Friday 10th April 2020

Daily Diary: That One Moment Of Weakness

I’ve always wondered what was so good about Good Friday, and I certainly don’t want to figure out what’s good about it today, other than the fact that it’s a beautiful spring day with a soft breeze, a slightly hazy sky and warm enough to be comfortable in a t-shirt. It seems a very small sacrifice to be under lockdown in such near-perfect conditions. The police have announced that they will be out over the Easter weekend, stopping those who can’t resist temptation.

I’m minded that ‘quarantine’ comes from the French for forty days and this is the end of Lent, where Jesus was tempted over and over again by Satan, Prince of Darkness. Succumbing to temptation is the very weakness within ourselves that the coronavirus is seeking out.

That one moment of weakness.

I’m one to talk! I had to learn the hard way. Just over a couple of years ago Vicky and I were flying back from Nepal. I had already learned in Pokhara, where I’d gone to paraglide, to avoid meat. A night of the screaming shits followed by a day of raw bowels and dehydration taught me that. At the restaurant I learned that the Nepalese version of a vegetable biriani made for a really appetising meal and omelettes for breakfast were a must. I’d learned about Nepalese omelettes from my flying friend Deepak Purna Thapa who I’d go out flying with around the hills of England and Wales. They were cold and in a polythene container, but still tasty. But a freshly prepared Nepalese omelette was something special, and it seemed wherever you ate it. The hotel we stayed at in Kathmandu, The Moonlight, was a really nice hotel that did good food, but on the morning we were due to depart I made a mistake.

Breakfast was slow that morning, especially the omelettes. I think the small stove they used to prepare them had broken down. I settled for a chicken sausage instead.

I broke my own rule. 

Within a couple of hours I wasn’t feeling well and from then on the journey back to London became one of survival, dealing with a fever all the way. Kathmandu Airport’s ageing and not fit for purpose departure lounge was crammed full of people. Its toilets were utterly foul. It was a relief to make the short walk across the tarmac to embark on the Etihad A320 to Abu Dhabi. On the plane the cabin crew were brilliant, but it was a tough journey, including weathering a five hour stopover at Abu Dhabi. Despite the never ending buffet in the business class lounge I couldn’t eat. I couldn’t even abide the sight of food. The most I could manage was sipping a little water. The A380 to Heathrow was more luxurious, which meant I could stretch out and weather it out, arriving at Heathrow at the height of the ‘Beast from the East’ blizzard. It was bitterly cold. There was a long and worrisome delay for a taxi from Addison Lee, but our lift arrived, having struggled through infernal road conditions to get to us. Our taxi driver was an older, well-educated Jewish gentleman, who raised spirits and sang Jewish songs along with Vicky, while I curled up pathetically. All I could think was getting home and being warm again.

A moment’s weakness. That’s all it took. The memory of the far-reaching consequences of a trivial mistake makes me cautious. Vicky and I talk about it between – and sometimes over – movies on Netflix and Amazon Prime. There is no such thing as one hundred per cent safety. All we can do is keep our risks down to a minimum.

There is a Home Office leak that is truly frightening. According to Byline Times, Home Office Rupert Shute stated that we will all get Covid-19 eventually. I’m torn between the shallowness and stupidity of the remark. I’m not sure whether it is the absence of a duty of care or something far more serious. Unlike New Zealand, who have nipped the problem in the bud, our own government have faffed around for weeks, fiddling while the virus burns its way through human lungs. I’m left with the conclusion that these guys are no wiser than I am and are just bodging and blagging as they go along.

Something I’ve long noticed is that institutions invariably become extensions of their leaders. The projection of Johnsonism – winging it as you go along – makes sense, as the muddle kills people day after day.

In lockdown niggles become bigger. Perhaps there is more time to become absorbed by them. Perhaps in a little world everything becomes bigger. Who knows? I tried last night to pay Emily online, but couldn’t. The bank had put an extra layer of security to prevent fraud. Now it’s PIN then password plus a texted code to your mobile that confirms it’s you. Only my phone network has an alpha block on codes being sent by text, also a security measure. So it means that between them, the two the security systems preventing fraud work so well that they are stopping me from spending any money from my own account! So I try the card reader, only to find that the battery is low, so it doesn’t work either.

I feel somewhat vulnerable about this. I’m in a technology trap. I prefer at the moment to avoid cash – it’s haram – and although the chap from the bank was really helpful in my plight and got things sorted, what was a small problem had grown into something so much bigger with the lockdown.

As for the ongoing Covid-19 saga, it’s both incessant and far-reaching. I can no longer catch all of it in a day. I feel like a barnacle, a creature that has begun its life free swimming and ends up glued to a rock, waving its modified limbs, its cirri to catch its food. A lot of stuff drifts by but the little barnacle catches enough to get by.

That’s how I feel at the moment.

Barnacles, by the way, are cute. Watch them feed, why don’t you? I’m sure there’s a clip on You Tube.

The Bigger Picture: Eliminate or mitigate? That is the question.

I’m pretty obsessed with flying. These days it’s foot-launched flight, the nearest thing to flying like a bird and it’s the sheer physicality of being in the sky, using the sky to stay up and maybe go places. But I think that desire for flight came from an army childhood, flying out to postings, and after the age of eleven flying out on holiday to Malaysia and then Berlin.

Those were remarkable days for a little boy who loved aeroplanes. If you belonged to the airline’s junior jet-club you could go up to the cockpit, and on an internal flight in Malaya I could even sit at the controls and supervised by the pilot do a basic manoeuvre or two. Whether the thirty odd passengers in the cabin of the Fokker F-27 knew what was going on is a different matter.

It left me with a ‘what if’ scenario. What if, for some mysterious reason, the pilot and co-pilot were no longer flying the aircraft? A double heart attack, or abducted by a passing UFO with a passing whim to cause havoc in the local transportation system? And it fell to me to fly the aircraft?

I’d have to do a lot of learning as I went along, with the worrisome load of three dozen other lives in my hand.

That’s the problem dealing with the pandemic. Both scientists and doctors struggle to understand the virus and the disease while in a state of flux. Our knowledge is constantly changing and it’s often disseminated as hundreds of preliminary scientific reports that doctors on the ground might not have time to scan, busy as they are saving lives.

There are some mighty big questions, not least because Covid-19 is so unequal in the harm it causes:

  • Why is a fifty year old a couple of hundred times more likely to be hospitalised and die from Covid-19 than a twelve year old? Someone in their seventies is around a thousand times more likely?
  • Why are men around the world up to twice as likely to die from the disease than women? Is it to do with social norms and gender behaviours, and do these in themselves confuse our ability to understand what’s happening? Or is it primarily a matter of biology, bearing in mind that the human immune system is closely associated with the X chromosome.
  • Why are minorities most at risk from Covid-19 and to what degree does societal racism and inequality play a part? This is a question that is not going anywhere and it’s one with far-reaching implications.

For governments there is a much more basic question about how their countries should respond to Covid-19. Should they do everything possible to eliminate Covid-19 from their population or do they manage the disease within it, a process that’s become known as mitigation.

Almost all “western” nations have chosen the mitigation option, “flattening the curve” so that their healthcare systems can cope with the load. The exception is New Zealand, which has adopted an articulated elimination strategy with the goal of completely ending transmission of Covid-19 within its borders, and even though it only took up that strategy as late as March it appears to be working, with new case numbers falling. Most cases are now returning travellers, who are safely quarantined at the borders, and the few remaining case clusters in the community are being traced and further spread stamped out.

New Zealand exercised rigorous quarantine at the borders and locked down heavily for a month. They made robust interventions, expanding testing, surveillance and contact tracing to interrupt and then eliminate the chains of viral transmission. Unlike a number of Asian countries around the Pacific rim, New Zealand has never experienced a major pandemic and had been barely affected by Sars.

For PM Jacinda Ardern’s government it was a politically brave commitment. They had rightly figured from the evidence it was the least bad option but there would be massive social and economic costs in the short term, and would require a range of measures to protect those with the least resources, namely Māori and Pacific populations and low-income New Zealanders.

It works. Compared to Britain’s rapidly rising Covid-19 death toll of 7,978 (over a thousand have been in residential care and they may not be included in the official totals) there has only one death in the months ahead. It will only rise in single digits over the months ahead.

There’s nothing like the bold decisiveness of New Zealand’s government. By contrast, we’re in a mess.

 Leaked recordings of a Home Office conference call on Tuesday reveal that the government has all but given up its fight against the coronavirus, and is intent on simply finding a way of ‘managing it within the population.’ The recordings show Home Office Deputy Science Adviser Rupert Shute stating repeatedly that the government believes the ‘we will all get’ Covid-19 eventually. The call further implied that the government will now consider hundreds of thousands of deaths unavoidable over a long term period consisting of multiple peaks of the disease.

It’s bleak. There should be a public outrage, but there isn’t.

The only consolation is a twisted variant of schadenfreude that things are possibly more chaotic the other side of the Atlantic. In New York State, epicentre of the disease in America, the outbreak is reaching its peak, hospital admissions and deaths still rising but the numbers are levelling.

While New York subway people struggle to distance themselves.

“Everybody is very scared,” a subway traveller admits.

In the White House the Trump administration wilfully ignores scientists and public health experts and downplays the severity of the disease, helping to stoke the spread of misinformation. State governors are either playing the party line, or fearful that annoying the president will result in less support to their jurisdiction, which is engaged in a free-for-all in terms of obtaining the resources needed for their citizens. For many it paralyses them from acting in a timely fashion.

There is an animus by the Trump administration towards the Centres for Disease Control and Prevention. It paralyses them too, hindering testing and stopping the distribution of masks nationwide.

“We’re being put at risk unnecessarily,” is a common complaint from medics.

It’s not clear where exactly President Trump is coming from when he plays these games, or what exactly he is trying to achieve, but it’s ordinary people who are suffering as a result.

The following is from a petition and it sums up the pain, frustration and betrayal:

“Debra is a patient with breast cancer who made the unbearable decision of delaying vital chemotherapy treatment for fear of going to the hospital during the Civid-19 outbreak. But instead of facts and reassurances Debra is frustrated by the lies, misinformation and lack of decisive action coming from Trump. We need your help in letting Americans know that it’s our President’s job to keep Americans, like Debra, safe.”

It’s a matter of degree as to whether mitigation is mismanagement. There’s a number of politicians in the US and Western Europe who are seeking to divert attention away from their lacklustre performance. China has become the convenient scapegoat. It’s not that China is without a lot to answer for? Why is patient zero so unknown, especially since it’s been possible to track the Spanish flu outbreak to a Kansas poultry farmer a hundred years ago? Why was China so secretive through late November and the whole of December 2020? They are valid questions and a resentment about a country that has been at the epicentre of the original outbreak is understandable, although disease outbreaks historically can happen anywhere.

Part of the resentment comes from seeing China get back on its feet again. In Wuhan the lockdown is being eased and citizens are returning to their normal lives, supported by Covid testing.

Another source of resentment is the way China has started to exploit the pandemic to cement domestic support internally and the political dependency of other nations. Now China is sending aid packages to the West, this time in the form of facemasks and breathing equipment. Its propaganda machine has gone into overdrive, enlisting China’s loyal captains of industry such as Jack Ma of Alibaba into the cause.

Along with China being an inexorably rising superpower, the dark side of a surveillance autocracy and ethnic cleansing of Uighur Muslims in Xinjiang Province, a disease-ridden West is deeply insecure.

A disease-free rising power is something to be concerned about. But that concern should not transform into xenophobic hatred. But it is and there are consequences, as  new data shows that US companies are definitely leaving China.

There’s news from Brussels that after weeks of wrangling, EU finance ministers strike a €500 billion relief deal for countries hit hardest by the pandemic.

The European Parliament buildings in Brussels and Strasbourg also address matters more directly, opening up to the homeless and vulnerable. In the case of Brussels, two spaces will be created inside one of its buildings. One for the homeless, and another for those who leave the hospital but still cannot return home. The kitchens will also work at full capacity, making more than 1,000 meals a day, for those in need, but also local hospital health workers. In the French city of Strasbourg, another European Parliament building will accept patients, but thoughts are already turning to exit strategies.

Economically, the hardest hit country in the eurozone is Greece, just as it looked as though things were going to improve.

While in the case of healthcare, in Spain the elderly suffer disproportionately. They aren’t usually being tested for COVID-19, nor are they being admitted to hospital intensive care units, which are prioritized for younger patients with a better chance of survival. Nationwide, only 3.4% of Spain’s ICU patients are over 80. It’s a similar situation in Italy. So the elderly suffer at home, alone, more isolated than ever and anxious about catching the virus, even from the medical teams they need.

In France fact echoes fiction, echoes fact. More than 1.2 million people left Greater Paris – or nearly a fifth of its population – during the week of the Covid-19 lockdown, according to an estimate by Orange, the mobile phone operator, based on aggregate data. Echoing the flight of Parisians from the city in ‘The Plague,’ by the French writer Albert Camus, in turn echoing the flight of wealthy Parisians from Nazi occupation in 1940. Coastal and rural villages alike have swelled as if it were August. The population on the Île de Ré, a chic holiday spot on the Atlantic coast, has jumped by thirty per cent.

It’s an exodus of the better off in cities across the globe.

Brits urged to stay at home over the Easter weekend as Boris Johnson fights the virus in hospital.

“Too early to lift lockdown,” says Dominic Raab – the Covid-19 peak is not expected for another two weeks.

Bogota police bid to arrest boredom of Colombians amid lockdown. Police in Colombia have been leading stretching and dance exercises as a new way of keeping people’s spirits up during the lockdown.

Good Friday is observed at home as in Japan a divide over the virus surfaces.

Turks try to ward off Covid-19 with eau de cologne. Soap is cheaper, but kolonya is a national obsession.

While in America there are queues outside methadone clinic lines and packed waiting rooms inside, leaving clients vulnerable to Covid-19. Problems have a tendency to layer on each other.

The pandemic weaves a tapestry of woeful human experiences. It’s in their retelling that it reveals itself:

  • Twin sisters, Eileen and Eleanor Andrews, aged 66,  who did everything together died within days of each other after they contracted Covid-19. They are believed to have contracted the virus at the home they shared together in South Wales.
  • A Grimsby primary teacher has been hailed as a local hero for walking five miles each day to deliver lunches to children who need them during the lockdown. Zane Powles, assistant headteacher at Western Primary School, delivers 78 packed lunches every morning to children who qualify for free school meals. Each lunch contains a sandwich, a packet of crisps, a biscuit and an apple.
  • Kay, a wedding dress seamstress has turned her skills to making NHS scrubs. With all the distractions and responsibilities that come with being a mother of four, she is still making about four sets of scrubs a day from home to help doctors, nurses and care workers.
  • Grandad, 101, becomes the oldest Brit to beat Covid-19 after two weeks in hospital. A Dutch woman of 107 was reported as Europe’s oldest survivor yesterday.
  • From a chief nurse: “Patients are understandably frightened. Staff are frightened as well – frightened that they can’t make their patients better, they can’t make this better – and they’re frightened for themselves, their loved ones, and their colleagues.”
  • Every single person discharged from Croydon University Hospital is treated like a lottery winner, a special celebration that is mirrored by hospital staff, not just from around the country but also the world.

The big fear at the moment is having to go to hospital and it’s easy to be side-tracked into believing that they are places of last resort when suffering from coronavirus. But health conditions haven’t gone on to hold. For some it might be a broken bone, for others a stroke or cardiac arrest, others yet again the consequences of deferring treatment for cancer the list is endless.

If only we could stop ourselves from getting poorly.

But it doesn’t end there.

The beginning of life has always been precarious, with risks and complications. During a pandemic those risks are both extended and magnified and As COVID-19 continues to spread, home births have become a compelling option to many pregnant women who’d previously planned to give birth in a hospital, and in the UK numbers of homebirths, always a minority choice (one in fifty in 2017) are starting to rise.

But it’s an option that presents its own problems. Two midwives are needed to attend a homebirth, pregnant women can contract Covid-19, although it’s believed it’s not likely to be transferred to the unborn child, if anything goes wrong it then demands an immediate response from already overstretched paramedics. The home is not always the best of physical environments, even though they have much to offer emotionally and psychologically, with issues like poor ventilation, possible limits to cleanliness and pets. In general, the NHS still prefers hospital births in a more controlled setting and during the pandemic deters all but the lowest risks.

Certainly, where there are any risks, especially co-morbidities such as asthma, or the need for a c-section, hospital is the only option. It’s not ideal. Maternity wards especially have to be kept as covid-free as possible, so childbirth becomes a lonely experience, with a limited or no presence at all of partners.

One mother described her treatment after a caesarean:

“All the staff I dealt with were kind, lovely and professional. I was taken care of and reassured. I had a reasonably calm experience.”

Another said:

“All the NHS staff we’ve come into contact with during and since the birth were working so hard and trying their best under such difficult circumstances.”

For most the time spent in hospital is as short as possible, rarely more than a night. One new mother who experienced complications stayed a second.

“The second night on the ward was almost eerie – they were so busy yet so understaffed. The midwives and nurses were simply amazing but you could really sense the fear of what was coming and how stressed they were.”

Beyond the labour wards, the Covid-19 surge creates further pressures in district hospitals. A number close, with all births relocated to larger city hospitals, often making the experience more lonely, distant and isolating.

Once back home Covid-19 continues its insidious effect on new mums, adding to the difficulties at what is all too often a very challenging time. For most this is the new normal:

“Since leaving hospital the follow-up midwife appointments have been very different to usual, with them wearing masks and no home visits allowed.”

Even one very vulnerable new mother, who had to isolate once she got back home, described the exceptional situation where she was visited:

“We haven’t been able to have the initial midwife checks in the house and have to weigh Violet in the porch to decrease the risk of catching the virus. The midwives wear protective gear when they come to the house and they have been absolutely amazing. I feel for them immensely.”

It’s easy to be drawn into the covid wards, into the ICUs, but the reality is that the impact of the virus is so much more far reaching for those who have dedicated their lives to the rest of our health and wellbeing.

For the mums, family and friends can’t visit. For some it’s letting everyone know with photos and mini-movies on Facebook and the like. For others, it’s walking round to gran’s and holding their beautiful newcomer to the family up to the window. For some, their partner is home-working, as a backhanded benefit. For others not so. The covid lottery begins.

Some are born into the new reality.

Most of us have to put up with it.

For example:

  • The pandemic provides the English Dictionary with new words: Covid-19, self-isolation and elbow bumping.
  • Theatre performances and shows go increasingly online.
  • Video dating evolves its own etiquette.
  • Hull Aquarium faces closure if it can’t get help. Its daily food bill comes to £6,500 for its marine wildlife.
  • Across Britain funerals are given 20 minute time slots to cope with the spike of Covid-19 deaths.
  • An unprecedented plunge in oil demand starts to turn the industry upside down. Electricity usage in the has also fallen sharply. As a result seismologists have been able to hear the Earth’s natural vibrations more clearly as the everyday hum of human activity has grown quieter.
  • A scaremongering message about overwhelmed ambulance services is spreading on WhatsApp. PHE warn it is fake news
  • While the EU identifies ‘pro-Kremlin sources’ as architects of disinformation. They don’t take sides, per se. They just like putting the boot in when people are down. As if a pandemic isn’t enough.

Finally, a notice  from the NHS, following features about Covid-19:

Stay at home to stop coronavirus spreading – here is what you can and can’t do. If you think you have the virus, don’t go to the GP or hospital, stay indoors and get advice online. Only call NHS 111 if you cannot cope with your symptoms at home; your condition gets worse; or your symptoms do not get better after seven days. In parts of Wales where 111 isn’t available, call NHS Direct on 0845 46 47. In Scotland, anyone with symptoms is advised to self-isolate for seven days. In Northern Ireland, call your GP.”

We all look forward to a future day when it will be nothing more than a historical curiosity.

It could be a long time coming.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s