Covid#14 - Thinking of Boris (and everyone else in hospital tonight)

Anyone who knows me won’t be shocked to read that I am no fan of Boris Johnson!  As of last night, however, the man’s in intensive care after being admitted to hospital in London on Sunday night, and his condition then worsening, and I am thinking of him with nothing other than good wishes.

In the past twenty-four hours, news teams with the BBC and ITV have taken us behind the scenes of intensive care units at hospitals in London and Bournemouth.  We saw desperately sick patients surrounded by trollies of equipment, screens, wires and tubes.  Machines whirred, whistled, pinged and beeped and patients gasped for breath.  Doctors and nurses in their blue gowns, masks and visors worked ceaselessly with professionalism, care and remarkable composure.

‘It’s unimaginable,’ one doctor commented, ‘None of us have ever seen anything like it.’  A nurse described how physically and emotionally draining it is, adding, ‘Some of our staff really can’t cope with it … it’s not uncommon for some to have panic attacks – just finding this so, so stressful.’  Another said she was scared.  Patients themselves told of how taken aback they had been by the severity of their illness, how hard it had been and of how they owed their recovery to the efforts of the medics who had treated and cared for them.  It was a harrowing insight to the struggle to save lives on the front line; yet, undoubtedly, what we saw on our screens barely scratched the surface.

Today, it’s hard to think of Boris Johnson as Prime Minister at all, or as the politician I dislike; today, I can only picture him as a fragile patient in an oxygen mask, probably anxious, possibly scared, surrounded by all that noisy paraphernalia of the intensive care unit.  He’s one of the many thousands of seriously unwell people in this country and around the world, fighting a very personal battle against a deadly virus, with friends and family who are deeply concerned for him.  He’s another victim of this dreadful disease, putting his faith in the hard-working medical team at St. Thomas’.

Last night, I asked a friend if he had heard that Boris had been moved to intensive care.  A short reply came back: ‘It’s sad for everyone going into intensive care with this virus.’  I was embarrassed by my own reaction to the news about the PM; in terms of this pandemic, he’s not special and as he himself would probably remind us all, the virus is indiscriminate.  Why should I be more shocked by his illness than anyone else’s?  Why should I – of all people – care more about him than anyone else?  The outpouring of concern for Boris on social media, the ‘get well soon’ photos, posters, signs and placards, the 8pm clap for Boris – they’ve all made me uncomfortable.  What about all the thousands of other people in intensive care tonight?

Maybe it’s inevitable that Boris now becomes the personification of the fight against Covid19 in the UK.  Once he recovers though, that will only increase the responsibility he bears.

Most of the time, I wish he wasn’t our Prime Minister.  Now though, I only wish him a speedy recovery and return to good health.  Importantly though, my prayers for Boris will be no more nor greater than for everyone else fighting for their lives in hospital.

Covid#13 - What's the plan?

This weekend started with reasonable concerns about how disciplined people would be as the sun shone, temperatures rose and the Easter holidays began.  There were warnings; if we ignored the social distancing rules that have been imposed, the virus would spread, infections would spike, the NHS would be overwhelmed and more people would die.  It seems that most people have stuck to the rules.  Sure, there have been well-televised exceptions, but here in Cornwall, for example, the car parks have remained empty and beauty spots like Kynance Cove and Lizard Point that would normally be rammed on a sunny weekend like this are completely deserted.

It might get harder the longer it lasts but so far, many of us have adapted surprisingly well to our social isolation.  Perhaps because we daren’t contemplate how long this might actually go on, one thing we’re not thinking much about is how it will end.

There are only two ways this can end and social isolation isn’t one of them.

The first is a vaccine but apparently, even if the testing of a vaccine is expedited, it is likely to be more than a year until one would be widely available.  Maintaining a strict lockdown for that long isn’t practical and the impact on us all individually, socially and economically would be disastrous.

The second is ‘herd immunity’.  This social isolation, however, means that we can not build it; apparently, it requires at least 60% of us to contract coronavirus but in doing so, the numbers of people who would become seriously ill would overwhelm our hospitals and Imperial College models suggested that up to a quarter of a million would die.  In suppressing the virus by ordering this lockdown, the Government’s reaction to that suggestion a couple of weeks ago was rapid; when you’re responsible for life-and-death decisions, a number like that is obviously unacceptable.  It’s not just the elderly and vulnerable who are shielded from the virus now, as was the original plan; we all are.  Consequently, there can be no herd immunity. 

At the earliest opportunity when the curve on that day-to-day graph of new infections firstly flattens and then heads back toward zero, this lockdown will have to be lifted.  The virus will not have gone away, however, and without herd immunity or a vaccine, it will likely resurge and we could find ourselves back in lockdown.  And this could become a pattern: lockdown, release, lockdown, release, lockdown, release.  Crucially, the NHS may just be able to cope with waves of infection controlled in this way, but it’s not an ideal solution. 

The long-term strategy must be to build that herd immunity, which will mean carefully managing the spread of the infection.  There will need to be efficient ways for people to report their symptoms when they fall ill, widespread testing, surveillance and support of those who self-isolate and effective contact tracing to identify others who may have been infected.  In China, one of the advantages authorities had was their everyday culture of surveillance and the access it gave them to data from mobile telephones.  Once a person had symptoms of coronavirus, he was able to use his phone to alert the authorities and a test was then arranged.  Remarkably, they were then able to use data from his phone to identify exactly where he had been and with whom he had been in contact.  This meant that if, for example, he had traveled somewhere by bus, the authorities knew exactly which bus he had been on and who else had been on that bus.  The bus was then taken out of service, the people who had been on it were instructed to self-isolate via their mobile phones, tests were arranged and there was further contact tracing.

In our western liberal democracies, we shudder at the thought of such state-intrusion on our lives.  It flies in the face of our freedom but perhaps in these exceptional circumstances, we need to think differently.  And we already are; understanding that our responsibility to wider society outweighs our individual rights, most of us have readily accepted restrictions on the freedoms we usually take for granted.

If, however, we can’t countenance even temporary Chinese-style surveillance, different means of achieving the same ends will have to be implemented.  Either way, we need to hear more from the Government about its long-term plan.

Covid#12 - What would Florence Nightingale make of coronavirus?

The new Nightingale Hospital at ExCeL, London opened yesterday, having been constructed in just a couple of weeks and with eventual capacity for up to four thousand Covid19 patients.  It’s impressive but another grim symbol of the magnitude of this emergency.

Over one million people in 181 countries have now contracted the virus and 53,000 have died.  The USA recorded over a thousand deaths in a day for the first time and looks to be on the brink of a catastrophe.  The PM is still in isolation with a fever and looks dreadful.  684 more people died in the UK yesterday – as my mum keeps commenting, that’s 684 more families.  They include two nurses: Aimee O’Rourke and Areema Nasreen. 

Florence Nightingale was a medic ahead of her time.  While she never saw a pandemic on the scale of Covid19, she certainly witnessed epidemics of cholera, typhus and typhoid in the Crimea, so I wonder what she would make of our twenty-first century response to Coronavirus.

On one hand, she would probably be in awe of the hospital that now bears her name, of the doctors that will save lives there and especially of the nurses.  She would commend the cleanliness, the hygiene, the disinfection.  She would approve of the training, the professionalism and the compassion.  She would be impressed by the attention we pay to washing our hands.  She’d recognise herself in the nurses and her admiration for them would be boundless.

She would also share the widespread concerns about the lack of personal protective equipment for health and care workers.  When Nightingale herself arrived in the Crimea, she was so appalled by the lack of supplies, that one of her first purchases was of towels and she later provided enormous supplies of (amongst other things) clean shirts and soap.  Today it’s masks, visors, gowns and ventilators that are lacking. 

This week, the daughter of a healthcare assistant from London who died from Covid19 blamed his death on the Government’s failure to provide vital protective equipment.  The BMA has called the death of frontline medical staff in Italy ‘an urgent warning’.  With hospital trusts giving up on the Government and striking deals directly with private manufacturers and companies openly asking why the Government has ordered nothing from them despite asking two weeks ago what protective equipment they could make, demand has grown for answers from the Government, together with sufficient PPE.

Nightingale would be fascinated by our advances in Science and especially our capabilities to test for illnesses.  I doubt it would take her long to question why more people are not being tested for Coronavirus.  This week, the Health Secretary, Matt Hancock – fresh out of isolation himself – promised to increase testing to 100,000 a day by the end of April.  There’s a sense of panicked catch-up in his response to some bad headlines: ‘550,000 NHS staff, only 2,000 tested’ screamed Thursday’s Daily Mail.

Criticism mounted as daily coronavirus testing passed 10,000 tests per day in the UK on Thursday – two days later than promised – while Germany tested 50,000 per day.  There’s suspicion that this is a legacy of the Government’s dismissal of the need for widespread testing when the pandemic first took hold here, despite the World Health Organisation’s insistence that it was critical to slowing the spread.  There’s also scepticism about Hancock’s promise to increase testing ten-fold in a few weeks.  There are issues about lab capacity to process tests, although the Government now says it will use private companies in addition to NHS labs.  Like many of us, Florence would roll her eyes and ask why they didn’t do so sooner.  Worldwide demand for the specific reagents needed for the tests far outstrips demand.  South Korea and Germany apparently started out with greater capacity for testing – South Korea has huge virology labs following the SARS epidemic of 2003 and Germany has long been a global testing base – but both acted faster than the UK Government, which has only just called on GlaxoSmithKline and AstraZeneca to make the required reagents.  Even now, a Health Department spokesperson has clarified that the promise is to have 100,000 tests available by the end of the month, not necessarily to carry them out.  I can imagine Florence’s exasperation.

More than one person has suggested that Johnson and Hancock might do better to promise less and deliver more, but Boris does like his numbers, which more often than not need some clarifying - £350 million per week for the NHS; 50,000 new nurses; 20,000 new police officers.  Some skilled political bluster and a good slogan might deal with questions about those figures; that won’t work when the numbers of infected and dead doctors and nurses rise.

Describing Scutari Hospital in January 1855, Assistant Surgeon Henry Bellew wrote, ‘There has been somewhat unaccountable neglect in the arrangements for this hospital.’  Today’s Government tells us, ‘Stay at home.  Protect the NHS.  Save lives.’  Fears are rising, however, that the Government itself might not have done all it should to protect our doctors and nurses.  Florence Nightingale would mourn the tragic passing of Aimee O’Rourke and Areema Nasreen.  With the advances in science and medicine that have been made since the nineteenth century and the resources available now that she herself could never have drawn upon, she would also be scandalised by modern-day unaccountable neglect.

Covid#11 - In which our inalienable human rights become alienable

During this lockdown, we’re all realising how much we’ve taken for granted, whether it’s the hard work of the NHS, time spent with our friends and family or the simple pleasure of popping to the shop whenever we want to.

Something else many of us in the UK routinely take for granted is our human rights; ‘inalienable’ as the Universal Declaration states them to be.  Yet now, surely for the first time since that landmark document was adopted in 1948, many of the fundamental rights enshrined in it have been suspended.  In a sense, it seems we hardly noticed.

Everyone has the right to freedom of movement and residence

within the borders of each state.

Everyone has the right to leave any country, including his own,

and to return to his country.

Everyone has the right to freedom of thought, conscience and religion;
this right includes freedom to change his religion or belief, and freedom, 
either alone or in community with others and in public or private,
to manifest his religion or belief in teaching, practice, worship and observance.

Everyone has the right to freedom of peaceful assembly and association.

Universal Declaration of Human Rights, Articles 13, 18 & 20

Just a few weeks ago, it was unimaginable that society, our social order, our ways of life would be so thoroughly upended as they have; nor that these rights would be taken from us.  We assumed that our rights were so sacrosanct that we barely had to think about them; they were just part of our everyday.  In their great proclamations, it seems even the writers of the Universal Declaration did not foresee a time when any of our human rights would be alienable.  In a way, they set us up to take them for granted, and that may be what they intended.

In fact, a few years later, the wily writers of the European Convention on Human Rights did make some allowances.  The corresponding rights to those in the Universal Declaration include the provision for ‘limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals’.  Article fifteen allows derogations in a time of public emergency threatening the life of the nation.

It’s another indication of how great our emergency is that most of us have accepted the restrictions placed upon us without thinking about the rights that have been taken from us.  There are, of course, other rights that take priority now – not least, the simple right to life.  Rights also go hand-in-hand with responsibilities and in our ‘all in this together’ spirit, we recognise that our responsibility to each other’s welfare, especially that of the elderly and vulnerable and of our doctors and nurses, outweighs our individual rights.  It’s an interesting and perhaps surprising consequence of this crisis.

I’ve had darker moments though, when I’ve slipped into a more dystopian mindset.  What if this emergency lasts longer than we think?  How could it be exploited by an unsavoury leader?  If the emergency deepens and worsens, might the restrictions need tightening further?

To promote further isolation, maybe fewer professions will be considered essential so journalists, for example, could be told to stay at home.  There are other ways that governments can share their daily briefings, after all.  There goes our free press.  Too much ‘fake news’ about this virus on social media might necessitate some intervention there too, all in the interests of health and well-being, of course.  Perhaps, free access to supermarkets will eventually prove too risky and they will need to close with generous food parcels sent to every household instead – along with government-approved recipes.  Everyone should have exercise but not everyone can be trusted to have the right amount of exercise or to avoid associating with others whilst doing it.  To keep everyone safely socially distanced, every street could be allotted a specific time to exercise and a specific route, supervised by the Police.  A larger police force will probably be needed too, complete with drones to keep a closer eye on us.  It’s not realistic for teachers to indefinitely teach remotely and surely children deserve greater consistency than we can deliver from our dining rooms, bedrooms and studies.  Why not simply beam one standard lesson from a Whitehall ‘classroom’ direct into homes all across the country?  Parliament has already been suspended and needn’t rush back – certainly not until it’s 100% safe for its members to reconvene.  If necessary, elections can be postponed.

It's a nightmare vision that I wake up from and almost completely dismiss.  ‘Almost completely’ because never in my life – never in most of our lives – has anything even close to it ever been as imaginable as it is now.  It reminds me of how precious our rights are; how we will all be relieved to have them returned to us and how we will celebrate.  Maybe they are one more thing we will learn not to take for granted.

Covid#10 - Dedicated to the staff of the NHS

The first death from Covid19 in Bournemouth was recorded yesterday, with two in Poole also.  It’s a tragic milestone that brings this emergency much closer to home.  When people die in your hometown, it takes much less than six degrees of separation before you know someone who’s lost a loved-one.

Beyond television drama, I have few points of reference for what it must be like to work as a doctor or nurse in a hospital.  I was seriously unwell about a year ago and had a day in hospital as an emergency patient.  I was enormously impressed by the care I received from doctors and nurses in several departments and by their professionalism.  They were all incredibly thorough and efficient and wonderfully sensitive and kind.  As I got better, I was in no doubt that without their excellent expertise, care and reassurance, my recovery would not have been so speedy.  My experience inspired confidence and admiration.  I wasn’t exactly surprised by the amazing hard work of the NHS, but it reminded me of how much we take them for granted for most of the time, when thankfully we don’t need them.

My cousin is a nurse in Perth, Australia and a friend is an F1 doctor, currently working in Bournemouth hospital.  I'm embarrassed that even after years of watching Casualty and Holby City, I only recently understood what ‘F1’ means!  Along with their colleagues, they are both very much on my mind today and I find myself regretting not talking to them more about their work, how a typical shift unfolds for them or how it affects them.  Not that much of what they are doing today is typical.

I’m not sure their hard work and compassion today is especially remarkable – it’s what they do every day.  What makes it extraordinary in these circumstances is how they so willingly and so selflessly set aside their own fears and anxieties about what must be the most dangerous virus they have ever encountered, shoulder the burden of caring for desperately sick, dying and infectious patients along with the inevitable concern they must have for their own health and the safety of their families and loved ones and manage the pressures of hospitals at the busiest they have ever been together with the apprehension of worse to come. 

My gratitude to the incredible staff of the NHS knew no bounds a year ago when I needed them myself but it and my admiration for them then is far surpassed now.  They are the heroes of this emergency.

Covid#9 - How this virus will define us

The ‘Church Closed’ sign on the local parish church was one of the most striking and sobering things I’ve seen so far.

It’s not because you would find me at church tomorrow or on any Sunday; I’m not religious and only go to church for a special occasion.  It got me wondering if there has ever been a time in British history when churches have been closed in this way.  I’ve done some Googling, and it seems there hasn’t.  As far as I can tell, even during previous great calamities – the Black Death, the English Civil War, the Great Plague, and the two World Wars, for example – churches stayed open.  The ‘Church Closed’ sign therefore emphasised the magnitude of our emergency.

There was a time when a pandemic like ours would have been seen as punishment by the Almighty.  During the Black Death of the 1340s, people turned to the Church for forgiveness of their sins, solace, reassurance and answers.  Ironically, the faith of many was rocked when the church seemed impotent and the very priests they turned to succumbed to the plague in large numbers.  During the Civil War, both Roundhead and Cavalier prayed in church for victory.  Churches remained open in 1665 when plague was once again attributed to divine retribution and the faithful sought God’s protection and mercy.  The start of the First World War saw a surge in church attendance as people identified with the justness of Britain’s cause and sought guidance from the Church, and the immediate inter-war years saw it rise again.

Historically, in times of emergency, we went to church and prayed for deliverance.  The closure of churches was unthinkable.  Today, relatively few will turn to God for solace, answers, protection or mercy and the closure of churches goes largely unnoticed.  

Instead of turning to priests for salvation, we turn to science.  Coronavirus is an invisible enemy just as Yersinia pestis was in the fourteenth and seventeenth centuries, yet we all know what it looks like.  It’s our doctors and nurses that we believe will save us and whom we’re urged to protect.  Virologists and epidemiologists explain the spread of the virus to us.  Science labs around the world are racing to produce a vaccine – today’s holy grail. 

For consolation, we turn to our smartphones and tablets and to the Internet.  We’re connected to each through myriad apps and more become available every day.  With a swipe of our thumb, we can message and call each other, video-conference and Facetime; we post memes, jokes, film-clips and photos to keep each other smiling; we stay up-to-date with the news and keep informed;  we continue to work; and when we feel anxious or upset, we find support.  Some of us even blog – like modern-day Samuel Pepys’!

Undoubtedly, this pandemic will define the generations that lived through it in the same way wars of the past defined our grandparents’ and great-grandparents’ generations.  More than that though, while the already diminished church submits to the microbe, Covid19 will help define our age as one of great scientific and technological discovery and endeavour.  

Covid#8 - This is just the beginning

When I started writing this Covid19 diary just over a week ago, we had just been told that schools would be closing at the end of the week, panic buying was still a relatively new phenomena, the over-70s and the vulnerable were still walking the streets and there had been 3,300 confirmed cases in the UK and 144 deaths. 

We were all grappling to come to terms with being in the grips of a global pandemic and I was reminding myself as much as anyone else that it was just the beginning.

A week on and we’re reeling from the impact of the virus and the change it has brought to everything.

Schools are closed.  Panic buying has been replaced by strict controls on our shopping – one-in, one-out at the supermarket and limits on what we can buy.  No-one is walking the streets; we’re staying at home and the Police keep an eye on our movements.  We’ve quickly become used to staying two metres apart from anyone we meet.  The friends and family we saw so regularly and hugged so freely are now just voices on the phone and faces on a screen and we don’t know when we’ll see each other properly again.  Pubs, restaurants, cafes and shopping centres are all shut.  Sport is off.  Many of us are working from home and accepting the limits on what we can achieve.  Many others find themselves suddenly with no work and no money.  Planes are grounded and the skies are empty.  Billions upon billions of pounds have been borrowed to keep us all afloat; after all those years of austerity, the national debt has abruptly rocketed.  The NHS is frantically readying itself for a ‘tsunami’ of cases.  We’ve been on lockdown for three days, with eighteen still to go – probably more.  The Prime Minister, the Prince of Wales, the Health Secretary and the Chief Medical Officer have all tested positive.

As of today, there have been 14,500 confirmed cases in the UK and 759 deaths.  Worldwide, there have been nearly 600,000 cases and 27,247 deaths. 

The picture is bleak but there’s cause for hope too.  Rainbows have appeared in windows across the country for children to spot.  We’ve found a deep new regard for our public services, especially the NHS.  We’ve remembered who the vulnerable are in our communities and shown how much we care.  An army of volunteers has mobilised.  Everywhere, people are supporting each other in wonderful acts of kindness.  Social media is alive with positivity and optimism.

We are still reeling.  We’re in shock and adapting to a new reality for which we weren’t prepared.  We’re fearful and uncertain of what the future holds, but we’re staying positive.  We don’t know how long it will all last.

There’s one thing I’m sure of though: this is still just the beginning.