This Is Going to Hurt Me More…

After two weeks of insulin, Oscar had a follow-up to check his fructosamine levels. The good news was that the levels had fallen several hundred points, into a range the vet considers “healthy.” He’d also lost a bit of weight, at a rate the vet also considered healthy. Barring acute events or observable change in behavior, he’ll goes back in three months to test again.

So the 7am/7pm feeding and injection regime is “the new normal.”

Cats, it turns out, are much better at knowing when they’re hungry than they are at knowing what time it is – so Ivan generally starts demanding food a couple hours before it’s time to be fed.

That’s far less irritating in the afternoon than it is at 5:30 in the morning.

Dawnise is really good at ignoring him and either sleeping through it or falling back to sleep. I, on the other hand, am not. And the cats figured out long ago that a pretty sure fire way to get my attention (and get me out of bed) is to make destructive sounding noises in a room just out of sight.

So, yeah… Three weeks in and it’s already getting old.

In other news, the UK’s third COVID wave seems to have peaked at 60k daily reported cases (a ~12% positivity rate in England) in mid July. So far much lower than the estimates – some as high as 100k per day.

The latest eyebrow-raising news is that the NHS has only recently started gathering and reporting data that differentiates people being admitted to hospital with COVID from those being admitted to hospital due to COVID.

That data shows that over the past month about 1 in 4 admissions are of people who test positive, but for whom COVID symptoms are not the cause of admission.

Hospitals were measuring and reporting what they were asked to measure and report. And from the perspective of a hospital, counting patients with COVID is reasonable and important. COVID infected patients demand more resources, in the form of increased isolation, PPE, etc., than non-COVID infected patients. So whether a patient arrives with a broken leg and tests positive, or comes in with low blood oxygen clearly due to COVID, that patient places more demands on the hospital. Knowing how many patients are admitted with COVID is a key data point for understanding the capacity of the health care system.

But health care system capacity wasn’t the only way the data was being interpreted by the media, the public, and seemingly by the government. As the vaccination program suppressed the link between infection and acute illness, public attention turned from case counts to more focus on hospitalization and mortality rates. And this reveals that recently, the hospitalization numbers haven’t quite represented what people thought they did.

The data being gathered told how many people were in hospital with COVID – and using that data to reason about the risk of being hospitalized due to COVID isn’t straight forward, indeed may be impossible.

But it was happening all the same.

Why is this data only being gathered now? I have seen no good answers. The Telegraph quotes Professor Carl Heneghan, director of the Centre for Evidence-Based Medicine at the University of Oxford, as saying: “This data is incredibly important, and this is information we should have had a very long time ago. We have been crying out for it for nearly 18 months.” (emphasis added) Going on to say “the Government might have made very different decisions about restrictions if it had access to data which actually measured the situation accurately.”

Were the decisions wrong? Hard to say. But making decisions that affect many millions of lives based on data that doesn’t mean what you think it means certainly seems … not great.

It’s also hard to say if the difference between what we were measuring and what people thought we were measuring has been consistent over time. It’s tempting to naively retroactively apply the 25% “over estimation” to hospitalization numbers from January – indeed that same article quotes Heneghan as saying “at the peak of the pandemic in January, we were talking about close to 40,000 patients in hospital – this new data suggests that back then around 10,000 of them were primarily there for other reasons” – but that’s almost certainly wrong. Nothing else about this virus has been stable over time, this seems unlikely to be the exception.

To be clear, I am not a statistician – I don’t even play one on television – clearly neither is Boris Johnson, and based on the quote above I have my doubts about Professor Heneghan, too. Having said that, I’m pretty sure a better past estimate could be had using long term hospital admissions data. Fortunately, that data exists, hopefully someone’s working on that as I type.

It takes context and understanding to turn “data” into “information,” and again to turn “information” into “knowledge.” Decision making, certainly on a national scale, demands rigor at each step.

If there’s a moral here, I think it lies somewhere between “lies, damn lies, and statistics” and “never attribute to malice that which is adequately explained by stupidity.”

And there’s certainly been no shortage of that.

My Elephant Votes “No”

A few weeks back, Dawnise got us tickets for tonight’s taping of Comedians Giving Lectures. Despite enjoying the host (Sara Pascoe) and the format, and really wanting to take steps back toward normal, we’ve decided to sit this one out.

We got an email this morning with updated tickets; “please use this updated ticket rather than the previous version.” it said, along with a note that “there have been two changes to the ticket; the social distancing statement has changed and the PPE statement has changed.”

Well, then, guess it’s time to re-read the fine print.

In line with the dropping of legal restrictions on Monday, the producers and venue decided that “at this event, there will not be enforced social distancing.” and specifically noted that “each group will not be seated apart from each other group.”

We’re both vaccinated, so the risk to our health seems low. On the other hand, the news cycle has been dominated lately with articles about the so-called “pingdemic” (the British press loves naming things) – a surge of people being instructed to self-isolate by test-and-trace. With the daily case count averaging 48,000 new cases per day – about 80% of the peak level seen in January – the heretofore largely vestigial test-and-trace system has suddenly woken from its slumber to rain on the freedom parade.

I figure the chance that someone in a shoulder-to-shoulder, young-trending audience tests positive for covid in the next few days is approximately 100%.

So while we’re unlikely to get sick, and even less likely to get “seriously sick,” we figure there’s a pretty good chance we’ll get ping’d by test-and-trace and have to sequester ourselves in our flat for a week and a half.

The final nail in the coffin was learning that Dawnise couldn’t head over to get in the queue for the taping ahead of me, while I finished up a work meeting – their check-in protocol is to hand out numbered wristbands on arrival, and they were clear that people who didn’t arrive together wouldn’t sit together.

So we decided we’ll stay home, and watch the episode when it ultimately airs.

And while everything I’ve just written is true, and tells a pretty good story for why we’re (not) doing what we’re (not) doing – I think the reality is that my elephant leaned away, and I’m just explaining its behavior.

Things You Learn to Live With

A week from Monday, on the 19th of July, England plans to remove all remaining legal restrictions on behavior instituted due to COVID-19. No more limits on the size of indoor gatherings, no requirement to wear masks indoors, no more mandate for social distancing, and no more government guidance for those who can to work from home. Fully vaccinated travelers still need outbound and return PCR tests, but can skip quarantine on return from “amber list” countries.

People are being encouraged to ‘exercise judgement.’

Case counts are doubling roughly every 6 days.

The new health secretary; Sajid Javid, who replaced Matt Hancock when Hancock was observed “breaking social distancing rules,” says the UK must ‘learn to live with’ COVID. Maybe it’s me, but this isn’t the sort of statement I’d expect from someone charged with protecting public health when cases are growing this quickly.

Israel – where the majority of the population (56%) is fully vaccinated – has responded to their case count rising by reinstating a mask mandate, six months after having removed all restrictions.

So I give it a 7/10 chance that some set of restrictions are re-introduced before Christmas. I’d be happy to be wrong.

Also from the things-you-learn-to-live-with department, Dawnise and I find ourselves – for the second time – caring for a diabetic cat. We took Oscar to the local vet about two weeks ago, having noticed an uptick in his fluid consumption and, um, return.

They did an exam, drew blood, and found acutely elevated blood glucose leading them to suspect diabetes. A subsequent fructosamine panel reinforced the diagnosis. So he’s getting twice daily insulin injections, and both cats’ eating schedules have been strictly controlled – which I assure you no one in the house is particularly happy about.

He goes back in a week for follow-up blood work to adjust his daily dose.

If the idea of jabbing your cat with a hypodermic twice a day isn’t enough to get you irritated, consider that it also means you – or someone you trust to jab your cat with a hypodermic – needs to be home twice a day, on a pretty predictable schedule.

So that makes life in general, and travel particularly… complicated.

We had been starting to discuss a return visit to Seattle, once the quarantine-on-return requirement was dropped, and this throws a spanner in those works. We need to at least get him on a stable treatment plan before the two of us can consider vanishing at the same time.

Our hope – which may be pure optimism – is that we can get to the point where his condition can be controlled through diet. Unlike humans, cats with type 2 diabetes can experience spontaneous remission – we know, ’cause our last diabetic cat (Junior) “got better” after a period of diet control and treatment. Fingers crossed.

Not much other news of particular import – Dawnise is starting to occasionally venture out of the flat – shopping trips around London, solo and with friends. I’ve been fighting the good fight to remain engaged and motivated. Some days are better than others, but mostly I feel like I’ve long run out of fucks. Whatever I have now are to fucks what chicory is to coffee, or carob is to chocolate. Sorta similar looking, but you’d never mistake them for the real thing.

I guess this is what burnout feels like.

Another thing to add to the list of things I’d rather not to learn to live with.