Category Archives: thoughts

current affairs, medical, thoughts

On Vaccine Logistics

Let’s think first about flu vaccination – not the vaccine itself but the logistics involved to get a needle stuck in my arm.

It is very tempting to ridicule the NHS and the UK government for failures to supply sufficient vaccines – especially flu vaccine – in sufficient quantity, and on time, when the requirements are apparently well understood. And indeed there have been supply failures in recent years. However it is salutary to consider the complexities of the logistics involved.

Somewhere around 30 million doses of vaccine have to be manufactured, packaged and shipped. Those 30 million are split between six different vaccines, made by five different companies. And there are tens of thousands of shipping endpoints (almost 10,000 GP practices in England alone, plus pharmacies, hospitals, …), all with differing requirements.

30 million doses can’t be manufactured, packed and shipped in the twinkling of a politician’s brain. It takes time, and the NHS isn’t the only customer of the manufacturers. So the supply from manufacturer to NHS warehouse will be phased; so the final shipping to the endpoint will also likely be phased. Which means at any time a given vaccine may not be available at every outlet, even if they did get their requirements correct the first time.

Keep in mind too that these vaccines are temperature sensitive and must be held in refrigerated storage at all times. That too complicates the distribution.

All of that is before one even thinks about the GP identifying, and calling those eligible for vaccination, and making enough clinic time (space, appointments, clinicians) available to actually stick needles in arms. Oh and chasing up those who don’t respond.

I know from experience of logistics at a much simpler level it is almost impossible to get this 100% correct every single time — hard though one might try! It’s almost inevitable that on this scale things will go wrong; and the further back in the chain the problem occurs the bigger the knock on effect out at the clinic.

(Incidentally it’s the same with supermarkets and getting things like loo roll on the shelves. Don’t just blame people for panic buying – although, yes, they do – but think about the logistics and supply chain involved.)

Amazingly this works the vast majority of times in developed countries. For instance, the UK currently has among the highest national coverage of flu vaccine in the world, vaccinating around 75% of the over-65s against flu every year; most countries either do worse or have no vaccination programmes for older people. But in places where the infrastructure and healthcare systems are more fragile, things break down quite quickly.

Now let’s extend this to vaccine(s) for Covid-19.

First of all let’s say that all of the above logistics still apply, but things get worse …

We don’t yet have a vaccine (or vaccines), so as yet we have no clue how many of what we are trying to deploy, or where, or how.

We don’t know if the vaccine(s) will require refrigerated storage, or actual cold storage. If cold storage (ie. freezer temperatures) is required – and this seems likely for many of the vaccines currently being trialled – this hugely complicates the distribution chain (and makes it pretty much impossible in developing countries).

How many shots of vaccine are required to provide immunity? Will just a single shot be enough? Or will patients need a booster (or two, or three, …). Again it looks as is many of the potential vaccines will need a booster shot after a few weeks. That doesn’t just double the amount of vaccine required; it doubles everything right down to ensuring patients get their booster.

And who is eligible for the vaccine? And when? Government is likely to plan on getting the vaccine to the most important people (eg. healthcare workers, food supply people) first, followed by vulnerable groups, and then everyone else. Ultimately they will want to catch everyone (barring the small number of nay-sayers): that’s 60+ million in England alone, with potentially two shots of vaccine – so four or five times the flu programme.

That’s a potential 120+ million doses of vaccine for England alone together with a huge amount of distribution and a great deal of clinical effort. That deployment will take time; maybe as much as an elapsed year! By which time the first recipients may need repeat vaccination if the immunity decays, as it well may.

All of that is before we even think about … How effective the vaccine(s) are (no vaccine is 100% effective). How many vaccines are available. Are particular vaccines (in)appropriate for particular groups of patients. How do we handle the case where the first vaccine available is followed up by one which is much more effective? – Do we revaccinate the first recipients now, or later, or not at all? What advertising campaign, or other incentives (maybe even legislation?), do we need to ensure the vast majority of people get vaccinated?

Of course, we don’t yet have a vaccine to deploy. The front runners are all still in Phase III trials which are unlikely to complete until at least the end of this year. Even if one (or more) of the candidate vaccines looks really good, it is very unlikely we’ll see an emergency approval much before next Spring. And then there may be the question of how that affects other ongoing trials.

Now you can be pretty sure that there will be people in the Department of Health and the NHS sweating blood to try to work all this out, now, even before we have a vaccine. And however well they do their job you can be sure they will get some of it wrong – because the problem is just too complex and contains too many risks and pitfalls. It isn’t at all easy, and it’s human nature to complain when things don’t work perfectly, but it helps to try to see the bigger picture.

So … (a) cut the healthcare system some slack when things don’t work 100% every time, but (b) do call the government to account if it’s their policies which cause the failures, and (c) don’t pin all your hopes on a Covid-19 vaccine being available to everyone (anyone?) real soon.

Further Reading

  1. Derek Lowe; “The Vaccine Tightrope”; Science Translational Medicine; 21 October 2020; https://blogs.sciencemag.org/pipeline/archives/2020/10/21/the-vaccine-tightrope
  2. David Salisbury; “If you’re pinning your hopes on a Covid vaccine, here’s a dose of realism”; Guardian; 21 October 2020; https://www.theguardian.com/commentisfree/2020/oct/21/covid-vaccine-immunisation-protection
  3. Jeremy Farrar; “Let’s get real. No vaccine will work as if by magic, returning us to ‘normal’”; Guardian; 6 September 2020; https://www.theguardian.com/commentisfree/2020/sep/06/lets-get-real-no-vaccine-will-work-as-if-by-magic-returning-us-to-normal
  4. Derek Lowe; “Cold Chain (And Colder Chain) Distribution”; Science Translational Medicine; 31 August 2020; https://blogs.sciencemag.org/pipeline/archives/2020/08/31/cold-chain-and-colder-chain-distribution
  5. Derek Lowe; “Preparing For the Vaccine Results”; Science Translational Medicine; 25 August 2020; https://blogs.sciencemag.org/pipeline/archives/2020/08/25/preparing-for-the-vaccine-results
  6. Megan Scudellari; “How the pandemic might play out in 2021 and beyond”; Nature; 5 August 2020; https://www.nature.com/articles/d41586-020-02278-5
current affairs, thoughts

Horrible Times 12: Business doesn’t Matter

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I’m thinking, again, about Covid-19 and the overall scheme of things.

What I suspected long long ago is still true.

No-one gets it! Not just the government, but YOU, out there 🠞 🠟 🠜 🠝 🠞

In the overall scheme of things, BUSINESS DOESN’T MATTER!

Yes, that’s right: protecting business, in these troubled times, is NOT the first, or even a high, priority.

What has to be done is to protect, and look after, the people. Get the people through this pandemic. And do that at the expense of almost anything else!

Yes, that’s a draconian – and no doubt unpopular – view. And I make no pretence it will be easy or comfortable.

But look at it this way … Businesses are expendable. It doesn’t matter if they fail. Businesses can be rebuilt, started afresh, etc. but only if there are people there to do it. There is no point in having a business if there is no-one there to run it or buy from it. And if the people are there then at least a core of businesses will survive. And when all this is over those surviving businesses can grow to fill the new demand, along with new start-ups and resurrections.

Business is secondary to people. No people = No business.

Yes, OK, there are a core of businesses which are essential: specifically utilities (water, electricity, gas, sewerage, rubbish collection), food supply (farm to shop), healthcare (drugs, doctors, hospitals), and transport (haulage, some public transport, fuel).

Beyond that it isn’t important if pubs, restaurants, car manufacture, garden centres, tailors, fashion houses, gunsmiths, jewellers, publishing, and so on, cease. It doesn’t matter if I can’t buy Epsom salt, a mousetrap, or a new camera. All these can, and will, be rebuilt to the extent that the post-pandemic world, and it’s population, needs them and there are people to work them. If there aren’t the people (either as employees or customers) then the business isn’t viable.

Even education (all of it from kindergarten to university) isn’t essential. Yes, we need educated people, because educated people feed business. But missing a year or two won’t be a tragedy, as many who’ve been long-term sick demonstrate. You can catch up on education later. Although again it may not be easy or pretty.

People’s ability to survive has to be supported and protected, first and foremost.

So wake up governments. People first. Then education. And business later.

thoughts

Imagine All the People …

2 Comments

My friend Ivan, over on his Restored World blog and under the above headline, has suggested the world he would like to awake to in 2030. It is worth reading as it captures many of the things which should result from my earlier posts on Reforming Society and Environmental Reform.

Ivan asks that we think about what should be added to his list of 13 items, and I thought I would do that here. None of my thoughts should come as a great surprise to regular readers.

Ivan’s list seems to concentrate on the physical: things which have to tangibly happen, like energy generation. But what I think is missing are a number of important attitudinal shifts.

Perhaps least of these, in my mind, is that humanity becomes much more open about sex and nudity. I have a whole page here On Nudity and Naturism (and sexuality) as well as having blogged about it many times, most recently here.

Something that Ivan implies, but doesn’t state explicitly, is to my mind one of the two most important aspects. We need to have ethical government. Without it few of Ivan’s desires will come about because there will be insufficient drive to make them happen, so we’ll be stuck in the current dysfunctional consumerist and money-oriented society. That is a big paradigm shift which I believe will enable everything else, rather than flow from Ivan’s ideas.

The other essential paradigm shift seems to me to be for there to be a shift in the whole mindset of Joe & Josette Public and John & Jane Doe. The current mindset is entirely selfish and childish. We’re seeing it with Donald Trump in the USA, and Boris Johnson in the UK. Both are interested only in what they want (ie. money and selfish power) and are essentially behaving as adolescent-brained six-year-olds: “Me invincible! Me want! Me! Me! Me! Now! Now! Now!”. And I’m sad to say that the vast majority of the populous, at least in the developed world, is exactly the same. This mindset has to undergo a complete paradigm shift to one which is much more ethical if there is going to be ethical government and any possibility of Ivan’s wishes coming to fruition.

[Incidentally, there’s a useful summary article on Ethics: paradigm shifts that need to be made for the transition from Pierre Calame, Chairman of the Charles Léopold Mayer Foundation for Human Progress.]

As I keep saying: it ain’t going to be easy. While it is good to look at the concrete, physical, changes one desires they aren’t going to happen without these two major paradigm shifts. And in any programme of change the paradigm shifts are always the hardest thing to achieve.

Wish us luck – we’re going to need it.

science, thoughts

Nature Hurts My Brain

I read quite a bit of scientific material. Not the deep research papers; those days are long gone and my knowledge is too out of date to follow along with immensely detailed analyses of ever more intricate experiments. What I do read is the commentary for the intelligent layman: the specialist science journalism in, for example, New Scientist, Science, Scientific American, Quanta, and various other places elsewhere online.

I don’t read everything – there isn’t time, and anyway there are subjects like climate change, extra-terrestrial life and artificial intelligence which bore me rigid.
[No I didn’t say they aren’t important, or don’t exist; I just said they’re not things I can enthuse over.]

The more I read, the more incredulous I become that anything in the living world works at all – let alone that it could have evolved from nothing, however long the timescales involved.

Apart from the way in which the SARS-CoV-2 virus seems to work, what brought this home to me most recently was and article in The Scientist about left-handed DNA. You see the normal DNA which makes up all our genes has a helical structure which twists in a right-handed direction. And the way that works is gobsmacking enough.

But DNA can twist the other way (left-handed) to form Z-DNA. This has been known for some time, but it is now thought it may have a role in cancer and autoimmune diseases. Even more bizarre is that short sections of normal DNA can flip to Z-DNA and this obviously has a major control on how the whole of the transcription process (which turns DNA code into proteins) works (or doesn’t work) – and that may be important for the prevention of autoimmune diseases or the growth of cancer.

It is fiendishly complex, and yet only one tiny piece in the corner of the jigsaw puzzle which is eukaryote metabolism. I remember when I was a postgrad student (45 years ago) having a huge A1 (maybe bigger) poster full of the (then known) metabolic pathways in tiny print. It was gobsmacking, and totally unmemorable, then and has since been shown to be many times more complex.

The way the living world works – from grass, to rabbit, to fox, and to you yourself – is absolutely incomprehensible and incredible. I can quite see why some people cannot believe in evolution and insist that the whole must be divine design. I don’t agree with that, but that makes it no less brain-addling.

current affairs, environment, thoughts

Reforming Society

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Following on from my post of some weeks back where I looked at a model for Environmental Reform, I’ve now had a go at writing flows for the other areas which need to be reformed together if we are to truly change the way our society works – and thus save ourselves and the planet.

As I see it, the four main arenas for reform are:

  1. Environmental
  2. Economic
  3. Political
  4. Social

They are, of course, highly interdependent.

The diagrams below are my attempt to capture and codify what needs doing.
You’ll see that I have marked with “IN” arrows those places which it seems to me are the simplest and most obvious starting points. Linkages between the areas are shown with lettered lightning flashes.

Click the images for larger views
Environmental Reform

Economic Reform

Political Reform

Social Reform

Yes, it’s very complex; and I don’t pretend I’ve yet got my head round it, nor that the models are necessarily complete. Others may very well disagree with me, be able to add key areas for attention, or linkages between items.

None of this is going to be easy. In fact even the “input points” are going to be fought over. There are too many vested interests amongst the “not-so-great and not-so-good” who hold all the wealth and power worldwide. But also because those of us in the western world have been (relatively) comfortable until now and embarking on this will both threaten that comfort and involve major change – neither of which mankind, as a species, is instinctively equipped to handle as over the aeons it would have been an evolutionary disadvantage. [See, inter alia, Ryback, Lee and Pianka.]

Well perhaps the Coronavirus pandemic can give us a kick start in helping us overcome our (now dangerous) instincts by showing at least the western (developed) world:

  • We can significantly reduce travel, especially air travel, for both business and leisure: business doesn’t need to do it and it will likely be neither affordable nor attractive for leisure.
  • We don’t all need to commute for 2+ hours a day to pile into an office. Sure, many jobs (eg. shops, manufacturing, farming) have to be done from your employer’s premises, but by far from all do.
  • We don’t need to consume stuff at the greedy rate we do (that too is no longer an evolutionary necessity); we can manage with less. Much (especially personal) technology is not essential, merely nice to have. We need to go back to “make do and mend” rather than “throw it away and buy a new one”. Most consumption (beyond the basics) is no more than “cake and circuses” which enriches the already wealthy.
  • There is more to life than earning ever more money; by working longer and longer hours; to show you think you’re two steps better than the guy next door; striving to continually climb the greasy pole; and kidding yourself you’re important. [See Hutnik.]
  • But perhaps most critically, we might come to understand how important it is to have open and ethical government – and that this is possible, though not inevitable. [See Mair.]

Will any of that happen? I hope it will. But I fear it won’t. I suspect this current panic hasn’t hit nearly hard enough, so not enough people are sufficiently shit-scared (or dead), and so the will (or necessity) for change won’t be there. Even the Great Plague and Great Fire of London (1665 & 1666 respectively) didn’t really hit very hard (they were too localised); the two World Wars came somewhat closer; but only the real devastation of losing 30-50% of the population in the Black Death (1348-50) really caused major reform. And who remembers back 670 years?

The will for change may be there amongst (some of) those of us who think and care. However I suspect that after this current Coronavirus panic is over “the people” will go back to their old ways, rejoicing at having escaped the demon bug (‘cos it never happens to them!), demanding what they had before, and being as selfish as ever.

Judging by recent behaviour, the signs are not good.

current affairs, thoughts

Horrible Times 8

The more I see, the angrier and more despairing I become – despite the fact that I know it isn’t good for my blood pressure.

Just what do these self-important, selfish, stuffed shirted twats think they’re on?

Almost every major sport is trying to (re)start their season. Football, rugby, cricket, tennis, Formula 1 … and on and on. Top flight football in the UK is intending to restart in mid-June. They aren’t alone.

Why? Selfish vested interests and money.

All they are going to do is to add fuel to the flames of a second spike of Covid-19. Why can these guys not understand this? Why are they (and their sport) so much more important than people’s health? How do we restructure their brains?

Sport is a recreation. Unfortunately it has become big business made up of prima donnas and stuffed shirts. (In fairness the stuffed shirts were always there, at every level.) Sport is not essential; it is recreation, fun. At the end of the day it is dispensable and one of the last things which should be (re)starting once all else is running and things are stable again.

The politicians are not helping. In England from next week up to six people may meet, in the open air (public or private) as long as they observe 2 metre social distancing. They can even have make burnt offerings, aka. barbecues.

Just like the government did too little, too late at the start of this, they’re now doing too much, too soon and risking the gains we’ve managed to salvage from their incompetence. Do they seriously think that Joe “Dumbo” Public is going to manage to observe (or care about) 2 metre social distancing in his garden, with his and his mates kids running around killing each other, while the adults swig larger and smoke “substances”? And how is this going to be policed? An unenforceable law is worse than no law.

It was my friend Katy, over on Facebook, who pointed out:

Juvenal [in The Satires] coined the phrase “Bread and Circuses”. It was about the fact that the Roman senators created a grain dole for the poor in order to buy their votes and keep the peace in a time of increasing unrest and hardship.

And the fact that the Emperor Domitian who was a right bugger, used to create big celebrations to take people’s mind off whatever the Roman version of Stalinist purges and gulags were. Massacred three thousand peasants? Chuck them a circus and some balloons on a stick and we’re laughing.

I’m not sure what the bread in our current case is – maybe Brexit? But the return of non-essential sport, and allowing people to effectively have parties at this time, certainly look a lot like a circus to me.

Just watch the upturn in Covid-19 cases by the end of June.

Gawdelpus with this set of clowns in charge.

amusements, thoughts

Greeking Hell?

It occurred to me the other day that the current cabal occupying the White House bear more than a passing resemblance to the Ancient Greek Underworld (and Roman too). The pantheon seems to stack up roughly as:

Pluto President Trump
Cerberus Mike Pompeo
Caron Vice-President Pence
Eurynomos Jared Kushner
Thanatos Eric Trump
Hypnos Barron Trump
The Eumenides Melania, Ivanka & Tiffany Trump

Or is it, as some have suggested, more like something from Heironymous Bosch’s Garden of Earthly Delights?

current affairs, thoughts

Horrible Times 3

At least some elements of the Labour Party are saying we need to have a National Income Guarantee Scheme, to ensure everyone continues to have the money to live. This is, in my view, the correct humanitarian response. But also one which should force the wholesale rationalisation and simplification of the benefits system.

People’s ability to survive has to be supported and protected, and not just by protecting them from the disease. This protection has to come ahead of bailing out business. If people survive, business will survive. Without people there is no business.

If people have secure income, companies are expendable. If businesses don’t survive, they can be rebuilt as long as there are people who survive to do it. Hence people must come first.

No, I don’t care if every (passenger) airline goes out of business. Or every manufacturer of TVs. Or every theatre and pub. They can be rebuilt later. But we do still need to be producing food and medicine – and moving it around.

Ultimately that is where the effort has to be: protect the people and the food supply chain.

Along with this I have seen it suggested that there should be a 0% interest rate on all personal/household debt. My guess is that this would need to last at least a year. I can see the logic behind this, although it would no doubt also mean 0% interest for savers. A reduction in debt interest would not affect us (our only debt is a relatively small amount on credit cards); but no interest on savings would hit us – although not hard because heaven knows we already get little enough interest on our savings.

This is all very fine, but one has to ask where the government finds the money for this. The government doesn’t have a money-tree. The only money they have is what they collect in tax or what they can borrow. They have already borrowed more than it is going to be comfortable to ever repay. Where does the tax come from? Your and my pockets: either directly (income tax, national insurance) or indirectly (VAT, excise duty, corporation tax). If we don’t have any money, the government collects no tax. Without tax income there can be no income guarantee scheme, no bailouts, and no NHS. This is the economics of the capitalist system we live in. Chicken meet egg.

beliefs, current affairs, thoughts

Horrible Times 2

OK, so were some days into … well what? … variable amounts of everything and nothing; huge amounts of existential worry and threat.

We’re effectively being told to stay at home permanently (almost under house arrest) although the supermarkets are open – with special hours for geriatrics and the invalid, which are reportedly more crowded than normal and seem a good way to kill off the unwanted. But if we do stay at home we could starve as supermarket deliveries are booked up weeks in advance.

Everything is feeling very fragile, demoralising and really frightening. It’s very much how the Black Death must have been back in 1349: one never knows where it’s going to hit next, if I’m going to succumb, or where one’s next meal is coming from. And, yes, we could get there! If we go into full lockdown, then there could well be issues with the food supply chain and access to supermarkets – on top of what we’re seeing now. Remember, with schools closed from tomorrow, there could well be people who can’t go to work because they can’t find alternative childcare, and that could hit all sorts of hands-on businesses which includes the whole of the food supply chain.

Am I being extraordinarily pessimistic? Well maybe, or then again maybe not. I know I always say “don’t worry about things you can’t control”, and we can’t control a lot of this. But when it comes to having food and drink one is threatening the very substance of existence, and reactions become especially visceral. Recall Maslow’s Hierarchy of Needs:

At least in western society we’re all used to working near the apex of the pyramid; certainly in the top two layers. But what’s happening now is sending us rapidly down a helter-skelter. The middle “love and belonging” layer is currently coming into it’s own. But some are already going to be down in the “safety & security” layer and any disruption to the food supply chain could leave people with a great deal of uncertainty about their very ability to survive. And once one gets down nearer to the bottom two levels people feel increasingly threatened and start to get nasty as they try to protect their existence – just as any animal will.

I have no idea what is going to happen, but I fear the worst; I’m pretty sure it’s going to get a lot worse before it gets better. And it looks like being a long haul: if we get away with anything much under two years I’ll be highly delighted.

Two years! Yes, because although we have protective restrictions now, once the infection rate drops and the restrictions are lifted it is highly likely the virus will rebound and we could go through a (say) six-monthly cycle several times before things settle out fully.

[Incidentally there is some good modelling of a number of possible interventions from the highly-regarded team at Imperial College, London; and it is this which appears to be influencing the UK’s current thinking. The paper is actually quite readable.]

None of this is at all good for those of us who already suffer with depression, or any other mental health issue. I, like I suspect many other people, feel totally disconnected from everything; completely isolated, both socially and physically; and scared about my ability to come out the other side of this.

But all we can do is to try to keep going as best we can.

people, personal, thoughts

Working from Home

Although I’ve been retired for 10 years, I worked from home for most of the last 10 years I was working. And I still work from home on most of my current community give-back activity.

There are now a lot of people around the world who are having to work from home for the first time, and maybe wondering where to start.

There are a lot of website out there which tell you how to work from home, but I have to admit I wouldn’t be finding their hints and tips always very useful – at least initially.

Working from home isn’t rocket science, but it does need a little bit of organising and discipline. Most of it is common sense, but not always obvious common sense. So I thought I’d put together a few of my thoughts in the hope that they may help some of you. Here goes …

Working from home is brilliant … Until the cat throws up on your laptop or your neighbour decides now is the time to rebuild his house (don’t laugh, the latter happened to me!). It won’t be long before you wonder why you ever bothered going in the office.

  1. Basically you need to treat your home workplace up as if it is your regular office.
  2. Have a set workplace. It doesn’t matter whether it is your study, the basement or the kitchen table, as long as it is always the same place. Resist working from your bed or sofa; or in front of the TV. I used to work at my desk in the study; this became my office when I took my laptop out in the morning; and it became mine again when my laptop was put away.
  3. It doesn’t matter whether you get dressed, spend the day in your nightshirt or even nothing, as long as you’re comfortable and aren’t having a videoconference with your group director. However some people feel more professional and work better if they’re wearing reasonable day clothes.

  4. If you’re spending the day in your pyjamas, don’t go out in them! If you need to pop to the corner shop, the post-box or to collect the kids, do please put on jeans and a t-shirt.
  5. Know when to “log on” and “log off”. Try to have a regular start and stop time. If possible use the same schedule as you would in the office; you’ll probably stretch it a bit at both ends but you should still get some extra time to yourself as you’ll not be commuting. I used to start about 8am and stop no later than 6pm. Do not be tempted to either lie-in or keep working into the evening; you can prevent the lie-in by having 9am team conference calls.
  6. On the other hand you do have the flexibility to work when you’re most productive, whether that’s 5am or midnight, although this must not be an excuse to work longer hours. You’ll still need to be available during office hours, so you still need that regular schedule.
  7. Remember, if you’re sick, then you’re sick and shouldn’t be working – just like you wouldn’t go in the office.
  8. Keep to your normal time management method; this will help you keep focus. If you’ve never been taught time management, find an online course and start now. Try to avoid taking a quick break to do the laundry/bath the cat/pop to the supermarket/whatever. It all too easily becomes an hour and a half.
  9. You might want to have a separate phone number for your work – possibly a second mobile. Likewise a separate laptop and email address.
  10. If you don’t have the technology you need (whether it’s a new laptop, or printer, or a piece of software) nag your boss until you get it. Without it you will not be optimally productive.
  11. Communicate, communicate, communicate. In fact, over-communicate. Ensure your boss and your colleagues know you’re there, and you’re being productive. All it needs is the odd phone call, an instant message or two a day, or emailing in that special report you wrote.
  12. Keeping in contact with other humans is allowed – preferably by phone or video, rather than just by email. If nothing else my wife and I talked briefly on the phone at some point most days. Instant messaging can also help a lot, especially if everyone you need to talk to is on the same platform. But voice is best.
  13. Don’t be frightened of phone/video meetings – they’re just like normal meetings, with maybe a bit more discipline, except you can’t spill coffee in Sharon’s lap.
  14. If you’re having a phone/video meeting, remember that you need to circulate any papers in advance by email.
  15. If you’re having a videoconference ensure you know how to share your screen so you can display your visuals and the whiteboard.
  16. Look out of the window. I found I did this quite a bit during 1-2-1 phone calls (and boring teleconferences) and I did quite a lot of garden birdwatching (no, feathered kind!) this way.
  17. In my opinion do not have music on, or the radio, or the TV. Despite what you might think you will concentrate better if it is quiet and there are no distractions. If you must, catch up on TV news at lunchtime.
  18. Do not be tempted to look at social media. I found that easy as I had a separate laptop and mobile phone.
  19. Do take proper breaks; refill your tea/coffee/juice; and go to the loo. Just ration the biscuits!
  20. Also ensure you stop for lunch, if only for 20 minutes. But do not waste time preparing and cooking a meal: either have a soup or sandwich type lunch, or prepare food the night before. This was something I found hard too do; with no-one to sit with at lunch it was too easy to grab some bread and cheese and eat it at my desk.
  21. If there are other people at home with you, set some ground rules, ensure they respect that you’re working, and they know what your routine is. If they’re children, make sure you work out in advance how to keep them amused and out of your hair. Do have joint lunch or breaks, but keep them to a normal length.

Those of you who are seasoned home workers will doubtless not agree with everything I’ve said, and have different things which help you. That’s good. The moral is that ultimately you have to find the way that works best for you – for me that was being totally focussed. YMMV.