Archive for the ‘Health & Wellbeing’ Category

It was a bad day for Spain yesterday who reported more deaths than Italy. Italy, on the other hand, maybe showing signs of levelling off. The UK had a fairly good day, but that may be due to underreporting: the BBC said the timeframes were chopping and changing, which might explain why we had few deaths yesterday but over one hundred today.

Here is the new graph for today. It shows cases across England broken down by NHS region, with the separate nations (Scotland, Wales, Northern Ireland) also getting their own slice of the pie.

A third of the cases are in London. But that is not abnormally high: they have 13% of the population and the most international travellers passing through. Still, might make you think twice before taking the tube. Otherwise, it is fairly well spread out across the country.

I mean, we have definitely had better days. Spain, France, the UK and the United States all had their highest ever death count yesterday. And bear in mind that I am only tracking seven countries. But there is a silver lining: although Italy had a bad day, too, it was not as bad as two days ago.

It is still too early to say whether the UK is going to follow Europe or China. But it would seem odd if it did follow China given we have been taking at best similar, and at worse, much more lax measures than the rest of Europe, while China went into lockdown early and did a lot of testing.

The problem is that we are still earlier on in this than everyone else. We’re on day 12. Italy is on day 29, Spain is on day 17 and France is on day 18. At this stage, everyone except Spain was behind us. Early indications from the NHS is that today wasn’t too bad, but it’s only 9pm, so we’ll have to wait and see.

I’ve updated the graphs for today. WHO report on what happened yesterday, so when I say today, I mean the data the WHO published today, but it’s actually yesterday’s data. And yesterday wasn’t too bad. Italy continued to decline for the second day in a row. And when I said the borderline for good for the UK was 331 deaths, we came in at 335, so pretty close.

That said, based on today’s media reports, we know that the UK, Italy and Spain are all having a really bad today. So, tomorrow the graphs are likely to look terrible.

Anyway, onto today’s graphs. I took the figures from Imperial College London on the likely mortality rates of COVID-19. These are adjusted based on many cases not being reported, and for a UK/US healthcare system.

I want to preface the following by sating: just because you have a low risk of dying, does not mean you can go around doing whatever you like. You can spread the virus without knowing and you could end up spreading it to someone with underlying health conditions, who are much more likely to die. And that would make you a murderer, morally, although not legally.

Ok, the graphs. First, your risk of dying is low.

Even if you are in the 80+ age category, you only have a 27% chance of needing hospital treatment and a 9% chance of dying. That is much higher than the everyday life of course! This is a serious thing that kills people. A lot of people.

But, for an individual’s risk, you have a 3/4 chance of being able to cope at home, and a 10/11 chance of surviving. Certainly not a Russian roulette game any of us would want to play. But it is good to know that our grandparents having a fighting chance.

Below, is the same graph but zoomed in. The X-axis only runs to 30%. This is not representative of your overall chances but means we can see it better.

In the lower age categories, the outcome looks rosy. If you are in your 30s, for example, you have a 3% chance of requiring hospitalisation and a one in a thousand chance of dying.

I don’t know what percentage of the population have underlying health conditions. But I imagine it increases with age and maybe around 3% for someone in their 30s and may well be 9% for someone in their 80s. If so, that would mean that COVID-19 typically only kills when you have underlying conditions. But I don’t have those figures, I’m speculating. The WHO has stressed that younger people are not invulnerable and they are literally the World Health Organisation, so we should listen to them.

It also seems likely that the stats for underlying health conditions are much higher than those percentages and that most people with underlying conditions are also fine. Or as fine as you can be when you have a nasty flu. As Chris Whitty keeps reminding us, the vast majority of people, even in “at-risk” categories, will get over it.

That’s all for today. See you tomorrow to talk about Black Tuesday :(.

The WHO has now released today’s situation report. Here are some of the headlines:

• China and South Korea are still seeing deaths, but not many.
• Italy recorded 649 deaths, compared to 795 yesterday. It has dropped before and then continued to rise, though.
• The US has reported 201 deaths today, doubling their total. As none were reported yesterday, could just be delayed figures?

Let’s update the graphs.

Deaths per day

Let’s hope today’s result is a sign that Italy is turning the tide and not just an anomaly. On the other hand, let’s hope the US result is an anomaly based on delayed data and goes back to normal tomorrow.

My previous graph showed the incorrect figure for the UK yesterday, which I have now corrected in this graph.

Cumulative deaths

Nothing terribly important to report here, I think. Italy and Spain are still on scary trajectories. It’s too early to say what is going on in the UK. We might follow China. But it is important to remember that Italy weas behind China until day 15. We’re only on day 10, so there is plenty of time for it to accelerate on Italy’s path.

Massively simplistic rules of thumb are a bad idea. But let’s make some anyway. It’s unlikely to start magically dropping at this point (see below), so anything below or around 331 cumulative tomorrow would be a good result. Anything significantly above that would be a bad result. And anything around the 381 mark would be a terrible result.

Social distancing has a delayed effect

One final thought: there is probably at least a 14-day delay between implementing social distancing and seeing any benefit. The virus has an incubation period, then five days of fever and coughing, then the respiratory issues kick in.

We implemented our first set of social distancing (telling people to work from home and not gather in groups) on Tuesday 15 March. That’s six days ago.

We implemented our second set, closing schools and telling people “seriously, stay away from each other” on Saturday 21 March. That was two days ago.

That means that we have 8-12 days of nobody was social distancing damage before we even get to the “we told you all to distance, not cough on each other in the royal parks” damage, which may or may not be resolved. What you do today affects what happens in the ICU two weeks from now.

I’ve been running some numbers based on the situation reports provided by the World Health Organisation. It is not a fun read. But the situation should improve once the first shipment of thoughts and prayers arrive in Europe.

I’m happy to take feedback on these. I’m not a statistician (although there is a lot of stats in psychology), and if you are one and think my graphs are terrible and misleading, I’m open to being corrected.

Deaths per day

China has the most deaths because they have been dealing with this for a long time. People have been dying for 7 weeks now. But not many people and their levels have been going down. The deaths per day in Italy and Spain is far out-racing anything than China saw.

To clarify, this is not cumulative. Even a flat line represents a lot of people dying. A line going up suggests the problem is getting a lot worse.

China still has a problem

This shows the number of deaths per day in China over the past two weeks.

The media are reporting that life in China is going back to normal and that any remaining cases are from people arriving in China. It is true that life is starting to return to normal and people are going outside again. Emergency hospitals have closed and travel restrictions have gone.

However, people are also still dying and the World Health Organisation still reports local transmission.

How far in are we?

This shows the cumulative number of deaths since the 10th death. I followed the Financial Times’s lead on adjusting it this way as, for example, France had one death very early on and then none for a long time. Once you reach the tenth death, you get a far more accurate picture to compare against. Unlike the FT graph, it is not logarithmic. Their graph is just better, to be honest.

At this stage, it is pretty difficult to predict what the UK curve is going to do. We’re only on day 9, compared to day 26 for Italy, day 14 for Spain and day 60 for China.

I’m a psychologist rather than a counsellor. However, I thought my work with Anxiety Leeds and Leeds Anxiety Clinic, and my life, in general, would benefit from a deeper exploration of the theories around talking therapy and person-centred. So, I enrolled on a course with Leeds City College.

Studying has been fun. In terms of academic theory, the textbooks I have been reading have gone deeper than the course does. However, getting to do the interactive practise sessions to allow us to apply the theory have been invaluable. It already feels like it has been translating into better delivery at our group sessions.

And, I’m now formally qualified as a Level 2 Counsellor, which is nice.

I’m pleased to announce my new course is now live! Here is the blurb:

Do you ever feel stressed about how productive you are? Are you hard on yourself for not getting enough done? Do you feel tired and struggle to focus on the more important things?

If so, Mindfulness for Productivity is the course for you. It gives you ten guided mindfulness practices you can follow along with to make you more productive, and maybe even a little happier, too.

It will help you:

• Feel more motivated about your goals
• Reduce stress around feeling unproductive
• Focus on the things that are important
• Carrying on when obstacles fall in your way
• Starting and ending your day positively

This course is suitable for all levels: we’ll jump straight into the practice videos that you can follow along with, but we’ll also cover how to mindfully meditate and the science behind it.

You can preview the course on Udemy.

The idea that being overweight is bad for you is well established. Being overweight takes years off your life, so it’s important to eat right and exercise to keep your weight under control. More recent evidence, however, has challenged this.

For example, a 2013 paper in the Journal of the American Medical Association found that overweight people had a lower level of all-cause mortality than people of a healthy weight. The paper was not well-received, but nobody seems to have been able to poke any holes in it, either.

Similarly, a 2009 systematic review published in Deutsches Ärzteblatt International concluded that:

The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification.

So, should we give up with the diets and let our waistlines expand a little? Maybe. But even if more evidence goes on to support these findings, there are some good reasons for sticking with the current line on what a healthy BMI is.

Overweight vs obese

Something that all the studies agree on is that people have worse health outcomes, including death, if they are obese. Overweight is one thing, but being obese is bad for you in any study.

And you might be surprised how easy it is to reach the category of obese. Consider that my BMI hovers around 24. 25 is the line between healthy weight and overweight. So, I’m nearly in the overweight category. And I look like this:

Not the buffest individual, that’s for sure, but I don’t look like I’m carrying around any extra weight either. And you only have to move up to a BMI of 30 to go into the obese category.

All-cause morality

As the NHS points out, these studies typically look at all-cause mortality, which means people dying of anything. The problem is that this contradicts individual studies of any topic. For example, if we look at heart disease or diabetes. Whenever we look at the individual causes, we find it is better to be a healthy weight.

There is a huge amount of evidence to support this, so in order for us to accept an alternative view, it would ideally need to explain this discrepancy.

Quality of life

The second problem is that these studies just look at mortality. But that is never the way that NICE or Public Health England have looked at how to provide the most efficient healthcare system.

We measure outcomes in quality-adjusted life-years (QALYs). It’s not enough just to be alive. Modern medicine allows us to keep pretty much anybody alive indefinitely. But sitting in a medically induced coma on a ventilator isn’t a life that any of us would choose.

As a study in Nature points out, being overweight is associated with fewer years of disease-free life. In short, you might experience a longer life, but it won’t be a happier or more fulfilling one.

Indeed, this could help explain the findings. If people are already inside the medical system because they’re having to be treated for obesity-related illnesses, we may be better at spotting other diseases. Or it may be that carrying around some extra weight will reduce your quality of life but also help you to stick around for an extra week when you become seriously ill because you have larger fat reserves.

Conclusion

There is genuine evidence that you will live longer if you are a little overweight (but not obese). However, so far we have been unable to explain why this is. And, more importantly, you will also have a reduced quality of life. Therefore, the current guidelines on maintaining a healthy BMI are still relevant.

Below, I’ve collated a bunch of my blog posts on mental health into a list of interesting stuff to read. It’s all been published here or over on the Worfolk Anxiety blog.

Does social media damage your mental health?

In May, Royal Society for Public Health (RSPH) and Young Health Movement published a report on the impact of social media on mental health. The TL;DR is that yes, social media can be harmful. But it also has its uses, so when used in moderation, like most things in life, can be a useful tool.

Things you should know about antidepressants

This is a pretty old article now, and if I wrote it today I would probably say way more. But it highlights a few key things to think about when deciding to go down the antidepressant route or not, and more widely, what opinion you hold of them.

Things to do when you’re well, according to people with anxiety

Mental hygiene is the things you regularly do to keep yourself mentally healthy. Just like we have a daily routine for physical hygiene and dental hygiene, there are things we can do to keep our mental health on the right track. But what actually helps? We asked people who live with anxiety.

Things to tell yourself when you’re not well, according to people with anxiety

In last week’s blog post, we looked at some good things to do when you are feeling well. But what about when you are having a rough patch and can’t find the energy to do anything? What should you tell yourself?

Will suicide nets stop jumpers at the Golden Gate Bridge?

When it comes to stopping people throwing themselves off the bridge, the question is, can a one-time intervention really save lives? Turns out the answer is yes.

We don’t need more money for mental health

You regularly hear politicians talking about how the NHS needs more money for mental health. In today’s post, I want to challenge this idea and offer a very different explanation and very different solution.

What would a mental health workout look like?

If you want to improve your physical fitness, you might work out. Maybe you would eat a high protein breakfast, hit the gym, do a warm-up followed by some intervals and then take a warm bath to recover afterwards. But what about mental wellness? What would a training session look like? What specifically would you do?

After much hard work, I’m pleased to announce the launch of my new course, Mindfulness for Social Anxiety. It follows on from the free 5-Day Mindfulness for Anxiety that already has thousands of students registered.