Day Sixty: Thursday 14th May 2020

Daily Diary: Tail Chasing!

Still in catch up. Writing, writing, writing.

I’ve been waiting for the ruling on general aviation all week. Finally, Nigel picked up on the letter from the Department for Transport and circulated it to the club on WhatsApp. The restrictions on leisure flying, including paragliding have not been lifted. In addition, the tardiness of the Government is that people’s hopes that had been lifted by Boris Johnson are then slammed down again.

Personally, at 68, I’m not going anywhere and certainly won’t go out to fly any time soon. But there are many other, especially younger pilots who are going to feel let down. It’s going to be hard to break the news, but it has to be done.

I’ve opened up Zoom for a brief chat at 8.30 pm with the committee. There’s a full club meeting scheduled tomorrow.

The Bigger Picture: Shockingly Unprepared But Evolving Rapidly.

We were shockingly unprepared.

How could we be so unready? It was common knowledge that there was a biosecurity threat. So many movies have been made about viral plagues they could be a genre in their own right. Health experts have warned about a coronavirus-like outbreak for years. But just like with previous epidemics, their recommendations were ignored, leaving countries around the world woefully underprepared.

The World Health Organisation has been criticised by some for its response to the Covid-19 pandemic, but the problem is deeper than that. Starting with the deep distrust of multinational corporations and their contribution to the widening divide between the rich and poor, which in turn has led to a global uber-class, there has been a lessened enthusiasm for the worldwide, along with a rise in more local and insular populism. In doing so, international organisations, such as the United Nations and World Health Organisation became caught in the fray, Trump on occasion hitting out at both of them, and he’s by no means alone in doing so. 

Nevertheless, there is no alternative to the WHO when it comes to fighting the disease, and any others that may appear in the future.

Another way in which the world was unprepared has been the mechanism by which scientific advances in preventing and treating a rapidly spreading disease such as Covid-19 went from research to medical practice. Traditionally, the process has been intentionally slow, careful and deliberate. But the pandemic moves far too fast for that.

So findings, such as in the case of remdesivir, go from pre-print to practice follow a fast track that brings with it its own set of problems, not least that the media get hold of the story and the public invest their hopes in it before everything is cut and dried. Data is released following preliminary analysis

The rationale’s easy to understand. In a pandemic, who doesn’t want insight into a useful therapy as soon as possible? So on this basis, the data becomes sufficient to allow Emergency Use Authorisation in hospitals, despite this is not the best approach to science or medicine.

Rather than release information in dribs and drabs, study sponsors whether a government, company, or university, should release all the results as soon as possible, especially when it comes to medicines for fighting a pandemic. Data should not be held back.

“If we can’t see the study protocol and a concise research report, you shouldn’t be talking about it in the news,” said Joseph Ross, a professor medicine and public health at Yale University, who studies clinical trial practices. “Instead, we now have a situation where partial data is disclosed and physicians have to use that to make a decision in the moment.”

Indeed. In the absence of full results, we lack further insight into safety or how the drug may work on subsets of patients. And for now, the extent to which remdesivir can prevent deaths – a key metric – is unsettled. Fewer patients died while on the drug than placebo, but the findings were not statistically significant and need further analysis.

But the decision moves from being scientific to being political.

So Dr Fauci, adviser and spokesman for President Trump, insists about the EUA for remdesivir “the conclusion will not change,”

Even so, until the data are released, doctors are left with a mix of facts and assumptions, we run the risk of making a decision based on the wrong info.”

And the combination of less rigour, along with allowing the media to access incomplete evidence about the efficacy and risks of treatments (and in time vaccines) allows for some members of the public to invest their faith and hope in more questionable therapies, such as hydroxychloroquine and ivermectin.

And that lowering of the bar will prove to be a growing problem as the pandemic progresses.

The Office for National Statistics has estimated that 136,000 people in England have been infected with Covid-19. Over thirty three thousand have died in the UK. By comparison, twenty seven thousand have died in France.

The independent SAGE group, twelve scientists and public health experts, warns that the UK will face further lockdowns if it follows the current path, calling the UK government to change its approaches to tackling Covid-19, and releasing a set of recommendations that challenge the current strategy. “We detect ambivalence in the Government’s strategic response, with some advisers promoting the idea of simply “flattening the curve” or ensuring the NHS is not overwhelmed. We find this attitude counter-productive and potentially dangerous,” their report states.

That ambivalence suggests that the Government simply didn’t ‘get it,’ having failed to engage with the crisis until it was fully upon the nation.

Jeremy Hunt, the former health secretary and Chair of the Parliamentary Health and Social Care Committee, said, “I don’t think it’s very important not to finger-point at the individuals, and I think the Government is getting excellent scientific advice. But to ask why it is that SAGE, the Government’s scientific advisory committee, didn’t model the South Korean test, track and trace approach that we are now adopting right at the beginning? The Government was given two very extreme options, the sort of extreme lockdown we are just coming out of, or mitigated herd immunity. And the middle way, the South Korean route, wasn’t modelled.

He also said that Covid-19 tests are taking much too long to be processed.

Sir Keir Starmer, Leader of the Opposition takes PM Johnson to task on care home deaths, using the Government’s own words and track record against it. How covid could be so carelessly sent untested from hospitals to care homes for such a vulnerable sector of society, seeding death after death like falling dominos, is an ignominious blunder, a stain on the Government and a failure of policy.

It’s unpreparedness, failure to mentally walk the walk, not even working through the findings of Exercise Cygnus carried out to test the UK’s readiness for a hypothetical flu pandemic, that leads to such catastrophes costing thousands of lives.

Meanwhile, Dr Nishant and his wife, Dr Meenal Viz are taking legal action to challenge the lawfulness of PPE guidance published by the Government, which they argue exposes healthcare workers to a greater risk of contracting Covid-19. The doctors also argue that the guidance is not in line with international standards set by the WHO or domestic legislation regarding health and safety at work, that it fails to address the greater risks faced by BAME healthcare workers and that the lack of clarity has resulted in inconsistent practices across NHS Trusts.

It’s a muddle. A mess. This time Johnson’s boosterism will not get us out of it.

Unlike the Brexit unicorns on the sunny uplands, people dying is for real.

Britain’s lack of preparedness and political focus on Brexit were the two key factors in the country’s economy shrinking at its fastest pace since the 2008 financial crash. The UK suffers a bigger economic hit than any other G7 economy. Chancellor Rishi Sunak admitted it was “very likely” the UK is in a “significant recession” as new figures showed. GDP fell by 2 per cent in the first three months of 2020. With just one week of lockdown in those stats the next quarter will be much worse.

There are losers, including struggling markets, such as airlines and oil and gas companies, that are sucking king’s ransoms from governments to keep them alive. 

Spectator sports wonder if they too will be among the losers. Can they survive the pandemic without spectators? Making professional games safe may be feasible.

Making them pay will be harder.

There are winners too. The biggest players are e-commerce – including Amazon, Alibaba and Walmart – have all experienced growth, thanks to the rise in online shopping.

Then there’s the economy that envelops our everyday lives.

  • English councils fear they will have to make budget cuts of 20 per cent and face a social care funding shortfall of £3.5 billion due to the pandemic.
  • House prices could take a year to recover from a Covid-19 slump, warn surveyors. As they call for stamp duty cut for downsizers.
  • A link between poverty and Covid-19 deaths in Scotland laid bare in shock new figures.

And the impact Covid-19 has had on the wider global economy. Economies are deeply intertwined, and the largest economies reach deeply into those of other countries.  So that when Australia has said that it will continue to push for an inquiry into the origins of Covid-19, even if it hurts trade relations, China responds by suspending beef imports from abattoirs and planning to impose tariffs on Australian barley, after warning that the inquiry could harm two-way trade ties.

The meat trade is more directly affected by the virus too. Meat processing plants have become hot spots and with a high incidence of affected workers, several meat processing plants have had to close, leading to a surge in American meat prices. Working conditions for migrants in German slaughterhouses are in the spotlight after more than 200 workers tested positive for Covid-19 at a factory near Caesfield, in the west of the country. Covid-19 outbreaks have also been identified in at least two other meat processing plants in Germany. The majority of people infected were from Romania and Bulgaria.

Warehouses have also become local epicentres for the outbreak. In a number of US states, officials demand that Amazon tell them how many warehouse workers have died from Covid-19. While in Britain the GMB union has called for the closure and deep cleaning of  fashion retailer ASOS’s warehouse at Little Houghton, near Barnsley, after reports emerged that workers have tested positive for Covid-19.

While billionaire and Tesla founder, Elon Musk, wins a legal battle with the State of California to reopen his car plant.

Early signs that business and manufacturing will weather the storm.

Even though it doesn’t feel like it at the moment.

Although we entered the pandemic poorly prepared, it has brought biomedical research front of stage.

The genomes of thousands of patients with coronavirus will be sequenced to understand how a person’s genetic make-up could influence susceptibility to the virus. The study will sequence the whole genomes – the genetic code – of up to 20,000 people who were previously in intensive care or who are currently in intensive care at 170 NHS units across the UK. Patients will have their results compared with 15,000 people who have suffered only mild or moderate symptoms. Experts hope to explain why some patients with Covid-19 experience mild infection, but others require intensive care or go on to die.

Meanwhile the consumer genomics companies 23andMe and Ancestry, each with tens of thousands of customers who have already been tested positive for Covid-19 have also joined the search for the relationship between our DNA and disease susceptibility.

The novel coronavirus known for infiltrating the body through the respiratory tract. However, researchers in Hong Kong are now warning that infection via the eyes is also a big risk, because the strain is stronger than previous coronaviruses. But they insist hand hygiene is still more important than wearing face protection.

Doctors in Bergamo, Italy have reported the first clear evidence of a link between Covid-19 and Kawasaki disease, a rare but serious inflammatory disorder that has required some children to undergo life-saving treatment in intensive care units. NHS bosses issued an alert to doctors after hospitals admitted between 75 and 100 children with a mixture of toxic shock and Kawasaki symptoms, typically including a fever, skin rashes, red eyes, cracked lips and abdominal pain. On Tuesday, medics at the Evelina London Children’s Hospital announced the death of a 14-year-old boy, the first known fatality from the condition in Britain. Doctors suspected early on that coronavirus played a role in the new disorder by triggering an excessive immune reaction in the children, but there was no proof that the two were linked.

The virus has changed, possibly irreversibly, how the process of medicine works. With a highly contagious airborne pathogen on the loose and the absence of a vaccine or especially efficacious medication keeping distance is the only option, one that has been around since Babylon had its first public health problem some time lost in antiquity.

That combines with the ultra-new. We can pick up what the good citizens of ancient Babylon would see as a work of magic, or maybe divine intervention, to see and even talk with each other. We can cheat isolation and being separated.

The massive decline in in-person doctor-patient consultations has been replaced in a rapid growth in telemedicine. In the US, Doctor on Demand becomes the first major telemedicine company to expand its services to Medicare Part B beneficiaries. My wife and I find ourselves, unable to get in touch with our long-standing family doctor, resorting ironically to our Babylon app.

And much as I would still like to meet up with our family doctor, who over decades has become an old friend who knows our personal journeys, at least in terms of our health, I have to accept that telemedicine has opened up new possibilities.

One has been with many vulnerable patients with opioid addiction. Coming to the clinic during a pandemic could well be more dangerous than staying home alone. In the US, Lev Facher reports in STAT that many doctors have taken advantage of new regulations that allow them to prescribe buprenorphine without evaluating patients in person, instead conducting visits by video chat or even by phone, and in some instances, it’s led to unexpected breakthroughs.

One doctor from Tennessee said that telehealth visits have allowed him to gain insight into his patients’ living situations, which has often led to critical discoveries about their life circumstances that he would otherwise have missed.

“I found three patients in the past two weeks that I didn’t know were homeless or living in a car. So we’ve been able to hook them up with some housing services that we have access to.”

Other doctors have argued the new allowances for telehealth and medication delivery could result in a sweeping expansion of treatment services in rural areas, where finding qualified doctors to conduct in-person visits is often difficult.

The Babylon Box can do more, as Erin Brodwin explains in STAT online magazine.

Tech companies, health providers, and patients alike were increasingly looking to remote devices like miniature electrocardiograms and blood pressure cuffs connected to the internet that let clinicians keep tabs on care from afar. Now, with virtual care emerging as a safer alternative to in-person care, remote heart monitoring tools may be having a breakout moment.

The devices could prove useful during the pandemic for a range of reasons, from their ability to catch undiagnosed heart abnormalities in patients missing routine medical appointments, to their usefulness in gauging Covid-19 patients’ responses to experimental medications that impact the heart.

Wearables like the kind made by Apple and Fitbit are already being tested as early warning systems to detect Covid-19 using data from the heart as well as insights on sleep and activity levels, all of which have been previously found to be helpful in predicting clusters of the flu.

There remains a question over whether the change in thinking around remote heart monitoring will stick after the pandemic subsides.

If virtual care — including remote heart monitoring — can give patients and clinicians a clearer picture of heart health in real time, experts project their use could become far more widespread in the coming months and years.

During which virtually all the heart-monitoring technology may well be Zio patches, Apple Watches, or Bluetooth phones for example.

Having said that, checks for cancer such as mammograms, lung x-rays, colonoscopies and smear tests still require in person visits and fears of Covid-19 have led to appointments dropping markedly. In the NHS the backlog was already worrying before the pandemic. It is set to get much worse.

Britain, amongst other countries, has been unprepared is in testing for the virus. The country hasn’t been clear, or honest, about what testing involves. We knew that test and trace had been effective in managing STDs, not least of all HIV/AIDS and some tropical diseases, such as Ebola,  brought in from the developing world by aid workers, with a limited number of contacts. That seems to have shaped public health thinking. Highly infectious airborne viruses, such as colds and flu were not considered sufficiently virulent.

The virus moves quickly, especially in an era of air transport, Britain’s borders were wide open, and by the time news reports were coming in about Covid-19 it was all too late – Covid-19 had arrived and established itself.

The spread of the virus might be tamed if people were to be tested in large volumes. But there simply isn’t the human or material capacity to test on such a huge scale. So the virus tears through the population, and getting a grip on the situation means setting priorities.

At this stage of the pandemic there are three: healthcare personnel and first responders, randomised testing of representative samples of the population to understand the overall pandemic dynamic, and high risk groups.

For a long time to come testing will be cumbersome, with PCR tests taking up to several days to produce results, and as has happened already the horse has bolted before the stable door is shut. Apps will prove inconsistent in tracing the virus and protecting individuals. Only when home-use lateral flow tests become widely available, with rapid results in less than half an hour, even if they are have a sensitivity of 80 per cent (see yesterday’s post about how the tests work), will testing have a widespread effectiveness.

If there is one aspect of dealing with the pandemic that Britain has been slow to adapt it has been the wearing of face masks. Despite the practice being commonplace in countries that had been hit by previous viral epidemics, such as South Korea, neither the Government nor public health leaders seem to have registered their significance. Throughout April the share of Americans wearing face masks increased dramatically, rising from 17 per cent in early April to 69 per cent by the third, although there is a considerable difference in usage rates geographically. By contrast, the UK languished at 26 per cent, despite the public’s very positive response to other measures, such as distancing, hand washing, avoiding public transport (which Brits have excelled at – working from home might have been a factor) and sanitiser.

Wearing a mask has been absent from the all too familiar Number Ten briefings, which focused on those other measures.

The Government’s advisers were themselves divided over the importance of masks, and there was a tacit messaging from Johnson’s libertarian government that somehow masks were an infringement of people’s liberties. Even leading politicians were heard to describe masks as muzzles and face nappies. Misinformation abounded, like wearing a mask for long hours to reduce the spread of Covid-19 will put you at risk of carbon dioxide poisoning.

It was nonsense. Hospital staff have long worn masks without such consequences. They mightn’t be especially comfortable, they do tend to mist up glasses, but that’s as far as it goes.

The precautionary principle, which I’ve personally adopted since before the lockdown when it comes to mask-wearing, in the same way as I look at my helmet, reserve parachute and pre-flight checks when paragliding, simply hasn’t been part of the playbook. For Boris Johnson it has always been the bold versus the timid, and masks are no exception.

But for the mask-wearing minority, people began to engage positively with the challenge. Some, like my sister started to make her own masks and went on to selling them to raise funds for her local hospice. She’s part of a growing mask-sewing army, lessening the acute shortage of masks by hospitals and setting a trend of mask individuality.

But masks never stop being a divisive issue.

Or as straightforward one, particularly where it overlaps with other divisive issues such as racism. Gabriel Felix, a black doctor, wrote in the medical online magazine STAT:

“With the emergence of Covid-19, I’ve spent time weighing the pros and cons of wearing a face mask on evening walks to pick up takeout food or to go to the grocery store. I often opted not to wear one so I wouldn’t be perceived as appearing “suspicious.” My decision-making went as far as limiting how often I went out after dark, knowing that some people will see a masked Black man as a threat.

Then I received a text alert from my city one morning telling me that using a face mask is now mandatory in public and that people who don’t comply with the order could face a $300 fine.

As a physician, I favour things that will help reduce the transmission of coronavirus infections. But as a Black man, I wondered how this order will affect people who look like me. I wondered if this order went into effect with any understanding of the fear and anxiety it could inflict on people of colour.”

In Flint, Michigan, a security guard at a Family Dollar store was fatally shot on a Friday afternoon after an altercation that had occurred over another customer refusing to wear a face covering, which is required in Michigan in any enclosed public space.

If covid teaches us anything, it’s nothing in life is ever that simple.

Even when there are a lot of folk telling you it is.

I’m not sure now whether this is a late message on my email feed from my local Nextdoor user group, or whether I was behind on catching up because of my birthday, but here it is:

“Police Notice: Coronavirus outbreak FAQs – what you can and can’t do. Thanks to your sacrifices, social distancing is working. But if we stop now, we risk increasing the spread of the coronavirus. The Government has now published ‘staying safe outside your home’ for guidance on what the new rules will mean. These will take place on Wednesday 13 May 2020.”

However, police in England revealed they have no powers to enforce two metre social distancing. New guidelines issued by the College of Policy and the National Police Chiefs’ Council urges officers to only enforce what is written in law. It is prudent. The loss of policing by consent in the longer term is a much bigger issue than managing the public during a pandemic.

Also in this new reality we find ourselves in:

Building sites are to stay open longer to ‘help workers follow social distancing.’ Sites in residential areas can remain operating until 9 pm and those in non-residential places can work later.

New cycle paths are being created to encourage people to hop onto their bikes rather than into their cars. Leaders and urban planners say it’s a unique opportunity to advance green policy goals while encouraging social distancing.

The Foreign Office has issued a warning for Brits with holidays booked for Spain. Following further border restrictions, only Spanish citizens, those who are legally resident in Spain, frontier workers or those who can prove they need to enter Spain for essential reasons will be allowed to enter the country. Only green residency certificates will be accepted as proof of residency in Spain and British travellers who are not resident and/or not in possession of this certificate should not attempt to enter the country. Padron certificates, utility bills and property deeds will not be accepted by Spanish authorities as proof of residency. British travellers who are not resident in Spain or do not have a residency certificate with them should not travel to Gibraltar and then attempt to enter Spain via the land frontier. From May 15, all new international arrivals entering Spain, including Spanish nationals and residents, will be required to self-isolate in their residence or hotel for a period of 14 days.

Holiday firms are accused of ‘bullying’ customers into paying balances. Customers have been told they must pay the remaining amount for their trips or lose their deposit.

Green and red zones: As summer approaches, governments fear the increased number of people will spark a fresh wave of infections. One study from Spain has an innovative solution. It suggests dividing Europe into red and green zones, according to the impact of Covid-19. Under the scheme, Europeans would be able to travel freely to and from proposed green zones, such as Norway, southern France and Scotland. Red zones, such as northern Spain, London and Sweden would be off-limits.

The EU is trying to salvage summer with social distancing rules for hotels.

But for some, like 39 year old Emiliane, who is spending lockdown in temporary accommodation in an inadequately converted office block Harlow, Middlesex, any idea of a holiday is a million miles away.

“I’m spending lockdown in a former office block with my two kids and I’m scared. I’ve felt scared living in this building,” she says.

Lockdown for many is horrible.

There has to be a way out.

And it has to be managed well.

Professor Mauro Guillén of the Wharton School of the University of Pennsylvania has advised a staggered reopening of businesses with periodic checks before proceeding. He has suggested an “incremental reopening,” with proper planning for transportation of people from home to work, and back to home. Alongside, there would have to be protocols in place for contact tracing if a worker falls ill, he said. In reopening schools, he has recommended that children be taken to school in groups of 20 per cent and step that up gradually while ensuring that the requisite testing and contact tracing capabilities are in place.

Well managed, lifting lockdown is achievable but in England the loosening of the rules remain confusing.

This problem is not unique to England. Protests have broken out in Madrid after the Spanish government eased the lockdown everywhere except for the capital and Barcelona. France is also leaving the lockdown, but the process is hampered by adversarial labour relations and distrust of government.

But elsewhere lifting lockdown goes more smoothly. Belgians resume social life. People in Belgium have been able to gather in small groups again after the government eased the country’s lockdown. Latvia, Lithuania and Estonia open borders to each other to form a ‘Baltic Bubble.’

One restaurant in Sweden is taking the new way of life as an opportunity to launch a truly unique dining experience. Bord For En, in the small town of Ronseter, lays out a single table a single chair and cooks up a three course meal for a single guest, once a day …. In the middle of a field.

In England, garden centres reopen. “Gardening helps me to deal with things,” one pleased customer declares.

Lifting the lockdown changes behaviour rapidly. Data published by location technology from TomTom shows that the level of road congestion in London at 8 am on Thursday was 19 per cent, up from 16 per cent a week earlier. Transport for London said there were 10 per cent more Tube journeys made between 5 am and 6 am on Thursday than the same period last week.

Well managed or not, clear or confusing, lockdowns in Britain and Europe are coming to an end and most are relieved.

In the US there is talk of lifting restrictions too and a growing desire to return to normality, even though polls indicate that a majority of Americans say that gatherings are unsafe, at least until July. Last week, the share of Americans staying home fell to 36 per cent, down from 44 per cent a few weeks ago.

In New York, the news about Covid-19 has improved over the past week. There have been fewer than 200 deaths in New York for two consecutive days, down from around 1,000 in early April. Nationwide, the number of confirmed new cases each day has finally begun to decline substantially.

As some governors consider easing social distancing restrictions, new estimates by researchers at Harvard University suggest that the United States cannot safely reopen unless it conducts more than three times the number of Covid-19 tests it is currently administering over the next month.

There is a growing gap between politicians and scientists and the medical profession. The main White House model now projects 147,000 people will die in the US by August 4th due to the easing of social distancing measures.

Dr Fauci testified to Congress that the country does not have the Covid-19 outbreak completely under control and the national death toll is “likely higher” than 80,000 as states begin to reopen.

A view which received sharp criticism from President Trump.

Wisconsin Governor, Tony Evers, a Democrat, had extended the prohibition on most travel and operation of non-essential businesses until May 26. But in a 4 to 3 ruling, the conservative-leaning court said that the measure had exceeded the top health official’s authority under state law.

Also in the US:

  • A new analysis says 80 per cent of people who have recently lost their jobs are likely eligible for healthcare coverage under Medicaid and Obamacare.
  • California State University, the nation’s largest four year public university system, cancelled in-person classes for the fall.
  • Paul Manafort, the former Trump campaign chairman, was released from prison to home confinement over fears of the spread of the coronavirus.

Most prisoners, without the connections in high places, were not so lucky.

Elsewhere in the world:

  • Pandemic fails to damp armed conflicts, despite truce calls.
  • The virus came late to Latin America, but death rates there are comparable to those in Europe.
  • A strong typhoon roared towards the Philippines as authorities work to evacuate tens of thousands of people, while avoiding overcrowding emergency shelters that could spread Covid-19. Governors say social distancing will be nearly impossible for residents staying at emergency shelters. Some shelters are now functioning as quarantine facilities, and they will have to be turned back to emergency storm shelters.
  • Taiwan responded quickly to the outbreak and appears to have limited its spread. Its government leveraged technology to trace and quarantine sick people, upped its mask production, and trained communities for lockdowns through large-scale simulations. At this stage it promises to come out of the pandemic stronger than ever, but there is still a long way to go.

While the unusual feature of today’s international news is a particular focus on so often much ignored and neglected Africa:

Lesotho: This tiny kingdom of has confirmed its first case of the coronavirus. Entirely surrounded by South Africa, which has more than 11,000 confirmed cases, Lesotho had been the only country in Africa without any reported infection. But this week dozens of people who arrived from Saudi Arabia via South Africa were tested and one case was found.

Uganda: A member of parliament was detained and tortured for ten days as the government and aligned paramilitary groups persecuted opponents in the name of halting the virus.

Liberia: Broadcaster Spoon FM closed its newsroom after its general manager was one of several journalists stopped by the police. Press pass issues were preventing journalists from informing communities on protection against the virus, she said, while a minister warned journalists that they would be ‘embarrassed’ at security checkpoints for not complying with the virus.

Cameroon: As battles with separatists continued, the government has banned humanitarian flights as part of its efforts to curb the spread of the virus.

Madagascar: Several African countries received shipments from Madagascar of a plant based ‘cure’ for Covid-19 promoted by president Andry Rejoelina, despite warnings from the WHO that its efficacy is unproven.

Tanzania: President John Magafuli denounced Covid-19 statistics from health officials as fake and “imperialist sabotage,” stopping release of further results, suspending the director of the national health laboratory and instituting an investigation. Tanzania also gets Madagascar’s anti-Covid-19 drink disputed by WHO.

Ethiopia: The government has been accused of using a state of emergency to crack down on freedom of speech.

Western Sahara: The wife of a Saharawi activist has called on occupying Morocco to free political prisoners from the country’s liberation movement as Covid-19 spreads through the nation’s jails.

Finally, another uplifting story.

Margaret Payne, a 90 year old woman raising money for health and emergency services by climbing the height of Suilvan, a Scottish mountain, on her stairs has said she is “looking forward to a good rest at the summit.”

Suilven is 2,398 ft (730m) high, and Margaret’s challenge means she’ll need to take 282 trips up her staircase in total.

Margaret is expected to take around two months to complete the challenge, which she says was inspired by the charity garden walks by 99-year-old veteran Captain Tom Moore, who has raised more than £18m for the NHS.

I’m hoping that such feats will mark what history will record as The First Lockdown. They tell a story of a moment in time, that like clapping for carers, will pass, but should never be forgotten.


Al Jazeera, Associated Press, BBC News, Care2, Crowd Justice, Daily Record, Economist, Euronews, Evening Standard, Financial Times, Forbes, France24, Guardian, Huffington Post, Independent, iNews, ITV News, Liverpool Echo, New Statesman, New York Times, Nextdoor, Open Democracy, Quartz, Royal Society, STAT, This Is Money, Wharton Business School University of Pennsylvania,

Day Fifty Nine: Wednesday 13th May 2020

Daily Diary: Over The Garden Wall – A Tale of Socially Distanced Celebration.

I’m really behind myself. I blame my birthday. Once you’ve had a drink or two it’s pretty hard to write anything. And best not to try.
It would have been churlish to grind my way through more of this diary than celebrate. So this was the proposition: Emily would visit with presents at around five. She would bring a collapsible chair and sit in Midge’s front garden (Midge having departed to her daughter’s in Rainham at the start of the pandemic), and Vicky and I would sit in ours and we’d have a wee family get-together, socially distancing over the garden wall. Since the new rules were you could meet up with one family member at a social distance and since Tom goes in and out of London two or three times a week we have a beer on WhatsApp while Emily heads over. That way it’s all pretty kosher. Tom, Vicky and I have a great glass-raising, beer drinking and whisky swigging chat, which goes on for an hour until Emily turns up.
The front wall is covered with party paper and cake and prosecco grace it, but not before the front of our house is decorated with balloons, ‘Happy Birthday’ messages and bunting. We celebrate and chat, Emily wears a face covering and rubber gloves.
Meanwhile, passers-by come along the street. Every time someone comes, Vicky, who’s entered the hail fellow, well met spirit of the occasion, calls out:
“He’s sixty eight, you know!”
Which obliges them to say, “Happy Birthday!”
One guy tells me that I didn’t look a year older than twenty,
“That’s a really hard-lived twenty,” I reply.
He doesn’t disagree.
Then a white van pulls up and a man in his thirties climbs out.
“He’s sixty eight, you know!” Vicky calls to him.
The guy’s very affable and wishes me a happy birthday. We talk a little over the front garden wall (socially distanced, of course), and in a moment of generosity Vicky offers him a glass of bubbly.
I see Emily look on in horror, and say, “Nooooo!”
Turns out the guy’s a plumber on call.
So we chat on a bit. The plumber’s called Danny and he’s a local lad. It’s awkward. Got to stay friendly and cheerful, but there’s an undercurrent of risk.
More of the general public pass and greet with varying degrees of enthusiasm. A distressed young woman passes by, intoxicated by drugs or alcohol and in a bad way.
She doesn’t get the “He’s sixty eight, you know” treatment. That would have been inappropriate.
At the end everything goes into a bucket of bleach. It was nice for Danny the plumber to drop by. But it wasn’t smart.
That night Vicky was anxious about the consequences, and I must admit I wondered if we had had that moment of weakness that could have opened up the gates of Hell, destroying what has been up to date a very careful existence.
I hope not.
Postscript: Little did any of us at the time realise that while we were consumed by angst and guilt about every slip up, the staff at the Prime Minister’s residence and heart of government were casually having regular alcohol-swigging get-togethers. But that’s another story to be told over a year and a half from now.

The Bigger Picture: Britain In A Bad Way

Covid Britain on the 13 May 2020 is a strange, disjointed land. A government driven by a whimsical cause to repatriate powers it had never lost and take back control of its borders, perversely has chosen to leave those borders wide open and its population unprotected from lethal infection.

Brexit continues to be a painful and messy divorce on an international stage, and like all too many divorces in their early stages involves bitterness, spiteful redress and irrationality. Point making and point scoring, which includes an apparently doctrinaire refusal to participate in EU programmes to procure ventilators, tests and PPE.

And that mother of Brexit – years of malignant austerity – contributed to the country entering the pandemic with vital protective public health systems downsized and dysfunctional. Urgent warnings from Exercise Cygnus in 2016 were suppressed and ignored while work by the Pandemic Flu Readiness Board and the Pandemic Influenza Preparedness Programme Board, including scheduling a pandemic influenza exercise in 2019-20, were paused or postponed to free up resources for EU exit work.

“We’re following the science,” is the government’s mantra, but in reality science policy advice on national biosecurity is manipulated by spin doctors. The old and vulnerable have been left to die unseen, untreated and alone, while health and care professionals have been sent with inadequate protection into harm’s way, for many at the cost of their own lives.

On this day, May 13 2020 the growing British pandemic death toll, much of it avoidable, is already the highest in Europe and outnumbers deaths in the WWII Blitz.

Britain is a country in a bad way.

The ONS, Office of National Statistics, reports a contraction of two per cent in the UK economy in the first quarter of 2020, after plunging 5.8 per cent in March as the coronavirus crisis took hold. The Resolution Foundation think tank warned that the first quarter drop was an ominous sign of things to come, while retailers warn of shop closures and job losses because of lockdown.

The Treasury is faced with £337 billion budget deficit. Furlough has been extended until October, which bodes ill for getting the nation back to work. Employers are to contribute to workers’ salaries from August, prompting fears of ‘mass redundancies.’ Speaking for the Government, Transport Secretary Grant Shapps said the furlough scheme is very generous and employers should not be claiming government money while making them work. In time it will transpire that over four billion pounds of fraudulent claims will be simply written off.

Holiday giant TUI said it will slash up to 8,000 jobs to trim costs in the light of the coronavirus crisis hit to the travel sector. The world’s largest package holiday operator wants to cut costs by one third and also to put more focus on regional breaks as opposed to jaunts abroad. The job cuts would represent 15 per cent of the workforce. The company is eyeing a return to tourism.

It’s a worldwide problem. The CEO of Boeing predicted that less airline travel due to the pandemic likely means a major airline will go out of business this year.

Brits in particular do a lot of flying from their wet and windy homeland to sunnier climes.

So the solution from government is as nearly purely political as you can make…..

Let’s lift the lockdown.

The first stages of easing restrictions, from ‘Stay at Home’ to ‘Stay Alert’ have been confusing to many.

Tory veteran MP Peter Bone blames Number 10 advisers for the PM’s communications errors. “Many of them have clearly been watching too many episodes of West Wing,” he says in a way that reminds me of the comedy dialogue routine by John Bird and John Fortune.

While Manchester and Liverpool metro mayors, Andy Burnham and Steve Rotheram wrote to the PM to say it is ‘too early’ to change the Stay Home lockdown slogan, and demanded regional publication of their own R-number for the virus.

But a message from a local resident on Nextdoor tells me that among libertarians frustration with lockdown is already bubbling up.

“I hope this isn’t serious,” the message says. “I received this and I’m not sure if this is true but let’s try to get through the next couple of weeks without protesting in Hyde Park.”

“UK Mass Gathering, Hyde Park: Saturday 16th May at 12:00 pm. Join the Freedom Movement and be part of the largest mass gathering since the lockdown. We say No to mandatory vaccines, No to the new normal and No to the unlawful lockdown.


It’s the height of lockdown and such a mass gathering is clearly an act of defiance. Of civil disobedience by those who share Johnson’s libertarian take on society.

So he needs to throw a morsel of red meat to fellow libertarian travellers.

Let’s lift lockdown!

There’s a lot of enthusiasm for lockdown easing and millions being set to return to work and spend more time outside from leader of the Commons, Jacob Rees Mogg, as he announces that MPs are to be ordered back to Parliament to ‘set an example,’ even though the prime minister is more measured, saying he was not expecting a ‘flood’ of people going back to work this week.

Transport secretary Grant Shapps publishes new guidance urging the public to travel by foot, bicycle or car in order to avoid public transport, while those who have no choice but to take the bus, train or tube are told they should wear masks on public transport and avoid peak times.

While health secretary Matt Hancock tells ITV’s ‘This Morning’ that it’s unlikely that big, lavish, international holidays are going to be possible for this summer.

It’s looking like British destinations are on the rise, and with the change in lockdown rules and a good weather forecast English tourist spots are on alert for what some describe as ‘weekend mayhem.’

Housing secretary Robert Jenrick unveiled new plans to restart the housing market with safer, ‘socially distanced property viewings, while big property developer Taylor Wimpey is to start reopening show homes and sales centres from next Friday.

Eating out makes its first baby steps back to a kind of normality. McDonald’s announces phase two of plan to reopen its restaurants, but when we are able to travel again and hotels open up to the public, breakfast buffets will not be coming back.

Reopening is still in question for schools, as the headteachers’ union NAHT warned that it may be ‘impossible’ for schools in England to start admitting more pupils from June 1, amid safety fears.

These are the first steps to manage human contact and social distancing. For the next, the UK is currently muddling over the idea of implanting “social bubbles” – a restricted form of face to face contact – while waiting for a vaccine to be developed. The general principle of a social bubble is that you can have contact with people outside of your household, but keep the number tightly restricted.

It is a human analogy of a top predator swimming over a coral reef. Down the food chain the lesser critters make themselves scarce, vanishing into every nook and crevice available. As the danger passes the critters re-emerge, bravest first, cautious last.

The coming out of crevices is happening all over Europe:

  • It’s a dilemma that restaurateurs have been scratching their heads about: how to reopen to diners and stay safe amid the Covid-19 pandemic. One venue in Amsterdam thinks it might have found a solution. Mediamatic Biotoop, an art centre in the Dutch city, is putting outdoor diners into tiny greenhouses in a bid to adhere to social distancing guidelines.
  • Most shops in Greece are allowed to reopen, but some owners are worried about what comes next. They fear that if infections rise again in the coming weeks and restrictions are reinstated, their businesses will never recover. While Greece has so far managed to weather the health crisis comparatively well, it’s expected to be one of the countries that suffers the most for economic fallout.
  • Commuters in Paris are subject to strict rules and regulations stretching beyond carrying a work certificate as they board public transport.
  • The Faroe Islands kick off the season, as football restarts in Europe.
  • Europe’s biggest budget airline will resume 1,000 flights a day from 1 July and restore 90 per cent of its pre-pandemic route network. Before the Covid-19 crisis, Ryanair was operating 2,400 flights a day. It will restart flying from most of its 80 bases across the continent. All passengers will be forced to wear face masks and yes, put their hand up if they want to use the toilet.
  • Putin is criticised for ending ‘non-work period’ amid record Covid-19 figures.

All the while, continuing to work the metaphor, there are fears of the return of the reef predator.

In this case a second wave. It’s well documented in studies of previous pandemics, a second wave is likely to occur this time as well, especially in the absence of a vaccine. Countries are starting to ease lockdown measures and citizens are gradually returning to return to some semblance of normality. Experts warn lower infection rates combined with higher temperatures could lead to complacency among people regarding social distancing and hygiene rules.

The niche of Covid-19 lies in the mechanisms of human behaviour and we’d all be well-advised to be mindful of that.

Especially as lockdown is lifted.

But the kid in us still remains, and we’re wired to resent being told what to do. Lockdown means precisely that. A London park boss warns that park rangers and security will “step in” if people breach social distancing rules as lockdown restrictions are eased in the UK. Visitors will be watched closely, with many expected to flock to parks and recreational areas following the Government’s relaxation of the “stay local” message, many people can drive to outdoor open areas.

It’s not the only conflict. Yesterday was International Nurses’ Day, a time to reflect on how important these healthcare providers are to maintaining healthcare and looking after Covid-19 patients.

For now, we clap and bang pots as gestures of appreciation. But as the weeks pass it begins to feel like tokenism, and already it’s beginning to wane. Coming from a military background I’m aware that ritual and symbolism eventually become substitutes for genuine empathy.

The reality is that nurses on the Covid-19 frontline need more mental health support. Health workers are becoming unexpected targets during Covid-19 and the toll on them may last long after the pandemic has abated.

And there are other signs of the new lockdown reality that call for recording:

Work: Twitter say they will allow employees to work at home ‘forever’ after the virus crisis.

Entertainment: Some Cinemas plan to have socially distanced film screenings. The drive in cinema makes a comeback.

Travel: The car is making a comeback, spurring oil’s recovery. Cars are becoming the de-facto means of transit post-lockdown, with roadtrips replacing plane and train travel for summer holidays.

DIY hairdressing: Buzzcuts are in and perms are out, according to Google searches.

A troublingly intimate impact: A third of girls in the UK are struggling to access period products in lockdown. The issue of period poverty has been exacerbated by Covid-19, a charity has warned, as many young women and girls have less access to free products.

Young activism: Eighteen year old Sophia Kianni, still at high school in Virginia, USA, has started a nonprofit called Climate Cardinals to translate climate and environmental information into different languages. She’s still working to get a website up and running as of this writing, but has already received international attention and has more than 100 volunteers participating in the effort.

Aged activism: 100 year old man raises £130,000 to fight Covid-19 during Ramadan with laps of his garden.

While in America Dr Anthony Fauci told a Senate Committee hearing on Tuesday that the US does not have the Covid-19 outbreak “completely under control,” and that the national death toll is “likely higher” than 80,000 as states begin to reopen, sparking concerns about a resurgence of the virus over the coming months.

The US must shore up key capabilities to safely reopen or ‘run the risk of having a resurgence,’ four senior health advisers to the Trump administration testified.

Because it was a virtual hearing it had an almost surreal quality to it (I always feel the same about Zoom). Other things that emerged were:

  • Even expert senators are overly optimistic about vaccine development.
  • Fauci is more willing to back Trump than other administration officials.
  • If the death toll is wrong, the claim is it’s because deaths are undercounted.
  • Top officials still can’t say how the government will distribute remdesivir.
  • Congress is worried about healthcare beyond just Covid-19 cases.
  • Even the Senate isn’t ready to reopen.

Susan Collins, a Republican senator from Maine, is worried about your dentist. And for good reason: During Tuesday’s hearing, she amplified the concerns of dental health providers across the country, who have fretted that Americans missing appointments for the sake of social distancing could cause a secondary crisis. Cavities that go unfilled could result in the need for root canals, and root canals that go untreated could result in the need for teeth to be extracted altogether. It’s a reminder that Covid-19 has upended health care in ways that have nothing to do with the disease itself. And this extends to many areas of medicine.

Elsewhere in US news Hollywood star Robert de Niro has reopened his feud with Donald Trump, claiming the US president “doesn’t care about how many people die from Covid-19,” while following on from Trump’s bizarre comments on air accidental poisonings from bleach and disinfectants continued to rise in April.

Among First Nation Americans there is a different attitude. Almost an acceptance, especially among elders. “They have been through so much and experienced so much that there’s no need to fear or even panic,” says Tiokasin Ghosthouse, the Stoneridge New York-based host of First Voices Radio and a member of the Cheyenne River Lakota Nation from South Dakota. “It’s almost like this (pandemic) is familiar.” As such, indigenous communities aren’t dwelling on the pandemic’s backstory. “Indigenous peoples don’t always need to go and explain what happened,” says the Reverend David Wilson, a Methodist minister in Oklahoma City and member of the Choctaw Nation. “We just know it’s there.” “We’re taught not to think of Nature as separate,” explains Ghosthouse, and that includes Covid-19. “The coronavirus is a being,” he says. “And we have to respect that being in an “awe state” and “wonder state” because it’s come to us as a medicine to “treat spiritual ills.”

Elsewhere in the world:

  • It was Africa, where a great deal of attention and money would be focused. There were fears that much of the continent would be overwhelmed, with many countries beset by weak healthcare systems, corrupt governments, war on megacities where social distancing would be impossible. The Financial Times reported that in early April that Sierra Leone had just one ventilator for its 7.5 million people. In the Central African Republic there were just three machines and Burkina Faso had eleven. The situation and predictions were dire.
  • Authorities in Wuhan, China, where the Covid-19 virus was first spotted, plan to test all 11 million residents after new cases crop up.
  • As Covid-19 cases in Yemen surge, some sources see undercounting.
  • Russia is now second in the world for total Covid-19 cases.
  • Refugees are being forgotten in the fight against Covid-19. Thousands of refugees remain trapped in dangerous conditions on Greek islands.
  • Care home deaths: The Irish government is coming under mounting pressure over the number of deaths in care homes. Residential and community care facilities, including nursing homes, now account for more than 62 per cent of covid related deaths in the country, according to figures released by the Department of Health. One nurse told Euronews that more than half of the care staff in the nursing home where she works are off sick.
  • As the coronavirus R-value rises above one in Germany, one in five companies has laid off workers as a result of the Covid-19 recession, as the economic consequences of the disease make themselves felt, even in Europe’s largest economy.

These are the pandemic’s darkest days in the west. The British government’s chief science adviser, Patrick Vallance has said there was no guarantee of a vaccine for Covid-19 but added he would be “surprised if we didn’t end up with something like a drug treatment or a vaccine.” There are few drug treatments specific to Covid-19, and certainly no ‘miracle cure’ as yet. There’s still too little data about the hottest drug on the block, leaving doctors struggling to decide which Covid-19 patients should get remdesivir.

The Biotech company, Moderna announced today that it is fast-tracking its Covid-19 vaccine candidate, but to get beyond Covid-19 all citizens should be vaccinated against it.

That’s going to be quite a challenge. Large numbers are not just anti-vax, but equally likely complacent. The current figure for Americans, for example, who have foregone getting vaccinated against influenza stands at 43 per cent.

All that we have to keep Covid-19 at bay is socially distancing supported by testing, and the testing industry is racking up its production on a scale hitherto never seen before.

If we can ‘see’ the coronavirus before it spreads we might be in with a chance.

Production is still at a level too modest for the scale of the problem. Abbott labs, for example, says it will have produced 60 million antibody tests by June.

So how do these tests work?

If the rest of today’s record gets a bit textbookish, I’ll fully understand if you skip it and call off today’s ‘Bigger Picture’ bit here.

So here goes…..

  • A Covid-19 test can give a positive result, meaning you have been infected, or a negative result.
  • The result of a Covid-19 test may be right or wrong, so you can get true and false positive results, and true and false negative results.
  • The two main tests are the PCR (polymerase chain reaction) test, which identifies and amplifies sections of the virus’s genetic code, and the Antigen (or Lateral Flow) test, which detects Covid-19 proteins.
  • The PCR test is much more sensitive, but takes around 24 hours to get a result.
    The Antigen test is less sensitive, but can give a result in 15 minutes, making it very useful, albeit less reliable, on a day to day basis.   

There are also Antibody tests, but these are part of a blood test and detect the presence of antibodies to Covid-19. They determine whether you have been infected, but can’t differentiate when that infection occurred, so it tells you that you have had the disease but not whether you still have it. Antibody tests are useful to researchers but impractical for day to day management of the disease – whether you should go to work, or travel, for example.


A low sensitivity would mean that many cases of infection will be missed. This is clearly not a good thing. An example of a low sensitivity test is using someone’s Tinder profile alone to determine if s/he is a good lifetime partner.

The PCR test is much more sensitive than the Antigen test but the logistics of taking a day and requiring a lab, along with the speed at which the virus spreads are disadvantages.


A low specificity would mean that many people would get positive tests when they weren’t actually infected. This can lead to a lot of people being isolated and worrying unnecessarily.

Positive Predictive Value

Are you confident that the positive test is correct? The positive predictive value (PPV) measures the probability that you actually have a Covid-19 infection if a test result comes back positive.

A low PPV means that a lot of people will think that they’re infected when in fact they aren’t.

Negative Predictive Value

If you get a negative test, what is the probability that you really don’t have a Covid-19 infection? The negative predictive value (NPV) measures this.

A low NPV means that many people will get false assurances that they’re not infected. This could lead to people not getting appropriate care in time and unknowingly spreading the virus to others.

Like many others I thought testing was all pretty straightforward, but the more I looked at it the more involved it became. Throughout the pandemic the nature of testing is changing, from a gatekeeping to a management tool for a disease that has fully infiltrated a population. Issues like test availability – a major issue on May 13th 2020, missed test opportunities and test turnaround all play their part. It’s imperfect and horribly complex and it is clear that many countries were not prepared in having fit for purpose testing regimes when Covid-19 struck. 

From a biosecurity perspective we’re still not that smart.

Imagine if we were as slack with other aspects of our national security.

It doesn’t bear thinking about.


ABC News, Bloomberg, Cleveland Clinic, Economist, Euronews, Evening Standard, Forbes, Global Citizen, Guardian, Huffington Post, London 4 Europe, iNews, National Geographic, Nextdoor, New Statesman, New York Times, PA Media, Reuters, Sky News, STAT, Telegraph.