Covid-19 What the UK Got Wrong

Lockdown and border closures
(BBC News Was the scientific evidence for lockdown flawed? 19 Nov. 2020.)

23 Jan. 2020: A woman unknowingly infected with Covid-19 flew to the UK from Wuhan and passed through the airport undetected. Eight days later she and a family member became the first confirmed UK cases, followed by many others who spread the virus in February and March when returning from China and from holidays in Italy, France and Spain. It is now thought that there were 1,500 UK cases during that period, so the UK was hit hard. Closing borders earlier could have reduced UK infections.

Modellers used information about the early cases held in the First Few Hundred (FF100) database to assess how the virus might spread, but FF100 was missing basic epidemiological information. Data was needed not only on where the virus was coming from, but also on who was worst affected.

 Mid-February. Evidence from China showed older people were especially at risk, so modellers advised that 'cocooning' would reduce deaths. Unfortunately models did not reflect how care homes actually work, or the serious risk from agency staff working in multiple homes.

Early March. Due to lack of accurate date, plans were still based on a fairly slow growing pandemic with a peak of cases in 12 to 14 weeks. One scientist thought official figures (913 cases) were wrong and called for an immediate lockdown; experts now estimate there were 75,000. Investigation focused on cases in intensive care units, as there be very many more who had a mild symptoms. The prediction was for c.100,000 new cases each day by mid-March, followed about a week later by 20,000 people each day needing hospital treatment. It was also realized that the NHS data  was out of date, in many cases up to a week old.

17 March. First restriction imposed - stopping non-essential contact with others, unnecessary travel, working from home and avoiding pubs, clubs, theatres and other social venues. It was thought that without this cases could double every five or six days. Data from Italy indicated that the virus was spreading at nearly twice the speed that had been thought - with the NHS potentially just days away from being swamped.

So should we have acted earlier? Modelling now suggests that if lockdown had been imposed a week earlier, we may have avoided around half the number of deaths. Relying only on modelling and using that alone to drive the response it turns out was not the right thing to do.

Test and Trace
(BBC News Coronavirus: inside test-and-trace - how the 'world-beater' went wrong. 20 Nov. 2020)

Just half of close contacts reported to England's Test and Trace are being reached in some areas. As attempts continue to get it back on track, it is still struggling with the legacy of decisions made at the outset.

NHS Test and Trace is not one whole service nor is it part of the NHS. It is a complex web of several programmes that have been bolted together quickly. Private firms play a key role, so some of the local expertise available in the NHS, universities and councils has been bypassed.

Private contractors overpromised what they could do (e.g. saying they could build 200 testing machines when they did not even have a prototype).

17 March. No-one from NHS labs was at a key government meeting with private firms (e.g. health-technology firms Randox and ThermoFisher) where it was decided to set up large, centralised labs outside any existing healthcare or research structures. This network of six mega-labs (Lighthouse labs) process the bulk of the tests across the UK. Testing sites were set up by financial and tech services company Deloitte. The contact centre is run by Sitel, and the 18,000 contact tracers are mostly employed by outsourcing company Serco - but does include c. 3,000 clinicians, some from the NHS. (This applies to England only, the rest of the UK has their own arrangements.) Contracts were awarded very quickly and many had no penalty clauses for poor performance.

Nov. 2020. England now has a large testing capacity, which can process more than 500,000 virus tests a day (up from 2,000 per day). But the system still struggles to get results quickly, since many samples were sent long distances for processing. If the approach had remained local by using existing networks of hospital, university and Public Health England, turn around would be much quicker.

Other companies were selling testing machines to NHS labs which did testing for hospitals - but the kits and chemicals needed for those machines were in short supply and being bought by the privately-owned Lighthouse labs.

The later move to more local contact tracing by councils was undermined by IT problems, leading to a reliance on spreadsheets and delays getting contact details.

Testing Targets

The government focused on hitting very high testing targets, but less so on who should get tests and why. People working in hospitals were not screened unless they had symptoms, despite evidence showing significant transmission there. However despite being 'effectively discouraged' to do so, some labs set up regular screening for healthcare staff. (E.g. The Univ. of Cambridge research lab partnered with nearby Addenbrooke's to offer this, and by the end of June had screened more than 10,000 hospital staff to detect asymptomatic carriers.)

Sept. 2020. Just as the second wave was starting, tests became near-impossible to access, due to people returning from holidays and children going back to school. The Lighthouse labs struggled as they were unable to forecast the sample numbers which varied wildly from day to day - so having enough staff to process 10,000 samples and only receiving 2,000 or having more than expected. As those involved in setting up the labs didn't always have experience with viruses, procedures needed constant tweaking, and there were issues with recruitment and training.

Tracing

Of the c. 18,000 contact tracers hired, only about 3,000 had a clinical background. While those who get the best results are good communicators, tracers were told to follow heavily scripted cues. With no room for discretion, call handlers had to try to make individual calls to every member of a household and go through the same forms. Unfortunately contact tracers often get abuse because of this. The government now says the system will be changed.

Performance is not at the right level. Advisors say 80% of those who test positive should be reached and close contact details obtained, and 80% of those contacts should be reached and asked to isolate. In some areas only half of contacts are reached. A change to greater local involvement was announced in August but funding was only announced in late October. 

And local schemes still face problems due to the centralised system. Delays getting cases passed down from the national team. Cases passed on are missing key contact information or are duplicates of cases already traced. Lack of access to NHS Test and Trace central IT system means councils are forced to record the information they collect on spreadsheets. Councils are only allowed to trace the infected case, so cannot deal with family members, even if they are on the door-step.

While money was allocated to find individuals, there was little thought on how to support people asked to isolate. The number isolating after a positive test or as a close contact is not routinely measured. Some have argued that the isolation period is too long - some other countries only require 7 days. Financial support for those isolating is limited to statutory sick pay; a one-off £500 payment for those on benefits is not available if you've been told to isolate via the app. The consequence is that people are less cooperative. 

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NHS Facts and Claims During Elections

During campaigning for elections, politicians make claims about their performance, the opposition performance and how they will make things better. So here are a few from recent elections from Boris Johnson and Jeremy Corbyn.

BJ: Claim: We'll get 40 new hospitals. False: Tory plans for £2.7 billion for 6 hospitals over 5 years, plus £100 million for 34 hospitals to start developing plans.

JC: Claim: Cancer treatment times have risen. Correct: First treatment within 62 days of GP referral is down from 86% in 2010 to 79% now.

BJ: Claim: Cancer survival rates have increased since 2010. Correct but not due to Tories. Surviving one year after diagnosis improved from 2010 (70%) to 2016 (73%). The same increase of 3% happened between 2004 and 2010.

JC: Claim: NHS has had the largest squeeze in its history (i.e. since 1949). Correct: The NHS budget has never fallen under any government, with an average rise of 3.6% p.a. But between 2010 and 2018 it rose just 1.3% on average. In 2018 announced an annual increase over the next five years of 3.4%.

BJ: Claim: There are 17,000 more NHS doctors and nurses than in 2010. Correct.

JC: Claim: There are currently 43,000 nursing vacancies. The UK needs around 60,000 more nurses to cope with an increasingly aged population. Correct.

BJ: Claim: Missed NHS targets in Wales (Labour led government.) Correct. (JC stated that the problems in Wales stem from Conservative cuts to the Welsh budget, and in real terms spending won't return to 2010 levels until around 2023.)
JC: Claim: Missed NHS targets in England (Conservative led government.) Correct.
Both parties cherry picked which figures to publicise. The target of 95% of arrivals in A&E being seen within four hours has not been met in England since 2015, and in Wales since 2008.

Tory Pledge: Train 500 more GPs per year. (Their previous pledge was to recruit an extra 5,000! In fact there was an increase of just 272 between 2015 and 2018. and the 2019 pledge of 500 was not met in 2020.)

JC: Claim: Regarding Brexit and trade deals - fears over a Trump deal wanting access to the NHS.
BJ: Claim: Said the NHS would be protected. (My note: Why should we believe someone who has lied in the past?)

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Six Types of Covid-19

Symptoms of  Covid-19 vary enormously. Initially thought to be simply a respiratory disease, it is now known to be able to affect all body systems, and age, gender, ethnic background and existing medical conditions will all affect how an individual is affected. A team from the Covid Symptom Study have now split the disease into six types.

Symptoms tend to appear between two and 14 days after infection.

1. Flu-like symptoms but no fever. Headache, loss of smell, cough, sore throat and aches and pains, but no fever. Around 1.5% of this group go on to require breathing support in hospital.

2. Flu-like symptoms with fever. Similar to group 1, plus a loss of appetite and fever.

3. Gastrointestinal. Diarrhoea alongside loss of smell and appetite, headache, sore throat and chest pain. Typically, no cough.

4. Fatigue. This cluster is considered more severe than the previous three, as 8.6% require breathing support. Fatigue accompanies headache, loss of smell, cough, chest pain and fever.

5. Confusion. Another severe category. People experience confusion in addition to symptoms listed in cluster 4. Around 10% will require breathing support.

6. Abdominal and respiratory. The most severe cluster, since almost half will require hospitalisation, and around a fifth will need breathing support. Symptoms include headache, fever, loss of smell and appetite, cough, sore throat and chest pain, along with shortness of breath, diarrhoea and abdominal pain, muscle pain, confusion and fatigue.

Some people contract Covid-19 but either show no symptoms, or very mild symptoms that cause no real problems. 

Children and Teens

Children seem to be affected differently to adults. A study at Queen's University Belfast suggests that the most predictive symptom is diarrhoea and vomiting, along with other of the possible symptoms. The current UK testing strategy would have missed 24% of symptomatic children, but including diarrhoea and vomiting would mean that 97% would have been detected.

The virus binds to ACE2 receptors. It is thought that children may express fewer of these receptors in the nose and throat.

Teenagers are more likely to report loss of taste and smell. Research currently suggests that symptoms for teenagers are closer to adult symptoms, though mostly are mild.

Source: Article Covid-19 symptoms rethink in New Scientist, 10 Oct. 2020. 

Vaccine Update

Several vaccines have been developed and have been undergoing trials for safety and effectiveness in order that they can be licensed. Here is the latest information and I will continue to update this post.

Vaccines are usually cultured in animal cells (e.g. chicken eggs for flu vaccines). Work is ongoing to develop plant based methods.

Vaccine timings. All currently (Feb. 2021) approved Covid-19 vaccines require two doses. In trials these were 3 weeks apart. Early Jan. 2021. As immunity develops over time, the UK extended the time between first and 'booster' doses to 12 weeks. 13 Feb. 2021. France has decided to give only one 'booster' dose of vaccine to anyone who has had the virus, and therefore already has some antibodies.

I can't have a vaccine, as my immune system doesn't function as it should due to an immune deficiency or because taking immune-suppressing drugs for another illness (e.g. cancer). A possible alternative to a vaccine is entering final stage trials, with first results expected in spring 2021. Developed by AstraZeneca, this uses Covid-19 antibodies from a single Covid patient in the US. The hope is that it will provide protection for at least six months, and possibly a year. However, the therapy is significantly more expensive than vaccination and difficult to produce at scale, so unlikely to be used for the wider population. AstraZeneca has also suggested it could possibly be used in care home settings to protect residents if a case is identified. While vaccines take time to build immunity, this should work immediately, so could be used as a preventative measure.

I have severe allergic reactions and carry an Epipen. People with known severe allergic reactions can react to any vaccine (including flu vaccinations) and are advised not to have a Covid-19 vaccine. If they do suffer a reaction they are treated with drugs such as steroids or adrenaline.

Common misconceptions about vaccine testing. Because of the speed with which vaccines were developed, some people are concerned that not enough testing was carried out. This is not the case. All normal testing was carried out as it would have been in non-pandemic times. However, researchers were able to move from one phase to the next without having to spend months or years to get funding for the next stage trials. However, rare side effects (of any vaccines or other drug treatments) are not always encountered in trials and are only reported when being used for prevention or treatment in many times larger numbers.

Side effects

• Many vaccinations do cause minor side effects, which usually quickly go away on their own. Typically there is often some soreness at the vaccination site. The most common other side effects are mild fever, chills, feeling tired and joint and muscle aches. 
• Women may sometimes experience a delayed period. This reverts to normal after one affected cycle. This side effect is not confined to Covid-19 vaccines, and can happen with other vaccines (such as flu vaccines) as well.

Serious side effects are rare

• Serious side effects are extremely rare, affecting 1 or 2 people in 1 million.
• Although vaccines are tested in large scale trials before being approved for general use, it is possible for rare side effects to only emerge once much larger numbers of people receive a vaccination. 
• As some instances are extremely rare occurrences not related to a vaccine, researchers will check to see if there is a link, and if there is, what is causing it. 
• They will compare the reported cases with the normal incidence in a population. For example, blood clots. While it now appears there may be 1 in 250,000 people who suffer this with the Astra Zeneca vaccine, far more will get this from other causes: 1 in 2,000 women develop blood clots from taking the combined oral contraceptive pill, and 1 in 1,000 people from air travel. 
• The possible Astra-Zeneca blood cases review did not compare the number of vaccinated people with this syndrome with the rate in unvaccinated people. Two of the reported cases had pre-existing blood clotting disorders, while for the other cases it was not stated whether they had recently had a Covid-19 infection, which itself can cause increased blood clots.
• Most of the cases occurred in women under 55, a group that already has a higher rate of blood clots because the contraceptive pill raises the risk of them.
• Being infected with Covid-19 also carries far more risks of blood clots developing. Thus 7.8% of cases develop pulmonary embolism, 11.2% deep vein thrombosis, 1.6% strokes and c. 30% thrombocytopenia. If admitted to Intensive Care Units, c. 23% of cases have venous thrombolism.

Vaccines approved for use in UK: Oxford Univ./AstraZeneca # Pfizer/BionTech # Moderna #

Oxford.Univ and Astra Zeneca (approved 30 Dec. 2020) UK has ordered 100 million doses. Vaccinations begun 4 Jan. 2021.

• Type: Uses a harmless virus that infects chimpanzees.
• Doses: Two doses a month apart. (Overall protection from both dosage trials is 70%).
• Protection (1): Full dose followed by full dose. Trial data indicates 62% of trial participants appear to be protected. Analysis also suggests a reduction in numbers being infected without showing symptoms.
• Protection (2): Half dose followed by full dose. Two weeks after the second dose, more than 90% of trial participants appear to be protected. 
• Protection (3): Why is the low dose better? (A) The immune system may reject the vaccine, which is built around a common cold virus, if it is given in too big a dose. (B) A low shot then a high shot may be a better mimic of a coronavirus infection and lead to a better immune response.
• UK and Overseas Trial: Phase 2 showed a strong immune result in adults in their 60s and 70s, based on 560 adult volunteers. Phase 3 in progress. No-one getting the vaccine developed severe Covid-19 or needed hospital treatment.
• US Trial: More than 32,000 volunteers, mostly in America, but also in Chile and Peru. The vaccine was 79% effective at stopping symptomatic Covid disease and 100% effective at preventing people from falling seriously ill. There were no safety issues regarding blood clots. The vaccine provided volunteers over 65 as much protection as younger age groups. Trial report March 2021.
• Side Effects: Apart from minor side effects (soreness at injection site, and mild headaches, fever and aches that clear up quickly) none were reported in trials. Early April 2021: a small number of cases of rare blood clots and low platelet levels were reported. There were 79 cases and 19 deaths among more than 20 million vaccinations in the UK. This equates to 1 case per 250,000 people (0.004%) and 1 death per million. The EU investigated 62 cases of cerebral venous thrombosis and 24 cases of sphlanchnic vein thrombosis, of which 18 were fatal from around 25 million vaccinations in the EU and UK. It is thought that a condition similar to heparin induced throbocytopenia occurs. Both UK and EU regulators deemed the vaccine safe to continue using but recommended that where possible people under 30 should be offered a different vaccine. 
• Notes (1): Can be stored at fridge temperature, unlike the Pfizer and Moderna vaccines, enabling it to be distributed world wide. 
• Notes (2): The Oxford technology is more established, so the vaccine is easier to mass produce cheaply. Costs around £3 per shot, less than Pfizer (around £15) or Moderna (£25) vaccines.
• Notes (3): A batch of trial vaccine was more concentrated. To avoid wastage, and with regulator approval, volunteers were given smaller amounts for their first dose and a full second dose. Results indicate that this gave better protection. 

24 Jan. 2021: Oxford University potential new vaccine (RBD-SpyVLP). Early animal studies show it could be effective in lower doses, making it easier to make in large quantities and be used in conjunction with other vaccines. This type of vaccine is not a competitor for the first wave of vaccines, it is hoped that it could be a standalone vaccine or a booster for those with a different Covid vaccine. Tests also show it is highly resilient, stable at room temperature and can be freeze dried without damage. These properties mean it would reduce dependence on cold chain transport and storage and help with global distribution. (Source The I newspaper 24/01/2021).

Pfizer and BioNTech: Licenced for use in UK early Dec. 2020. First order of 10 million doses started to arrive in early December; a further 30 million doses already ordered. 

• First vaccinations: 8th Dec. 2020. Over 80 age group and hospital and health care workers.
• Contraindications: Anyone with a history of severe allergic reactions. Reactions like this are uncommon but not unknown with various vaccines, including flu vaccines.
• Type: RNA - virus genetic code (uses part of the Covid-19 genetic code)
• Doses: Two doses, three weeks apart.
• Protection: Trial data (based on the first 170 volunteers to develop symptoms) indicates that 95% protection is achieved seven days after the second dose. There is also emerging evidence that it protects against severe Covid, but this is based on only 10 cases.
• Trial: 42% of all participants are from diverse ethnic backgrounds and 41% are aged between 56 and 85 years old.
• Side effects: Myocarditis (heart inflammation) can occur after infection with Covid-19 (typically within three months of catching it), with males 12-17 most likely to do so; rate of this complication is c.450 cases per million infections. Myocarditis following a second dose of Pfizer vaccine is much less common with just 67 cases per million. Mild cases are usually treated with anti-inflammatory drugs such as ibuprofen, with most people recovering within a few months. 
• Notes: There are massive manufacturing and logistical challenges as the vaccine has to be kept in ultra-cold storage at below minus 80C.

Moderna: Licenced for use in UK 8th Jan. 2021. Each person needs two doses. Not one of the six the UK initially ordered; 17m now on order, should be available spring 2021. 

• Type: RNA - virus genetic code
• Doses: Two doses, four weeks apart.
• Protection: Trial data (based on the first 95 to develop symptoms) indicates 94.5% is achieved after the second dose, appears to be effective in older age groups.
• Notes: The vaccine remains stable at minus 20C for up to six months and can be stored in a standard fridge for up to one month.

Novovax: The UK has secured 60m doses, which will be made in Stockton-on-Tees in NE England. If approved, supplies are expected to be available in the second half of 2020.

• Type: Uses recombinant nanoparticle technology to grow harmless copies of the virus spike protein, teaching the body's immune system to recognise and fight the pandemic virus.
• Doses: Two doses three weeks apart.
• Protection: Trial data indicates 89.3% effective in large-scale UK trials, and that it is effective against the faster-spreading variant present in the UK, and the South African variant.
• Notes: 

Russia Sputnik V: Registered for emergency use in August 2020, although had only been tested on a few dozen people. December 2020: doctors, teachers and social workers are being offered Sputnik V in a mass inoculation campaign ordered by President Putin. Still in trial, so some Russians are wary of receiving it yet.

• Type: Uses a harmless virus that infects chimpanzees. Comprises two entirely different injections, using different 'vectors' or carriers each time. This puts extra pressure on producers as the first component is the most stable but the second needs strict temperature controls.
• Trials: Still in midst of safety and effectiveness trials.
• Data: Reported to be 92% effective.
• Notes: Must be stored at -18 C at least in its liquid form. A planned powder version is not yet being made in large amounts.

China CoronaVac: Produced by biopharmaceutical company Sinovac. Although already in use and being shipped to some Asian countries, it has yet to finish late-stage trials.

• Type: An inactivated vaccine, using killed viral particles to expose the immune system to the virus without risking serious disease response. It is a more traditional method that is used in many vaccines like rabies.
• Doses: Two are required.
• Trials: Stage 1 and 2 trials completed, stage 3 still in progress. Jan. 2021: trials in Brazil found it only 50.4% effective.
• Notes: Can be stored in a standard refrigerator at 2-8 C. Therefore like the Oxford-AstraZeneca vaccine is more useful to developing countries where ultra low temperature storage is an issue.

In development

• Canadian company Medicago has produced a Covid-19 vaccine. (Jan. 2021. No details on this.)
• Janssen (trial volunteers being recruited). Type: Uses a modified common cold virus.Trial: 6,000 volunteers to be recruited in the UK, as part of 30,000 worldwide to assess whether two doses are more effective.
• Codagenix, US: Single does nasal spray using a modified synthesised version of the virus to provoke an immune response. Feb. 2021: in Phase 1 trials.
• Valneva, France: Whole inactivated virus two-shot vaccine. This type of vaccine can be given to vulnerable populations at risk of allergic reactions. Feb.2021: in Phase 1 and 2 trials, with plans for testing on children.
• Inovio, US: Synthesised DNA version of Covid-19 spike inserted into DNA plasmids. Two-shot vaccine blasted into skin using re-usable 'gun'. DNA Vaccines don't require frozen storage, have a one-year shelf life at room temperature and up to five years in a refrigerator. Feb. 2021: in Phase 2 trials.
• CureVac, Germany. Uses mRNA built from naturally occurring nucleotides stabilised to induce a strong innate immune response. A portable mRNA printer is also being developed to rapidly manufacture doses where vaccine is needed and used to produce on demand. Feb.2021: in Phase 3 trials. (UK says it will buy 50m doses if approved.)
• Vaxart, US: In early stages of developing a vaccine in pill form that could be distributed by post. Weakened human adenovirus (Ad5) loaded with genes from the coronavirus for both spike and shell. Designed to break down in the small intestine. Feb.2021: Phase 1 study shows it elicits response from T-cells in bloodstream and antibodies in nasal lining but no antibodies in bloodstream. 
• CanSino Biologics, China: A vaccine similar to the Oxford/Astra-Zeneca one. Feb.2021: in Phase 3 trials, which include 30 children aged 6 and 12 given two shots.
• GCVI, global initiative: Vital part of spike protein grown in transgenic yeast and mixed with an adjuvant. This type of vaccine has a good track record, and is similar to a common hepatitis B vaccine. Such vaccines cost about $3 for two doses, and is likely to be suitable for children. Feb.2021: in Phase 2 trials in India. GCVI will seek emergency authorisation in India within months and is negotiating with manufacturers in Africa, Latin America and the Middle East.

Sources: Various.

Why People Use 'Um' and 'Uh' When Talking

If you listen to conversations, it is clear that we don't speak in beautifully formed sentences. Spontaneous speech is often vague and full of potential for confusion, not least because people generally come to a topic with different backgrounds and levels of knowledge.

The use of words such 'uh', 'um' and 'like' are often criticised, but it turns out that these filler words are actually essential for efficient communication, enabling two speakers to better understand each other. Without changing the meaning of a sentence, they help us co-ordinate conversations with minimal confusion. 

Uh and Um don't replace pauses in a speech, they announce them. The pauses after um are usually about twice as long as those after uh. This suggests that they signal something specific, managing the listener's expectations of what will come next. Pausing mid-sentence without an um or uh to signal a delay is very disconcerting.

Umming and uhing used to be thought to be a sign of deception, with truth tellers not having to come up with a convincing story. Unfortunately, the latest research indicates the opposite. Lots of umming and uhing  may signal someone is telling the truth, perhaps because they are making less of a conscious effort to present a front.

All these filler words rely on interpreting another  person's mind, which is a highly cognitive skill. It seems that 2 year old children don't respond to filler words but 3 year olds do, suggesting that our understanding of these signals develops along with other verbal and cognitive skills.

UH Using uh before a plot point in narrative seems to improve listeners subsequent recall, while replacing the uh with a cough reduced the recall. 

UM Prepares us to be surprised by something new or unfamiliar, a signal that something is changing in the conversation. 

HUH Provides essential feedback to speakers, allowing them to clarify a point before a mistake gets out of hand.

MMM Signals our intention to let the other speaker continue with their point.

LIKE Speakers of every language co-opt certain words to punctuate sentences in a way that seems gratuitious. In English, one such word is 'like', but its use may not be as random as it first seems. It may be that it acts as a form of emphasis, based on the participants' knowledge of each other. If you like a band, saying 'the concert was, like, 2 hours away' would mean the concert was worth the effort of a long drive. But saying 'the concert was, like, 2 hours away' if you hate driving, would mean that the distance was too far for you to be willing to go make the effort.

Source: Article Speak like, uh, a pro by David Robson, New Scientist 17 Oct. 2020

How Representative is the UK Cabinet Feb 2020

 In February 2020 Boris Johnson had a substantial Commons majority, which allowed him to reshuffle his Cabinet. While it had been rumoured that it would promote talented women and bring in MPs from the north, in reality this has not happened.

Diversity: Rishi Sunak replaced Sajid Javid as Chancellor of the Exchequer, so keeping the diversity level.

Education: But whereas Javid, a bus driver's son went to a state school, Sunak was head boy at elite public school Winchester. Across the Cabinet, state-school educated numbers dropped from 7 to just 5 out of 22 seats. In the real world, 93% of Britons go to state schools.

Gender: The new Cabinet has proportionally fewer women than his first, with less than a quarter of the seats.

Geography: Although 15 of 21 members sit for areas outside the home counties, only three have seats in the north of England, while Sunak's Richmond seat has been Conservative since 1910.

Source: Article How representative is Boris Johnson's new cabinet? in the Guardian, 14 Feb 2020

Testing Baking Powder and Bicarbonate of Soda

Over the last few days my bakes haven't risen properly. Soda bread, sponge pudding and new mini cake recipe all flat. Then I looked at the best before dates of my raising agents - out of date!

Searched the internet and found that these products do in fact lose their effectiveness over time. If you want to check if they are still good here's how.

Baking Powder
Put a few tablespoons of warm water into a small bowl. Add 1/2 teaspoon of baking powder. Should fizz moderately if fresh enough to use. No reaction - buy a new canister.

Bicarbonate of Soda
Put a few tablespoons of white distilled vinegar into a small bowl. Add 1/2 teaspoon of baking soda. If fresh enough to use, should fizz and bubble furiously. Not a strong reaction - replace for cooking purposes, but you can still use it for cleaning pots and pans.

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Eating for Health

A new book advises (among other facts) that you:

1. Don't skip breakfast.
There is no evidence that this helps weight loss.

2. It's not just what we eat, but when we eat.
Our body metabolism is more active in the morning, so we burn more calories early in the day.

3. Eat porridge
Eating porridge for breakfast keeps you feeling fuller for longer, so you'll eat less at lunch (for some it could be a lot less).

4. Activate your 'BAT' signal.
The white fat in our belly stores fat. But brown fat (brown adipose tissue - BAT) found high in our chests, in the neck and shoulder areas, burns fat. The more active it is, the thinner you tend to be. One way to activate it is to feel a bit chilly - so turn down your heating thermostat a bit.

5. Drink tea or coffee without milk.
It's thought that tea without milk activates the BAT signal and coffee without milk raises metabolic rate slightly (having milk stops this).

6. Eat a tomato before every meal.
Tomatoes are anti-inflammatory, helpful for artery function. Eating a large ripe, tomato before lunch means you are filling up a fist sized portion of your stomach with something that is 95% water and only about 15 calories right before a meal.

7. Nuts
Nuts are high in calories but eaten in moderation they lessen the appetite. So a mid-morning snack of nuts means you are likely to eat less at lunch. They also have health benefits.

8. Use Black Cumin (nigella seeds).
Add some nigella seeds to your pepper grinder along with the peppercorns. It seems to be helpful in reducing bad cholesterol as well as helping with weight loss.

9. Use vinegar in salad dressing.
Vinegar acts as a wake-up call to the body to switch from storing fat to burning fat. Don't drink it straight (it can damage your oesophogus), but use in salad dressings (and pickled onions and gherkins, etc.)

10. Eat boiled potatoes.
This is the most filling food - so including in a meal means you'll eat less of the other items.

11. Everyday activity is better than exercise regimes.
It takes five minutes of snacking to wipe out a whole hour of exercise. Concentrate on regular activities like standing, moving and fidgeting. Take the stairs, get laughing, singing, cleaning, cooking and gardening.

12. Embrace the scales.
The best device for monitoring weight loss remains the bathroom scales. Doing it twice a day (on waking and right before bed) seems to have the best effect.

Source: Article in Daily Mail, featuring How Not To Diet: the groundbreaking science of healthy, permanent weight loss, by Dr Michael Gregor (£20, Bluebird).

MS Nerve damage repair drug trial

 Multiple sclerosis is an immune system condition where the myelin sheath of nerve cells is damaged. This means that nerves carry messages less efficiently, and need more energy to compensate.

New research has shown that nerves have a natural ability to boost energy supplies after being damaged by moving mitochondria to the damaged part of the nerve, in a process called ARMD (axonal response of mitochondria to demyelination). 

While this natural ability is not enough alone to compensate, it has been found that an existing drug - pioglitazone - can further increase the number of mitochondria. Using this drug for MS treatment is now in clinical trial.

Source: feature in MS News, Sept. 2020

Gum Disease Possible Link to Dementia

 Gingipains. A bacteria that causes gum disease has been linked to Alzheimer's disease. Gingipains is an enzyme which is given off by the Porphyromonas gingivalis bacteria, which causes periodontitis. 

Around half of adults have periodontitis, with around 10% having a severe version, which erodes the gums and the bones that keep our teeth in place.

A small study of 53 patients with Alzheimer's found that 96% had a form of the gingipains enzyme known as arginine-gingipain in their brain tissue, and 91% had lysine-gingipain. These levels were significantly higher than control samples. It has not yet been determined if different strains of P.gingivalis are more virulent than others in causing brain infection.

Trials of COR388 (which blocks gingipains) on people with mild to moderate Alzheimer symptoms have begun, with first results expected in late 2021.

Other scientists remain cautious about the finding, and work continues on other factors such as genetic make-up.

Sources: Various.

How To Help Young Drivers Stay Safe

Got a teenager wanting to learn to drive? First of all, young drivers amount to just 1.5% of all UK licence holders, but are involved in almost one in ten accidents. And a quarter of drivers under the age of 24 will have an accident within two years of passing their test.

Research in Scandinavia shows that pre-17 driving instruction could reduce accident rates by as much as 40%. It seems that it is important for young people to get as much experience and confidence as they can before they are ready to go solo on the roads. Other research shows that extending the time period over which youngsters learn creates neural pathways in the brain to help the mechanical elements of driving become more automatic; this then gives them more head space to consider the wide dangers and risks when they are on the road. Here are some ways to do this.

 Try indoor carting as a way to improve their reactions and understand changing conditions.

Children as young as 10 can have a driving lesson at Young Driver, the UK's largest pre-17 driving school. This operates at more than 70 sites across the UK, offering youngsters the chance to drive a dual-controlled Vauxhall Corsa with a fully qualified driver. Realistic raod systems are set up at each venue to allow drivers to experience everything from roundabouts to traffic lights and junctions, as well as special areas where they can practice manoeuvres such as parking and steering.

Source: Feature in Good Housekeeping, March 2020.

Miscarriage

Women (and society) often believe it is something they did, or did not do, that caused the miscarriage. Early pregnancy tests mean that women often know they have miscarried when in earlier times it would have been put down to a late period. Much scientific research has gone into how common miscarriage is, and why it happens. An article in New Scientist brings together the latest findings.

• In 1975, researchers calculated that the number of babies born to married women in their 20's was 78% lower than expected. They proposed that miscarriages typically happen early and are a method of quality control. New research supports this theory.
• Today it is thought that for women in their early 30s, 60% of pregnancies end in miscarriage.
• The general population think miscarriages happen infrequently because they usually happen before the 12 week mark when it is socially acceptable to announce a pregnancy. Couples therefore often feel very alone and isolated when it happens to them.
• There is some evidence that stress, smoking and heavy alcohol consumption slightly increase the risk of miscarriage, as do conditions such as endometriosis and thyroid disorders, and infectious diseases like flu.
• But most miscarriages are unavoidable because they are caused by chromosomal errors in the embryo. The risk of miscarriages rise with maternal age as chromosomal abnormalities in embryos rises as women get older.
• Human embryos contain far more chromosomal errors than those of most mammals. Up to 80% of in-vitro fertilized embryos contain at least one chromosomally abnormal cell, and it is thought that the figure is probably similar for naturally conceived embryos. [The figure for mouse embryos is few than 10%.]
• Chromosomes contain all the genes needed to build a functioning human, so embryos with significant abnormalities usually don't survive. 
• Humans only have one child at a time so it is extra important that there are no abnormalities. [Animals with litters of 10 can afford to lose a couple and still have 8 live births.]
• An embryo starts burrowing into the endometrium (lining of the uterus) around 5 days after conception. It seems that endometrial cells usually flock to them and release chemicals that promote implantation and growth. But endometrial cells avoid embryos with chromosomal abnormalities and stop secreting the implantation chemicals. It is now estimated that about three-quarters of miscarriages occur at the implantation stage.

Whenever the miscarriage occurs, it is distressing, as many people start planning for the future as soon as they know they are pregnant. It can be a huge source of grief.

Understanding how the endometrium works as a gatekeeper may also explain the small proportion of couples who struggle to have children, either because they can't get pregnant or suffer repeated miscarriages. This might be that the endometrium sensor is programmed on a slightly wrong setting.

• If the sensor is overly selective, it will block the implantation of all embryos, leading to infertility.
• If it is overly receptive, it will let through embryos with chromosomal abnormalities, potentially resulting in later miscarriage or stillbirth.

Other factors may also govern the outcome. It has been noted that in the three to five months after traumatic events (such as New York September 11 attacks, or the Fukushima Daiichi nuclear disaster in Japan) birth records show there were fewer male births than usual in affected areas.

• Normally more males babies are born than female, as fewer survive infancy.
• But exposure to stressful events during pregnancy may promote the loss of male fetuses because males are more vulnerable in infancy than females. In very troubled times, stress may trigger a long-evolved process not to invest in a male that may not survive. 

One researcher feels there needs to be more education and public conversation about the true rate and causes of miscarriage, so couples aren't blindsided if it happens to them.

Source: Article Rethinking Miscarriage by Alice Klein in New Scientist, 8 Aug. 2020.

What Caused Brexit?

Who do I blame? Eight reasons we ended up in this Brexit mess. By Ian Jack

Who’s to blame? The problem is where to start.

1. De-industrialization. Jobs in UK manufacturing shrank from 7m to 5.1m between 1979 and 1986. More were lost in service industries. Of these losses, 94% were north of the line between the Wash and the Bristol Channel. Happening mostly during the Thatcher years, it has been wrongly attributed to government policy rather than the consequence of economic misfortune. Wealth and opportunity moved south. The social ruin was terrible. Skills were lost, traditions ended. Part of what it meant to be British disappeared. Nobody knew or seemed to care what was supposed to happen to places such as Oldham and Paisley.

2. Immigration. Both natives and immigrants need to revise ideas about where they live and the kind of people they are. As things started to settle after the 1950s influx, concerns were re-ignited with the 2004 Blair government decision to open the UK labour market to the eight new EU states, later conceded to be a mistake (only Sweden and Ireland did so as freely). In the first year 129,000 migrants turned up instead of the expected 5,000 to 13,000. “Nobody asked us!” said those who felt strongly about it (and then, in June 2016, somebody did ask.)

3. Cultural dementia. Historian Professor David Andress argues that France, the US and Britain are all engaged in “particular forms of forgetting, mistaking and misremembering the past”. As a population we are older than we have ever been, but seem to focus on daydreams of the past and along the way stir up old hatreds, give disturbing voice to destructive rage and risk the collapse of our capacity for decisive, effective and just governance. One such daydream is the belief that the nations of the old empire are “queuing up” to sign trade deals with the country that once ruled them.

4. The Dam Busters. Difficult to explain but England has a curious fascination for an Anglocentric version of WW2, which has grown even as the event has receded, perpetuating old notions of difference and moral superiority. This leads us to …

5. English exceptionalism. Sitting at the top table of nations, punching above our weight, a freedom-loving people ever ready to fight faceless bureaucracies and red tape seem to be predominantly English ideas.

6. The playing fields of Eton. Their damaging contribution to contemporary British politics includes David Cameron, Boris Johnson and Jacob Rees-Mogg: a too-confident incompetent, an opportunist and a cartoon version of the ruling class.

7. The newspapers. While some blame poor education for the Brexit vote, and the electoral influence of newspapers may shrinking now, with their circulations, they are far more rabid (eg the Mail, the Sun and the Telegraph) in England than in Scotland, and inform far more of the public debate.

8. Complacency. During the 2014 Scottish referendum campaign, some voters opted for independence because they felt that in areas like Sunderland, people want to leave Europe. Independence could allow Scotland to stay in the EU. Few were as farsighted.

Source: The Guardian, 3 March 2018

https://www.theguardian.com/commentisfree/2018/mar/03/brexit-immigration-jobs-eton-europe

Dishwasher Tips

Once a week, clean the filter to remove any build up of food and grime so it does not get put back on to your plates. Wash the filter in the sink using a soft brush.

Every two months, fill a plastic jug with 500ml distilled white vinegar, place on the top rack and run the machine empty. This will reduce limescale and remove grime and smells.

Every two months, carefully remove spray arms. Use a piece of wire or skewer to poke through and unclog the holes in the arms.

If cutlery is touching, water and detergent won't circulate and clean. Place half the cutlery facing upwards in the cutlery basket, and the other half facing down. Keep knives pointing down for safety.

Load crockery face towards the water jet and spray arms to enable water and detergent to reach inside bowls.

Unload bottom rack first to prevent water sitting in cups or saucers on the top rack spilling on to dry dishes below.

Keep dishwasher salt and rinse aid topped up. The salt helps prevent limescale and boosts the cleaning power of the detergent. Rinse aid helps drying and avoiding streaks.

Source: feature in Good Housekeeping, April 2019

Death Rates in UK Compared to Covid-19 Deaths

What is the true rate of Covid-19 deaths in the UK?

Covid-19 accounts for an average of 11 of the 1,687 deaths in Britain every day, according to official statistics.

In comparison, 124 people died each day from flu and pneumonia in the week ending Sept. 4.

Heart disease – Britain’s biggest killer – accounted for 460 deaths every day last year, while cancer kills an average of 450 people per day.

Around 87,000 people die of dementia each year – about 240 a day. Lung disease accounts for 31,000 deaths, or 84 every day, while fatal accidents at home – often while doing DIY – lead to 16 deaths per day.

Every day 5 people die in road accidents across the UK, while infections (including C.difficile and stomach bugs) kill 5,691 a year, about 16 people a day.

Last year (2019), there were 5,691 deaths attributed to suicide, an average of 15 per day.

There were 2,958 stillbirths, 2,831 deaths in infants under one year, and 3,248 deaths in children under five in 2018.

Source: article in Daily Mail, 20 Sept. 2020

Covid-19 Interferon Beta Treatment

Preliminary results of a clinical trial suggest a new treatment for Covid-19 reduces the number of patients needing intensive care.

The treatment. Developed by Southampton-based biotech company Synairgen. Uses a protein called interferon beta which the body produces when it gets a viral infection. The protein is inhaled directly into the lungs of patients with coronavirus, using a nebuliser. The hope is that it will stimulate an immune response.

The double-blind trial involved 101 volunteers who had been admitted for treatment of Covid-19 infections at nine UK hospitals. Half were given the drug and half a placebo (an inactive substance).

Initial findings. Suggest that the treatment  cut the likelihood of a patient developed severe disease (e.g. requiring ventilation) by 79%. Patients were two to three times more likely to recover to the point that everyday activities were possible. Indications were that there were very significant reductions in breathlessness. The average time spent in hospital is reported to have been reduced to six days, down from an average of nine days.

Publication and peer review. Stock market rules required the company to report preliminary results, but they have not yet been published in a peer reviewed journal. As the full data has not been released, the BBC were unable to confirm the claims. While the trial was relatively small, the indication that the treatment benefits patients was strong.

Implications. If results are as reported, it will be an important new treatment for coronavirus infections.

• Many governments have indicated that they will work as fast as possible to get promising coronavirus treatments approved. This could include emergency approval.
• Another possibility is that more patients will be able to receive the treatment while being monitored to confirm it is safe and effective.
• If approved for use, the drug and the nebulisers used to deliver it would then need to be made in large quantities.
• Previous clinical trials by Synairgen show it can stimulate an immune response and the patients with asthma and chronic lung conditions can comfortably tolerate the treatment.
• The Synairgen team believes the drug could be even more effective at the early stages of infection.

Reported 20 July 2020. Have not found any further updates.

Source: Coronavirus: protein treatment trial 'a breakthrough' by Justin Rowatt, 20 July 2020. BBC website: https://www.bbc.co.uk/news/health-53467022.

Deaths From Other (Non-Covid-19) Causes

 Deaths from other causes

In a normal year, there is a predicted number of deaths (e.g. strokes, heart attacks, cancer and old age) plus excess winter deaths due to respiratory diseases (including flu), circulation diseases, and dementia and Alzheimers diseases. 

It is important to distinguish between these and Covid-19 deaths. In England and Wales, excess winter deaths were 34,300 in 2016-2017 and 23,200 in 2018-2019. Flu deaths worldwide range from 290,000 to 650,000 per year.

END

Zinc

Zinc is an important part of our diet. It is found in meat, shellfish, dairy and some cereals. Most people get enough from a balanced diet.

Zinc is pivotal in would healing, keeping the protective skin barrier intact, and supporting the function of white blood cells.

Woman need about 7mg a day, men need about 9.5mg. Too much zinc can reduce copper absorption by the body, carrying a risk of anaemia and osteoporosis, so if you choose a supplement, stick to a maximum of 25mg per day.

It has been suggested that zinc can reduce the ability of some viruses to multiply, so there have been many studies looking at the effect of zinc lozenges on both preventing and treating the common cold. While results have been conflicting (partly due to uncertainty about the dose and type of lozenge) there is some evidence that they might speed recovery from colds.

It is still too early for reliable studies into its effect on the coronavirus, though it is possible that it might inhibit the action of some viruses.

Source: Health column in Good Housekeeping, June 2020.

Covid-19 Who is most at risk?

Who is most at risk?

Adults over the age of 60.

Age is one factor in whether someone dies from Covid-19. This is because past the age of 60, someone is more likely to have heart disease, cancers and other medical conditions such as diabetes, which mean the body is less able to fight off the infection. The proportion of Covid-19 deaths by age groups is:

• 90% are over 60. (52% are over 80 and 39.7% are between 60 and 79.)
• 7% are between 40 and 59, while 0.72% are between 20 and 39
• 0.077% are between 0 and 19.

Very few children become severely ill with the virus

Children of all ages may catch the disease but are likely to have milder symptoms and a lower chance of severe disease than adults. They are also less likely to pass on the infection. Australian researchers have identified a number of factors which may explain this.

• Children have strong undamaged cells in their blood vessels which prevent inflamation and clotting, and their blood clotting system is different.
• They have elevated levels of vitamin D.
• Their immune system is fast acting. They are more likely to be infected with other pathogens such as colds and and other germs picked up in the playground. This can build a strong natural immune system.
• They have often been recently vaccinated for other diseases, including MMR. This effectively 'trains' the immune system and keeps it 'firing on all cylinders'.
• They have fewer ACE2 receptors, which the virus uses to infect cells. ACE2 becomes more prevalent as they grow up.

However a coronavirus-related inflammatory syndrome occasionally occurs in children. Symptoms include high temperature, low blood pressure, a rash and difficulty breathing; some also had tummy pain, vomiting or diarrhoea, and inflammation of the heart and abnormal blood test results. Experts say these are signs the body becomes overwhelmed as it tries to fight of the infection.

People who are overweight or obese.

Obesity increases the risk of a number of diseases, (e.g. heart disease, cancer and type 2 diabetes). The more overweight, the more fat you carry, the less fit you are and the lower your lung capacity. So it's a bigger struggle to get oxygen into the blood and around the body, which impacts on the heart and blood flow. Being overweight, you also have a demand for more oxygen. This can be a serious problem during a respiratory infection like coronavirus; the obese body  becomes overwhelmed by the lack of oxygen. Overweight and obese people in intensive care are more likely to need assistance with breathing and support with kidney function.

An enzyme called ACE2, present in cells, is the main way for the virus to enter the body. Higher levels of this are thought to be found in adipose (fatty) tissue, which could explain the higher risk of catching the disease and a higher risk of being ill with it.

The ability of the body to fight off the virus (the immune response) is not as good in people who are obese, due the inflammation driven by immune cells called macrophages which invade our fat tissue; they interfere with how our cells respond to infection. This can lead to a 'cytokine storm' - a potentially life-threatening over-reaction of the body's immune system which causes inflammation and serious harm.

And there can be challenges in managing these patients in intensive care: (a) it is more difficult to intubate them (put onto a ventilator); (b) to scan them because of weight limits and (c) they may be more tricky to turn, or prone, in order to relieve their breathing.

Men

Men are slightly more likely to die, but in some countries this is may be due to higher smoking rates in men which compromise lung function. New research shows that men have higher levels of the ACE2 receptor on cell surfaces, which binds to the new virus, allowing it to enter and infect cells. Men have a higher level of ACE2 found in the heart, kidneys and tissues lining blood vessels, and especially high levels in the testes. 

Black, Asian and Minority Ethnic (BAME) populations 

UK data (May 2020) suggests that 35% of critically ill patients are from BAME backgrounds. The following factors appear to be important.

Many BAME populations come from lower socioeconomic backgrounds and work in public-facing occupations (healthcare, cleaners, restaurant workers, transport and delivery workers and other public services). They are likely to be in inter-generational households, with more of the aged still at home, and religious activities with large numbers of attendees. Between 15% and 30% live in overcrowded households in contrast to just 2% of white British households.

They have an increased risk of certain diseases (e.g. diabetes and heart disease).  People from BAME backgrounds have more of a specific type of fat tissue which is prone to macrophage invasion (see section on obesity and the ACE enzyme), have elevated rates of diabetes, and may therefore be more vulnerable to the virus.

Pregnant women

Pregnant women may be at higher risk for severe infection but data is not yet available. 
Those with a pre-existing condition (e.g. high blood pressure, diabetes, heart disease and lung disease) are more likely to die.

People with disabilities that limit activity.

People (over the age of 9) with a disability that limits activity account for nearly 60% of UK Covid-19 deaths, but form only 16% of the population. (Study reported 18 Sept. 2020.)

Certain blood groups may be more likely to have severe infections

Ethnic and national populations can have different proportions of blood groups. Worldwide the rarest blood type is AB, while Rh negative blood types are found in 0.3% of Asian populations and 15% of European populations. Proportions can also differ within a country. In the UK, the ratio is O = 48%   A = 38%   B = 10%   AB = 3%. In southern England: O = 44%   A = 45%   B =  8%    AB = 3%.

A study in China (March 2020) found that the normal population ratio was A = 31%   B = 24%   AB = 9%   O = 34%, while the ratio for those with the virus was A = 38%   B = 26%  AB = 10%  O = 25%.  Researchers concluded that "blood group A had a significantly higher risk for Covid-19 compared with non-A groups, whereas blood group O had a significantly lower risk." (Their findings were published before peer review, so need to be treated with caution.) In the US, another study found a similar pattern but only among rhesus positive patients. NB. Susceptibility to infection does not necessarily equal risk to getting seriously ill. Other studies on infection rates and severity of illness relating to blood groups are currently in progress in several countries.

Another study of patients in Italy and Spain with Covid-19 respiratory failure found two genetic variants associated with the severity of their disease. One cluster of six genes had included genes that regulate ACE2. The other variant was the ABO blood group system. However, an analysis of medical data from thousands of people in the Boston area of the US found no association.

Note: Some other viruses are blood-group dependent. People with type A blood seem to be more susceptible to hepatitis B and HIV, while people with type O are somewhat protected against catching SARS.

END

 

Covid-19 Diagnosis

Covid-19 Diagnosis

Have I got the virus?

The standard test uses a nasal swab (which can be self-administered) or a nose/throat area swab (done by trained healthcare workers). Current tests are thought to have up to 30% false negatives.

A study indicates that saliva collection may be easier to use and collects more viral material. The false negative rate appears to be better too (only 12%). Still to be confirmed by other studies.

Have I had the virus?

Antigen tests (which identify someone has had the infection) use a blood sample. These are still in development.

END 

Managing Human Hunger Appetites

Studies over a 30 year period have discovered new facts about human nutrition, that changes how we understand appetite, explains the obesity epidemic and suggests a way to solve that. Here are the main points of their theory.

Appetite balancing is common across the animal kingdom, including slime molds, cockroaches, spiders, cats, dogs, mink and non-human primates. Some species turn out to have two appetites. Others have five appetites for specific nutritional requirements: three for the main macro-nutrients (protein, carbohydrates and fat) and two for specific micro-nutrients (sodium and calcium).

If a species were to have a separate appetite for each necessary nutrient, they would need complex biological  systems. Species have evolved to focus on the nutrients that are needed in very specific quantities. For other things, natural diets were rich enough for them to automatically get enough of the other nutrients needed. In a food environment that is poor in one of the essential nutrients, individuals will eat more of other items in order to keep up the calorie requirements.

Humans are among the five appetite species. People typically need 15% to 20% of daily calories from protein. It turns out that humans are living in a protein dilute, energy-rich environment. Between 1961 and 2000, the proportion of protein in an average US diet fell from 14% to 12.5%, with the balance made up fats and carbohydrates.That shift was the only way people could maintain target protein consumption was to increase total calories intake by 13% - more than enough to create an obesity epidemic.

Experiments have shown that most of the extra calories eaten by those on a low protein diet came from savoury snacks, especially those tasting of umami, the signature flavour of protein. The protein-deprived were craving things that tasted of protein, even though composed of carbohydrates.

Ultra-processed foods are designed to be irresistable, and tend to be low in protein (expensive) and high in cheap carbs and fats. Such foods include pizzas, crisps, breakfast cereals, sweets, bread, cakes, mayonnaise, ketchup and ice cream, items which make up more than half of a typical US and UK diet - with some people eating these almost to the exclusion of everything else.

Our appetite for protein is stronger than our ability to limit carb and fat intake, so when protein is scarce, our appetite for it overwhelms the mechanisms that normally tell us to stop eating fats and carbs. Ultra-processed foods also contain very little fibre, which is filling and puts a brake on our intake.

How to manage your appetites

1. Calculate your protein target by looking up the daily energy requirement for your age, sex and level of activity. (This is can be done with the Harris Benedict equation calculator, available on many websites).
2. Work our the proportion that should come from protein by multiplying that figure by 0.15 (to give the 15% of energy from protein). Depending on age, you might need to use the multiplier of 0.18 (for 18% needed by 18 to 30 year olds), 0.17 (for the 17% needed by those in their 30s, or 0.2 (for those over 65 who need 65%).
3. Divide the resulting number by 4 to get the number of grams of protein a day you should eat. ( gram of protein contains 4 kilocaolories of energy.)
4. Then work out how to obtain that protein from protein-rich foods such as meat, fish, eggs, dairy, pulses, nuts and seeds. The protein content is often listed on food labels, or available online.
5. If you eat this amount of protein, it will satisfy your protein appetite and automatically ensure you don't overeat carbs and fats you won't need to track these at all).
6. Make sure you supplement the high-protein foods with mostly wholefoods, mainly plant-based, which will also supply your fibre needs.
7. Most importantly, avoid ultra-processed foods by keeping them out of the house.

Source: article: In perfect balance by David Raubenheimer and Stephen Simpson, New Scientist 23 May 2020.

Adolescent and Lifetime Offenders

Long-term research into male anti-social behaviour indicates that it is concentrated in adolescence, with fewer than 10% of males committing more than 50% of crimes. The offenders fall into two groups in adulthood, lifetime offenders and adolescent delinquents. A third group never offend.

Life-course persistent offenders (LCPO). Show extreme/violent anti-social behaviour from early childhood and on into adulthood. Brain scans show that LCPO individuals have less grey matter in some regions of the cortex, most of which are linked to anti-social behaviour (goal-directed behaviour, regulation of emotions and motivation). Possible causes are: (a) born with brain structure abnormalities, (b) bad childhoods or (c) both of these.

Most people with a low polygenic score for educational achievement have a lifelong struggle with self-control.They also tend to be late talking, don't use language very well, have difficulty learning to read, trouble concentrating and controlling thoughts, and struggle to remember facts and figures. This means that they find school frustrating and humiliating, and leave as soon as they can. A lack of qualifications leads to difficulty finding a job, and turning to a life of crime (and if good at it, brings self-esteem). LCPO are still locked up to keep the public safe.

Adolescent limited delinquents (ALD). Show a similar level of anti-social behaviour at around 18 but grow out of it. Deprivation, abuse and neglect allow vulnerability grow into anti-social/criminal behaviour. Many adolescents feel the need to prove themselves as adults and commit risky crimes, but once entered into adulthood, this lifestyle loses its appeal.

It is easy to walk away from offending if you have avoided having a criminal record. UK policy therefore tries to divert away from courts and jails, using approaches that aim to contain and change their behaviour without bringing formal charges.

Not-offending (NO). These individuals never commit anti-social behaviour. They simply don't want to break the law and adolescent culture no longer sees them as outcasts (the 'goody-goody' ones).

What we need to do.

• Develop treatments and rehabilitation protocols rather than invest in new prisons. 
• Effective prevention programmes need to start in early childhood. 

Source: Crime and punishment article in New Scientist by Terri Moffitt, King's College, London (July 2020)

Covid-19 Management Strategies

The most important fact is that this is a new virus for humans and we are still learning about how it infects, spreads and affects sufferers, and how best societies can deal with the problems.

1. The typical incubation period is thought to be 5 or 6 days. Since at this point it can be spread before symptoms occur (and in some cases sufferers show no symptoms) reducing spread requires reducing social interactions.
2. Herd immunity is a poor strategy, as post-infection immunity is not proven. It leaves lasting ill effects for many sufferers, both physical and mental.
3. Lockdown timing is crucial. Best to do this early and lower the R number - how many people an infected person can infect before showing symptoms.
4. Lockdowns vary in impact on different societies. Worst in densely populated low and middle income countries, with low quality housing and loss of income.
5. Lockdowns most effective early, and once levels are minimal, localised lockdowns at infection hotspots. (Pakistan is trying 2 weeks locked down followed by 2 weeks fewer restrictions - it remains to be seen if this is effective.)
6. Enforce border controls early. People working abroad panic and want to return home. Such mass migrations are difficult to screen effectively. They are hard to implement and people find ways around them. Putting people into enforced quarantine ties up a lot of resources, money that is better spent elsewhere.
7. Block the right travel routes. Blocking travel from China to the US did not help, as the early spread into the USA was from Europe.
8. Government messaging needs to be clear, concise and follow best practice. Mixed messaging causes uncertainty and less compliance. Certain national leaders have made decisions that have worsened their country's infection rate.
9. Mask wearing. There is a lack of good trials that prove the most effective slowdown of infections. Current scientific views are that wearing a mask reduces the risk of you spreading the infection to others, so it is important that as many people as possible do so. It is thought that wearing a mask might also help people to remember to keep other members of the public at the recommended distance.

Sources: various.

Cancer

We are all familiar with the various types of cancer which occur in various parts of our body, breast cancer, pancreatic cancer, skin cancer and so on.

However some people have vague and non-specific symptoms, and only when they have scans are cancerous growths are discovered and then confirmed by biopsy.

Referred to as CUP cancers (cancinoma of unknown primary), these tumours have little relationship to the organ or tissue where the growth is found, and a primary tumour is not found. World-wide some 3% to 5% of tumours world-wide fall into this category.

Among researchers there is a growing feeling that CUP may be a specific type of cancer, rather than a metastasis from a primary.

Work is ongoing to identify metastatic tumour driver genetic mutations. If the tumour shows a specific mutation that is a feature of a known organ or tissue cancer, then using the current treatment for that cancer might be effective. For example, a specific mutation in the BRAC1 or 2 gene (one of the causes of breast cancer) might be causing growths elsewhere, which might respond to the PARP inhibitor. For CUP sufferers it will mean personalising therapy for the best outcome, rather than focusing on the organ or tissue in which the cancer occurs.

Source: feature in New Scientist, 11 July 2020

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.

END

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.