Archive for the ‘Health & Wellbeing’ Category

When I was young, printing was high quality. Printers used sharp fonts and everything was easy to read.

Now, for no reason, the entire industry has started using low quality blurry fonts that are hard to read.

For the past month, I’ve been having a hard time with my physical and mental health. it has been a tough gig because I have been doing client work throughout, so helping others manage their mental health while managing my own has been quite a challenge. Not made any easier due to medication limiting my ability to exercise.

Luckily, I have a very supportive family to draw upon. One of the downsides of greater mobility is that we can often find ourselves in a new cities, or even new countries, that take us away from our support networks and it can be difficult to rebuild those locally, especially when working multiple jobs, and studying, and doing whatever else we may have going on in our personal lives.

I’ve also gone as far as to do nothing. Or at least nothing “productive”. I’ve read a lot of books, destroyed a lot of civilizations on Age of Empires II, and finished off the whole of Downton Abbey. Not forgetting some time at the beach, as well.

After spending the first quarter of last year rehabbing my broken ankle, this January has been déjà vu. There isn’t even a cool story behind it: I fell over at a soft play. This year it was the opposite ankle and only a sprain. Thankfully, after four weeks of rehab, I’m now back up to running long distances.

Last week I was leading a club run when due to some combination of poor foot placement, a bit of gravel coming down from a curb and maybe just some plain old bad luck, I decked it. I went over on the ankle and it hurt a lot. Thankfully, Lucy was running in my group and was able to lead everyone back to The Edge.

I booked an appointment with my GP to get it checked out but when I asked for a telephone appointment, explaining I couldn’t walk, they said they were only doing face-to-face appointments (they’re going to freak out when they hear about COVID) and so I had to go to the walk-in. The irony was lost on them.

Next, I tried the minor injury unit at Middleton. However, they don’t allow you to drop in, you have to phone 111. Which I did. 111 booked me an appointment at the LGI A&E. I found this hilarious as pre-bookable emergencies was a Monster Raving Loony Party policy proposed in 2015. Although the LGI had some trouble finding the referral details, everything here was really good: almost no wait going through assessment, x-ray and minor injuries. They checked it out and referred me to the fracture clinic who phoned back the next day.

End result: it is fractured. It’s called an avulsion fracture which is where the ligament rips off a tiny piece of bone. I have to wear a walker boot for 4 weeks, and no running until 8 weeks post-injury at least. Not what I wanted given I had just start my training for Race to the Castle. But it’s happened so I just have to get on with life.

You msy think that Ironman training is great for weight loss. But training so heavily makes you ravenous, and I like to eat plenty in the first six months as I am attempt to build muscle and get stronger. Then the next three months is race season and I am busy having fun. That leaves the final few months of the year for weight loss.

This means dieting through Christmas which is always a pain. But this year has gone extra well and I made it through the festive period without any cheat days. This wasn’t easy, for me or Venla. I started Christmas Day with a two-hour run to pre-burn all of the calories and El Junior was not impressed at having to wait to open her presents.

But, earlier this month I hit my weight goal and it proves promising for going up hills faster. An FTP test suggests I am still the cyclist I was last year (4 watts down, so negligable) but seven kilos down from October. My time up the climb in Innsbrook (29:37) beat my previous time by three minutes. Although it should be noted that I am now riding a Specialized Shiv Disc with DT Swiss wheels, rather than stock Zwift frame and wheels.

Typically, we only want to supplement when we cannot build a diet that provides enough nutrients. But, in the case of vitamin D, we get it mostly from exposing our skin to the sun, rather than from food, so it is difficult to get additional vitamin D from your diet.

Given that many of us do not get outside enough in normal times and that we’re all inside because of the pandemic and lockdowns, vitamin D deficiency is probably pretty common right now, And there is some evidence that it is a good idea to supplement. So, I thought I would give it a go.

Labelling can often be a little confusing, but a typical adult intake should be around 600 IU (international units) which is 15 µg (micrograms). However, we can safely tolerate up to 4,000 UI (100 µg).

I picked up some vitamin D gummies from Boots. These contain 25 µg per gummy so one per day should provide plenty of vitamin D (and I will still get some from going outside, and a little through diet) and yet be safely within the tolerable limit.

I probably won’t let you know how I get one because I’m not expecting a vitamin D gummy per day to make any noticeable changes. If I don’t report back, assume it went fine (or I’ve exploded).

The Mindfulness for Anxiety app is now available for both iOS and Android on the Apple App Store and Good Play Store respectively. The app is completely free to use and comes with five guided audio practices, a self-timer mode that allows you to set any time length and a learning section where you can find out more about mindfulness.

Huge variations in estimates mean that we are 25% of the way through this to 2% of the way through this. All of this underscores the desperate need to start wide-scale antibody testing so that we can make evidence-based decisions on how we fight coronavirus.

The number of people likely to die depends on two factors: how likely you are to die when you get it (IFR) and how many people you will spread it to (R₀). Below, I’ll explain both of these and run the numbers based on current estimates.

How many people you will spread it to

R₀ represents how many people an infectious person will give it to. With seasonal flu, this is typically around 1.3. With highly infectious disease, such as measles, this can be as high as 9. Anything below 1 is great because it means the disease will slowly disappear as anything less than 1 means you are not even passing it on to one other person.

The Lancet has given an early estimate that COVID-19 at 2.35. But other studies have suggested it could be as high as 5.7.

The amount of people you infect is also dependent on the percentage of the population that are vulnerable. If half the population is immune because they have already had it or because they have been vaccinated, you can divide R0 by two. The number of people you infect is actually R₀ * percentage of the population that is vulnerable (R₀S).

R₀ is important for two reasons. First, the higher it is, the faster it will spread. We can artificially suppress the number to be lower by using things like social distancing and lockdowns. If we can get it down to 1 we can control the situation. This is easier to do at 2.35 than it is at 5.7. The problem with social distancing is that it only artificially suppresses the outcome. Once you end the social distancing, the number jumps back up and the whole process starts again.

Second, it defines the number of the population that need to be infected or vaccinated before the disease will start to disappear. At 2.35, we need around 60% of the population to be immune before the number drops below 1. At 5.7, that means 80% of the population.

How many people die from it

The second factor is how deadly the disease is. If you haven’t followed the coverage too deeply, you might think the death rate is anywhere up to 3.4%. But this is not the case. What you’re looking at here is the case fatality rate (CFR), which is the percentage of people who test positive and then die.

This is quite high in some countries that are not bothering to test anyone and quite low in countries that are widely testing. But nobody is pretending it is the infection fatality rate (IFR), which tells you of the people who get it (tested or not), how many of them die. This we can only poorly estimate because we haven’t tested enough people.

In the UK, we know we are missing a lot of people because we are only testing those admitted to hospital (plus Prince Charles), and the results from testing in Iceland suggest that 10-50% of people are asymptomatic.

Estimates on the IFR vary. In an article in The Lancet, Imperial put it as high as 0.66%. Oxford University, however, put the figure much lower, estimating it to be somewhere between 0.1% and 0.36%.

Combining the variables

Here is the data modelled at for both an R₀ of roughly 2.36 (60% of the population required to develop immunity) and for 5.7 (80% of population).

A few things should be noted: first, this only calculates the point at which the disease starts to disappear. It won’t disappear overnight. Even if we get R₀S down to 0.8, that still means that if 10 people get it, they will infect another 8. It’s on it’s way out but it is still throwing a few punches.

Second, if you want to be an optimist, you could say the IFR could be even lower. In the early days of swine flu, we were talking about high death rates (1-2%) and, in the end, it turned out to be 0.02%. This makes sense from a psychological point-of-view. Much better for a researcher to overestimate and say “sorry, it wasn’t that deadly after all” than to fail to raise the alarm, let everyone die and say “sorry, turned out it was super dangerous and it’s my fault everyone is dead”.

Other exit strategies

There are two other ways this could end. One is that it magically goes away over summer. Trump is still hoping for this option, I think, but even if this did happen, it may well just come back next winter.

The other exit option is a vaccine. Experts have said this is still 18 months away (12 if everything went perfect). But, importantly, this is just to deliver the vaccine. There is a difference between developing the thing and embarking on a nationwide or worldwide immunisation campaign. We have PPE equipment and COVID-19 tests now, for example, but getting them to the people who need them is still a logistical nightmare taking months.

So, we’re probably looking at two years until we’re immunised. For this to save lives, we would have to artificially suppress R₀S to less than 1 for that entire time, which means two years of varying degrees of lockdowns and social distancing.

Whether this can work depends on how easy it is to suppress the virus. If South Korea continues to limit their deaths to a handful per day, they could keep the total number down to 2,000. New Zealand seem to be doing even better. How well this will work in the long-term is unclear; China is now battling a second wave of foreign infections, for example, and normal life is far from resumed in any of these countries.

Conclusion

Somewhere between 40,000 and 400,000 people in the UK are likely to die with COVID-19.

At the best-case scenario, we could be in for another three weeks of grim death counts before the virus starts to disappear forever.

In a worst-case scenario, we’re 2% into this, which will either see us go through a full year of this many deaths per day or a two-year-long lockdown while we hideout waiting for a vaccine. Neither of these options is appealing because it involves a lot of death, or in option B, two years of social isolation, mental health problems, suicides, drug and alcohol abuse, lack of a healthcare system, missed cancer screenings, job losses, domestic abuse, children not getting their education and the many other social costs.

All of this underscores the need to start large-scale antibody testing to confirm what the IFR is. Once we know that, we can start making evidence-based decisions about what the plan should be.

Patrick Vallance previous said he thought the UK would need around 60% infection rates in order for a country to develop natural immunity. As discussed in today’s government press briefing, he’s also quoted as saying 1 death represents 1,000 cases, confirmed or not. This is just a rule of thumb as we do not have enough data to know for sure.

Based on those numbers, we would be looking at around 36,000 deaths in Italy, 28,000 in Spain and 41,000 in the UK. It should be noted that, as previously discussed on the blog, we don’t really know what the death rates are, but some people have placed it higher. Anyway, that disclaimer over…

If we assume the midpoint will line up with the peak (and I don’t know if that is the case), there is some good news on the horizon. Based on current death rates, both Italy and Spain would reach their peak in 5 days (which is from yesterday, because it’s yesterday’s WHO data, so 7 April).

The UK is more difficult to predict. Based on the current death rates, we wouldn’t hit the peak for another 40 days. But, that death rate is likely to continue to increase further as it has been doing all week. If it doubled, that would half the time to 20 days (still a pretty grim prospect).

There is a bunch of stuff that could throw this off. Valance’s numbers could be incorrect. The peak may not lead up with the midpoint. And the social distancing may slow down the whole process, or even move us back to a containment phase if things went spectacularly well.

Today’s government spoke of “green shoots” and the idea that things might be getting a little better in the number of infections, which will have a knock-on effect later down the line. Unfortunately, that “down the line” could be a long way away.

This graph includes today’s provisional figures for Italy, Spain, UK, France and the US.

Italy and Spain are still rising, and while deaths per day are not increasing, they’re not decreasing, either. Italy is now three weeks into its lockdown. Most other countries, including France and the UK, seem to be following the same curve. The UK is still ahead of Italy at this point and by an increasingly large margin.

If the US figures are accurate, they have had the worst single day of any country without this entire crisis. But their reporting is a bit patchy, so it’s plausible that some of the deaths from yesterday were only recorded today.