Life & Death – Coronavirus week 5 – what’s the next step?

An uncertain timescale, and new ways of working.

As the total passed 20,000 this week I fear the announcement of a high number deaths in the previous 24 hours is becoming part of our daily routine. I had some favourable comments about last week’s blog on statistics and am grateful to our son David for sending a publicly available link to the NHS Statistics site that details how these are compiled and it is at;

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/

David pointed out that the term ‘daily death toll’ is misleading as they are compiled from a series of numbers, some of which can be from a few weeks before. If you want to see how many have died in your local hospital trust these are on the different sheets in the spreadsheets.

The daily briefings are now showing some of the additional community and care home figures, which increases the totals. There has also been a discussion this week on how exactly registrations of death in the community are classified. The new guidelines allow for dying of Covid-19 or dying with Covid-19 and having one of the reasons as ‘pneumonia-like’ symptoms.

Looking at the current versions of the Johns Hopkins charts from last week’s blog, there is not really a definite ‘plateau’ in the figures, never mind any sign of a decline.

Unlike the virus, the shock of a high number of daily deaths appears to be something we are becoming immune to. Chief Medical Officer (CMO) Professor Chris Whitty suggested the current measures might need to be in place until the end of the year. The situation has been compared to a war, and in my less optimistic moments I worry that like the First World War when the ‘experts’ of the time, the military analysts, declared it would be ‘over by Christmas’, we will need to come to a more realistic appraisal. The first few months of the Great War were characterised by patriotic parades, rousing speeches, a general call to arms, volunteering and government spending. After Christmas, however, when it was clear that the proposed strategy of a short campaign followed by bringing enemies together to negotiate, was not working, countries had to change their economies and society and put them on a ‘war footing’ for the long-haul. Most of the time, however, I am optimistic that we can see out the current ‘war against an unseen enemy’, and a return to ‘normal’ is on the horizon.

No one wants to think of this war going on for a few years and our government having to borrow over 25% of Gross Domestic Product (GDP) annually, as happened in the two wars, compared to the short term 15-20% our chancellor has sanctioned so far. In the two wars GDP increased due to more production of munitions and uniforms etc. There is already some increased activity in sectors of the economy such as supermarkets, food manufacturers, logistics, suppliers of PPE and the pharmaceutical sector supplying medication and carrying out testing.  The problem (as it was during the previous wars) is that much of this expenditure is government-funded and needs to be repaid at some point.

An increasing theme of questions to ministers at the daily briefings, and from some of the government’s own MPs, has been a desire to talk about the plan to get out of lockdown.  The week started with former prime minister Tony Blair’s Foundation the Institute For Global Change producing an outline 10-point plan for how this might happen. It uses a ‘traffic light’ system of the metrics that would allow certain activities when an amber stage is reached, and more when a green might follow. If infections, hospitalisation and deaths start to climb again, it allows for a red stage and return to lockdown.

Nicola Sturgeon Scotland’s First Minister released a similar document to start what she called an ‘adult discussion’ about the gradual release of restrictions.  For example, on how schools might have to be adapted to keep social distancing measures. One of the opposition parties in Scotland claimed that this was as much to do with trying to have a separate track from the UK government, and to steal a march on the ‘English Parliament’, as it is a real attempt to plan.

We had an idea of how releasing the lockdown might look after I joined an ‘on-line queue’ last Sunday to place a small order with DIY retailer Wickes. We had a text on Tuesday when it was ready to collect. Alyson drove to an empty car park where a member of staff brought the order out and put it to one side for her to place in the car. It was so long since Alyson had been out that the car clock was an hour behind. Alyson was so excited that in a Shirley Valentine moment she said, ‘hello car, it’s been a long time, how are you doing?’

It may be that any retailer that wants to re-open, must think about making such adjustments and change the layout and operate a queue and collection system. As our good friend David said during a Skype call ‘every shop will be like Argos’. Talking to my brother-in-law Paul, on a Zoom call for Friday evening drinks, about Jaguar Land Rover (JLR) planning to restart production at two of their car plants, he said they will have ‘re-engineered’ the line. Paul knows about such things having been involved in similar plans before retirement. Instead of having two or three people working on the cars as they go down the line, the engineers will be changing the order and reprogramming the robots used to allow the build to continue within the ‘social distancing’ guidelines. Whether there will be the customers to buy the finished vehicles is a different question.

The UK is fortunate to have some really educated and clever people working in our small and large private and public enterprises. We must hope that, like JLR, they will have been working on ways to ‘re-engineer’ what they do in a ‘post-pandemic’ world. Some of these changes may have been the way to improved productivity anyway, and the space and time during this outbreak was needed to get them implemented. Other businesses less able to adapt and change and whose business model was not ‘fit for purpose’ will disappear.

Apparently a group of experts are meeting with the various sporting bodies to determine how the leagues and events might resume in May/June. There is talk of playing behind closed doors with safety measures in place for players/officials and broadcasters. I will return to this topic in the coming weeks, after more details are released. For now, I am curious how a game of football will look if players must keep two metres apart and the ball must be wiped down with sanitiser after every header or a throw by the goalkeepers!

For me the first few weeks of lockdown has brought an increasing number of video calls. Two months ago I knew about Skype, but Zoom was a new product to me. Such is the growth of this platform that, like Google, it has gone from being a noun to a verb quite quickly. We now say we are ‘having a Zoom’ with a colleague or we say we have ‘been Zooming our family’.  Looking back I have had 16 such meetings in the last fortnight and a few more 1-2-1’s helping people setup Zoom. This week we had our first ‘virtual coffee morning’ with members of the head injury charity I am trustee/volunteer for. Given one of our aims is to reduce the social isolation of people who suffer such injuries, I have no doubts that this is an aspect of our work that will continue whenever the situation gets back to ‘normal’. It was a wonderful time of sharing for the ten of us on the call from all over Cheshire.

Technology is another sector of our economy that is booming as people need to be setup for working from home. Some of this business-to-business (B2B) spending is from the private sector so, even if it is funded by borrowing, is adding to our GDP.

Another crisis in the nations’ health being stored for the future?

After last week’s headlines about the current crisis in the care sector, this week doctors leaders and Sir Simon Stevens, Chief Executive of the NHS, highlighted a fall in general attendance at hospitals and GP surgeries. There could be people who need on-going treatment for heart conditions, cancers and other serious issues not getting these. People showing other serious symptoms of stroke, early-warning signs of cancers are choosing not to get checked out. 

Related to this is the mental health of those who are isolated or trapped in homes with an abusive partner or parent. The increase in retail sales of alcohol, the boom in business for wine delivery merchants, some of which is the result of the closure of pubs and restaurants, should also be an area of serious concern.

Alyson and I are blessed to live as a couple with all the interaction that brings and so far are generally getting along amicably! I saw a piece on one of the news channels about the lack of ‘human touch’ that is becoming a real problem even for those who wouldn’t normally classify themselves as ‘touchy-feely’ types. This could be something as simple as a touch of a hand when upset or a hug with a child or grandchild. One new grandparent said, hopefully semi-seriously, ‘well perhaps I will get to see them before their first day of school…’

My thoughts have been with a church friend who lives on her own following the death of her husband last April. This lack of touch is becoming a real problem for her. She had to manage the anniversary of her husband’s death on her own, without the special touch from her son who lives 150 miles away. Her daughter lives in Australia and has a son who was born a few days after her husdand’s death. So she couldn’t even share a first birthday cuddle with him, just a ‘virtual cuddle’ via the ‘FaceTime’ app on an iPad.

Other news this week.

  • Not a new item but a ‘correction’ from two weeks’ ago when I stated that the birds were singing more loudly as a sign of new life. During one of our virtual coffee chats with friends David and Janis, they sent a link to some research showing that the decibel volume of birdsong has actually fallen. This is true particularly in urban areas and near airports as they don’t have to compete with the ambient background traffic noise anymore.
  • This week a potential vaccine against the coronavirus was injected into a human in the first stage of a trial. The remarkable speed at which this has happened is a chance for some optimism, but the scientists tell us that it will take months for any useful results to be available and analysed. In the rush to get this game-changer out to the world, great care needs to be taken to be sure that there are no side-effects that could make the harm done in the long-term far greater than the deaths of the outbreak.
  • The science needed to understand vaccines and terms like re-infection rates, on-going immunity, blind trials, cohort selection, existing morbidities, aggravating factors etc are not simple. I tried to resist mentioning President Trump again this week, but his suggestion of injecting or inhaling disinfectants to ‘clean out the virus in a minute’ was not only dangerous but showed a complete lack of any of the science on which his experts have briefed him. I do think this quote, and his subsequent attempt to pass it off as sarcasm towards the reporters in the briefing room, will be seen as a ‘game-changer’ in the longer term. The idea that a President who has any sort of basic education is unable to see the difference of putting a powerful chemical on surfaces such as metal, porcelain or man-made plastics is no different to the delicate structure of skin or the inside of a human lung is frightening. It is like a parody of the story of ‘The Emperor’s New Clothes’ or in this case ‘The President’s New Coronavirus Treatment’ where everyone else can see it is completely ridiculous idea, but the person elected to lead thinks it is a brilliant one. Will any of his advisors or leaders in his administration have the courage to criticise him in public?
  • There was some ‘outrage’ that Richard Branson would apply for a loan from the government to support his airline Virgin Atlantic. It was pointed out that he has a lot of personal wealth and despite putting his private island (valued at ‘only’ a few tens of millions of pounds) as an asset against the £500Million loan, his press was not favourable. I can see the need to support his employees in the UK, but this is one example for the government and big businesses to negotiate over. The ownership of the company by one of the major US airlines and the tax regimes they operate in needs considering. Denmark was one of the countries this week to announce that any company that hides some of its tax offshore, without true transparency, will not be allowed a loan.
  • On Sunday morning it was announced that prime minister Boris Johnson had recovered enough from his coronavirus after effects to return to Downing Street and lead the government again. Writing as someone who has also come close to death during a 12-week stay in hospital, my hope is that the episode might have given him a new perspective on what really matters in life. The decisions he takes, the way he views the NHS and key workers, might mean a change in approach.

Thoughts at the end of week 5.

Covid-19 has claimed the life of another person I knew. Sharon was a local church treasurer in our circuit, and we talked at meetings. She had some other health problems, but the loss of any life, particularly from this virus, and the effect isolation has on close family is devastating.

The weather continued to be warm and dry so we enjoyed lovely walks outside viewing plants and wildlife. I went for two more substitute parkruns. The goods we managed to get from Wickes meant we could get on with work in the garden and complete painting the fence.

I have really enjoyed all my Zooming this week, particularly catching up with friends and family for coffee and chat.

Alyson continued learning her new skill of sign language and sewed a mask from cotton material should she need to wear it outside.

My lack of any new improved DIY skill was demonstrated by the fact that it has so far taken me over three hours to put up three simple shelves in our garden shed. The phrase ‘all the gear and no idea’ definitely applies to me. What made it worse was that the neighbour who backs onto our garden has made a whole Japanese design inspired pergola from scraps of wood in the same time. Complete with a decorative hand-carved finial. I looked on with some envy at the way he constructed it and used his power tools and screws in a way that I can only dream of. I will report how long it took to put my final shelf up in the next blog.

Stay safe and let’s see what week 6 brings.

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