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How deadly is Covid-19? Italian study finds mortality rate is 7.4% while Qatari study says 0.01%

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Scientists still cannot agree on how deadly Covid-19 is — with fresh data from Italy suggesting it may kill up to 7.4 per cent of patients.

Experts have been baffled as to the true mortality rate of the disease since the start of the pandemic in December.

World Health Organization chiefs first claimed the infection-fatality rate was 3.6 per cent but this week changed their estimate to 0.6 per cent.

But experts who analysed coronavirus data from a small town in the Italian region of Lombardy found that around one in 13 people who get infected die.

One epidemiologist — who has reviewed evidence on death rates — claimed it was ‘by orders of magnitude the highest I’ve seen’.

He also pointed to data from a separate study in Qatar that suggested it may be as low as 0.01 per cent — the equivalent of one death for every 10,000 cases.  

Gideon Meyerowitz-Katz, of the University of Wollongong in Australia, said it was ‘by a very long way the lowest I’ve seen’.

Similar antibody surveillance studies have produced wildly different results across the world, ranging from as low as 0.25 per cent to 1.4 per cent.

The Italian study said the mortality rate was 7.4 per cent - far higher than any other researchers' estimates which range from 0.01 per cent to 1.4 per cent

The Italian study said the mortality rate was 7.4 per cent - far higher than any other researchers' estimates which range from 0.01 per cent to 1.4 per cent

The Italian study said the mortality rate was 7.4 per cent – far higher than any other researchers’ estimates which range from 0.01 per cent to 1.4 per cent

THe WHO believe Covid-19 kills 0.6 per cent of all patients or one in every 167. Although it sounds minimal, it means Covid-19 is six times deadlier than the flu and almost as twice as fatal as polio

THe WHO believe Covid-19 kills 0.6 per cent of all patients or one in every 167. Although it sounds minimal, it means Covid-19 is six times deadlier than the flu and almost as twice as fatal as polio

THe WHO believe Covid-19 kills 0.6 per cent of all patients or one in every 167. Although it sounds minimal, it means Covid-19 is six times deadlier than the flu and almost as twice as fatal as polio

A top WHO official revealed this week that the agency’s best guess on the infection-fatality rate (IFR) was 0.6 per cent.

Dr Maria Van Kerkhove admitted the estimate, based on data from several studies, ‘may not sound like a lot but it is quite high’.

The estimate suggests the coronavirus kills around one in 167 patients, making it six times deadlier than seasonal flu.

The IFR is different to the case-fatality ratio, another measures of how many people die of a disease which is based only on confirmed cases. 

WHAT ARE THE DIFFERENT MORTALITY RATE ESTIMATES FOR COVID-19? 

7.4%

Researchers led by Gabriele Pagani, of the Università degli Studi di Milano screened the entire population of Castiglione d’Adda, a town in the Lombardy region that has been heavily hit by Covid-19.

Almost a quarter of the population had antibodies (22.6 per cent) – 1,028 of the 4,550 inhabitants. But the official number of cases reported in the town, as of June 21, is five times lower, at 184.

The town had also recorded 76 Covid-19 deaths by June 21, which out of the 1,028 cases estimated, equates to a death rate of 7.39 per cent.

1.4%

Cambridge University analyse real-time COVID-19 data in the UK to paint a picture of the epidemic now, and work up a forecast of infections and deaths. 

The statistical modellers, led by Dr Paul Birrell, are working with Public Health England (PHE) and their information feeds directly to government teams.

Their modelling suggests the overall infection mortality rate is 1.4 per cent – but it could be as low as 0.98 and as high as 1.8 per cent. It ranges from 0.0046 in those aged between 15 and 24 years old, and 18 per cent in those over 75.

1% 

Most coronavirus modelling, including the grim Imperial College London projection that warned 500,000 Brits could die without action and convinced ministers to impose a lockdown, are based on a death rate of around 1 per cent. 

0.75% 

Epidemiologist Gideon Meyerowitz-Katz, from the University of Wollongong, and James Cook University’s Dr Lea Merone, collected information from 13 global studies that tried to calculate the true death rate of the coronavirus and settled on an overall estimate of 0.75 per cent.

They said it was ‘likely’ that it was somewhere between 0.49 and 1.01 per cent and that it would be higher among elderly people or the chronically ill, and lower for younger people. 

The number chimed with data emerging from New York, where random antibody testing in April suggested a quarter of the city of eight million people had been infected with the illness, meaning the 16,000 fatalities equaled a death rate of 0.79 per cent.

0.6%

World Health Organization officials believe the infection fatality rate of Covid-19 is 0.6 per cent based on various studies, or one in 200 patients.

At a virtual news briefing from the WHO’s headquarters in Geneva on August 3, Maria Van Kerkhove, WHO’s technical lead for coronavirus response said the figure ‘may not sound like a lot, but it is quite high’. 

0.5%

A study from Harvard University found that the death rate on the Diamond Princess ship was 0.5 per cent. The cruise ship is ideal for studying because there is complete data available for everyone on board at the time there was an outbreak.

The team found the fatality rate was 1.8 per cent – 13 deaths out of 712 cases – but the rate was adjusted to 0.5 per cent to reflect the general population.

0.37%

In April, researchers did swab and antibody testing of a randomly selected 919 people from 405 households in Gangelt – a small town in Germany where the country’s outbreak began.

Results showed around 15 per cent of the population of Gangelt had been infected with the coronavirus.

The town had recorded seven deaths out of 1,800 confirmed cases, which equates to a death rate of around 0.37 per cent.    

0.25%  

A review of antibody surveillance studies suggests the coronavirus has a mortality rate of 0.25 per cent, meaning it kills one in every 400 people who get it.

The new estimate was based on figures from 23 different testing surveys carried out worldwide, which suggested the actual mortality rate ranged from as low as 0.02 to as high as 0.78 per cent.

They measured antibodies in the blood, a sign of past infection, which may be more reliable than estimating how many people have been infected.

0.01 per cent

Qatari researchers led by Dr Laith J. Abu Raddad from Cornell University, Doha, used a mathematical model to get an idea of how many people in Qatar had been infected over the pandemic. 

The model was based on data about how the SARS-Cov-2 naturally spreads in a population and the results of a series of studies in Qatar that used swab and antibody tests until around the date July 10.

The model showed that the IFR was 0.01 per cent, which was ‘remarkable’, the researchers said.

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But it is not entirely reliable given so many infected people have went untested for the virus during the course of the pandemic.

For example, the CFR ratio in Britain is around 15 per cent — which would mean the disease is 30 times’ deadlier in the UK than what the WHO believes. 

The IFR estimates how many people die from the disease overall, including patients who don’t show any symptoms and may never get tested. 

To measure IFR accurately, scientists must know exactly how many people have had the coronavirus — technically called SARS-CoV-2.

Millions would have had the disease and not been tested due to a lack of capacity in the early days of the crisis.

The only way academics can currently accurately estimate this is through looking at how many people have developed antibodies to the virus.

Infected patients make antibodies — proteins made by the immune system to fight off pathogens in the future — weeks after their battle with the disease.

But not everyone who has Covid-19 develops antibodies if other parts of their immune system clears the virus, and studies have shown antibodies can wane over time, making them undetectable with testing.

The Italian study was based on screening the blood of thousands of people living in Castiglione d’Adda for antibodies.

Almost a quarter of the population tested positive for antibodies (22.6 per cent) — 1,028 of the 4,550 inhabitants.

But only 184 cases had been officially reported in the town as of June 21 — a week before the study by Gabriele Pagani and colleagues was published. 

The town had also recorded 76 Covid-19 deaths by June 21, which out of the 1,028 cases estimated, equates to a death rate of 7.39 per cent.    

It would make it almost as deadly as SARS, a related coronavirus which killed one in ten people during an outbreak between 2003 and 2004.

The researchers did not explain why so many people in the town had coronavirus. But they noted Castiglione d’Adda was one of the first places in Italy to be hit, and therefore may not have been prepared.

They also did not say when the study was conducted, as this would have an impact on antibody prevalence.  

But researchers have often noted that Italy has an older population, which may to blame for higher cases.   

Around one fifth of Castiglione d’Adda’s population is over the age of 65 compared to around 13 per cent in the UK.

When the same death rate is applied to the UK, it suggests the true number of cases is only double what has been detected through testing.

Some 46,300 Britons have officially died after testing positive for the virus, meaning 625,000 people would have been infected if the IFR of 7.4 per cent was true.   

But the true size of the epidemic is believed to be in the millions based on antibody surveillance testing ran by the UK government.    

The Italian research — released as a pre-print on Medrxiv — was not published in a journal, meaning it has not been through a review process by other scientists.  

However, the aim of the research was not to figure out the IFR. Instead, the experts wanted to see how infection rates differed between ages.

The IFR was pointed out by Mr Meyerowitz-Katz on Twitter, who also revealed the very low rate found in the study from Qatar.

Experts at Cornell University in Doha used a mathematical model to get an idea of how many people in Qatar had been infected over the pandemic.

The country of 2.8million people has had only 177 deaths and 111,538 cases up until August 5, according to official data.

The model was based on data about how the virus naturally spreads in a population and the results on results of mass swab and antibody tests. 

Experts led by Dr Laith Abu Raddad found that the IFR was 0.01 per cent, which was ‘remarkable’, the researchers said. 

They wrote in their pre-print paper: ‘Remarkably, while widespread, the infection has been characterized by relatively low case and infection severity and fatality rates, which were not well above those of a severe seasonal influenza epidemic.’ 

But the estimate — that Covid-19 only kills 0.01 per cent of people it infects — cannot physically be true for the UK.

It would mean the UK has had 426million cases. For comparison, the population of the UK is around 66million. 

Dr Meyerowitz-Katz’s own estimation of the IFR is 0.75 per cent but could be as low as low as 0.49 and as high as 1.01.

He and his colleague Dr Lea Merone, of James Cook University, searched online for IFR studies from around the world. 

Meanwhile, a review of antibody surveillance studies by Stanford University experts has suggested the coronavirus has a mortality rate of 0.25 per cent.   

Harvard University took a different approach, and studied the Covid-19 outbreak on the cruise ship the Diamond Princess.

Cruise ships are deemed an ideal environment to study because there is complete data available for everyone on board at the time. 

The team found the fatality rate was 1.8 per cent — 13 deaths out of 712 cases — but the rate was adjusted to 0.5 per cent to reflect the entire population.

Another German study which honed in on the small town of Gangelt put the rate  at around 0.37 per cent.

By comparison, the seasonal flu kills around 0.1 per cent of those it infects. Ebola kills around 50 per cent of all cases. 

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Do tougher rules REALLY work? Glasgow’s coronavirus outbreak has slowed dramatically

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Tougher lockdown rules could work, suggests official data showing Glasgow‘s spike in coronavirus cases was controlled within days of being hit by fresh restrictions.

Residents in the city, home to around 600,000 people, and two neighbouring areas were banned from visiting any other households back at the start of September, in a desperate attempt to curb the spread of Covid-19.

The decision, announced by First Minister Nicola Sturgeon, was prompted by figures revealing Glasgow’s spiralling outbreak was to blame for nearly a third of new cases in Scotland.

Around 37 people were testing positive for the life-threatening infection each day on September 2, the day when the restrictions came into place. 

This had risen six-fold from the middle of August, when an average of six people were being diagnosed each day, and was up massively on the rolling average of just one infection a day in July.

But government statistics show the city’s infection curve had started to flatten just five days after the measures were imposed, showing the rolling average had hit 52 on September 7 and has barely risen since.

Figures from Public Health Scotland, the country’s health agency which updates Covid-19 data daily, shows a small uptick in cases over the past few days, with the rolling average standing at 64 on September 20. 

Fresher data is not yet available because it is based on when samples were taken and not how many were actually registered on any given day. It can take several days for patients to get their results back.

This uptick in the past two weeks is in line with the rest of the UK, which has been blamed on children and adults returning to school and work, and appears to now be dipping again. 

Sir Harry Burns, a professor of global public health at the University of Strathclyde, said data shows the lockdown measures in the west of Scotland are working.

Because of this, he supported Ms Sturgeon’s decision to impose a blanket ban on social mixing in households from today.  

And it’s claimed Professor Chris Whitty, England’s chief medical officer, is adamant England needs its own household visit ban. 

Glasgow's seven-day rolling average of Covid-19 cases (blue line) has flattened since residents were banned from visiting any other households on September 2

Glasgow's seven-day rolling average of Covid-19 cases (blue line) has flattened since residents were banned from visiting any other households on September 2

Glasgow’s seven-day rolling average of Covid-19 cases (blue line) has flattened since residents were banned from visiting any other households on September 2

A similar pattern was shown in West Dunbartonshire

A similar pattern was shown in West Dunbartonshire

A similar pattern was shown in West Dunbartonshire

In East Renfrewshire, cases continued rising (blue line) after restrictions were imposed on September 2. But since then, cases have dropped back down again

In East Renfrewshire, cases continued rising (blue line) after restrictions were imposed on September 2. But since then, cases have dropped back down again

In East Renfrewshire, cases continued rising (blue line) after restrictions were imposed on September 2. But since then, cases have dropped back down again

Nicola Sturgeon imposed a blanket ban on social mixing in households from today in Scotland

Nicola Sturgeon imposed a blanket ban on social mixing in households from today in Scotland

Nicola Sturgeon imposed a blanket ban on social mixing in households from today in Scotland

Around 1.7million Scots are now under tougher local restrictions — almost a third (31 per cent) of the country’s 5.4million population.  

Aberdeen, home to 208,000, had previously been under a strict ‘lockdown’ from August 5 to August 23, which included the closure of pubs and restaurants, a household mixing ban and a travel restriction of five miles.

Glasgow, West Dunbartonshire and East Renfrewshire were then slapped with new Covid-19 control measures on September 3.

It was expected to be in place for two weeks, however the Scottish Government has not yet lifted them.

Restrictions on visiting other households were applied because ‘transmission appears mainly to be happening inside people’s homes and between households, rather than in pubs and restaurants’, Ms Sturgeon said. 

The daily average of cases in Glasgow at the time was 36.6. Cases continued to be diagnosed, reaching an average of 52 five days after the measures were announced. 

But then, a week after the restrictions were put in places, cases levelled off at 44.6, suggesting the spike had been stopped in its tracks. 

A similar pattern was shown in West Dunbartonshire, home to 89,000 people.

The average went from seven on September 2, to nine on September 6, before levelling off between five and seven cases a day. 

It appears both Glasgow and West Dunbartonshire saw a sudden spike in cases again in mid-September. But data from the past two to three days shows this may be resolving.

In East Renfrewshire, around four people a day were testing positive for the coronavirus when the area was put under ‘local lockdown’.

This continued to rise sharply, doubling to eight by September 11. But since then, cases have dropped back down to four per day.

Although it is at the same level as when the measures were imposed, the data shows the outcome is still better than what could have been, had the virus been allowed to continue spreading. 

On September 7, Ms Sturgeon ‘regrettably’ extended the measures to East Dunbartonshire and Renfrewshire, home to around 286,000 people, combined. 

Both have seen a significant stalling in the spiralling Covid-19 cases.  

South Lanarkshire is starting to show improvements, having been added to the list of places in Scotland hit with harder measures on September 12. But North Lanarkshire’s cases are still climbing. 

East Dunbartonshire seen Covid-19 cases drop (blue line) since restrictions were put in place on September 7 (pictured)

East Dunbartonshire seen Covid-19 cases drop (blue line) since restrictions were put in place on September 7 (pictured)

East Dunbartonshire seen Covid-19 cases drop (blue line) since restrictions were put in place on September 7 (pictured)

Renfrewshire has seen Covid-19 cases stall (blue line) since restrictions were put in place on September 7 (pictured)

Renfrewshire has seen Covid-19 cases stall (blue line) since restrictions were put in place on September 7 (pictured)

Renfrewshire has seen Covid-19 cases stall (blue line) since restrictions were put in place on September 7 (pictured)

South Lanarkshire is starting to show improvements in Covid-19 cases (blue line), having been added to the list of places in Scotland hit with harder measures on September 12 (pictured)

South Lanarkshire is starting to show improvements in Covid-19 cases (blue line), having been added to the list of places in Scotland hit with harder measures on September 12 (pictured)

South Lanarkshire is starting to show improvements in Covid-19 cases (blue line), having been added to the list of places in Scotland hit with harder measures on September 12 (pictured)

North Lanarkshire has seen cases dip very slightly (blue line) before rising again after a 'lockdown' was imposed on September 12 (pictured)

North Lanarkshire has seen cases dip very slightly (blue line) before rising again after a 'lockdown' was imposed on September 12 (pictured)

North Lanarkshire has seen cases dip very slightly (blue line) before rising again after a ‘lockdown’ was imposed on September 12 (pictured)

Chris Whitty ‘tells PM England may need to follow Scotland and ban households mixing indoors’

England may need to follow Scotland’s lead and ban households from visiting each other, Boris Johnson has been told by his chief medical officer.

Chris Whitty, who threatened to break ‘unnecessary links between different households’ on Monday, is understood to have recommended Nicola Sturgeon’s hardline approach to coronavirus to the Prime Minister.

England’s chief medical officer reportedly believes that further restrictions are inevitable this winter and that draconian new measures – including a 10pm curfew on pubs and restaurants – will not bring the virus under control. 

The Scottish First Minister claimed that advice from her chief medical officer and national clinical director was that Mr Johnson’s programme ‘on its own will not be sufficient to bring the R number down’.  

Chief medical officers from all four home nations met on Monday to agree advice to each of the devolved administrations, according to The Times. It is understood that Prof Whitty concurred with his Scottish counterpart, Gregor Smith.

Jonathan Van Tam and Jenny Harries, Prof Whitty’s deputies, are thought to believe that the tough new restrictions in England did not go far enough – but accepted that the Prime Minister would have to try less strict measures to save the economy first.   

A source told the paper the plan was a ‘phased approach’, adding: ‘We’re still in early autumn and we shouldn’t be optimistic that this won’t get worse.’

It came as Ms Sturgeon admitted that banning Scots from visiting each other’s homes is a ‘step backwards’ but will stop coronavirus from ‘spiralling out of control’. 

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Ms Sturgeon has now taken the Covid-19 response a step further in Scotland, proving to be moving more cautiously than neighboring England once again. 

Scots are being barred from visiting other people in their own home – with some exemptions – officially from Friday. But people are being encouraged to comply from today. Ms Sturgeon also confirmed that Scotland would be following England in imposing a 10pm curfew on pubs and restaurants.  

It came as part of a package of measures to try to stop coronavirus from ‘spiralling out of control’ in Scotland. 

Sir Harry told BBC Scotland’s The Nine: ‘I can understand the reasons for the decisions the First Minister has made.

‘That’s basically because the data on the progress of the partial lockdown in the west of Scotland shows that it’s been effective, so she’s extending that to the rest of Scotland.

‘I don’t think we can do this too early, to be honest. I think we were a bit late going into the first lockdown and that may be why we had such significant impact. But I think we are seeing increasing daily cases.

‘Initially they highest number of cases were in the 20-40 year olds. We are now beginning to see cases increase in the over 60s and hospitalisations are increasing.

I think if we don’t go now, we will see significant numbers of hospitalisation, significant strain on the hospital system again, and significant numbers of deaths.’   

Ms Sturgeon accepted the ‘tough’ new restrictions felt like a ‘step backwards’, but they had not been introduced lightly. 

She also defended her decision to introduce tougher coronavirus restrictions than in England.  

The Scottish First Minister insisted the expert advice she received was that a curfew on pubs alone, as is the case in England, would not be sufficient to halt rising case numbers.

She refused to directly criticise UK Prime Minister Boris Johnson for failing to take action to prevent households from mixing indoors, as she has done.

But she did say she believed governments should ‘try to co-ordinate as much as possible across the UK’. 

Speaking on ITV’s Good Morning Britain programme she said Scotland and the UK were in a ‘tough spot’.

Warning that ‘we are again at a tipping point with Covid’, Ms Sturgeon added: ‘If we don’t act now, urgently and decisively, then we might find Covid running out of control again.

‘The judgment I have made, and it is not an easy one, is if we take tough action now we might actually manage to be under these restrictions for a shorter period of time then we would end up being if we delayed that action.

‘So these are tough judgments but I think, given the loss of life we know that Covid can result in, the health damage that it does, we’ve got to be prepared at moments like this, people like me, to take tough decisions and to be prepared to do things even if they are unpopular, for the greater good.

‘I can only look at the situation in Scotland and I can only speak for the judgments I am making.

‘And my advisers say to me, yes, a curfew on pubs is certainly something that should be done and we have taken that decision, but in and of itself it is not going to be enough to arrest this increase in Covid cases and bring the R number down and bring the epidemic under control again.

‘That’s why I made the difficult judgment yesterday to go further.’

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British Medical Association calls for government to make masks compulsory INSIDE offices 

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Dr Chaand Nagpaul, chair of council at the British Medical Association (BMA), said the latest lockdown restrictions in England are not tough enough to prevent a devastating second wave

Dr Chaand Nagpaul, chair of council at the British Medical Association (BMA), said the latest lockdown restrictions in England are not tough enough to prevent a devastating second wave

Dr Chaand Nagpaul, chair of council at the British Medical Association (BMA), said the latest lockdown restrictions in England are not tough enough to prevent a devastating second wave

Face masks should be made compulsory inside offices to halt a devastating second wave of coronavirus, leading medics warned today.  

Boris Johnson announced yesterday that all staff in retail and hospitality will have to wear face coverings, as part of the latest suite of lockdown restrictions. 

But the British Medical Association (BMA) said today it was ‘illogical’ for this rule not to have been enforced over summer when shops, restaurants and pubs reopened.

The doctors’ union said the new rules were not tough enough to prevent a devastating second wave and is now calling for all indoor work places to have mandatory face coverings. 

It also blasted ministers for hurrying staff back to offices and actively encouraging workers to ditch working from home at a time when cases were rising – rhetoric which the Government has now U-turned on.

BMA chairman Dr Chaand Nagpaul said: ‘The BMA has consistently argued that it was illogical for staff not to be required to wear facemasks in shops, pubs and restaurants as customers are, so we’re pleased to see this belatedly coming into force. 

‘However, given that the infection is equally like to spread in all indoor settings, these rules should also apply to offices and other workplaces.’

Dr Nagpaul’s comments come after two prominent scientists on the Government’s Scientific Advisory Group for Emergencies (SAGE) criticised the latest lockdown guidelines for not going far enough.

Professor John Edmunds, an infectious disease expert from the London School of Hygiene and Tropical Medicine, warned action was not taken quickly enough back in March and that ‘mistake’ is about to be repeated because the new rules are too lax. 

And Professor Robert West, a health psychologist at University College London and member of SAGE, added: ‘Closing early will have some impact but I don’t think it will be anything like enough, even with the other measures announced, to stop the increase.’

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Dr Nagpaul called on the Government to do more to help employers make workplaces Covid-secure when home working is not possible, and to cut the number of people permitted to meet indoors.

‘The Prime Minister missed an opportunity today to revise the ‘rule of six’ which, as currently interpreted, allows members of six different household to meet indoors whereas previously members of only two households could do so,’ he said.

‘Data suggests that transmission between households is by far the biggest driver of infection and this should therefore be rectified at the earliest possible opportunity.’ 

Yesterday Boris Johnson imposed a 10pm curfew on all restaurants, bars and pubs across England from Thursday with the hospitality sector also being restricted to table service only.

A requirement to wear face coverings will be extended to include retail workers and customers in indoor hospitality settings, except for when they are seated at a table to eat or drink.

He also announced the end of the Government’s back to work drive as he said he is now ‘asking office workers who can work from home to do so’.

The Government has been actively encouraging workers to ditch working from home and yesterday’s U-turn represents a humiliating climbdown for the PM who earlier this month had told his Cabinet that ‘people are going back to the office in huge numbers across our country and quite right too’.

The BMA also wants to see the public given more information about infection rates in their areas, making it as easy to look up as the weather or pollen count.

Professor John Edmunds, an epidemiologist from the London School of Hygiene and Tropical Medicine, warned that the Government has not learnt the lessons from March

Professor John Edmunds, an epidemiologist from the London School of Hygiene and Tropical Medicine, warned that the Government has not learnt the lessons from March

Professor John Edmunds, an epidemiologist from the London School of Hygiene and Tropical Medicine, warned that the Government has not learnt the lessons from March

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Scientists at war over new lockdown rules 

Britian’s top scientists have traded blows over whether Number 10’s latest coronavirus rules have gone far enough.

Two SAGE advisers criticised the Government for not going far enough with their latest suite of lockdown rules.

Professor John Edmunds, an infectious disease expert from the London School of Hygiene and Tropical Medicine, warned action was not taken quickly enough back in March and that ‘mistake’ is about to be repeated because the new rules are too lax. 

And Professor Robert West, a health psychologist at University College London and member of SAGE, added: ‘Closing early will have some impact but I don’t think it will be anything like enough, even with the other measures announced, to stop the increase.’

However, other experts have recommended the UK switches from a ‘suppress the spread of coronavirus’ strategy, to a more relaxed Sweden-based strategy aiming to contain it.

Professor Carl Heneghan, director of the University of Oxford’s Centre for Evidence-Based Medicine told BBC Radio 4 he thought there had been a shift after he had a meeting with the Prime Minister.

‘We are starting to understand that we are trying to control the spread of the infection as opposed to suppress it,’ he said. ‘What we are starting to see is a move towards Sweden. So for instance, when you look at bars and restaurants, that’s the policy there – they have table service. I’m hoping we now start to see a more consistent poluicy, one that stays in place.’ 

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‘Members of the public want to do their bit to keep infection rates down – ministers must empower them with the information they need to take proactive action,’ Dr Nagpaul said.

‘Not only would these additional measures pose no risk to the economy in the immediate term, they could be key to preventing further lockdowns and significant disruption to business and economic activity.’

He added: ‘Indeed, putting the right safeguards in place to minimise the risk of infection is crucial to providing people with the confidence they need to go out safely and boost the economy.’

Professor Edmunds accused the Government of failing to heed the warnings from March on BBC Radio 4’s Today programme.

Speaking in a personal capacity, he said the authorities will let cases of coronavirus ‘double and double and double again’ before taking the right steps, but by then it will be ‘too late’. 

‘And then we’ll have the worst of both worlds, because then to slow the epidemic and bring it back down again, all the way down to somewhere close to where it is now or where it was in the summer, will mean putting the brakes on the epidemic for a very long time, very hard,’ he said.

‘(This) is what we had to do in March because we didn’t react quickly enough in March, and so I think that we haven’t learnt from our mistake back then and we’re unfortunately about to repeat it.

‘I suspect we will see very stringent measures coming in place throughout the UK at some point, but it will be too late again.’

Adding to the sense of alarm among epidemiologists, Professor West told The Times: ‘Closing early will have some impact but I don’t think it will be anything like enough, even with the other measures announced, to stop the increase.’

He said there is a ‘drinking equilibrium’ where people have the ‘amount they want to drink’, and that through an early closure ‘you might have some decrease but it won’t be proportionate to the reduction in hours’.

But scientists remain divided on the issue, with others arguing the restrictions will limit the spread of the virus. 

Dr Jennifer Cole, biological anthropologist at Royal Holloway University, said yesterday that one of the biggest influences over people observing social distancing, and hence controlling the spread of the virus, was alcohol.

‘The more drunk you are, the less inhibited and less risk-averse you are,’ she said.

‘Closing the bars and restaurants at 10pm simply keeps people more sober. It gives them plenty of time for a meal, or a quick drink with friends after work, but means they are likely to be sober enough to remember to put on a face-covering on the train or bus home, and to be careful around elderly relatives when they get home.

‘It gives restaurant and bar staff time to give the venue a thorough clean when the last customers have left, without having to work unreasonably late. This means that a lot of the risk is reduced.’ 

Professor Whitty is understood to support Scotland’s move to limit social interactions in household, and believe that England should have followed in its tracks, reports The Times.

Jonathan Van Tam and Jenny Harries, Professor Whitty’s deputies, are also understood to have expressed concerns that the measures did not go far enough.

Boris Johnson told the nation last night that unless his warnings were listened to and measures were followed there would be further restrictions on the cards.

‘The virus is no less fatal than it was in Spring,’ he told the public, ‘and our best weapon against it is commonsense and community.’

It comes on top of the rule of six, which has been in force for more than a week, which has stopped people meeting in large groups.

In Scotland, Nicola Sturgeon went further by banning people from visiting others homes, unless they lived alone.

She claimed advice from Scotland’s chief medical officer and national clinical director was that the Prime Minister’s package ‘on its own will not be sufficient to bring the R number down’.

She added: ‘We must take account of the fact that household interaction is a key driver of transmission.’

The rules will be closely monitored for the next two weeks to see whether further action needs to be taken. 

Local areas in England with larger outbreaks have imposed tighter restrictions, including stopping households from mixing.

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Get in shape to fight off cancer: Learn how to reset your own body clock

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get in shape to fight off cancer learn how to reset your own body clock

Taking regular exercise is one of the most important ways of staying healthy and avoiding illness — and the good news is you don’t have to go mad in Lycra to see significant results.

No special equipment is needed, either. A well-fitting pair of trainers or walking shoes is all you need to make a start on getting fitter and cutting your risk of serious diseases, cancer included.

As you’d expect, this is all based on solid science.

Several scientific reviews have estimated that at least 15 per cent of all breast cancers and 40 per cent of bowel cancers could have been prevented by regular exercise.

Taking regular exercise is one of the most important ways of staying healthy and avoiding illness ¿ and the good news is you don¿t have to go mad in Lycra to see significant results (stock image)

Taking regular exercise is one of the most important ways of staying healthy and avoiding illness ¿ and the good news is you don¿t have to go mad in Lycra to see significant results (stock image)

Taking regular exercise is one of the most important ways of staying healthy and avoiding illness — and the good news is you don’t have to go mad in Lycra to see significant results (stock image)

And you’re 30-40 per cent less likely to relapse after treatment for a primary cancer if you exercise moderately for three hours a week, found a large review of the world’s most prestigious studies by the National Cancer Institute in the U.S.

There’s also evidence that exercise can slow the progression of ongoing cancers as well as helping you to cope better with the toxicities of treatment.

And the other good news is it’s never too late to make a real difference, even if you haven’t exercised for a while.

As an oncologist who’s spent most of my professional life studying the causes and consequences of cancer, I’m convinced we are not destined to develop disease because of the genes we inherit.

In fact, I believe that the way we live our lives is far more important.

It is why I wrote my latest book, How To Live. I wanted to share my lifetime’s work on taking control of your health and cutting your risk of cancer by making simple changes to the food you eat and the way you live.

I’m not suggesting for a moment that we abandon traditional medicine — which saves lives every day. I’ve seen too many referrals of patients who’ve refused potentially successful treatments because they opted to go it alone with lifestyle strategies, with tragic results.

Several scientific reviews have estimated that at least 15 per cent of all breast cancers and 40 per cent of bowel cancers could have been prevented by regular exercise (stock image)

Several scientific reviews have estimated that at least 15 per cent of all breast cancers and 40 per cent of bowel cancers could have been prevented by regular exercise (stock image)

Several scientific reviews have estimated that at least 15 per cent of all breast cancers and 40 per cent of bowel cancers could have been prevented by regular exercise (stock image)

But the more patients I listen to and research I do, it’s clear that the little decisions made day in day out can make the difference between developing cancer or not. They can also have a profound effect on how well your body fights back if you do get it.

So it might not matter if you don’t go out for a long walk today — but it’s when days turn into weeks and months, that you store up trouble. That is why, in the last of this series to help you reduce your cancer risk, I’ve chosen to focus on living a more active life, a vital step in protecting against disease of all sorts.

Before we get started I need to warn you exactly how dangerous it is to sit down for long periods of time on a regular basis.

A 2011 study found that people who spent most of their working lives sitting at a desk increased their risk of bowel cancer by a third compared to people with physically active jobs — even if they still went to the gym once or twice a week.

And I’m afraid it’s bad news for couch potatoes, too.

A study that looked at the effects of watching TV, which followed 8,800 adults over six years, found that for every extra hour of daily television viewing, there was an increased risk of dying early from any cause by 11 per cent; for cardiovascular diseases the increased risk was 18 per cent and for cancer 9 per cent.

But every little bit really does help — taking a break from your desk every hour, walking to the shops instead of driving, going for a stroll after dinner in the evening.

… But don’t overdo it!

For all the proven health benefits of exercise, I really must stress that it’s very important not to overdo it — particularly if you haven’t worked out for a while.

If your regime is too strenuous, you can end up with tissue damage and actually increase inflammation in the short term.

So it is important to embark on a training programme, preferably one that is supervised, that will build up your fitness gradually.

Build up your exercise levels sensibly, so your muscles, heart, lung and joints can repair between sessions. Your body will also gradually increase its levels of antioxidant enzymes (vital for repair and fighting disease).

This is particularly important for older people whose bodies adapt more slowly to these changes.

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And the benefits of being more active increase with the more that you do — this is still true for anyone who’s already been diagnosed with cancer.

One study, involving men with prostate cancer, found that those who walked for more than four hours a week had a better survival rate than those who walked for just two hours.

Yet research frequently shows how few of us exercise enough, particularly as we get older.

As part of a recent study conducted at Cambridge, we recorded the exercise levels of 400 elderly men with prostate cancer and were troubled to find only 4 per cent exercised at a moderate intensity for three hours a week (this is generally accepted by doctors as the level needed to start reducing the risk of chronic diseases, including cancer)

Some had genuine reasons, such as arthritis, but many had a misplaced fear that exercise would worsen symptoms.

This is simply not the case. Even if you start slowly because you haven’t exercised for a while, being more active can increase the production of hormones that make you feel happier, while improving sleep, skin tone, libido and mental activity plus slowing the biological clock embedded deep in our DNA.

You’ll not only cut your risk of cancer, or cancer returning but find that you are living a healthier and happier life, too.

HOW IT PROTECTS AGAINST DISEASE

Any form of exercise that raises your heartbeat can help lower cholesterol levels and improve blood pressure. It also helps you to maintain a healthy weight, build muscle and improve the supply of oxygen and nutrients to your body tissues.

If you exercise outside you’re also boosting your vitamin D levels from exposure to the sun (we know Vitamin D can slow the progression and growth of cancer).

Exercise also triggers more than 180 direct biochemical changes in your body, most of them beneficial, which can have important effects on the risk of cancer and other diseases. Research found regular exercise can lower IGF (the enzyme Insulin-like Growth Factor that can make cancer cells grow rapidly) and raise cure rates. Several randomised controlled trials have shown that exercise also improves insulin sensitivity and lowers blood sugar levels — which also lowers the risk of being overweight, another cancer risk factor.

DAMPENS DOWN THE BAD GUYS

Regular physical activity has a significant impact on whether or not ‘bad’ genes that cause disease are activated as we go through life.

This was neatly demonstrated in the GEMINAL study, a pilot trial involving men with low-risk prostate cancer in the U.S.

Scientists found that a set of genes capable of transforming normal cells into cancer cells were ‘damped down’ after an exercise and lifestyle programme. Genes that showed a marked response to exercise included those involved in DNA repair.

If you haven’t exercised for a while, don’t feel daunted. The key is to take it in stages and not overdo it. Once you begin to see the results, you will be motivated to continue. A walk before mealtimes is great for your circulation and digestion as well as weight control.

The benefits of being more active increase with the more that you do ¿ this is still true for anyone who¿s already been diagnosed with cancer, writes Professor Robert Thomas (pictured)

The benefits of being more active increase with the more that you do ¿ this is still true for anyone who¿s already been diagnosed with cancer, writes Professor Robert Thomas (pictured)

The benefits of being more active increase with the more that you do — this is still true for anyone who’s already been diagnosed with cancer, writes Professor Robert Thomas (pictured)

How exercise helps from Top to Toe 

From helping you to combat the threat of brittle bones, reducing anxiety or cutting your risk of cancer, regular exercise has far-reaching benefits for the health of your whole body as well as helping you to lose a spare tyre. Here are just a few of the major rewards you can hope to reap.

Head and Brain 

Research shows that being physically active improves mood, reduces anxiety levels and helps to fight depression, partly by releasing increased levels of the ‘feel-good’ hormones endorphins.

The exact mechanisms are not yet exactly understood but it’s also thought that activity provides a mental distraction, which can act a s a ‘circuit-breaker’ to negative thought patterns.

Regular exercise also increases levels of the chemical serotonin in your brain, boosting your mood and overall sense of wellbeing.

WHAT TO DO: Aerobic exercises such as running, cycling or dancing that increase your heart rate are particularly good for this.

Exercising outdoors is another mood-boosting bonus as research shows sunlight can reduce seasonal-associated depression and your body’s circadian rhythm — so try to exercise outdoors in daylight if possible.

From helping you to combat the threat of brittle bones, reducing anxiety or cutting your risk of cancer, regular exercise has far-reaching benefits for the health of your whole body as well as helping you to lose a spare tyre (stock image)

From helping you to combat the threat of brittle bones, reducing anxiety or cutting your risk of cancer, regular exercise has far-reaching benefits for the health of your whole body as well as helping you to lose a spare tyre (stock image)

From helping you to combat the threat of brittle bones, reducing anxiety or cutting your risk of cancer, regular exercise has far-reaching benefits for the health of your whole body as well as helping you to lose a spare tyre (stock image)

Eyes and Face

Eyes are a muscle just like the rest of the body. With age, our ability to look up, in particular, diminishes so from time to time during each day, keep you head still and look up, then look left and right.

For menopausal women, one of the troublesome consequences of naturally falling levels of oestrogen and testosterone is that this causes an imbalance in the body’s cooling system.

This can lead to hot flushes, a sudden and unpleasant sensation of heat spreading across the face and chest that can range from a mild heat intolerance to prolific sweating throughout the day and night, disrupted sleep and sometimes even leading to fainting and exhaustion.

WHAT TO DO: Aerobic activities including brisk walking, swimming or cycling. Research shows that sedentary women who started a programme of brisk jogging or pedalling four or five times a week, experienced a 60 per cent reduction in the frequency of hot flushes, and also found improvements in other menopausal symptoms such as mood, weight gain and insomnia.

Bone

Bone is a constantly changing organ, continually remodelling itself in response to accidents, weight-bearing exercise or changes in your environment or diet.

It’s well known that bone density decreases with age, making brittle bones and falls a risk for older people.

Some medications, including steroids for asthma, phenytoin for epilepsy and hormones for breast cancer, can also increase the rate of bone loss .

So it’s sensible to do regular exercise if you’re taking these as studies show it will help maintain bone density.

WHAT TO DO: Weight-training is a good defence against bone loss, but the best type of exercise to prevent it is called High-intensity Resistance and Impact training (HiRIT).

Authoritative studies have shown HiRIT to have a significant impact on bone density (and physical strength) in the hips and back, with no increased risk of fractures. It is also safe; despite many participants having osteoporosis, the study found no fractures caused.

Studies have shown that yoga and Pilates significantly relieve joint pain and improve mobility (stock image)

Studies have shown that yoga and Pilates significantly relieve joint pain and improve mobility (stock image)

Studies have shown that yoga and Pilates significantly relieve joint pain and improve mobility (stock image)

Knee and Hip

More than 8.5 million people in the UK are living with the discomfort and disability caused by arthritis, a debilitating condition that affects the hands, feet, spine, hips and knees in particular.

Arthritis is characterised by inflammation and damage to cartilage and bone in the joints, leading to pain, stiffness, swelling and deformity.

Certain drugs make arthritis worse, including statins for high cholesterol and hormonal drugs for prostate and breast cancer.

Being overweight, smoking and having a high-sugar diet can all contribute to making joint damage worse.

There is no cure for osteoarthritis, as it is very difficult to restore the cartilage once it has been destroyed.

WHAT TO DO: Exercise that involves stretching is the most effective way to slow its progress and help alleviate the swelling and pain.

The problem is that pain often gets temporarily worse at the start of exercise, giving the impression that it should be avoided. But it does wear off if you persist.

Studies have shown that yoga and Pilates significantly relieve joint pain and improve mobility.

Being overweight, smoking and having a high-sugar diet can all contribute to making joint damage worse (stock image)

Being overweight, smoking and having a high-sugar diet can all contribute to making joint damage worse (stock image)

Being overweight, smoking and having a high-sugar diet can all contribute to making joint damage worse (stock image)

Leg and Lung 

One leading cause of preventable death that people rarely talk about — venous thromboembolism (VTE) — a condition in which blood clots form within a vein.

These clots can break off and block the blood supply to the heart or lung. In the brain, it can be the cause of a fatal or disabling stroke. About half a million people in Europe die as a direct or indirect result of blood clots events every year — more than breast cancer, Aids and traffic accidents combined.

Although blood clots can form anywhere in the body, they are most common in the legs (deep vein thromboses which can lead to blocks in the blood supply to heart or lungs) and in the lungs (pulmonary embolism when a blood vessel in your lungs gets blocked causing chest pain and coughing up blood).

Both are medical emergencies that require immediate hospital treatment. You’re more at risk of spontaneous clots if you have a family history — but several lifestyle factors are also key.

These include smoking, being overweight and periods of prolonged immobility such as long car or plane journeys.

The last two patients I saw with pulmonary embolism had both driven nine hours to Cornwall in heavy traffic.

Being active and moving regularly are therefore important ways you can cut your risk.

WHAT TO DO: Regular aerobic exercise, including brisk walking every day. Jogging, cycling, dance classes or interval training are all good ways to lower the risk of blood clots.

About half a million people in Europe die as a direct or indirect result of blood clots events every year ¿ more than breast cancer, Aids and traffic accidents combined (stock image)

About half a million people in Europe die as a direct or indirect result of blood clots events every year ¿ more than breast cancer, Aids and traffic accidents combined (stock image)

About half a million people in Europe die as a direct or indirect result of blood clots events every year — more than breast cancer, Aids and traffic accidents combined (stock image)

Heart and Blood Pressure

Numerous trials show exercise improves high blood pressure and can reduce the need for medication. The main reason for this is that it makes your heart stronger. A stronger heart can pump more blood using less effort. If your heart can work less to pump, the tension in your artery walls decreases, lowering your blood pressure. Regular exercise also helps you maintain a healthy weight, another important way to control blood pressure.

WHAT TO DO: To keep blood pressure low, you need to keep active regularly, rather than hitting the gym once a day and sitting around the rest of the time. Schedule regular aerobic activity — swimming, gym classes or cycling and be more active in between. Stand to take phone calls, take a stroll at lunchtime. If your job means sitting for much of the day, try to stand and walk around at least once an hour.

Waist and Stomach

Many people find themselves carrying excess weight as a ‘beer belly’ or ‘muffin top’. If weight loss is your goal, research shows the best approach is to concentrate on regular and prolonged aerobic endurance exercises, plus some resistance training. Couple this with a diet and intermittent fasting (leaving long gaps between meals or extending your overnight fast). Studies have shown that supervised exercise programmes help people lose six to ten per cent of excess body weight per year. I also believe timing is important: exercising on an empty stomach is more effective because the body cannot find immediate energy in food and must take it from its energy stores, including fat. Exercising before breakfast also extends the period of overnight fasting, which has been shown to help reduce your risk of developing cancer or type 2 diabetes.

WHAT TO DO: The Department of Health recommends adults do two and a half hours of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

If you are already overweight you need to restrict your daily calorie intake to no more than 2,500 for men and 2,000 for women — as well as exercising — to even start burning up energy stores. And you need to keep it up for several months to see a long-term benefit.

The Department of Health recommends adults do two and a half hours of moderate-intensity aerobic activity, such as cycling or fast walking, every week (stock image)

The Department of Health recommends adults do two and a half hours of moderate-intensity aerobic activity, such as cycling or fast walking, every week (stock image)

The Department of Health recommends adults do two and a half hours of moderate-intensity aerobic activity, such as cycling or fast walking, every week (stock image)

Hands

We take our hands for granted — until they don’t work properly. Dupuytren’s contracture is a common preventable degenerative condition that affects the hands, causing discomfort and disability.

It starts with a slow-growing, fibrous inflammatory thickening of the tendons in the palm of the hand, which eventually creates a deformity in the ring and little fingers. In later stages, the fingers are pulled towards the palm. Once this occurs, the affected fingers can’t be straightened.

It’s not known exactly why the immune system starts laying down these contracting fibrous layers, but Dupuytren’s contracture is more common in smokers, people with a high alcohol intake and those taking long-term medication such as phenytoin for epilepsy.

Patients in the late stages of the disease are often angry when it is suggested that lifestyle strategies could have prevented its progression, citing trials which found little benefit from exercises for patients with established contraction. But I have reached a different conclusion from other evidence and my own experience.

Eighteen years ago, when I noticed the characteristic nodules in my own hand, I researched natural measures to prevent progression. I stretched the fingers and hand every day and started massaging in a polyphenol-rich essential oil balm. The theory was that a combination of stretching and the natural anti-inflammatory properties of the oil would penetrate the thickened tendons. Today the contracture remains hardly noticeable and the range of movement has even improved.

WHAT TO DO: It is essential to stretch the fingers in all directions, so, as well as flexing, extend, rotate and push from side to side, but avoid overstretching or causing pain as this could trigger more inflammation. A video of the appropriate stretches can be found at keep-healthy.com

Prostate

Whether commuting, having fun with the kids, or taking holiday tours in the Alps, middle-aged men in Lycra are increasingly to be found on their bikes — but is this popular hobby damaging their prostates?

Concerns have been raised about injury to the perineum (the area of tissue between the anus and the scrotum) from the saddle.

This is said to be responsible for an increase in erectile dysfunction, infertility, problems urinating and even prostate cancer — but, I’m not asking you to stop cycling!

A 2014 study involving 500 cyclists reported a six-fold rise in prostate cancer among those who trained for more than eight hours compared to men who trained for no more than 3.75 hours a week.

But what was less widely mentioned in the media reports was that all the men in the study had a cancer rate three times lower than average.

WHAT TO DO: Cycling increases the risk of osteoporosis (loss of bone density), so it’s a good idea for keen cyclists to include weight- bearing exercise such as jogging or squatting with weights into their training routine.

Give your immune system a boost 

Exercise also improves the blood flow through the tissues, giving your immune cells a better chance of getting to anywhere they are needed. During exercise, increased levels of a hormone called catecholamine stimulates the white blood cells to flow into the bloodstream, improving immunity throughout the body.

This explains why people who regularly perform more than two hours of moderate exercise a day have 30 per cent fewer chest infections than those with a sedentary lifestyle

And while few of us will ever train as hard as this, anyone who does two-three hours of moderate exercise a week will still see benefits to their immune system.

This is particularly important as we get older, too, because our immune systems become less efficient with age.

Exercise also improves the blood flow through the tissues, giving your immune cells a better chance of getting to anywhere they are needed (stock image)

Exercise also improves the blood flow through the tissues, giving your immune cells a better chance of getting to anywhere they are needed (stock image)

Exercise also improves the blood flow through the tissues, giving your immune cells a better chance of getting to anywhere they are needed (stock image)

Exercise is also important for boosting the immunity of anyone who is overweight or obese as their bodies produce fewer natural killer cells (a type of white blood cell) and cytokines (small proteins which coordinate the body’s response to infection) — both are key parts of our natural defence system. When you exercise you set off a chain of chemical processes in your body that results in greater activity by your own natural killer cells.

And as your body finds its own natural defences boosted, so your immune system perceives less need to circulate inflammatory chemicals to combat disease. High levels of inflammation can, over time, cause cell mutation, as we’ve seen — so this is another mechanism by which regular exercise directly helps to reduce your cancer risk.

Moderate, regular exercise also reduces blood levels of prostaglandins, which is beneficial as these compounds play a role in dealing with injuries such as wounds — but can also trigger chronic inflammation if they are present in excessive quantities.

Regular exercise directly lowers blood levels of the hormones oestrogen and leptin. This may explain the fact that post-meno-pausal women who exercise have a lower risk of hormone-related tumours such as those of the breast, uterus and ovary than those who don’t.

Learn to reset your own body clock 

We all get tired from time to time, but constant fatigue and poor sleep patterns can be an indication of disruptions to your circadian rhythm, the internal 24-hour clock that regulates our sleep-wake cycle.

Our circadian rhythm enables our metabolism to slow down at night and speed up during the day, which is important in terms of cancer because our cells take advantage of the time we’re asleep at night to make vital repairs, helping us to stay healthy.

If these are not completed properly and the important sequence of genes in our DNA gets altered, this can lead cells to mutate when they divide and repair themselves. And this, in turn, leads to cancer.

This poses a risk for shift workers and people who often travel between time zones (although the pandemic has reduced this for some) includ-ing pilots and air stewards.

We all get tired from time to time, but constant fatigue and poor sleep patterns can be an indication of disruptions to your circadian rhythm, the internal 24-hour clock that regulates our sleep-wake cycle (stock image)

We all get tired from time to time, but constant fatigue and poor sleep patterns can be an indication of disruptions to your circadian rhythm, the internal 24-hour clock that regulates our sleep-wake cycle (stock image)

We all get tired from time to time, but constant fatigue and poor sleep patterns can be an indication of disruptions to your circadian rhythm, the internal 24-hour clock that regulates our sleep-wake cycle (stock image)

And the risk increases according to the number of years of sleep disruption, the frequency of rotating work schedules and the number of hours per week working at night. Interestingly, an evaluation of the large UK biobank dataset suggested that women who woke early and did not have more than eight hours of sleep had a lower risk of cancer than women who went to bed late and rose later — suggesting that it is the disruption to the circadian rhythm rather than lack of sleep itself that is the most important factor.

Chronic disturbance of your body clock is also linked to depression and loss of motivation. Numerous studies have shown that it is also connected to premature ageing, obesity and degenerative conditions — particularly dementia — as well as an increased susceptibility to cancer.

Your body clock is set by a variety of external factors, the most important being the level of light during the day and darkness at night.

Not only do hormone levels vary throughout a 24-hour period, but the sensitivity of different types of cells towards hormones can also change throughout the day. This affects every system in your body, from your immunity and temperature to digestion and excretion.

Feeling exhausted also has an impact on your decision-making, making you more prone to reach for sweet foods as a pick-me-up (and we’ve seen already that there are many ways in which a high-sugar diet is a cancer risk.)

It also makes you less motivated to exercise, and so miss out on all the profound health benefits you can reap from being more active. It is no surprise then, that when your circadian rhythms are properly regulated, you sleep well, you have more energy in the mornings, you are in a better mood and are less tired during the day.

Here’s what I suggest you try:

There are also numerous ways to reduce stress, some easily available online include yoga and mindfulness classes, which have been shown to help you unwind and improve sleep patterns (stock image)

There are also numerous ways to reduce stress, some easily available online include yoga and mindfulness classes, which have been shown to help you unwind and improve sleep patterns (stock image)

There are also numerous ways to reduce stress, some easily available online include yoga and mindfulness classes, which have been shown to help you unwind and improve sleep patterns (stock image)

BE YOUR OWN SLEEP DOCTOR

If you’re struggling to sleep at night or find your sleep is disturbed you should take a look at your lifestyle habits to see how you could make positive changes to help regulate your body clock.

However, if you are suffering from extreme fatigue to the extent that it is interfering with your daily activities, it would be worth consulting your doctor, as it could be a symptom of anaemia, thyroid disturbance, heart failure or a side-effect of medication.

GO OUT IN THE MORNING 

One of the best ways to set your circadian clock is by exposure to bright light (ideally sunlight) during the day, preferably in the morning.

This is because the component of sunlight that tells your circadian clock that it is daytime is blue light. If you work indoors consider getting a light box, which is a device designed to produce blue light, and use it for at least 15 minutes at the same time each morning.

Conversely, to signal to your body it’s night you should keep your indoor lighting dim in the evening.

If you’re using a computer monitor or watching television at night there are two options: either install a flux application in your computer, phone or tablet and set the screen brightness to the lowest setting, or wear amber- tinted glasses for the last two to three hours of your day.

Several scientific studies show that wearing these glasses in the evening improves sleep quality and supports production of melatonin, the hormone that regulates the sleep–wake cycle. Before you go to bed, switch off phones and tablets and try to sleep in total darkness.

BALANCE & STRETCHING 

Working on your balance and regular stretching can help the joints, reduce fibrosis in the tissues, stimulate the mind and help maintain mobility and independence in later life. Exercises involving balance also prevent falls — a big advantage if you have brittle bones. Yoga, tai chi, Pilates and Qigong are all good for this.

To work on core strength, which is needed for balance, it is important to do exercises such as squats which will not only improve our balance but also our bone density. The neck and thoracic spine bend forward with age, leading to a characteristic stooped posture. To prevent this, focus on posture when walking, sitting or standing.

A good stance involves bearing your weight primarily on the balls of your feet, keeping your knees slightly bent with your feet about shoulder-width apart. Try to be as straight and tall as possible with your shoulders open, your chin and stomach in and your chest out.

At intervals during the day, if possible, lie on the floor and raise your hands above your head trying to touch the ceiling. Also move your arms up and down by your sides, like a snow angel.

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LEARN TO BUST STRESS 

The stress hormone cortisol plays an important role in regulating your body clock, which is why if you’re under stress and your cortisol levels rise, your sleep patterns can be disrupted. Set time aside for exercise, which as we’ve seen causes your body to release chemicals that improve anxiety and mood.

There are also numerous ways to reduce stress, some easily available online include yoga and mindfulness classes, which have been shown to help you unwind and improve sleep patterns.

KEEP A REGULAR BEDTIME 

Your levels of melatonin (often referred to as the sleep hormone) start increasing two hours before your bedtime in order to prepare your body for sleep.

So if you’re munching a sugary snack (that produces blood sugar spikes when digested) or watching a scary film during this time then you will be overstimulating your body and affecting your circadian rhythm.

You need to aim for seven or eight hours of sleep every night — so calculate when you need to go to bed and wind down for a couple of hours before this.

DO SPORT TO BOOST SLEEP 

We’ve already seen how important regular activity is for every aspect of your health, but it’s also known that physical exercise helps your body to produce melatonin, which is one of the reasons it helps you to sleep better at night.

But avoid energetic evening gym sessions, as intense exercise keeps you revved up for longer and delays your melatonin production.

Sports scientists have found that regular, light-to-moderate exercise is better than irregular high-intensity exercise — for your general health as well as your sleep.

The issue with irregular high-intensity exercise is that it draws heavily on energy reserves and can lead to post-exertional malaise. The best results come from supervised exercise programmes involving a build-up of intensity over several weeks. 

EAT MELATONIN-RICH FOODS

Eating foods high in melatonin ensures your body has good supplies to use for your natural sleep-cycle. Try to eat more of these foods in the evening. Shellfish is an excellent source of the amino acid tryptophan, which is converted to melatonin in the body. Plant foods rich in melatonin (known as phytomelatonins) include: mushrooms, ginger, pepper, pistachios, tart cherries, cranberries, strawberries, lentils, whole grain rice and corn.

A good nightcap would be some grated ginger with hot water, a little lemon and mint.

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