COVID-19: MOBILE TESTING DAY 3 - THE TEST

I had a swab test today.  I hadn't booked, but was invited when I talked to a staff member at the mobile testing station.  This had been set up temporarily in a car park at the back of my local Tesco's.  This was on day 3 of their visit.  Here is Day 1 and Day 2.


I was promised the result within 24-48 hours, as processing the test in the lab is complex.

Update Monday 31st: Result through as "Negative".  15.5 hours turnaround overnight.  Very good!  Here's some of the email I received, from which relevant parts are written out below:

THE RISK OF FALSE NEGATIVES

A negative result is good news.  But is it correct?

We know that swabbing done by a trained professional can result in false negatives of up to 30%.   The test processing is reliable, but swabbing isn't.  "It’s a swab that requires some experience to do well". 

In my case, I had to self-swab.  Untrained, I'd probably be less effective at swabbing.  Higher risk of false negative. I'll be better next time (if I really develop symptoms), but could have done with a practice run this time with a spare swab.

The instructions had been written for the main testing stations, where people tend to arrive by car.  Sometimes a professional will do the swabbing there, but the instructions were for self-swabbing.  Small typeface, poor diagrams.  Illegible, without my reading glasses . Could have done with page headings, such as "Preparation" and "Swabbing". Good job I was supervised.

I haven't seen the instructions for self-swabbing at home.  But without someone to supervise, even more chance of poor swabbing and false negatives.

"Touch your tonsils with the swab" I was instructed.  Sadly I had them removed age 6 (and that's another story!). Was what I did right?  Then up the nose.  Again done correctly?

As I said, I could have done with a practice swab.  Often people want to gag when it is put down the throat, but it's no problem doing it twice.

I was also comfortable being in full view of passers-by, there were so few.  

In summary, I was simply unconvinced I had done it properly.


THE CONSEQUENCES OF FALSE NEGATIVES

The email I received advises I should still self-isolate for 14 days if "someone you live with tests positive or you've been traced as a contact of someone who tested positive."

However "If you're not a contact [of someone tested positive] you may return to work if you've not had a fever for 48 hours and feel well" or otherwise get back out living 'COVID-normally'.

At least until I show symptoms again, when I should "get tested and self-isolate for 10 days from when they start".

So it seems I should self-isolate for 10 or 14 days if there's any doubt.  I would also need to wait 2 days after fever or feeling unwell, which is a typical time for any other type of illness.

So that minimises the consequences of false negatives.  Provided people follow these instructions.  But what if they don't?  People on zero-hour contracts and the self-employed will tend to work through being ill, not only to avoid losing income, but to avoid losing their jobs.

Sweden's chief epidemiologist, Anders Tegnell, is against masks on balance for a number of reasons, one of which is that people might think it gives them a licence to go out and about despite symptoms.  This is a false concern:

• Anyone coughing or sneezing is immediately showing they are symptomatic.  The last concert I attended before lockdown was amazingly quiet.  Nobody dared cough like normal.  But if you've got COVID-19, you may not be able to help it.
• If someone has a temperature or just lost their sense of taste or smell, isn't it better that someone out and about should be wearing a mask to minimise the chance of infecting other people?        

SUPPORT ARRANGEMENTS

Asking people to self-isolate is a big ask, especially if they could lose income or even lose their job.  If they have young kids, how will they get them to school?  Will people take the risk?  Bet they would!


Scotland realised this all early on, and so their 'Test and Trace' was originally called "Test, Trace,  Isolate, Support", now known as "Test and Protect".  It includes "we will make sure that support is available to enable people to isolate effectively" meaning:

• "For some people, somewhere to isolate away from the rest of their household."  Studies have shown the obvious, that most infections are contracted from family and housemates at home.  Especially for the over-crowded houses often found for immigrants who are staffing our food factories, where there has been major breakouts.
• "Practical support with food and medicine"
• "Ensuring their physical and mental health needs are met. 
• "Any necessary financial support." subject to fudns from UK government.  These do not appear to have been forthcoming

In terms of food factories "The virologist said the virus remains on surfaces longer in the cold, it can be difficult to socially distance in factories and many of the workers may live together or not be keen to report symptoms as they need the work."  Just as I said.


England has just started a trial in parts of the north-west, where infection rates are high,to give extra money for "those those who claim Universal Credit or Working Tax Credit".But at only £13 a day, that's only £130 for a 10-day isolation or £182 for 14 days.  Better than nothing, but enough to make a difference whether people ignore restrictions?  Unlikely.


THE BASIC TEST PROCESS

Getting back to the basic test process, I was pleased that the result came through first thing this morning.  Yesterday would have been better.  But that would require a change of testing technology, albeit still likely to be based on swabbing.

As someone who has designed complex inter-departmental business processes, it takes real skill for Serco to screw up such a simple process.

Each person tested needs to be provided with just three pieces of information for them to complete their registration for their results on the internet:

• Test reference number
• Web site URL address
• Postcode of test centre, the first question the website asks

The test reference and the URL were on two different cards.  The postcode wasn't provided.  Postcode for a car park?  I typed in the first "outward" portion of the area.  No, wouldn't work.

Found a possible postcode, and all the sites were listed within about 10 miles.  Isn't the outward portion enough to list at least some of them?  It is on other websites.

Got there in the end.  But doesn't reflect well on the overall organisation of Serco's side of Test and Trace.


COST-EFFECTIVENESS

Each swab test costs around £100.  Presumably including lab time and personnel.  The total cost of testing must be enormous.  I would expect far better for this sort of money.

Clearly this level of expense is not sustainable.  There are cheaper tests in development.  But the only way of getting the need for testing down is to get the level of infections down.  Another reason to go 'COVID Zero' or #NearZero .



NUMBERS OF PEOPLE

Yesterday I was told "hundreds" over the 2 days.  Today I was told over 400 over the three days.  Not sure how many of these were actually symptomatic, given my own invitation.  But indicative of a major problem here nonetheless.

As discussed yesterday the estimate is that some 180 people are out and about infectious without realising it in this City, which is now on Amber Alert.

That's a mile away from #NearZero


IMPACT ON NHS STATISTICS

One question on the online registration is what is the postcode for the person tested, suggested to be where registered for a doctor.  It raises the question whether the NHS statistics for "new confirmed cases" are for the test location or this answer.  There's also whether cases identified first in hospital are recorded in the area of the hospital or the address of the patient.  I shall try to find out.

Increased testing also has two other impacts:

• Is any increase in cases, at national or local level, simply due to increased testing?  Clearly this will happen at local level when these mobile units are wheeled in.  But at national level, testing levels have remained pretty consistent during August.  But something to look out for.

• The total number of new cases has been estimated nationally at five times the reported "New Confirmed Cases".  This is mainly due to routinely only testing some of the people symptomatic, and completely missing asymptomatics who can still be carriers and infectious.  Identifying a higher proportion of these people means that the local figure at extra-test areas should be reduced to maybe 3 or 4.  But it may mean other areas need to be 6 or 7 to keep the national average.  That higher level is what would be expected if only symptomatic people are tested.

ON THE WAY HOME 

I've also been critical of the government's publicity campaign.  So it was refreshing to see posters up at the end of my road, looking like this:

Been there a while, by the looks of it, as it mentions Eid that was at the end of July.


IN CONCLUSION

Being tested is straightforward, but getting it right is difficult.  A spare swab to practice would be useful, plus clearer instructions. 

That would help to reduce false negatives arising from poor swabbing.  Whilst that isn't as much risk to people being incorrectly released into the community as I feared, that depends on whether people actually follow instructions to self-isolate when they should.  But false negatives would be a waste of £100, and understate "Confirmed Daily Cases".

The administrative process was not impressive, even when having been set up quickly.  Indicative of what goes on behind the scenes?

This isn't a process that could be scaled up to national level.  Reagents availability and testing cost would be prohibitive, if nothing else.  Wheeling in extra testing capacity like this would only work with far lower infection rates.  That's one of many reasons why we should aim for #NearZero .

COVID-19: WHY NOT RE-USE SURGICAL MASKS?

Waiting for a bus

This blogpost is a question for which I cannot find a suitable answer.  Can the general public re-use surgical masks, or if not why not?


WHAT ARE SURGICAL MASKS, AND WHAT ARE THEY FOR?

"Surgical Masks" (aka "medical masks") are the typically light blue masks made to the EN14683 standard.  They consist of a triple layer of material, typically melt-blown polymer, most commonly polypropylene, placed between non-woven fabric.  The tri-layer masks have been used regularly in South East Asia for years, especially during 'flu season to protect one another.  Masks can also be useful to filter polluted air.  Wearing of these masks by the general public certainly isn't new.


RE-USE OF SURGICAL MASKS

In an actual medical environment, surgical masks are used by front-line professionals.  In that context, surgical masks are regarded as single-use and should be disposed.

But is that necessary for the general public?

We ae advised that we can wash fabric face coverings and re-use them.  Why not Surgical Masks?  If they are better than fabrics to start with, why would washing them at modest temperature make them any worse?

There doesn't seem to be any coatings that could be disrupted by soap or detergent.  But even then the nature of the fabric would make them better than ordinary fabrics if washed.

Simple question.  Why no available answer?


ECOLOGICAL CONSEQUENCES

The use of surgical masks by medical professionals and the general public across the world is very good for the manufacturers and their supply chains fore and aft.

Mask down

But the sheer quantities involved are a drain on resources, and can result in a shortage for medical professionals.

There's also a growing problem in their disposal. We're all familiar with masks discard on roads and worse.  But the pressure  on landfill is also most unwelcome.


FINANCIAL INCENTIVE

I also have a personal objective.  My box of surgical masks is about to run out, and that's £30 for the next box if I don't shop around.  Surgical masks aren't cheap.

The mask in the photo above was one of three that I was given before I could buy my own.  I had to re-use the three masks, so hand washed them in rotation.  There was no obvious change in physical properties.  I can find no mention of coatings that would get disrupted by detergent or soap.  In any case, the basic construction would be better than simple fabrics.

So someone, please tell me.  Can the general public wash and re-use surgical masks, or if not why not?  Thanks.

COVID-19: MOBILE TESTING DAY 2

Yesterday I reported on the mobile testing unit set up in a car park behind my local Tesco's in Oxford.  I walked past it again today at lunchtime, and can report:

• There were 4 people being swabbed.  Male and female, younger and older adults, whites and browns.  COVID-19 is indiscriminate.  Out in the open, no privacy, but that's not too much of an issue
• The security guard told me there had already been about a hundred people tested today, and hundreds yesterday.  Difficult to know if that is an exaggeration.

I understand from a reliable source who has tried to book a test that they are only accepting people in two situations:

1. Symptomatic
2. Been contacted by a tracer from NHS Test and Trace who has asked them to get tested

The rules for a negative result include that the person tested should continue to self-isolate unless:

• "everyone you live with who has symptoms tests negative"
• "everyone in your support bubble who has symptoms tests negative"

This means two major problems:

• People who are not yet symptomatic don't get tested, unless specifically requested by NHS Test and Trace.  It is they who are out and about not realising they are infectious
• People returning from abroad don't get tested until become symptomatic.  Depending on the country visited, they are supposed to continue to self-isolate for 14 days regardless.  That is grossly unfair if not carrying COVID-19.

Effectively tests are being rationed, I imagine for three reasons:

• The reagents are in short supply
• There is only so much lab capacity and staffing
• The tests are expensive.  The Financial Times suggests £100 a test using current testing methods, which may only be reagents and swabs.

INFECTION RATES

As at 21 August, Oxford was 17th highest for new infections on the list of English towns, cities and districts.  It has officially been placed on Amber alert.   The data for the last 7 days, as below, suggests 40 new cases in Oxford localities, but rather oddly 1 or 2 cases in each locality are not counted.

So let's say 44 in the last 7 days, or 6.3 per day.  That's 28.9 cases per hundred thousand per week, 4.1 a day.

These daily figures, derived from usual testing arrangements without the mobile units, need to be multiplied by at least 5 to reflect:

• Not all symptomatic people get tested, possibly only 1 in 3
• Swabbing, especially self-swabbing, creates false positives up to 30%
• Asymptomatic people, who can still be infectious, are at least 50%

If we then assume that people are infectious for an average of 5 days before they self-isolate, 6.3 x 5 x 5 is maybe some 160 people infectious out and about in Oxford.  These are not tested and not realising they are infectious.

If hundreds tested at the mobile testing has been the case, even if exaggerated, there may be an even higher level of COVID-19.  It typically takes 5 days to display symptoms, so we know results are about a week behind the true rate.  There could truly be a major COVID-19 problem in Oxford !


ADVANCES IN TESTING

Currently tests are carried out using a complicated technique using RT-PCR technology.

By coincidence it is an Oxford University spinout Oxsed Limited that has developed a test using RT-LAMP technology that can give results in minutes at under £20 per test. Currently being evaluated

Other acedemics and commercial businesses across the world are also trying to improve testing.  The holy grail is to be simple, quick and cheap enough to support mass testing at home of everybody every few days, or even daily.


News from the USA is of "inexpensive paper-based test ...described as being similar to at-home pregnancy tests".  There are at least three such developments.  Watch this space as such tests would be transformational. "As long as those testing positive stay home, a cheap, at-home testing regimen has the potential to provide a kind of artificial herd immunity, interrupting enough transmission nationwide to cause the pandemic to stall."  As effective as vaccines.


IN THE MEANTIME

From a personal perspective, I need to protect myself:

• I have a simple rule not to go inside premises unless essential, such as for food or to buy a drink to then sit out in a pub garden.  Going to be more difficult as summer turns into autumn

• I have bought a small bottle of 60% alcohol sanitiser.  Tesco's provides this to wipe basket and trolley handles at the entrance, but the local Co-op Food doesn't.  Other premises often provide anti-bacterial sanitisers that are ineffective against the virus that causes COVID-19

• As I leave the house I wear a "surgical mask" to the EN14683 standard.  This is primarily for source control, to reduce the chance of someone infectious infecting someone else, but is also regarded as providing a little protection to the wearer.

• In the context of viral transmisison in "aerosols", clouds of microdroplets that can float across rooms, I am also looking to buy a visor to provide myself with some extra protection.  That matches what is now expected of hairdressers, and often seen worn by people serving in restaurants. Not easy to source, but must be available.

IN CONCLUSION

Oxford has a major COVID-19 problem, and is on the verge of a local lockdown.  This is a problem in many towns and cities across the UK.  I'm taking personal precautions.  But unless everyone realises the risks to young and old, and takes COVID-19 seriously and adopts precautionary measures, we won't be able to keep schools open, nor properly re-open the economy.

I've said it before and I'll say it again and again.  We need a #NearZero policy and strategy, similar to but more pragmatic than ZeroCOVID, plus a far better public information campaign.

Here is Day 3, when I got tested.

COVID-19: ENGLAND'S FIVE STRATEGIC OPTIONS

I have a confession to make.  I love music.  Playing music.  Listening to live music.  Dancing to music.

My daughter is a professional dancer.  Or would be if there was any work.  She's supposed to be on a cruise ship.  Many of my musician friends are also struggling, whatever their genre.

We all want live music to re-start.  And stay open.  But how?

It's not just live music and theatre.  We want schools and universities to re-open and stay open.  We want the economy to recover.  We don't want to die.  If we survive, we don't want LongCOVID either.

So how can England achieve all these objectives?

We looked at strategies here, four weeks ago.  But that's a long time in the battle against COVID-19, so now it's time for an update.

There are essentially 5 types of strategy.  Let's look at them in turn:

1. Herd immunity
2. Voluntary restrictions
3. Living with low-medium levels of infection
4. Strict Zero
5. Near Zero

HERD IMMUNITY

The idea of 'herd immunity' is that if enough of the population is immune, if someone becomes infected it will be more difficult to find anyone else to infect.  The R number would naturally drop below 1, and the infection die out.

Remove all restrictions, let people get on with their lives, and the disease will disappear. 

That's fine in theory, but to do it naturally without a vaccine, there are some serious drawbacks:

• It would take years at any reasonable infection rate
• There are major 'costs':
• A lot of people will die early
• An awful lot of people will suffer from LongCOVID
• Absenteeism through illness (and worse) will make it difficult for many organisations to function
• The health service would be overrun
• Resulting in services for cancer etc being unavailable

The result would be that society as we know it would likely be destroyed.

Usually herd immunity is achieved through use of a vaccine.  Indeed there is hope for vaccines, with well over a hundred initiatives worldwide, using at least four different basic approaches.  But there is still no guarantee that one or more will prove both safe and effective.  Like flu vaccines, an annual booster may be needed, to prolong immunity and cover new mutations of the virus.  We'll have to see.

In any case, a vaccine won't be available properly tested and in bulk quantities until next year, 2021, at the earliest. 

Restrictions could be avoided if there was a medicine that safely and reliably either:

• Avoided anyone catching the disease
• Avoided anyone getting serious symptoms, and/or
• Improved survival rates, without LongCOVID

There are some developments set out here, with some extras such as these since that was written. 

But no drug or other treatment has yet proved good enough.  There was certainly nothing suitable around in February or March

So no country has adopted a pure restrictions-free 'herd immunity' strategy. 

But if individuals ignore the virus, and carry on as if it wasn't there, they are effectively contributing towards a herd immunity strategy.  Undermining whatever other strategy is officially in place.


VOLUNTARY RESTRICTIONS

The most liberated strategy is that adopted by Sweden.  They have basically let schools and businesses carry on with two major restrictions:

• Prohibiting large gatherings over 50 people.  So little traditional indoor or outdoor entertainments
• Closing schools for over 16s, who are effectively adults from a viral perspective

Their justfcation for this approach is that COVID-19 is going to be with us for a very long time, and people cannot be expected to comply with restrictions imposed upon them for very long.  That is exactly what we see happening in Spain and elsewhere in Europe, where initial restrictions were very tough.  Easing restrictions has resulted in a very sharp rise in infections.

Sweden's populace did a voluntary lockdown, for example cutting travel as much as their Scandanavian neighbours.  But death rates have been higher, although eclipsed by Spain and others in deaths per million.

The restrictions mean it cannot be said to be a 'herd immunity' strategy, and their Chief Epidemiologist Anders Tegnell has made that clear.

Other aspects of their strategy have been more contentious, especially about wearing masks.  His view in this interview is this: "Everything tells us that keeping social distance is a much better way of controlling this disease than putting masks on people. We are worried (and we get at least tales from other countries) that people put on masks and then they believe they can go around in society being close to each other, even going around in society being sick [unwell]. And that, in our view, would definitely produce higher spread than we have right now."

It's a view, though many would disagree.  Indeed internally in Sweden there is growing pressure to increase the controls, such as wearing masks.

In the meantime Sweden is seeing infection rates fall as if they had almost reached herd immunity.  This maybe because of 'cross-immunity', but the evidence is not yet strong enough to suggest other countries should follow suit with the Swedish approach.


LIVING WITH LOW AND MEDIUM LEVELS OF INFECTION

The BBC have today published this graph of new confirmed cases:

This shows a rising trend in infections, which in August is no longer explained by a rise in testing capability.  This is a real rise which has reached a 7-day average of 1,190 per day in the UK.  This is inherently understated by a factor of about five, as explained here.  So a better estimate of infections is some 6,000 a day, around 9 per hundred thousand, and rising.

A 'very low' level is 2 per hundred thousand, as discussed below.  The UK is currently at a 'low' level.   Elsewhere the rates are higher than that, at what can be regarded as 'medium'.  Here's a graphic compiled by the Guardian from data from the European Centre for Disease Prevention and Control in early August.

The figure for the UK is more than double my daily estimate, as more than 10 times UK official figures, so these figures are likely to be per week:

Across Europe this means:

• Some restrictions are still in place in every country
• Attempts to ease restrictions are being met with an increase in infection rates, as seen in the UK and throughout Europe
• For countries that have attempted to reopen schools, some are getting infected and having to close again.  Open, close, open, close, etc obviously isn't good.
• Parents are not confident about sending their children to school.  The risk to them may be very low, but the risk to teachers, parents and other adults is a real problem for community infection levels.
• Many people are not confident to go to workplaces, especially if that involves public transport.  
• Those people who have been shielding are not confident about going out
• As a result, businesses are still struggling.  The economy isn't recovering as fast in the UK as would be liked

This part-open, part-closed merry-go-round isn't working.

In particular night-life is best-part closed.  Some events are taking place outdoors, but as the summer ends, getting indoor venues open is a real challenge.

The Night Time Industries Association, which represents they say 6% of the UK ecenmy and 8% of jobs, is not going to let that stop them.  Their latest report "Nightclub and Venue Re-opening Strategy" says:

Only just now a friend said he was thinking of going to an illegal rave, where there would be no controls, until I told him about the new penalties starting today in England. As the BBC say "Those who attend gatherings and those who do not wear face coverings where it is mandatory can be given a £100 fine, doubling on each offence up to £3,200." "Police in England will be able to fine organisers of illegal gatherings of more than 30 people such as raves up to £10,000".

Update 31/8/20: The first £10k fine was given to organisers of an illegal rave in South Wales over the weekend (29-30 August), inolving some 3,000 revellers.

There is a hell of a lot of frustration brewing amongst younger adults.  Maybe because they don't fully understand the risks of COVID-19.  Unless something is done soon, this isn't going to end well.

ZERO COVID / STRICTZERO

New Zealand recently celebrated 102 days without a single person getting infected with COVID-19 on New Zealand soil.  A couple of British ladies had brought COVID-19 into the country in June, but there wasn't any onward transmission.

Restrictions had been lifted, entertainments could restart, and people could hug each other again.  Life back to normal.  Hurrah!

Then a family of four were tested positive in August.  With the “go hard, go early” strategy for the virus, the government put Auckland into lockdown the next day, banning residents from leaving home for non-essential reasons.  That's some 1.6 million people for an outbreak that affected less than 100 people in all.


Even New Zealand's geographical isolation and their strict quarantine arrangements for people arriving from abroad, the virus had still got through.

Maybe people would accept a hard lockdown again once, maybe twice.  But surely they can't keep going into full lockdown every time there's an outbreak?  There will be other outbreaks.

If this SARS2 was like MERS, another coronavirus that has been known to kill one in three people who are infected, then New Zealand's strategy would be absolutely essential.  Indeed should a SARS3 or SARS4 come along that was both highly infectious and highly murderous, then there would be no hesitation in adopting New Zealand's strategy.  Why it is so important to find a vaccine against SARS 2 that would potentially provide immunity against future more murderous variants.

But SARS2 is not as dangerous.  Whilst New Zealand's strategy has worked so far, is it sustainable?  Somehow we need to live with the virus whilst opening most if not all of society.  Including nightclubs and entertainment venues where large numbers congregate indoors.


#NEARZERO

So we've concluded:

•  'Herd Immunity' is not achievable in reasonable timescales without a vaccine, which is not available yet.  In any case there are substantial drawbacks.  Such a strategy with limited controls would result in health services overrun with consequent detrimental affect on services for other ailments such as cancer.  Deaths and LongCOVID numbers would go through the roof. 
• Sweden's approach of voluntary lockdown has its merits.  But is being heavily criticised internally, and has not yet been shown to be suitable for other countries.
• Low and medum levels of infection, as in UK and most of continental Europe, makes it difficult to open all the economy, especially Night Time.  Schools are likely to have to close periodically, and generally life cannot function as it used to.
• A 'Zero COVID' strategy like New Zealand has been following has its attractions, but it's unlikely that it is sustainable.

So what do we do, in England and indeed throughout the world?

Back at the start of May the two co-chairs of the SAGE group of scientists suggested a 'very low' level of infections was appropriate.  That was understood to mean under 1000 new infections a day, being around 2 per day per hundred thousand.

Given the people tested is far less than actually have caught the disease, by a factor of about five, that's 2 per 5 days of official new confirmed cases.

This 'very low' level would be transformational:

• The chances of meeting someone else infectious would be much more acceptable.  In a town of a hundred thousand people such as Watford, only 8-10 people would be out and about infectious, instead of 40-45 with the UK average now.  That's if we assume 4-5 days' worth of people out and about infectious without knowing it. 
• Schools could reopen and much more easily stay open.  Even in Scotland, where infection rates are lower than England, schools are starting to have schools disrupted.  Universities too, more difficult as students are susceptible to COVID-19 as young adults.
• Everyone including those who have been shielding could go out with more confidence
• Public transport could be used freely, albeit better with masks.  A special problem for schoolchildren and students
• Offices, factories and other workplaces could be used with little chance of outbreaks
• Deaths and LongCOVID would be far less than at current infection levels
• The Night Time economy could readily implement the NTIA's recommendations 
• Testing would be at a far more sensible scale.  
• The economy could thereby recover.  Indeed the current level of infections is holding us back economically.

There would need to be some fairly strict arrangements:

• At the first sign of an outbreak, testing would need to be wheeled in, backed up by appropriate tracing and isolation support.  It's possible like we've seen in Oxford just today.   
• Control over incoming people and goods:
• Visitors from abroad, including returning citizens, would need to be carefully tested and quarantined.  Better than currently.
• Goods, foods and other objects brought into the country would need careful attention, if there's any indication that could be route for the virus to enter

GETTING TO #NEARZERO

So how do we get to that 'very low' level?   A second lockdown perhaps?  The first lockdown reduced infections to a sixth of peak levels in just three weeks , which is more than would be needed to get current UK levels down to 'very low'.

But would it be that simple?  European countries also now have far further to go.  Being geographically close, we're all in this together.  Certainly if infections are beginning to rise, the sooner action is taken the better.

A further discussion of #NearZero and how to get there is here.

COVID-19: MOBILE TESTING DAY 1

Oxford has a problem.  Daily infection rates have been rising at a disconcerting speed.  As of 21 August, the City was 17th highest in the country, after Oldham, Leicester and a few others.

The response has been to set up mobile testing stations in the car park behind my local Tesco's, for the next three days at least.  I was going to pop in to the shop anyway, so dropped by to have a chat with the staff proudly wearing their NHS Test and Trace weatheralls.

The folks from Serco had arrived in unmarked white vans, and set up several gazebos in the rain, with boxes of swab kits.  Swabs are then sent off to labs for processing.

The first thing they confirmed is that they are only doing "Got it" tests, not "Had it" antibody tests.  They want to find out what's going on with infections now, and get relevant people to isolate.  Presumably then follow up with tracing contacts.

The second thing is that the test involves self-swabbing with two swabs:

• 10 seconds tickling one's tonsils
• 10 seconds up the nose

The person I spoke to couldn't advise on false negative rates.  But false negatives have been known to be up to 30%, even when done by medical staff.  Could be higher if self-swabbing.  At least people tested here are supervised, whereas testing kits sent to people's homes are not supervised.


CONSEQUENCES

False Negatives

My concern about these tests, especially when self-swabbing, is that people with COVID-type symptoms could be released into the community as apparently uninfected.  Indeed the official guidance allows that, with a number of provisos.  This is discussed in more detail for Day 3, when I received the official Negative test result.


Accuracy of "New Confirmed Cases"

The official PHE statistics on testing for daily "New Confirmed Cases" from NHS Test and Trace are inherently understated:

• Not everyone eligible for a test gets it done
• False negatives, as above
• Asymptomatic people are not eligible to be tested.  They can be infectious.

At the country level, comparison of PHE statistics with those from other studies suggests that official figures need to be multiplied by around 5 to get a more realistic estimate of total daily infections.

Where local testing makes it easier for people to get tested, the multiplier would be expected to reduce.  The estimate is around 4 times the local figures.  Still significantly higher than the basic figures reported.

Furthermore, when consdering the number of peope out and about infectious, we should assume that not everyone who should self-isolate does so.


Interaction with National Testing

As set out here, a national testing programme at the scale that would be required would be ridiculous, both from practical and financial angles.

So the focus of testing must be these mobile teams visiting hotspots.   But the need for them must be the exception.  That can only be done if general rates are far lower than they are now.  As part of a #NearZero strategy.

Here are the updates for Day 2 and Day 3, when I got tested.

COVID-19: POISON

The key problem with COVID-19 is that people who are infectious often don't know it.  They can be living life as normal, and be either:

• Pre-symptomatic:  It typically takes five days (2-14) to display symptoms.  During that time it is thought the person can be more contagious than after they start to display symptoms.
• Asymptomatic:  They are carrying the disease but for some reason they do not develop the standard initial symptoms.  It is unclear to what extent they can be infectious, but quite possible during the time they are fighting off the virus.  Maybe longer.

On that basis the estimate is that the number of people out and about infectious, but not aware they are, is around four to five times the daily infection rate in an area.  In turn that can be as much as five times the official 'confirmed new cases' rate, for a combination of reasons set out here.

So that's 20-25 times the official daily figure in an area.  10 new infections a day is 200-250 people out and about, unaware they are infectious.


COVID-19 AS POISON

COVID-19 is like a poison.  It can make someone very ill initially, confining them to bed for some days, and then potentially making them seriously ill.  Death is a possibility, with a higher chance of ongoing symptoms, referred to as LongCOVID.

Whilst there are ways to alleviate symptoms, there is no known cure.  Not yet.


POISONERS

On that basis, anyone infectious would be a poisoner.  Unwittingly if they are not displaying symptoms.  Friends, family, strangers.

The problem is we don't know which person is a poisoner and which isn't.  Could it be me?  Meeting people is like playing Russian Roulette, but with different odds of the various risks.

The only way we can protect ourselves is to treat everyone as if they were a poisoner. Especially indoors in crowded places, be that a pub, a workplace, a train, or wherever.

This isn't much different from regarding everybody as a potential pick-pocket or mobile phone thief.  We take basic precautions.  Except it's not just strangers, it's people we know and trust too.

If we going to beat COVID-19 and get back to some normality, we've got to get daily infection rates down.  Taking better precautions because other people could poison us is going to be vital,  As is protecting others from ourselves.  "I look after you, you look after me."

"On pain of death"

That's applying the simple rules we know:

• Social distancing.  2m better then 1m, further if possible.
• Wearing masks to stop viruses escaping an infectious person on water droplets
• Washing hands and not touching mouth, nose, or eyes
• Sorry guys.  Less of that hugging and kissing!

'Poison' may sound too strong.  But no.  If we adopt the attitude that COVID-19 is like a poison, but still get on with life, we can beat it.  But if we carry on as if there are no risks, or 'it won't happen to me', the disease is going to blight our lives as a society for years to come.

Poison.

COVID-19: WINNING THE BATTLE AGAINST FAKE NEWS

"Fake news" has become a major term in discussion of current affairs.  It is a major barrier to dealing with COVID-19.

I have just carried out an analysis of official data on deaths published by the Office for National Statistics.  They count the death certificates, and also analyse the data by age, gender and reasons.

Taking the total number for the first thirty three weeks of 2020, and comparing it to the equivalent totals in the last five years, we get a comparison that is accurate.  As close to a fact as any fact I know.  Fact.

Yet I've had someone say it is "fake news", an acquaintance say it's part of a conspiracy and there's "better data" (as yet not forthcoming), and others question whether it is just my opinion.   But the data is fact.

Yes we need to question what the causes of death are, and why the specific trends have happened.  That is a matter of opinion, and there may need to be some debate over them.  But a scientific education has meant understanding the difference between primary and secondary effects.  So if deaths were up by two due to the alignment of Mercury and Uranus, or some such matter, that's of little interest.  The dominant factor in 2020 has been COVID-19 without a doubt.

In each case their resistance to the facts has been because they have established a position from wallowing in fake news, and by making false conclusions.  That position often becomes more entrenched by arguing with them.  They dig their heels in. That happens with a view on any matter, not restricted to COVID-19.

Now that's all well and good.  Let them have their opinions.


SO WHY DOES THIS MATTER?

But if we are to win the battle over COVID-19, it can't be undermined by people arguing in public against the facts and well-guided opinions.

Yes we need to discuss the worth of different types of masks, for example, as the experts don't all agree. But the list of risks of COVID-19 should not be in doubt if properly communicated.

Yet the government's public information campaign has been utterly dreadful.  Do this, do that, often contradictory in recent weeks. Little if any explanation.  I still meet people in management positions at premises unaware that COVID-19 is caused by a virus and that is different from a bacteria.  For example, hand sanitisers need to be over 60% alcohol, but many anti-bacterial ones I see in use aren't.

Getting an actor to sneeze

In this video age, where are the public information videos the like of which were seen in the 1950s?  Even this one on coughs and sneezes from the Department of Health in 1945

That is the least we need to do to educate the public.  Common sense is based on experience, and has proved useless when people have not lived with such a virus before.  Education is a must if we are to beat COVID-19.

But any public information campaign will be completely undermined by a small number of people bleating their 'fake news' nonsense at every opportunity.  Whether that is on social media, in print or on the airwaves.

Step forward you communicators and change management experts.  The battle against COVID-19 will be so much easier if we can win the battle against the purveyors of fake news.

COVID-19: EXCESS DEATHS (to week 33)

There are three vital statistics in the fight against COVID-19:

1. New daily infections
2. Survivors suffering from LongCOVID
3. Excess deaths

New infections kick off the 'process' which leads to death or survival.  The number of daily new infections is therefore critical in managing COVID-19, and is covered extensively elsewhere in this blog.

The initial symptoms of COVID-19 often last up to 3 weeks.  But a significant proportion subsequently suffer from LongCOVID for 2 or 3 months or more.  The symptoms are of two main types:

• Lethargy
• Pain and other problems where the virus has attcked the heart, liver, kidney, brain, lungs and other organs

Statistics for LongCOVID are scant as yet, but is thought that this could become a bigger problem than death, especially for young people.  It is such a problem that a specific support group has been set up, which provides a host of resources to help 'longhaulers'.

But death is still a massive issue for COVID-19.  So this blogpost takes a closer look.  As there are issues with establishing cause of death, it is simpler and more reliable to look at "excess deaths".


EXCESS DEATHS

The Office for National Statistics (ONS) collects and publishes data from death certificates.

The reasons given on the death certificates are of two relevant types, as the ONS explains:

• "An 'underlying cause of death' refers to the main cause of death"
• "A cause being 'mentioned on the death certificate' means that it might be the main reason or a contributory reason to the cause of death."

The problem with both statements is someone has had to decide, and the methods used in different countries are not necessarily comparable.

A more reliable and comparable method is to track "Excess Deaths", which is simply comparing total deaths for 2020 against the average of the previous 5 years 2015-2019.

Graphing the ONS weekly data, on a cumulative basis for year to date, we get:

There are four distinct phases:

• 2020 started well, with deaths falling behind the average for the last five years until mid-March.  
• Then the excess rose dramatically through till mid June.  
• After this deaths have fallen slightly
• Until mid August, when they started to rise again

The total excess for 2020 at 14 August was 53,084.  But the total from mid-March to mid-June, covering the peak of the pandemic, is 59,345.


60,000 in round  terms.  This would have been far higher if there hadn't been a lockdown and subsequent restrictions.
 
Excess deaths take into account three aspects:

• Death from COVID-19 itself
• Any additional deaths indirectly caused, for example by not identifying other criticial illnesses as early as normal
• Any reduction in deaths indirectly caused, such as fewer road deaths as a result of less travel

Excess deaths is therefore a reliable measure of the net impact of COVID-19 and the nation's response.


WHAT ABOUT OTHER SPECIFIC YEARS?

Within the last five years, the worst total of deaths was for 2018.  Charting 2020 against 2018 and the five-year average, again on a cumulative basis for year to date, gives this picture:

This clearly shows total deaths for 2020 overtaking 2018, which wasn't that much different from the average.


BUT AREN'T DEATHS MAINLY OF OLDER PEOPLE?

This is true, but let's look at younger adults.

The basic ONS statistics only use seven age categories in 2015-2019, whereas there are bands of just 5 years for 2020.  For comparative purposes let's look at the 15-44 year old bracket.

Here are the excess deaths of 2020 compared to the average of 2015-2019 for the 15-44 age group, again on a cumulative basis for year to date:

This graph again shows four periods:

• 2020 started well, with deaths falling behind the average on January, but increased in February and March to levels seen in some previous years.  
• Then the excess rose dramatically through April, to a cumulative total of 254, being 5% higher than normal
• The lockdown had a more marked affect than other age groups from May to July
• Stopping the rapid rise
• Curtailing other dangerous activities
• Then in August, started to rise again when restrictions reduced

So COVID-19 looks like it killed some 250 more young adults than normal in the first wave, and the lockdown restrictions not only stopped the rise but reduced other dangerous activities.  Though excess deaths are now increasing as resttictions are reduced, such as pubs opening.


IN THE CONTEXT OF INFLUENZA

The BBC reports that 4,000 deaths from 'flu in the season spanning 2018-19 to more than 22,000 in 2017-18.

The ONS data used for the analyses above reports deaths from all respiratory diseases, which is a higher number totalling between around 40,000 and 50,000 a year.

Using thjis ONS data, in the four months from mid-March to mid-July, cumulative deaths from COVID-19 overtook the worst previous year 2018, despite the lockdown's restrictions.

Had there not been a lockdown, it looked like hospitals would have been overrun, and deaths from COVID-19 would have exceeded the usual level of all respiratory diseases by a big margin.  Again on a cumulative basis for year to date:

IN CONCLUSION

By looking at cumulative numbers, as we've done above, we can see the total impact of COVID-19 on deaths in England and Wales.  Specifically:

• The total number of deaths in 2020 so far is significantly higher than any of the last five years.

• By comparison to flu and other respiratory diseases, deaths related to COVID-19 caught up seven months in just four.  Deaths would have become far higher if there had been no lockdown.

• The excess deaths in England and Wales to week 33 (14 August) is 53,084.  But the total from mid-March to mid-June, covering the peak of the pandemic, is 59,345.  Nearly 60,000.  A significant number of people dying before their time.

• The impact on younger adults in the 15-44 age range has, as would be expected, been lower in absolute numbers. But cumulative excess deaths rose to some 5% of the average number of deaths, and we are again seeing a rise.

• These figures would have been far higher if there hadn't been the restrictions of the lockdown.  The coming winter threatens to make the figures rise far higher if suitable precautions are not followed.

COVID-19: HOW A SURGE AFFECTS A CITY

The Oxford Mail's headline in print today is "COVID RATE IS UP IN THE CITY" but is online as "Oxford coronavirus spike 'disproportionately' 18-30-year-olds"  It goes on to talk that it "was now expected to be worse than a previous surge in late July".

Is it a 'spike' that's back to earlier levels and under control, or a 'surge' that's out of control?


The local Director of Public Health is quoted as saying "It now seems we are back up to those late July levels again and they are continuing to rise beyond this."  So a 'surge' then.

Here's the graph from Public Health England (using results from NHS Test and Trace), which goes up to 21 August.  There's a dark blue line that denotes the trend in the 7-day average, rising in late July, dropping in early August, and then rising strongly again.  Peaked perhaps?  Too early to say for sure:

PHE graph by specimen date

I'm not surprised.  Most young adults I see out and about in Oxford are taking no obvious COVID-19 precautions.  Little social distancing.  Few masks.  Pubs open.  Not packed like before, but people laughing and talking loudly close to one another.  Fun, but risky for COVID-19 infection.


Indeed he "has warned young adults are putting their loved ones lives at risk if they flout the rules."

"The message to younger people is that you may not experience the worst of the symptoms yourself, but you may pass it on to loved ones [and others] in older age groups or those with underlying health conditions who do."

This is true. Hospitalisation and death of younger adults from COVID-19 is much lower than for older people, but not zero.  Furthermore LongCOVID does affect young adults, and I'm surprised so little mention is made of it by government or the media.

As Devi Sridhar, an advisor to the Scottish government and a member of the Independent SAGE group warns at 30min30, this virus is “too dangerous to spread through the population, not only because of the mortality [dying] but because of the morbidity [LongCOVID] it causes in young adults…that’s going to be the story about COVID, not about the deaths”.  Chilling stuff.

Here's an article describing extreme lethargy symptoms for younger adults, plus additional symptoms.  There's also a "Long Covid Support Group" that has been set up working in partnership with the UK Sepsis Trust.


IMPACT ON OXFORD CITY

The graph above goes up to 21 August.

The article says "There were 28 cases in Oxford during this period [the week to 14 August], compared with 16 the week before."  With a population around 150,000, the local director of public health says "although the rate of 18.4 cases per 100,000 people in the City [in the week to] August 14 was still below the thresholds which have seen measures reintroduced elsewhere in the country, it is higher than many other areas in the South East."

A subsequent article says "As of August 14, the seven-day rate in the city was 18.4 per 100,000 people but this has now gone up 26.2 [for week to August 21]. This is due to 40 new cases [in the week], compared with 28 the week before."   That takes Oxford up to 17th in the country.

40 cases in a week is 5.7 a day on average. As discussed here, in looking at national data to 21 August, the tests are voluntary and only for the symptomatic, so this figure needs to be multiplied by about 5 to get a realistic daily level of infections.  That's 28.6 a day.  To estimate how many people are out and about infectious, for an average of say 5 days, that's around 140 people.

140 people out and about not knowing they are infectious, and often acting as if they weren't. I don't know about you, but given the six risks of COVID-19, I don't want to be out and about with them, at least not indoors.  Outdoors is safer, though not risk-free.

As discussed here, Oxford with some 150,000 people should only have about 15 people out and about infectious, with 3 actual infections per day (2 per hundred thousand).  That is equivalent to PHE's number being only 2 every 5 days.  So Oxford's COVID-19 infections are currently nearly 10 times higher than they ideally should be, and rising.

Action to get this right down is needed if we want to keep schools open and get back to any kind of normality.


WHAT ACTION SHOULD BE TAKEN?

Oxford is covered by two Westminster MPs.

Highlighted is East Oxford (including most of central Oxford), for which the MP is the Shadow Chancellor, Anneliese Dodds.  For COVID-19, she is campaigning for support for jobs.  This is especially the 7000 in the hospitality and retail sectors in her side of Oxford.  The constituency also includes the BMW Mini factory where over 400 jobs are now at risk.

The MP for Oxford West and Abingdon is a Lib Dem, Layla Moran, a former maths and physics teacher who now chairs the All Party Parliamentary Group (APPG) on Coronavirus.

The Group is calling for a 'Zero-COVID' strategy to take daily infections down below that 2 per hundred thousand limit.  Being a pragmatist, I would call that #NearZero.  That's aiming for zero, but with the important proviso that there will be outbreaks that need to be identified and countered.

It must be the right thing to do.  #NearZero will minimise the chances of infections in schools and higher education, and thereby help to keep them open.  If people are confident to go out, the economy can recover.  Plus the lower the infection rates are before the winter, the lower any second wave.  That means far fewer deaths and sufferers of LongCOVID.  There really is no sensible alternative. 


A PLEA TO YOUNGER (AND OLDER) ADULTS

The local director of public health added: "The plea is a simple one – be consistent in remembering those simple measures that help keep us safe – keep your distance, wash your hands, wear a mask".  This plea is not just for the young, but everyone.

.
"If we all do these things, we will avoid having to introduce measures that we’ve seen elsewhere in England."

Update 3/9/20:  Data for week ended 28 August now out, with reduction in new cases


IN CONCLUSION

So please.  Everyone in the media.  Tell the youngsters about their responsibilities to their fellow citizens as the article above suggests.  But also mention that LongCOVID can badly affect them.  Or we'll never get those nightclubs and other entertainments open.  It's very much in their interests to take care about COVID-19 !

As a nation, we need to get infection rates down to #NearZero across the British Isles if we want to keep schools open and let the economy properly recover. 

COVID-19: YEARS TO LIVE

Life has its ups and downs.  But I don't want to die any earlier than I need to.  Especially not from an illness like COVID-19.  So how many years would I normally expect to have left?

I found some actuarial tables for England and plotted the graph.  Here it is.

This is suggesting that when someone is born, a male's life expectancy is some 79 years, a female's 83 years. Pbviously on average, smokers and non-smokers, regardless of any ailments.

Both my father and his father passed away from natural causes at 84.  So a bit longer for me as a male than the graph suggests, perhaps.  How about you?