The mathematics of pandemics

There's been a lot of coverage on how people are still not getting the message about keeping your distance and minimising contact with others. I guess a lot of people are wondering what difference their contribution might make - even if they were infectious. And anyway, isn't it all like flu which comes round every year?

“If you are irresponsible enough to think that you don’t mind if you get the flu, remember it’s not about you - it’s about everybody else.”

Intensive care specialist Professor Hugh Montgomery explains why this coronavirus is different from the ordinary flu. pic.twitter.com/h9sQorHQUv

— Channel 4 Dispatches (@C4Dispatches) March 22, 2020

If you haven't got time to watch the video, or you didn't follow it, here's the calculation.

On average someone with flu infects 1.3 people (OK there's no such thing as 1.3 people, but it's an average)

If that infection process happens 10 times over then 1.3x1.3..  [ten times over] = 13.78. Let's call it 14.

On the video he says flu infects 1.3-1.4 on average. Put 1.4 in the equation and you get 28.9. Let's call that 29. That's double.

But if a virus is more easily transmitted, each person with it will infect more. Let's see what happens if a bug meant each infected person passed it on to 2 more people, and that happened 10 times over

2 x 2 = 4
2 x 2 x 2 = 8
...
2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 = 1024

According to Professor Montgomery, with covid-19 the it's 3 people. And if you put 3 into the calculation, you get:

59049

That's right. Over 59,000 people infected. And that's why it's important to close off as many avenues as possible for this thing to spread.

Bereavement 1: Marking the Journey

As I said a while ago in a previous post, I've had mixed feelings over blogging about being alongside someone with cancer and now the experience of bereavement. Debbie's blog was very much about her story, and I didn't feel I had a lot to add in those weeks. However, since Debbie died I've been wanting to get a few ideas and feelings logged somewhere, so I'm going to post a few reflections. I have dealt with hundreds of bereaved people, but inevitably you are always at a distance. Writing about it first-hand is a very different project.

I'm very conscious that posts like this could become quite self-indulgent, and it's true that it will help me to clarify my own mind and get things out of my system. However, I'm also aware that my familiarity with funerals and other people's bereavements gives me a perspective that could be helpful to others. So, I hope these next posts help some people; if they don't, that's absolutely fine. I'll blog about football or something before too long!

A couple of days ago on the the BBC Today programme, there was a discussion about how many people die in hospital, when this was probably not the outcome that they or their relatives would have wanted. In a new book, Dr Seamus O'Mahony argued that many of those who die in hospital do so over-medicalised and without having made any kind of advance care plan. Obviously there will always be people who die in hospital, due to acute or sudden injury or illness, but many of us don't realise there are choices we can make. The key issue is getting people talking about it, because doing so brings out so many of our fears.

At a very early stage in the diagnosis of Debbie's cancer, we knew, at the very least, that her life was in grave danger and the possibility of curative treatment was, as she put it, a fragile hope. Not only did Debs blog about those issues, but she also did a lot to help us to anticipate what her dying would mean for us, and how we might all best prepare for it. Initially she wrote poems and letters for people, wrote an initial draft of her funeral (more about this in a future post) and talked very openly about letting go of some of her hopes for the future. Paradoxically as she did that, it seemed clear to me that she became more and more content and appreciative of what she had experienced in the past and the life she was enjoying in the present.

Having had some involvement at our local hospice as a minister, Debbie knew a little about it. It always struck us as a place which was peaceful, caring, and concerned with the whole person and their family. So we asked questions about what resources the hospice could offer, and how people came to be referred there. If, as seemed likely, her illness was terminal, then we both wanted to avoid the latter part of Debbie's life to be dominated by an endless round of interventions, and Debs was also clear she had no desire to die at home, especially if that meant our home would be a constant flow of nurses and visitors and our bedroom would look like a hospital ward. If possible, we agreed the hospice would be the best place for that final care of both her and us - and so it proved to be. Further down the line, Debbie completed a document where she explained her choices.

The critical issue is to get the conversation started. This coming week is the 2016 Awareness Week for the Dying Matters coalition, titled The Big Conversation. It's to encourage us all to start talking, whether there is a pressing reason to or not.

There are also other resources to get the conversation going, such as the Church of England resource Gravetalk, and a local initiative called My Last Orders.

Of course, you don't need any of those to talk about death and dying, but they can help to break the ice and get the conversation started. Whatever route you take, I can vouch for the fact that talking things through in advance is hugely worthwhile. Some people die suddenly, leaving relatives wondering what their loved one wanted; others reach a point in their illness where they can no longer communicate their wishes to those they will leave behind. Our experience was that talking it all through at an early stage meant there were no major questions left unresolved for us. We knew what Debbie wanted and felt, so we could work with her to achieve that, insofar as it was possible. What's more, we could get on with getting the most out of the time we had left. In the event, everything worked out according to her wishes, and that makes a big difference to how we are all feeling now.

So start the conversation. As the poster says, talking about dying won't make it happen.

Debbie

I know a lot of friends and contacts will already know about what has been going on with Debbie's health. It's been quite a journey so far, and there's a lot to come. I'm not going to use this blog for updates about her, as you can follow news and also Debbie's reflections on her illness and treatment on her own new blog. Just click here if you'd like to view that and keep in touch with what's going on.

Is Choice a Virtue?

An irritating politician was on the radio a little while ago, saying how important it was to give parents choice in their children's education "because parents know best". Do I? I'm not sure that I do. I'm not qualified in education/teaching and I'm not confident I know all the criteria on which to assess a school and its staff.

Then there was an interview with a health minister. Apparently it's important that patients can make informed choices about their health care as they know best. No I don't. If I'm ill I want someone who knows what they are talking about, and who is competent in administering treatment to get on with it. How should I know what's the best way to treat my condition. By all means ask my consent, and feel free to discuss the options, but let's not pretend I'm an expert.

Pricing and Binge-drinking

I find the proposals for minimum pricing for alcohol quite an interesting idea. Basically the idea is that a minimum price per unit of alcohol is set, and then any drinks can't be sold for less than that price. The talk is of 40-50p per unit as a minimum level. Although it can't solve all alcohol abuse problems, it is believed that it could combat people drinking a load of cheap vodka before going out on the town. It would also set a more challenging price for the big plastic bottles of cheap strong cider.

As an experiment, I was looking at some of my favourite drinks and wondering what effect it might have on them. A bottle of Hobgoblin Ale by Wychwood Brewery has 2.6 units. A 50p minimum would mean it had to be sold for £1-30, which would be quite a competitive price; 40p would mean £1-04 minimum. Bottles of wine would have to cost £4 or £5, depending on strength and the level set. The biggest impact would be on cheap bottles of spirits, as a bottle typically contains 25-30 units, so that's £10-12 minimum. Again, no effect on the better quality end of the market.

So, is this common sense, or will it simply penalise the poorer drinker?

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• How will Scotland deal with its alcohol problem? (telegraph.co.uk)

Atheism, Hospitals and Prayer

Got a good response to the Atheist post which all took place over on facebook, which this blog feeds into. The conversation discussed what people mean when they self-describe as atheist. As I said earlier, I suspect that for many it just means "I don't do God" or even "can't be bothered to think about it", rather than the adoption of a clear ideology. There also seem to be passive and active atheists in the latter category - some who keep their views private, whereas others want to convert you as passionately as Christian evangelists.

Meanwhile, there is now a debate about prayer in hospitals, which follows on from a case where a nurse was disciplined for offering to pray for a patient. The BMA will be debating a motion about the right of health care professionals to offer to pray with patients.

The coverage has interested me. "Doctors are demanding the right..." was the BBC Sunday radio headline, and is echoed on the news website. In fact, the motion being put to the the BMA representative meeting is as follows:

Motion by THE AGENDA COMMITTEE: That this Meeting:
(i) recognises that the NHS is committed to providing spiritual care for patients;
(ii) notes the position on inappropriate discussion of faith matters in GMC Guidance on
Personal Beliefs and Medical Practice;
(iii) while welcoming the constructive and necessary advice in the document "Religion or
belief", is concerned that some paragraphs suggest that any discussion of spiritual matters
with patients or colleagues could lead to disciplinary action;
(iv) believes that offering to pray for a patient should not be grounds for suspension;
(v) calls on Health Departments to allow appropriate consensual discussion of spiritual matters
within the NHS, when done with respect for the views and sensitivities of individuals.
(Sheffield Division has been asked to propose this motion)

Full agenda available at http://www.bma.org.uk/images/ARMgenda2009_tcm41-187028.pdf

Hardly the mandate for aggressive and exploitative manipulation of vulnerable people, which the National Secular Society spokesman suggested. The Radio 4 debate descended into a rather odd conversation about whether it was inconsistent not to offer prayer to everyone, when he seemed to be suggesting that one could be a little more discerning than that. After all, not praying with a patient doesn't mean you don't pray for a patient.

Banning spiritual/religious issues from the practitioner-patient conversation would be a conscious decision to make health care atheistically secular. A democratic society is entitled to make that decision, but it isn't a decision to be taken by default. Even limiting that conversation to Chaplains represents a compartmentalising of spiritual matters. If the NHS is more than a mechanistic service, and seeks to offer person-centred care, then it would seem that every aspect of a person needs to be cared for.

Patient Concern, a (not Christian-based) patient advocacy organisation seemed to be the voice of reason in the midst of all of this.

But Joyce Robins, co-director of Patient Concern said: "Most complaints from patients are about being on a conveyor belt of care. They don't rate with staff as real people.

"Offering to say a prayer is a warm and kind thought. Most patients will accept it as such. It is no more offensive than being offered a sleeping pill. You can say thanks but that sort of thing isn't my cup of tea.

"But if Christian doctors see this as an opportunity to promote their faith to people at a time when they are particularly vulnerable, that is totally unacceptable."

Quoted from http://news.bbc.co.uk/1/hi/health/8116497.stm

Lent: Day 2

If you just want to view Lent posts, click Lent under the labels heading in the right-hand side-bar

Debbie was out last night, so whilst channel flicking I stumbled across something on BBC1 called the 34 stone teenager . It documented the story of Bethany, who is now 19 years old and weighs 34 stone (476 pounds/216kg). She was so dangerously obese that she took the decision to seek surgery to help her to lose weight. Until she was an adult, this was not possible in the UK.

It was almost terrible to hear the story of her eating, which often increased when she felt bad about herself or her appearance. She was trapped in a vicious circle of gaining weight, feeling depressed about weight and then comfort eating.

The surgery reduced her stomach quite drastically, and it was an operation with significant risks (1 in100 fatalities). In her case, all went well, and in the following weeks of recovery, Bethany lost about 4 stone. She was obviously impatient to lose more, but even that began to make quite a difference to her appearance.

One conversation she had was with another man who had had similar surgery. They touched on whether losing the weight was really the solution, and it was interesting to observe that Bethany was worried about how she would be when she was thinner, whereas the guy (who had already lost his weight) was feeling great and in a serious relationship.

It all seemed quite topical for Lent. What sort of changes do we want to make to our lives, and what's the best way to effect them. Clearly Bethany would rather not have been in the situation which required this drastic intervention. The question remained open as to whether the issues that have made her so unhealthy would disappear when she was in better physical shape. On the other hand, some external changes can really start to turn people's confidence around, otherwise 'Trinny and Suzanna' and 'You Are What You Eat' TV shows wouldn't work.

I guess Lent can be a time to make an intervention of change in our lives which may be contrived - giving up alcohol, chocolate, etc. We know it's temporary and short-lived, but it might open up some further questions about priorities and lifestyle which otherwise we would bury and ignore.

But maybe we should really be working on getting to a place in our lives where interventions aren't necessary; getting to a healthier place in our relationships and self-understanding that means that unhealthy or dysfunctional behaviour is no longer desirable.

Easier said than done, and I suspect we all sometimes need the metaphorical equivalent of Bethany's surgeon's knife. I hope she gets to where she wants to be, and most of all that she resolves the underlying issues.