from John in Brighton, UK: Final Reflections

Herewith, my final Covid Diary contribution and some disparate reflections on the last 22 months. I am deeply grateful that I have been spared and offer my sincere condolences to the 166,730 who didn’t and have Covid on a death certificate.

If there were an official Covid Society then as a resident of Hove I’d feel affiliated. One of the first cases in the UK was one of our own – a Hove businessman who’d been to a meeting in Singapore, popped in for a skiing holiday on the way home and developed the symptoms of an unknown infection soon after hitting UK terra firma in late January 2020.  All but simultaneously there were a couple of cases in York – Coronavirus was identified and the rest is history as they say. The second Hove link is that in March 2020 Oaklands Nursing Home, just around the corner from where I live, was one of the first in the country to suffer an outbreak in the staff and residents. In July this year it was revealed that four in ten people who had died of Covid in Brighton and Hove were care home residents.

A little over a century ago the world was recovering from the “War to End All Wars” – how fitting that I start to write this on Remembrance Sunday. But one nightmare segued into another as the Spanish flu of 1919 took hold and is now recognized as one of the deadliest pandemics in history.  About 500 million were thought to be infected, roughly 1/3 of the global population. Mortality was of about 50 million, 3% of the world population, which could have been as much as twice the military and civilian deaths combined in the War.

The ensuing century saw medical developments beyond our wildest dreams – antibiotics, scans, intensive care, safe anaesthetics and childbirth and possibly the most important birth of all in 1948 – no, even more important than Prince Charles was our cherished NHS.  It was a privilege to work for nigh on forty years in this jewel of our Nation and breaks my heart to see it creaking towards breaking point. I was shocked recently on phoning my GP for an appointment for a hernia I’d noticed only to be told that I’d be wasting everyone’s time as a decision has been made locally not to offer surgery unless specific clinical features were present – wait for it to obstruct or strangulate or, excuse my cynicism, but sotto  voce I can almost hear “have you considered the private hospital, Sir?” No rationing, my foot!  Or more accurately my groin!  Fifty years ago on a relative pittance of funding patient waiting times and doctors’ hours were long and food topped the whinge list. But it was patient centred with doctors having some say in priorities and before it was subsumed by a management culture with business ethos and becoming a political football. You won’t find a more committed workforce and money has never been the driver but they deserve better than the current offering.

Pandemics would come and go over the century albeit of lesser severity than that of 1919 – Asian in ’57, Hong Kong ’68, Russian ’77 and SARS (corona viral-like Covid) in 2003. The Government to its credit identified the importance of being prepared and between 2015 and 2019 there were eleven pandemic and epidemic preparedness exercises. To its utter shame there appears to have been no actions or measures set in place and seeking further information is impossible as they are treated as “top secret”.

Despite this Matt Hancock claimed that projects like Exercise Cygnus looked only at flu pandemics and coronavirus is different. The medical profession retorted that some transparency and scrutiny should have been applied and the MERS exercise would have been highly relevant to the current Covid-19 outbreak. Top secret not, failure in duty of care and keeping citizens safe – Government’s first priority – seems more likely and hence the cover-up. That lack of preparation catalysed a domino effect of disaster and failures. Insufficient PPE, shortage of testing equipment, discharging the vulnerable elderly to care homes where the virus lurked was like lambs to the slaughter and Boris the libertarian delaying lockdown with an enhanced death rate in consequence.  But not to worry as the deaths were essentially “all over 80” and he wanted it to “wash through the country” – Boris lingo for cleaning out the nursing homes, maybe. Had he forgotten that his Dad was an octogenarian? To ensure no family upset he defended Stanley to the hilt after his breach of rules when popping over to the Greek villa   Befitting to his Newmarket constituency when away from the DHSC Matt was an expert at getting his leg over most famously on Star of Bengal – eh, what do you mean? No, it’s not a pseudonym for Gina. Perhaps his most glaring failure in the Covid Mismanagement Stakes (he was unseated after five furlongs) was employing his good friend and fellow horse-lover Dido Harding to run test and trace. Her executive committee of 15 had just one public health doctor  / medical adviser and it racked up a cost to the taxpayer of £37 billion for very little return.

Like the glow worms I love to see on a summer’s night there were two bright spots in the darkness the first of which was the Covid-19 vaccine.  The brilliant work at Oxford in producing an effective and essentially safe vaccine in double quick time and secondly the efficiency with which the vaccine programme was swiftly rolled out and the enthusiasm of volunteers and most recipients in stacking up the numbers desperate for protection and some return to normality of lifestyle. The government have latched on to this like bees to a honeypot as mitigation in lieu of their disastrous performance and vaccine minister Nadhim Zahawi was all but adorned with a halo. I’m not so sure that he deserves his gold medal.  He certainly had no part in producing the vaccine: Matt Hancock’s sole positive contribution was approving the purchase of ample supplies but it was the excellent NHS local services that rolled out the immunisation programme. Yes, those same public health teams would have made a much better job of test and trace at a fraction of the cost.

The Covid-19 pandemic has exposed just how starved has been Bevan’s baby, now as scrawny as an infant in a famine. I remember only too well how year on year we would be asked to make “efficiency savings” – a euphemism for cuts. Last week the news showed how up and down the land ambulances filled A&E car parks unable to offload due to insufficient bed space. The much respected and independent Kings Fund report that in 1987/88 there were 299,000 beds in the NHS but that has fallen by over a half to 141,000 in 2019/20. Far more day case surgery and care in the community would justify some reduction but an ageing population with more health needs and the advent of more complex treatments has not been factored in and hence the current crisis. Covid-19 exacerbates the deficiency but its roots were embedded well before the virus surfaced. A particular low point for me over the last couple of years was seeing Johnson and Sunak doing the Thursday night NHS clap which I perceived as a sop and seldom partook. They were clearly dissembling as they went on to offer a 1% pay rise to health care workers as that was “all we could afford”. Fortunately, public uproar twisted arms up to 3% which many would still consider scarcely adequate. If we want a Rolls Royce NHS then we need to provide sufficient funding and Johnson’s neoliberalist low tax system is not the answer.

The second bright spot was how the very best of human nature rose like the cream on milk. Health and social care staff worked tirelessly under the most physically and emotionally demanding conditions. But in parallel, the general public went to great lengths to ensure that the elderly and vulnerable were safe and provided for. And the vast majority ignored Dominic’s example (surely Specsavers is safer than the Cummings variant of driving as an eye test) and adhered to the strict guidelines necessitating isolation from family and friends for months on end. Even a non-techno like me acknowledged the merits of a laptop be that with family Zoom or online bridge. Although I criticise Boris and his claque I like to think they acted with a morsel of good faith but I keep the worst till last – the egregious and totally unforgivable. Last week the HMRC revealed £5.2 billion of furlough fraud, crime gangs and possible errors – that’s a lot of beds, nurses and a bit of social care to boot. Excuse my touch of schadenfreude that they or maybe a family member could be festering on one variant of the waiting lists.

It’s the morning after the night before … as we hope that the worst of Covid-19 is behind us the elephant in the room emerges. Just as WW1 gave way to an even larger disaster so pundits predict the same just now as global warming takes pride of place – a truly existential crisis. It won’t just be the elephant threatened with extinction. COP26 is winding up and having slagged off his party I must give credit to one Tory MP Alok Sharma who I think did remarkably well to get some degree of entente cordiale amongst 200 nations with widely varying needs, expectations and demands. It feels like significant progress has been made but as the school  report would say “tries hard but could do better”. I have concerns as to achievability when some heavy polluters abstain from selected pledges, some timescales which feel far too long and major financial implications to fulfil all that is signed up to … Watch this space and as with Covid-19 we can all do our bit.    

… anyway that’s it, gotta go and get my booster. 

It just remains for me to thank Brenda and Anne for giving me the opportunity to share a few thoughts over the last year or two and to hope that you too get boostered, stay healthy and avoid getting flooded or roasted.

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