a kind of morbid fascination. The same fascination that prevents you from averting your gaze from a car crash. And the numbers emerging from the WHO and elsewhere (Johns Hopkins is a very good page) are fascinating in their insights into each national response to the pandemic. The data are, to use President Trump’s comically inappropriate adjective “beautiful”.

But you have to know how to think about the data. The raw numbers themselves are a code and it’s up to the scientists to decode the information. Let me give you an example.

Take the UK for instance (not that anybody would bother). 8000 cases of coronavirus more or less. 400 dead more or less. On the face of it that amounts to a 5% death rate for the condition. The number of dead divided by the number of cases. 5% is an awfully high figure even for this virus so can it be accurate? Other countries publish much lower kill rates. How can this be?

It comes down to testing. Covid-19 is not the only illness to present with a dry cough. Nor is it the only illness characterised by fever, aches and pains. And it wouldn’t be the first lung infection to mature into pneumonia. So a patient presenting with any or many of these symptoms could well have Covid-19. It’s a fair bet.

But it’s exactly that – a bet and not a certainty. The only way to be sure that it is Covid-19 is to test. Without the certainty of a test result, it is no more than a backed hunch. So it’s clear that you have to test in order to have a firm diagnosis, the correct treatment plan and the appropriate recording of outcome whether good or bad. Individuals need to be traced and tracked through the entire sequence of diagnosis to treatment to outcome.

In the UK, although things are changing rapidly, patients are mostly tested when they present in hospital. Many of these patients will be transferred to intensive care where their outcome will be documented. Not surprisingly, these are very sick people. Many die. So our testing programme in the UK is, until recently, focused on those who present as hospital and are therefore already very sick and thus more likely to die.

In order to get a true picture of the mortality of Covid 19, we need to know how many people in the country either have had the illness or currently have it in a very mild form. We have been told throughout that, say, 4 out of every 5 people who contract the illness will not find themselves hospitalised. We don’t have those numbers because, until recently, it was not part of the testing programme.

Yet these data are critical to our understanding of how the disease spreads and how ultimately it may be defeated. Without this information we are applying controls and measures of uncertain value. Why? Because we can’t assess their efficacy without a knowledge of the whole population. As it stands, all we have is this 5% mortality in the UK. If it turns out that four out of every five recover in their own homes, then we are in reality looking at a 1% rate. Much more plausible.

Don’t get me wrong – an illness which kills 1% of the country’s population, particularly the old and wise, is cataclysmic by any standard. A 5% kill rate on the other hand is apocalyptic.

We also need to be careful of comparing data over different time frames. The number of people diagnosed is straightforward and up-to-date. But the number of the dead does not have the same temporal consonance. Going back to the figures for a moment – 8000 diagnosed, 400 dead – we are looking at different time points. To put it bluntly, most people do not die immediately after being clerked. Patients may be treated for a week, two weeks perhaps, before they die. In this case, the 400 dead should not perhaps be compared with the current 8000 diagnosed but with the figure a week ago. Looking at the date of this way paints a more bleak picture. On this basis, the kill rate is much higher.

Let’s also factor in health service resources. The death rate obviously bears a relationship to the provision of ventilators and staff to operate them correctly. If the number of intensive care beds needed falls below those available, then patients are in with a good chance. If on the other hand the number of beds needed exceeds those available, the outcomes are inevitably going to be worse. In Italy, demand outstrips availability manyfold and doctors are having to triage the arrivals. Triage, most often applied in the battlefield context but then this is a battlefield, means dividing patients broadly speaking into three categories – those that will most likely survive without ventilating, those that will most likely occupy a ventilator and then die and finally those where there is a realistic chance of improving the outcome by treatment. Only the last category will have access to a ventilator. And the doctors in Italy have found themselves having to make those choices.

When the health service resources are inadequate, the death rate rises dramatically. And this is why when there’s been so much talk about “flattening the curve”. I have seen illustrations with graphs, memes and buckets of water. They all illustrate the principle well, that of keeping demand below supply by flattening out the number of cases per week. And on the face of it it looks reasonably optimistic until you factor in the harsh reality of numbers and acknowledged that even the best estimates put demand way above supply. Our health service already cannot cope and we haven’t even begun this battle yet.

Much is said where we are on the curve relative to Italy. Italy has become the tragic illustration of what happens when you don’t get it right. Complacency for perhaps two weeks when the condition wasn’t taken seriously as led to the present viral holocaust. In turn, other governments have learned or ignored the lessons of Italy. Only time will tell.

That is why social distancing, self isolation or whatever we want to call it needs to be taken seriously. Because this is where everyone of us can make a difference. If we become ill, we may need an intensive care bed. And if we are occupying it, somebody else isn’t. By becoming ill, we are in essence depriving another person of life-saving treatment. So when the Prime Minister talks about everybody doing their bit, this is what he means. We have to stay well so that others can stay alive. It’s that simple. For every one of us that stays out of hospital, somebody who needs to will be able to. This is what flattening the curve is all about. Because if we don’t, the alternative is unthinkable.

Mutation is not all bad

People are already beginning to talk a lot about virus mutation, in essence taking the view that the virus is one step ahead of us in our development of a vaccine. The inference is that with every successive mutation it becomes a more dangerous little chap, and we’re left chasing shadows.

I’m no virologist, let me make that clear. But I don’t think that’s the case. My recollection, from the limited amount of microbiology I have been exposed to, is that with time viruses become less pathogenic. Not always but in general.

Look at it from the virus’s point of view, if it had a point of view. The virus has only one purpose in life – to replicate and therefore spread. Any mutation that improves the chances of doing so is likely to be successful. And vice versa. So in terms of propagation of one’s genome, killing the host is not just rather ill mannered but also counter-productive.

You have to remember that being harmful to the host does not improve your chances, as a virus, of proliferating your genome. Actually a pretty bad idea. If a virus is particularly virulent and kills its host in too short a space of time, it actually reduces its reproductive capacity.

It’s a fine balance. The virus needs the host in order to replicate its genome. It’s best chances of doing that are by reducing its pathogenicity or by increasing its infectiousness during the presymptomatic stages in the host. The latter is perhaps more difficult to achieve so in general viruses become less virulent with time. Presumably mutations which cause less damage to the host allow more opportunities for virus transmission.

There are of course exceptions. The 1918 influenza pandemic was biphasic. The first phase, in the early months of 1918 killed many but the second phase in autumn killed twice as many.

There are no guarantees in virus mutation. Each is in essence a throw of the dice. But to mutate to a less pathogenic form makes the virus more successful in its own terms of replication. From a Darwinian perspective it makes sense for the virus to be less harmful. With time, less pathogenic forms will win out. So my message to the coronavirus is to try and be a little less antisocial. Play nice.

*If a proper virologist has time to skim through these ramblings, I would be very grateful. I don’t want to spread misinformation. Or sound like Donald Trump.

The good, the bad and the ugly.

On the whole, this has been a much less depressing weekend than it might otherwise have been. Why, I hear you ask. Because finally we in the UK are beginning to strike back against the virus. The private medicine sector has been co-opted by the health service to help out in this crisis, bringing with it some 1100 ventilators and 20,000 staff. A small army. To be honest we need a large army but it all helps.

A big story and it was interesting to observe how that tasty morsel was given to the journalists. The NHS had, at substantial cost, bought up the private sectors services to fight coronavirus. Don’t get me wrong, I’m grateful, terribly grateful, for anything that will make our chances of surviving this improve. But it’s significant, to my knowledge, that the NHS made the approach. As I understand it, this wasn’t a case of the private sector saying “how can we help you?” It was more an example of Boris saying “what do you want for the ventilators?” Now I may be completely wide of the mark (in which case please correct me) but I have the impression that this was no bargain buy.

In actual fact neither party had any real choice. The NHS needed the ventilators. The private sector had ventilators. Some agreement was bound to be reached. People would not put up with the accelerating daily death toll in the NHS if the private sector was continuing business as usual. But wouldn’t it have been a much better headline if the private sector had made the offer rather than waiting to be asked. As I said before, correct me if I’m wrong but they seem a little slow out of the blocks.

The good?

The good news for me was the way in which small engineering firms (and some pretty big ones – let’s not forget McLaren) have turned their hands to making ventilators out of… Well more or less anything. I saw one man taking an angle grinder to a Dyson vacuum cleaner – and who hasn’t wanted to do that. Everywhere, saws, hammers, screwdrivers and who knows what else are being turned on household appliances to produce contraptions worthy of Professor Branestawm. You’re probably too young to remember him. This is British inventiveness at its absolute best. It’s what happens to men when they have power tools and a shed far enough from the house that nobody can hear what they’re up to. These are men who played with Meccano and watched Blue Peter during their formative years. And I’m not talking about the Johnny come lately’s of the more recent series. I mean Valerie Singleton, John Noakes and Peter Purves. At a pinch I will admit Lesley Judd. We can debate that one.

If anything defines British resolution in the face of adversity it is this. Small-scale, fussy but effective solutions with huge ramifications. Think of cats eyes in the road. Same deal. And if anything gives me hope in this pandemic it is this kind of garden shed engineering. Forget about stealth fighters at $100 million each or whatever it is and are the fruit of design teams bigger than towns. This is a testament to the use of hand tools and gaffer tape. This is what built the empire. This is why men have sheds.

The bad?

Despite being given a substantial smack on the wrists, the British public still continues its pillaging of the food stores. It really is time to stop this nonsense. All this will achieve is rationing. And don’t think the government won’t do it – look at what it has done in the last week. And you really don’t want rationing – you might get broccoli.

But that’s not my biggest bugbear. The thing that is really worrying me is the extent to which people are ignoring the advice, nay instruction, to stay at home for your own benefit and that of others. Only today I saw a troupe of people heading up my street. Three generations of the same family it appeared all in close proximity with linked arms and hugs. I thought initially that they were making some kind of statement but, on reflection, I don’t think that’s the case. I think they just simply don’t appreciate the importance or choose to take the risk. They may be “determined to carry on as normal”. Good luck to them. The virus is certainly carrying on as normal. And that means killing people. Sadly the actions of stupid people will be paid for by everyone. If the isolation instruction is ignored, and in places it is, there will be many more deaths than necessary. This isn’t rocket science. It’s that simple.

The ugly?

Well that’s easy. You don’t need to look further than the White House and its orange occupant. At least the American people are finally seeing the man for what he is. Morally bankrupt and both intellectually and emotionally inadequate. His dawdling and denial cost valuable time. Many more will die as a result.

That’s all for today. Continue isolating. Start isolating. This is not a drill. If we don’t lock down voluntarily, you won’t believe what happens next.

‘The better angels of our nature’

I’m tired of hearing that we are in uncharted waters or that the present viral outbreak is unprecedented. We are and it is. Enough said. Move on.

It’s still hard to imagine that two months ago the coronavirus outbreak in China was a “… And finally” item on the news. Now it is the news. All of the news. Sport is suspended indefinitely. The schools are closed. Contractors are building makeshift mortuaries to cope with the anticipated number of dead. Over 70s and the chronically unwell are more or less under house arrest. For their own safety you understand. Supermarket shelves look like stock images from pre-glasnost Communist Bloc countries. And this is only Friday. More extreme measures will be needed for sure.

And we have seen the worst of humanity – the fatuous stockpiling of toilet paper is the thin end of the wedge. Clearing the shelves of food like locusts is even more unattractive. If it were not for the fact that they queued and paid, it would be called looting. In terms of depriving other people of necessities, it amounts to the same. Perhaps most repulsive of all are those individuals who steal the hand sanitiser from the ends of hospital beds, thereby endangering patient and health service staff alike. And ultimately themselves of course if they happen to find themselves as patients in due course, as many of us will.

We forget that ‘society’ is little more than a veneer of manners, codes and rituals designed to provide order or the illusion of order over a fermenting cauldron of different opinions and behaviours. In the end, we are fundamentally hedonistic creatures, separated from other lifeforms by much less than we would like to believe. We share 60% of the same genetic information as watercress. Chimpanzees are 99% human, genetically speaking. It is no wonder our behaviour, when brakes and restraints are removed, reverts to animalistic, almost feral.

A good friend of mine frequently dissects, for my benefit, the two principal motivators of human action – fear and greed. He is a Skinnerite behaviourist without knowing. And his analysis is entirely reasonable. The stock market, perhaps the most overt embodiment of this, is quick to revert to animal behaviour. Just watch the trading floor as a crash gets underway – it’s like Lord of the Flies.

Fear and greed. And of course panic is the symbolic embodiment of both. We become animals, prisoners of phylogenetically ancient parts of the brain such as the amygdala. The coronavirus outbreak has given our amygdalas full range. That’s why you can’t find pasta or toilet rolls anywhere.

But set against this backdrop of selfishness, I’ve sensed a change. In Madrid, people stood to applaud the emergency workers. Shops are providing food gratis to those on the frontline. Amid the darkness flicker tiny lights of compassion, fireflies of altruism. People are keen to help. Several times my door bell has rung and a neighbour or friend wants to know what they can do to help me. Can they get me groceries? Do I need a lift to the post office? Am I okay for food? Do I have enough toilet paper?

And it goes beyond individuals. Already groups are being formed online to help counter the loneliness of long-term self isolation. Volunteer teams help identify the vulnerable and needy and offer practical help. Gradually people are looking to help.

The frenzied overpurchasing is stopping (mind you, there is nothing left on the shelves to buy, whether in a state of panic or not). Slowly but surely people are becoming less self-centred and turning into better versions of themselves. I believe it. At least I want to believe it. I want to believe that when this plague has passed, when we emerge, blinking in the light, it will be as what Abraham Lincoln called ‘the better angels of our nature‘.

The beautiful game

It’s funny really – I haven’t been to a football match in more than 30 years yet suddenly, as the football authorities shut down all manifestations of the beautiful game, I feel a yearning to be back on the terraces at Elland Road. The moment you tell me I can’t have something, I want it more. And it’s not as though I can claim to be a resolute come-rain-or-shine supporter. So why do I feel this misplaced sense of injustice, just as the once mighty Leeds United, take the top spot in the EFL championship, poised once more to take up their rightful place in the premiership?

Amongst the various options being considered by the footballing authorities in the UK, there are three front-runners – abandon the season and pretend it never happened, stop the season where it is and declare promotions and relegations on the basis of current positions, or try to complete the season in some form later in the year.

Currently all football in the UK is suspended until the first week in April. Obviously the notion that it can be resumed then is fanciful. If a current death toll of 21 was enough to stop all football, the position in a few weeks time when the body count will be much higher is clearly not going to provide a mandate for a resumed kick-off. I think we have to face the fact that the season is over whatever way you look at it. It seems hardly relevant in the face of the current situation, but my preference is for promoting Leeds United on the basis of the current position. In the premiership, that would make Liverpool champions. And rightly so. There has never been a team so overwhelmingly talented as the current Anfield squad.

Ridiculous really that in a time of pestilence, football should suddenly be important again. But then, to quote the late great Bill Shankly, “Some people believe football is a matter of life and death. I am very disappointed with that attitude. I can assure you it is much, much more important than that.”.

Schools – open or closed?

Two days ago we were shocked by the first daily influx of new cases exceeding 100 (in the UK). The government did nothing. Elsewhere in Europe and further, the administrations were closing schools and limiting mass gatherings. Today, Friday 13th, the UK tally of new cases is 208. That’s what happens when you do nothing. I am rapidly growing tired of listening to government talking heads telling us that the measures have to be proportionate and delivered at the right time. Nobody has specified what the right time is. Is there a predetermined number of new cases that will trigger an emergence from this governmental torpor? Is there a time component?

A week ago we laughed at President Trump’s incoherent ramblings in the face of the CDC. At least we didn’t have anyone like that in power. Then we had the briefing from Boris Johnson to the effect that we would all lose loved ones before their time before passing it over to the scientists to do the hard yards, explaining an inexplicable “wait-and-see” approach to the condition. Well we have waited and we have seen. In the space of a week, we have gone from just over a hundred cases to just under 800. Projecting forwards, we will have around 5000 this time next week. Assuming no decisions are taken and implemented by government.

One of the pivotal decisions to be made is whether or not to close the schools. And here, Britain stands very much out of step with the rest of Europe. In Europe governments are beginning to close the schools in the countries. The philosophy is simple – hundreds of kids interacting with each other in the playgrounds and classrooms is a huge potential reservoir of infection. Admittedly it appears that the very young are not particularly vulnerable to this virus but the point is the same. Remove them as a reservoir of infection.

Britain has so far resolutely held firm against this line of action, stating that it is currently unnecessary but with the caveat that they may call upon this measure “when the time is right”. Sir Patrick Vallance, countries chief scientific officer reasons it thus:

  1. You cannot keep large numbers of children at home anyway. They will always find friends to play with.
  2. By being at home, children will require childcare. This will often be in the form of grandparents, pretty much the most vulnerable group of all.
  3. In the absence of grandparents, parents themselves will need to take time off work to supervise their children. Many of these parents are health service workers who really cannot be taken out of the front line without dire consequences.

I have to say the logic is quite strong. It is unclear whether this is a premeditated response rationale however or a post hoc justification for the inertia shown by the government.

Counter reasons are (point by point):

  1. Yes children sent home from school will probably find ways of interacting with their friends. But even the most popular kids will tend to have friends round one at a time. An average school these days is maybe 1000 pupils. Having visitors in ones and twos is nowhere near as harmful as allowing 1000 children to interact in close proximity. Try telling 1000 kids to stay 2 m away from each other. In any case, most teenage boys will simply lock their bedroom door and play on the computer. Social distancing is practically part of adolescence these days. We complain about normally but now misanthropy and social withdrawal are survival characteristics.
  2. Childcare certainly would be an issue, no doubting that. But we live in unimaginable times at the moment that I am sure solutions can be found. Again, most kids with access to a computer will entertain themselves these days. I don’t suppose any of us foresaw that it might be the route to their family’s survival!
  3. Exposing the grandparents shouldn’t be an issue if families are aware of it. In any case that depends on whether the children are already infected. And they are more likely to be infected if they have been at school.

I thought initially that it was a clear-cut issue. Close the schools. Simple. But in actual fact it isn’t. There are counterarguments. And some of these are quite persuasive. At the end of the day it’s a numbers game. Which strategy will result in the fewest deaths? We simply don’t know and in some ways we are part of a gigantic experiment which will answer those questions.

It’s hard to believe, and I can’t quite believe I’m writing this, but the current pandemic is going to provide a wealth of information on how best to handle epidemics. If we pull through this one in reasonable shape, we will know much better on how to do the next one. It’s not an experiment that we would have chosen to make but the sheer variety of different approaches in different countries is gradually putting together what will be the ultimate manual of best practice in outbreak management. Sadly, it looks as though some of these strategies will be losers.

We’ve never played this game before. It’s going to take time to learn the rules. And sadly time, as the Italian premier said, is something we don’t have.

The wrong tense

Yesterday (12th of March), France closed schools, colleges and universities. The US shut down all Broadway theatre, major sporting events and travel to from Europe. The Dutch closed the Rijksmuseum. These are just some of the measures around the world being taken their bid to halt or to slow coronavirus and its relentless progress. And what have we done in the UK?


The Prime Minister has addressed the nation and told us that many more of our loved ones are going to die and that the country was now moving from containment to delay as its strategy.

Big deal.

I judge people less by their words than by their actions. Crocodile tears from our leaders don’t sway me in their favour. So what exactly does the movement “from containment to delay” actually entail?
Principally it involves the Prime Minister saying one thing and doing another.

The tenor of Mr Johnson’s speech yesterday was that the government has a veritable smorgasbord of options available and would be thinking which to best use over the coming days.

This is ridiculous. It’s 24 hours more of the battle that we are losing. 24 hours in which our enemy grows stronger and we grow weaker. There is no half-time in this war. Time in which we tread water is time lost in the fight.

Why are we laying out our options but not implementing them immediately. If viruses could laugh, coronavirus would be rolling on the floor laughing at our inertia.

So what will it take for us to do the obvious and stop large gatherings of people? There must be some kind of trigger point at which the government actually moves into “delay” rather than simply talks about it. What will it take? A day in which the number of new cases rises by 200 perhaps? Maybe a day in which say five people die?

Yesterday the chief medical officer, presumably speaking from a government script, attempted to explain to journalists how the delay strategy would work. And why going for a blanket ban on gatherings too soon was a bad idea because of people’s innate impatience over time.

I can see this argument but I don’t buy it. If you are fighting an enemy that is gaining strength, you don’t give it the benefit of time. It’s all very well telling us, the people, how we are likely to behave, but without any evidence. We simply don’t know how people will behave. We have never faced a plague like this in our history. Every day we prevaricate is a day when we have lost the battle. A day closer to Italy.

I’m tired of hearing what we will do, what measures we will take. I want to hear about what measures we are taking. Tell us that. Because at the moment you are using the wrong tense.

When friends become enemies

It has all happened with such lightning quick rapidity that we are barely keeping our heads afloat in the sea of information, misinformation, rumour, whispers and projections about the course of coronavirus illness. We are not really used to exponential growth in infection rates. Well, in a manner of speaking we are. The common cold is transmitted in much the same way but has much less severe consequences. What I should perhaps have said is that we are not used to exponential growth in viruses as exquisitely nasty as this bug.

And the speed of transmission is the root of the problem. There is no time to develop a strategy, put it out for critical opinion, form working groups to draft a White Paper, amendments and implementation. None of that. While we are still coming to terms with the phoney war that exists at present, the virus is conducting a silent blitzkrieg on us. We are learning new facts almost by the minute.

Last week we did not know that the virus can live on surfaces for up to a week. That was a bit of a blow. Last week we didn’t have the genetic sequence of the virus. Now we do. And not a moment too soon.

Last week, we knew little about lock downs. That was something that happened in the Far East – China, Malaysia, South Korea. Those sort of places. Places with quasimilitary regimes that could enforce such drastic measures with guns. Not the kind of thing that happens in the West.

But the fundamental truth is that these measures seem to work. The war there isn’t over but there is at least the realistic possibility that the virus may be halted there. Drastic measures, sure.

We balk at these kind of measures in the West, in essence locking up entire populations of cities or, as in Italy, countries. But as the Italian prime minister said, in an almost valedictory tone, “there is no more time”. Without finger-pointing, the reason there is no more time is because they took too much of it in the early stages before they recognised the holocaust that was to follow.

Before anybody feels that this lesson has been learnt, let me urge vigilance not complacency. It only takes a couple of wrong decisions for any country in the early stages of this illness to descend into the same abyss. And when I say a couple of wrong decisions, they don’t even need to be wrong. Just late.

The UK government is broadly speaking still talking of containment. Just as the WHO was reluctant to press the button labelled “pandemic”, so does the UK administration cling to containment. The number of cases in the UK rose by 73 yesterday, the biggest single daily rise yet. This is not containment. Not by any standard. It’s time to bite the bullet. Whether you call it such or not, we are now in the “delay” phase.

So get on and make those decisions. Make them tomorrow when another huge increase in cases will turn public opinion against your “sit tight” approach. Action is needed now and action requires leadership. So show some.

The principal argument against Draconian measures is that they are considered to be disproportionate and likely to induce non-compliance if maintained for long periods of time. The feeling is that if we close the theatres, cancel football games and prevent rallies and marches, people will begin to resist such an imposition after a few weeks. This coincidentally will probably be at the time of peak mortality. Not a great time to give up on your only strategy.

I don’t really buy that. Every day the virus gains new footholds, creeps into areas previously untouched. More countries are added to the list of those infected. This is not a time for genteel moderation. It’s a time for all-out war on the virus. If we are going to prevent a collapse in our health service provision, that’s what we have to do.

Firstly, we need to self isolate. Those who can work from home need to do so. Secondly, wash your hands more than you would when you were a kid. Imagine your mum nagging you. Do it that much. Thirdly, if you are a member of the government, cancel football matches, theatre performances and all gatherings. If you are not a member of the government, just stop going to them. Big gatherings are ways of turning sparks into wildfires. One person sneezes on 10. A week later those 10 have infected 1000. And so on. Fourthly, and I’m a bit hesitant about this one, wear a mask. I don’t know if they are any use but they do at least reduce the likelihood of you infecting somebody else. And they act as a clear visual signal that you are taking this thing seriously. And that in itself is not a bad reason.

The biggest change I think is in our social customs. The Dutch Prime Minister gave a brief spiel in Brussels about not shaking hands and then promptly shook the hands of his deputy. It may have been a brief moment of farce, but it showed how strongly ingrained such behaviour is.

Over the last week I have seen very few friends or family and it has been a real conscious effort on my part not to greet them with the familiar hug, kiss on the cheeks, or handshake. They are my friends after all. What danger could they possibly be? And the answer is of course that they present every danger there is. Their very familiarity makes them dangerous. Trojan horses essentially. Unwitting assassins.

We are being stalked by an invisible enemy. It may be miles away. It may be on our doorstep. Or in our houses already. We don’t know. It will be another week before we know where it was amongst us.

So act now. Take the steps you can. Encourage those who can take bigger measures to do so. We are peering over the edge of a precipice at the moment. If we don’t take a step back, the virus will take the step forward for us. Act now.

Toilet roll wars

The last couple of days have seen complacency turn into blind panic as the UK tries to control the spread of coronavirus. The number of those infected stands at over 300 and the first five deaths are now recorded. Again we are “reassured” that the latest deaths were of old people with underlying health problems. Reassuring I’m sure, unless you happen to be an old person with underlying health problems. The government needs to make its messages a little less overtly Darwinist.

But even in these rather dark times there is still a sort of black comedy. What is all this nonsense about toilet rolls? The shelves are bare, as the toilet roll locusts descend upon the supermarkets. YouTube spills over with video footage of people fighting at the checkouts over loo rolls. The world is facing its biggest global health concern ever and people are brawling over toilet paper. You couldn’t write this stuff.

The emergency meeting of Cobra today was called to discuss next steps in the management of coronavirus (inasmuch as it can be managed). The government has, for administrative reasons as far as I can tell, pigeonholed the condition into four stages – containment, delay, mitigation and research. Of course it’s really only three stages since research is ongoing throughout. The tenor of the meeting today seems to be a desire to maintain the country on “containment” as a strategy before going to more Draconian measures once we enter the “delay” phase. At the end of the day it doesn’t really matter what we call the phases. That’s just a headline for the writers. Especially if the transition to delay is blurred as has been the case today with the advice that even people who are only slightly poorly should stay at home.

This seems hardly worth saying. Obviously people who are unwell should stay at home anyway, and especially so in this time of heightened awareness and sensitivity. Do you really want to be the one who brings coronavirus to your office? It’s amazing really that it was felt necessary to say this. However, this advice presumably is a substitute or an interim measure, intended to delay the transition to the delay phase if that makes sense.

To my mind we have a clear glimpse of the future, well about a week in the future, in the shape of events in Italy. Sensible measures that could have been taken, with minimum inconvenience, were not. The lockdown of 16 million people is the result. Locking the gate after the horse has bolted.

I can’t help feeling that this will, at best, have us chasing the game. We will always be one step behind the virus. If we want to defeat this thing we have to outrun it. That means taking uncomfortable measures. Cancelling football games, closing theatres, that sort of thing.

The principal argument against such extreme action (and I concede that this is extreme) is the damage to the social and economic fabric. After all there are only 300 cases in the UK. This is presumably why Mr Johnson today spoke of the government’s commitment to the right measure at the right time as he put it. I have little doubt that the stock exchange would wish to avoid such measures. I suspect however that the health service workers would rather we did. In any case, even if we do not take such measures now, we may be forced to do so in a weeks time. And by then they will be less effective.

I don’t envy the government in the slightest. They have a nigh on impossible task ahead of them, balancing public safety and economic stability. Either can compromise the other and, over the weeks ahead, we will learn who is the winner. If we get this wrong, it really will be a lose-lose situation. Ultimately it’s their decision. But if it was me, I would reduce the number and size of gatherings whether schools, universities, theatres or sports grounds. And I would impose a curfew. Italy shows what happens when you don’t.

Draconian? You bet.

Lies, damned lies and statistics

As we all try to make sense of coronavirus and what the resultant outbreak of Covid 19 means to us, we are bombarded by numbers without necessarily the skills to interpret those numbers correctly. And if that were not an adequate confounder in its own right, you can factor in sufficient additional caveats about data collection to render the headline numbers meaningless.

Let’s be candid about the numbers. What we all wish to know, in essence, is “Am I and my family going to survive this?”. Obviously it’s impossible to give any kind of real answer to that question. It’s essentially a game of roulette. Especially so in the light of the most recent number published by the WHO, which predicted an overall mortality of 3.4%. This is, to say the least, a terrifying number. The UK government is quick to say that the brunt of the deaths is amongst the elderly and those with comorbidities (that’s other illnesses in plain English).

I think this message is intended, in some way, to be reassuring. In essence “as long as you’re not old or already ill with other stuff, you’re gonna be okay “. Now, speaking as somebody who is, by the government’s definition, elderly and living with Parkinson’s and type II diabetes, you will understand that I am somewhat less than reassured. The tone of the message seems almost to suggest that I’m expendable. I don’t much like that idea.

But hang on there, let’s look at the statistics. 3.4% overall mortality? Broadly speaking they have divided the number of dead by the number of people known to be infected. There are any number of good reasons that mean that number may be wildly inaccurate.

Firstly, let’s get the scary ones out of the way, the number of dead is incontrovertible. But the number of those who are going to go on to die is a projection. The number of dead now reflects the number who were infected up to say a week ago. A much smaller number. On that basis, one would project the death toll to be much higher. That’s right, higher.

Bear in mind also that these statistics reflect the initial wave of infection for which the various governments round the world have made at least some provision, in the form of specialist units to deal with coronavirus. In the UK, these units at 30 hospitals have a hundred beds between them. The total known UK cases of Covid 19 stand at 164 currently. Obviously some will have recovered and gone home. But either way, we must be teetering on the edge of capacity. If not today then tomorrow. Once we have to start treating people in Portakabins or whatever, it’s likely the mortality will go up. I am assuming at this point that we do not have the Chinese capacity to build entire new hospitals in two days (incidentally wasn’t that amazing!) so we are stuck with what we have.

You could be forgiven for thinking the situation looks bleak. But it’s worth remembering that the numbers used by the WHO to calculate the death rate are subject to significant other biases. First and foremost, we don’t know the true rate of infection. All we know is the number of those infected amongst those tested. For the most part those tested and found positive will likely be sicker than the wider population. The fact that they have in essence self diagnosed by presenting themselves for testing indicates that they are among the more unwell. Unknown is the number of people with very mild symptoms who simply do not submit themselves for testing. In many cases this may reflect a degree of denial – the “it’s just a cold” mentality – with its attendant consequences. People out there with the symptoms of coronavirus but taking no precautions to protect the public, are putting people’s lives at risk.

We won’t know the true death rate until this is all over. We should not delude ourselves that this will be a matter of a few weeks. Pandemics don’t work like that. It’s more likely to be a year or thereabouts. Nobody knows.

In the meantime, let’s dispel a few myths:

“it’s just like the flu” – no it isn’t. And a friend of mine pointed out to me that many of those who say this have never had flu itself. We tend to upgrade the common cold to flu status in our heads, perhaps somehow to legitimise our truancy. Flu itself, true flu, is crippling. So don’t let’s downplay this.

“It’s just like the 1918 flu” – well, yes and no. The symptoms are quite different for a start but the overall mortality may be similar. Or worse.

“There will soon be a vaccine” – no, there won’t. Vaccines take time. Even the most optimistic figure I’ve seen suggests about a year for one to be proven effective. Obviously longer for sufficient to be manufactured. Most scientists suggest significantly longer. And remember also that even the annual flu vaccine is only partially effective.

To summarise, the WHO headline death rate is at best a guess. It could be out by an order of magnitude either way. The situation could be either better or worse. It still comes down to the fact that there is only one effective way of fighting this plague – self isolation and quarantine. That will reduce the risk of becoming infected and also the likelihood of spreading the illness. in this respect we each have individual and collective responsibilities.

We don’t know how this is going to turn out. But we know more about how it will turn out if we fail to take the precautionary steps we need to. And that doesn’t mean just buying toilet rolls. Get real.