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For COVID-19, we need to consider the risks from two angles:
- From the perspective of each individual
- From the perspective of society, such as ensuring the NHS doesn’t get overrun with COVID-19 cases
FROM THE PERSPECTIVE OF EACH INDIVIDUAL
COVID-19 is clearly far worse than flu. Not everyone exposed to COVID-19 will display any symptoms, possibly due to 'cross-immunity', But there are six specific risks if we are exposed to COVID-19:
- Typically ill for 2-3 weeks, much longer than for 'flu, which is disruptive and can mean lost income
- Sometimes longer illness, including possibility of needing to be hospitalised
- Death, although this happens mainly to older people, and in any case below about 1% of those people infected
- Long term lethargy, which again is disruptive and may mean being off work
- LongCOVID symptoms, where the virus has attacked other organs such as heart liver, kidneys, digestive system and brain, which can go on for months if not a lifetime
- Strokes, even in the young
Lethargy and other LongCOVID symptoms has been shown to apply after two or three months to more than half of people who have had COVID-19, even if only mildly. It can apply to the young as well as old. COVID-19 is not so much about the dead, but about the survivors.
Yet it is young adults who are now some 40% of new cases on the continent. The average age of new cases in Germany is now 34. Here in the UK, in a university City, I observe young adults acting as if COVID-19 wasn't here.
Catching COVID-19 is clearly a significant risk to our health and livelihood. One we cannot ignore.
RANGE OF ATTITUDES TO RISK
People have different attitudes to risk.
High-risk
A pal of mine was one of David Attenborough’s wildlife photographers, including filming the elephants in the cave you may have seen. He’s used to putting himself in dangerous situations. Chatting over a pint, he tells me philosophically that “I will go when it’s my time”. But of course he takes relevant precautions in each situation.
Other people will take risks with smoking, despite the health warnings, and risk their life by rock climbing or other high-adrenaline activity. A reckless 'it won't happen to me' attitude. Young adults in particular are inclined to deliberately take risks. Arguably how mankind has developed.
I also know a couple of real daredevils, both of whom live near Oxford:
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- Gary Connery the stuntman and 'extreme sports professional' who parachuted into the 2012 Opening Olympics Ceremony as the Queen and was the first person to jump 2400 feet from a helicopter without a parachute. He was wearing only a wingsuit, and landed without injury in a pile of cardboard boxes
- Richard Noble OBE, the former Land Speed Record Holder in Thrust 2, and the man behind beating the sound barrier at 763 mph with ThrustSSC and pilot Andy Green Richard’s 'autobiography' is fittingly called “Take Risk!”. He's now onto his next hi-speed project, on water.
These people take risks. But they are sensible, they understand the risks and take appropriate precautions. My concern is many people do not understand the six risks of COVID-19 as set out above.
Low Risk
At the other end of the risk spectrum is a pal who I often used to meet at live music events. A science writer who would be out several evenings a week. He would cycle around Oxford with a ‘cello on his back. The very definition of risky. Especially for the ‘cello. Now his attitude to sitting outdoors with other people in a beer garden is “will stay safe and home”.
In that attitude, he's not alone. Especially those people who are older or otherwise have attributes known to make them more susceptible to serious COVID-19 symptoms.
Middle Risk
Many people will take a view somewhere in the middle. That’s certainly my attitude, as set out below. Assessing how risky a particular activity is, doing some but not others.
The Spectrum
So different people will take a different attitude to COVID-19, on a wide spectrum. Provided they understand all the risks, that’s fine. It's their decision. Except:
- The risks of LongCOVID and some of the other risks have not been properly explained to the British public. Young adults are taking a much bigger risk than most of them I see seem to realise
- If someone becomes infectious, they put others at risk, especially family and friends in their own household. That may include people who have been shielding. It is very selfish not to think of others as to whether one should risk catching COVID-19, in case one then passes it on to cause death and suffering.
FROM THE PERSPECTIVE OF SOCIETY
The key issue is avoiding the NHS being overrun, such as would produce scenes we first saw from Italy, and which would reduce the service for other health problems.
This can require people as a society to make personal sacrifices, such as lockdown, social distancing and wearing masks.
In the latter case it is to reduce the chance of someone who is infectious, but doesn’t yet realise it, to pass on infection to other people via micro-droplets bearing viruses. These are believed to be the main means of transmission, and even simple masks will catch them and any bigger droplets.
It is a perfectly reasonable request for people to comply. “My mask protects you, yours protects me”. I wonder whether people refusing to wear masks don’t understand the risks and that principle, or are just too self-centred?
HOW DO WE EACH ASSESS RISK?
We would be wise to take appropriate precautions. Just like we do when crossing the road.
From each person’s personal perspective, the attitude to COVID-19 will not only reflect their general attitude to risk, but will also depend on medical advice. Each individual will be regarded as High. Medium or Low risk of serious COVID-19 symptoms. GPs will usually have reviewed their patients’ records, and written to each of them assessed as High or Medium. No letter means Low risk, though do contact your GP practice for confirmation or to talk through your assessment with your GP.
We don’t know for sure whether natural immunity is acquired by having COVID-19, nor how long it might last. So even people who have the disease cannot yet relax about the risks. My Immunology Professor pal tells me that some infections, such as Dengue fever, can be much worse if having had strain A, a person gets infected by strain B, C or D. COVID-19 has nearly 200 variants, in multiple strains. As there's been little chance yet of anyone being exposed to more than one strain, we don’t yet know if such an affect applies.
Obviously the lower the infection rate in one’s locality, the lower the risk.
MY LOCKDOWN BEARD
Which at last leads us on to the title of this blogpost. My lockdown beard.
To put this in context, I am taking a 'moderate' attitude to COVID-19. Assessing each activity, doing some things low risk folk won't, but only doing what I feel is low risk. I will not yet sit indoors in a pub or restaurant, though a garden outdoors is OK.
From tomorrow 15 August, some indoor entertainments will re-start. I won't be joining in, much as I would like to. I am making a simple rule. Outdoors good, indoors bad.
That's because outdoors is far safer. The biggest risk of catching COVID-19 seems to be from viruses in micro-droplets of water in infectious people's breath. Hence masks and simple face coverings to catch the droplets. There's more droplets if the person is laughing, shouting or singing. More still if coughing or sneezing. In still air, such as in a lift or poorly ventilated room, studies show micro-droplets can hang around for 3-4 hours. Outdoors the slightest breeze will quickly take the microdroplets away and dilute them.
This reluctance is because the local infection rate in my locality is too high. Indeed far too high nationally, as discussed below.
My ‘Robinson Crusoe look’ is developing because I don’t yet trust the barbers to be that close to me without knowing whether or not they are infectious with COVID-19. Watching the local community's men out and about, they are generally ignoring social-distancing, so I can't trust any of them.
It’s not just my thinning locks that are now demanding a trim. For the first time in my life I have grown a beard. My ‘Lockdown Beard’ started in March, through sheer laziness of knowing I wouldn’t be meeting people. My beard is now long enough to twirl. I’m really quite enjoying it, and seems such a shame to shave it off after all this effort. But it does need to be tidied up if I am to go to professional meetings. That means a professional trim. That means a barber standing right in front of me. The riskiest situation I’m likely to face until music venues re-open fully.
When hairdressers first re-opened, a few weeks ago, I walked past all the local barbers shops, of which there are several. Only one had barbers wearing the regulation visors, which reduce the chance of them getting infected and help protect their clients. Few were wearing masks, which reduce the risk of them infecting customers with micro-droplets which can escape around a visor. Other un-masked people in the shop too. Not an environment I would feel safe. It’s a bit better now, but not good enough yet.
As of 15 August a number of changes are being implemented per the Hairdressers Journal, and here are the actual regulations, with detailed advice to workers. Relevant aspects are:
- Barbers are allowed to carry out intricate beard work
- All hairdressers and other 'close contact' workers are now obliged to wear both a visor and a proper 'type 2 surgical mask', or 'medical mask' which is the 3-ply ear-loop masks marked "EN14683"
- Plus what was announced from 8 August "Clients are expected to wear a face covering immediately before entering a number of indoor settings, which includes hair salons and barbershops and must keep it on until they leave" unless a treatment requires its removal
For public transport, I’ve been on buses, because I can see there is virtually nobody on them, and can easily get off early and walk if necessary. But I won’t be going on trains, tubes or aeroplanes where social distancing is going to be impossible for me to control.
But surely there is a level of infections for which I would be prepared to take the risk of public transport, for work or pleasure? Prepared to go into a barber shop and get my hair and beard trimmed?
Update 27/8/20: Things are getting desperate. I'm going to put my hair into bunches. It's tickling the top of my shoulders and almost covering my ears. I can grab more than a handful of hair each side and back. Never had it this long, even as a kid or student. As for the beard, definitely needs a professional trim. But sadly not yet!
REDUCING COVID-19 RISK TO ACCEPTABLE LEVELS
At the start of May it was reported that Professor Chris Whitty has suggested England should have no more than 1000 new cases a day, equivalent to about 2 per hundred thousand. The Independent Sage group take it a step further to 1 or zero.
A city like Oxford, with a population of around 150,000 might then have a background infection rate of no more than 3 new cases per day, or 21 a week. With it taking around 5 days before someone has symptoms and hopefully self-isolates, there might be 15 people around the City at any one time who are infectious. Provided local 'test trace and isolate' folk get any outbreak quickly under control.
Taking elementary precautions, I think I could live with that. I could put aside my 'outdoors/indoors' rule, get my hair cut, go to a restaurant, and catch a plane. Even get my beard trimmed.
CURRENT INFECTION RATES IN ENGLAND
I can imagine many other people thinking likewise, which would allow the economy to properly recover. That won't happen at the higher rate happening just now, which in reality is about 4-5 times higher than the official figures. This is because official “confirmed new cases” arising from NHS testing are inherently under-stated for three main reasons:
- Not everybody with symptoms gets tested,
- Nor those who are asymptomatic, but still infectious, including children.
- There is also an issue with false negatives of around 30%, due to the difficulty of swabbing, unless negative results are re-tested.
Here is a really useful analysis by Steve Brown, including this diagram showing a total of the official "confirmed new cases" as having been around 8 per day per hundred thousand, for tests up to 3 August, which reflects new infections in late July. [This is 4 times higher than I would have expected, as it implies 4400 new cases a day rather than around 1000, so scaling it back...] This realistically means around 10 per day, and I doubt it has changed much in the last fortnight. But we should be below 2.
For some reason the government is prepared for R to be teetering about 1, which means no general reduction is being targeted.
Applying this national average to somewhere like Oxford, with a population of around 150,000, that's 15 a day. Some 75 people out and about infectious. Go out in Oxford and there's a reasonably high chance of meeting at least one of them.
Some people with knowledge of all the risks might still be happy to go out and do many of their normal activities with 75 infectious people about. But there would be many like me who would only be comfortable with 15 or less.
Parents would be much happier to send their kids to school in September with 15 rather than 75 infectious people milling around the city. Schools would also be far less likely to have to shut and re-open, and then shut again. To do that would be very disruptive to parents and their employers. A very low infection rate is therefore important to keep schools open.
The government has got to apply measures to get infections down to 2 per day per hundred thousand If that means a national lockdown, let’s just do it before the schools go back. It would need 3-4 weeks. That means doing it now!
Update 14/8/20: The Government has just announced that lockdown easings originally scheduled for 1 August will now be allowed from tomorrow Saturday 15th. Clearly intent on not locking down nationally in August. Thereby making it more difficult for all of us in the autumn unless they change tack.
Update 7/9/20: Yes. Infections rising such that the BBC News headline is "Coronavirus: Rise in UK cases a great concern, Van Tam says". He says a rise in infections in younger adults is filtering throuhg to older people.
WHAT THE GOVERNMENT OUGHT TO BE DOING (in context of 14 August update)
People would be far happier to send their children to school and generally get on with life if the daily infection rate was down to 2 per hundred thousand or less. England is realistically on average around 5 times that currently [to be checked], which is simply too high. Some towns and areas far higher.
The government is accepting that local rates around 10 a day per hundred thousand are acceptable (the official 2 times 5). That’s far, far too high. The government should have taken steps in August to get infections down to far lower levels, but has clearly not taken the opportunity.
The government wants to “get schools back in September”, with the target of when term is supposed to start in the first week. It looks like they are ‘hoping for the best’ that having delayed and then allowed some easing of lockdown restrictions, the summer advantage will naturally get infection rates down across the parts of the country not under lockdown.
But what if infection rates don’t fall far enough? Should we not ‘err on the side of caution’?
Whilst I hate lockdowns, because of all the awful ‘side-effects’ to our lives and livelihoods, I believe there is still no alternative to a national lockdown. As lightly as possible, sympathetic to holidaymakers and the hospitality industry. Keeping beer gardens open of course. If not in August, in September by delaying schools opening?
One side-effect of lockdowns which I hadn't thought about when I started writing this blogpost, but directly relevant to beards, is 'lady beards'. A major problem for some women. Allowing laser treatments would be part of a lockdown being 'light'.
If come September infection rates are still well above 2 per day per hundred thousand, and assuming we don’t want to see schools opening and closing willy nilly, and want to see people confident to go out and spend, that means a national lockdown of 3-4 weeks. That would get infections down to about a sixth of then-current levels, based on the success of the first lockdown. Given there is less that 3 weeks to the end of August, every day of delay is a day later for schools to re-open safely.
IN CONCLUSION (in context of 14 August easings)
The current infection rate on average in England is around 10 new cases per day per hundred thousand. A sensible target to get life, livelihoods and the economy back to near-normal is around 2. A substantial reduction is necessary.
The government is seemingly happy to persist with the far higher rate. This is just storing up problems for the autumn, when schools are due to go back, and the economy needs to motor again.
We then need to bear in mind that autumn and winter will naturally favour the virus, as we head indoors. The lower the rate now, the lower the rate then. It makes sense to get it very low, less than 2 per hundred thousand.
So if we don't do a national lockdown in August, we need to do it in September. Every day delayed is more lives lost, more lives blighted by LongCOVID, and a bigger hit to our economy in the autumn.
How will you know when the infection rate is low enough for life to get going again? When my lockdown beard has been professionally trimmed!
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