Life & Death – Coronavirus week 7 – preparing for the ‘new normal’

Using technology for good – to help us ‘ease the lockdown’.

In terms of the coronavirus pandemic, week 7 was one in which we all speculated on what Boris would announce during his ‘address to the nation’ on Sunday by way of a ‘road map’ for lifting the restrictions. Lots of documents were ‘leaked’ and guidelines for certain businesses were published on the .gov.uk web site.

At the start of the week daily death totals (now in all situations) didn’t appear to be falling as quickly as many had hoped, but the last two days’ figures of 346 and 269 were lower, even for a Bank Holiday. By Sunday evening the number of lives lost was 31,855. On a purely numerical measure the UK is second to the US in terms of total deaths. There were more discussions on international comparisons. I have written in previous weeks about statistics and the difficulty of comparing countries. Factors such as the age profile, ethnic mix, housing density in cities, poverty and whether a country is an international ‘transport hub’ need to be considered.

Another topic that took up a lot of time during news bulletins and daily briefings was the launch of a ‘Track Test Trace’ (TTT) application for mobile phones. This is an example of ‘using technology for the good of society’.

On a basic level everyone who downloads the app to their smartphone can collect data about close contact with others who have the same app. If someone shows symptoms of infection by coronavirus they complete some details on the app and a central server sends a message to all of the people they have been in contact with over recent days informing them of steps they need to take. As with all ‘technology’ and especially programmes or apps, things are not so simple as I explain below.

My life using information technology for almost 40 years could be the subject of another blog. Even though one of my sons, now in his 30s, recently called me a ‘dinosaur’ for asking what I considered a reasonable question about how he implements systems in the complex world of on-line and mobile banking apps, I think my knowledge of the principles still stands me in good stead. I am proud of showing him and his brother before they got to secondary school, that there was more to computing than the games they played on our Atari console. This probably helped set them on the way to the complex systems they are responsible for now.

So I asked our two sons their professional opinion on the planned NHS TTT app development, its data usage and architecture. I read some articles with concerns around privacy, and the two departments party to it, the NHS and the intelligence agency GCHQ, not having a good track record with implementation of IT projects. GCHQ is all about surveillance so is the app as much about location as it is tracking the proximity of nearby devices?

Their reports were that most countries are going with an app produced by two of the largest technology companies, Google and Apple joining forces. They are promising an approach where all the data is stored ‘locally’ on the users device which also sends messages to the relevant contacts if required. No central data is held on individuals. Their  ownership of the two operating systems that all smartphones use, means they can maximise the efficiency of the Bluetooth file transfer exchanges and minimise the use of battery power on the devices.  It is this deep technical knowledge that may cause other countries, including the UK, problems in developing their own. 

An example of the problem is that in its standard form Google and Apple restrict apps from broadcasting Bluetooth constantly, as this has been exploited by companies connecting and sending targeted advertising. This means that most apps only broadcast if they are running in the ‘foreground’ or looking at it. If your phone is locked or you are not actively using the app there is a danger that some interactions will not be registered. There is some debate as to what counts as an ‘interaction’ is it that you are close to someone for a certain time such as five minutes, or just when you pass by on the street?

Michael found an article referring to a petition by developers to the French government demanding that there is complete openness on privacy, asking for published details of exactly what sort of data is collected, how it is used and when it will be destroyed after use. This is part of the ‘privacy v health’ debate around such applications. The UK government wants to use data to track the areas the virus is spreading.  David’s ‘research’ concentrated on battery life and foreground running. He says that with Bluetooth there is something called  “Received Signal Strength Indication” to determine distance between devices, but it’s not particularly accurate. This probably means there will be a lot of false positives, and even cases where it’s picked up a neighbour’s signal through a flat or house wall.

Whatever the pros and cons of the privacy debate, my concerns are about the practicalities of the system.

• What incentive is there to report symptoms when people get them?
• Alternatively what stops someone maliciously reporting symptoms if they are so minded just to cause a nuisance?
• Is there a necessity for a positive test before the messages get sent and if not won’t the ‘false positives’ cause a lot of unnecessary disruption?
• Given that a lot of people will go to a supermarket once a week, many ‘contacts’ will take place. The consequence is that one or two customers getting symptoms can lead to many supermarket workers having to isolate. Similarly, one supermarket worker getting symptoms could lead their fellow workers and hundreds of customers isolating. The result, after a few days, could be no supermarkets open and no customers going in.
• Most transmission currently seems to be taking place in hospital and care home settings where there are lots and lots of ‘contacts’, so I am not sure how practical it is to use the app in those areas. Most medical staff take care not to contact people at home or outside the work situation anyway.

The biggest problem with the TTT system is the same as with the current hard lockdown. If there is a large minority who don’t engage or download the app, and they are the ones responsible for being lax on other ways of controlling the spread of the virus, they will still be responsible for causing some ‘needless’ cases and deaths.

We await the results of the Isle of Wight larger scale test but given that we have been told the app will be available to us ‘by the middle of the month’ there doesn’t appear to be much time to analyse how the system is working.

Readers of this blog know I love an initialism, so the last word goes to the writer of a blog three days ago suggesting countries trying to develop a (deep breath..) Pan-European Privacy-Preserving Proximity Tracing app or PEPPPT, will find themselves changing course and adopting the Apple-Google model. He predicted that by the end of the month the UK will have done so.

Is the change in message another sign that we are in for a long haul?

If today’s papers are to be believed Boris’s ‘address to the nation’ this evening will change the message we have been used to seeing as illustrated below.

The not so subtle change from red to green along with a ‘traffic light system’ for alert levels suggest to me that we are in for a period of trying changes, and if they don’t work putting restrictions back on. If, as has been trailed in the press, there are a whole variety of ways that businesses, workplaces, schools and social situations will change, then confusion (and some anger and worry) could be widespread.  The words of epidemiologist Professor Peter Horby interviewed on The Andrew Marr Show stood out to me. He is chair of  New and Emerging Respiratory Virus Threats Advisory Group or NERVTAG – sorry folks it is too lovely an acronym to ignore.  He stated

the virus is not like a storm or hurricane where we batten down the hatches until it has passed by, and then emerge into the sunshine and it has gone. It’s still out there and most of us have not had this virus, so if we get this wrong it will very quickly increase across the population and we will be back in a situation of crisis. So we have to be incredibly cautious about relaxing the measures.

NERVTAG told the government that getting the relaxation wrong could lead to a figure of 100,000 deaths in the UK. We still don’t know the proportion of the population who have had covid-19, but if the professor is correct there might be a lower but steady number of deaths for many more months yet.

The fact that the extra Nightingale Hospitals haven’t been closed is probably a sign that the politicians expect if not a ‘second wave’, then a lot more cases. As well as balancing privacy vs health for the new tracking app, there is even more pressure to balance health vs the economy. 

Finally, on Sunday evening we listened to Boris address the nation. He set out the way the five ‘alert levels’ would be set by monitoring the R-level by an advisory group. He set out timescales for now, the end of May, end of June when certain parts of the economy such as construction, manufacturing, garden centres, shops, and eventually limited hospitality would restart.

He encouraged anyone who can’t work from home to return to work tomorrow, and from Wednesday encouraged everyone to take more exercise and play sport with their family.

However, the main ‘confusions’ straight after the announcements were;

• How people, who the prime minister said should go ‘back to work’ if they could the next day, would get there given limited public transport.
• The other nations of the UK have announced that they are sticking with the ‘old message’ about staying at home. Scottish First Minister Nicola Sturgeon even asked the UK government not to run the information ads in Scotland. In Wales where you can’t drive for exercise, people from England could get fined for driving to the Brecon Beacons for exercise. Do Welsh workers need to drive to England if their employer decides that they need to work?
• The detailed instructions for all sorts of workplaces have not been set out, so it is uncertain how that might look.

We will see what happens in the coming week with clarification and further statements to parliament on Monday, and questions from the public in the daily briefings.

Other news this week.

• VE Day was celebrated in a ‘socially distancing’ way on Friday 8th May. The 75th anniversary was a special one and street parties held, and old-time songs sung. An evening concert held at Buckingham Palace featured a ‘virtual duet’ with Katherine Jenkins and Dame Vera Lynn of the wartime favourite ‘We’ll Meet Again’. One lady told the story that on the original VE Day she and her sister had to ‘socially distance’ and sit on a separate table as they had mumps, and she didn’t think that 75 years later she wouldn’t be able to join in a street party due to social distancing again.
• In last week’s blog I wasn’t having a go at radio DJ Chris Evans specifically over his fundraising efforts. I listen to Virgin Radio’s Breakfast Show most mornings and Chris and his team try to spread joy and positivity in these difficult times.  He has also been party to raising literally tens of millions of pounds during his time at Radio 2 and Children in Need auctions and events. Chris by his own admission comes from ‘humble roots’, found fame and has had his well-documented ‘excesses’. But he tries to see the best in people and teach others lessons he has learned.  The message from last week was that our much-needed public services should be properly funded by us all and not rely on the charity and voluntary sectors.  Chris, his family and many celebrity friends have now raised in excess of £1 million from two auctions of memorabilia, and his son Noah over £100,000 by sleeping in a den in the garden. This money will go to producing more than 220,000 sets of scrubs for the NHS workers. 
• On Friday transport minister Grant Shapps gave news of a £2billion scheme to encourage us to cycle or walk to work. For people travelling on public transport to maintain social distancing then they need to run at about 10% capacity. 
• Other countries started to ease their lockdowns and in Germany Chancellor Angela Merkle allowed all shops to reopen, pupils are gradually returning to classes, and the Bundesliga – the country’s top football league – will restart next weekend. Initial signs are not promising as the dreaded R-number, a measure of the number of people each confirmed patient infects – moved to above 1.

Thoughts at the end of week 7

We continue to enjoy good health and the warm weather meant we ate a few meals outside. Alyson planted more seeds and worked on the garden. I managed to put the last shelf up in our shed in under an hour!

After finishing Terry Waite’s book Alyson has started the one by John McCarthy and Jill Morrell ‘ Some Other Rainbow‘ that documents the same time and similar events. We have been watching some more ‘culture’ on YouTube with recorded performances of Shakespeare and ‘Frankenstein’ by The National Theatre.

At today’s live stream service from Methodist Central Hall, Rev Martyn Atkins talking about being ‘salt and light’ referenced a talk he had heard where a student illustrated Christians being all shapes and sizes of candle, some battered, some old, some coloured – but all shining as a light to others. Something we are called to do at this time. One of his daughter’s friends when she was frightened would ask her dad to ‘turn off the dark’! We needed to use the battered candle I display some Sunday evenings to remember our carers as we had a power cut on Saturday evening.

We have had the usual Zoom meet up with friends and family. The week coming up is both Christian Aid Week and Brain Injury Awareness Week, so I have two ‘Zoom quizzes’ to prepare and host.

Alyson is hoping to get back to ‘frontline’ work by helping the NHS 111 Service and doing calls to patients who have been referred to a pharmacist for advice. She has been training and is waiting on information on how to setup a ‘call centre’ from her study – i.e. our spare bedroom.

I am a follower of a blog by the wonderful modern poet Brian Bilston and if you have never seen his work I can recommend you looking him up. He has produced some thought-provoking work over these last few weeks and I leave you with one of my favourites;

On Leaving the House and Encountering Another Human Being

I’m sorry I dived into the bushes.
It’s not personal, you understand.
You happened to walk in my direction
and my nerves got the upper hand.

I’m sorry I screamed when you came near me.
Don’t take my angry shrieks to heart.
Idiomatically, let’s stay in touch –
and physically, six feet apart.

Apologies if it seems like you repulse me,
that I recoil when you come near.
In other times, we might have spoken,
shared a joke or had a beer,

or waltzed together down the footpath,
perhaps we may yet still one day.
But just for now, embrace the margins
and wave to me from far away.

© Brian Bilston’s Poetry Laboetry

 

 

Keep safe everyone and remember, ‘We’ll meet again some sunny day’.

 

Life & Death – Coronavirus week 5 – what’s the next step?

An uncertain timescale, and new ways of working.

As the total passed 20,000 this week I fear the announcement of a high number deaths in the previous 24 hours is becoming part of our daily routine. I had some favourable comments about last week’s blog on statistics and am grateful to our son David for sending a publicly available link to the NHS Statistics site that details how these are compiled and it is at;

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/

David pointed out that the term ‘daily death toll’ is misleading as they are compiled from a series of numbers, some of which can be from a few weeks before. If you want to see how many have died in your local hospital trust these are on the different sheets in the spreadsheets.

The daily briefings are now showing some of the additional community and care home figures, which increases the totals. There has also been a discussion this week on how exactly registrations of death in the community are classified. The new guidelines allow for dying of Covid-19 or dying with Covid-19 and having one of the reasons as ‘pneumonia-like’ symptoms.

Looking at the current versions of the Johns Hopkins charts from last week’s blog, there is not really a definite ‘plateau’ in the figures, never mind any sign of a decline.

Unlike the virus, the shock of a high number of daily deaths appears to be something we are becoming immune to. Chief Medical Officer (CMO) Professor Chris Whitty suggested the current measures might need to be in place until the end of the year. The situation has been compared to a war, and in my less optimistic moments I worry that like the First World War when the ‘experts’ of the time, the military analysts, declared it would be ‘over by Christmas’, we will need to come to a more realistic appraisal. The first few months of the Great War were characterised by patriotic parades, rousing speeches, a general call to arms, volunteering and government spending. After Christmas, however, when it was clear that the proposed strategy of a short campaign followed by bringing enemies together to negotiate, was not working, countries had to change their economies and society and put them on a ‘war footing’ for the long-haul. Most of the time, however, I am optimistic that we can see out the current ‘war against an unseen enemy’, and a return to ‘normal’ is on the horizon.

No one wants to think of this war going on for a few years and our government having to borrow over 25% of Gross Domestic Product (GDP) annually, as happened in the two wars, compared to the short term 15-20% our chancellor has sanctioned so far. In the two wars GDP increased due to more production of munitions and uniforms etc. There is already some increased activity in sectors of the economy such as supermarkets, food manufacturers, logistics, suppliers of PPE and the pharmaceutical sector supplying medication and carrying out testing.  The problem (as it was during the previous wars) is that much of this expenditure is government-funded and needs to be repaid at some point.

An increasing theme of questions to ministers at the daily briefings, and from some of the government’s own MPs, has been a desire to talk about the plan to get out of lockdown.  The week started with former prime minister Tony Blair’s Foundation the Institute For Global Change producing an outline 10-point plan for how this might happen. It uses a ‘traffic light’ system of the metrics that would allow certain activities when an amber stage is reached, and more when a green might follow. If infections, hospitalisation and deaths start to climb again, it allows for a red stage and return to lockdown.

Nicola Sturgeon Scotland’s First Minister released a similar document to start what she called an ‘adult discussion’ about the gradual release of restrictions.  For example, on how schools might have to be adapted to keep social distancing measures. One of the opposition parties in Scotland claimed that this was as much to do with trying to have a separate track from the UK government, and to steal a march on the ‘English Parliament’, as it is a real attempt to plan.

We had an idea of how releasing the lockdown might look after I joined an ‘on-line queue’ last Sunday to place a small order with DIY retailer Wickes. We had a text on Tuesday when it was ready to collect. Alyson drove to an empty car park where a member of staff brought the order out and put it to one side for her to place in the car. It was so long since Alyson had been out that the car clock was an hour behind. Alyson was so excited that in a Shirley Valentine moment she said, ‘hello car, it’s been a long time, how are you doing?’. 

It may be that any retailer that wants to re-open, must think about making such adjustments and change the layout and operate a queue and collection system. As our good friend David said during a Skype call ‘every shop will be like Argos’. Talking to my brother-in-law Paul, on a Zoom call for Friday evening drinks, about Jaguar Land Rover (JLR) planning to restart production at two of their car plants, he said they will have ‘re-engineered’ the line. Paul knows about such things having been involved in similar plans before retirement. Instead of having two or three people working on the cars as they go down the line, the engineers will be changing the order and reprogramming the robots used to allow the build to continue within the ‘social distancing’ guidelines. Whether there will be the customers to buy the finished vehicles is a different question.

The UK is fortunate to have some really educated and clever people working in our small and large private and public enterprises. We must hope that, like JLR, they will have been working on ways to ‘re-engineer’ what they do in a ‘post-pandemic’ world. Some of these changes may have been the way to improved productivity anyway, and the space and time during this outbreak was needed to get them implemented. Other businesses less able to adapt and change and whose business model was not ‘fit for purpose’ will disappear.

Apparently a group of experts are meeting with the various sporting bodies to determine how the leagues and events might resume in May/June. There is talk of playing behind closed doors with safety measures in place for players/officials and broadcasters. I will return to this topic in the coming weeks, after more details are released. For now, I am curious how a game of football will look if players must keep two metres apart and the ball must be wiped down with sanitiser after every header or a throw by the goalkeepers!

For me the first few weeks of lockdown has brought an increasing number of video calls. Two months ago I knew about Skype, but Zoom was a new product to me. Such is the growth of this platform that, like Google, it has gone from being a noun to a verb quite quickly. We now say we are ‘having a Zoom’ with a colleague or we say we have ‘been Zooming our family’.  Looking back I have had 16 such meetings in the last fortnight and a few more 1-2-1’s helping people setup Zoom. This week we had our first ‘virtual coffee morning’ with members of the head injury charity I am trustee/volunteer for. Given one of our aims is to reduce the social isolation of people who suffer such injuries, I have no doubts that this is an aspect of our work that will continue whenever the situation gets back to ‘normal’. It was a wonderful time of sharing for the ten of us on the call from all over Cheshire.

Technology is another sector of our economy that is booming as people need to be setup for working from home. Some of this business-to-business (B2B) spending is from the private sector so, even if it is funded by borrowing, is adding to our GDP.

Another crisis in the nations’ health being stored for the future?

After last week’s headlines about the current crisis in the care sector, this week doctors leaders and Sir Simon Stevens, Chief Executive of the NHS, highlighted a fall in general attendance at hospitals and GP surgeries. There could be people who need on-going treatment for heart conditions, cancers and other serious issues not getting these. People showing other serious symptoms of stroke, early-warning signs of cancers are choosing not to get checked out. 

Related to this is the mental health of those who are isolated or trapped in homes with an abusive partner or parent. The increase in retail sales of alcohol, the boom in business for wine delivery merchants, some of which is the result of the closure of pubs and restaurants, should also be an area of serious concern.

Alyson and I are blessed to live as a couple with all the interaction that brings and so far are generally getting along amicably! I saw a piece on one of the news channels about the lack of ‘human touch’ that is becoming a real problem even for those who wouldn’t normally classify themselves as ‘touchy-feely’ types. This could be something as simple as a touch of a hand when upset or a hug with a child or grandchild. One new grandparent said, hopefully semi-seriously, ‘well perhaps I will get to see them before their first day of school…’

My thoughts have been with a church friend who lives on her own following the death of her husband last April. This lack of touch is becoming a real problem for her. She had to manage the anniversary of her husband’s death on her own, without the special touch from her son who lives 150 miles away. Her daughter lives in Australia and has a son who was born a few days after her husdand’s death. So she couldn’t even share a first birthday cuddle with him, just a ‘virtual cuddle’ via the ‘FaceTime’ app on an iPad.

Other news this week.

• Not a new item but a ‘correction’ from two weeks’ ago when I stated that the birds were singing more loudly as a sign of new life. During one of our virtual coffee chats with friends David and Janis, they sent a link to some research showing that the decibel volume of birdsong has actually fallen. This is true particularly in urban areas and near airports as they don’t have to compete with the ambient background traffic noise anymore.
• This week a potential vaccine against the coronavirus was injected into a human in the first stage of a trial. The remarkable speed at which this has happened is a chance for some optimism, but the scientists tell us that it will take months for any useful results to be available and analysed. In the rush to get this game-changer out to the world, great care needs to be taken to be sure that there are no side-effects that could make the harm done in the long-term far greater than the deaths of the outbreak.
• The science needed to understand vaccines and terms like re-infection rates, on-going immunity, blind trials, cohort selection, existing morbidities, aggravating factors etc are not simple. I tried to resist mentioning President Trump again this week, but his suggestion of injecting or inhaling disinfectants to ‘clean out the virus in a minute’ was not only dangerous but showed a complete lack of any of the science on which his experts have briefed him. I do think this quote, and his subsequent attempt to pass it off as sarcasm towards the reporters in the briefing room, will be seen as a ‘game-changer’ in the longer term. The idea that a President who has any sort of basic education is unable to see the difference of putting a powerful chemical on surfaces such as metal, porcelain or man-made plastics is no different to the delicate structure of skin or the inside of a human lung is frightening. It is like a parody of the story of ‘The Emperor’s New Clothes’ or in this case ‘The President’s New Coronavirus Treatment’ where everyone else can see it is completely ridiculous idea, but the person elected to lead thinks it is a brilliant one. Will any of his advisors or leaders in his administration have the courage to criticise him in public?
• There was some ‘outrage’ that Richard Branson would apply for a loan from the government to support his airline Virgin Atlantic. It was pointed out that he has a lot of personal wealth and despite putting his private island (valued at ‘only’ a few tens of millions of pounds) as an asset against the £500Million loan, his press was not favourable. I can see the need to support his employees in the UK, but this is one example for the government and big businesses to negotiate over. The ownership of the company by one of the major US airlines and the tax regimes they operate in needs considering. Denmark was one of the countries this week to announce that any company that hides some of its tax offshore, without true transparency, will not be allowed a loan.
• On Sunday morning it was announced that prime minister Boris Johnson had recovered enough from his coronavirus after effects to return to Downing Street and lead the government again. Writing as someone who has also come close to death during a 12-week stay in hospital, my hope is that the episode might have given him a new perspective on what really matters in life. The decisions he takes, the way he views the NHS and key workers, might mean a change in approach.

Thoughts at the end of week 5.

Covid-19 has claimed the life of another person I knew. Sharon was a local church treasurer in our circuit, and we talked at meetings. She had some other health problems, but the loss of any life, particularly from this virus, and the effect isolation has on close family is devastating.

The weather continued to be warm and dry so we enjoyed lovely walks outside viewing plants and wildlife. I went for two more substitute parkruns. The goods we managed to get from Wickes meant we could get on with work in the garden and complete painting the fence.

I have really enjoyed all my Zooming this week, particularly catching up with friends and family for coffee and chat.

Alyson continued learning her new skill of sign language and sewed a mask from cotton material should she need to wear it outside.

My lack of any new improved DIY skill was demonstrated by the fact that it has so far taken me over three hours to put up three simple shelves in our garden shed. The phrase ‘all the gear and no idea’ definitely applies to me. What made it worse was that the neighbour who backs onto our garden has made a whole Japanese design inspired pergola from scraps of wood in the same time. Complete with a decorative hand-carved finial. I looked on with some envy at the way he constructed it and used his power tools and screws in a way that I can only dream of. I will report how long it took to put my final shelf up in the next blog.

Stay safe and let’s see what week 6 brings.