Covid-19 Testing and Tracing

In order to understand the facts of the pandemic and better implement measures to contain it and to be aware of rises in infections, both testing and tracing are important.

Testing (Finding a rise in cases early means measures to reduce spread can be implemented sooner.)

• Currently the UK uses nasal or throat swabs for testing purposes. Initially testing was restricted to health service workers and patients due to limited stocks. This means that until around the end of May 2020 the number of infections was very much under-reported.  As further stocks became available, testing was widened to include a number of other categories who are showing symptoms, but this coincided with a drop in infections. As infections started rising in September, the extra demand for tests has put strain on the labs who process the samples and further labs are to be opened.
• A sewage-based coronavirus test could pick up infection spikes up to 10 days earlier than with existing medical-based tests. Research revealed that people infected with the virus "shed" viral material in their faeces. Sampling wastewater at different points in the sewerage network can gradually narrow outbreaks to smaller geographical areas, enabling public-health officials to quickly target interventions at areas of greatest risk of spreading the infection.
  The UK Centre for Ecology and Hydrology are working on a standardised test to "count" the amount of the virus in a wastewater sample. The UK has six labs that are capable to doing these tests. Scientists are now working on how to measure levels of infection regularly and reliably across the water-treatment network. (More details.)
  23 Oct. 2020: Ninety wastewater treatment sites in England, Wales and Scotland will start testing more sewage for coronavirus. The aim is to create an early warning system to detect local outbreaks before they spread. Scientists had to overcome some issues to refine the technique, as wastewater by its very nature contains a lot of contaminants and samples vary widely, making it tricky to develop a one-size-fits-all standard, accurate test. However, a pilot in south-west England has already helped to spot a rise in infections that occurred in September in Plymouth, where a cluster was silently growing as a result of several asymptomatic cases. These tests are not a substitute for an effective test-and-trace programme, but are an "added tool in the box". (More details.
• Saliva-based testing. The current test for the virus involves taking swabs from the back of the nose and the throat. This is unpleasant and taking the swab can cause patients to sneeze or cough with more risk to health-care workers. Researchers at Yale found that saliva samples from just inside the mouth were more accurate and consistent than deep nasal swabs taken from 44 patients and 98 health care workers. Saliva testing requires fewer materials, making it more immune to supply chain problems, and any cup or collection used for the sample could be re-used after disinfection, and health-care workers would need to wear less PPE. (More details.) 

Tracing

• In many UK situations (where you encounter other people not in your household or support bubble - e.g. hairdressers, pubs, restaurants, cafes), you will now be asked to leave your name and contact details. These are held for a specified time (in case someone you may have encountered has now tested positive for the virus) and then destroyed. If you are potentially at risk, you will be contacted by the Test and Trace service regarding need for testing and other advice.

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Large Electrical Appliance Disposal

The UK is one of the world's biggest producers of waste electrical and electronic equipment (WEEE), which includes everything from printers to power tools, to TVs and tumble dryers.

When disposed of correctly, rather than being sent to landfill, some useful components can be salvaged and recycled, and any harmful materials can be processed properly so they don't pollute the environment.

Smaller items can be fairly easily disposed of through kerbside collections, in-store at electrical retailers or via recycling banks, but getting rid of large items can be more difficult.

Item Still Working
Others may benefit so consider the following.

• British Heart Foundation collects TVs, music equipment and washing machines for free to sell in their chops.
• Find a local organisation that is part of the Reuse Network (reuse-network.org.ukdonate-items). Some only collect small appliances but others collect white goods free of charge to be resold through a charity shop or donated to a low income family.

Local Councils
Most councils will pick up large appliances (e.g. washing machines, fridges) from outside your house as part of their 'bulky waste' collection service. There is usually a fee to pay, which varies from council to council. However, you may be charged less if you receive certain types of state benefit, so check before you pay. (to check for your local services use uk.gov/collection-large-waste-items).

Pay for Pick Up
Depending where you live, it may be more convenient to use ao.com's Collect & Recycle service. For £20 (2020 price) you can choose a pick-up day. A text reply before 8am on the day will advise you of your allocated three hour pick up slot. You can choose pick up outside the house if you won't be in, or inside the house to save you carrying out, in which case make sure item is disconnected from mains, gas or electric supply and that freezers are defrosted and dry inside. The services covers cookers, fridges, freezers, washing machines, tumble dryers, dishwashers and TVs and you don't need to have bought a new product from ao.com to use it.

Many other retailers will collect your old appliance when delivering a replacement. Fees vary from company to company.

Source: Good Housekeeping, March 2020.

The Yamnaya and the Rise of Violence in early Europe

Colin Barras examines how Neolithic Europe suffered a devastating conquest.

The sarsen stones of Stonehenge were erected some 4500 years ago but within a few centuries those who built it vanished, with almost every Briton from the entire country wiped out by incomers. DNA evidence is now informing what we know about these migrants.

A group of livestock herders called the Yamnaya occupied the Eurasian steppe north of the Black Sea and the Caucasus mountains. Between 5000 and 4000 years ago, they and their descendants colonised large areas of Europe, leaving a genetic legacy that persists to this day. Studies of archaeological finds shows that their arrival coincided with big changes in social and cultural behaviour, such as burial practices, and alongside this there appeared a warrior class and a sharp upturn in lethal violence.

Before about 5000 years ago, Neolithic Europe was prosperous, community-minded and relatively peaceful, occupied by farmers who worked together and built large stone structures, many of which were used as shared graves, with up to 200 burials. They were innovators, who it is thought had worked out how to use livestock to pull heavy loads, and may have had wheeled vehicles.

Staring about 5000 years ago in south-east Europe the dead started to be buried singly in 'pit graves', with the body decorated with ochre, a red pigment and the grave covered with wooden beams and a mound of earth, known as a kurgan. This burial custom was associated particularly with the Yamnaya. By 4900 years ago, the Corded Wear people (named after their distinctive pottery and adopting many other Yamnaya practices) began to appear in central and northern Europe.

Until about five years ago, the generally accepted theory was that this happened through the movement of ideas and technology while people stayed were they were. In 2015 geneticists suggested an alternative. It was discovered that occupants of Corded Wear graves in Germany could trace back about three quarters of their ancestry to the Yamnaya. They were not copying Yamnaya practices, they were largely Yamnaya in origin. This migration happened in just a few generations, and it is likely that this happened through a combination of disease, warfare and death.

Just before the Yamnaya arrived, Neolithic Europe was in crisis. Populations began shrinking about 5300 years ago. Studies of Neolithic teeth indicate plague-causing bacteria began spreading across Europe perhaps as early as 5700 years ago. When the settlements reached their greatest size, thousands of people lived in unhygienic conditions and in close contact with livestock.

The Yamnaya found a small and weakened indigenous population. Even so, the sheer speed of the change suggests that the migrants were dynamic and aggressive, perhaps mainly young male warriors as Yamnaya women seem to have joined the migration later. It is thought the incomers were horse-riders, and ancient DNA suggests they were unusually tall for the time. The males from outside displaced local males almost completely to the extent that only they fathered children. The latest genetic evidence reveals that they also went east into the Indian subcontinent.

Source: History of Violence by Colin Barras, New Scientist 30 March 2019

[I have elsewhere read about the behaviour of primates in Africa. Bonobos are generally peaceful and deal with disagreements by consensual sexual acts, while chimps carry out violent raids; the two species live in distinct forest areas and do not come into contact. Given human primate descent, it might be that a similar evolution happened, but the open land area of Europe allowed the Yamnaya to take over.]

Diabetes

 Diabetes is a condition where not enough insulin is made. This means that blood sugar levels can go up and down, with various effects on the body.

Risks if you have diabetes, or have it but not been diagnosed.

• You are twice as likely to have a heart attack or stroke than someone without diabetes.
• High levels of glucose damage the eyes, kidneys and nerves.
• Women with breast cancer and diabetes are more likely to have problems with tiredness, sleep disturbance and sexual problems compared to those who don't.

There are two types of diabetes.

Type 1 is an auto-immune  disease. Your immune system attacks your pancreas, and stops it producing insulin. It has nothing to do with weight or lifestyle, and you will need insulin administered from day 1.

A small minority of people have rarer forms of diabetes, including maturity onset diabetes of the young (MODY) and latent autoimmune diabetes in adults (LADA).

It can't be cured, but meticulous monitoring and insulin treatment can greatly reduce the risk of complications.

Type 1 - Monogenetic diabetes. People with this condition produce some insulin, but less than healthy people. They often present with similar problems as those with type 1 diabetes, such as constant thirst and subsequent need to urinate, blurred vision and weight loss, which is why the two conditions are often confused. But since they produce some small amounts of insulin, it could be possible to control their condition with 'dietary tweaks' or daily tablets that stimulate the body to produce more insulin. (Type 1 patients can't take these tablets as they are unable to produce insulin.) 

Until now doctors have struggled to diagnose this condition, but  now increased training and testing is finding more patients. If patients constantly struggle with varying blood sugar levels, it might be due to monogenic diabetes rather than simple type 1.

Monogenic diabetes is caused by a genetic fault that leads to the pancreas producing less insulin. There are numerous sub-types of this condition, linked to problems with different genes and it tends to run in families. The usual HbA1c blood test only shows that someone has the diabetes, not which type. If a parent is diagnosed with type 1 diabetes, it may be worth testing parent and child(ren) for monogenic diabetes.

Type 2 is almost all about lifestyle. It is mostly about your body's ability to process insulin.

Risk of developing diabetes. Obesity is the biggest risk factor, accounting for 80 to 85% of the risk of developing diabetes. Those of South Asian or Afro-Caribbean origin also have an increased risk. Some women  develop diabetes during pregnancy; while their blood glucose usually settles after delivery, they remain at higher risk of developing diabetes type 2 in later life.

Until a few years ago it was considered a chronic, progressive disease. Then a 2016 study demonstrated that after eight weeks on a very low calorie diet (VLCD) people lost substantial amounts of weight, and if this was maintained for at least six months, more than two in five had glucose levels in the normal range. It is thought that the weight loss removed excess fat from the pancreas, allowing if to produce insulin more efficiently, thus controlling blood glucose effectively. This needs to be overseen in a medical setting, but while Type 2 diabetes cannot be cured, it now seems possible to stay in remission. NHS England has agreed to start providing access to VLCDs on the NHS.

The basis for the low carb diet is the increased understanding that starchy carbs (e.g. bread, potatoes or breakfast cereals) digest down to a surprisingly large amount of sugar.

Not everyone can achieve remission with diet but there are signs that another treatment can help. The surgical procedure Revita (endoscopic duodenal mucosal resurfacing) has been shown to be beneficial but is not currently available on the NHS. 

Sources: Feature Diabetes: the other health crisis by Dr Sarah Jarvis, in Good Housekeeping, July 2020 and article in Daily Mail by Ethan Ennals on 6th Nov. 2021.

Covid-19 Infection and Transmission in Children

 In the early days of Covid-19 it was thought that children might be more susceptible to catching the virus and more likely to spread it, as is the case with flu. However, the evidence from many countries is that it appears that this is not the case.

• Children have a very low risk of becoming ill if they catch Covid-19.
• A study of 55,000+ patients found that just 0.8% were under the age of 19.
• At 31 July 2020, those admitted to critical care units in England, Wale and Northern Ireland were 60 or older. More than three-quarters (75%) were over 50, and fewer than 10% were younger than 40.
• Children often have a 'milder disease than adults'. Although cases of an inflammatory syndrome have been reported, this is extremely rare.
• August 2020. There is some evidence that infected children present with gastric symptoms such as diarrhoea, vomiting and abdominal cramps. A US study of 992 children revealed 68 had virus antibodies. Of the 68, around a third (21) had fever, and nearly a quarter (13) had gastric symptoms. 

This finding is replicated across the globe.

• China: none of the infections in family groups were likely to have been introduced by children.
• French Alps: children testing positive did not pass it on to anyone of the more than 100 people they had had contact with.
• Community studies in Iceland, South Korea, Italy (which tested 70% of its population) and the Netherlands all found evidence that children were less likely to have (or have had) the virus than adults.

One theory is that as children are still developing physically, their lungs have fewer ACE2 receptors (which the virus uses to infect people) than adults.

On the issue of school opening, it is thought that any spread is more likely among the staff and among parents at the school gate.

Source. Article in New Scientist, July 2020 plus other later news items.

Keep Make-up Brushes Clean

Make-up brushes should be cleaned regularly to avoid giving you blemishes.

Wash brushes in warm, soapy water into which you mix a little coconut oil. It will help break down make-up residue to keep them clean, and ensure the bristles stay soft.

Source: Sunayah Arshad in Good Housekeeping, May 2019

The Health Difference Between Women and Men

Health outcomes are very different between the sexes. It has been known for some time that women generally outlive men, and are less susceptible to some illnesses and more susceptible to others. 

(This article concentrates on the typical XX (female) and XY (male), and ignores the sex chromosome abnormalities of loss, damage or addition of one or both sex chromosomes, which cause a number of developmental syndromes.)

In humans, sex is largely determined by chromosomes that carry tightly coiled DNA that carry our genes. The cells of most women possess two X chromosomes, while most men have one X and one Y chromosome. For women, one of the X chromosomes is mainly switched off, and the one that remains active seems to be chosen at random during the first few weeks of pregnancy. So half of a woman's cells generally use the X chromosome inherited from her mother, and the other half the one from her father. If one X has a harmful mutation, cells that use the other X can compensate. This explains why it is rare for women to be colour-blind, while around 8% of men cannot see a difference between red and green, and some are totally colour-blind. Almost all women can see 1m colours, but 5-15% of women have a visual superpower and are able to see 100m colours.

(Men are genetically programmed to have greater muscle power, lift heavier weights and run faster. More female embryos are lost during the early stages of pregnancy but are more likely to survive birth and onwards; more males die at and soon after birth.)

The two X populations cooperate and share not just genetic material with one another but also proteins and enzymes, which give an extra ability to handle disease. Even in tissues where the ratio of the Xs is 50:50, that can change. With a skin injury, one population of X cells might take over the healing process, but the ratio will drop back to 50:50 once healing is complete. If the heart cells carrying paternal X survive the lack of oxygen, it will be that population that survives; that benefit can occur in other organs such as the liver and kidneys.

The X chromosome is rich in immune-related genes. This means that women's bodies can cell population shift to the more effective X for an illness. One important group of genes on X helps cells recognise single-stranded RNA viruses,such as the coronavirus. Woman therefore have twice the options of recognising such a virus. The gene for the ACE2 protein is also on the X.

A further advantage for women is that the male hormone testosterone supresses the immune system, while the female hormone oestrogen makes it more aggressive. Although after the menopause, oestrogen levels decline, female cells still tend to be more critical and powerful in defending against a possible attack.

The downside to XX is that women have higher rates of autoimmune conditions. Female hormones (oestrogens) stimulate the immune system, while male testosterone inhibits it, but even before puberty, autoimmunity is still higher in females. 

In both sexes, in the fetus, the thyroid gland immune cells go through an "educational process"; if immune cells recognise other cells from the person's body, the immune cells self-destruct. This happens so that once the baby is born, autoimmunity does not happen. This works well in males, but in females, who have two genetically different cell populations, it is more likely that not all self-recognising cells are destroyed.

On the other hand, having a somewhat autoreactive immune system means XX can more easily detect microbes that resemble human cells. It may also explain why XX have a lower chance of certain cancers; women may be clearing pre-malignant cells before they are detectable medically. This pattern seems to hold true even with cancers that start before puberty, although higher rates of smoking and drinking in males does have an effect.

This sex difference is increasingly recognised but public and health professionals alike are accustomed to attributing the differences to behavioural issues. And it is difficult to understand the difference between biological strength and physical strength, and that a five-foot-three woman has a survival advantage over a six-foot male Olympic weight-lifter. There are also implications for treatments as women (i.e. XX) have different sensitivity to medications.

Moalem believes that having two versions of X explains why women are less vulnerable to certain congenital disorders and better at fighting off infections, including the coronavirus.

• Supercentenarians (over 110) are 95% female.
• More girls than boys reach their first birthday.
• Girls who have asphixia at birth do better cognitively than boys.
• In general, drugs are metabolised slower by XX, and gut transit time is slower, so XX have to wait longer after eating to have an empty stomach.
• Melanoma kills twice as many young men as women, because XX benefit from stronger immune response and female sex hormones, while XY are not necessarily using less sun screen or not going to their doctor. 

Source: The stronger sex by Sharon Moalem, in New Scientist, 1 August 2020.
Source: Feature in Good Housekeeping, August 2020.

British Postcodes

Mail Obsession: a journey round Britain by postcode by Mark Mason. A history of the British postcode system and some facts about each of the postcode districts.

The first attempt at using postcodes was a scheme for London set up by Sir Rowland Hill in 1857. He split the capital into N, NE, E, SE, S, SW, W and NW plus EC (East Central) and WC (West Central). Later Anthony Trollope merged NE with E, and splitting S between SW and SE, leaving just eight codes. The 1930s saw postcodes introduced in larger towns and cities but the current system was introduced starting with Croydon.

There are 124 UK postcode areas, including the Crown Dependencies of Jersey, Guernsey and the Isle of Man. Postcode areas, towns and districts do not follow political boundaries and usually serve larger areas than the place names indicate.

The postcode area is the largest geographical unit and forms the initial one or two characters of the alphanumeric code, which are generally intended as a mnemonic, e.g. AB for Aberdeen. Areas are divided into districts with a number, with number 1 always used for the main sorting office. As a general rule, large post towns are are numbered from the centre out, with outlying districts having higher numbers. The area and district is followed by a space. Then there is a number to indicate sectors within districts, e.g. AB10 1. The following two letters identify streets or sides of a street, e.g. AB10 1FQ which is the postcode for Aberdeen Art Gallery in Schoolhill.

Area: SP = Salisbury Plain. Districts: SP1 (main sorting office), SP2, SP3, SP4 and SP5 are used for Salisbury. SP6 = Fordingbridge # SP7 = Shaftesbury # SP8 = Gillingham # SP9 = Tidworth # SP10 and SP11 = Andover.

Zeroes are high rather than low, so only used after numbers 1 to 9 have been used. The final two letters in a postcode are never CIKMOV.

Did you know?

• Some postcodes cross national boundaries. 
• People can't get new build house insurance cover until a postcode is allocated.
• SE2 residents of Bexley Heath get charged London levels of insurance premiums.
• Because Kirkwall (KW) includes Orkney, mainland residents of this postcode end up paying higher delivery charges which are applied to the all KW addresses.

Only four non-London areas have single letter codes: S is Sheffield, B is Birmingham, G is Glasgow, L is Liverpool and M is Manchester.

The full list of postcodes areas.
AB = Aberdeen # AL = St Albans # B = Birmingham # BA = Bath # BB = Blackburn # BD = Bradford # BH = Bournemouth # BL = Bolton # BN = Brighton # BR = Bromley # BS = Bristol # BT = Belfast # CA = Carlisle # CB = Cambridge # CF = Cardiff # CH = Chester # CM = Chelmsford # CO = Colchester # CR = Croydon # CT = Canterbury # CV = Coventry # CW = Crewe # DA = Dartford # DD = Dundee # DE = Derby # DG = Dumfries and Galloway # DH = Durham # DL = Darlington # DN = Doncaster # DT = Dorchester # DY = Dudley # E = London East # EC = London East Central # EH = Edinburgh # EN = Enfield # EX = Exeter # FK = Falkirk # FY = Blackpool / Fylde (Bolton already using BL) # G = Glasgow # GL = Gloucester # GU = Guildford # GY = Guernsey # HA = Harrow # HD = Huddersfield # HG = Harrogate # HP = Hemel Hempstead # HR = Hereford # HS = Outer Hebrides # HU = Hull # HX = Halifax # IG = Ilford # IM = Isle of Man # IP = Ipswich # IV = Inverness # JE = Jersey # KA = Kilmarnock (Kilmarnock and Ayr?) # KT = Kingston-upon-Thames # KW = Kirkwall # KY = Kirkcaldy #  L = Liverpool # LA = Lancaster # LD = Llandrindod Wells # LE = Leicester # LL = Llandudno # LN = Lincoln # LS = Leeds # LU = Luton # M = Manchester #  ME Rochester (Medway towns) #  MK = Milton Keynes # ML = Motherwell # N = London North # NE = Newcastle # NG = Nottingham # NN = Northampton # NP = Newport # NR = Norwich # NW = London North West # OL = Oldham # OX = Oxford # PA = Paisley # PE = Peterborough # PH = Perth # PL = Plymouth # PO = Portsmouth # PR = Preston # RG = Reading # RH = Redhill # RM = Romford # S = Sheffield # SA = Swansea # SE = London South East # SG = Stevenage # SK = Stockport # SL = Slough # SN = Swindon # SO = Southampton # SP = Salisbury Plain # SR = Sunderland # SS = Southend-on-Sea # ST = Stoke-on-Trent # SU = Sutton (Sutton and Morden?) # SW = London South West # SY = Shrewsbury # TA = Taunton # TD = Galashiels # TF = Telford # TN = Tonbridge # TQ = Torquay # TR = Truro # TS = Cleveland # TW = Twickenham # UB = Southall (Uxbridge) # W = London West # WA = Warrington # WC = London West Central # WD = Watford # WF = Wakefield # WN = Wigan # WR = Worcester # WS = Walsall # WV = Wolverhampton # YO = York # ZE = Lerwick (Zetland) #

Also
BF = British Forces  #  XX = used by online retailers for returns by Royal Mail.

The British Postal Museum and Archive is at 15-20 Phoenix Place, London, WC1X 0DA.

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