Is It Covid-19 or Flu or a Cold?

We in the UK are now in the season where we can expect to catch colds, or possibly flu, but it could be the coronavirus. So how do we tell the difference when some symptoms are common to more than one of these infections?

Fever - temperature of 37.8C:  Common with Covid-19 and flu but rare with a cold.

Cough: Common with Covid-19 and flu; may have a mild cough with a cold.

Loss of taste and smell: Sudden with Covid-19, rare with flu, sometimes with a cold.

Fatigue: Sometimes with Covid-19, common with flu, and only sometimes with a cold.

Headaches: Sometimes with Covid-19, common with flu and rare with a cold.

Aches and pains: Sometimes with Covid-19, common with flu and a cold.

Runny/stuffy nose: Rare with Covid-19, sometimes with flu and common with a cold.

Sore throat: Sometimes with Covid-19 and flu, common with a cold.

Sneezing: Not with Covid-19 and flu, but common with a cold.

Shortness of breath: Sometimes with Covid-19 but not with flu or a cold.

Diarrhoea: Sometimes for children with Covid-19, and sometimes (especially for children) with flu but not with a cold.

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Social Distancing and the Need for Human Touch

Social distancing has been difficult to comply with and hugging is very much missed, and it seems that the need for touch is deeply embedded in humans, and indeed many other species, especially those that are highly social. Physical contact greetings are found in many cultures - handshakes, hugs, social and romantic kisses, and nose rubbing - while other cultures prefer more distance by bowing. Some more recently invented greetings are fist bumps and elbow bumps. Understanding the role such greetings play in other species (especially primates) can give an insight into our behaviour.

• Mammals tend to use scents to 'suss each other out', which is why their greetings are so intimate. Sniffing another individual's face, flanks and genitals for volatile chemicals that reveal its hormonal state, reflecting its strength and fertility, allows animals to size up potential opponents and mates.
• The duration and intimacy of the exchange reflects the nature of the relationship. Subordinate rats submit to prolonged sniffing from a more dominant one, but risk a fight if they become over-friendly themselves.
• Cats and dogs exchange smells with a characteristic rub of the head. A study of cats and dogs living in the same household found that 75% regularly engage in nose sniffing, which appears to help them live together. A cat's raised tail and a dog crouching and looking upwards both seem to signal friendly intent.
• Some baboons use lip-smacking, head-bobbing, and touching buttocks or genitals, while white-faced-capuchin rituals include finger-clasping.

• Many behaviours - especially those involving the genitals - include an element of risk and vulnerability. So there must be a significant benefit to outweigh the danger.
• The riskier and more intimate behaviours are more common in highly co-operative species. It is thought that greetings help individuals build their trust in each other and build alliances that could improve their chances of survival in the future.

So what about humans?

• Any greetings that involve bodily contact may offer us a way to pick up chemical cues. Research suggests that a possible explanation for romantic kissing is that we may be able to assess someone's physical fitness and fertility from compounds in their saliva.
• There is evidence that body odour can communicate someone's emotional state and even their sexual arousal. Our greetings can allow us to sample this without openly sniffing someone. (A researcher noted that at a conference, people often ran their hand under their nose after shaking hands with someone.)
• Our tactile greetings also allow us to assess someone's character and establish our trust in them. One study found that the strength and duration of a handshake offered a fairly accurate assessment of personality traits such as extraversion, neuroticism and open-mindedness, while another found that hand shaking before a task promoted honesty.
• Sports teams that use fist bumps, high fives, hugs and huddles signal our willingness to work with the other person in good faith.

The downside of contact

• No matter how much we trust another person, close contact brings the risk of transferring infections. Many cultures recognised this long ago and modified their greeting etiquettes. Where risk is high, distanced greetings symbolically express the desire for co-operation and trust, and romantic kissing is much less likely.
• We find it especially difficult to stop hugging or kissing our family and friends as we assume they are part of our 'in group' and so less likely to transmit diseases than strangers. The problem is made worse because these are the people we crave the most physical contact to reaffirm bonds.

Source: Article Greetings! Evolution holds the key to why social distancing is so difficult by David Robinson, New Scientist, 14 Nov. 2020.

Sore Eyes - Digital Eye Fatigue

Digital eye fatigue is eye strain (basically eye muscle ache). Intense peering and focusing along with glaring overhead lights can cause headaches and blurry vision. Another symptom is dry eye syndrome characterized by dehydrated, burning and sometimes watery eyes.

Eye strain is not harmful to the eyes, but chronic dry eyes can lead to infection and eye scarring, so should not be ignored.

What you can do

• Take a break from your screen every hour.
• Look at a distant object 20 feet away for 20 seconds every 20 minutes (the '20-20-20' rule).
• Make a point of blinking. Its not radiation or heat from your screen that dries the eyes, but reduced blinking rate. We seem to be primed to stare into bright lights, suppressing the blink reflex that coats our corneas with moisture and protective oils. [Those who frequently play online games only blink twice a minute, compared with the usual average of 12 blinks per minute.]
• Lower the light intensity of your screen to help you blink more, but not so low that you starting peering instead and cause eye strain that way.

For added lubrication use eye drops (but avoid those with 'whitening' agents which can irritate and dry out eyes further. Use irritant-free drops free of preservatives. [E.g. Blink Intensive Tears, £4.99, Boots.com]

• 
  

Warm compresses on the eye area help to re-liquify the oils in the natural tear film. [E.g. Eye Doctor Hold & Cold Eye Compress, £21.99, boots.com]

Source: Feature in Good Housekeeping August 2020.

Alternatives to Clingfilm

 We now rely on clingfilm in the kitchen but there is an environmental price. Plastic film accounts for more than a third of plastic packaging used in the UK, and much of it - including clingfilm - isn't currently recyclable. Here are some alternatives for food storage.

Bee's Wrap. Beeswax means it is easy to stick the edges of these sheets together. After use, wash with washing-up liquid in cool water. They will last for up to a year and are compostable, but are not suitable for raw meat. [£19.99 for a pack of 3, johnlewis.com]

Nature Fresh Clingfilm. Certified home-compostable; it should break down in your compost bin within 12 months. No compost bin? Don't add it to food or garden waste bins as it won't break down at the same rate as food peelings or grass cuttings at the processing facility. So if you can't compost it, use food storage boxes, waxed paper or beeswax wraps.

Stasher Reusable Storage Bags. Versatile silicone bags that can be used in the fridge, freezer, microwave and oven. Clean in dishwasher after use - place them open between the prongs on the top rack. [From £12.99, amazon.co.uk]

Joie Silicone Food Storage Lids. Silicone lids form an airtight seal when placed on bowls and other containers. Available in 3 sizes. Microwave, oven and freezer safe. [£11.99 for  3, lakeland.co.uk]

Source: Item in Good Housekeeping, June 2020.

A Better Way to Cope with Covid-19?

In September 2020, Oxford scientists Dr. Tom Jefferson and Prof. Carl Heneghan came up with another way to combat the virus, but this has been ignored. They argue that lockdowns do not work in the long term but just push the problem further in the future, while ever-increasing restrictions will destroy lives and livelihoods. They identified four key failings that need to be addressed, in order to enable us to live with the virus.

1. Address the problems in the Government's mass testing programme.

In theory the mass swab tests provided by the NHS should tell us who is infectious, how far the virus is spreading and how fast. In practice, the process is 'somewhat aimless' and indiscriminate. 

Results identify large numbers of 'positive' cases in people who are not infectious, as their viral load is so low they will not infect someone else. This makes a 'positive' reading difficult to interpret.

Administrative errors creep in, due to the volume of testing.

The tests give a simple yes/no answer but fail to identify those who pose a genuine risk. An eight-year old is less likely to transmit the virus, while a 75-year-old could be highly infectious and be in personal danger, especially if suffering multiple health problems.

• Stop relying on yes/no results and separate into age groups and symptom groups.
• Target tests at those who really need them - care workers rather than primary school pupils. Contact tracers will perform better is they have fewer, but more important, case to follow up.

2. Stop using shoddy data

The statistics are not transparent, a variety of methods are used, and at times they are politicised. In a 48 hour period, the number of new infections was variously reported at 96,000, 36,000 and 55,000 cases. The multiple predictions made on the basis of these figures don't help.

3. Protecting the vulnerable.

This is key to living with the virus while maintaining some semblance of normal life and could be the single most effective measure of them all. Those who are over 85 and those who are already unwell account for the vast majority of deaths.

• Increase the number of staff in care homes by a minimum of 20% and set up specialist clinical teams to support them. Prevent staff moving between care homes and taking the virus with them.
• A percentage of infections (possibly up to 25%) occur within hospitals.

4. Inform the public about the true and quantifiable costs of lockdown.

There has to be a measured discussion that includes the consequences of lockdown as well as the supposed benefits. People are confused and fatigued, and increasingly see that crude restrictions targeting the whole of society - irrespective of risk - are counterproductive. They also result in deaths. Of the 23,619 excess deaths in England in people's homes. just 10% of these are directly related to the virus. The rest are likely to have been the result of restricting national life and access to usual healthcare.

Source: Article in Daily Mail, 31 Oct. 2020

Covid-19 Mutations and Variants

It is in the nature of viruses to mutate. Often these die out but sometimes a mutated version will become the predominant variant in a population. New strains become more common by being in the right place at the right time. (Flu viruses behave in the same way, which is why flu vaccines are tweaked each year.) Vaccines train the immune system to attack several parts of the virus, so even though the spike has mutated, the vaccines should still work. Should we get to the stage where vaccines need to be regularly updated, the ones we have are very easy to tweak.

• The virus that was first detected in Wuhan, China, is not the same one you will find in most corners of the world. It probably spread at low levels initially, only being noticed when a serious outbreak of cases occurred. 
• By this time it is thought that it was already spreading outside China, maybe as early as September 2019 in Italy, and later that autumn in France, Brazil and the US. This strain was different to the original Chinese strain and became the dominant strain as it spread world-wide.
• The D614G mutation emerged in Europe in Feb. 2020 and became the globally dominant form of the virus.
• Another, called A222V, spread across Europe and was linked to people's summer holidays in Spain.
• The Alpha variant first detected in London UK in September 2020. (A similar strain was circulating in Italy as early as August 2020, before the first known cases in England. )
  
• The Beta variant emerged in South Africa.
• The Gamma variant was found in Brazil in Nov. 2020. 
• The Delta variant was found emerged in  India in Oct. 2020.
• Variant 20C-US (identified in Jan. 2021) now accounts for almost 50% of new cases in the US.
• A Nigerian variant (P681H) has a number of gene changes.
• Variant Omicron emerged in Botswana (reported on 24 Nov. 2021). It has an unusually large number of mutations which make it more transmissible, and is now present in many countries. So far cases are mild and few require hospitalisation. Symptoms are more like a common cold.

Covid-19 variants (mutations) are labelled in several ways.

Media reports typically refer to the country where the new variant has first been identified. For example, the Brazilian, South African or UK variants. However, this does not necessarily reflect the country where the mutation first occurred, as it may have spread to other countries before being identified. Some countries (e.g. UK) are doing more testing to identify mutations than others. 

• A new variant may initially be referenced by noting the area of the genetic sequence where the mutation occurred. For example, the D614G mutation. 

Scientists are now building a family tree that indicates where mutations have occurred and how they are linked. This starts with year date that the mutation was found and a sequential letter. The first virus is labelled 19A. This split into 19B and 20A, and 20A has further mutated into 20B and 20C. Further numbers indicate specific mutations.

• 20B.1.1.248: A variant with 12 mutations (including N501Y and E484E) identified in Brazil.
• 20B.1.1.7.: A faster spreading variant spreading identified in the UK in late 2020 and early 2021. 
• 20C-US: A variant found in the US. 

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Vitamin D Levels and Ethnicity

Why is vitamin D so important?

• It helps regulate the amount of calcium and phosphate in the body. These nutrients are needed to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone deformities such as rickets in children and bone pain caused by osteomalacia in adults.
• It is widely thought that vitamin D reduces the amount of 'stress hormone' cortisol within the body. Cortisol is linked to high blood pressure, in turn increasing the risk of cardiovacular disease.
• There is some evidence from small studies that vitamin D may give some protection against Covid-19.

 Sources of vitamin D

The main source of vitamin D for humans is sunlight, the level of which varies over the world. Around the equator, sunlight levels are high year round. As you travel north or south, the level of sunlight varies over the year, with lowest levels in the winter season. Natural sources of vitamin in the diet are oily fish, red meat, liver and egg yolks, though these contain limited quantities.

Ethnicity

People with dark skin are especially vulnerable to vitamin D deficiency due to their high melanin levels, which inhibit vitamin D production and protect against skin cancer. The level of vulnerability varies with the amount of melanin, so those with the darkest skin are the worst affected. As more people with dark skin ethnicity move to live or work in lower sunlight areas of the world, their vitamin D levels are not enough; a finding which is supported by some research in the US. Note this research was carried out some years ago, and uses the terms "black people" and "white people".

• One study found that 97% of "black" people and 70% of white people had vitamin D deficiency. 
• Another study found that "blacks" have half the vitamin D levels of white people.

Other social factors can also reduce exposure to sunlight. 

• Workers on permanent might shift will spend less time in sunlight.
• In some strict Muslim areas, women are kept indoors for much of the time. 
• Some cultures rate paler skins as being more beautiful; people may therefore restrict time spent in full sunlight, and/or cover most of the skin with clothing when outdoors.

Supplements

Therefore people (especially those with dark skins) in countries with big seasonal variations are advised to take supplements of the vitamin. A dose of 10 micrograms a day will be enough for most people. Taking too many supplements over a long period of time can cause too much calcium to build up in the body (hyercalcaemia) , which can weaken bones and damage kidneys and heart.

Sources: various

Herd Immunity

With the current Covid-19 pandemic, some people have been advocating allowing people to resume normal life, suggesting that at some point herd immunity will happen.

If enough people become immune to an infectious agent, the entire population (or a specific community) is protected  because infectious people rarely encounter a non-immune person, so the transmission dies out.

The level of individual immunity to get to herd immunity level for a virus depends on how infectious it is - measured by R, the average number of people that each infectious person infects.

• The classic example is measles, which has an R number of around 15 and a herd immunity threshold of 95%.
• For Covid-19 the R number is about 3.5 and the herd immunity threshold is thought to be around 60 to 70%.

Herd immunity has only ever been achieved by vaccination. This is because herd immunity can only be built if the immune response totally prevents individuals from picking up and transmitting the virus. That sometimes happens but often it doesn't. While a person's immune system may stop them from falling ill if they reacquire a virus, it doesn't prevent onward transmission. The same is true of vaccines.

'Letting the virus rip' would mean letting between two-thirds and three-quarters of the population catch the virus. There are a number of issues with this proposal.

• Collateral damage: even if the death rate is 1%, letting the virus run free will hospitalise and kill millions.
• We can't take it for granted that individual immunity will automatically create herd immunity, since we don't yet know what immunity a person gets from having survived Covid-19, and how long this lasts.
• While they survive a Covid-19 infection, some people are now experiencing the symptoms of 'long covid'. These symptoms can be severe, and affect more than one of the body systems.

So, herd immunity is not the answer.

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Can MMR Jabs Protect Against Covid-19

 A study by scientists from the University of Georgia claims that the MMR vaccine may protect some people against severe Covid-19 (a 29% lower chance), and may prevent some people from catching the coronavirus. Those with the highest antibody levels specific to mumps were 'immune' to Covid-19, but the same effect was not seen for measles and rubella antibodies. This is a possible explanation of why children only seem to get mild Covid-19 illness, if any at all.

Other scientists have also theorised that this could explain the lower Covid-19 death rate in continents with measle-free status, including Africa and Asia.

A team at Cambridge University found in April 2020 that part of the coronavirus structure is similar to mumps, measles and rubella.

All children in the UK are offered the vaccine and around 91% currently are immunised by their second birthday. The first jab is given from nine months old, and another before they are six years old. While antibodies fade over time, they can still offer some protection against viruses. Mumps antibodies decline by the age of 14, which is the same age as coronavirus prevalence increases sharply.

The MMR II vaccine (introduced in the early 1970's) is considered a safe vaccine with very few side effects. Study researcher Dr. Hurley suggests that adults over the age of 40 should be given the MMR jab if they have never had it.

Source: Various news media.

Welcome to 2021

 I don't usually write this sort of post but 2020 has been a difficult year. Wishing every reader and their family and friends a happy and healthy 2021.

Here are the bad bits.

• Boris Johnson was Prime Minister and Donald Trump was US President. Neither competent at dealing with the pandemic crisis.
• The UK finally leaves the EU - being in Europe is better than going it alone.
• The pandemic has changed so many lives. People have died earlier than they would otherwise have done, many more have been seriously long term, education has been disrupted, and businesses have struggled or gone under.

There have been positive things too.

• Neighbours shopped for others in lockdowns.
• In our area, almost everyone kept to the rules on mask wearing and social distancing, so we are well down on the infection table.
• The internet proved a godsend, with WhatsApp messaging, and Zoom, Facetime and other virtual meetings.

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