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.]