Each day in April 2021, I am posting my personal journal entry from one year before. Join me as I try to make sense each day in spring 2020 of the dramatically unfolding COVID-19 pandemic. And perhaps take the opportunity to reflect on your own experiences in that remarkable month when the world seemed to tilt on its axis, changed for evermore.
Read here for more context on how the journal was written.
30 April 2020
TS Eliot’s chilling start to The Waste Land – April is the cruellest month – has deep resonance in the time of COVID-19. We seem to be exactly in that instant when ‘the dead tree gives no shelter’, when ‘I was neither living nor dead’, and when ‘He who was living is now dead’. The mere 30 days of April described here have felt like a lifetime, stretched out in a moment-by-moment barrage of suffering, loss and death, overlaid in turn with interpretations, facts, opinions, theories, and commentaries of every stripe.
I have tried to explore some of this in a blog post, which gets published today. Afterwards I feel tired and finished. In some ways I think it is too good for a blog, but the advantage is rapid publication and no editorial filters and constraints. Still, I wonder if someone might want to re-publish it somewhere.
At 10.30 we assemble for the End of Life Studies Group monthly team meeting. Dr Elissa Campbell from Western Australia should have been with us today, but has been unable to travel because of the pandemic. But we are still over a dozen in number on Zoom and it is interesting to hear updates from students (on funerals in Cumbria and hospice care in Lancashire) and colleagues (on anthropological theories and COVID and on death doulas).
After the meeting I reflect that pandemic is by almost by definition global and in some ways has a unifying quality. We frequently hear of the ‘The Pandemic’, but my perception is really of many epidemics. These work themselves out in more restricted geographies, they insinuate into care systems, local communities, organisations, friendship groups and the countless social networks of modern life. They play out behind closed doors, in private spaces, and on public platforms.
This makes for multiple narratives. We all have a story to tell. Sometimes several. So navigating the pandemic requires effort, energy and fleetness of foot. Things change quickly. Today’s confidence is tomorrow’s doubt – one of many reasons why the UK ministerial statements from government seem relentlessly bland and equivocal.
Yet we are all experts now. Quick to judge the ‘evidence’, eagerly passing on our latest shard of knowledge, casually garnered from tweet, soundbite or image, then lightly dusted in personal ownership for added authenticity. We seek out new facts and insights at every opportunity. If our workplaces, and places of learning, and the shops, cafes, churches, temples, mosques and clubs are closed, the information highway is endlessly open, and mostly toll free. It becomes easier to consume than to produce. But produce we do. From haunting stories by bereaved people, harrowing accounts written by care workers and COVID-19 survivors, to more abstracted framings and new theorisations of what is going on. The ‘pandemic’ has become endemic in our communications with one another.
MGC and I have another art class today, and we draw a figure from an animation film. It is a day of sunshine and showers. We walk down to the post box. I haven’t had much exercise in the last few days and need to get out in the garden more. There are lots more seeds to sow as well as things to plant out now the rain has come. I also have weeding to do.
Meanwhile Boris Johnson has bigger issues to report. Today, returning to the daily briefing for the first time since he contracted Coronavirus, he announces that the country is ‘past the peak’ of the disease. The daily death rate from the virus is slowly beginning to decline. The numbers in ICU are declining. The NHS has not been overwhelmed. ‘We are past the peak and we are on the downward slope. And we have so many reasons to be hopeful for the long term. The UK is leading international efforts to find a vaccine. Today Oxford University has announced a partnership with Astrazeneca to develop what they believe could soon be a means of inoculating ourselves against this disease. But until this day comes – and I am afraid we cannot say exactly when it may be. We will have to beat this disease by our growing resolve and ingenuity. So I will be setting out a comprehensive plan next week. The Government is beginning to look ahead at when and in what ways restrictions might be lifted’.
For me, I am still conscious, as Dylan Thomas once observed, that April is a ‘bone breaking’ month – full of contradictions, false hopes, and deceptions. Day by day, this April has layered grief upon hope, confusion upon clarity, strength upon weakness, power upon vulnerability. It has fostered neologisms of distress (corona-shock, corona-stress, corona-shaming) and brought forth new demonisations and novel sanctifications, generating fear and optimism in oscillating measure.
April 2020 is the month in which the world pivoted, but didn’t know which way to turn. Following an April like this, can we even bear to think what the next month will hold – as Eliot puts it:
After the frosty silence in the gardens
After the agony in stony places
The shouting and the crying.
|New Cases UK||6,032|
|New Cases Worldwide||71,493|
29 April 2020
At 6am I am making tea and checking on the heron, who is wading in the pond looking for breakfast. Not sure I want to see the outcome again!
I read a qualitative study, published today in Lancet Global Health, describing the experiences of Chinese health care workers during the COVID-19 crisis in China. It is a fascinating early glimpse into the pandemic front line, drawn from interviews conducted in February among staff in Hubei with no previous experience of dealing with infectious disease. The people in question showed a tremendous sense of responsibility and concerted effort in alleviating patients’ suffering, working in a totally new context that led to physical exhaustion due to the heavy workloads and use of protective gear, as well as the fear of becoming infected and infecting others, and feelings of powerlessness to handle patients’ conditions. Among, several quotes about PPE, I was struck by this extended comment from a nurse:
‘It feels clumsy to walk and do procedures. Although I am good at venepuncture, I cannot feel blood vessels to draw blood with three layers of gloves even when I palpate carefully. My glasses and protective goggles a blurry because I am hot, and it is very difficult to do things, such as writing nursing notes and medication administration. I must hold the medicine close to the face shield to read the words on it. I am very anxious and irritable, because I have so much work to do but I can’t see well.’
And this from a physician was also telling:
‘We are not treating the disease, we are treating the patient. Many patients have severe anxiety and we need to deal with this.’
It’s commendable that the doctors and nurses involved had the foresight to conduct such a study in the face of huge pressures. No doubt we will see more of these as the pandemic unfolds. Meanwhile here at home the UK government belatedly appeals to the universities for wider expertise to bolster SAGE. Four days ago on Twitter, Anthony Costello listed the some key absences from the group: molecular virologist, ICU expert, nurse, epidemic control expert, social scientist, public health scientist, information technology scientist, citizen scientist, digital app innovator, logistician, adviser from Hong Kong, China or Korea, adviser from WHO.
On the domestic front and as part of the re-invigorated home schooling, MGC and I had our first ‘art class’ this afternoon – drawing a bunch of tulips with help from some American guys on You Tube. The results are surprisingly pleasing. I then nip to the vet and come back with more medications for the dog, but I am poorer as a result.
At last the rain has arrived and the garden is enjoying a prolonged soak. Just before bedtime a boat builder in Taunton emails to ask if I still want the tiny pram dinghy I ordered from him last October. No rush there …
|New Cases UK||4,076|
|New Cases Worldwide||64,730|
28 April 2020
I am up just after six. From the utility room window, I watch in amazement as our semi-resident heron repeatedly stabs a foot-long eel, which it has caught in the pond. I delay my departure with the dog, not wanting to scare off the heron and be left with the half dead eel. I manage to get a bit of the action on video and even put it on Facebook later. It’s the early heron that catches the eel.
With Dr G at home, the morning progresses well for MGC, who gets help with maths and is shown a whole range of great books that we already have in the house that will support her learning. She also gets locked on to the class internet system. By the end of the day she seems much happier and has a sense of achievement. I even manage to turn our afternoon walk into a bit of a nature trail, as we identify five different trees in a short stretch of hedgerow. All of our excursions are on foot. For the first time since I owned a car, it is more than a month since I visited the garage for fuel.
The wider consequences of restricted travel and economic activity are staggering. The skies over our house, normally criss-crossed by vapour trails, are devoid of aircraft. Some of the most polluted environments in the world are suddenly cleaner, the air breathable. Last week I read a piece from India about whether the COVID-19 lockdown can spark a clean air movement. In Delhi, where six months ago air quality had reached unbearable levels, there is talk of ‘alpine weather’ beneath azure skies. A similar story is repeated across many Indian cities. Beyond the pandemic, is there a future for greener, more sustainable approaches to transportation, business and energy use, or will it be business as usual as soon as India’s lockdown ends, on 3 May?
In the afternoon here at home, there is a scare. Dr G gets a bad headache and is packed off to bed. Soon afterwards she is sick. I fear Coronavirus, but it may just be a migraine. These are worrying times. By evening she is feeling better but not completely right and at bedtime I start up with a tickling cough.
On the work front the day goes pretty well for me, though I send my apologies for a ‘research directors’ catch up’ at 3pm, and get an understanding response from the chair. I have a good Zoom meeting with a part-time PhD student, and his other supervisor. A hospice CEO in Lancashire, the student is interviewing his peers in a study of hospice leadership. It’s remarkable that he has been able to keep the interviews going more or less unchecked since lockdown, by the simple expedient of switching from face to face to telephone. However, he reports only 7 patients in his 17 bed hospice and all the local hospitals at around 50% occupancy. Locally, the COVID cases remain very low and it does feel that a shift in orientation is needed. Many staff are underworked and there are worries about delayed treatment. At the same time, it raises the wider question of why in other times we are providing so much healthcare, perhaps for little benefit. Some GPs seem to think things can never be the same after this, there could be more triaging, more video consultations and less people in the surgery who perhaps don’t need to be seen face to face, or perhaps at all.
The Domestic Abuse Bill was debated in the House of Commons today and Theresa May made a speech highlighting an increased incidence of abusive behaviour during the period of lockdown. It is another example of an issue that for some people may be worse than the virus itself, as perpetrators seize on a period of isolation and confinement, knowing their victims have limited options to escape.
I spot an editorial in the journal Progress in Palliative Care, just published today. It contains reference to our COVID-19 and palliative care blog post from last month, which is seen as one of a number of examples of a ‘virtual community of practice’ that is building up in palliative care around the Coronavirus pandemic. There is also an excellent piece in Discover Society on the Swedish approach to handling coronavirus. In a country with the lowest anti-biotic use in Europe, the focus is on reducing long term consequences, directing the virus to those most able to resist it (in effect younger people) and promoting the idea of ‘working with’ pathogens. So no lockdown, and very few of the restrictions we are seeing here and elsewhere. It is a radically different approach.
I spend quite a bit of time on my ‘April’ blog and am quite pleased with it. Send it to a colleague, who is impressed and complimentary. As she says, the diary has paid off! At about 2,500 words, it just needs some finessing now for publication on Thursday.
Corona-stories continue to draw my attention and Dr G and I spend much time each day sharing our pieces of news and insight. Today there was one minute’s silence at 11am in memory of the health care workers who have died of the virus. In New York, an emergency department doctor called Lorna Breen has committed suicide in the face of pressures in her work, and whilst in the process herself of recovering from the virus.
Another Guardian article on loneliness and loss in the pandemic made for sad reading today. So many stories of people badly affected by isolation and confinement. The one I identified with most was that of a namesake of mine, in Ireland. David’s wife Maureen died in a hospice on 3rd April, after a seven year illness. He was not allowed to attend the funeral and said his farewells at the roadside with other friends and neighbours, as her body was taken for cremation. In the weeks since he is trying to make sense of it all, and the awfully dislocated ending of almost half a century together as a couple.
|New Cases UK||3,996|
|New Cases Worldwide||76,026|
27 April 2020
We are awake at 6am and drinking tea. Later I see a photograph of the dawn sky on Twitter, posted by one of my colleagues. It was taken at 4.40. Maybe it’s the early light, maybe it’s COVID-19, but it can be hard to sleep sometimes.
Dr G gets off to work early, by which time I have done a pile of ironing. I eat a big bowl of porridge and get down to work. MGC follows suit, but I sense her resolve is a bit weaker and the school work doesn’t seem to go so well. So many weeks into lockdown now and Monday morning, it’s not really surprising.
At 11am we Zoom into Sheffield and my grandson’s second birthday. He is out in the garden, already using the tools we sent him and looking very much like a chip off the old block. He seems to love pottering about, collecting firewood and being outdoors. It’s nice to see him in action and to talk to his parents, who seem very content. Just over a month now until his little sibling is due, so I imagine life will get a bit more complicated then. Even so, I wonder how you keep up with an energetic two-year old through each long day – can’t believe we were doing it not so long ago!
I do various small tasks but focus most of my energy during the day on my ‘April’ blog post. It’s coming together now. In the evening I read some material on Twitter critiquing the government from a social science and public health perspective, and raising important questions about the ‘science’ that is being invoked – much of it a toxic mixture of mathematical modelling and ‘nudge’ theory. Meanwhile WHO principles are ignored.
I have a bit of a melt down with MGC in the late afternoon. Too much fussing about devices, social media, this app, that app. She is only 11 and will have to have some kind of break from these things. We sit up fretting and make a plan for a more engaged form of home schooling. Dr G and I will both have to take some time off to dedicate to this. Our plan A has gone quite well, but is now wobbling. And it looks like lockdown in its present form will be with us at least through May. But we also reflect on the Channel 4 news item we watched of people in a high rise flat, shielding and with a small child. Very, very tough. We don’t have any right to complain here.
|New Cases UK||4,309|
|New Cases Worldwide||73,400|
26 April 2020
Sunday. I sleep very well, until 7.15. The morning dog walk is still and blissful, though at this point the skies are grey and misty. As the day unfolds the sun comes out. Dr G is in great spirits, recording one of her songs for Gareth Malone’s national choir that she has joined. Meanwhile I get in a good spell of gardening.
The big border in the field has never looked better and is ready to burst into colour. I’m also increasingly happy with the woodland look of the borders at the back of the house, as I gradually introduce more appropriate and interesting ferns, aquilegia, trilliums and hostas. I give the latter and some peonies a good top dressing with well-rotted dung. I have also received a great tractor bucket load of leaf mould. We will be well mulched this COVID-19 year.
I’m curious to learn of another small anti-lockdown protest, which took place yesterday, this time in Glastonbury. Piers Corbyn, brother of the former Labour Party leader, was in the (Somerset) news this time, apparently telling a small crowd: ‘We know there is no pandemic … We’ll have more deaths from loneliness, suicide and people being kept out of hospital’.
We have a substantial dinner of pot roast and potato and celeriac mash, followed by lovely home-made fruit tarts with Scottish raspberries and strawberries. Then we sit outside in the last of the sunshine. It promises to be a cool night: time to put on the fire and write the COVID-19 diary.
|New Cases UK||4,463|
|New Cases Worldwide||84,899|
25 April 2020
I am off to Marks and Spencer by 8.30. It is an odd feeling going out into the world. In the shop I bump (not literally) into one of my colleagues and enjoy a ‘distanced’ conversation with him in one of the aisles. We talk about the post-COVID future for higher education and in particular the Crichton Campus in Dumfries, where we both work. He will be ok, he is a citizen of the world and will adapt. He tells me about ‘the album’ he is recording in a Dumfries studio and promises to send me a track. As we part I feel a little emotional – the first work colleague I have met face to face in five weeks.
It is a beautiful hot day, and we spend the day outdoors and relaxing, feeling slightly guilty about jobs that need doing. I dig out a Penguin copy of Camus’s The Plague (1) that I first bought in 1973, and start re-reading. It is very good – and begins in April. I’m struck by the parallels between now and the novel. We have our daily briefings, with numbers of new cases and associated deaths. Camus has the tally of dead rats found each day as fear and concern unfold, in what he calls the first period, one of ‘bewildering portents’.
In most of the discussions about trends and rates of COVID-19 we see little reference to a well-established sociological concept – the social construction of official statistics. This refers to the nuanced social processes in which the people involved act to produce specific readings of external phenomena for bureaucratic and political purposes. My sense is that the figures with which we are presented daily – whether mournfully, cautiously, optimistically, even defensively – serve to obscure the underlying and contingent processes involved in their compilation.
For example, what is a COVID-19 related death?
Death certification procedures are notoriously different between countries. In Scotland, legislation introduced in 2011 requires documentation of the underlying cause of death, as the disease or injury which initiated the train of morbid events leading directly to death. It also has a requirement to state any other diseases, injuries, conditions, or events contributing to the death. That means factors not part of the direct sequence, but which made the person more vulnerable to the fatal condition, so that death occurred sooner than expected.
People may thus die from COVID-19, or die with it. Both are COVID-19 related deaths.
Today the United Kingdom reached the solemn milestone of 20,000 people whose death was COVID-related. Yet on 17 March the government’s chief scientific adviser, Sir Patrick Vallance, had said keeping such deaths below 20,000 would be a ‘good outcome’. Given that the UK mortality figures presented each day are still restricted to those who die in hospital, and taking into account probable deaths in the community, the 20,000 milestone was probably reached some time ago.
In the evening I place a fire-pit in the increasingly shallow burn. Once lit it looks enchanting and atmospheric. We sit with the neighbours ‘across the water’ for a couple of hours. When we return indoors I watch a home performance of Martin Simpson singing The Times They are a’ Changin’. It’s a song for the moment: the old road is rapidly fading …
|New Cases UK||4,913|
|New Cases Worldwide||93,576|
(1) Camus, A (1960) The Plague. Harmondsworth: Penguin.
24 April 2020
An absolutely glorious day of still, warm weather. I join a morning catch up with colleagues and hear the latest update from the university. The picture is uncertain, shifting and worrying. Hundreds of people now on furlough, concerns about cashflow in the coming months, anxieties about international student recruitment. The list keeps growing.
I keep focussed on my work and feel better for it, making progress and enjoying the time to get things right with papers for publication. Start a blog entitled ‘April is the cruellest month’; the first line of the Wasteland.
Dr G gets home mid-afternoon. It is too warm to venture into town for food shopping, so I put it off until tomorrow. My neighbour suggests drinks across the burn at 5.15 and it turns into a very enjoyable gathering. Dr G makes two delicious quiches. We struggle to decide which is best, eventually favouring the cheese and ham over the local hot smoked salmon and chives from the garden. But it’s a close call.
|New Cases UK||5,386|
|New Cases Worldwide||81,529|
23 April 2020
The morning was good. We all got on with our tasks, in a settled routine. I made progress on the LCP paper. Beautiful weather, and the cold wind gone. MGC had a good piano lesson after lunch and I caught up with colleagues. Made the evening meal, which everyone ate with pleasure. But then one of those out of the blue lockdown moments put everyone in a low mood. I was the only one to go out for the NHS ritual, which felt empty and pointless.
This thing is taking its toll in all sorts of ways, though we are profoundly fortunate, as Dr G later pointed out, to be in the situation we are in. Nicola Sturgeon’s ‘plan’ for how to ease lockdown, announced today, seems to be a bit of a damp squib, though we must admire her frankness and lack of phoney bluster. The truth is she doesn’t really know what to do any more than anyone else, though she is surrounded by advice and is apparently working on this around the clock. The sense more and more, is that aspects of the restrictions, are going to continue for a very long time. The university is clearly gearing up for some hard times ahead.
I was impressed this evening by a second blog from a group of palliative care doctors, Simon Tavabie and colleagues, who are developing a really worthwhile project. Their focus is on up to the minute insights from clinicians in different settings as they grapple with the unfolding dimensions of #COVID19. It is a piece of social history in the making. Never mind any issues about the sampling and or any qualitative data analysis flummery, it simply provides interesting insights in a timely way. Curiously, the oncologist they interview for this blog seems to have nothing to do. That is an issue that is blowing up in a bigger way around access to cancer services, a concern for the growing numbers of patients who are not getting treatment, and the possibility of very poor outcomes next year and beyond. One news report today quotes the oncologist Professor Karol Sikora as saying that there would normally be about 30,000 cancer referrals from GPs this month, whereas the projected figure is 5,000: ‘Where have they gone? People have got cancer. It’s not that they haven’t got cancer in April. It’s that they’re not getting diagnosed because the system is blocked to them.’
During the day I text my greatest ever musical hero and ask how he and his wife are keeping. A fan of Robin Williamson for over 50 years, I am thrilled to get a nice and reassuring response by evening. Robin phoned me just before the lockdown began to cancel the September gig that we had booked for Dalswinton. He has played here every year since 2010. It was a very poignant conversation but he and his wife Bina are keeping spirits up and playing music at home. Fortunately we have his enormous back catalogue to keep us going in the absence of live music and there are always obscure treasures from past performances to be found on the internet. I doubt whether we could persuade Robin to put out a few tunes, spoken word or songs on Facebook, though a lot of musicians are doing just that. Martin Simpson has been playing some very evocative guitar pieces in his Sheffield back garden in the Spring sunshine, that are hugely uplifting.
|New Cases UK||4,583|
|New Cases Worldwide||73,656|
22 April 2020
Dr G is awake at 4am. We drink tea and eventually get back to sleep before it is too late to bother.
After breakfast I get MGC settled to her schoolwork and then begin my own work – around 9.15. I have no school run to do at 8.30 and no dash to the university campus thereafter. My fuel consumption and related carbon footprint have plummeted. Today, I catch up on email correspondence then plot out on paper a ‘spreadsheet’ of publications about the Liverpool Care Pathway from 18 countries in the period 2003-2019. By late afternoon and with the help of my excellent colleague AM, I have it on Excel. Making progress each day on this very large and demanding paper.
After lunch I have the unusual experience of a lockdown veterinary consultation. I arrive at the surgery, call to say I am there, am told to tie my dog with a lead outside the main door, he is then taken in and examined, they ‘phone me back, I collect him and the medication, and pay over the phone. It all works well and I come home with some anti-bacterial wash for the dog’s sore feet.
It’s a warmer day to day, with less wind, but still very dry. Dr G and I go for a walk up the hill and then I get dinner ready. We feast on gammon, chips, and a massive dish of Mediterranean roasted vegetables.
I feel I’m running out of patience with lockdown and running out of enthusiasm for my work, though I assiduously seek to see every target completed before I retire. It’s therefore a welcome ‘get a grip’ moment to read something that is both work and COVID-19 related and that is more conceptual in character. Jonathan Cohen is a public health leader from the Open Society Institutes. He does not question the established fundamentals of infectious disease control, but his piece in BMJ Opinion today turns much of the public health narrative upside down. Here are some examples:
‘The public health framework tells us that covid-19 was caused by a novel pathogen, not by population density, weak, and fragmented health systems, and other social processes that turned a pathogen into a pandemic.
Public health tells us that covid-19 is spread by droplets, not by denial, wishful thinking, and epic failures in political leadership.
It tells us that covid-19 impacts people with “pre-existing vulnerabilities,” not people who have chronic disease because of histories of structural racism, people who are forced by poverty and marginalization into unhygienic living conditions, and people without health insurance.
It tells us that covid-19 is solved by human behaviors—isolation, quarantine, and social distancing—not by political accountability, global cooperation, and a social safety net’.
This gets me thinking further. I find there is much talk of public health. We are expected to know what it is, and many affect to do so. The World Health Organization is often cited as the arbiter of good practice in the pandemic, not least in stressing a mix of social distancing, testing, contact tracing and isolation. But much of the public health perspective we have seen so far is narrowly epidemiological in character. It makes little reference to structured inequalities, community perspectives, assets based approaches, or to political and cultural dimensions. Instead we see a strengthening nexus between power and knowledge – and also data – as an agent of control, in a way first articulated by Michel Foucault in his famous concept of bio-power.
‘Flattening the curve’ is something we all now feign to understand. The reproduction number R, defined as the number of secondary infections generated by an infected individual, is invoked by news interviewers without even the need for explanation. Social distancing, we ‘know’ will drive down R. Just as testing capacity is everywhere being ‘ramped up’ and the UK government battles its way to a target of 100,000 tests a day by the end of this month.
An enormous space has opened up for bio-medical reasoning. The sense of Foucauldian bio-power is everywhere. It has become the protecting shield of our politicians. The nation state is pulling out every tool in the locker to exercise control over human populations. Foucault’s words in 1976 are more than ever apparent today, as we see ‘an explosion of numerous and diverse techniques for achieving the subjugation of bodies and the control of populations’ (1). In the time of COVID-19 colonizing this ground comes by following the scientific advice and taking on board the medical guidance.
Yet this in itself has caused concern, and the editor of The Lancet is on record as saying that the medical and political establishment has been co-opted into supporting the UK government line on COVID-19 and that the failure to identify and take seriously the threat of the pandemic exposes a huge weakness in science policy.
Other counter-logics to bio-medicine have begun to emerge. The contortions around lockdown and the economy demonstrate this vividly, not least in the idea of a trade-off between the number of deaths from COVID-19 that is acceptable, if business and commerce are to ‘get going’ again. Stefan Ecks has described coronavirus lockdowns as ‘conflicted biocommensurations’. They have taken a myriad forms, making comparisons of their relative value highly problematic. They also have many consequences – for health, but also for the economy. They bring benefits – preventing the surge, protecting the health services. But they have their own sequelae – in mental illness, isolation, poverty and economic hardship.
There are signs too that even within the health care system itself, the exercise of bio-power is meeting resistance. Throughout April the military has been on view in UK hospitals. Local NHS managers locked in emergency meeting rooms have stratified their ‘command structures’ into ‘bronze’, ‘silver’ and ‘gold’. Some clinicians are growing sceptical of all this. In addition to flattening the curve, there are calls around the NHS for a flattening of the hierarchy and the abandonment of militaristic language.
Our ‘local’ specialist in global public health, Professor Devi Sridhar, continues to write useful pieces for wider consumption. In the Guardian today she explores how, as COVID-19 spread across the world, some countries acted swiftly, based on their previous experiences with Mers or Sars. For these countries, like South Korea, Taiwan, Singapore and Vietnam, containment of the novel coronavirus became the imperative, regardless of cost. Meanwhile, other countries chose to treat it like a bad flu strain that would be unstoppable and spread across the population until some kind of immunity was reached. Until the late March lockdown, the UK seems to have be the paradigm case in this category, with Sweden taking the same route, albeit more purposefully. Prof Sridhar has strong views on ‘the curve’. In her opinion, the goal should be to ‘crunch’ it. Countries that are seeking only to flatten the curve, rather than stopping the spread completely, ‘are just gambling with people’s lives, and will be caught in cycles of lockdown/release that will destroy the economy and cause social unrest, as well as increased Covid-19- and non-Covid-19-related deaths’. Is that where we are heading?
(1) Foucault, M (1976) The History of Sexuality Vol. 1 An Introduction, p140. London: Allen Lane.
|New Cases UK||4,451|
|New Cases Worldwide||73,920|
21 April 2020
The early part of the morning can be a bit odd under lockdown. I like to get on with household tasks (ironing, washing clothes, doing the dishes) whilst Dr G is getting ready for work. That’s a good system. I also like to have on the BBC Radio 4 Today programme, playing quietly in the utility room. I’ve learned that it is on the whole better not to get into discussions about the pandemic and the government’s handling of it, at this point in the day. The morning news always brings items to annoy us both. Better to see Dr G leave feeling relaxed and ready to face the day. Each day now she will see patients with confirmed or suspected COVID, so a low key departure is a priority. Things are much easier for me than her.
After she goes, I look ahead to the day here. Now I must say that it is not at all a bad state of affairs. Far from it. But there can be issues in dealing with MGC. Today these bubble to the surface so we mainly go our separate ways until lunchtime. During the morning I do some more work on the LCP paper and enlist help from a colleague AM in creating a particular kind of table. We also break through the logjam with Wellcome Open Research and it looks like our paper on children’s palliative care will be published quite soon.
I spot a new website during the day, launched by the COVID-19 Recovery Collective. It is focused on those who are still unwell months after encountering the virus, and apparently having survived it. One piece, by a nurse, captures something of what is being explored: ‘It is to be expected that the more severe cases will take longer to recover, but I believe the acute phase of Covid19 can even for moderate cases just be the footnote of what can be a much longer illness’. As someone who suffered for a number of years with post-viral illness, it is an alarming thought that we may be about to see a significant wave of people still to break free of the infection, long after their initial symptoms have abated.
MGC has made a nice card for her young nephew and we walk down to the post box after lunch. En route we meet up with neighbours heading for a picnic up at one of the hill lochs. The weather continues sunny, with a stiff, cold wind. But generally I feel well – and am so much improved on three weeks ago.
At 2 o’ clock I join a UoG College of Social Sciences Zoom meeting with 20 plus others, about the REF. I say nothing in the hour, but find it quite interesting to catch up. With the REF delayed, my only concern is that the census date remains the same at 31 July. That seems to be the case, but no one is clear when the submission will be, though 31 March 2021 gets mentioned as a possibility. By then I will have been retired for six months …
|New Cases UK||4,301|
|New Cases Worldwide||82,625|
20 April 2020
Another bright, chilly morning. MGC is well organised and quickly gets on with her work. She seems to be enjoying learning under lockdown rather more than at school. Today she does maths, science and starts a new topic on suffragettes, working from a book that our friend SS has sent to her for her birthday.
I clear off some bits and pieces and then at last manage to devote some time to summarising the literature review I’ve done with JS on the international spread of the Liverpool Care Pathway. I need to condense 30,000 words of review into a fairly short section in our analytic paper. I could do with a large format print out of the review, to mark-up key points, but that’s not happening anytime soon. Nevertheless, I make some progress and there is momentum there. There is good news from one of my former postdocs, who is now back in Trondheim – she has got a job in the applied ethics unit of the her local university. I’m pleased for her and also relieved.
After lunch I potter a bit among the seed trays and am very happy to see the first signs of germination among the blue meconopsis – very exciting! I am aiming to have a large drift of them in the newly extended border by the rill.
Dr G gets home mid-afternoon. We take a walk, just the two of us, around Dalswinton Loch and I tell her that it feels to me like my ‘to do’ list is gradually getting shorter. My pre-retirement plans are about where they should be – apart from the lockdown – which means I have been unable to appoint an intern to help me with the archiving of my papers. Meanwhile the clock ticks …
A group of grief specialists, some of whom I know, have published and interesting piece today. They rightly point out that all bereavements take place in a social context, and describe the wider losses that are resulting from the COVID-19 global pandemic – routines, freedoms, jobs, meeting with others. ‘And some people have lost their lives while others have lost the opportunity to be with people who are dying or grieving’. They talk about the importance of grief literacy, defined as the capacity to access, process, and use knowledge about the experience of loss. The pandemic is restricting how we say goodbye – when someone is dying and when they are dead. It is hard to imagine how grief is being experienced by the 5296 people whose deaths from COVID-19 have been reported around the world today, and no doubt with many more to follow.
One feature of the pandemic is the massive variation of COVID-19 incidence, prevalence and the claimed effects of particular measures taken by individual nation states at specific junctures.
Why have some jurisdictions such as New Zealand, Denmark and Vietnam, apparently contained the pandemic? What factors explain the huge number of cases in Britain, Italy, Spain and the United States? Why is it that on 21 March no less a figure than Atul Gawande, writing in the New Yorker, could describe Singapore as having ‘a handle on the epidemic’ with daily cases on that date at 47, when by today, daily cases had reached 1,426? Similarly, Japan’s low COVID-19 infection numbers were seen as a success story but seem to have led to a lapse in public vigilance, followed by a subsequent state of emergency.
Meanwhile, I spot what I think is the first empirical study of palliative care for COVID-19 patients. Drawing on data from two London hospitals, the paper shows that the main symptom experienced by patients was breathlessness. In addition, patients near the end of life commonly experience agitation, while cough is infrequent. Time spent under the palliative care team was very brief, with a median time 2 days but symptom control with subcutaneous infusion was achieved in most cases using relatively small doses of opioid and benzodiazepine. Seventy-four percent of the 101 patients referred to palliative care during a period of less than one month, died in that time. This is palliative care as it has not been seen before.
Today may also have seen another first, in the form of a protest against the lockdown. A couple of young men held out for several hours holding up a banner on the roof of a college in Shrewsbury before being escorted off by the police. The protesters are apparently part of the Shropshire Corona Resilience Network Group. I wonder if more such groups are forming around the country?
Just before bedtime we go outside in the clear, cloudless evening air in an attempt to see the convoy of satellites that is promised to be passing ovrhead. Taking time to look at the stars is very worthwhile. They seem to brighten and proliferate the longer we watch. But we see just one satellite.
|New Cases UK||4,676|
|New Cases Worldwide||73,262|
19 April 2020
The government seems to have made four errors so far in its response to COVOD-19. First, it introduced the lockdown too late (and Boris Johnson himself provided the worst possible role model by continuing to shake hands with people long after it was a public health no-no). Second, it has not had adequate stocks of PPE. Third, it is woefully slow to implement testing on a mass scale. Fourth, it failed to anticipate the spread of the virus (because of its essential disinterest in) care homes.
The daily briefings become increasingly farcical. Who will they field next? A string of unknown politicians, all far too calm, trot out a constant stream of dogma and cliché. Meanwhile, no word of the Prime Minister in almost a week. Is he still quite ill and needing time to recover (understandable). Or is he hanging back for political reasons? Or is he still quite sick whilst no one can take any major decisions without him? Meanwhile the Cabinet is incapable of saying anything about when the lockdown will end. During the morning I hear Michael Gove on the radio sounding rattled. Criticism of the government is mounting and some commentators seem not to want to wait for a post-hoc enquiry into what has gone wrong.
Then I read a harrowing account from USA Today, describing how a group of middle aged siblings encountered the death of their 76 year old father. He had been admitted to hospital after a fall and had then developed a cough and was diagnosed with COVID-19. As his condition deteriorated the siblings kept in regular contact with him by telephone. They were just five miles away from him, but could have been continents apart, given the sense of separation they felt. As he became more sick, they entered into a remote ’group call’ vigil that went on for 36 hours. Just after they had all agreed to take a break whilst staying on the line, their father died. The sadness of the story seems amplified by that cruel twist at the moment of death, one which clinicians know so well, and the like of which I experienced with my own father. Just as the vigil is temporarily broken, the person dies. Here this scenario is enacted with an added layer of poignancy, shaped by separation, isolation and the available technology.
There is more cause for concern in an article on the Guardian website today about some research being done by colleagues at the University of Glasgow. Professor Rory O’Connor in the Institute of Health and Wellbeing is leading a survey into experiences of the lockdown, with a particular focus on how physical containment is raising levels of anxiety, depression and stress. Underlying these measures of distress are feelings of loneliness and entrapment. In this regime of lockdown, eventually entered into so hurriedly, what account has been taken of the mental health consequences, and how, I wonder, are they to be mitigated?
Meanwhile, at home we have a day of blue skies and brisk winds. Jobs in the garden, in the house, a walk, and a good meal in the evening, followed by sitting round the fire, our faces burning from the sun, but our bodies chilly from the cold easterly winds on our post-dinner walk. After a wobbly start, I am beginning to get into the escapism of Robert Harris’s Pompei, so much so that I have begun to construct whole phrases in cod Latin. It is a good story though, and the account of Pliny is fascinating and new to me. The end is of course predictable.
|New Cases UK||5,850|
|New Cases Worldwide||81,153|
18 April 2020
In many ways it is an idyllic Saturday. The sun shines early and late. After breakfast Dr G and M go for a walk round Dalswinton Loch, where they are delighted to see the familiar sight of the nesting pair of swans. Whilst they are away I get on with a good deal of sowing – mainly salads and herbs in pots and various receptacles. As I work, Iistening first to the Trembling Bells and then to the Incredible String Band, at reasonable volume. It hasn’t rained for weeks, but there is a cool to cold drying wind a lot of the time, so it’s tricky to get things going. I have some trays and pots inside an otherwise empty acquarium, trying to create better conditions for germination. Watering the various recepticles is fiddly but usually enjoyable. More of a chore is watering a newly planted laurel hedge, topiary box, and trees at various places around the domain. I have enlisted the help of HS, who is quite content with routine jobs of this type.
Before lunch we have a go at short tennis. As a result of this extended dry period the grass has never given such a good bounce, and it is great fun. Dr G and I score 11 on the ‘Andy Murray challenge’ to do 100 volleys across the net. Work to be done.
We have a rather lavish platter-style lunch. Dr G retires with a magazine. I do more gardening and HS gets stuck into moving a pile of leaf mould that AK has brought for us. It is going in an expanded border by a rill, to spread around acers, primroses and astilbes. AK is an excellent worker, who cares for and feels proud of the garden which in recent years he and I have co-created – the adjacent rented field especially. As a thank you I give him a boxful of beer, plus some nice biscuits and chocolate for his girls.
Using Google translate, I read an online opinion piece by Isabel Neto in Portugal. She is a palliative medicine doctor and a member of parliament. I first got to know her when she and her son took on the task of translating Cicely Saunders’ book Watch with Me into Portuguese. Here she writes about how COVID-19 has filled the news media with stories about death, end of life issues, associated ethical matters and questions of social justice. But she reminds us of the scale of need relating to older people who have needs for palliative care that mainly go unrecognised and which existed pre-COVID. She maintains that in Portugal, palliative care reaches only 30% of people who could benefit from it. She rails against the redeployment of palliative care specialists to mainstream duties. She argues that the pandemic has exposed the inadequacies of the wider care system in Portugal and is vehement in her criticism of those responsible.
|New Cases UK||5,525|
|New Cases Worldwide||85,678|
17 April 2020
We are awake at 4am drinking tea. Several people I have spoken to have mentioned how their sleep is being disrupted in the current times.
I speak to my colleague DC at the start of the working day and we sort out some issues in the ‘policy’ paper we are working on based on data from our global mapping of palliative care development. It shows that only 55 countries in the world have a recognised palliative care strategy, endorsed by government. I’ve worked quite a bit on the paper this week and it is getting into better shape for its intended audience. We are planning to submit it to the Journal of Palliative Medicine, so it will be quite simple and empirical. But it is showing up some more interesting broader issues that we intend to address in a conceptual paper that another colleague, SW, is developing about the ‘policy’ engagement with palliative care. Looking at our data and taking a wider view does raise further concerns about the relationship of WHO to palliative care, I must say. It is hard to see their interventions making significant impact on the growth of the field over time.
Meanwhile I come across a video piece, published yesterday from the American palliative care thought leader, Diane Meier, in which she persuasively and simply sets out the palliative care contribution in the pandemic: eliciting the person’s wishes, directly or indirectly; finding ways to communicate by phone and tablet when direct contact is not possible; helping families to say their goodbyes when death is imminent. She sees it as work on the front line, as she has described elsewhere, that makes up ‘an extra layer of support’ to those providing acute medical services.
I read a BBC news feature based on interviews with healthcare workers in the UK, USA, Spain and Italy. The dominant fear they express is around the limited supplies of essential protective equipment, as in each case they see the initial stocks dwindling. The virus has also changed their relationships with their patients, co-workers and families, and some are struggling under the psychological weight of the crisis. An ICU nurse from Seattle states:
‘If we run out of masks, I don’t know what I’ll do. It’ll be a huge ethical dilemma. I feel that my commitment to my profession does not extend to sacrificing my own life and doing knowingly needlessly reckless things. My employer has a responsibility to continue providing protective equipment to keep nurses safe’.
A colleague of mine in New Zealand, Merryn Gott, is part of a team there that has just published an interesting piece on equipment issues, in this case the use of the ventilator for people with COVID-19. It’s a useful factual guide answering such questions as: what is a ventilator, when is it used/not used, and what do we know about the (mainly unpleasant) experience of being attached to one? The authors that for many who will not require hi-tech medicine, there is another kind of intensive care, ‘called palliative care’ that is provided in hospital, home and residential facilities for older people’.
Given all these factors and complexities it is little wonder that there is growing critique from academics, journalists and public health activists, who are raising important questions about what kind of ‘science’ is being invoked by the government (much of which it would seem, is a toxic mixture of mathematical modelling and ‘nudge’ theory) and how it is being applied to strategy. Today the New Scientist sets out the various issues concerning the government’s Scientific Advisory Group for Emergencies (SAGE): in particular a lack of clarity about membership and process and the decision to postpone publication of its minutes until after the emergency is over. I’ve not seen this kind of commentary before and it seems set to escalate as people have a growing sense of government by secrecy and fiat.
In the late morning I have a Zoom catch up with my colleague and former assistant, AM. She seems to be doing fine and busily making herself indispensable in her temporary new role. But the shock email of the morning was from our Principal, Professor Sir Anton Muscatelli, a man for whom I have a lot of respect. He announces that there will be no P&DR scheme this year; he is referring to the annual system of staff review and appraisal that over the years, the University has made mandatory for everyone. Things must be serious if this management Holy Grail is being absented for the duration.
Dr G phones gets home and kindly suggests I go to Marks and Spencer and do a bit of luxury shopping. Leaving the house, I feel a twinge of nerves, it will be my first time in a shop for more than three weeks. I have to queue outside in the bright sunshine, but still chill wind. Paradoxically, the husband of a colleague who I often see in M&S on a Friday late afternoon, is there in front. The shop is quiet, but well stocked, and the staff couldn’t be nicer. I return home somewhat poorer, but with a wonderful stock of comestibles.
During the day I catch up with my elder daughter RH, who is expecting a baby on 1st June . We are hoping that she and her husband will have avoided COVID-19 in the interim. Meanwhile we are focussed on my grandson TH’s second birthday – 27th April. We have bought him a toy lawnmower and a set of gardening tools, as he already seems horticulturally inclined and that is to be fostered!
|New Cases UK||5,599|
|New Cases Worldwide||82,967|
16 April 2020
I wake up to a dry, broken-cloud morning. Dr G gets off to work, MGC settles to her studies. In a handful of emails to friends and colleagues I reflect on a few thoughts about the pandemic, that I might start to sketch out further, maybe for a blog. Then it’s onto Zoom for a PhD student supervision session; we talk about how a scarcely-begun study could be reimagined in the light of COVID-19. I have a late morning catch-up with SS, my old school friend and a still active (post- institutional, as she puts it) sociologist. She is one of the editors of Discover Society which she says has published about 70 pieces on the pandemic already – I must keep looking at those. I also talk to PQ, our Lincolnshire friend and occasionally resident builder. He has a job today in an empty house, but other than that hasn’t worked for three weeks. He should have been coming here next week to commence work on a new workshop and greenhouse.
After lunch, just as I leave the house with MGC, we see the first swallows of summer, diving in and out of the garage at the Mill. We walk to the nearby Journey Garden, a fascinating place for reflection created a few years ago by the owners of the Dalswinton Esate, Peter and Sarah Landale, to a design by Silvy Weatheral. We enjoy a few minutes there in the circle of lettered stones, with their curious message: ‘look where you are, see where you have been, decide where you want to be’. In the centre is a labyrinth carved into a huge vase-like piece of stone, retrieved from an old railway bridge across the river Nith. I pause for a moment and think of my brother PC, a prison chaplain who is making small labyrinths for exercise yards and hand held ‘finger’ versions the size of a CD, for use in the cell.
The meaning of lockdown continues to unfold in the mind, peeling back layer after layer. As we wander home we stand at a five bar gate looking at the cows and calves in a field that slopes down to Dalswinton Loch, with the big house beyond. It is a pastoral scene out of the 18th century, now belied by the nearby searing whirr of chainsaws as they slice through Larch trees condemned to destruction by another modern scourge – phytophthora ramorum, an algae-like organism that is spreading through our woodlands and beyond. My student SG published a good piece on our blog yesterday, about how Coronavirus is affecting the hospice he manages. He likens our current situation to an ‘environmental apocalypse’ – a feeling that grows in me as I walk with my 11 year old daughter, and the chainsaws whirr on …
The debate about mask wearing is escalating. There is a paper in the Lancet today which takes a public health approach and emphasizes that mask wearing benefits the entire community, it protects others and may be at least as important as handwashing and social distancing as a form of mitigation. The authors conclude: ‘This measure shifts the focus from self-protection to altruism, actively involves every citizen, and is a symbol of social solidarity in the global response to the pandemic’. An excellent argument.
HS cooks the evening meal – meat balls and pasta – after which we practice Ode to Joy in preparation for yet another up-swelling of the conscience collective, as we are enjoined by the National Youth Orchestra to play Beethoven’s piece from our windows at 5pm tomorrow. MGC already has it off pat on solo piano (in C). Dr G and I busk our way through it (in D) on violin and guitar. Not bad! Then at 8pm it’s out in the biting east wind to salute the NHS, this week with the regular saucepan on the neighbourly side, now augmented with a tambourine, and me ripping my digits on the African thumb piano. With lockdown continuing for at least three more weeks despite infection rates around one for each person with the virus, we are living in very strange times indeed.
|New Cases UK||4,617|
|New Cases Worldwide||76,646|
15 April 2020
I sleep pretty well, apart from dreaming about a news article I had read the previous evening from two Canadian palliative care doctors who describe the harrowing symptoms of COVID-19 in the late stages – the sudden decline, the breathlessness, the separation from family and significant others. They write: ‘In this pandemic, we need to consider not just treatment for those we may be able to save, but also the suffering of those we cannot. Palliative care should not be seen as a luxury, but as a necessary part of the response to humanitarian crises’.
In the morning make progress with a paper reporting data on policy actions from our global study of palliative care development. Get plenty of washing done too – and dry it in the breezy sunshine. Then lunch with HS and MGC, who has again worked well through the morning. A walk round the field before I’m into a Staff meeting via Zoom. The University is facing some terribly complex challenges and I would not want to be at the sharp end of implementing the solutions.
One thing I have noticed around the house, when we go for walks and on the very rare occasions that I am in the car, is the buzzards and red kites that seem to be out in profusion. Though no orthinologist, I pride myself on being able to distinguish the fan tail of the former from the v-tale of the latter. I love to see the buzzards circling high, especially in the mating season when I once counted seven in a group, mewing like cats and drifting languidly on the thermals. Most of all I love the supremely confident, elegant swooping and direction changing of the red kites as they dip and turn, exposing their rufous plumage and black wingtips, parading their elegance for all to see. Sad to read today that in these times of lockdown the raptors may be more vulnerable to egg stealers and unscrupulous gamekeepers taking advantage of the absence of scrutiny in the quiet countryside.
Meanwhile the news reports that President Trump is to remove its funding from the World Health Organization. Yesterday in a White House news conference he stated that he would direct his administration to halt funding until a review is conducted to assess the World Health Organization’s role in what he describes as ‘severely mismanaging and covering up the spread of the coronavirus’. It makes you wonder if any investigation will ever hold Trump to account on the same accusation.
|New Cases UK||4,603|
|New Cases Worldwide||70,053|
14 April 2020
The BBC reporting of the pandemic continues to repeat the question of when the lockdown restrictions will start to be eased. No one has much idea, or if they do, they are not saying. Today there is a big emphasis in the news on the fact that the Government is only giving daily reports of hospital deaths from Coronavirus. They are going to introduce weekly updates on deaths in the community, including in care homes, where fatalities are escalating rapidly. There is growing criticism of the Government’s handling of the crisis, and some talk of the questions that will be asked in the public enquiry that is likely to ensue. For example, I read a good string of tweets yesterday pointing out that the Republic of Ireland shut down on St Patrick’s Day, in the same week that 350,000 people attended the Cheltenham horse racing festival in England. It also pointed out the much lower death rate from COVID-19 per 100,000 in Ireland, compared to the UK. In fact, I read a paper in Wellcome Open Research yesterday, arguing from a mathematical model, that ‘super-spreading’ was more likely the product of large scale gatherings, rather than individual level transmission. The UK was very slow to recognise this.
The notes of the government’s SAGE committee meeting held today give further support to a notion I have developed of ‘one pandemic, many epidemics’. R in the community is highly likely to be below 1 and could plausibly be any value between 0.5 and 1. There is currently significant transmission in hospitals, where R is above 1, as well as a large degree of variation between different hospitals, and there is insufficient data to be able to estimate R in care homes.
Today has seen us return to the ‘new normal’. Dr G left for the hospital at about 8am, MGC settled down with her work at 9.15, and I dedicated most of the morning to reviewing two research grant proposals from colleagues at Dumfries. Washing got done and hung out to dry, we ate lunch just before 1pm and MGC and I then enjoyed an afternoon walk. After that 45 minutes of housework.
Whilst doing the cleaning, and for reasons I can’t explain, I find my thoughts turning to the idea of ‘flashpoints of the social’. In my memory I have always attributed this to Jeffrey Weeks and his work on HIV/AIDS. When I looked it up though, I was reminded that Weeks drew the idea from Jacqueline Rose, who observed in 1988 that ‘flashpoints of the social’ are ‘the very point where reason itself is at its least secure’. It is feeling like that during this month, as we listen to apparently reasonable claims and counter-claims, and even more starkly to the improbable and deeply problematic utterances of the President of the United States.
The social reverberations of COVID-19 are going far, far beyond bio-medical discourse. Commentary on the social dimensions of COVID-19 is now fully into its stride.
This is taking many forms. We see how the pandemic is exposing pre-existing fissures and inequalities in society. COVID-19 creates greater vulnerabilities for the old, for the poor, for migrants and homeless people. It shines a light on the contradictions of globalisation, world travel, tourism and patterns of conducting business. We see moral entrepreneurs, priests, environmentalists, writers and critics (who prophesize with their pens) – all urging us not to yearn to get ‘back to normal’. COVID-19 has introduced ‘the new normal’, and questioned the old one. For these harbingers of change, a future normality may be blessed with many virtues, as we somehow connect with ‘what is really important’. There is a widespread sense of ‘reculer pour mieux sauter’.
The British NHS has been embraced by the nation, and is applauded each Thursday. At 7pm every night, health workers are similarly thanked in New York. Random acts of kindness, everyday heroism, and community spirit pervade our daily discourse. Musicians play from their living rooms and gardens. Virtual choirs are everywhere singing. We seem to be living at least an octave above our usual emotional pitch.
But there are also stories of increased domestic abuse (‘the shadow pandemic’), more calls to helplines, families isolated and in poverty, exacerbations to mental health problems, loneliness and despair. There are reports from Mexico, India and the Philippines of nurses attacked in public places and whilst making their way to work, by those fearful of contagion. Health care workers have been ostracized by neighbours or evicted from their homes.
The newspapers foment moral outrage with photographs of people gathering in parks, sunbathing in public, or otherwise flaunting the lockdown. Italian mayors have been seen in fits of video rage over the numbers of ‘dedicated runners’ that have suddenly emerged in their towns or the rise in home visiting hairdressers. A trip to the supermarket has become loaded with introspection about timings, aisle etiquette, and the rituals of decontamination that accompany the return home.
To act according to the rules of lockdown has become a measure of one’s personal worth. To contravene them is to invite opprobrium. And of course the debate about masks itself unmasks bio-political assumptions, cultural transgression lines and imputations of motive: are we protecting ourselves or those we encounter?
The late Phil Strong picked up much of this in 1990, in what was a first attempt at a general sociological statement on:
‘… the striking problems that large, fatal epidemics seem to present to social order, the waves of fear, panic, stigma, moralising and calls to action that seem to characterise the immediate reaction … since this strange state presents such an immediate threat, actual or potential, to public order, it can also powerfully influence the size, timing and shape of the social and political response in many other areas affected by the epidemic’.
Perhaps even Strong would not have imagined the scale of the social impact of COVID-19, which almost daily takes on new ramifications far beyond the epidemiological and the medical, and becomes like the ghost in Hamlet, a ‘deus ex machina’ for civilisation’s many discontents.
I push aside these thoughts and concentrate on the here and now. The end of the day is warmer and sunny. Dr G gets back from what seems to be an unusually quiet hospital, which is anticipating a surge that has so far not arrived. We spend time in the evening pondering the data from numerous countries, especially the shape of different graphs. If London is near the peak now, Scotland may be also – but at a much lower incidence and a lower mortality. Meanwhile, from the 5pm government briefing, the news is full of the economic consequences of COVID-19, where long term and dire effects are forecast. I guiltily wonder what it will mean for me and my planned retirement.
|New Cases UK||5,252|
|New Cases Worldwide||71,749|
13 April 2020
I sleep well. Shaking off yesterday, I get up in a better frame of mind, make porridge and take a small bowl to Dr G in bed. Then I take a large mug of tea out to my multi-purpose ‘shed of dreams’, put Bill Frissell’s ‘Good Old People’ on the system and attempt to decorate an egg. I come back in and everyone else has a go at the breakfast table. I am the only one who chooses a COVID-19 theme. Dr G’s Minion is the best.
At 11am we FaceTime our friends T and J, who are on lockdown in Lancashire, but fortunately are able to walk out of their house each day and trek up into the Pennine Hills, behind them. They tell us how they have found and visited for the first time the memorial to a Polish pilot who crashed his American plane there in World War Two. We run through other examples like it that we know and wonder just how many dead pilots and crashed wartime planes are scattered across the British Isles, hidden in woods, on fell and mountain, or deep in lake and loch. Or perhaps like in Sheffield, in an urban park where the descending plane narrowly missed a group of boys out playing football.
I have long worn the ubiquitous Barbour jacket, beloved of country dwellers, but I have never aspired to any product made by luxury designer label Louis Vuitton. Yet I learn today that both companies are now engaged in the manufacture of PPE. Based in Jarrow on South Tyneside, the redoubtable Barbour company is now making protective gowns for staff in local hospitals. Like its usual products, the gowns are handsomely packaged and contain the royal seal of approval.
In her update today, the First Minister emphasises the increasingly worrying situation, not in hospitals, but in care homes. She promises that better data will be available from later this week. We are all thanked for staying home over Easter, which we did.
|New Cases UK||4,342|
|New Cases Worldwide||76,496|
12 April 2020
It’s Easter Sunday, but hard to feel festive or to feel rejuvenated by the symbolism of the empty tomb. Dr G and I have a pleasant breakfast together. It’s a cold morning with the wind in the north. We enjoy putting out the chocolate for the Easter egg hunt, but just as we leave the house for the hunt with MGC and HS, Dr G traps her fingers in the front door. Very painful. We seem to go through the motions. We make a rendezvouz with the neighbours across the burn. There are nibbles, drinks and some desultory conversation. I have little appetite for contacting people. I send a few Easter greetings but have no particular desire to speak to anyone.
I fall to thinking about that most terrifying of symptoms, which is common with COVID-19: breathlessness. This disease which is borne by our breath also attacks our breathing in a most frightening and distressing way. And yet, as I recall, a popular Easter hymn entreats: ‘Breathe on me breath of God, fill me with life anew’. The words of Edwin Hatch allude to the Book of Genesis, where God formed man from the dust of the ground and breathed into his nostrils the breath of life. They also refer to the New Testament when the resurrected Christ is said to have breathed on his disciples and said ‘Receive the Holy Spirit’. Breath and breathing are redolent with cultural meanings as well as stubbornly physiological in character. Our idealised picture of the good death may perhaps contain the notion of a person quietly breathing their last. I wonder if the COVID death may be the antithesis: people with a new and little understood infectious disease fighting for breath, struggling to stay alive, raging, raging against the absence of breath.
Shaking off such thoughts, we prepare and eat an Easter lunch of roast lamb, with accompanying vegetables and a glass of Fleurie, the wine Dr G chose for our wedding in 2009. We should, like then, have been enjoying a delicious meal with others, in good company. But today the mood round our table is muted. During the day and evening we are constantly looking at graphs and tables showing how the virus is developing in different contexts. I become disillusioned with the relentless media coverage. When it’s all over, will the world have tilted on its axis or will our lives flip back to their usual orbit – the very one which created this pandemic and made it so lethal?
I make a half-hearted effort to watch the film Dunkirk, with Dr G, who is more engaged than me, though the film does look remarkable. I flip back to my novel from the corner chair and half watch at the same time. As the horrors of the cross channel evacuation play out on the screen, the central character in my book One Scheme of Happiness, by Ali Thurm becomes more extreme in her behaviour and appears to be going mad. As Yasmin Gunaratnum once observed: ‘total pain is cumulative’.
|New Cases UK||5,288|
|New Cases Worldwide||85,678|
11 April 2020
There were 2,000 Coronavirus deaths in the USA yesterday, the largest so far recorded for a single country. But Dr G shows me a graph of the Scottish data, that does appear to be flattening. Meanwhile the news is full of injunctions to stay at home, despite the glorious Easter weather which seems to be covering the whole country.
What really strikes me though is today’s issue of the Lancet, which contains an editorial on palliative care and COVID-19. The journal’s cover image is just one stark sentence from the editorial: ‘Palliative care ought to be an explicit part of national and international response plans for COVID-19’. It is a remarkable commendation for a still neglected field. Yet palliative care was not even mentioned in the World Health Organization operational guidance for maintaining essential health services during a COVID-19 outbreak, published a just few weeks ago, on 25th March.
Before breakfast I went outside to discover a wonderful gift of Rowan trees, grown from the berries by our neighbour. After a much needed but not substantial enough shower of rain, I wander out to the garden looking for places to plant them. I have two each of pink, white and red berries and am pleased with the chosen locations, including three right on the edge of the burn at different points.
It is so hot that we can have lunch outside, lolling there afterwards into the afternoon, reading, dozing, playing the guitar (I am working rather hopelessly on ‘Heard it Through the Grapevine’). MGC and I knock a tennis ball across our little net, and walk the dog around the garden, watching him swim in a deep pool in the burn, easily encouraged there by casually thrown twigs.
I read two new pieces on bereavement in the pandemic, published yesterday and both from the USA. Clea Simon, in the Harvard Gazette observes how COVID is derailing grief in the context of attenuated funerals, the need to focus on the mundane new challenges of daily life, and above all our isolation from others. All of these are effecting how we mourn. Alone, we don’t deal well with grief. It is difficult to imagine the burden of pent up sorrow, unexpressed feelings, stories left untold, lives not properly celebrated. Writing in Rolling Stone magazine, Elizabeth Yuko describes the aftermath of her mother’s death, which took place a few months before the pandemic hit. Spending time together during hospice care, having the opportunity to say farewells, and then to mourn following established funeral practices, all experienced then, are all now denied in the pandemic. For Yuko, who lives in the Queen’s district of New York (‘the epicenter of the epicenter’) the contrast with the new situation induces a sense of guilt. Death is now everywhere, but all support mechanisms are stripped away. For some the pain of earlier losses is re-opened, and for those newly bereaved, they are grieving the loss of a loved one, but also a normality that is now torn from us.
A further dark side to the pandemic is gaining attention – the rising level of domestic abuse as families and households are kept confined and previous risks and ill treatment become amplified. Domestic abuse services are to receive an additional £2m and the Home Office has launched a new support campaign. We are being encouraged to take part in the government’s campaign by sharing a photo of a heart on our palm in the window and by using #YouAreNotAlone on social media.
The pandemic is becoming heavily populated with signs, symbols and slogans that shape its meaning, mould our responses and govern our thoughts and actions.
|New Cases UK||5,233|
|New Cases Worldwide||89,657|
10 April 2020
Good Friday. We are awake at 5am and drinking tea. It’s a beautiful morning. San Francisco style, the hazy cloud soon ‘burns off’ to reveal a sharp, clear day that gradually drifts into gentle warmth.
The sky is empty of aircraft, but the bustle of the farm that surrounds us still goes on as usual, perhaps even more so as work goes ahead to cut down diseased larch trees, repair dry stone dykes and free up blocked ditches. We too busy ourselves around the domain. Dr G paints a metal love seat on the terrace, I water recently planted trees and shrubs, haul out newly cut down holly branches and sow peas and coriander in pots. The dead hedge continues to diversify and I am delighted to see a wren busily checking it out as a nesting prospect. Birds abound in the garden as never before. I am not sure why. Mice too – they come out in the bright sunshine, apparently with no fear of danger.
The First Minister’s daily briefing, always delivered with calm compassion by Nicola Sturgeon, is particularly detailed today. For Easter weekend she stresses that nobody should be travelling, unless it is absolutely essential. She makes a particular point about travelling for holidays or to second homes in rural or island communities. These areas may be less populous, but they are especially vulnerable to the impact of the epidemic. She makes the situation crystal clear: ‘All of us need to continue to do the right thing – and follow the guidance. Every day we do that will bring us closer to a return to normality’.
Scotland is preparing for a potentially overwhelmed NHS by building the Louisa Jordan Hospital at the Scottish Exhibition Centre (known as the armadillo) in Glasgow. Over the past week, more than 20,000 square metres of flooring have been laid at the new facility, which will provide 300 extra hospital beds, with the ability to expand to over 1,000 if required. The current hope and expectation is that the temporary hospital will not need to be used, but it will put the country on a high state of readiness. I decided to look up Louisa Jordan, a name I had not come across. A nurse from the west of Scotland, she enlisted with the Scottish Women’s Hospitals for Foreign Service in December 1914. The following year she was in charge of a typhus ward during the Serbian epidemic. She died of the disease in March 1915 but is remembered for her determination and effectiveness – two qualities of which we are much in need at the moment.
By evening we sit outside by the firepit, field glasses and accompanying bird book to hand, amateurishly seeking to spot, name and salute the songsters that chorus around us.
|New Cases UK||5,706|
|New Cases Worldwide||85,054|
9 April 2020
It is Maundy Thursday, the Christian holy day that commemorates the washing of the feet of the apostles and the Last Supper. I mainly think of it, recalling a memory from childhood, as the day the monarch gives specially minted ‘Maundy Money’ to elderly people, pensioners.
With the Easter weekend almost upon us, I am pondering on a little book I produced with Dr Cicely Saunders, called Watch with Me. The idea for the book came after Dame Cicely gave me a copy of a lecture that she had given at Westminster Cathedral in June 2003 and asked me if it could be published somewhere. I reviewed it with interest but concluded that it would be better as part of a small collection of similar writings. I read through her relevant past publications and identified four other pieces that I thought worked together in a complementary way. Surprisingly it turned out that they were each written in a different decade, from the 1960s onwards. Dame Cicely was happy with the choice, so I set up a small imprint to publish the collection privately, took the cover photograph myself and designed how the book should look. It came out in 2003 and over time two full print runs were sold, of about 3,000 copies in total. It has since been translated into nine languages and the English version is now available free online.
The eponymous opening chapter is taken from a talk given at the AGM of St Christopher’s Hospice, in 1965 – two years before the hospice opened and became a beacon of inspiration for many others near and far. It is about foundations – material, practical and above all the foundations of care, taken from words spoken by Christ in the Garden of Gethsemane. Subsequently, ‘watch with me’ has become synonymous with the idea of accompanying a dying person in the last days of life.
Until now I hadn’t realised on just what a slender edifice Cicely Saunders’ idea of ‘Watch with Me’ is based. I have been doing some digging and it seems the phrase only appears in one of the four Gospels (Matthew) and it is absent from some editions, such as the New English Bible. I need to explore this in more detail, including a return to Cicely’s relevant texts. I am no expert on exegesis, but it looks like an even more marked form of the ‘total pain’ phenomenon, that she also conceptualised, whereby an idea of hers takes on legitimacy and salience, despite rather than because of the detail of its articulation.
I work in the morning and give feedback to two colleagues on separate papers we are writing together and then catch up with one of my part-time PhD students. SG is the CEO of a hospice and is clearly busy at work, though they have seen no COVID cases so far. He reports that his team is feeling very positive about the challenges they face, albeit tempered by a degree of fear about the risks.
There is an interesting paper in the journal Nature today from a group of authors in Oslo who are part of an initiative called the Coalition for Epidemic Preparedness that is summarising progress on vaccine development for COVID-19. In a process of unprecedented rapidity, the first candidate vaccine, I learned, entered human clinical testing on 16 March, less than five weeks after the publication of SARS-CoV-2, the Coronavirus that causes COVID-19. As of yesterday, 78 confirmed active vaccine projects were underway, 73 of which are in the exploratory or pre-clinical stages. Five projects are in clinical development and in phase 1 trials. A variety of platforms are in use, including DNA and RNA. The authors note that some platforms may be best suited to specific population groups, such as older people, children or immune-suppressed groups. The biggest group of active developers (46%) is US based, compared to 18% in Europe and 18% in Asia. Nineteen countries are represented in the active group, with no current information on vaccine development from Latin America or Africa. Most striking are the public-private partnerships that are present, as well as the speed of development, which, the authors speculate could lead to early use of vaccines by the beginning of next year. It seems a long way off, but may well break all records if achieved. Let us hope so.
Meanwhile I spot more commentary on the wearing of masks. The practice is still not endorsed by WHO or Public Health England. Yet mask wearing has been widespread in Asian countries since the start of the pandemic and is recommended by the Centers for Disease Control in the USA. The editorial acknowledges that there is very little evidence about the benefits of masks outside of clinical settings, but concludes: ‘As we prepare to enter a “new normal,” wearing a mask in public may become the face of our unified action in the fight against this common threat and reinforce the importance of social distancing measures’. In a related article Trish Greenhalgh and colleagues recommend the wearing of masks as a ‘precautionary principle’. So far and on my limited excursions into public places, I have observed only very few people with a face mask and they tend to stand out. But how long before the opposite is true? Social distancing is something most of us are learning to practice. It becomes a shock if a person gets too close in the supermarket, on walks we see people standing back from the track to let others pass, or tracing an exaggerated curve as they plot a course that will maintain the two metre distance (quite a long way in fact) between us.
In the afternoon I catch up with an old school friend, who calls from Shropshire to touch base. Members of a cohort that started grammar school in 1964, we are in very intermittent contact – the last time we spoke was late December 2018. He seems well and appears to think they are somewhat sequestered from the virus in a mainly rural area. We think the same, but for how long one wonders?
After the call, Dr G and I tackle an overgrown section of the garden, albeit an area never fully incorporated, down by the burn. It could be lovely but we need to be realistic about how much it is possible to tame it in the short run. But with its mossy stones, leafy path, ferny and arum clothed patches, it holds great promise. It is a Japanese garden in the making. Then it’s more mundane tasks, such as planting lettuce, sowing spinach and watering the newly planted beech hedge.
Yet the day feels unsettled. This is our holiday, but we all seem to be working from home in some way or other. Above us hangs a cloud of uncertainty. Dumfries and Galloway has not yet had the predicted surge. Will it arrive and all the preparations be vindicated? Or will it be a false dawn leaving everyone with a sense of confusion, even bathos? It is 100 days ago today since the first cases of Coronavirus were reported in Wuhan, China.
In the evening we are down by the burn again, saluting the NHS. I find a harmonica to add to the general racket that we manage to kick off each Thursday evening at 8pm. I am not sure how long we will feel up to this orchestrated demonstration of the conscience collective.
Boris Johnson is out of intensive care.
|New Cases UK||4,675|
|New Cases Worldwide||82,837|
8 April 2020
My mother was born on this day in 1923: Ethel Spavin. She grew up on the north side of the river Tees in North East England in an industrial community created around salt mines and chemical works. My mum had three sisters and two brothers, one of whom died in infancy. When World War Two came, her father was relocated to the ICI plant at Heysham in Lancashire, taking the whole family with him. This did not deter the romance that was by then developing between my mother and Joe Clark, an apprentice painter and decorator who was soon to enlist in the Royal Marines. They married in January 1943 and she lived the rest of her life in dad’s home town of Thornaby-on-Tees, where I was born a decade later, the youngest of three sons. After my father died, mum moved into a small flat, living independently for 15 years until shortly before her own death at North Tees Hospital on 23 April 2010, sensitively cared for by the staff there, latterly on the Liverpool Care Pathway – an end of life care intervention that I continue to teach and write about in various ways.
Several times recently I have thought of my dead parents and what they would have made of our current situation. Perhaps they would have recalled stories from their own parents about the ‘flu pandemic at the end of the First World War. Or looked back on their own fears of diseases like diphtheria and polio, transmitted like Coronavirus, by respiratory droplets. For the latter years of his life my father took a good long walk each day, across his home town and out to Basildon Woods, with its heronry, on the banks of the Tees. Today he would doubtless have been out there among many others, taking a scheduled dose of lockdown exercise and escape from the confines of home. Paradoxically, in her own later years my mother left behind a gregarious outlook and gathered herself into a form of self-isolation, content to retreat into an introspective world, telling me once that she didn’t fear loneliness, only dying alone. I feel sure she would have looked COVID-19 in the eye and been entirely fatalistic about it.
Today I am up at 5am, unable to sleep because of pain in my hip. One week after visiting the doctor I am improved, but the initial rapid change has not been sustained. I’m hoping the warming weather is going to make a difference. I do some ironing whilst listening to the Today programme on Radio 4. Boris Johnson is still in intensive care.
Before breakfast I take a look at a paper by two members of our Mitori Project team, which brings together early career researchers from Japan and the UK to examine end of life issues in the two countries. They are writing about ‘lonely death’ or ‘kodokuschi’ as it is known in Japanese. In its most stark manifestation this is seen when a person dies entirely alone, unbeknownst to others and whose body is not found for perhaps many months, sometimes semi-mummified by the time of discovery. Deaths of this kind are occasionally reported in the British press, but are a much more widely known phenomenon in Japan. If this is a stark, even now still uncommon, manifestation of isolation and loneliness in society, the underlying notion of ‘social death’, articulated by Mike Mulkay in a book I edited in 1993 seems much more pervasive. I think of social death as a state in which one’s life becomes of diminishing relevance to others. Our current state of lockdown seems set to exacerbate such a condition.
Wuhan, a metropolitan area in China of around 11 million people and the apparent source of the new Coronavirus, has today been released from a lockdown that began on 23 January, when the central government imposed movement restrictions there and on other cities in Hubei, affecting a total population of about 57 million. The goal was to quarantine the entire region in which COVID-19 had originated, with almost everyone confined to their homes. How long it will take to return to some level of normality after 76 days of stringent constraints – for example the schools are still closed – is anyone’s guess. Official figures indicate that something like 2,500 people have died from the virus in Hubei. But in the present climate of suspicion about China, of which the United States President is a key source, it is hard to know how much public confidence there is in the published ‘facts’ or their consequences.
There are growing concerns about the slow rate of testing for COVID-19 in the UK. Last Saturday the Matt Hancock, Health Secretary for the Westminster Government, now himself recovered from Coronvirus infection, published his already trailed plans. They are described as five ‘pillars’. The first pillar is about boosting existing swab testing by Public Health England and NHS labs for patients and frontline workers in the NHS. The second pillar is the creation of new swab testing capacity delivered by commercial partners. The third pillar is the development of antibody tests, designed to detect if people have had the virus and are now immune. The fourth pillar is surveillance through population surveys involving antibody tests, to establish incidence and prevalence. The fifth pillar is the most ambitious and provocative and involves the rapid creation of a large diagnostics industry (which apparently we currently lack) to ‘ensure we can get tests for everyone who needs them’. A target has been set of 100,000 tests per day by the end of the month. News media and opposition parties are checking daily on progress towards this figure, with dark warnings that it will not be achieved. I suspect we will see similar forced partnerships between venture capital and public health in the future, not least in relation to vaccine development.
One target that has been met is the completion of the Nightingale Hospital, which is now up and running in the ExCel London exhibition centre. The work was done in just nine days. Bringing together the army, the NHS and the private sector, the one million square foot conference space has been transformed into the largest hospital in Britain, with potential for up to a mind-boggling 5,000 beds across 78 wards. It has also brought in furloughed cabin crew staff from Easy Jet and Virgin Atlantic, to change beds and assist with related non-clinical duties. The nurse who gained experience in the Crimea from 1854, transforming the charnal house and insanitary conditions of the military hospital at Scutari, and going on to revolutionise education and training in her field, is being remembered once more as we brace ourselves for a surge that could overwhelm NHS capacity to respond. The naming of the hospital affords a curious mixture of jingoistic colonial symbolism, militaristic associations and enduring public health messages. Other Nightingale ‘field’ hospitals seem set to follow elsewhere, though perhaps with different names in the other jurisdictions of the United Kingdom.
Here in Scotland, Glasgow is our New York City, perhaps the epicentre of our national epidemic. Official figures out today from National Records of Scotland (NRS) show that as of 5th April there had been 354 deaths where COVID-19 is mentioned on the death certificate. Greater Glasgow and Clyde accounted for 122 of these deaths, followed by adjacent Lanarkshire with 48. Orkney’s island health board is the only place to have no COVID deaths so far. The first COVID death to be recorded in this way occurred in Scotland on 16th March – already feeling like aeons ago. Perhaps most interesting in these latest figures is that the number of all deaths recorded for the week ending 5th April was 1,741 – up 662 on the previous week. The report notes that over the last five years, deaths in Scotland in this week have averaged 1,098. So we are looking at a massive spike. What might be going on here? Unrecorded COVID deaths, excess mortality resulting from a failure to get life-saving or life-prolonging treatment due to limited access to mainstream medical services, or perhaps even an aversion to seeking help in the time of pandemic? These NRS figures give a more nuanced picture than the daily Scottish Government briefings provided by Health Protection Scotland which report COVID-19 deaths only where the person has had a positive test in the previous 28 days.
Commenting from Edinburgh, Devi Sridhar writes another excellent article in the Guardian. She takes the view that ‘the months ahead will involve a fragile balancing act between the interests of public health, society and the economy’. This will make global inter-governmental co-operation more vital than ever before. There will be two sides to the challenge. First, in the production of a vaccine, antiviral therapies and rapid diagnostic testing. Second, in manufacturing sufficient doses, distributing these fairly and equitably, and ensuring they reach everyone who needs them around the world. I fear that the second challenge – and particularly fairness and equity – may prove far greater than the first. I would wager that the hard science of discovery and vaccine formulation will prove less taxing than the soft science of implementation, logistics and roll out.
I turn my gaze to the beautiful spring day. Leafless trees around the perimeter of the garden stand out in their grey prison pallor against the steel blue of a sky, flecked with white cirrus clouds like fragments of torn surgical gauze. Around a corner, a Magnolia Stellata, about nine feet tall, is in full white blossom, magnificent testimony to the small dormant stick, bought impulsively years ago at a supermarket checkout. White is the predominant theme of the garden day. Green-white hellebores dip their shy faces from the sun, mop-head primulas sit blowzily at the edge of the pond, white trilliums make a tentative appearance under woody shrubs, delicate epimedium petals emerge the moment your back is turned; and aberrant hosta leaves, rolled white, surface from a deep winter covering of leaves, for all the world like blanched asparagus.
After lunch, Dr G who has been helping MGC with her maths this morning, takes a holiday nap and I snooze in the sun – very restorative. At the end of the afternoon four beautiful Japanese maples arrive from the local garden centre. We enjoy placing them carefully in the borders for subsequent planting. A further addition to my Japanese garden ‘turn’.
JW is an exceptional postgraduate student of mine. From a background in literature and medical humanities he is doing great work on Cicely Saunders’ notion of total pain, a subject that has long interested me. He reads widely and draws deeply on literary sources. Today, unbidden, he has published an excellent piece on our group’s blog. JW takes us back to Daniel Defoe’s Journal of the Plague Year, fictionalised and set in 1665, it describes the experiences of ‘HF’ in London, as contagion sweeps across the city. There are weekly bills of mortality reporting the numbers who have succumbed, people walk in the middle of the street to avoid one another, and fear of the plague spreads faster than the contagion itself. JW begins by highlighting the ‘unprecedented times’ through which we are living now, but quickly reminds us of significant parallels with the past. What a privilege to work with such talented young people.
|New Cases UK||5,865|
|New Cases Worldwide||73,639|
7 April 2020
I am up early with an aching hip. Take the dog for a walk, make our morning tea, and then do the ironing whilst listening to Radio 4. The government isn’t saying much about the Prime Minister’s condition (‘he’s not on a ventilator at the moment’; ‘they have marvellous doctors and nurses in St Thomas’s’) but the fact that he appears to have got worse in hospital does say something. Meanwhile Dominic Raab is in charge – we think.
As the day goes on there is very little news of the PM. ‘He is a fighter’ says Raab, injudiciously implying that those who have died so far were not. And we are told he has had some oxygen, but does not have pneumonia. Meanwhile, I read harrowing accounts from NHS tweeters about multiple deaths on the wards and final communications with relatives via iPads and tablets. Yet here in Dumfries and Galloway it remains strangely muted.
On Twitter I also spot that the clinical staff at the hospital where my father died in 1993 are all wearing a quite large photograph of themselves on their lanyards – giving patients and family members a chance to see what they look like, when PPE obscures their faces. It’s a nice but of frugal innovation.
A report from the Australian Broadcasting Corporation (an interesting source for international news, as Dr G often points out) paints a bleak picture of the current situation in the United States. The number of people known to have died from Coronavirus is now in excess of 10,000, but that looks like a serious underestimate. Next week is going to be ‘our Pearl Harbor moment’ says one health care worker. At the same time there is still no uniform platform for reporting coronavirus-related deaths in the US and the reality is that many states have been unable to categorize deaths as COVID vs. non-COVID. New York City is the epicentre and here the sheer pressure of numbers is making it difficult to gain additional data for death certification purposes.
Then I come across a scorching piece on a platform called Spiked, by the columnist Rob Lyons. It’s entitled ‘The hypocrisy of Catherine Calderwood’. In addition to some witty jibes, the article makes a more serious point. First there is the frank duplicity of her actions – she had even visited her holiday home the previous weekend, in March, suggesting a careless pattern to her pandemic discretion. But second, is a point about public health messaging. Rob Lyons agrees with her that visiting the coastal getaway was absolutely the right thing to do, and potentially, would have harmed no one. The trouble is that the rest of us are not allowed to make such judgements for ourselves. As he puts it: ‘Unfortunately, that’s not what the rest of us plebs can be trusted to do. We can’t be relied upon to get as far as the local park without infecting people left, right and centre. We, the dim witted masses, collectively no brighter than a low-wattage light bulb, are potentially causing carnage by lying on a bit of grass in a public place … In the eyes of public health, thinking things through for yourself is a thought crime’. The article, I am afraid then goes into a wider and Neanderthal anti-public health rant that doesn’t bear repeating. Yet a good point has been made in this particular instance.
I am curious too about the gendered aspects of the commentary on what I am now thinking of as ‘Caldergate’. It is clear that the CMO’s husband was with her on the trip to Fife, but there is apparently no mention of his misdemeanour. So who is the spouse? It turns out he is one Angus London and the couple married in St Giles Cathedral, Edinburgh last September. In fact yesterday The Times reported that he too had been reprimanded by the police for the weekend trip to Fife and had made a public apology. After working for the Ministry Defence for 34 years, London became the executive director of St John Scotland in 2015. According to its website the charity’s ‘teams of members, volunteers and supporters across the country run projects which help save and enhance lives every day’. Neither of these goals were prominent for the charity’s boss last Sunday, it would seem; but no resignation is forthcoming from him.
Away from Coronavirus, I have today (holiday working!) completed the first full draft of the LCP international review. It looks pretty smart. I consult with Wellcome Open Research, who come back quickly with good advice about how it might be published.
Dr G bakes bread and a beautiful Quiche Lorraine. We eat well at lunch and dinner and after the former, sit in the sunshine on the terrace, me reading a book called Swimming Home. Deborah Levy’s novel is atmospheric, set in the south of France where a very English party of friends and relations are sharing a villa for ‘the summer’. Do people do such things? The hot weather and languid pace of each day combine to make a perfect setting for inter-personal cracks and tensions to emerge. But things only get worse when a besotted fan of the writer in the party turns up to fatal effect …
I make an email order with the Loch Arthur Community food store. This wonderful social enterprise is part of a residential community caring for people with learning difficulties and complex problems. We often go there on a Saturday for breakfast and then stock up on their extraordinary bread, vegetables and cheeses, produced on site. Since the lockdown they have rapidly switched to ‘click and collect’ orders, as well as letting just three people into the shop at any one time. I am concerned for Loch Arthur and hope it will be resilient enough to see its way through the present crisis – protecting everyone in the community and continuing to run the farm, cheese making and the shop. Already the locked down and closed café has been turned into a store-room for the preparation of orders.
On the telephone, I get through to the local garden centre. They normally have 60 staff across their three local outlets, but are down to six family members at present. This is where the Coronavirus Job Retention Scheme, comes into play – commonly known by the previously unfamiliar word ‘furlough’, which we all now bandy around at will. Backdated to 1st March, it pays 80% of salary, up to a maximum of £2,500 per month, to those who can no longer work because of the pandemic. At the garden centre, a member of the skeleton staff takes my order and offers delivery tomorrow or the next day. Again, they have flipped their business model. In the classic busiest month for gardening, they are supplying their customers direct to home.
Later in the afternoon, assisted by HS, who digs out the contents of one of the compost bins, we plant potatoes in a raised bed. It’s a lazy method which brings good results. Sprouting potatoes from the kitchen vegetable rack are carefully laid out on top of the soil. Those from Loch Arthur are excellent for this purpose as they are grown organically. We then gently cover them over to the depth of about 15 inches with a rich layer of garden compost. If the latter is still a bit lumpy, no matter, it will soon break down. We look forward to eating the first of the crop in early July. It seems a long way off at present.
When the lockdown came on the horizon, for some reason I got my lovely Froggy Bottom guitar out of the case where it has languished for years and brought it into the sitting room. Sitting handsomely on its stand, it would at least prove decorative. Then my stepson AS introduced me to GuitarTuna, an excellent tuning app that is so much better than the battery driven tuners of yore. Now perfectly in tune, and with my E string dropped down to a droney D, I pluck away most evenings and am thoroughly enjoying my return to the fretboard. I am not worthy of my beautiful ‘parlour guitar’, but given time, who knows?
Music practice over, we settle down to watch The Bookshop. I read Penelope Fitzgerald’s novel a few summer’s back whilst we were on holiday in Aldburgh, Its melancholic themes of local myopia, power, exclusion and sheer vindictiveness are compelling. The film is beautifully done, and the leading figures exquisitely cast (Emily Mortimer, Bill Nighy and Patricia Clarkson). In its understated but grippingly dramatic conclusion, Florence Green the bookshop owner, sees all she has worked for consumed in flames on a funeral pyre of thwarted dreams. Our only reservation was that it wasn’t filmed in the glorious Suffolk light and landscape within which it so eminently belongs.
|New Cases UK||3,888|
|New Cases Worldwide||68,766|
6 April 2020
It was announced 10 days ago that the Prime Minister, Boris Johnson (I find it hard to type that sequence of four words) has Coronavirus. Since then he has been running the country in his ever more shambolic fashion from self-isolation inside 10 Downing Street and via Zoom meetings. Now we learn that last night he was admitted to St Thomas’s Hospital, where he is apparently doing well and seemingly still in charge of the government. It is a mess of historic proportions wherein we all suffer from his earlier reckless behaviour, inappropriate hand-shaking and failure to socially distance or mitigate. Now the country is being run, not from 10 Downing St, but from a hospital bed in St Thomas’s, London. But there is no need to worry, his hospital admission was only a ‘precautionary step’.
It is just two weeks since Johnson addressed the nation on TV and announced the monumental changes we are living through. I can still picture the horrible close up of his panic stricken eyes as he blustered and auto-cued his way through a pre-recorded speech that put the UK into ‘lockdown’ – unless of course you want to go out for a run, a walk or a cycle, or to buy food and medicine, or go to work if you are an essential worker. Boris Johnson blows hard – but lacks gravitas, sincerity, truthfulness or wisdom. The reality is that his Coronavirus strategy has little coherence and lurches from one recommendation to another, depending on which government minister is speaking at any given time.
The daily briefings exemplify this.
Today the Foreign Secretary, hard Brexiteer and all-round right winger, Dominic Raab leads the show. He is flanked by the Chief Medical Officer, Chris Whitty (newly returned from self-isolation after experiencing COVID symptoms), along with Deputy Chief Scientific Adviser, Angela Maclean. They are gathered in a panelled room in Downing Street, with the Union flag on prominent display. Stilted and bland, Raab seeks to reassure us the Prime Minister is ‘in good spirits’ and ‘continues to lead the government’ from his hospital bed, having been admitted there, we are told once again, as a ‘precautionary step’.
Raab reads mechanistically through the government measures, which are based on ‘following scientific and medical advice and … taking the right measures at the right moment’. We are exhorted to ‘stay at home, protect the NHS and save lives’. Meanwhile moves are underway to procure more ventilators and protective equipment, increase the number of intensive care beds, support local businesses, and to bring home stranded British nationals. The death toll from COVID in the UK has now reached 5,373. Maclean speaks naturally, though number 10 seems to be without a podium from which the speaker can advance the slides herself. She begins with a startling graphic showing the rapid decline in the usage of all modes of transport since the first week in March. We are clearly not moving around much at the moment, especially on public transport. She claims that the efforts to control the virus are working. The growth in numbers is less than would have been expected without the measures, she says, presumably based on scientific modelling, though she then concedes that it is too soon to know the effect of the recent restrictions.
In the questions, the journalists coming in remotely and crackly from broadcasting studios as well as their own homes, press for information about when restrictions will be eased. Though the peak is expected next week, there is still no robust mechanism for testing and tracing. Whitty emphasises the repercussions beyond increased mortality from COVID-19. These include other emergencies that fail to get a timely response because of system pressures, deaths resulting from delayed diagnosis of treatment (in my view the example of delayed cancer diagnosis is the most likely contender here) and also the more generic effects on mortality among poorer people whose situation is worsened by income loss resulting from the economic effects of the pandemic.
All of these incredibly complex factors are delivered to us in simplistic sound bites. The journalists want to know why the Prime Minister is still running the government. We are placated by Raab and Whitty, who tell us benignly that Boris Johnson is taking the advice of the excellent clinicians at St Thomas’s Hospital. Somehow, I don’t feel calmed by this.
We now know that around the world there have been 1,302,421 confirmed cases of Coronavirus and 71,958 deaths, with 273,859 people ‘recovered’. Dr G checks worldometer every day. It is a good source for global information and country breakdowns. The USA heads the league table, but close to the top there are some small countries like Portugal, Switzerland and Austria. Everyone is looking anxiously for the curve to start flattening. People are wondering how long the lockdown will last. I am beginning to wonder how long the lockdown will last.
To distract my thoughts, I indulge in more gardening – hoeing and weeding, re-potting big plants, and generally clearing up. I need to find my bank card reader so that I can enter more fully into the age of electronic finance. No one wants cheques these days, even cash is currently unwelcome.
We take the unusual step of watching Channel 4 News. I find the sheer weight of commentary, news stories and narratives is overwhelming. What is there left to be said in the pandemic of discourse that is enveloping the pandemic of disease?
Despite that, I’ve started listing a number of themes that emerge in my mind as the days go by and in conversation with Dr G: 1) the drive from so many sources to produce specific guidance on care for people infected by COVID-19 – and in particular the palliative care guidance 2) the emerging stories on social media about personal experiences of Cornavirus infection, especially those of clinicians, and the palpable sense of fear they contain 3) the practice of layering (for example, four escalating ways to administer oxygen) and what might be called ‘multiple triaging’ (for example, phone 111 and get assessed, if necessary then given number for local COVID hub, call that and be assessed again; if necessary arrive at COVID hub at a given time, be met by a chaperone and then assessed face-to-face, before either i) get sent home for self-management ii) be referred to usual assessment centre iii) be assessed in COVID context by specialised team and finally 4) the sense of how the virus is changing the face of dying and specifically (as CC says) is reformulating the practice of palliative care.
One further trope I have detected is the notion that, even in the midst of our social distancing and by staying at home wherever possible, there is a paradoxical suggestion that we are becoming more connected than ever, by social media. In the face of catastrophe and as the resulting stratagems force us to isolate for one another, we turn yet more to new technologies that foster inter-relatedness. An example I’ve noticed is the way musicians are appearing everywhere online. Take the great Highland fiddler, Duncan Chisholm, whose Strathglass CD trilogy (Farrar, Cannaich and Affric) is a moving and reflective musical representation of the ancient Chisholm clan lands. Now, using the hashtag #COVIDCeilidh, he is embarked on a daily tune on Facebook, sometimes indoors, sometimes outdoors. Today his offering was an invigorating march in 2/4 time, Captain Carswell, written by the piper Willie Law (1881–1916) of Ballachulish.
I may not get to check it out but I gather that another favourite musician of mine, Richard Thompson is doing a You Tube concert at 9 o’clock tonight. Since I was at school and bought my first Fairport Convention album, I have long admired his narrative song writing skills and unique style of acoustic and electric guitar playing. He has moved from California to New York recently I believe. But I still remember a surprise visit he made to my Aberdeenshire croft, in January 1984, brought there by a neighbour of mine Marc Ellington, who sang on a Fairport album and who had known him for years. Curiously (since Richard had converted to Islam in the 1970s) they were on their way back from the early service in the local Episcopal Church. The lesson from that Sunday morning was, if you are going to be visited out of the blue by a long-time hero, try not to be in your pyjamas and dressing gown at the time. Closer to the moment, MGC is playing the piano as never before. Receiving her lessons by Facetime and doubled up to twice a week, she even composed her first tune today. I must re-double my own guitar efforts. After much practice, a performance each day via Twitter would be possible – but extremely repetitive!
Reported COVID deaths today in the UK go over 1,000 for the first time. HS comes into the sitting room around 8.30 in the evening and announces that Boris Johnson has gone into intensive care.
|New Cases UK||4,143|
|New Cases Worldwide||77,198|
5 April 2020
MGC brings us lovely toast and jam in bed. By mid-morning the sun is out and catalyses a burst of activity. Outside, with a power hose (always addictive to use) we rehabilitate garden furniture and paving slabs from the incursions of winter weather. Inside we mop, polish, wipe-down surfaces, and throw out unwanted items that have sat around for years. When the wider world is full of stress and torment there is a strange urge to purge, purify and polish in the private sphere. The results are pleasing and we admire our efforts, before pressing on to even more. It is as if we are preparing our home as a moral shield that will protect us if the virus strikes.
Dr G goes briefly to the hospital. While she is away I manage to sneak back to the LCP journal article that is in preparation. There is something exhilarating, slightly worthy, but also liberating about doing a bit of creative academic work on a Sunday morning. But for work-related, uncreative non-academic chores, the reverse undoubtedly applies.
Afterwards it’s into the garden. I plant Christmas Roses, the white hellebore, gathered up from a winter display and now finished flowering, along with three pots of locally grown alliums recently purchased. Later there is sowing of salad seeds in handsome wooden claret boxes that I sometimes manage to acquire (empty) from a special source – today I have two exceptionally good chateaux from St Emilion! These go into our little summer house, which has been partially repurposed for food production. After lunch we sit and chat with our neighbours across the burn. Then feverish activity is renewed – wood stacking, plant re-potting, sweeping up and mulching (my stepson HS proving very handy with the wheelbarrow for this). Clothes are hung out to dry, windows are opened, and there is genuine warmth in the windy air.
I see on Facebook that Gustavo Simone, a palliative medicine colleague in Argentina, has produced palliative care / COVIID-19 guidelines with his group Pallium Latin America. They have devised a protocol for the pandemic called Activemos Un Cuidado Humanizado (AUCH!) – ‘let’s activate humanised care’! The initiative came about when Gustavo’s team heard the story of Alicia, a woman recovering from COVID, but with severe complications. She received high-flow oxygen therapy and medication that contributed to her physical improvement, but only found comfort when a nurse gave her the iPhone to communicate at a distance with her pregnant daughter and grandson. Sharing a brief prayer together was healing for her mind and spirit.
These international medical networks, facilitated by social media and web-based communication, are fuelling a remarkable exchange of ideas, knowledge and experiences. They are by no means confined to the sometimes idealized compassion of the palliative care field. I heard recently that one of the reasons that ICU units around Britain have geared up effectively in their preparations for COVID-19 is because they quickly tapped into an existing professional network, long established through conferences and journal publications, across Europe and beyond.
Then the big news of the day hits us.
Scotland’s Chief Medical Officer is Catherine Calderwood. I first learned of her soon after her appointment in 2015, when she started to champion the notion of ‘realistic medicine’. This approach is predicated on having a sensible and practical idea of what can be achieved or expected in healthcare and on representing things in a way that is accurate and true to life. The goal is for all aspects of health and social care to be delivered in this way, in particular, delivering care in a way that is right for the person and their family and takes into account their priorities. It is a viewpoint that has met with a lot of interest. More recently the Chief Medical Officer has become known to a much wider public through her regular, it has to be said, rather anaemic, exhortations at briefings and in dolorous filmed announcements, to ‘stay home, protect Scotland’s NHS and save lives’.
Yet today, we learn, Dr Calderwood has been cautioned by police after travelling from Edinburgh to spend the weekend at her second home in the East Neuk of Fife, on the north side of the Firth of Forth. The Scottish Sun got the scoop and reveals that yesterday she was pictured ‘44 miles away from home, walking with her husband and children near their coastal retreat in posh Earlsferry, Fife’. The whole thing seems to reek of privilege and a sense that there is one rule for the establishment and another for the rest. At a daily briefing with the First Minister in the afternoon Calderwood makes a public apology, but thereafter Nicola Sturgeon responds to most of the questions directed at the CMO, still seeming to show continued confidence in her, but acknowledging that the rules are the same for everyone. Dr Calderwood is soon wickedly parodied by Scottish comedian Jane Godley, who in a broad west of Scotland dialect over-dubs the CMO’s speech, admitting she was ‘right out of order to go to the caravan at Girvan’ (a somewhat less salubrious destination) and confessing she is ‘pure sorry’ about it all.
Bristling with indignation about Dr Calderwood’s actions, we sit down to a dinner of Boulangere potatoes served with confit de canard, from a can bought in a French hypermarché, some years back and just about to reach its sell by date. It’s a delicious meal, with a glass of red wine, followed by a rhubarb cobbler, made by MGC. Yes, I know, our own lockdown also reeks of privilege.
At 8pm we watch the Queen’s address to the nation and I find it oddly moving, particularly the flash back of a photograph showing her and Princess Margaret speaking to the nation from the same desk at Windsor, during World War Two. I don’t like the Monarchy and think it should go. The extended family and so-called Civil List is a nonsense. But paradoxically and perhaps irrationally I have respect for the Queen. Once again tonight, she gets it right and makes a difference with her carefully chosen words.
By bedtime the Chief Medical Officer for Scotland has resigned.
|New Cases UK||6,199|
|New Cases Worldwide||82,123|
4 April 2020
I am awake early and walk the dog in a grey Spring mist. No sign yet of warmer weather. The trees are etched, leafless against a skyline that is disrupted by occasional corvid squabble and their echoing, jangly noise. The dawn is pussy willow grey, but without the softness. Yet it’s Saturday and feels leisurely and there is enough of it ahead to return to bed with mugs of morning tea and no need to get up for anything in particular.
Thus disposed, we do our best to feel ‘on holiday’, here at home in Nithsdale, part of the old county of Dumfriesshire. Dr G, ever the spotter of interesting places to stay, had booked this week in a holiday cottage in the Angus Glens of North East Scotland, and we were going to be joined there by our friends T and J. A chance to see the local Pictish standing stones at Aberlemno, eat a Forfar bridie, drop in on family members in nearby Dundee and visit the V&A. All abandoned now. But there is little room for disappointment, still less for self-pity, when we have the good fortune to live in such a place as this, surrounded by the garden and then copses, fields and forest, leading out to open moor.
After breakfast I venture out to sow salad seeds, but it feels too cold to proceed. My garden helper, AK, arrives and we discuss various jobs, including the ‘Japanese turn’ I am planning, with more moss, stones and acers. He seems enthused and I loan him a book on Japanese gardens that has been inspiring me of late. Hurried gardening has been my practice for years, fitted in amongst a list of ‘daily tasks’ dominated by my work. Maybe the lockdown will also be a slowdown. Since I made an academic visit to Japan last December, working with the philosopher Professor Hirobumi Takencouchi, and learning from his thinking on life, death and – yes – horticulture, I have felt drawn to the reflective aspects of the garden. I am taking time to look more carefully, and to be ‘in the moment’ when something is observed, and perhaps even understood, in a new manner.
I see from an email that my dear friend and colleague in Spain, CC and his team, have produced Version 4 of their palliative care guidance in the context of COVID-19. It’s already a document of 40 pages covering the classic palliative care areas of communication, symptom control, attention to the family and to children, delirium, sedation, attention at the time of death, and self-care of the professional. It is all contextualised for the time of COVID. As before, I rapidly share it with Scottish colleagues, who are eager to learn from contexts where Coronavirus deaths are already at very high levels. In fact, COVID deaths in Spain are now falling, at 670 today from a peak of 929 on Monday of this week. Let’s hope that will continue.
I get through to CC on his mobile. He has been redeployed to work in Madrid but is in good spirits after a few days of rest and is now driving back to his base in Pamplona. The situation in Madrid is like nothing he has seen before. The small 50 bed University of Navarra hospital in the capital has been turned into a 200 bed facility – entirely for people with Coronavirus. CC’s role has been looking after the sickest people and those who are dying. In his touchingly halting English, he tells me about the severity of the symptoms, the sudden and very rapid decline of the patients and the restrictions and challenges of communication with the family members. ‘The patient is alone, exhausted because of the virus, very, very tired. Unable to express the deep existential suffering that is experienced. Short of breath but with less anxiety or anguish than it is usual in chronic or terminal disease. And the professional and the family are far away, very very far (too far!) by mandate’. It is palliative care as never seen before. Now he will bring his expertise to the University Hospital in Pamplona, in anticipation of a surge there. He feels very supported by his networks of friends and colleagues in various places. His own health is good but he reports that in the Madrid hospital, the director, pharmacist and other senior people were all sick with the virus. Palliative care is being changed by the situation, he says, and when it is all over everything will be changed. I ask if there is anything I can do to help. ‘Can you pray?’ he asks.
My father’s funeral took place on this day, 4th April, in 1993. His death came less than 10 years into his retirement from a lifetime’s work as a painter and decorator and just a few months after he and my mother had celebrated their 50th wedding anniversary. After weeks in hospital following an aortic aneurism, he died messily in a renal unit with none of his family present. Assembled for a dying man’s vigil, we were ushered outside at one point to allow a ‘shift’ changeover. When we returned my father was dead. I found him behind a screen, lifeless, bloodied and grey. We never knew whether someone had switched off his life support, or whether as Dame Cicely Saunders was fond of saying, we had to go away to let him leave us.
Coming out of the hospital that night, the consultant, rather didactically I thought, told us to remember him as he had been in his living and not in his dying. So it was fitting that the Saturday of his funeral in 1993 co-incided with the running of the Grand National steeplechase, at Aintree. My dad loved a flutter on the horses, though he never studied form in depth. Each Saturday he would go over to the bookmakers to put on a series of doubles and trebles, and the even more complex ‘Yankee’. This bet is a four selection wager consisting of 11 elements: 6 doubles, 4 trebles and a four-fold accumulator. It’s said to be named after an American soldier in the UK who once placed a small wager, which due to the multiple roll-over mechanics at work won him back hundreds of thousands of pounds. My dad’s five pence Yankees were just such a gamble, though I don’t ever remember him winning on one.
On the afternoon following his funeral, my two older brothers, our mother and me gathered in the family home in Thornaby-on-Tees for the Grand National. I don’t recall us betting on the race, perhaps out of a sense of decorum, but at the appointed hour we sat around the TV for what was to be the 147th running of the race. ‘It’s what dad would have wanted’, we perhaps thought to ourselves, though no one said it. Certainly though, some mischievous spirit was at work. A series of blunders at the start culminated in 30 runners eventually setting off, not knowing that nine others were left at the tape, and a false start had been declared. Many of the 30 went on to complete the course, but to no avail. The race was declared void and was not re-run. It was pilloried as a ‘shambles’ at the time.
I haven’t thought about any of this much in the 27 year interim, until today when the 173rd Grand National was due to take place. But of course, the race this year has been cancelled due to Coronavirus restrictions. In the absence of the real racecourse action, the drama is to be played out in some curious computer simulation, the outcome of which will be determined by a set of ‘special algorithms’. I guess my dad would have been completely perplexed by the prospect of this and would have turned instead to the football pools for his afternoon entertainment.
But here’s the thing. A company called Randox was sponsoring the Grand National this year – a global healthcare enterprise dedicated to ‘disruptive diagnostics’. What a co-incidence that Randox is also a partner with an integral role in the UK government COVID testing programme. In fact, last month, Randox was awarded a £133m contract to produce the testing kits for England, Wales and Northern Ireland. There was no external or competitive tendering process. Stranger still that Health Secretary Matt Hancock is also a keen amateur jockey, and is MP for West Suffolk, home to Newmarket racecourse, where he is a regular attender. Of course these connections also raise questions about how the decision was made last month to proceed with the Cheltenham Festival of horse racing, which took place 16-19 March, just days before the lockdown began. More than a quarter of a million attendees flocked to the Gloucestershire event. Not surprisingly, it looks like the Festival will turn into a Coronavirus ‘super spreader’ event of no mean proportions. Stories of high profile racegoers who developed COVID-19 symptoms after attending the Festival are already appearing in the press, and the Festival organisers are even now responding to criticisms about why the Festival went ahead at all. I suspect more stories may yet emerge. It’s a shambles of incomparably greater consequence than that of the Grand National ‘false start’ in April 1993.
In the evening we have an excellent curry in the dining room. Eating there together every night is a good ending to the day and brings a sense of calm and order. Far from CC’s description of ‘the chaos, stress and fear.’
|New Cases UK||4,000|
|New Cases Worldwide||78,995|
3 April 2020
After breakfast I join a University staff meeting, with 50 people on Zoom. It seems to go quite well (significantly more people attending than usual). All the talk is of a switch to blended learning, with a much greater emphasis on remotely delivered classes and lectures. At the same time the message is ‘we are not the Open University’. The School of Interdisciplinary Studies at the Dumfries Campus of the University of Glasgow, where I am based, is now locked up and off limits. I gaze at the faces of colleagues on the screen, sitting in their homes, searching for answers to questions, which when forthcoming, then subtly shift from day to day. In an academic year that is already winding down, the focus is on assessments, protocols and mitigations in a context where no in-person examinations will take place. It is unlikely there will be any graduation ceremonies in a few months’ time. Looking ahead, and if the pandemic continues to unfold, will new students want to come to university in the autumn, and in particular what will be the situation for those outside the UK and beyond the EU, whose learning comes at a high financial cost to them and generates such significant income for us?
I see that the Scottish guidelines on palliative care and COVID-19 have been published, and will be updated on a weekly basis. They begin with the noble sentiment: ‘The palliative care community will stand with those who are facing suffering related to any illness, those who die during this pandemic, those who face bereavement and all who provide care’. But the core of the matter is the relief of suffering among those dying from COVID-19 lung disease. For these people there is the possibility of severe symptoms and a rapid, distressing decline. Responding as early as possible is key here, but the list of likely symptoms is frightening: high breathlessness with ‘air hunger’, high distress, high delirium and agitation, high fever. The guidelines are packed full of detailed information that could be invaluable to clinicians on a steep and demanding learning curve in the care of those dying from COVID-19. The recommended drugs, dosages and methods of administration are laid out meticulously. But there is also reference to simple, non-pharmacological approaches. Though fans are not to be used, reducing room temperature, removing excess bedding, and cooling the person’s forehead with tepid sponging (if personal protective equipment is available) may all be beneficial. If the guidelines contain such jarring phrases as ‘risk of cessation of life over a short number of hours’, they nevertheless are a vital source of information in a pandemic where palliative care teams will be stretched and health care workers of all kinds will be involved in caring for people who are dying from COVID-19. I know how hard colleagues in the palliative care community are working to prepare and maintain such material and to learn from fellow clinicians in other places. Last month I was able to mobilise my international networks to get information and feedback from professors of palliative medicine in Spain, Italy and the USA, which was then passed through to colleagues in Scotland. It is odd to feel moved and humbled by a set of ‘guidelines’, but we are so fortunate to have the expertise and resources to make them available.
In a local news report from BBC West of Scotland however, it is not the clinical symptoms that sit in the centre of the narrative. The widow of a man who has just died from COVID-19 tells how an NHS doctor wept over the telephone when telephoning to explain that her husband was dying. There followed uncertainty about whether she could visit in hospital, until finally this was permitted, subject to full PPE being used. Minutes after her husband’s death a nurse visibly pulled back when just about to comfort the newly bereaved woman. The first days of widowhood were spent in self-isolation, unable to be with her adult children to share in their loss.
At some point in the day I also read a sad and thoughtful article on the BBC news website about two doctors from Sudan working in the British NHS. Dr Amged El-Hawrani and Dr Adil El Tayar are the first two doctors in practice in the UK to die from the virus. Amged was based in Burton-on-Trent and Adil in London. Both worked as surgeons, Adil in transplantation and Amged as an ENT specialist. Amged endured almost three weeks of high-tech Extracorporeal Membrane Oxygenation (ECMO) treatment, an advanced type of mechanical life support, before the machine was switched off and some of his children were allowed to be at the bedside as he died. Adil was ill for 11 days and died on a ventilator, watched by his children from behind a glass screen. Adil’s family believe he was ill- equipped at work, and became infected due to a lack of protective equipment. The provision of ‘PPE’ has been described by the Health Secretary Matt Hancock as ‘one of the biggest logistical challenges of peacetime’ but, as we saw last night, his rhetoric is shaky.
The sociologist Yasmin Gunaratnum, writing in Discover Society, has already commented on the issue of health care workers dying from Coronavirus, highlighting the over-representation of those from migrant backgrounds. She draws attention to this ‘perverse subsidy’ whereby the NHS depletes the healthcare capacity of poorer countries. Further afield, there is more ‘unmasking’ of the health inequalities revealed in the pandemic. It is increasingly seen in the USA that COVID deaths are spiking disproportionately among black and brown communities. Illegal ‘redlining’ of poor areas, environmental racism, the wealth gap, are all exacerbating health problems. ‘Inequality is a comorbidity’, writes member of the House of Representatives Alexandria Ocasio-Cortez to her 10 million followers on Twitter. Meanwhile today in the USA at a press briefing in the White House, the President states: “The C.D.C. is advising the use of nonmedical cloth face covering as an additional voluntary public health measure. So it’s voluntary. You don’t have to do it. They suggested for a period of time, but this is voluntary. I don’t think I’m going to be doing it.”
In the afternoon I meet up with my colleagues in the Glasgow End of Life Studies Group, on Zoom. I am delighted to hear that, despite all the uncertainty, the position of an early career member of our group is to be made permanent. After our various updates, an interesting conversation surfaces on writing about the pandemic for wider audiences. I make the point that these days every social scientist is a journalist and every journalist is a social scientist. If we are to say interesting things as social scientists, there has to be a storyline to what we write, as well as an academic perspective.
There is much to be learned in this context from the writing of someone like Arundhati Roy. Today my stomach lurches and my heart aches as I read her new piece in (of all places) The Financial Times. She begins with the unfolding catastrophe in the USA, which she follows each day in the briefings of the governor of New York State. She then turns her gaze to her own country. Arundhati reminds us that as growing global concern about COVID-19 was mounting in February, Donald Trump and Narendra Modi met together in India for a carefully choreographed series of image-bolstering mass events and mutual ego-affirmation. Otherwise detained, it was not until 19 March that Prime Minister Modi first addressed the people of India about the COVID-19 crisis and urged them to come out on their balconies on 22 March to bang pots and pans and salute the health care workers of the nation. Then on 24 March he suddenly announced the lockdown of the whole country, which would start within a few hours. As the wealthy looked to their own sequestrated interests, the poor took to the roads, spilling out of the cities to return home, now less concerned about the virus than about further impoverishment, starvation and police violence.
Arundhati packs so much detail into a short piece, leaving my academic-self feeling leaden, ponderous and lacking acuity. She describes how the virus has followed the networks and trade routes of the world’s industrialised nations, and paradoxically, has brought capitalism to a ‘juddering halt’ in the process. This brings opportunity as well as threat. She portrays the pandemic as a portal. We can choose to walk through it, dragging with us the dysfunctional elements of neo-liberalism and greed, or go with a lighter step, ready to re-imagine and to create a different kind of world.
It is a structural and ideological position that contrasts sharply with the idealised and individualistic homiletics that are springing up everywhere. These focus on injunctions to be kind, to slow down, to think and feel differently. Worthy in themselves, I nevertheless find them unlikely to be sustained or world changing.
In a bid to make the transition to our ‘holiday’ next week, I go out into the garden in the late afternoon and attend to the ‘dead hedge’. First seen on a TV gardening programme last winter, this contrivance consists of tree branches, as thick as your arm, hammered into the ground in parallel, half a metre apart, and between which all manner of woody material can be layered and inter-twined. Today I have a large bundle of beautiful, newly cut green and red dogwood stems for this purpose. The task could not be simpler and yet the results are disproportionately satisfying. The dogwoods look stunning, rippling in and out of green fronds of yew, pine and laurel trimmings, and slipping smooth-skinned through twigs of hornbeam, birch and oak. As I proceed, I find a wren’s nest from last year and am watched by a frog protruding in perfect disguise from the damp vegetation on the ground. I am so glad I discovered the dead hedge. Despite its morbid name, it is replete with life and comprises a beautiful, environmentally friendly multi-level apartment block for birds, bugs and small creatures of many kinds. I find solace in an eco-system, however small, that is apparently working to mutual advantage for all its inhabitants.
|New Cases UK||4,672|
|New Cases Worldwide||76,190|
2 April 2020
Dr G is hugely impressed with the birthday bouquet, and photographs are duly taken for social media. I have bought her some handmade clay pots, which are also well received, already planted with violas. It’s a good start to the day, with second mugs of tea all round.
Over our porridge we listen to Radio 4 and later I tweet the following:
‘Professor Paul Cosford on @BBCR4 today politely highlighting the excellence of our medical science in tackling #COVIDー19 – & by implication (to this listener) the incompetence of a govt led by posh journalists, grubby businessmen & their ilk. & I don’t usually do political tweets’.
Lots of people seem to agree with my sentiments. Paul Cosford has an incurable cancer and has come back to work for Public Health England as ‘Emeritus’ Medical Director. He speaks eloquently on the radio and is completely informed on the Coronavirus issues. His defence of his colleagues is robust and his silence on the government’s response is absolutely deafening. I discover that today he is also blogging about his personal experience. He writes as calmly as he speaks, describing his reaction to the ‘shielding’ which he must now undergo as a result of his condition. The changes imposed on him are not because his cancer has worsened: rather they are to reduce his risk of contracting Coronavirus, even though as a trained doctor he wants to play his part in the pandemic. So he settles for working from home, playing his part as best he can.
In February 2018 I was in the same room as Paul Cosford, at a meeting of the Royal Society of Medicine on the future for assisted dying. He spoke movingly of his own diagnosis, his discovery that palliative care specialists could offer him help and support right through the trajectory of his illness and treatment, but his settled conviction that if assisted dying were legal, it would be his preferred way to die. Whether or not you agree with that sentiment, there is no doubt that people of such integrity are badly needed as we navigate the threats of the pandemic and anticipate the rising death toll that it will bring.
Meanwhile, my own new medication, for a problem far less serious than Paul Cosford’s, seems to be working, and the back pain is already gone. MGC and I work through the morning, sitting opposite each other at the dining room table, as we grapple with our second week of ‘home schooling’. She has a mixed agenda of maths, science, reading, drawing, and later on, outdoor activities. I concentrate on a paper about the international spread of the Liverpool Care Pathway (LCP) and should have a hefty draft ready to send to my co-authors by Friday. MGC is working on electric circuits and seems fully wired.
The anticipated COVID onslaught has not yet reached us in Dumfries and Galloway and, according to predictions, may not arrive until the week after next. For no informed epidemiological reason, but influenced in my thinking by our small and scattered rural population, patterns of dispersed habitation in the countryside and the continuous presence of open spaces and fresh air, I am beginning to consider there will not be a major crisis here. Why I should think this puzzles me, for today Johns Hopkins University in the USA reports that there are now 1 million recorded cases of COVID-19 infection around the world – that’s double the number from one week ago – and 50,000 people have died from the virus. But the beleaguered health secretary Matt Hancock, shows how far across the statistics he is, when stating on Newsnight that ‘some nurses’ have died from Coronavirus, only to be interrupted by Dame Donna Kinnair, Head of the Royal College of Nursing, who tells him that such numbers are not even being counted at the moment.
Death academic Kate Woodthorpe, writing in the Independent today takes up some of the implications of the pandemic. She outlines the death denying society we have become in the presence of medical progress and the absence of global war and explains that our death complacency, born of progress, is now unravelling in the face of COVID-19. She urges us to consider our mortality, think about the rituals that will mark our passing, whilst at the same time making the most of our lives. It feels like a slightly opportunistic piece. I reflect that death is always ubiquitous, but now it seems fully exposed.
Dr G gets home about 4pm and goes through her now established ‘decontamination’ ritual, entering by the back door, where all bags are left, placing her clothes straight in the washing machine, and then taking a shower. The morning sees the same thing in reverse. It is a daily rite de passage of the kind once described by the anthropologist, van Gennep. The three parts commence with a ritual of separation on leaving for work and then of reincorporation on returning home. In between lies a period of dangerous liminality when the usual rules may be suspended or inverted, where there is uncertainty, displaced norms and yet also the prospect of creativity and innovation. Grandly put, that liminality is exactly what people like Dr G are encountering everyday as they work in the healthcare system. They are on the margins of the unknown, with shocks and surprises at every turn. Meanwhile, for me and my ilk who are working from home, we grapple with the known, the familiar and the domestic, trying to see our way through the quotidian world of domestic lockdown, and just maybe, gain some new insights in the process.
Our home is in Kirkmahoe, a parish in Dumfries and Galloway. It contains the settlements of Kirkton, where the main church is located, as well as Dalswinton (which has its own beautiful wood-lined tin-church, painted red) and the hamlet of Duncow. The name Kirkmahoe commemorates St Kentigern, the patron saint of Glasgow. Mo Choe is the Gaelic equivalent of Mungo, the so-called Cumbric diminutive of Kentigern. The name Dalswinton contains the Old English place-name swīn-tūn ‘pig farm’, to which the Gaelic dál, meaning ‘haugh or water meadow’, has been added. In the year 2010, I started up a series of local non-profit music events that have been running ever since, and called the enterprise Kirkmahoe Concerts. It has a nice ring to it, but as attendees have learned, the concerts can be hard to find, even for locals. ‘Kirkmahoe’ appears only on specialist maps and its name is absent from all road signs.
Though sunny today, there is still a bitterly cold wind blowing from the East. In the early evening we drink a half bottle of champagne by the woodstove, to celebrate Dr G’s birthday. It’s followed by a pleasant mash-up meal of various bits and pieces hot and cold, which everyone enjoys. At 8 o’clock we join the collective zeitgeist and go out to applaud the NHS, making a huge socially distanced racket with our neighbours across the Pennyland Burn that runs between our gardens, banging pans and drums, in a reverse charivari. Rough music of celebration, not blame.
|New Cases UK||4,522|
|New Cases Worldwide||72,846|
1st April 2020
This All Fools Day starts badly. I feel unwell and have wrestled and turned through a sleepless night. I have pain in my right hip, going down into my leg and up into my back. A conversation ensues in which my wife, Dr G, tells me I really must contact the GP, something I had not even contemplated in the current circumstances of the COVID-19 pandemic. She reminds me that primary care services are still available, and then heads off for a day on the frontline in the local hospital.
I telephone the surgery, and get straight through to the receptionist. To my astonishment she offers me a telephone consultation for 40 minutes hence. Dr W calls promptly, I go over my prepared history of problems and he asks me to come straight in to see him. Thirty minutes and one dystopian drive later (the roads are eerily deserted), I am on the couch and the said doctor is manipulating my leg. He thinks there is arthritis in the right hip and it is quite bad. He prescribes some suitable medication and explains that I will need an X ray as soon as the current situation is eased. He speaks of the possibility of surgery but adds ‘that should be delayed as long as possible’.
He intends no irony, but I suspect it may be a long time indeed before I reach secondary care. The hospitals are already largely cleared of non-urgent patients and much of the clinical workforce has been re-deployed to COVID-19 related activities, with backlogs elsewhere the inevitable result. I am not surprised with the ‘diagnosis’ however. These problems have been grumbling away and gradually getting worse for most of a decade, but it is a blow, just as I am preparing to ease out of the world of paid employment. I suppose I have had a good run, medically and haven’t had surgery since I was 11 years old and had a tumble from the pommel horse in a school PE lesson.
I drive home from Dumfries into the back roads of Nithsdale, crossing small bridges over shallow burns, the route weaving through rolling drumlins left here by the last ice age. The fields are green as new peas. I love this place and have put down deep roots here. At many levels it is no hardship to be confined in its under-stated landscape, one that brings rich rewards from careful observation. So I resolve to keep this journal going for a while, at least for this month. It can be a chronicle of sequestered living, enforced through the co-incidental pincer movement of pandemic strategy and personal mobility restriction.
It already seems a long time since 23 March when Boris Johnson announced this ‘lockdown’ through which we are now living, though I have noticed that the Westminster Health Secretary, Matt Hancock, claims to have trumped that with a statement he made in Parliament on 16 March to the effect that all un-necessary social contact should cease. We don’t seem to have an official definition of ‘lockdown’, though we are already using the term quite freely. What it means though is that across the UK: working from home where possible is now mandated, schools are closed, and apart from key workers, everyone must stay at home, leaving only for daily exercise and food shopping. The country is living under an unprecedented level of constraint on individual freedoms, perhaps even greater than in wartime.
In Scotland, tradition has it, April 1st is the day for hunting the Gowk, the cuckoo. There is something of this in the way the university world is seeking to maintain a ‘business as usual’ attitude as the pandemic rages around us. As in the All Fools tradition, it feels like we have been sent a collective letter from the university authorities, which when read aloud by the recipient will portray us all in a foolish light: ‘dinna laugh, dinna smile, hunt the gowk another mile’. I take up the injunction and after one of our already ubiquitous Zoom meetings, quickly get back to some of my research work, pressing on with the chase for the academic cuckoo.
As a medical sociologist, I have a special interest in end of life care. So these days, and following a successful blog I published with my colleagues less than two weeks ago, I am scouring the sources for new writing on COVID-19 and palliative care. At the moment not much is turning up, though I suspect that will soon change. This afternoon however I discover a newly published piece on equity and ‘COVID palliative care’. Written by two Canadian nursing academics Erin Donald and Kelli Stajduhar, who work in the inner-city. It forecasts how those already socially disadvantaged will be among the hardest hit by the Coronavirus. Erin and Kelli catalogue the challenges: people in poverty living with compromised immune systems, where physical distancing and regular hand washing are hard to realise, short on family and friends to support them, limited at every turn as other mainstream support services are held back by new restrictions or have closed their doors. This account of people at high risk of contracting COVID-19 and getting very sick, unable to self-isolate and with an increased likelihood of dying is a welcome example of more socially aware palliative care commentary that is thankfully increasing. COVID-19 is pressing the case for a greater focus on equity, fairness and looking ‘upstream’ at the lives of those who may need palliative care services, and should not be left behind. But the challenges are enormous.
Dr Devi Sridhar, Professor of Global Public Health at Edinburgh University, was clear from mid-January that the COVID-19 outbreak in Wuhan must be taken seriously by everyone. Since then she has been speaking truth to power with a growing audience and, among many salient points, criticising the UK government for its slow response to the pandemic. Today she writes in the Guardian that the lockdown is only a means to buy time while we race to catch up with the important work of mass testing, say 75-100,000 people per day. This should focus on those presenting with symptoms and then tracing all their contacts. All those testing positive should then go into quarantine, leaving most of society and the economy ‘to continue on a somewhat more “normal” basis’. Without a data-driven approach, she argues, we face over the next year a continuing cycle of ‘lockdown and release’. It’s a dismal prospect.
I’m relieved when my thoughts are pulled elsewhere. Our daughter MGC, age just 11, decides to pick flowers and twigs from the garden to make a surprise bouquet for her mum’s birthday tomorrow. She and I slip outside on the pretence of a dog walk, concealing our secateurs. A botanical treasure hunt ensues. Withdrawing to the garden shed, we inspect and arrange our gleanings. For half an hour we are in a florist’s shop of activity. We have gathered daffodils and narcissi, bare dogwood stems in red and green, hornbeam in deep-lined leaf, as well as delicately flowering camellia and magnolia. We have twine and scissors and our fingers contort to control disorderly stems into a ‘hand tied’ bouquet of rustic appeal. Soon MGC is fully in command. The shape is there and seems to be holding, so much so that she feels free to expertly move a twig here and a flower there, bringing the whole thing into a green, yellow and white arrangement of informal balance.
It’s a delight. So this is what the commentators are saying about finding new and simple pleasures in the teeth of lockdown. Simple enough, yes, if you just happen to have a garden of your own that is bursting into Spring as together, and lovingly, you celebrate a family birthday.
|New Cases UK||4,567|
|New Cases Worldwide||72,737|