Wednesday 1st April 2020

Daily Diary: Dark Odds And Stories That Don’t Have Legs

No pranks or mischievous little lies. No wind-ups and teases. Midday soon arrives and April Fool’s Day becomes like any other. It’s shopping list day and Vicky and I discuss supplies for the coming week – possibly two. Hopefully, Emily can do this again so we can remain in isolation. It seems selfish, but at the age we’re at we know we could develop severe symptoms if we become infected. It’s not fear of death, or even fear of a horrible death, when you’re too paralysed in the chest to breathe. It’s the impact each of us would have on many frontline health services and how, if one of us was hospitalised, the other would manage on their own.

Vicky worries about Emily and Tom, along with what we’re asking of them. News has come out of a twelve-year-old girl dying of the virus in Belgium and yesterday, a thirteen-year-old boy has died of Covid-19 in South East London. It’s a lottery, and even though it is weighted in favour of the young and fit, when it comes to health matters it can never be an absolute. Memories come back of Vicky believing, after the pre-op consultation with the consultant, that she’d be one of the 98 per cent who would come through an operation without complications, turning out to be one of the 2 per cent that would spend time at death’s door. Such lived experiences leave more than a belief that anyone can fall foul of medical misfortunes. They leave an understanding.

By a cruel coincidence the best estimate at present of the odds of dying from Covid-19 should you test positive is two percent. For both Vicky and I there’s a dark resonance in those odds.

The ex-Dukies, old boys from my old school, are exchanging emails about all sorts of issues, ably co-ordinated by my old friend and house captain, Chris Crowcroft. One wrote about his son:

“I’m pretty certain my son (mid-30s) in Boston has just had Covid-19. High fever. 103/39 for two days, muscle aches, cough. Self-isolated and almost back to normal now, three days later. He had dark urine, so he went to hospital to have a blood and urine test. No Covid test due to the King T policies. Elevated myoglobin indicating muscle damage, a known effect of flu and now known about Covid-19. A friend published (a paper) last week on the connection with cardiac damage – (heart being mainly muscle) and increased mortality. For those of you with cardiac issues, take note.”

I sign three petitions. The first one concerns missionaries in Brazil spreading the disease among the indigenous population. It’s a problem that preceded the Covid-19 outbreak and one that President Bolsonaro actively encourages. I put this one out on Twitter. It coincides with news that some churches are still inviting congregations. In Eyam all those years ago, in 1665 the good people weren’t as stupid as these fools are. I imagine there were such fools a-plenty in those days, only they never made it into the history books.

The second is to extend the transition period, especially so British bioscientists can work with their European partners, or that if a vaccine is developed on the continent there aren’t unanticipated barriers to importing it. Coronavirus exposes the Brexit rhetoric for what it is.

I had to wrestle with the third – a petition for partners to be present at the birth of their children during the Covid-19 outbreak. It’s a personal matter as well as one of principle, as it’s an issue within my family. I know there are PPE and public health issues. I know there have been a couple of cases worldwide, where a child dying during birth tested positive for coronavirus. It shows how inadequate our health service is that it is unable to provide sufficient protection and our society regresses to the less compassionate practices from bygone eras. I think it was that. It was a protest for the importance of our humanity that I did sign.

It’s very easy to polarise decisions. To do so simplifies. But we need to acknowledge the greyness. The ambiguity at the edges, despite the virus’s mechanical ruthlessness.

More news appears in my email inbox, especially what’s become known as the ‘Dukie-Loop’ of lost loved ones, of friends and relations dying from the virus. I know this means each and every one of us is just a couple of steps of separation away from infection. We hope, like grazing critters in the centre of the herd, it stays two steps away, but fear it could be one. Or even worse, zero.

I took a nice photo this morning from the front porch that looks out on the common. It’s of a man, seated on a bench, talking to a woman standing by a lamp post three metres away. I imagine what the backstory is, but the posture, body language and gesture describe a socially distanced friendship. Neighbours chatting? A liaison? I don’t know but I like how the pic comes out.

I’m too busy to continue my project of building a model portee two pounder anti-tank gun, used by my dad in the early years of the Western Desert campaign in the Second World War. It’s a project in memory of my father and there is no kit for it as such, which is quite a challenge. So I have shelved it to another day. I get a notice from Toyota about their much-diminished servicing arrangements, subscribe to The Economist and try to organise assistance to an older relative who appears to have slipped through the help-net. Age UK Coventry give us a list of addresses but are overloaded with respect to direct support. There are those who land on their feet and those that don’t.

It should be a story with legs. It’s a story that hardly climbs onboard.

The number of cases rises again. Two days ago, it was an increase of thirteen percent and in spite of politicians talking about “green shoots” it’s back to seventeen per cent, where it was on March 23rd. The death rate rises by an alarming thirty-one per cent, the second highest so far.

The pandemic is a force of nature.

A force that’s stress-testing us all.

The Bigger Picture: We Don’t Do Exponential Well

If there’s one thing the pandemic has taught us is that we don’t do exponential well and are fully capable of transitioning from idle complacency to total panic in hardly any time at all.

The UK’s Covid-19 death toll jumped 563 in a single day today. Yesterday, it was 381. On Monday, 180. Overall fatalities now stand at 2,352. More than 29,000 people have tested positive for the virus, mostly hospital admissions as there is no system in place to monitor on a wider basis.

Worldwide, sometime in the next twenty-four hours there will be a million cases and fifty thousand deaths. It’s projected by the White House that US deaths could possibly reach 240,000, or eighty 9/11s, and already, at over four thousand, exceed those in China. Donald Trump said the country should expect a “very, very painful two weeks”.

Spain’s number of Covid-19 cases has passed the hundred thousand mark and has reached a record daily death toll of 864.

It’s grim.

Russia too now sees itself facing the coronavirus outbreak and introduces strict covid laws after a rise of 500 including jail terms for breaking quarantine rules. President Putin self-isolates following a handshake a week ago with a doctor who tested positive.  Like so many other countries there are problems with PPE. Unlike many other countries the state makes every effort to stifle complaints from medics in the frontline.

Despite that, Russia has dispatched a cargo plane with masks and medical equipment to the US after Donald Trump accepted an offer of humanitarian aid from Vladimir Putin to fight the coronavirus outbreak. In America it is highly controversial. In Russia it’s great public relations.

Each day the statistics, grim though they are, sanitise the stories beneath the numbers. Each day the stories differ in the detail but paint a bigger picture of human suffering. Here are some:

Doctor Alfa Saadu becomes the first doctor to die from Covid-19, after returning from retirement to NHS. One former colleague writes in tribute: “He was loud, bold and loved a challenge. Enjoyed his football, family and was looking forward to retirement to spend it with his grandchildren.”

In Belgium Suzanne Hoylaerts, a ninety-year-old woman dies from coronavirus after refusing a ventilator. In a quiet act of personal courage, she asked if it could instead be used to save someone younger.

Thirteen-year-old Ismail Mohamed Abdulwahab, from Brixton in south London, died in King’s College Hospital early on Monday. He is thought to be the youngest person to have died with the virus in the UK. A statement on the fundraising webpage for his funeral said Ismail died without any family members close by due to the highly infectious nature of Covid-19.

John Carter, aged 75, A British national is among four people to have died aboard the coronavirus-stricken Zaandam, a Holland America Line cruise ship departed from Buenos Aires on March 7, a day before the US State Department advised against cruise travel and before any substantial restrictions were in place in Florida. It had been scheduled to stop in San Antonio, Chile, then complete another 20-day cruise to arrive in Fort Lauderdale, Florida, on April 7. But fear of coronavirus and the media publicity across Latin America, portraying the Zaandam as a plague ship resulted in her being denied permission to dock at port after port. Passing through the Panama Canal passengers were asked to keep their rooms dark and leave their curtains closed.

To reach Florida and find the state governor Ron DeSantis, often called ‘Florida’s Trump’ is reluctant to allow disembarkation for the more than 1,000 people on board the Zaandam.

“Just to drop people off at the place where we’re having the highest number of cases right now just doesn’t make a whole lot of sense,” he told a news conference.

The matter went to the White House.

President Trump shows an uncharacteristic moment of compassion.

“They’re dying on the ship,” Mr Trump said at a coronavirus press briefing. “I’m going to do what’s right. Not only for us, but for humanity.”

A cat in Belgium fell ill with coronavirus after her owner suffered symptoms of the deadly virus following a trip to northern Italy. The cat had diarrhoea, vomited and suffered breathing problems. It illustrated how coronavirus can jump species and the cat family appear particularly susceptible. That black and white feline from two doors away that likes to sunbathe on our garden furniture seems just a little more sinister, even though she likes having her tummy tickled.

It’s becoming apparent that the principles behind dealing with the virus are straightforward. So long as it can be detected, treated and prevented from spreading through the population. The Chinese are now approaching the other side of their Covid-19 outbreak and are now moving on to asymptomatic cases: China reported 36 new Covid-19 cases and 130 new asymptomatic cases, bringing the total number of such cases under observation to 1,367.

This is a draconian society and visions of citizens being manhandled into ambulances and doctors being silenced are fresh in people’s memories. Such behaviour would be unacceptable in western democracies and the struggle to turn principles into practices in democracies is a central theme in the story of the pandemic.

Without detecting the virus, managing it becomes close to impossible. The UK government abandoned testing and tracing in the wider community in mid-March, limiting its use to hospital staff and admitted casualties. Reports suggest that the reason behind the struggle to increase the amount of testing to 25,000 per day is due to a shortage of equipment. The current level of testing is 8,200 a day, way behind the Germans who are at 500,000 every week. Germany tested early and tested a lot. It saved lives.

Health secretary Matthew Hancock has ordered all spare coronavirus tests to be used for NHS workers, as it emerged only a small proportion of those in isolation appear to really be ill with the virus.

Other than that, Britain is blind.

Treatment is limited to the general expertise of ICU medics, learning from each other’s practices, successes and experiences, for example that severe Covid-19 patients are more likely to recover lying on their fronts and that intubation is not always the best intervention. Coronavirus-specific interventions are still in their early stages and medications are on a hit and miss basis.

So, all we’re left with is preventing the virus from spreading, and Biosciences are far away from producing a vaccine, although the global race has begun.

Which means we are almost entirely dependent on people’s behaviour and fickle as it is, unless constrained in a straitjacket (sent mail-order from China?) that’s a tough call. Former president Barack Obama compares the White House’s response to climate change denial. 

When we don’t factor in the possible existence of the virus that’s when it does its worst. So a religious gathering at a New Delhi mosque becomes a superspreader event. Dozens test positive, some die and a thousand are isolated.

The capacity of society to cope is related to the scale of the pandemic. India isn’t coping too well and there is anger at how the country treats its poor, who are beaten up in the streets for breaking Covid-19 restrictions by police with batons and even hosed down with chemicals in the name of public health. Hundreds of thousands of day wage workers have been left without money, food and shelter across India’s cities.

Doctors call out for the public to exercise social distancing. It’s ignored by sun, sea and surf-seekers on Sidney’s Bondi Beach during much of March and this results in a spike in coronavirus cases. So Bondi Beach closes, as there are too many who are prepared to be careless about social distancing. The only visitors are to the Covid-19 testing centre which has been set up. Japan closes its schools until early May, and Brazil closes its border with Venezuela for health reasons, although many are still arriving in the country from abroad.

Italy’s lockdown measures are to be extended until April 13th. The health minister Roberto Speranza has the foresight to warn that Italians must not confuse the first positive signals with an ‘all clear’ signal.

Someone else who has shown foresight is Republican Ohio Governor Mike DeWine, who imposed sweeping measures days before a single case had been reported in his state. On 5th March Mr DeWine got a court order to shut down much of the Arnold Sports Festival – an annual event featuring 20,000 athletes from 80 countries, around 60,000 spectators each day, and an expected $53m for Columbus, the state’s largest city.

It was much criticised.

“This is a balancing test,” Mr DeWine responded.

Over the next three weeks spectators were excluded from major sporting events, well before US sports organisations cancelled their seasons. He was first in the nation to declare a state-wide school shutdown and invoked an emergency public health order to postpone Ohio’s presidential primary the night before it was scheduled on 17 March.

In short, Mr DeWine was one of few American leaders who acted pre-emptively and prevented his state being on catch-up.

Hi critics dismissed Ohio’s strict regulations as overblown and out of step with neighbouring states, let alone fellow Republican Donald Trump, who until later in March downplayed the threat of the virus, saying it would “go away”.

Mr DeWine selected Dr Amy Acton as Director of Ohio’s Department of Health, which was a smart move when it came to controlling the pandemic.

“Mistakes that I have made throughout my career have generally been because I didn’t have enough facts, I didn’t dig deep enough,” Mr DeWine said. “So, I made up my mind I was going to have the best information, the best data available.”

At a recent briefing Dr Acton said, “On the front end of a pandemic you look a little bit alarmist, you look a little bit like a Chicken Little, the sky is falling.”

Then added, “At the end of a pandemic, you didn’t do enough.”

Still, while Ohio’s infection numbers are rising, with 2,199 cases, 55 deaths and 585 hospitalisations, it has so far avoided the surges seen in states like New York, Washington, and Louisiana, ranking 15th nationwide in terms of reported cases.

“It has to be the type of response you take in war time because we have been invaded, literally.

“We’ve got to stay at it.”

Last week, Ohio reported 187,780 jobless claims – the second highest nationwide and almost half the total claims from all of last year. But the economic fallout is a consequence of doing what needs to be done. The two are neither ‘either-or’ in a zero-sum game way, nor are they mutually exclusive, tempting though both positions are being taken by some policymakers. There are broad patterns:

  • Firms dealing with personal services and hospitality, such as restaurants, hairdressers, clothing stores and cinemas are shutting down.
  • Elsewhere there are firms in demand: supermarkets (Tesco recruited 35,000 in 10 days in March), farming – 9,000 workers needed; transport and logistics – Morrisons extra 2,500 drivers and pickers and 1,000 more in distribution centres, food production, care workers, call workers, pharmacies.
  • Changes in people’s daily behaviour changes their energy needs. So the price of oil slumps, despite Saudi Arabia flooding the market and America trying to pump up prices. In the end the rules of supply and demand are so much stronger than individual countries’ tinkering.
  • All this leads to stock markets around the world, the first quarter was one of the worst in history. The start of the second isn’t looking any better, with Asian and European markets opening lower and US futures implying they will follow suit.

Both widespread lockdowns and the volatility of both national and global economies all have a bearing on our everyday lives. Here are some examples:

  • Art galleries and museums go online, but some of the ‘real thing’ is hard to replicate.
  • Covid-19 is creating a short-term boom to streaming services.
  • Petitions appear for PPE for frontline workers.
  • A family’s lockdown adaptation of Les Misérables song goes viral
  • Staff shortages could mean power blackouts
  • Disney’s multiplayer online game, Club Penguin is back and 6 million users have already signed up
  • Leslie Jordan, a sixty-five-year-old actor goes viral with live video feeds about enduring the day to day of lockdown. Looks like a lot less work than me writing all this, but I don’t think I’ll swap somehow. Makes me feel old too!
  • Postman delivers in fancy dress to cheer people up during lockdown
  • A puzzle company is selling a jigsaw that Is completely see-through
  • Corona fraud. To date Interpol have dealt with 30 Covid-19 scams and frozen more than 661,000 euros in bank accounts.

But there is one silver lining and its appearance is almost magical. The sudden halt of economic activity has led to a visible decrease in air pollution across Europe and beyond. The skies, especially in urban areas, become bluer and clearer. It holds promise, even if the changes are likely to be too short-lived to have any effect on climate change. Maybe the hardships of the pandemic itself will focus the public’s mind on the even greater threat in our future. Maybe humans are simply too fickle.

In truth, nobody knows.

But pandemic greening is a reality as nature starts to reassert itself. Goats invade Llandudno in Wales as empty streets give wildlife a chance to flourish during the coronavirus lockdown. A large herd of Kashmiri goats have been feasting on flowers and hedgerows and giving us all a feelgood story that’s brought us all out in a smile.

Excluding those who planted the flowerbeds, I guess.

But it’s not all roses – more likely tulips.

When nursing home workers were asked about their fear of catching and spreading the virus, one of them asked:

“Who else is going to take care of them?”

Back to reality…..

It’s raw and uncompromising.

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