Tuesday, 22 December 2020

Mutated Virus

Coronavirus seems to have taken a turn for the worse, with the latest announcment creating Tier 4 as the science stresses the point of no return. It seems a bit apocalyptic! However, humans have had to face strengthening viruses before.

Take TB [tuberculosis] for example.

Tuberculosis is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person. It mainly affects the lungs, but it can affect any part of the body, including the tummy [abdomen], glands, bones and nervous system.

Tuberculosis is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke. Diagnosis of active TB is based on chest X-rays, as well as microscopic examination and culture of body fluids. Diagnosis of latent TB relies on the TST [tuberculin skin test] or blood tests.

In 1869, Jean Antoine Villemin demonstrated that the disease was indeed contagious, in 1882, Robert Koch revealed the disease was caused by an infectious agent, in 1895, Wilhelm Roentgen discovered the X-ray, which allowed physicians to diagnose and track the progression of the disease, and although an effective medical treatment would not come for another fifty years, the incidence and mortality of tuberculosis began to decline.

What I am trying to point out here is that eventually coronavirus will be beaten by mankind, and the current situation does not have to look so bleak.

Sunday, 20 December 2020

Tier 4

A new tier created for Christmas, well not exactly.

The following areas were moved from Tier 3 to Tier 4:

Kent, Buckinghamshire, Berkshire, Surrey [excluding Waverley], Gosport, Havant, Portsmouth, Rother and Hastings;

London [all 32 boroughs and the City of London];

the East of England [Bedford, Central Bedford, Milton Keynes, Luton, Peterborough, Hertfordshire, Essex excluding Colchester, Uttlesford and Tendring].

Monday 14th the Prime Minister announced that as things were going, Christmas would not be cancelled. This appeared to be a PR statement after speculation that the 5 day break was frowned on by scientists.

Friday 19th the Prime Minister announced Tier 4 because a 'NEW' strain of coronavirus has appeared. It is stronger and faster than the original. A lot of what has been happening during November & December seems to have been media lead rather than science lead. The media love U-Turns by a government, however, a virus doesn't care what the media thinks, unfortunately people believe what they read.

The public decided that the announcement affected them personally as the panic that happened at railway stations air & sea ports of Friday 19th was nothing like we had seen before. During the day air fares rose at an exponential rate. At a later broadcast, the scientists tried telling people to unpack their bags and not to travel. It was paitently obvious that they were not listened to as the public moved like a plague.

Sunday, 13 December 2020

No Deal Brexit

With the prime minister Boris Johnson and the European commission president, Ursula von der Leyen, due to decide today whether to halt stalled talks and make the momentous decision to accept no deal, an outcome that would lead to tariffs and quotas on UK-EU trade and rising prices.

The use of gunboats to patrol UK fishing waters in the event of no deal was backed by Admiral Lord West, a former chief of naval staff. “It is absolutely appropriate that the Royal Navy should protect our waters if the position is we’re a sovereign state and our government has said we don’t want other nations there,”.

Greg Clark, the former business secretary and current chair of the Commons science committee, said: “It is clearly unacceptable for the UK to be expected to agree to be unilaterally punished if we declined to follow future EU policy.”

So what would change? [probably]

Prices could go up for the goods the UK buys and sells from and to the EU. That is because the UK and EU would trade on WTO [World Trade Organization] terms, the basic rules for countries without trade deals. The EU would impose taxes [known as tariffs] on goods coming from the UK. The average is about 2.8% for non-agricultural products, but 10% for cars and more than 35% for dairy products. That would put some industries under pressure.

Co-operation on security and data-sharing will become more difficult, causing problems for cross-border investigations. The UK would immediately lose access to databases of things like fingerprints, criminal records and wanted persons. There are big questions about services. The UK has been waiting for a decision about whether the EU will recognise UK rules for financial services. Without that it will be difficult for UK firms to operate in the EU. Some banks have already moved offices and staff to EU countries.

If the UK gets to the end of the year without a trade deal with the EU, that does not mean there will never be one. It has been suggested all the problems it would cause for both sides would focus minds on reaching a deal as soon as possible in the new year. But there are those on both sides who say it could be many months into 2021 before talks were to resume in this scenario.

With the 31st December 2020, deadline for a trade agreement between the European Union and United Kingdom approaching, the risk of a "no-deal Brexit" is mounting. When the U.K. initiated Brexit [its exit from the EU] on 31st January 2020, the Withdrawal Agreement provided 11 months for negotiating a new trade relationship and extended U.K. participation in the EU single market and customs union during the transition. If no deal is reached by the deadline it will trigger what is called a no-deal Brexit. In this case the U.K.-EU trade relationship will be governed, by default, by the trading rules of the World Trade Organization.

The sudden switch to WTO rules would greatly increase tariffs and other trade restrictions, raise the cost of goods, and complicate regulations, greatly increasing financial and administrative burdens for companies. A no-deal Brexit will greatly impact the U.K., causing an estimated 8.1% reduction in its GDP [gross domestic product] after 10 years.

Outstanding issues include the allocation of British North Sea fishing rights to EU countries. Although fishing is minor part of the EU economy, this issue is politically significant in Denmark, Belgium, the Netherlands, Ireland, Germany, and especially France. Also unresolved is the extent of permissible government subsidies for business for which the U.K. has sought expansive latitude. For a time the prospect of an agreement was severely threatened by the Prime Minister submitting to Parliament a proposal to disregard the Irish Protocol. The U.K. proposal would re-establish a border between the areas of Ireland. Faced with strong opposition by EU members, and especially by the United States, whose politicians threatened that violating the Irish Protocol would bar any U.S.-U.K. trade agreement, the Prime Minister announced that the U.K. would comply with the Irish Protocol.

On Thursday 23 June the referendum took place and the talks have so far lasted four years.

Sunday, 6 December 2020

False Negatives

This week has made "false negatives" trend.

A negative test, whether or not a person has symptoms, does not guarantee that they are not infected by the virus. How we respond to, and interpret, a negative test is very important because we place others at risk when we assume the test is perfect. However, those infected with the virus are still able to potentially spread the virus.

Using RT-PCR [reverse transcription polymerase chain reaction] test results, along with reported time of exposure to the virus or time of onset of measurable symptoms such as fever, cough and breathing problems, researchers have calculated the probability that someone infected with SARS-CoV-2 would have a negative test result when they had the virus infection.

Scientists have warned the government’s multi-million-pound plan to mass test everyone in Liverpool for Covid-19 in a bid to bring the virus under control may be fundamentally flawed, because the tests may not actually be accurate enough. The rapid lateral flow tests set to be used in the scheme are so unproven they come with a manufacturer’s warning: “Negative results do not rule out infection”. The lateral flow tests are just one of three kinds of tests being used in the pilot but, because they have the quickest turn-around time and are especially easy to use, it is thought they will make up the largest majority of those carried out.

Diagnostic tests [typically involving a nasopharyngeal swab] can be inaccurate in two ways. A false positive result erroneously labels a person infected, with consequences including unnecessary quarantine and contact tracing. False negative results are more consequential, because infected persons [who might be asymptomatic] may not be isolated and can infect others.

Interpretation of a test result depends not only on the characteristics of the test itself but also on the pre-test probability of disease. Clinicians use a heuristic [a learned mental short cut] called anchoring and adjusting to settle on a pre-test probability [called the anchor].

They then adjust this probability based on additional information. This heuristic is a useful short cut but comes with the potential for bias. When people fail to estimate the pre-test probability and only respond to a piece of new information, they commit a fallacy called base-rate neglect.

Another fallacy called anchoring is failing adequately to adjust one’s probability estimate, given the strength of new information. Likelihood ratios can give a clinician an idea of how much to adjust their probability estimates. Clinicians intuitively use anchoring and adjusting thoughtfully to estimate pre- and post-test probabilities unconsciously in everyday clinical practice. However, faced with a new and unfamiliar disease such as covid-19, mental short cuts can be uncertain and unreliable and public narrative about the definitive nature of testing can skew perceptions.

We draw several conclusions. First, diagnostic testing will help in safely opening the country, but only if the tests are highly sensitive and validated under realistic conditions against a clinically meaningful reference standard. Second, the FDA should ensure that manufacturers provide details of tests’ clinical sensitivity and specificity at the time of market authorization, tests without such information will have less relevance to patient care.