Demography - Why comparing individual countries is difficult

The statistics here are approximate - based on previous census data (used in a previous study comparing population aging.  It is worth noting I am not arguing that such comparisons are impossible because they are not - but they require an examination of multiple complex factors) 

As this pandemic has spread, and countries have undertaken measures to prevent the spread of the virus, there has been a lot of talk about comparisons.  “Are we on the same track as Italy?” has been a common question both in the UK and in the USA, as Italy’s health system becomes overwhelmed by patients.  It is hard to put across the complex mathematics behind modelling epidemics, and pandemics, in a few sentences.  Predictions can be made, but numerous factors have to be taken account of.  As more than one expert has remarked – we really won’t be able to make those kind of comparisons until after the pandemic has come to an end.  The simplest of the issues to explain is one of demographics.  Even countries which border each other can have vast differences in demography, even when cultures are similar.  While the coronavirus that causes Covid-19 does not discriminate in terms of hosts, there has been a disproportionate rate amongst two populations – the elderly (while the definition varies the usual statistical boundary varies between 65 years of age and 70 years of age), and those with certain pre-existing health conditions.  There is naturally some overlap – as people age they are more likely to develop underlying health conditions which can complicate treatment of even relatively common health problems.  This is one of the areas where demographic difference influences the way in which countries have been affects.  Italy, now overtaken by the USA (as of 28/03/2020) as having the highest number of cases, if affected by this.  Using the definition of over the age of 65 Italy has the second highest population of elderly people in the OECD – 23% - with only Japan having a higher percentage – 27%.  The UK by contrast, while not within the top 20 nations ranked in percentage order – 23^rd overall, has 19% of the population being over 65 – the same as Spain – which also has 19%.

Geographical area – and geographical boundaries – may equally be a factor though this again has to be counterbalanced by the general lack of advanced health care systems in rural areas.  This is one reason of multiple reasons why rural communities are desperate to stop the flow of second home owners seeking to escape outbreaks in the cities moving to the countryside – placing pressure on healthcare systems which are barely adequate in normal circumstances. 

Social attitudes also play a part – personal space being just one factor – it has been noted in previous studies that people living in crowded cities have smaller areas of personal space – having become socialised to smaller areas – while those living in rural areas tend to have large boundaries.  Social mores around physical contact also play a part.  Traditional and Religious factors can also play a part – particular those which involve hygiene - some of which are easier to change than others.   One example of a change, taken relatively early in the outbreak in the UK, was of some Anglican churches moving to the use of ‘communion in one kind’ for Holy Communion – where only bread is used.  This was viewed by many as the safest valid option.  In some cultures taboos around the use of right and left hands for ‘clean’ and ‘unclean’ activities may impact on the spread of certain diseases.  Historically, strict cultural rules around hygiene have been given as one factor in growing prejudice against the Romani community – since some Romani groups held (and some still hold) to strict rules about cleanliness.  In some groups individuals do not share personal items – crockery, clothing, towels – each having their own which are for their sole use and there is a strong taboo about even touching such things belonging to others.  Furthermore in many of these groups items must be washed only in running water (generally considered to have been to avoid contamination from stagnant standing water).  These rules made these Romani communities less prone to infection – and their apparent immunity led to allegations of being the cause of such outbreaks.  In some cases these habits persist amongst people who have moved outside of the general Romani community and live in non-Romani populations.  

In short multiple factors mean making such comparisons during an ongoing pandemic hard – they can only be done with any degree of accuracy, in a way that can be clearly understood, afterwards.  Those predictions we do have are based on complex mathematics in order to create working models.  Some may view such predictions as alarmist – but where these kind of outbreaks are concerned it is always better to go slightly too far – than not far enough – especially when your mistakes are counted in lives lost.

Covid-19 Pandemic Diary 24/03/20

I have chosen not to put the second half of this entry behind a Read More cut - because I feel there is an important message here to those people who have seen fit to make a number of unhelpful and dangerous comments about the current situation in the UK.  Content Warning for discussion of disease, viruses, and chemical/biological warfare.  

Today is the first day of the nationwide lockdown.  I have left my flat twice today – one an essential journey to top up my electricity meter, and the other a short walk the length of my street to stretch my legs.  On this second journey I saw no-one, and was glad of that.  I phoned my family, and sent texts to check in on some friends.  On the science front the latest news I’ve read shows that the virus is mutating slowly – which is a good thing since it means that a vaccine may provide long lasting protection.  The government is also putting in place antibody testing – to check who has had the virus and recovered – to allow key works who have had suspected symptoms to return to essential work.  As far as my own situation goes – I’m safe, I have supplies, and I have enough work to do. 
There have been moments however when I have felt burning anger at some of the things I have seen online.  People claiming this virus is ‘fake’ or a ‘hoax’.  A further symptom of the matters discussed in this entry.  People seem to believe that the ability to comment on a video on YouTube, or post on Twitter, makes them an expert, and that their view is as valid as those of people with years of experience in medicine, virology, epidemiology, etc.
The maths are simple – 1 person, disobeying the rules on social distancing etc, can cause thousands of cases.  Spreading false rumours and claims that the virus isn’t real, or that it was released deliberately, these rumours are both as dangerous and this kind of misinformation will lead to more cases and more deaths.  I call it monumental stupidity, and anti-intellectualism on a massive scale.  My grandfathers (who lived through the Great War, and World War 2, respectively) would both have had another word for it.  Treason.
Stop spreading rumours.  Stop making snide remarks about the conditions, or the rules.  This is not the time for people to build a bit of ego – when people could die as a result.  In normal times you might call these internet conspiracies harmless, or trolling, but in an epidemic or pandemic, they are far more dangerous. 
Regarding the possibility that this was a weapon – there are many reasons why this is highly unlikely, medical, scientific, and geopolitical.  The most obvious evidence against it is that this virus can be wiped out by soap and water.  It doesn’t survive well on surfaces.  In terms of other viruses and pathogens which have developed in nature this is weak – compared with MRSA (methicillin-resistant Staphylococcus aureus) for example, which as some readers will know is a mutated form of Staphylococcus aureus which developed resistance to certain antibiotics, and is known as a 'superbug' as a result.  Compared this previously developed biological weapons, particularly nerve agents such as VX this is not in the same league of biological persistence.  It is true that viruses have been weaponised in that past, however, there is a vast amount of debate as to whether they would prove effective - and it is worth noting that as a candidate for weaponisation coronaviruses are unlikely to have been considered for two logical reasons - 1) some are prone to rapid mutation in transfer between people and are therefore too unpredictable and 2) there are other far more dangerous viruses which have been considered for such projects.  In fact it is notable that the virus generally considered to be the most lethal (in terms of number of people who die after showing symptoms), rabies is the most dangerous - since by the times symptoms present the condition is already to far advanced for it to be reverse or treated.  Treatment of rabies is reliant on vaccination as soon as possible after exposure (such as an animal bite) and continue vaccination after exposure to ensure the virus cannot take hold.  While viruses frequently appear as weapons in video games, films, and TV series - the practicalities of producing, replicating, and delivering viruses in such a way that it would be an effective weapon (without it mutating or effectively going rough in the wild) - alongside the fact that many viruses burn themselves out (smallpox outbreaks were often found to self limit due to the death rate outpacing the spread of the virus) - make them impractical when compared to alternative conventional military forces, and political actions, even before the cost in manpower, time, money , and resources required is factored in.  It is also worth considering that Covid-19 is one of family of viruses which include others which are now to have crossed from animals to humans (a route common to most viral infections - and common to the six most deadly viruses known to science). 

On a personal level my message to those young people who seem to feel that because the majority of cases are their mild to moderate, or asymptomatic, they don’t have to change their lives – because they don’t have a high risk, or have an underlying health condition, is this.  You can’t be 100% you don’t have a condition you don’t know about.  I taught someone some years ago.  They were a young, healthy individual.  They were in their early 20s.  They were fit, and an athlete – training several times a week.  They were, to all we knew and they knew, in the prime of life.  They died less than a few months after graduating from university, having collapsed and died in a matter of seconds.  It was only discovered through post mortem examination that they had a previously undetected heart condition.  You don’t know how much time you have.  You don’t know the inside of your own body.  Your personal confidence does not convey immortality.    For the sake of yourself, of your friends, your family, and their friends and family – you have to stick to these rules.  A fine, or even time in prison, is nothing compared to the guilt you will feel if through your actions and in-action you contribute to another person’s death.  Don’t do it.  Don’t spread rumours which can be all to easily believed.  Don’t spread lies or worse ‘cures’ which have no foundation in medical science.  Comments about masks don’t help.  The reality is most people have no idea what kind of masks and respirators are suitable for what situations in medicine, or in hazardous environments.  Keep those comments to yourself.  Don’t do things which could harm others. 

Stay at home.  Nothing but essential time outside.  Wash your hands. 

Lockdown, Social Distancing, and Patriotism

It feels as if some people need this underlining in the current circumstances.  Despite repeated warnings to avoid going out on unnecessary journeys, to stay at home, work from home if possible, and only go out for exercise and to avoid contact with people, at the weekend hundreds took to trails and drove to the coast.  The attitudes displayed in the face of a deadly pandemic were frankly disturbing to anyone with a knowledge of how illness spreads.  These people were risking their own and each other’s lives.  Some even expressed the view that they didn’t have the virus and so were fine.  My response to that is – How do you know?   There are asymptomatic patients out there – we know that.  This virus is a symptomless spreader – you would be infectious without knowing.  Such cavalier attitudes are unfortunately common.  The rejection of expert advice – more so.  A few years ago Michael Gove publicly stated that the people had ‘had enough of experts’.  Since that expression it has often felt that anyone expressing a nuanced or contrary opinion can be dismissed in the same way.  And because of this anti-intellectualism, now, people who otherwise would not have been infected will be.  Some may die.  There are actual human lives at stake here.
It feels necessary to put this in a paradigm people might understand.  A patriot is someone who wants their country to do well.  This doesn’t equate to a belief in national superiority, or racial superiority.  It is an expression of the desire for your country to do well.  Ignoring government advice and going about activities that you want to do which contravene it, in a time of a national epidemic – is not a patriotic act.  You are putting the lives of British people – of all colours, all creeds, all religions, all social classes, all faiths, all genders – at risk.  If that means nothing to you – think of the healthcare workers who could become part of the chain of infection which you may or may not be part of.  The doctors, nurses, radiographers, consultants, paramedics, healthcare assistants.  Their lives are at stake too.  If you continue to defy this, regardless of the risks to yourself and your family – you are not a patriot.  If your belief that stopping these things is against the British spirit – you need to read some history.  British history.  If you keep doing those things be assured you are not helping.
If you panic buy supplies you don’t need – when you’ve already got enough at home for weeks – you’re not a patriot.
If you empty supermarket shelves rather than buying just what you need to survive – you’re not a patriot.
If you gather with your friends outside in groups five or ten or fifteen – you’re not a patriot.
If you defy advice to keep your distance from others and crowd your way in to get into places you need or don’t need to go – you’re not a patriot.
If you are one of those who defy this for the sake of it – you’re not a patriot.
If you are one of those people who took a trip with your family to the coast and crowded the beaches and seafronts with others and are now complaining about tighter restrictions that are now in force – you’re not a patriot.
You are putting scores of lives at risk.
If that doesn’t get through to you think about it this way – imagine you are an asymptomatic carrier – or a mild case – and you see fit to go out.  You stand too close to someone in the supermarket – you haven’t washed your hands because they look clean to you.  You transfer the virus to the person next to you.  They transfer it to their partner at home – a doctor.  Days later the doctor develops symptoms and has to isolate.  And because of that absence – there just aren’t enough staff to carry out all the treatments needed – and your own mother or grandmother – who contracted it through no fault of their own – who isn’t asymptomatic – dies.  The people around you when you go out have families, friends, co-workers, all of whom care about them just us much as you care about you and your own.  Not keeping to these restrictions is putting lives at risk.  If you care about your own family, if you care about this country – follow the protocols – stay at home except for work that isn’t closed down, minimal trips out for supplies, exercise, and medicines, wash your hands regularly.  If you call yourself a patriot this is your duty to your country right now.

(If it helps – just imagine the above being read to you in the voice of Winston Churchill, Clement Atlee, etc as appropriate to your political affiliation and auditory preferences).

Covid-19 Pandemic Diary - 21/03/20

Today has been a tough one.  Yesterday the government ordered the closing of all pubs, eateries, etc – with the exception of those who could provide take-out only services.  It wasn’t long before one particularly ill-informed individual on Twitter remarked about the fact that pubs stayed open during the Blitz.  Of course, it is astoundingly obvious to someone with either basic common sense, some knowledge of elementary virology, or both – that this is a ridiculous comparison.  Covid-19 is not a plane stocked with bombs flying from a distant land.  There aren’t warnings – it’s already here.  These actions are about saving lives.  It’s easy to think it doesn’t apply to you when you hear the phrase that it’s the elderly and those with underlying health issues that are at risk – because it’s not personal.  To quote Adam Hills ‘When it’s your granddad and your asthmatic mate, it starts to feel different’.  And that is the hard reality here.  You may get an asymptomatic or mild case – but your best friend might not be so lucky.  These are matters of life and death.
Follow the advice - stay at home, wash your hands regularly - save lives.

{... I've put the second half of this entry behind a cut because it discusses misinformation that has been spread, and also discusses xenophobic myths, and makes reference to both the slaughter of animals, and cannibalism.....................................]  

Covid-19 Pandemic Diary - 20/03/20

Today –  I had two errands to run.  Visit the university library – which closes for the foreseeable future at 5pm – to return a few volumes, and check out a few more I knew I would need.  Visit the Post Office to top up my electricity meter key.  Then when my lift arrived go to the supermarket.  While there was fresh produce – fruit and vegetables, and bakery bread, we walked through near empty aisles.  And this is after most supermarkets began bringing in restrictions to try to curtail the panic buying which has run through the system leaving chaos in its wake.

A recent remark on the radio was that the panic buying and stockpiling had led to toilet roll becoming the latest cryptocurrency.  Part of me has to wonder just how accurate that may become – with the gap between those who can afford to build up massive stockpiles and those who can’t – the idea of bartering what we do have for what we need often seems the only practical solution.  The reality is that people are automatically panicking despite the assurances that the supply chains are there and are stable.  The empty shelves are a symptom of two issues – public panic over supplies and fear that controls on food and other produces may become tighter still if new measures are needed – and behind the scenes the ‘just in time’ nature of distribution.  As it stands in terms of the logistics warehousing is less common today with things being delivered directly, with idea being they arrive just in time to be sold on again.  This low inventory method of manufacturing and production is itself important – being originally a product of the rebuilding of the economy of Japan after World War II.  While not unique to it Just-in-time manufacture is strongly linked to Toyota – and is sometimes referred to as the Toyota Production System – Taiichi Ohno is considered to be the main originator of this method within Toyota and is sometimes referred to as the ‘father’ of it.  The system migrated to the west – where it was adopted by a number of companies and has become influential in how many firms operate logistically.  In this country we rely on food imports and industrial scale farming which is becoming increasingly unsustainable both economically and environmentally.  While the supply chain is strong – the reliance on imports is a risk factor which has been identified by food security analysts.  I am reminded once again of conversations with my father recalling the very different agricultural world of the 1920s which he remembered.  There have been many articles written on the so called ‘death of rural England’ – often noting the lack of services, for example the closure of bank branches and cash points in rural parts of the North West.  Many in these communities feel politically abandoned.  Multiple factors play into this – everything from employment and production issues, the increased use of automation, tourism, and the lack of restriction on second homes.  I have often thought that the best summation of this situation, in England at least, comes from the band Show of Hands, and the song Country Life.  These lyrics in particular have always stood out to me –

If you want cheap food well here's the deal

Family farms are brought to heel

Hammer blows of size and scale

Foot and mouth the final nail

The coffin of our English dream

Lies out on the village green

While agri-barons CAP in hand

Strip this green and pleasant land

Of meadow, woodland, hedgerow, pond

What remains gets built upon

The CAP (Common Agricultural Policy) had negative affects on smaller farms, while supporting larger scale enterprises, which led to fundamental changes in agriculture across the country – and tensions over this have been suggested by some as explaining the support in some rural areas of the UK’s vote to Leave the EU in the (consultative) referendum which led to the UK’s exit from the European Union.

Mentally as people we build walls between certain realities of life and distance ourselves from them.  Unless it directly involves them at either a professional or personal level few people have time, energy, or perhaps desire, to consider the complex web of supply chains which provide their food and other products.  This can be seen in numerous areas of life – for example the ethical problems of using technologies which rely on conflict minerals such as Coltan – the mining of which financed conflicts in the Democratic Republic of Congo.  The use of the word epidemic has often been associated with things other than infections – such as the media’s use of the term to speak of knife crime, or the misuse of drugs.  In terms of health to many it will bring up images of other countries – often African countries, and often linked with the concept of foreign aid.  This could be seen as a psychological defence and a form of distancing – these events do not take place in our here and now – they are distant events which do not affect us.  Much of the anxiety leading to the current panic buying, stock piling, etc is the result of the shattering of this illusion of safety.  This pandemic is here, and now, it is real.  Even as this begins to sink in some still deploy distancing language or attribution – such as Donald Trump’s references to the virus by its point of origin.  Some have argued that this is intended as labelling by origin, rather than the racist xenophobia which is clearly is ( - especially given that it fits within a wider pattern of behaviour by the individual in question - ), and some have gone so far as to remark that the 1919 flu pandemic has always been referred to as the ‘Spanish flu’.  This is of course based on ignorance.  The 1919 flu pandemic was caused by the H1N1 strain of flu viruses (a new strain of which would cause the ‘swine flu’ pandemic in 2009), and is identified by viral strain and year primarily.  The reason the term ‘Spanish flu’ became commonplace was in fact due to wartime censorship – which meant that the press under reported cases in the belligerent nations of the Great War (including by that stage of the war the USA).  The press in Spain, which was neutral in the Great War, were not under the same restrictions and as such the press reported in detail  on the epidemic.  This lead to the impression that Spain was disproportionately hit by the disease and to the use of the term ‘Spanish Flu’.  Thus even this claim of accuracy is based on ignorance – or a deliberate misunderstanding of the realities of how viruses, epidemics, and pandemics are named.

These illusions are rapidly giving way to the reality that this pandemic – the Covid-19 pandemic of 2020, is here, and now.  To prevent the spread we have to continue to take the appropriate actions.

Covid-19 & Unintended Consequences: Contactless? Welcome! Homeless? Not so much…

As I mentioned in my post on 19th March, many shops were slowly moving towards cashless payments – contactless and card only.  It is a good measure – it minimises physical contact, and therefore virus transmission.  In this situation its fundamentally a good measure to stop the spread of virus - along with regularly hand washing and the other measures outlined by Public Health England and the NHS.  It is a change that has been being forecast for some time.  It’s been a change which has been written about extensively over the last few years as people increasingly use contactless and the so called ‘death of cash’ has been predicted by more than one headline.  However it has unintended consequences, which could be devastating for one community in particular.  The homeless.

Covid-19 Pandemic Diary - 19/03/2020

It is two weeks since measures started being put in place to curb the spread of Covid-19.  Currently those who are in at risk groups have been asked to self-isolate for 3 months.  Anyone with the headline symptoms – a persistent new cough and a high temperature/fever – are being told to self-quarantine for 7 days – similarly for 14 days if anyone in the household is affected.  They are advised to stay indoors – leaving only for exercise at a same distance from other people (at least 2 metres from anyone).  The latest NHS Information can be found here

Those who are not considered at risk are to continue with the standard advice – regular handwashing, minimising social contact – ‘social distancing’ – minimising contact with anyone.  Shops are starting to limit their opening hours, and many are now are only accepting card and contactless payments.  It’s hard to find words to express the mood of the community.  For the most part people are doing what they can to look after themselves and their own.  As I ran errands in town today – visiting the Post Office, the bank, my mobile phone provider – I found myself subconsciously listening for my phone’s news alert tone, and checking the time – waiting I realised, for 5pm, and the now daily press conference from the Government, and wondering what the next steps would be. Hoping for more hopeful news.  Today there was good news, and people do appear to be taking on board the advice for the most part, at least in this city.  There are however signs of problems which are easily visible.  Today I saw a man yelling at no-one in particular that the virus was the fault of China and Chinese people, and that all Chinese people in the UK should be expelled from the country – this in a city which once saw the same rhetoric against Jewish people lead to mass murder.  Of course the man had nothing to say on the fact that one of the most right wing governments in modern British history has been in power for ten years and has systematically under funded / de-funded both healthcare, social care, and medical research.  This kind of anti-migrant hatred Is one of the things about this which makes me nervous.

From a scientific standpoint there is a lot of work going on, unseen, across the world to fight this pandemic.  The virus itself can be destroyed on surfaces by ordinary soap and water, or by 80%+ alcohol gel – because the coating which surrounds the DNA of the virus Is weak – much weaker than MRSA for example.  At the root of this pandemic, and the lack of preparation, is a consistent willingness by governments and populations to ignore the warnings of academics and experts.  The President of the United States, Donald Trump, claims no-one saw this coming – yet on YouTube 4 years ago at a TED event Bill Gates can be heard stating clearly that we are not ready for the next major pandemic.  The warnings were there – but no-one listened.  It is hard to explain the feelings of those who have been worried about exactly this kind of scenario for years.  There is no joy in having been proved right -  if anything there is a sense of guilty that maybe somehow we could have done more, and made ourselves heard.  The truth is – nothing would have made people listen.  Everything that could be done to get the message across was done.  Now we have to fight the pandemic with everything we have.  From an epidemiological standpoint this situation could be worse.  The reality is, we need more funding, and we need more data.  We need to gather every set of outbreak data we can so we can see a bigger picture of how these things spread and grow, to inform our methods of containment and treatment in an increasingly interconnected world.