Monday, 29 June 2020

COVID19 - June update

It's time for my monthly update as we enter a new phase of the pandemic. There are less people getting infected and thankfully less deaths as the graph below shows. Consequent relaxation of the restrictions are being timed with tub-thumping announcements from the Prime Minister who is keen to minimise our position as the nation hardest hit by the epidemic in terms of the number of deaths per head of the population. 

Yet, the tail of the epidemic is levelling very slowly, spikes are appearing and there are real fears that we will still have cases heading into the Autumn and winter when COVID19 might become more widespread again and the influenza season kicks in. 

The bottom line so far is that since the pandemic arrived, there has been 60,000 excess deaths, an an increase of 45% on the normal 5 year average for this time of the year. Mortality seems to have fallen to pre COVID19 levels for the first time since March. I don't know about you, but to me that seems like a long time ago.

Yet from the viruses point of view, things are going rather well which means in global terms we don't seem anywhere near the pandemic's peak.

Declining UK deaths


This graph shows how our confirmed new daily cases have fallen, and by late June we had the lowest number since the lockdown started. It can be seen that the tail of the infection is still wagging though.


Deaths too are falling, though following the same pattern as cases, unfortunately not going away entirely.



Here In Devon we have really got away with it lightly! The south west is the least affected region and in Devon there has been "just" 831 confirmed cases, and 209 deaths. For Cornwall, 595 cases. 203 deaths. Sad indeed, but it could have been so much worse. The actual number of cases will be much higher of course, probably many thousands of mild or asymptomatic infections, plus those not counted before testing became more widely available. 

I can see no other explanation for this other than the restrictions and distancing. Perhaps we have higher Vitamin D levels down here but I doubt that is the main reason. Our 'peripherality', so lamented by politicians and the business community, has been our best defence. We will now see what happens with an influx of tourists. Tourism like in so many parts of the world is our industry of last resort. Pardon the pun. 

Might this be the beginning of the end?


It seems unlikely. It would be wonderful for it just to go away, rather like SARS did. The SARS experience though was rather different. Critically, it didn't have such a long incubation time so individuals became infectious after they developed symptoms. Isolation and quarantine was effective. That was a close shave; this time we have not been so lucky.

It is as if evolution has made a more effective virus. Less deadly, more transmissible. Well, evolution that is, driven by the pressure on land caused by Agribusiness. More on this horror story at the heart of the pandemic later.

Looking at the global whole, the pandemic is still roaring ahead with a surge in many southern hemisphere countries making the global picture very sad one indeed.

Global COVID19 deaths


Whereas over here the virus particularly attacked our elderly population, around the world the pernicious effects of inequality, that is excess poverty and excess wealth, as well as overcrowding and some pretty dire political leadership is allowing the virus to continue to spread despite their generally younger populations. 

Remember however that viruses have no mind, nor ambition, nor intent. It relies on chaos and human and ecological disorganisation to flourish; like some biological feedback for everything that is wrong with society. Political incompetence and a lack of the health, social and welfare systems we need to rise to this modern multi-pandemic age are lacking is many areas of the world and are far from perfect in others.

 . 

Viruses don't hibernate


Over here at least it's a bit more of a struggle for the coronavirus right now. It's harder for it to jump from person to person and find another host. For one thing, some people will have antibodies (though not that many) and with the summer and the heatwaves we have experienced lately there is far more immune boosting Vitamin D around. Peoples behaviour has changed with varying degrees of distancing becoming the norm and lots of activity still suppressed. 

And of course, it does tend to fade away in the summer anyway.

Today in the UK there were 115 recorded deaths, which though sad, represent progress, and still 689 cases from the 133,000 tests done. Of those being tested in the community, that is those who think they might have an infection or in contact with a case, about 1% are testing positive. 

In the US there are some significant state wide spikes despite the summer heat, the number of
Climbing US Deaths
daily cases is rising, and deaths running at about 500 a day.  It looks like Donald Trumps early throw away comment (aren't they all) that it would be an achievement to have less than 200,000 American deaths underestimated the problem which has been compounded by terrible political leadership and poor public services in an increasingly fragile USA.

Spikes of infection are evident all over the globe in countries past the worst of the outbreaks and are everywhere testing the public services in a test of what we can, in this modern age, term our level of civilisation.

 

Elastic social distancing


Guidance has changed and we are now advised to keep ONE metre away from others. This will make a huge difference to business, especially the hospitality sector, but still serves as an  illustration of how simple commands from above are divorced from day to day reality of living on the ground. 

In some situations, like meetings outside in the sun and in localities where there have been no outbreaks it hardly seems to matter, the risks of infection are so low. 

UK social distancing (BBC)
Indeed, if there are no spikes after the escapades on Bournemouth beach (see pic) then there will have to be some serious head scratching. 

I have seen no reports of spikes after the Black Lives Matter protests, or the previous mass gatherings on the beaches in the May bank holidays, or after illegal raves in Manchester. If there really are no spikes, then a bit more nuance is needed in advice from the centre. 

Yet indoors, and in contact with those who work with others two meters may not be far enough.



Certain occupations, like workers in meat processing plants which are kept cold, and in other roles where distancing is not possible, and working conditions poor, create particular risks for creating local outbreaks. One metre might not be enough if you are next to a fellow worker all day.

It's very clear that COVID19 does not like it outdoors in the summer, it lasts just minutes in the sun and it spreads far more rapidly indoors. The great outdoors is the safest place to be.

In other words, social distancing depends on the precise experience you are having and relies on common sense the government clearly think is lacking in the general population. Kettles and black I might suggest!

Localism needs intensive care


The stubborn rate of infection in Leicester is not explained by any one particular event, and is more likely to be due to a mixture of the local conditions and population. Perhaps the thriving fast food business with its congregations of customers might be maintaining the level of infection, as well as crowded conditions in the city's garment industry where low pay results in  low paid employees working through illnesses due to lack of sufficient sick pay.

One thing is evident, and again that is the dead hand of centralisation. It seems the mayor of  Leicester had little more information than you or I up till the night before government announcements requiring prolongation of the restrictions. This is despite this being a local affair needing local infrastructure which has been dissolved by political diktat over the last few decades. The mind boggles.

One of the positive messages, or warnings, the virus has offered is that we need to rebuild the local infrastructure essential to deal with our many of the challenges of the modern world. All around the world we see countries with decent local infrastructure coping better. 

There is now a scientific case for devolved regional powers and strengthened local governments. 


COVID19 and the brain


It seems the virus is more interesting than we thought. Not only are there concerns about the complicated recovery experienced by many patients hospitalised by COVID19, but the virus is clearly able to hit a number of organs including the brain. ACE receptors, its target cell, are widespread in body.

It seems that neurological symptoms vary from mild confusion to those consequent on full blown infections of the brain and strokes and might be more common than we thinkPost traumatic stress is understandably common amongst those who needed intensive care, but for some there are other neurological consequences too.

This is likely to explain why many people are complaining of protracted recoveries involving fuzzy thinking, poor concentration, mood problems, muscular pains and fatigue, amongst other things. In some unlucky cases it might also trigger diabetes. It is clear that the NHS will continue to need increased funding to help people through the rehabilitation phase to full recovery.

COVID19 at work....


Images from electron microscopes in my lifetime, have lit up the world of science and revolutionised our connection with all things tiny. 

This image shows what COVID19 gets up to at the cellular level. It hijacks the protein making machinery of its target cells and sets them to work making what are called filopodia (latin = filament legs) and with which they infect nearby cells.

Science fiction seems so dull compared to what goes on at this "science fact" microscopic level!

Infected cells produce tentacles known formally as filopodia (orange) extending out from the cell surface to enable budding of viral particles (blue) and infection of nearby cells.
Dr. Elizabeth Fischer, NIAID/NIH

Understanding exactly how the virus works, the genes it uses to take over cells, and how it spreads between them offers the potential of putting spanners in their works and coming up with an antiviral which would hit them without affecting other cellular machinery. No news on this yet.

Treatments


At least there is one treatment option which seems not to have fallen on the appropriate hurdles of well conducted trials. That is the old fashioned, readily available and cheap steroid dexamethasone. Through its blunderbuss anti-inflammatory actions, it significantly reduces the death rates in those with more severe infections needing admitted to Intensive Care Units. For those ventilated, mortality dropped from 47% to 29% in the treated group and that is good news.

This will now become standard treatment in this setting.

The timing of treatment is important as too early it might do more harm than good, and too late will not work so well, so no Donald, don't add this to the less than useless hydroxychloroquine.
 
The USA have bought up the worlds supply of the next few months of Remdesivir production from the manufacturers Gilead. The drug has modest anti viral effects and hastens recovery by a few days though without evidence of  saving lives. 

This manifestation of "America First" policy in action raises more issues that it solves. Will the UK government buy generic products from India and elsewhere in defiance of long upheld
respect for intellectual property rights of drug companies? Given that the virus doesn't respect borders, how will the US help solve the global crisis? What happens when a vaccine is developed?

We are really all in this together, one big global community, and the US administration is clearly putting November election success before any semblance of international co-operation. Disappointment is dulled by the complete lack of surprise.  

Vaccines are still in the pipeline but might raise some interesting issues as they will not work so well in the older people most at risk from the infection. This is not entirely new. Like with influenza immunising children might protect their grandparents more that vaccinating the grandparents themselves; I suspect the anti-vaxxers will have a field day with this.

Testing testing....


In an ideal world inevitable local outbreaks will be dealt with promptly. Potential "super-spreaders", those 10% of cases who cause 90% of infections will be supported to stay at home on a decent level of pay, their contacts traced and tested and relevant isolation or quarantine monitored and supported. Meanwhile the unaffected continue to get back to normal. 

Ideally.

Yet our Testing and Tracing, said to be a vital for this to work, are both continually beset with problems. With our shiny NHS tracing App ditched (along with the millions it cost), and replacements in what seems to be a very long pipeline, my mind boggles at the possibility of what will go wrong next?

Even with the money (£108million) flowing to the private sector tracing teams, local health protection teams have traced nearly eight times more contacts (77,642) that the national call centres (9997), and at a tiny fraction of the cost. This is because they deal with what are called 'complex' cases, which it turns out appear, predictably, to be most of them.

This is not surprising. In the middle of lockdown it is easy to know who you have been in close contact with. Now, after a weekend on the beach and a couple of shopping trips as well as potentially, school trips, the answer to the question "Who have you been in close contact with?" could be a good few thousand people. Outside of lockdown, all cases are complex. That is where the App is meant to come in. 

More worrying still, up till the 10th June, only 14,000 of the 33,000 people reported by the ONS as infected have been traced at all, so the foundations of our response to the virus are very shaky indeed right now. 
Thanks to Steve Bell

According to "The Science", that is, the Governments SAGE group, 80% of contacts of cases needing to isolate to quell outbreaks.This is clearly not even close to being achieved. 

What happens next?


In other words, there is a possibility we are going to struggle to contain any further significant outbreaks, but might be ready to do so at some time deep into the winter. Poor over-centralised dogma driven decision making is exacting a high price and lessons seem not to be learned. Nothing new there!

Yet might we be lucky? With social distancing so often breaking down and mass events taking place, there are some big epidemiological experiments going on. If there are no spikes reported as a consequence of big crowds in the summer, new guidance might be needed. Thinking must evolve faster that the virus.

With the pandemic surging in the southern hemisphere and increasing in the US, it might suggest we are in for a resurgence up here in the north in the winter. Various other spikes in the north also demonstrate that Sars-Cov2-19 is here to stay.

Backward forward thinking


Thats not a typo! We are simultaneously clever and stupid. 

In China (in epidemiological terms just around the corner) nasal swabs from pigs and workers from pig factories show that novel and dangerous viruses continue to be generated by factory farming and released into the general population via the workers. A new variant of flu in this case. Excellent monitoring, yet how insane is it not to tackle intensive farming methods which generated the new strain in the first place.

Perhaps they think investment in viral labs in Wuhan and elsewhere might keep us on top of this problem, yet Sars-Cov2-19 has proved them wrong.

While the world deals with the human and financial cost of the coronavirus, the profits of Big Farmer are left untouched and often untaxed despite their leading role in generating many of our new viral cohabitees.

It seems to me that the global spread of infections, rocketing levels of obesity and ill health, environmental destruction and species loss are tied together under the umbrella of metastatic "fast farming" and the health destroying edible food like substances it produces. 

We are, literally, sowing the seeds of our destruction as we speak.

Good Health


As always, and with every post, I am reminded that this little virus has magnified the critical importance of lifestyle. Good food from good farms with good soil, fresh air, exercise, sun and vitamin D are critical to enable our defences to fight off Sars-Cov2-19, as well as basic hygiene, a bit of luck, and good science. 

Moments of joy and happiness can keep us going through more worrying times and these need to be cherished when created or encountered. Enjoy the summer!

Thursday, 25 June 2020

Agribusiness at it again - COVID19 outbreaks and the meat industry

I visited Tavistock yesterday and found it a bit eerie. Half the shops are still closed and pedestrians sparse. There was a faint atmosphere of optimism among those I talked to and hopes of getting through the year pending recovery next year. Another Plan A. 

We are on the downslope of the curve. Cases and deaths are slowly falling and the restrictions are being lifted as we enter the 'new normal' mixed with much of the 'old abnormal'. Yet with the easing of restrictions, how worried should we be about further outbreaks?

Don't say "R"


The R number has almost become a part of the culture; not a day goes by without hearing it mentioned somewhere. If it's more than 1 the pandemic is growing; less that 1 and its going away. As simple as that.

Its therefore not surprising that headlines were made when the R0 number for Germany suddenly went up to nearly 3!

The sudden increase in the otherwise well managed pandemic in Germany is due to a significant local outbreak in meat processing plant, (1,500 cases and a lockdown of 36,000 people) but their total number of cases remains low.  

With a low level of infections, the R0 number seems to matter less. Any outbreak will push it up. Effective local measures will bring it down. 

We have to admit we lag some way behind these more organised, collectively bright and technologically advanced nations. Yet even they are proving that absolute victory, that jingoistic call from politicians more used to military metaphors than biological reality, is clearly not possible. I get the feeling that we are in more more local outbreaks in the UK. 

If so, local lockdowns and restrictions are likely to become a part of our culture too. The virus seems still to be very much around, and outbreaks seem to be concentrated in certain indoor activities. Like those of our intensive food industry.

Its Agribusiness again...


While in South Korea outbreaks seem to have started in Churches and nightclubs, many of the outbreaks elsewhere seem to originate in meat processing plants. I have posted before about the influence of "Big Farmer", whose displacement of traditional farming in China is likely to have played a big part in the emergence of the virus from its reservoir in bats.  

Early in the pandemic there were significant early outbreaks in meat processing factories in the USA. Astonishingly, over half their outbreaks came from factories killing, processing and packaging chickens beef and pigs, and the number of outbreaks seems to be growing. Why?

Behind these numbers lay poor protection of underpaid staff, working long shifts in crowded conditions. Their poor heath and terrible working conditions have come about due to de-regulation over the last few decades. Trump, despite his otherwise casual approach to COVID19, declared meat processing plants essential infrastructure after the conveyor belt of meat from the factory farm to the plate were affected.

Yet the outbreaks continue. Companies made adjustments, but the whole infrastructure of these factories is designed around the need for speed and profit and can therefore hard to adjust.


"Despite U.S. President Trump's April 28 executive order requiring  meat plants to remain open, 47 meat and poultry plants were temporarily closed as of May 11 due to the rapid spread of worker infections.  Confirmed COVID-19 cases jumped 40% in the week after the executive order in U.S. counties with major beef or pork slaughterhouses, compared with a 19% rise nationally. At least 30 meat workers have died and thousands have been infected.

Two meatpacking plants in Alberta, Canada, have given rise to nearly one in six of the province's 3,400 cases of COVID-19."


IUFW image
Many meat processing plant utilise migrant labour who are housed in cramped dormitories and bussed to work in sardine like conditions. Air flow patterns, lack of any potential to distance, having to shout above the noise of the factory floor all make these places ideal conditions for COVID19 to run rampant and then spread to the surrounding community.

If you want to find out more about how the virus is spreading through the food production sector in the US, then go to the excellent Food and Environment Network

Yet, as might be expected from the global nature of Agribusiness, this is not just happening in the US. Around the world it seems that the conditions in these food factories are fuelling the pandemic, with outbreaks in Australia, Brazil, France, Ireland, Spain and Canada. We have our own outbreaks in a number of meat processing plants in the Wales and Yorkshire. I suspect there may be more.

Catching a cold?


Another factor might be the cold conditions in these factories which the virus prefers. However, there have not been similar outbreaks in other sectors such as dairy and frozen food factories which also require low operating temperatures.

If it were the case that low temperatures are in any way behind these multiple outbreaks it would imply that next winter is likely to be a big problem. I personally do believe that cold could be a factor, but this can't be used to hide the basic design flaws of the whole food processing system from start to finish.

The message on the supermarket shelf:


The pandemic not only has its origins in increasing industrialisation of food production in China, but is now being fuelled by the whole global process of delivering low cost and low quality meat to the table.

In reality meat is a luxury food which has been made commonplace throughout the world by some pretty horrendous intensive farming practices. That cheap slab or beef, bacon or the £2
Science says 'Yeuch'!
 chicken on the supermarket shelf comes with gigantic hidden costs. Introduce stress into the system, like a pandemic, and the whole edifice and ethos of cheap meat starts to crack. 

Higher quality meat might seem more expensive, but it would be far cheaper for society as a whole. 

The profits of the meat processors are dwarfed by the costs to us all, in taxes, destruction of  traditional farming and the soil as well as the many costs which will have to be picked up in the not too distant future. The profits go to the corporations and the costs are paid by local authorities, national governments, you and I. 

There is no such thing as cheap meat. 

Trade Deals and Brexit - it could well get worse -


There are other messages from the COVID front line. A trade deal with the US is very much on the cards and is currently being negotiated behind closed doors. It will inevitable seek to remove many of our regulations regarding food quality, and enable the imports of food we would have, pre-Brexit, considered to be substandard. 

In the US, 95% of small family farms have been lost over the last few decades, a sad trend we we are seeing here and which a trade deal will accelerate. 
The dangerous duo

Worryingly, the government recently prevented proper parliamentary scrutiny of the process and it seems likely the Americans will get much if not all of what they want. After all, what are our bargaining chips?

Further, it is glaringly obvious that we need more and better regulations for the protection of soil, the production of food, in particular meat, for the protection of workers in the sector and consumers whose health is compromised by processed meat. 

Politicians who promised "world-beating regulation" before the EU referendum need to be true to their word, but its not looking like they will.

Our experiences with COVID show that much of the anti-EU drive to reduce the 'burden' of regulation could not be more inappropriate.

In the meantime, we consumers are at the very end of the food pipeline.

Be careful what you buy. 









Friday, 19 June 2020

The Johnson effect.

I try to keep politics at bay during these posts; there is enough science around to keep any health blogger busy - however, politics and the pandemic are interwoven. 

On the one hand, I keep hearing about how we in the UK are "world beaters". The most recent claim focused on testing and tracing, this is despite our system yet to be properly up and running and already beset with technical and human problems. It lags well behind many others. Im afraid the bullshitometer has gone well into the red!

On the other hand, it does sadly seem that in one sense we are truly leading the world -  in our rates of death from COVID19.  The graphic below sadly displays our 'world beating' performance. 



Only Belgium has more deaths per head, but they have counted deaths in the community when COVID was suspected, so have overinflated their figures. I'm not sure why Johns Hopkins missed out Spain from this graphic, but they slightly lag behind us.

If the figures for Scotland and Wales are removed, English deaths per head of the population look even worse.

So listening to Boris Johnson and his merry team describe our response to the pandemic as world beating had driven me to put down in words how we have indeed achieved our status as a world leader. In COVID related deaths.

So, on the basis of what we have learned, let me describe:

10 tips to create a bigger, longer pandemic! 


1. Make sure the population is as unhealthy as possible

FOOD. First, ensure as many people are eating as much highly processed low quality food as possible. This will ensure that most people are overweight or obese, and we know already that people poisoned in this way fight infection less well and indeed spread viruses further.

Work towards future trade agreements with the USA, the undoubted world leaders in the production of low quality food. This will ensure even more people become overweight and metabolically compromised as well as getting rid of our smaller mixed farms which produce healthier food. Planning for the next world beating pandemic already.

POVERTY. Increase poverty to the point where as many people as possible can only afford to buy said cheap ultra-processed food. Poverty also increases stress which makes people think they needs "treats" and "rewards" to alleviate the anxiety of day to day life.

SMOKING AND ALCOHOL Cut funding for smoking cessation clinics to ensure that a significant chunk of the most vulnerable sections of the population continue to smoke. Make alcohol as available and as cheap as possible. 

AIR POLLUTION Don't do anything to reduce air pollution as this increases susceptibility to infection and absolutely ignore any improvements to health resulting from lockdown induced reductions in the amount of poisonous air people have to breathe.

VITAMIN D Make sure most people spend as much time indoors as possible. Low pay and having to work long hours to make ends meet will also compromise immunity. Warehouse and call centre jobs are ideal for this and will be much in demand during the pandemic. 

Low population levels of Vitamin D will also help the pandemic along. So its essential not to mention Vitamin D at all, especially when it becomes clear that people with low levels are dying more, and keep well clear of any suggestion that taking Vitamin D supplements might help avoid these needless deaths until it is too late to make any difference. 

PUBLIC HEALTH ADVICE In press briefings make sure not to mention anything that might give people a clue how to get healthier. Avoid all mention of sugar, tobacco, sugar or alcohol or lifestyle at all. 

People who smoke are overweight, lack exercise, drink to much alcohol and eat a poor diet are 20 times more at risk of becoming ill, even before COVID19 came along. 

PR Hint - Call this Individual Choice.

2. Increase social inequality


Increasing social inequality also ensures the population as a whole is less pandemic-ready. High levels of stress and day to day financial worries reduce individuals resistance to infection. Keep wages as low as possible for as many people as possible and destroy ways of mitigating this, like Sure Start for kids, and youth clubs for young adults.

The appropriation of the nations wealth by a small number of people with will help the virus get a hold.  As you said in Febuary, the pandemic offers a golden opportunity to cash in.

PR Hint - Call this Opportunity


When it becomes clear that the underprivileged and in particular BAME groups are hit harder by the pandemic, promise to commission reports which report back only when it's too late to do anything. Make sure to redact the reports before they are published to ensure nothing needs to be done. Ensure more reports are recommended and agree to do listen to what they say at some unspecified time way into the future.

PR Hint - Call this Anti-Racism.

3. Create a weak public sector


Slim down Local Councils, public health departments and community health teams, ideally to the point of extinction. Make it impossible for primary health care teams, health visitors, social workers and district nurses to work effectively together. Make sure also that local public health departments have no input whatsoever to anything at all.

Create multifaceted staffing crises my making training expensive for medical, nursing and even midwifery students. Reduce pay for staff, and increase the workload of clinical staff while at the same time paying for more management needed to administer complex contracting systems. Duplicate this wherever possible. 

In particular, a recruitment crisis in primary care would make effective responses less likely and ensure that primary care staff spend as much time on admin tasks as possible. This has already been achieved.

PR Hint - Call this Modernisation.


Making sure European doctors and nurses are made to feel unwelcome and return to their countries of origin. Make it difficult for overseas staff to work in the NHS by charging them for the services they provide, whether they use them or not - and try to stop them coming here in the first place. Setting income requirements above that generally paid in the NHS or care sector would help achieve this. Extend this charge to every member of their family and make it annual.

PR Hint - Call this Patriotism.


Ensure that social and health care systems operate with completely different and highly strained funding streams. Keep promising to sort this out, but never ever do.

Fragmentation, poor communication across the sector, no structural leadership, administrative chaos and variable quality will ensure the sector is always one step behind. Ensure also that as many of the profits from care homes as possible are sequestered offshore by equity companies to ensure they are not simply taxed recycled and reused. 

PR Hint - Call this Competition.

4. Get rid of any spare capacity in health care


Make sure that there is no slack, no spare capacity, no contingency whatsoever in hospitals. Ensure everyone is already working flat out and that there are no spare beds at all before the pandemic hits. Reduce ITU beds to the absolute minimum.

Make sure that the care privatised, fragmented, leaderless care home sector are desperate to maintain the high occupancy levels needed to make a profit. Reassure them that taking COVID19 will be fine and that there is no evidence that this will cause a problem. When the evidence of harm pours in, simply state that it is now time to move on. 

PR Hint - Call this Rationalisation


Shelve any pandemic planning that might suggest money is spent on resources like PPE that just sit there doing nothing until an emergency comes along. To back this up, get rid of any stored PPE. 
Reduce capacity in NHS or public health laboratories by centralising and privatising so we are not ready for widespread testing for months. This will ensure the pandemic gets off to a world beating start. 

PR Hint - Call this Efficiency.

5. Show personal leadership


Be unfit - Demonstrate the difference obesity makes by weighing in at 17st 7lb and 5ft 9in, with a BMI was of 36.2. This is well into the obese category. (BMI over 30). This is known to impair the immune system ability to counter COVID as well as creating other illnesses along the way which also make the outcome worse

Get infected early. -  Make sure you visit a big hospital and shake as many hands as you can.
Prime Minister Boris Johnson shakes hands with nurses during a visit to Addenbrooke’s Hospital in Cambridge (Alastair Grant/PA)

This not only ensures that you pick up the infection yourself, but also that you spread it around as many of the front like staff as you can.

Make an announcement:

“I am shaking hands. I was at a hospital the other night where I think there were coronavirus patients and I was shaking hands with everybody, you will be pleased to know, and I continue to shake hands"

Any ensuing infections will cause staff to isolate, putting pressure on those still working and means that staff have to be brought in from other wards and agencies to fill gaps, thus further increasing the chance of spread the infections.

Ensure you have the best treatment available though do not mention that such care is beyond the capability of the private sector.

Spread the infection

Make sure you visit places where you can meet as many people as possible. Shake lots of hands and don't be shy with the hugs. Sport provides an ideal seeding ground and if possible import spectators from hot spots like Madrid if you can. Ideal for this would be a four day festival where 250,000 people share as small a space as possible and chummy up to as many of them as possible.

Big up Herd Immunity.

And then deny you did any such thing


PR Hint - Call this the British Bulldog spirit

6. Delay decision making


Make sure that ongoing decisions are made as late as possible, are totally centralised and don't involve local authorities, GP's, NHS trusts or anyone else with their feet on the ground prior to announcements.

Don't attend COBRA meetings. COBRA meetings are so called because they refer to Cabinet Office Briefing Room A meetings, and no doubt because its a catchy title. Their purpose, according to the Institute of Government, is to co-ordinate decision making in the event of high level emergencies and civil disruption. Like a pandemic. Avoid them like the um, plague. 

Have swish American Style daily party political broadcasts. Call them press briefings and make them as paternal, chummy and friendly as possible. At all times thanks everyone for everything and keep manners on full throttle. Appear to be very nice and speak calmly and slowly. Allow friendly questioning from hand picked media. Defer to the scientists at all times and imply that everything that goes wrong is their fault.

Travel freely while telling people not to and issue fines for people who flout ill defined regulations as long as they are not chums.

Make special advisors special - Make sure that public health messages are compromised by supporting rule-breaking by special advisors who do what they like. Forgive them for doing exactly what you are telling everyone else not to do. That is why they are special.

At all times state that you have made the right decisions at the right time based on world beating advice and that you are proud of everything. Look exasperated when asked if there are lessons to be learned.

PR hint - Call this certainty

7. Privatise the public health response.


Make sure that the potential for developing permanent public health expertise is not achieved. Thus usual method of contracts with chums who will keep costs low will suffice and ensure the NHS misses the chance to develop this capacity with well trained better paid staff.

  SERCO     

The private sector will guarantee poor or even no communication with existing public health services, keep training and pay to a minimum, as well as giving lots of contracts and cash to the usual chums. At all times prioritise Conservative party donors who excel at avoiding tax. 

8. Make the economy work for you


Behind the scenes, prepare to turn our backs on our neighbours. Start agreeing to trade deals with America making sure at all times to not mention their effect on health or agriculture and most important of all, ignore the effects on climate change.

This will preserve the cascade of wealth from the bulk of the population to most wealthy and ensure chums in the corporations are not fettered by rules and regulations related to health, food quality, safety or the environment. 

Borrow lots of money from chums in pension funds, investment banks, and insurance companies who will get generous risk free returns paid for by the taxpayer. Rather like the debt recently paid off for the abolishment of slavery.




PR Hint - Call this prudence
 

9. Play the Blame Game


Claim all successes as your own and simultaneously ensure that all failures are placed where they belong - elsewhere. 

Compromise every good idea by delay, prevarication and underfunding. 

At all times tell people that we are leading the world in whatever the subject matter is at that moment in time.

10. Repeat the whole thing during the next pandemic


Ensure the whole system can evaporate into thin air and local expertise is not developed before the next pandemic, when we can go back to number one and start all over again.

The real lessons to be learned are how to shift more money from the taxpayer to the expanded private sector, which after all, is the whole point of being in government.


These measures and more will ensure that in the UK we sit at the top table of COVID19 infected nations and have a world beating pandemic!



 












Friday, 12 June 2020

Ticks and the diseases they carry- the quieter pandemic.


Ticks before and after lunch
https://www.lymediseaseaction.org.uk
Just as COVID19 start to quieten, for some of us at least, there is another curious interaction between humanity and the rapidly changing natural world, evident today on my dog and on my skin.

Welcome to the strange world of Ticks.

Ticks are parasites. That is to say, the benefit of our relationship is all for them. Unlike most viruses who have loaded our genome with useful genes and the benefits of   our bacterial microbiome, Ticks do us no good at all. 

At best, they are a minor irritation and at worst a vector of significant disease. A sort of land-bound mosquito carrying all sorts of microscopic life from reservoirs in the wild like deer and mice upon whom they feed early in their lifecycle.

So whats the story with ticks and why is it so relevant to this COVID19 dominated moment in history?

Tickfest


For one thing, there are now lots more of them.

My go-to place for birdwatching is the Tavy estuary, accompanied by Zola (see pic), yet this beauty spot is now out of bounds. After finding Zola covered in several ticks after every walk there, I must save the joy of that place for mid-winter only.

After the long journey from where they land to their favoured locations on Zola's bare skin around her eyes and mouth, they insert themselves for the long bloody feast. Thankfully she seems unbothered but they drive some dogs mad with itching. 

The Ticks clearly know what they are doing and have evolved to do it well. They travel upwards till they hit bare skin, for a hairy dog that's around the head, though anywhere they can get to skin will do. 

They like humans too. While scratching an itch the other night I found one of the little critters happily dug in for the long haul. Nicky's nursing skills and a Tom Tick Twister did the rest. I shall leave it to your imagination as to where it decided to stay, but its not the first time I have had a tick in my nether regions!

Their spread was recently confirmed by the experiences of moor loving friends, one of whom has to visit the doctor to have dozens of them removed after a camping trip on the moor.

Its clearly festival time for ticks!

Tick lifestyle


It all comes down to the ticks lifecycle. In a sentence this involves jumping from one animal to another, sucking blood at every turn, thus spreading infections between one host and another. 

Rather like sharing needles with other species! Their amazing lifecycle is worth understanding.

From eggs, they hatch into larvae which latch onto small animals like mice and reptiles, feed till full, drop off, moult and become nymphs

These too then find another host on whom to dine till full, drop off, moult and become adults.

Adults, being larger, can crawl up grass and lie there waiting for a larger animal to brush by. They latch on, feed again, drop off, mate with any males in the area, lay about 5000 eggs and die. 

Off the cycle starts again with many many more larvae emerging to enjoy the warning weather and wait for a unwitting passer-by.

Simple, beautiful biology. Heres a picture of the egg to egg journey from the American Center of Disease Control.






This lifestyle also happens to be perfect for sharing any bacteria or viruses from the creatures on whom they dine, including us.

As with mosquitos, their mouthparts are like little hypodermic needles and so are the perfect disease generating vector. Don't blame the ticks, all they want is lunch. The culprits are that unknown reservoir of pathogens which are a part of the natural world yet cause mayhem when they spillover into ours. 
Tick Prevalence
Remind you of the origin of COVID19? Indeed.

Ticks travel well. They can hook onto migratory birds and beasts, travel on pets and traded animals and have thus spread around the world.
They are hardy too, able to survive cold and heat and even submersion in water for days and in between their feasts they use almost no energy. Like a spider that just waits for months for a meal, they can survive for very long quiet spells, just waiting.

They breed well too, each adult laying 5000 eggs many of which survive and begin their own parasitic lifestyle.

So what diseases do they bring?

Lyme disease.


While I did not have many consultations for ticks in my urban practice, the subject did come up as more people became aware that caution after a Tick bite is a good idea. 

When I was diagnosed with MS, I thought I'd better not make a fool of myself by missing Lyme disease (whose later stages have many symptoms similar to those of MS), as I had been bitten by a quite a few ticks though never with a rash or consequent fever. All tests thankfully negative. Leaning more about Lyme disease was sobering.

If you see this, see a doctor
Lyme disease is named after a town in the USA where is was first noticed as recently as 1975. It's caused by Borrelia burgorferi, a bacterial fellow traveller with Ticks, and one of a class of bacteria called Spirochetes, so is distant cousin of Syphilis.

If a Tick is infected, and in some US states more than half of them are, then you may get infected after a Tick bite. The first stage of Lyme disease features a flu like illness and a rash which sometimes though not always, heralds the infection. This can appear from 3 days to THREE MONTHS after a tick bite. Even if you cant remember a tick bite, a rash like this means a trip to the GP.

Indeed any symptoms after a tick bite means a call to the Doctor. Further, because Ticks can bite, feed and depart without you even knowing it, a rash like this, or odd symptoms might be due to Lyme disease even if you can't remember being bitten. If you live in an areas where Ticks are prevalent, this is important to bear in mind.

Like Syphilis, it causes a milder flu-like initial phase, then a secondary and final phase as it impacts around the body, This is thankfully rare, but shows the importance of early recognition and treatment after a Tick bite.

Treatment

It is treatable with antibiotics, and the earlier the treatment the better. A vaccine has been developed to which ran into problems typical of the difficulties of modern new vaccines development. 

The vaccine, LYMErix, was withdrawn in 2002 after a class lawsuit rendered the vaccine unprofitable. The scientific consensus suggested that the vaccine was safe, with far more benefits than side effects, but the presence of some side effects and the medio-legal quagmire in the US means it is hard to see vaccine developers having another attempt. This represents the loss of a very useful method of managing Lyme's disease.

UK Lyme disease cases 2001-17
It is now found in all US states and has travelled around the world, even to Antarctica. It now infects 300,000 people in the USA every year, is the most common vector borne disease in Europe and dare I say it, has rightly been called a pandemic.

Of course, the Tick just goes about its business of reproducing, they don't choose which organisms join them on their journey.
So might it be interesting to look at what other diseases they bring with their dinner? I'm afraid so......

Other tick borne illnesses

Once again I get a feel for the incredible reservoir of microscopic life out there and our changing relationship with the natural world we are so changing.

Without going into excruciating detail of the individual illnesses the Ticks transmit, around the world, their fellow passengers cause: 

  • Rocky mountain fever
    Rash of Rocky Mountain Fever
    From Wikipaedia
  • Queensland tick typhus
  • Finlanders Island spotted fever, (Australia)
  • Ehrlichiosis
  • Babesiosis which comes from protozoa. 
  • Powassan virus
  • Crimean Congo Haemorrhagic fever
  • Alpha-gal syndrome which leads to allergy and anaphylaxis to meat.
And in other animal hosts:
  • Ghost moose with emaciated animals ill due to thousands of feeding Ticks
  • Swine fever, which infects pigs
  • Canine piroplasmosis, which infects dogs
For a recent review on tick borne diseases, click here, but for me, one other significant illness comes to mind:

Tick borne encephalitis

This is caused by the unimaginatively named Tick Borne encephalitis Virus (TBEV) and can cause significant neurological illness in humans with a mortality of 1-2%. It has been present in Eastern Europe since the 1930's and has now arrived in the UK, having been found in Ticks in Norfolk, though has not directly infected humans in the UK, so far. It seems just a matter of time.

For those working in forests the risk is one case per 10,000 hours of woodland work. It is common enough in affected areas for science to have come to the rescue with a vaccine available to travellers to endemic areas and woodland workers.

Public Health England consider the risk to the public to be very low as it is, but TBE is clearly on the horizon. I see no reason why it should not become more common.

So, what to do about ticks?


Don't get bitten.


I can talk! I have had lots of visitations from Ticks, but now feel I will do better. Wearing long trousers in the woods helps; keeping away from areas known to be riddled with them in the warm seasons might be a good idea too. 

Brush any off that might be climbing up your skin or clothes or on your pets.

If you do get bitten.

Be aware that you won't notice the bite. When hidden from view they can feed for some time without you noticing their presence at all. Itching might give the game away, but I had a whopper on my back which felt like a skin polyp before my wife spotted it. 

How do they manage to do this?

Cleverly, they spray an anti-inflammatory onto the skin before hooking on, so you will not feel the bite. It means that they can bite, feed and drop off without you even knowing it.

Without this, you would feel the bite and brush them off, and they would remain hungry and die out. That they have evolved this mechanism speaks of the wonder of evolution!

If it's too late and you notice an embedded tick, you can remove then as described on the website of the excellent Lyme Disease Action group. The manufacturers also have a video showing exactly how it's done. If you haven't got one of these little tools, and live or visit tick infested areas, then get one.



Tom Tick Twister


This is really important: if you get bitten and remove the tick, put it in a container, and keep in in the freezer for at least a few weeks. This means that if you are unlucky enough to get ill, then knowing the species of tick and its contents might be useful to know.

If you don't get any symptoms then you can take part in Public Health Englands scheme for tick survelliance by sending the tick to themUnfortunately, they don't test for the pathogens the tick carries, but doing this can help them keep track on what is going on.
 

If you get ill after a tick bite.

Any rash, fatigue or cold or flu like symptoms after a Tick bite means a trip to the doctor to consider the need for treatment with antibiotics. There is a blood test which can diagnose the acute illness though treatment should be started immediately while the results are awaited if the rash is present, or if you feel unwell. There are also blood tests to discover if you have been infected in the past.

The Tick Pandemic.

I had intended this to be a light hearted, COVID free post, prompted by my latest brush with Ticks. Yet a closer look at the world of Ticks bring me right back to the modern world and the problems caused by our troubled relationship with nature. 

There is undoubtedly a global pandemic of Ticks going on with the health impacts dependent on the pathogens they happen to bring with them in your particular area. They cross borders and spread globally, are increasing in number and carrying more pathogens.  

It's not hitting the headlines of course, but this in only due to its background spread and its carriage of many different pathogens, not just one.

Why is all this happening now?


1. Climate change means more Ticks are active for longer

Warmer shorter winters mean that the tick season is getting longer and their territory is expanding. This is a global phenomenon, with ticks and their passengers spreading, for example, from the US to Canada who have recently reported a 14 fold increase in cases of Lyme disease.

It is evident here too with ticks noticeable on Zola for most of the year, and spreading from Lopwell up the river Tavy to Denham Bridge and onto the moors. Further, they only lie dormant with subzero temperatures and without this they will be active thought the year even if the do really prefer the summer. 

Warmer temperatures also mean Tics bite more aggressively.

This is climate change in action. No longer a warning - a consequence.


2. Species loss means more Ticks and more Tick related disease.


Species are disappearing at an alarming rate and this is changing the balance which kept Lyme disease quiet for humans till now.

High biodiversity reduces transmission to humans, but now with less species around, the Tick brings, and so any infections of mice and deer hosts are coming more and more into contact with humans. Suburbs are impinging on forests and deer, without any significant predators are increasing in numbers. Our huge number of pets also have a big role to play is the success of Ticks.

A Tick wont jump from dog to a human, at least not most of them, but they will drop off the dog, lay 5000 eggs somewhere very near and then start their life-cycle with all their bacteria and viruses on board. 

More ticks, more mice, more deer and dogs, more human bites, more Lyme Disease and the rest. The romantic might see it as "nature fighting back", but nature is indifferent. 

The pattern is entirely logical and predictable.


3. Globalisation means a new Tick is coming to your area


Just like COVID19, all you need is one person, or pet, or animal to travel from one area to another with tick on board too, for a tick to spread globally. And that is what has happened in the USA. 

The Asian Long-horned tick has been found on sheep in the USA and doing well for itself there. It brings with it many strange and exotic viruses and bacteria which have infected
 livestock, and is known to carry pathogens causing an emerging deadly hemorrhagic fever. 

So far no cases in the US, but is it just a matter of time? 

It can reproduce without the inconvenience of mating, producing 2000 eggs containing clones of itself every six months. Thus it has rapidly spread across the USA. Watch this space!

Another example of this occurred in Mexico. In 2018 an outbreak of Rocky Mountain Fever caused by the bacteria Rickettsia Rickettsii delivered by the brown dog tick, led to 7,000 cases and hundreds of deaths. Thankfully, it can be treated with antibiotics.


4. Tick evolution- they are getting smarter.

The more ticks contact humans deer and dogs, the more those Ticks will reproduce. This creates an evolutionary pressure which means Ticks are coming far more into our lives. In the US, species have become more likely to attach themselves directly to humans and this can be seen as a marker for what is happening around the world.

This is not going to get any easier.

The final words


Just as I end this post, a tick drops off Zola and onto the floor. I now think of biosecurity. I crush the little critter between a sheet of paper with care not to contact any of its blood. Then into the bin and from then to its ultimate incineration in Plymouth. No 5000 eggs from that one!

Perhaps I should have worn gloves and eye protection? What bugs were in its blood? Would they be able to jump from human to human? Should I self-isolate? Notify Public Health? 

Ring any bells?? 

The story of Ticks mirrors the story of Sars-Cov2-19. Instead of bats, think mice and deer and instead of pangolins (or some other vector) spreading the disease to humans, think of Ticks doing the dirty work. 

Globalisation, habitat destruction and climate change are changing the world. The chaos of COVID19 shows how unprepared we are for biological threats, Tick borne diseases do too.

Yet, COVID19 might well go away or become a part of life, like flu. Ticks however will not. Even if richer nations are able to treat some (though not all) of the tick borne illnesses with antibiotics or prevent them with vaccination (occasionally) we are behind the curve when it comes to rapid diagnosis and treatment or Tick borne illnesses.  

All around us species from the tiniest viruses to bacteria, and bats are evolving fast and we are not only driving this evolution but barely keeping up with what is going on. We are only now becoming aware of how little we know about our global ecology which gives us our life and which can also take it away.

These manifold, incredible creatures are not moving into our habitat, we are moving into theirs

The warnings are over, the consequences are here.

We need to adapt and adapt fast.

Want to know more?


There is an excellent series written by Alex Bhattacharji which will take you further into the world of Ticks and many of the links in this post will also help you expand your understanding.

That is if, like me, you are hooked!