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

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 16^th 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.

BRING A PICNIC, SOME MUSIC AND LET’S HAVE SOME FUN AND SAY YES TO LIFE.”

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.

Sensitivity

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.

Specificity

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 13^th 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.

Sources:

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.