A simple equation has changed the way that we live. It is having a greater impact than any of the ground breaking theories from science. The reproduction number \(R\) is being used to change our behaviours to reduce the spread of the Covid-19 virus and will leave its mark on us well into the future.

Governments around the world are using \(R\) to guide their actions in controlling the spread of the Covid-19 virus. The version of \(R\) that they are using is the “basic” reproduction number, \(R_0\) ( or \(R\) nought) and it is the situation when when no one has been vaccinated, no one has had the disease before and there is no way to control the disease. Calculating \(R\) is a complicated process but comes down to three components: how long a person is infected, how often they come in contact with others and how the disease is spread. A long period of infection will increase the value of \(R\). If a person comes in contact with lots of people then they increase the value of \(R\) as well as how it is transmitted for example airborne diseases will give a higher value.

The value of \(R\) is used to assess the contagiousness of a disease. For example if \(R\) has a value of 2 then one infected person will pass the virus onto another two other people who in turn will each pass it onto another two and so on. If \(R\) is less than 1 then the spread of the virus will decline. Calculating $R$ requires complex mathematical modelling, lots of data and powerful computers which results, at best, in an average for its value. For example $R$ has a value of between 1 - 2 for the common cold, SARS is 2 - 5, and at the early stages of Covid-19 it varied between 1.4 - 5.7. The UK Government’s action plan is aimed at reducing \(R\) by breaking the transmission of the virus with regular messages by washing hands, enforcing social distancing and a lockdown for non-essential workers. Early signs, but unconfirmed, is that \(R\) could be between 1 and 0.5

But it is the impact of reducing \(R\) which is having a dramatic impact on our lives. Health and Social Care systems are having to respond to the virus in ways that were never expected as they fight to save as many lives as possible. Non-essential parts of the UK economy have hit a brick wall while other sectors plummeted to their lowest levels of activity since records began. There is a similar picture around the world which is slowing global trade and will ultimately reduce economic activity in national economies. The response of governments to the pandemic is starting to raise fundamental questions about how we live and work. How will those people who are identified as key workers be valued in the future by society? Will government intervention in the economy during the crisis remain for many years ahead? Is their proposed tracking and tracing app a step too far in monitoring society? How much do we really know about the human body and how it works and how its it translated into medicine Will the growth of the digital economy accelerate through on-line entertainment and delivering more goods to our doorsteps but will it go on to change the type of work? Are the days of commuting over? Will on-line learning become an integral part of education? Will the remote monitoring and support of patients be a few clicks from a doctors desk? Should the length of supply chains be reduced to within our shores and we make more of our own products so that we can respond quickly to future crisis?

If \(R\) had stayed buried in technical papers and and discussed in specialist conferences with the occasional discussion at a government strategic committee then we would never of heard of it. But now it has made its way into everyones lives, through the actions of governments, then lots of questions are bubbling to the surface. The longer that the fight against Covid-19 goes on then the greater the public will require action in answering these questions.

Over a century ago Einstein’s equation \(E=mc^2\) was brought to the publics attention which heralded the start of a revolution in our understanding of how the universe works, from planets down to the quantum level, which created the technology that has shaped our lives. \(R\) has signalled the start of another science revolution but this time it will be in our understanding of how we live together and down to the level cell activity s which will change our future.

At a recent meeting of the World Economic Forum in Davos, HRH Prince of Wales delivered a keynote speech about combating climate change. In the speech one statistic caught my attention: “With consumers controlling an estimated 60% of global G.D.P., people around the world have the power to drive the transformation to sustainable markets.” As a consumer do I really have the power to change the world for the better?

The speech was aimed at governments, businesses and other organisations and was strategic in nature but what is needed is a translation from the high level ideas into to what it means for how we spend our money. The first question that I asked was do I really control 60% of my income? A quick back-of-the-envelop calculation using some average numbers: the UK’s Gross Domestic Product for 2019 was £2.21 trillion pounds and the total tax receipts including VAT was £821 billion pounds which gives around 63% which was left for us to spend as I wish. However, there are certain things that we have to purchase by law for example car insurance and TV licence, and other requirements e.g. house insurance, therefore very roughly it is correct that we control how we spend 60% of our income.

The next question is what exactly is a sustainable market? After all isn’t growing food not sustainable? The farmer grows a crop and holds back some seed to grow the crop the following year. Is that not a form of sustainability? However, with increasing mechanisation and automation in agriculture, with its subsequent increase in the Carbon footprint along with overworking of the soil ( which the experts claim that we only have around 60 years of harvesting left ) it is not as sustainable as I thought. A quick web search produced the following description for sustainable markets: “can be loosely defined as those that contribute to stronger livelihoods and more sustainable environments. In linking with the pursuit of ‘sustainable development’, such markets have a multiple focus on social, environmental and economic outcomes. Sustainable markets aim to reflect the true costs (or externalities) of natural resource degradation, environmental pollution, and promote just and safe labour practices.”

But how do I know that the goods and services that I purchase are sustainable? There are two aspects for any goods or services: how the item is produced and how we consume it. For example buying a DVD: how sustainable is the method of manufacturing, sales, playing it and its final disposal? The same question can be asked about each item that we purchase which can cover hundreds of products and services) ranging from a cup of coffee to holidays. The operation of national and local governments and organisations such as charities can fall under this question. The Prince of Wales emphasis this point in his speech “ … we cannot expect consumers to make sustainable choices if these choices are not clearly laid before them. As consumers increasingly demand sustainable products, they deserve to be told more about product lifecycles, supply chains and production methods. For a transition to take place, being socially and environmentally conscious cannot only be for those who can afford it. If all the true costs are taken into account, being socially and environmentally responsible should be the least expensive option because it leaves the smallest footprint behind. We must communicate better with consumers about the sustainability of the goods, services and investments we offer.”

The Prince of Wales’ keynote speech outlines a ten point plan to achieve sustainable markets which I believe will be a start to combatting climate change and I hope that governments, business and other organisations start to implement ASAP. In the meantime I shall be taking my spending power and asking questions about the sustainability of the products and services that I buy - I will keep you up to date with what I find.

A TV fishing series has opened up a conversation about men’s health. But is it all talk?

The TV series Mortimer & Whitehouse: Gone Fishing shows the comedians Bob Mortimer and Paul Whitehouse try, with mixed success, to catch a particular species of fish for example the beautiful coloured brown trout or the mighty carp. Each episode takes them to a scenic river or lake in the UK where they spend most of the day fishing. During the long periods of sitting waiting for a fish to bite they crack jokes, mess about and discuss life’s great problems. The TV series has had an impact on men. I have lost count of the times when I mention that I am an angler there is a reply: “have you seen Gone Fishing?” which is an opener for a discussion about fishing and men’s health. But is there any science to back up the claim that fishing can improve men’s health?

The statistics for men’s health in the UK makes grim reading: 68% of men are overweight and 14% of men have untreated high blood pressure. The statistics for men’s mental health has worsened with 37% admitting to regularly feeling worried or low in 2009 to 43% today.

Although on the surface, fishing doesn’t seem to be as active as cycling, swimming or football, there is more going on than meets the eye. Studies have shown that there are many benefits from standing in the fresh air: boosting the immune system and increasing levels of energy. Fishing also includes the challenges of how to reach the river bank with rods, nets, bait etc. and trying not to fall in! Carrying equipment strengthens muscles and improves heart health. Walking over the rough surfaces of a river bank or around a lake has been shown to improve balance and coordination.

Apart from the physical benefits there are mental health benefits to be gained from fishing. Scientific reports have shown that fishing provides a perfect stopgap measure for dealing with short-term stress. Also, in a recent study, a team of researchers found that combat veterans had significant reductions in stress and post-traumatic stress disorder symptoms along with improvements in sleep quality after participating in fly fishing. Also, studies have shown that connecting with fellow fishers and belonging to a club, and [learning new skills]((https://www.nhs.uk/conditions/stress-anxiety-depression/learn-for-mental-wellbeing/) can boost self confidence and improve mental health.

In summary there are lots of scientific support for the physical and mental health benefits from fishing for men. Therefore my call to the medical professionals dealing with men’s health is that instead of reaching for a programme of drugs, or activities with strange sounding names, why not prescribe some fishing?

Bob and Paul may not catch many fish during their TV series but they have caught the attention of the wider public and men in particular. Let’s hope that the discussion continues and develops into concrete action to improve men’s health.

I have reached an age where urinary infections are impacting on my quality of life. But my recent experiences with managing the problem has highlighted inconsistency in the urology expertise of the NHS.

I have been troubled for many years with Urinary Track Infections ( UTI ) because of an enlarged prostate. After a particularly bad infection which developed into Prostatitis I was put on a bag catheter and then eventually moved onto Intermittent Self Catheterisation ( ISC ) to reduce the risk of any further UTIs.

My story starts with two consultants at different hospitals. Let me label them consultant A from the Urology Department in one hospital and consultant B from the other hospital. After recovering from Prostatitis an appointment was made with consultant A for further tests and to discuss the best way to manage my health problem. When I met with consultant A he advised me to stop using the catheters. Life settled into making sure that I was drinking enough water and carefully marking out the location of public toilets! The situation was tolerable and I was beginning to feel that this was the new normal. When I left the consultant I made an appointment to review the situation in six months time however the hospital cancelled it closer to the date. When I hadn’t received a date for an appointment I contacted the hospital’s help line to be told that they hadn’t forgotten about me and I was still on the waiting list. After about 18 months and with no signs of an appointment with consultant A I discussed the situation with my GP and asked to see another consultant who had helped me in the past and I was switched to consultant B. I received an appointment within a week and if I hadn’t been travelling abroad I would have seen him before the month was out. Two long haul flights later and I came down with a bad UTI which required 3 weeks on antibiotics by which time I was on my way see consultant B. In consultant B’s Urology department I we went through a series of tests and a questionnaire about how the medical problem was affecting the quality of my life. During the consultation I explained what had happened over the last few months and then consultant B explained that I had been sitting too long and should have used my catheters. He then went on to explain why I needed to use the catheters for the rest of my life and how they ensured that my bladder was emptying. When I was leaving I asked if he wanted to see me on a regular basis for example annually he replied that that would not be necessary because he felt that I was competent enough to manage the situation.

Under the new catheter regime looking back I realise that I probably had a low level urinary infection since I saw consultant A. I now feel a lot better and the inconvenience of using the catheters is insignificant when compared to the improvement in my quality of life.

Looking back over my experience with both consultants I realise that I had assumed that the level of expertise of urology consultants across the NHS would have been approximately the same. I say ‘approximately’ because I realise that due to the complexity of the human body and we all have different medical histories. However, I felt that my condition was not uncommon in older men and therefore the diagnosis and medical support should have been the same.

So what could have contributed to the difference in advice? Lack of resources between the two hospitals could have contributed to the difference in advice with consultant A not having enough time to analyse the test results and have an in-depth discussion. There could be a wider issue of the organisation of Urology departments which are under increasing pressure from changing employment contracts, a challenging on-call system, changing training requirements as well as the increasing threat of litigation. All of these factors could have contributed to the difference in advice. However, I think that the difference comes down to the approach. Consultant A viewed my medical problem as a problem where he prescribed the appropriate solution a bit like a mechanic fixing a problem on a car. Consultant B looked at the problem from the patient perspective and by increasing my knowledge of the underlying problems and taking the time to explain why the course of action would improve the situation. Consultant B took a patient centric approach where I was seen as part of the solution.

I remember listening to a surgeon on the radio where he said that curing medical problems boils down to two approaches: medicine or surgery. We automatically think that medicine comes in a bottle or a tablet, but it could come in the shape of knowledge, and it is how it is applied that makes the difference.

Big thanks to the Nurse who helped me overcome my fear of inserting a catheter as well showing me a few ‘tricks of the trade’, both urology consultants and their staff and my GPs for their on-going support.

Much of the public’s perception of engineering is gathered through the media, in particular the news on television, where somebody is wearing a HI-Vis vest, wearing a hard hat and discussing the failure of a large building project. It is no wonder that engineering struggles for recognition. How can this perception be changed?

Many years ago I was standing around a coffee machine with some colleagues discussing the usual office politics when one of them mentioned that they had to complete a project about the public perception of engineers through the media as part of their degree course. The puzzled silence was broken by a few more coins pushed into the coffee machine and as it filled up our cups a few examples emerged. First name was Kevin Webster who ran the garage in the long running TV soap opera Coronation Street. But was he an engineer or a mechanic? We weren’t sure. Next was Tom Howard in the series Howards Way who designed yachts but always seemed to be in a psychological state close to a nervous breakdown. Anyway we only ever saw the back of a drawing board and there was a discussion about whether he was holding his pen correctly. Our time at the coffee machine was coming to an end and the last name that came up was Scotty from the long running series Star Trek who always managed to get a few more drops of power out of the overstretched warp drives just in time to save the USS Enterprise! We wished our colleague lots of luck with their project and headed back to our desks.

Over the years there have been some new TV series with engineering themes for example MacGyver and Scorpion but their lead characters had super human skills which didn’t relate to everyday engineering. Other programmes included: Scrapheap Challenge that shows the creativity of engineers but reminds me of the local blacksmith and not the high tech environment of a racing car company, Robot Wars which is more about entertainment rather than making the world a better place, and a few documentaries for example Engineering for the World and Extreme Engineering but they concentrate on how the cars, planes etc. worked rather than the creativity and problem solving that the engineers used in developing them. There have been a few notable attempts to show the impact of engineering on peoples lives. For example the comedian Robbie Coltrane in his series Coltrane’s Planes and Automobiles tells the story of some of the greatest engines that have been built and explains how they work and their impact on society. Another is the film The Boy Who Harnessed the Wind (2019) where a young schoolboy in Malawi overcomes many obstacles to save his village from drought by building a windmill to power an electric water pump. But overall there has been no improvement in media of engineers and therefore it should be no surprise that it is seen as a poor option compared to other careers such such as a marketing director, lawyer or celebrity!

But there is an engineering skills crisis in the UK with around 186,000 skilled recruits needed each year until 2024. The demand will only increase with major challenges such as the impact of climate change, feeding a growing population, and improvements in health and social care. Therefore we need to encourage more people into the profession.

What engineering needs is a ‘Brian Cox.’ to increase the awareness of engineering and inspire the next generation of engineers. The Brian Cox Effect has increased the number of people taking A-Level physics by 20% and UCAS reported that applications to university physics courses increase by 52%. We need to see a similar improvement in the take up of engineering. The engineering equivalent of Brian Cox would bring their enthusiasm and communication skills to a wealth of material. For example how about a series on the engineers behind the everyday things that we use and affect our lives such as heating, electricity, transportation, the internet or mobile phones? Or covering the engineering being used in current research for example using Formula 1 technology being applied in the construction of skyscrapers or using AI to optimise the materials used in constructing solar panels. Finally speculating about future engineering challenges, for example the engineering that will be required to scale up lab grown meat to full production so that we can reduce the amount of the Green House Gas methane from cattle.

I doubt whether there will be any coffee machines in the future for people to gather around and discuss the issues of the day. But wherever they gather lets hope that the discussion starts about an engineering programme that they have seen on television, or other devices, that is presented with the same clarity and enthusiasm as Brian Cox!