Dear Government, Just Do One Thing….

Dear Government,

I’m really only talking to the Northern Ireland government here, but if the rest of you want to take a leaf, then do something about it.

Everything is “Covid-Paralysed”. I just see inactivity in every area. People holding their breath. It’s not good enough. We have to be pro-active. But as a “cultural hand grenade”, I figured I’d write a list of things our government departments could do while they’re waiting for society to re-open.

  1. The Executive Office. – frankly, I have no idea what you do anyway other than argue and be ineffectual. This isn’t a personal dig – the EO has always failed to deliver. Look at the unspent social investment fund.
  2. Department of Education. – We have been constantly training more than 200 teachers than we need every year and we have a large bank of supply teachers. So rather than having parents killing themselves trying to educate children, get your act together and use this resource. Yes, not everyone has and iPad or whatever, but that doesn’t mean you do nothing. Find out who needs resources and work together. Use the existing teacher pool, the supply teachers and the unemployed grads to deliver education over Zoom or your tool of choice and take the pressure off parents.
  3. Department for the Economy. – Every skills program that can be opened over Zoom should be opened over Zoom. The lecturers are being salaried. We are in exceptional circumstances and much of it can be delivered over Teams or Zoom. So do it. Make it free and allow people to upskill quickly.
  4. Department of Health. – Be honest, we haven’t yet sorted this crisis. So make sure there’s enough PPE, find more staff to re-open the wards force to close because of sick nurses and doctors and let’s beat this thing.
  5. Department of Justice. – Start preparing law suits against employers who fired or made redundant workers rather than furlough them. And maybe a case against the UK government for wilfully endangering millions of people resulting in the deaths of thousands of people
  6. Department of Infrastructure. – You know, I’m never going to step into a taxi and I’m damn sure it’s going to be a while before I’m on a bus or train. So change the narrative. Convert parking spaces into bus and bike lanes. Do it now while you still can. And while you’re at it, a Greenway from Lisburn to Belfast would cut down on traffic. Plan it now. Execute when lockdown opens up a bit.
  7. Department of Communities. – it’s time for more parks, more leisure facilities, more public art (by local people, not half a million quid to somewhere else). You have a month before the summer starts properly. Are you going to watch the tourist industry completely fail? Get a move on.
  8. Department of Agriculture, Environment and Rural Affairs. Take some leadership and sort out broadband. Thousands of families are struggling without connectivity and if Education get their act together then the families will need it. Do it now.

The Realm of the Possible: Inventing a New City

After DRIVING past the new “death trap” paint on the Sydenham Bypass that’s meant to be a “cycle lane”, I am comforted to see that some cities have leaders who are prepared to re-make the world as we would like it, and not just rely on what has been past. .

Seattle to permanently close 20 miles of streets to traffic so residents can exercise and bike on them

Nichola Mallon, our Infrastructure Minister, isn’t being advised on what’s in the realm of the possible. It’s the problem with that department (and in particular Roads Service). When you ask a road engineer on what would solve a problem, they think in terms of roads.

I tend to think of the realm of the possible extends from impossible to impossible!

So how do we get people cycling and walking more?

Is it impossible to make cycle lanes which are more than paint?

No, plainly not. Here is a part of the Sydenham Bypass with a kerb! This would make cycling much safer. So, why is the department so happy with a line of paint? If we have it for part of the Sydenham Bypass, why not all of it? Why not extend it to Bangor and Ards?

Is it impossible to close BT1 to private street traffic?

No, it’s not. In fact, a lot of that is in the Regional Transportation Strategy including deflecting traffic from hope street straight to the Ormeau/Cromac area via a new road at Bankmore Square. Essentially the only cars in the centre outside of emergency services and buses, should be taxis and disabled vehicles.

Is it impossible to turn every non-disabled parking space in that area into cycle lanes to protect cyclists from buses, lorries and taxis?

No, obviously. We will see a decrease in traffic overall after the pandemic passes as a lot of people-intensive businesses will be re-looking at their leases for commercial property (some large businesses are closing multiple sites and having their workers work from home because working from home can improve productivity (as long as the kids are at school!) If you think about it, all of the streets in the CBD of Belfast are host to “car corpses”. Cars which are driven in and just lie dead all day. Our streets are littered with them. What are the knock on effects of that?

So we don’t need as many parking spaces? Or commercial parking lets? Or office buildings?

No, we really don’t – so that frees up huge amounts of space for cycling and pedestrians. Think of the lives saved from cars not careening into people.

What about those offices? Will they lie empty?

Well, Belfast City Council has been trying to square the circle of getting people to move into the centre of the city, but there just hasn’t been the space. So, if we are talking about maybe a million square feet of unoccupied office space right now and perhaps up to five times that in two years, that’s a thousand 1000 sq ft apartments now, and 5000 in the next decade. That solves the “Belfast is a graveyard” problem every evening as well as fostering small business in the city centre – including the eateries in the city which really deserve a bit of an uplift after the runaway rates and Covid-19 related collapse.

Thousands more living in the city would be a massive uplift for the city economy. And we have the space.

Are there other things we can change?

Of course, with decreased traffic and more reliance on public transport, we don’t need that M2/Westlink Exchange upgrade. That’s a waste as it is, it’s doubly so after the pandemic. We could invest that in live/work apartments in the city centre. We could invest in arterial segregated cycle lanes from four quarters of the city as well as dedicated cycle freeways along the M1, M2 and A2. With the decreased pollution of decreased traffic, Stockman’s Lane might be bearable to cycle through.

Anything else?

Well, I’m always going to say “free public transport”. The fact that it would decrease pollution and particulate matter, reduce the burden of road repairs on the taxpayer, increase social and economic mobility for just about everyone, equalise some of the society and put cash in the pockets of low and middle income workers is just the tip of the iceberg.

We have an opportunity to change the city and be an exemplar. Wouldn’t it be great to be proud of Belfast for things that were great and that worked? Stuff we could boast about that was good on a global stage and not just “better than what we deserve”. Can’t we aspire to greatness as a city? Celebrate our best and brightest?

Rather than a ship that sank, forty years of civil war and an alcoholic footballer?

#NoOneLeftBehind #RuralUrbanDigitalDivide

Bridging the digital divide means guaranteeing access to adequate broadband

It is easy to assume NI is digitally connected and everyone has a smart phone or computer at home. The reality is this is not the case and many homes are forced to choose between buying larger data allowances or buying electricity and food.

Kate Clifford sets out a cogent case against privilege in this article.

I remember sitting in rooms filled with civil servants crowing about how Northern Ireland had the best digital platform in the world.

A claim that was patently not true if you even took a second to survey the rest of the world.
A claim that was even more embarrassing when you excluded developing countries from your survey.

Society is feeling the effects of the digital divide even in areas which are well served with hardware and broadband. At home, my own broadband is creaking under the strain of multiple zoom calls, content delivery by iPlayer and YouTube. Imagine then being in an area poorly served.

The hardware issue is….also difficult. I’ve offered Raspberry Pi computers from my Dojo (and given away a couple) and also given away two slightly ageing Chromebooks – in an attempt to get people up and running. But a lot of content out there just isn’t accessible on more open platforms. It just won’t run on slower computers.

And don’t get me started on Classroom 2000.

Patriotism is the last refuge of the scoundrel

One night during a global pandemic, comfortable in my privilege, I sat chatting to friends across the world.

We were discussing America. And how it might be time to take steps.

America is currently being besieged by rebels calling out for the execution of elected representatives. Their crime? Slowing the spread of the global pandemic mentioned earlier. This sort of thing gets you thinking; a dangerous pastime in any era.

These rebels, complete with wooden painted machine guns and spent husks of rocket launchers, are marching on government buildings, posing with their buddies and complaining at the lack of common services like hairdressing. It hardly needs to be said that while this service is easily done at home, it important to remember Thomas Jefferson “the tree of liberty must be refreshed time to time with the blood of patriots”. That said, Jefferson also put into his Canon, “Never trouble another with what you can do yourself”.

Jefferson also said: “The Christian god can easily be pictured as virtually the same god as the many ancient gods of past civilizations. The Christian god is a three headed monster cruel vengeful and capricious. If one wishes to know more of this raging three headed beast like god one only needs to look at the caliber of people who say they serve him. They are always of two classes fools and hypocrites.”

Which I can offer no argument against.

But what’s the future hold?

It might seem a little hysterical but America is not well. The thesis goes:

  • If in November 2020, President Trump does not get re-elected to the highest office in the country, the outburst from loyalists will shake the very foundations of the Republic. If the angry white men can march, armed and armoured, on the Capitol building because they want haircuts, imagine what will happen when they’re told that Trump lost the election due to foreign interference. Liberals wring their hands, Conservatives make shells.
  • If in November 2020, President Trump does get re-elected, it’s possible to expect Washington, Oregon and California to begin secession. It’s been talked about before. The US has been a single country in name but never united politically or culturally. Whether or not you think the two party system is desirable or not, it exists. And if these states move to secede from the Union, even through a legal process, expect the military to be used to force them to stay.

The status quo therefore becomes totally untenable. Needless to say, conversations will begin again in the GOP about allowing a president to stay longer than two terms and with their control of the Senate and the Supreme Court, who is left to challenge them?

But as I said above, it may be time to take steps. Even while we recover from the grips of the pandemic, there will be a need to take in refugees from war-torn America. Gird yourselves.

A Physician completely refutes Plandemic

From Facebook by Kat Montgomery

**KAT EDITED TO ADD: I wrote this post to help my friends sort through misinformation and did not expect it to go viral. Several commenters have asked me to cite sources, and I agree that this is important to do. I still have a day job, but I have edited to include primary sources for all points when possible.

**SECOND EDIT: People seem to not understand that PubMed (ncbi) is the international database for cataloguing medical research studies and instead think it only contains government-funded information or research. This is not the case. It is basically the Google of peer-reviewed research studies.**

*The following statements represent my personal informed views and not those of any institution*

First, background: I’m a physician (specifically a board-certified pathologist, which includes microbiology and laboratory medicine) with a master’s degree in epidemiology.

In the last day or two, several friends have shared or posted about a video “documentary” called “Plandemic”. The film depicts now-discredited former researcher Judy Mikovits who shares a plausible-sounding narrative about the current pandemic. The problem here is that nearly all of her scientific statements are demonstrably false. If you have more to add to this list, or credible data to the contrary, please start a discussion. I suspect there are many more false claims in this video, but these are just the ones that stuck out to me as a physician with epidemiology training.

– She states “There is no vaccine for any RNA virus that works.” Incorrect: Polio, hepatitis A, measles, to name a few. (Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763971/)

– Her retracted paper was actually not about vaccines at all, even though she insinuates that it was. (Here is the article: https://www.ncbi.nlm.nih.gov/pubmed/19815723)

– She states that Ebola could not infect humans until it was engineered to do so in her laboratory. This is false. (Here is an article describing an outbreak of Ebola in 1976, long before Dr. Mikovits was conducting research: https://academic.oup.com/jid/article/214/suppl_3/S93/2388104 )

– Likewise, many other zoonotic viruses have been shown to gain mutations that allow them to infect humans. This would not be some kind of new, crazy idea. We actually predicted it years ago: we just didn’t know exactly which virus or when it would occur. (Here is an article from 2015 discussing the likely emergence of future coronavirus pandemics: https://virologyj.biomedcentral.com/articles/10.1186/s12985-015-0422-1 )

– She states that the US was working with Wuhan to study coronaviruses years ago, like it’s a “gotcha” moment: yes, of course we were doing this – Wuhan is a coronavirus hotspot and it makes sense to study this family of viruses where it naturally occurs. (Same article as above: https://virologyj.biomedcentral.com/articles/10.1186/s12985-015-0422-1 )

– She states that COPD lungs are identical to COVID-19 lungs. As a pathologist, this is ludicrous – any practicing physician would be able to tell COPD from COVID-19, both clinically and histologically. (One article discussing an overview of tools for diagnosing COVID19 https://pubs.acs.org/doi/10.1021/acsnano.0c02624, one about CT specifically https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1750307, and one about histology specifically https://academic.oup.com/ajcp/article/153/6/725/5818922)

– The statement taken out of context from the CDC death certificate recommendation reads in full “In cases where a definitive diagnosis of COVID-19 cannot be made, but is suspected or likely (the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID-19 on a death certificate as “probable” or “presumed”. In these instances, certifiers should use their best judgment in determining if a COVID-19 diagnosis was likely. Testing for COVID-19 should be conducted whenever possible.”. My physician colleagues are not being pressured to put COVID-19 on death certificates when it should not be there. (Here is the actual document with instructions for
filling out death certificates from the CDC: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf )

– The idea that physicians are incorrectly diagnosing COVID-19 due to financial incentive is also ridiculous. Medicare sometimes bundles payments for some conditions (i.e. if you have a heart attack, medicare may pay XX for your treatment) – it’s possible the hospital could get paid $13,000 for your COVID-19 admission, but do you know what that’s based on? The fact that the average cost of a hospital admission for a respiratory condition is $13,297. (I can’t post a scientific study here, since this isn’t a scientific fact, but this article describes the procedure in detail: https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/ )

– She states that hydroxychloroquine has been “extensively studied in this family of viruses” – in fact, it has not been studied well in coronaviruses. It HAS been studied in malaria, which is not a virus. (Here is the one study that was performed that people like to cite, and it is an in vitro study (not in humans), of SARS (not COVID-19), and chloroquine (not hydroxychloroquine): https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-2-69 ). And yes, it is considered an essential medicine for the treatment of malaria. Not for coronaviruses.

– Furthermore, the data on hydroxychloroquine are much weaker than they originally appeared: the small study that was highly publicized was not a randomized controlled trial, and the only patients who died were those who received hydroxychloroquine (and these were EXCLUDED FROM ANALYSIS!). This is terrible science. Even so, we want to investigate all possible treatments, so controlled trials are being conducted on hydroxychloroquine right now. (One study published on May 7 shows no benefit to using hydroxychloroquine https://www.nejm.org/doi/pdf/10.1056/NEJMoa2012410?listPDF=true )

– She insinuates that there is a hydroxychloroquine shortage as a result of reduced production. In fact, the shortage has resulted from an increase in demand: people who take this medication regularly are writing extended prescriptions and because physicians are using it for COVID19 patients because they have nothing else to try. (https://jamanetwork.com/channels/health-forum/fullarticle/2764607?fbclid=IwAR2oKdwc0aZVFvkKUvw82r6XpnKeq0sFc1iIxqO4JdKscy-81mC6hkRQ6fs).

– “All flu vaccines contain coronaviruses”. Nope, absolutely false. (In fact, it’s so false based on the way vaccines are made that there are no studies specifically stating this claim. It would be like trying to conduct a study to examine whether humans can live with zero oxygen. Nope, we can’t. No study needed.)

– The ideas that sheltering in place somehow harms your immune system or that you may reactivate a virus in yourself by wearing a mask have been thoroughly debunked in other posts and I won’t get into the details here. Both national societies of emergency medicine have condemned the statements of these doctors, one of whom is not board-certified. (Please refer to Dr. Kasten’s post and others about these)

– Lastly, private companies removing false information from their platforms does not represent repression or promotion of propaganda. It’s helping to promote the spread of sound scientific information. If you think lies should be permitted to circulate freely alongside the truth with the intention of reaching people who won’t be able to tell the difference, you are part of the problem.

Raise the bar: maybe you have a great idea…

Coming into mid-Spring, it’s now time to start making calls for the second cohort for our Raise programme. Every six months we start a new formalised intake (though technically companies can join at any time).

We’re delivering remotely (as we have for a decade) though when lockdown ends, we have existing office space in one of the best streets in Belfast.

Raise is the only commercially focused accelerator for startups in Northern Ireland – we only succeed when you do. If you don’t understand why that’s important, come and talk to us. And if you don’t care, well, there’s some incubators out there where you can gestate on your idea for as long as you like.

What do we do?

Well, we teach the things that others can’t or won’t. We get you familiarised with the terms so you won’t be blindsided. We will challenge your idea, contribute to your plans, help you build confidence and develop your pitching style. We’ll help with grants, forms, proofing, explaining. We’ll introduce you to investors, advisors, non-execs, designers, developers and troubleshooters.

So, with that in mind, and with the fear of failure neatly pushed under the rug for a bit, what do you really have to lose? Apply now.

Possible Changes to Cycling/Walking Provision in Northern Ireland:

From the Department of Infrastructure:

I am delighted to announce that there will now be a walking and cycling Champion within my Department. Our champion will ensure that we deliver our commitment to increase the percentage of journeys made by walking and cycling. Inspiring our communities, restructuring our spaces, changing forever the way we live – and changing it for the better.

“I want to increase the space available for people who want to walk and cycle by extending pavements, pedestrianising streets and introducing pop up cycle lanes. I have already identified some parts of Belfast City Centre and Derry City that can be transformed in this way

This is a fabulous opportunity. Northern Ireland missed out on some key legislation regarding eBikes. We are way behind the rest of the UK with this.

The UK legislation was harmonised with EU law EN15194 in April 2015. Your steed is an “electrically assisted pedal cycle” (or EAPC, or ebike, or Pedelec) if: the bike has pedals that propel it; the electric motor won’t assist you when you’re travelling more than 25 km/h (15.5mph); and the power doesn’t exceed 250 watts. In the UK you must be over 14 years old to ride an electric bike but you don’t need a licence, nor do you need to register it or pay vehicle tax.

The cycles that meet these requirements (which affect two-wheeled bikes but also tandems and tricycles) can be ridden on any cycle paths and anywhere else that bikes are normally allowed.

In all cases, these are pedal assist cycles and not “twist and go” throttle based solutions.

Either way the announcement from the Minister for Infrastructure could go a long way to changing the face of Belfast. Increasing mobility and reducing congestion are key to further health concerns both in terms of environment but also in the current pandemic. I’m excited about the possibility of cycle lanes that might, for instance, shadow the M1 into Belfast rather than track slowly along the Lisburn Road dodging buses and parked cars. Talk about an infrastructure ready project.

And while we are at it, the Minister may want to look at the York Road Exchange upgrade with a sceptical, future looking eye. Sacrifice a car lane for a bike lane all the way up to Mallusk and Jordanstown. Extend the bike courses out from Bangor and Lisburn. Make sure there’s a solid Bike access lane from West Belfast and the small streets of North Belfast.

And please, please, make the cycle lanes more than just paint on the roads. It’s bad enough that we sacrifice pavement for cars, but parked cars render cycle lanes utterly useless.

The Great Pandemic of 2120

Between 1918 and 1920, the world was assaulted by an Influenza strain (H1N1) which infected an estimated 500 million people (almost a third of the worlds population). It’s reckoned there were probably in excess of 25 million deaths due to it. That’s a guesstimated 0.05% mortality rate. The parallels continue in the virus causing a cytokine storm (though Covid-19 is assaulting more than one type of T-cell so the storm is worse). But it’s thought that worldwide conditions of malnourishment, overcrowding of medical facilities and general poor hygiene resulted in bacterial superinfection (where the weakened immune system enabled a secondary infection from a bacteria to thrive in the victim). In comparison a second outbreak (know as Swine Flu in 2009) killed probably 250,000 people.

SARS-CoV-1 killed 8000 people in the early 2000s (with a 9.5% chance of death on a wider infection). This latest version SARS-CoV-2, the virus causing COVID-19, has killed 20 times as many. In January 2020, five different genomes of SARS-CoV-2 had been sequenced but it’s possible there’s more than 1000 different genomes at the time of this writing.

The thing is. We are lucky.

This new virus takes an average of 11 days to present symptoms after infection. The mortality rate is relatively low. Probably less than 2%.

Somewhere out there is a zoonotic virus which has a 14-30 day infectious period (where you’re running around spreading the infection without knowing you have it, and then it has a 50% mortality rate. (The Nipha virus from Malaysia had a 14 day onset with a 50-75% death rate. Ebola can take up to three weeks to show symptoms and has a 50-90% mortality rate.

We are lucky.

But we have to learn from this. This current pandemic is a warning shot. It’s telling us that our current liberties (travel everywhere) is potentially not sustainable. We worried about nuclear annihilation or pollution or a meteor killing us all, but this is something that we knew could happen. I mean, it’s essentially the plot device of “War of the Worlds” and it’s been well documented in Hollywood movies.

We have to prepare.

What can we expect in the new normality?

I love travel, but travel will be harder. And more expensive. Queues will be long and you can be expected to be turned away from a flight if you present with illness.

I had tickets to a gig in June. 50,000 people in a crowded stadium. They’ve just emailed to say the gig is postponed to June 2021. Do I really want to be in a crowded stadium with the great unwashed?

I think the last two months have certainly indicated that some jobs can be done remotely. And while many have mixed reactions to videoconferencing, I’m finding focus to be increased without daily distractions.

I’m thinking not just about what will go back to normal, but the things that I want to go back to normal and the things that I want to change.

Because the next great pandemic might not take 100 years to appear.

COVID-19: The Pressure of Inevitability

This isn’t the first. This isn’t the last. It may be the worst; that remains to be seen. You would hope that modern medicine will out, but that takes time.

Pandemics

Around 500 BC, the Plague of Justinian killed 25-100 million people (about 50% of the population of Europe).

In the 14th Century, the Black Death killed 75-200 million people in Europe (about 60% of the population).

Between 1918 and 1920, Spanish Flu killed 17-100 million people worldwide.

Between 1877 and 1977, Smallpox killed 500 million people worldwide. And that wasn’t the first episode of Smallpox.

From 1960 to the present, HIV/AIDS has killed more than 32 million people worldwide.

Between 2009 and 2010, H1N1 killed nearly half a million people.

We are bloody lucky though. With a death rate of 0.3%-13% (depending on location and the demographic of the host), this is recoverable. But even at the lowest rate of 0.3%, that’s 240 Millie people worldwide. That’s the problem with big numbers.

The Power of Networks

Metcalfe’s Law is a concept used in computer networks and telecommunications to represent the value of a network. Metcalfe’s Law states that a network’s impact is the square of the number of nodes in the network. For example, if a network has 10 nodes, its inherent value is 100 (10 * 10).

This is the other problem with big numbers, things get very scary very quickly. You only have to look at the logarithmic graphs of the spread of the pandemic to get an appreciation of it. Log graphs make big numbers look like small numbers.

You can see the power of networks in this transmission of the disease. The more we were connected, the more we were able to travel, the larger the groups we congregated in; the more the virus would spread. Imagine how hard it was for the diseases to spread in the past (and thankfully for some like the Plague, we had antibiotics in recent years). But when something is being spread by rats, there have to be rats. This is spread by us.

We heard about other epidemics; Ebola, Zika, Nipah, SARS, Dengue fever – but most of them were in other places. People think we are being punished for whatever; for our arrogance? But this was inevitable. Viruses and bacteria have been preying on the world forever. They’ve killed millions before.

It’s ignorant exceptionalism to treat this as anything other than it is; inevitable