From David Vincent in Shrewsbury, UK: The technology of bereavement

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April 9.

“Always go to other people’s funerals,” advised Yogi Berra, “otherwise they won’t come to yours”.

The list of other people’s funerals I have not attended is growing. Early in March my godfather died at 94 in London. A fortnight later a contemporary died in Scotland, six weeks after the death of his wife. None of these fatalities, as it happens, were directly from Covid. Pneumonia, cancer, a fall in old age, have not taken a vacation during the pandemic.

We are particularly diminished by the sudden loss of our friends in Scotland. We began our careers and our families together, living and working alongside each other for three decades, and then regularly exchanging visits as our paths diverged. In John Donne’s terms, a full promontory has been washed away from our lives.

In each case, the lockdown has prevented us from attending the final ceremony. In Scotland the current rules permit a congregation of no more than twenty. They must not sing, for fear of infection, although by arrangement a bagpiper is allowed. What science has determined that the coronavirus will be safely contained within a bagpipe I know not. In any case our friend, from a professional Edinburgh family, a world-class Russian linguist in his working life, had, like many Scots, no sympathy at all for kilts, tartans, bagpipes, and, at least until Brexit, the nationalist movement.

Instead we depend on Obitus, which describes itself as ‘a leading UK provider of bereavement technology services.’ The firm was apparently founded a decade ago, an indication that virtual mourning was not invented by Covid. It has expanded in the last year, working with funeral directors to connect the congregations unable to attend. We sit at home, three hundred miles away, equipped with a login and a password, and five minutes before the ceremony is due to begin, an empty, unnamed, funeral chapel appears on our screen.

It is easy to criticise the proceedings. There is one fixed camera at the rear of the chapel, transmitting an unchanging view of the backs of twenty mourners. The sound quality is indifferent, the visual effects non-existent. After half an hour the congregation leaves separately, unable to attend a wake larger than six people, and we close the lid on the laptop. In a week’s time we will repeat the process for my godfather.

Obitus fully occupies the digital universe, with all its perils. The small print of the contract specifies that, ‘in particular, we will not be liable for any damage or loss caused by a distributed denial-of-service attack, any viruses trojans, worms, logic bombs, keystroke loggers, spyware, adware or other material which is malicious or technologically harmful that may infect your computer, peripheral computer equipment, computer programs, data or other proprietary material as a result of your use of the Website or you downloading any material posted or sold on the Website or from any website linked to it.’ Not problems faced by a clergyman with his prayer book.

But as in so many Covid contexts, the technology is better, much better, than nothing at all. Whilst the long-standing debate about the threat posed to privacy by digital communication becomes ever more urgent, in the pandemic computer screens have in all kinds of ways helped to keep families and networks of friends together. And they need not be the final means of bidding farewell. In the case of our Scottish friends, a more relaxed memorial is planned for when physical gatherings are once more possible.

That is what we must do when the pandemic is over. We will spend our days celebrating the lives of those we have lost.

From David Vincent in Shrewsbury, UK: Developing a Conscience

March 24. Most days we have a delivery to our house.  Apart from one pre-breakfast raid on B&Q in the moment of relative freedom last summer, neither of us have been inside a shop for almost twelve months. 

Instead we depend on vans and drivers, for whom we are the most troublesome customers.  The final leg of a delivery is up an un-made, un-named, hundred-yard long lane, too narrow for a large vehicle to turn round in.  Most drop-offs end with a reverse through puddles lately filled by a series of storms.

There are occasional peaks of business.  This week it has been my wife’s birthday.  The family has been active on the websites, piles of empty cardboard boxes have accumulated.  So when my wife met the same, middle-aged driver coming to the door on  consecutive days, in the wind and rain, she apologised for the trouble we had caused him. 

“We can’t have you developing a conscience about it, madam”, he replied, with a smile, and returned to his van.

Difficult not to though.  Delivery firms normally pay by piece rate, up to £1 an item on completion.  If there is no-one home and nowhere to leave a parcel, no fee.  If the house is in a distant village where only the postman can find his way around a series of randomly numbered addresses, the fee is the same.  Small wonder a recent driver left a parcel at our gate, claiming on the company website that he was deterred by a dog.  We have no dog.

The weekly food deliveries pay by the hour – £10 50 in the case of Sainsbury’s – but expect so much more than simply unloading boxes:

“Being a Sainsbury’s Driver isn’t just about delivering goods on time and in great condition. It’s about being yourself, offering a friendly approach and a service that will really wow our customers. We’ll expect you to make every delivery a great experience, always doing the right thing for our customers and keeping them aware of any delays, so they ask us to drop their shopping off again and again.”

In the case of Waitrose (this is an actual job advert for the shop that supplies us):

“This is a really important ‘front line’ role. You represent us with every single customer you meet, and their impression of Waitrose is down to you. So, as well as having a flexible approach and the ability to use your initiative to deal with unexpected situations, you should be passionate about providing the very highest levels of customer service.”

The whole pandemic has been conducted on the basis of an extended class system.  Lockdown, particularly for the two million ‘extremely vulnerable’, has been totally dependent on this rapidly expanded proletariat.  Their labours lack the frontline drama of nurses and doctors, but in their way have been just as crucial and not without risk to health. 

I am currently reading a collection of Mass Observation diaries covering the early weeks of the crisis.   Until the online-delivery systems of the major supermarkets caught up with the sudden surge in demand and developed a working algorithm for prioritising the vulnerable, there was widespread apprehension about whether, where, and how it would be possible to obtain basic supplies, let alone the myriad of other goods a household needs to keep itself going over time.

Millions of people have avoided infection and run something like normal lives at the expense of men (just occasionally women) driving from home to home at all hours and in all weathers.  It’s not just our material wellbeing.  This is Sunday, and there has been a Waitrose delivery to feed us (cheerful, if not passionate), and two other deliveries bringing Mother’s Day presents, uniting us with our children still separated by lockdown.

When this is over, there will be no national pay award of any kind, just redundancies as the shops open. 

From David Vincent in Shrewsbury, UK: Dead Horses

March 4. I respect but find it difficult to share David Maughan Brown’s reaction to the mis-treatment of a dead race-horse.

Although, unlike my wife, I have never ridden a horse, I am pleased enough by their company. When they are in the field adjacent to our garden, I feed them windfall apples over the fence, carefully halved (under instruction) to prevent choking.

What my sojourn in the countryside has taught me, however, is how unsentimental farmers can be about their livestock. The field next to us was owned by one of the last representatives of the age-old tradition of working the land with horses, a culture celebrated in the books of the oral historian George Ewart Evans.

Tractors were introduced before the First World War but did not become commonplace in agriculture until the 1950s. Jim had started work on a farm at Clun, deep in the Welsh Marches, where there was minimal machinery. As a lad he learned how to plough behind a pair of horses. His employer was also a dealer and one of Jim’s tasks was to break in new animals which could then be sold. The technique was to harness an experienced with a fresh horse, which over time would learn the discipline of drawing a plough. Jim was a short man and these horses were the size of small buses. It was, he said, a dangerous occupation. But as he told me with pride, in a good year he could, plough ninety acres.

In his retirement he kept the seven-acre field next to us, which was the fiefdom of his stallion, a mix of carthorse and hunter. Jim never bothered to name him, at best calling out ‘Jim-boy’ amidst a stream of guttural curses and injunctions. A mare would keep ‘Jim-boy’ company through the year, producing a foal in early summer. So casual was the care of this mare that one June day it was noticed that she had given birth yet there was no sign of a foal. Various theories about predators were rehearsed before a search was organised, assisted by my wife and a couple of neighbours, and eventually it was found, unharmed if unfed, hiding in a copse on the edge of the field.

Other retired horses were put out to graze in the field. In the middle of an afternoon I saw that one of them was lying motionless on the grass. On investigation it evidently had died. Jim was told and came over to inspect it. A heart attack he thought. The next morning a borrowed excavator appeared, and a hole was dug where the horse lay.

This was entirely at variance with veterinary regulations, but for Jim as with many of his colleagues, the law was always a distant obligation. So far as I recall he did not employ the horse as a seat whilst he used a phone, if only because, then in his late eighties, he did not possess such a device. Otherwise the event was conducted with an absolute minimum of respect and feeling.

When Jim himself died a few summers later, his son took over the field. He is a contract farmer, driving large machines to plant and harvest potatoes for crisp manufacturers. ‘Jim-boy’ was sold to a farm in South Wales, where, we were told, he was to have the company of five mares. We hope he is content.

From David Vincent in Shrewsbury, UK: The Two Queens

March 3. The last post featured Britain’s Queen. This time it is America’s, singing as she was vaccinated, to the tune of ‘Jolene’:

“Vaccine, vaccine, vaccine, vaccine, I’m begging of you, please don’t hesitate.

Vaccine, vaccine, vaccine, vaccine, because once you’re dead, then that’s a bit too late”

I have just read the latest of the doctors’ diaries of the early months of the pandemic. Jim Down is a consultant anaesthetist at University College Hospital London. His account nicely balances a self-deprecating perspective with a clear-eyed account of the scale of the difficulties he and his colleagues faced in the Intensive Care Unit.

There is plenty of detail on the medical processes involved. If you want to know exactly how a doctor intubates a patient, what the techniques are, what are the risks of failure, this is the place to go. At the end there is a useful glossary for the scientifically challenged.

Two features of the experience stand out, beyond the mounting exhaustion experienced by all the staff in the crisis months of late March and April. The first is the constant uncertainty about what to do. We are used to politicians and epidemiologists working through their doubts in news conferences. On the wards, large teams of professionals were debating day in and day out the correct procedures in the absence of any reliable data about how to manage the disease.

The second is the pervasive low-level apprehension that they might themselves become victims, or take the virus home to their families. When their own colleagues began to be admitted to the Intensive Care Unit, the anxiety increased. “I was stressed and I was fearful” writes Down. “I am not claiming that Covid didn’t frighten me. Like almost everyone I was waiting to get it, expecting at any moment to develop a fever and a cough, and take to my bed.”*

Nearly a year later, we have the means of addressing those fears. At the same time, as discussed in my previous post, there is evidence of a deliberate refusal of the vaccine by some medical staff.

The issue was addressed in an opinion piece in yesterday’s Guardian. It went through all the reasons for hesitancy, including the factors of race and class. But it came to a conclusion which both Queens would endorse:

“Compulsory vaccinations for all NHS and care staff are surely a valid last resort. Concerns about protecting individual liberties are reasonable, but vaccines for healthcare workers cannot be spun as a matter of personal choice. Your freedom does not include the right to potentially harm others. Besides, if the pandemic has taught us anything, it is that we each have a collective responsibility to protect one another – something that is never more true than for those who have signed up to do so as a professional duty.

“These are complex ethical and practical questions to address, but there are lives at stake. For the past year, high-risk people have had to fear every interaction with another person. It is unfathomable that they will be expected to see potentially infected nurses and care workers at a time when they are already at their most vulnerable – not least when the vaccine now offers such an easy solution.”**

Difficult to sing that though.

* Jim Down, Life Support. Diary of an ICU Doctor on the Frontline of the Covid Crisis (Penguin, London, 2021), p. 111.

** https://www.theguardian.com/commentisfree/2021/mar/02/healthcare-professionals-uk-moral-duty-covid-jab-vaccine?CMP=Share_iOSApp_Other

From David Vincent in Shrewsbury, UK: One’s Jab

February 26.To lifelong republicans, the Queen is a continuing disappointment.

Not only is she still protecting us from the unpalatable prospect of Charles III, she remains capable of embodying essential truths amidst a national crisis.

As the vaccination programme spreads out across the population, voices are being raised about potential discrimination against those who decline the offer. The people in question are not those who for medical reasons should not be vaccinated, such as pregnant women. Nor those who have somehow fallen through the cracks in the official bureaucracy and are not on the radar of the NHS.

We are discussing those who have been invited, could have accepted, and have refused. As I have written in earlier posts, when attitude becomes choice, the numbers of those declining seem to be much smaller than was at first feared. Nonetheless they do exist, and may multiply as the programme reaches younger cohorts who do not feel much threatened by a death on a ventilator.

It is argued that they could suffer discrimination if vaccine passports are issued, denying them access to pubs, restaurants and other organised pleasures, or, in the form of some yet to be agreed documentation, travel to the beaches of Europe. Or they could face actions by employers who will only recruit those who can prove they are unlikely to infect fellow workers or customers of the enterprise. This is seen to be unjust in the case of those who have comprehensible long-term issues with secular authority, including the NHS.

I assume that the Monarch was at the head of the queue when the vaccination programme started, if only because of her age. But today she has made a public statement about her experience:

“Once you’ve had the vaccine, you have a feeling of, you know, you’re protected, which is I think very important. I think the other thing is, that it is obviously difficult for people if they’ve never had a vaccine … but they ought to think about other people rather than themselves.”

The morality is not complex, but it is fundamental to the struggle against Covid-19 since the first lockdown eleven months ago. In all parts of the country, in all walks of life, people have taken actions which cause private harm in the interests of public good. And give or take the odd illegal rave and concealed wedding, mostly they are still doing so.

The current debate about the non-vaccinated threatens to reverse that calculation. The harm that is discussed focusses wholly on the individual, their right to make up their own mind on the risks of illness, their right to oppose any kind of injection, their right to uphold long-held religious objections, their right to dwell in the playground of conspiracy theorists, their right to earn a living irrespective of the health of the larger workforce.

Someone has to point out that they are just making a wrong decision. The Queen has done so. And she has said why.

From David Vincent in Shrewsbury, UK: ‘Sadly’

February 24. We have become accustomed to the ritual announcement of Covid data.

The Government is producing daily figures on the progress of the pandemic. It falls to the newsreaders on the main television channels to deliver these at the head of the bulletin. There are scores for infections, hospital admissions, deaths within 28 days of a Covid diagnosis, and recently, vaccinations.

When it gets to the deaths, always the same feeling is inserted. ‘Sadly’ XXX deaths were reported in the last twenty-four hours.  The point of this extra descriptor is presumably to indicate that the broadcasters comprehend the tragedy that is unfolding day by day. They are not just reading from a teleprompter, but somehow engaging with their own emotions. When they can remember, politicians will also furrow their brows and put the word in front of the deaths they are discussing.

‘Sadly’, when repeated night after night, is an oddly featureless term. I might use it to describe the recent demise of several roses in the arctic winds that blew through my garden last week or the failure of an online order to arrive. I would not think it adequate to encompass the pain I might feel if I were being connected to a ventilator or if a close relative had died.

There is, after all, a thesaurus of terms commentators could use: ‘tragic’, ‘devastating’, ‘infuriating’, ‘unnecessary’. Instead repetition turns ‘sadly’ into a cliché, expressing little more than indifference. This week it means, ‘who cares as long as the figures are coming down.’

Finding a public language to describe the constellation of grief that Covid-19 causes is far from easy. Attention has lately been drawn to an American study which recalculates the bereavement multiplier, the number of individuals left suffering after a death.* The research increases what has been the conventional ratio of five (see my post ‘Computing the Sorrow’, January 22) to just under nine. In the UK context, the current death toll of 121,000 would generate a little over a million bereaved people; globally the figure would be twenty-two million.**

As is often the case, however, sophisticated mathematical tools are being applied to very coarse data. The American study focuses on the nuclear family network of grandparent, parent, sibling, spouse, or child, and asks, given the age-specific Covid mortality and US demographic patterns, how many people would be affected by a death. It is essentially a connections survey. No attention is paid to wider networks of relatives, friends and neighbours, nor are there any questions about the nature of the loss, which presumably can range from shattering grief to passing regret. In the end it is just another version of ‘sadly’, a generalised description of an event which in the States has now accounted for 500,000 lives, or, by this multiplier, 4.5 million bereavements.

More useful research is beginning to appear on the quality of the experience.

Deborah Carr and colleagues (good to see the old stars still working) identify two kinds of death: “Good deaths …are distinguished by physical comfort, emotional and spiritual well-being, preparation on the part of patient and family, being surrounded by loved ones in a peaceful environment, being treated with respect and dignity, and receiving treatments concordant with one’s wishes.”

Whereas: “bad deaths … are distinguished by physical discomfort, difficulty breathing, social isolation, psychological distress, and care that may be discordant with the patient’s preferences.” For the bereaved they are characterised by “the erosion of coping resources like social support, contemporaneous stressors including social isolation, financial precarity, uncertainty about the future, lack of routine, and the loss of face-to-face mourning rituals that provide a sense of community and uplift.”**

Yesterday evening’s newsreaders should have said: “in the last twenty-four hours there have been 548 bad deaths.”

*https://www.theguardian.com/world/datablog/2021/feb/22/covid-4-million-family-membersgrieving-us-study-finds

**Ashton M. Verdery, Emily Smith-Greenaway, Rachel Margolis, Jonathan Daw, ‘Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States’, Proceedings of the National Academy of Sciences of the United States, 117, 30 (July 28, 2020):17695-17701. https://doi.org/10.1073/pnas.2007476117.

** Deborah Carr, Kathrin Boerner, Sara Moorman, ‘Bereavement in the Time of Coronavirus: Unprecedented Challenges Demand Novel Interventions’, Journal of Aging & Social Policy, 32, 4-5 (2020): 425-431. https://doi.org/10.1080/08959420.2020.1764320

From David Vincent in Shrewsbury, UK: Concentrating the Mind

Samuel Johnson: “Depend upon it, sir”

February 15.  When the awards are handed out at the end of this pandemic, a gold medal must surely go to the Office for National Statistics (ONS).

From the beginning it has been the source of sober, relevant and trustworthy data not just on the progress of the disease but on a wide range of associated behaviours and attitudes. It has published reliable answers to the right questions, including attitudes to vaccination now that the programme has gained real momentum.

It has just issued data relating to the end January. With vaccinations being offered to the top four categories it found that 99% of those aged 70 and over had accepted or would accept a vaccine.* Last autumn, when it was being reported that a sixth of the UK population would certainly refuse and offer, and a similar number might do so, I wrote that “the question constitutes an interesting case history for the capacity of digital communication to shape private behaviour.”** Since then the anti-vax campaign has increased its efforts as the vaccines were given approval, and Facebook continued until the last minute to carry its messages.

The ONS survey suggests that orthodox medicine has won a decisive victory. When the invitations were sent out, the conspiracy theories evaporated. Even amongst those still hesitating, the ONS found that most of the doubts had little or nothing to do with stories in the social media. The lead concerns were anxiety about side and long-term effects, then waiting to see if the vaccines actually worked. Only a small proportion of negative respondents declared an outright opposition to vaccines in general.***

The most obvious reason for the outcome, which is critical to the defeat of the coronavirus, is the difference between a hypothetical and a practical choice. The conspiracy theories promoted by the internet should be divided into two categories.

There are those which reflect a state of mind that need never be tested in the real world, and those which sooner or later will have to be. Views about race, sex and religion, about the unreality of climate change and the reality of extraterrestrial beings, may coalesce into active protest, but there is no requirement, no point at which a behaviour has to occur. Like a flu virus they may just mutate over time. Whereas other beliefs, such as the misbehaviour of elected governments, or the evils of vaccination, will at some point become a formal choice, when the polling cards or the medical invitations arrive. In those circumstances, interim polling of attitudes are contributions to a debate, not predictions of an outcome. Also this week it is reported that the Conservatives have opened up a five point gap over Labour. No-one mistakes this for an accurate description of an election that is still four years away. It just has an impact on current political debate. Similarly the anti-vax findings last year stimulated on-line counter-propaganda by orthodox medicine, which may have helped in the final result.

The choice itself foregrounds practical concerns. Since the early weeks of the pandemic we have been told by the ONS and many other authorities, that the elderly and those with pre-existing conditions stand a far greater chance of becoming seriously ill or dying from Covid-19. To paraphrase Samuel Johnson, “Depend upon it, sir, when a man knows he is likely to end up in an intensive care unit, it concentrates his mind wonderfully.”

It is not surprising, therefore, that the ONS returns for those under 70 currently display a greater resistance to vaccination, though the difference is not large. Of the 3% of 50-69 year-olds who currently are not fully committed, two thirds are just saying they are not certain yet. Amongst 30-49 year-olds, where 89% respond positively, the next largest group is 6% don’t know / won’t say. Except for younger medical workers (where there are worrying accounts of BAME resistance) and a few clinically vulnerable, most of these age groups are still discussing only the possibility of vaccination.

There is also the effect of the group. In my network, the over 70s and the clinically extremely vulnerable, emails and blog posts have been buzzing since the New Year with descriptions of what it was like, accounts of after-effects (usually very minor), and complaints from those who had to attend inconvenient centres or had yet to receive their invitation. It was a party everyone was joining and from which no-one wanted to be excluded. The minority of the young, invited because of their role in health or social care, had less of a sense of what in a related area is termed a herd behaviour.

Alongside the vaccine data, the ONS has also updated its measure of the mood of the nation: “Following a decline in well-being in early January 2021, this week well-being scores for life satisfaction (6.4), happiness (6.4) and feeling that things done in life are worthwhile (7.1) remained at some of the lowest levels recorded since the survey began in March 2020.”****

This reflects my own view. I have been surprised by how small the lift in spirits has been since I drove down to Ludlow racecourse to get my jab at the beginning of the month. Euphoric is not a term I would use. At best mildly relieved, and aware of the road yet to be followed.

*https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddisea ses/articles/coronaviruscovid19weeklyinsights/latesthealthindicatorsinengland5february2021#vacci ne-attitudes

**November 11, 2020.

***https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddis eases/articles/coronaviruscovid19weeklyinsights/latesthealthindicatorsinengland5february2021#vac cine-attitudes

****Opinions and Lifestyle Survey, Great Britain, 27 to 31 January 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing /bulletins/coronavirusandthesocialimpactsongreatbritain/5february2021

From Bishop Ralph of Shrewsbury: Pray Devoutly and Incessantly

Ralph of Shrewsbury

Almighty God uses thunder, lightning and other blows which issue from his throne to scourge the sons whom he wishes to redeem. Accordingly, since a catastrophic pestilence from the East has arrived in a neighbouring kingdom, it is very much to be feared that, unless we pray devoutly and incessantly, a similar pestilence will stretch its poisonous branches into this realm, and strike down and consume the inhabitants.[1]

Thus Bishop Ralph of Shrewsbury wrote to the archdeacons of his diocese on 17 August, 1348.

Unfortunately, the prayers and the processions that he ordered failed to prevent the Black Death crossing the Channel from France. A year later the Prior of Canterbury asked the bishops in the southern province to take action:

“Terrible is God towards the sons of men, and by his command all things are subdued to the rule of his will. Those whom he loves he censures and chastises; that is, he punishes their shameful deeds in various ways during this mortal life so that they might not be condemned eternally. He often allows plagues, miserable famines, conflicts, wars and other forms of suffering to arise, and uses them to terrify and torment men and so drive out their sins.”[2]

The populations suffering the devastating pandemics of the fourteenth century were at once powerless and active agents in their own destiny. All were exposed to the wrath of a vengeful God, but through prayers, penitential processions and reformed morals it might be possible to hasten the end of a plague and delay its recurrence.

Over the succeeding centuries, the practical task of managing populations and devising cures in a pandemic has gradually transferred to governments and scientists. The moral drama of sin, retribution and repentance, has, however, continued in a new form.

Successive outbreaks of respiratory diseases in this century have been blamed on man’s increasing exposure to infected wildlife. SARS (Severe Acute Respiratory Syndrome) in 2003, MERS (Middle East Respiratory Syndrome) in 2012, and now Covid-19 have crossed the species barrier, probably from bats which carry a wide range of pathogens. An increasing body of literature, together with organizations such as the Coalition for Epidemic Preparedness Innovations, have warned that, like the Black Death in the fourteenth century, one pandemic is almost certain to be followed by another in a matter of years.

Animals may be the proximate cause, but the fundamental problem is the behaviour of people. Land is cleared for population growth, the exploitation of raw materials, and for dairy and meat farming, and as a consequence there are lethal encounters with hitherto isolated reservoirs of viruses. The risks are compounded by the rapid increase in international travel and commerce. The pandemics thus become a metonym for the ecological crisis more generally. As the Professor of the History of Medicine at Oxford writes, “‘emerging diseases’, as they are often termed, have been seen as Nature’s retribution for environmental degradation.” [3]

Mankind has misbehaved, is being punished, and, with increasing urgency, is seeking effective forms of repentance.

The Christian churches, pushed to the side-lines by the secular response to disease, are seeking to reclaim the leadership of what they see as a new moral crusade. “I think the future we are called to build”, writes Pope Francis in response to Covid-19, “has to begin with an integral ecology, an ecology that takes seriously the cultural and ethical deterioration that goes hand in hand with our ecological crisis.”[4]  The Archbishop of Canterbury wrote in 1375 that, “in our modern times, alas, we are mired in monstrous sin and the lack of devotion among the people provokes the anger of the great king to whom we should devote our prayers. As a result we are assailed by plagues or epidemics”.[5] In a pale echo, we have the words of the 105th incumbent: “Around the world, climate change is affecting food security, creating social vulnerability, and disrupting peace and security. There is no doubt we need to act.”[6]

This time, praying will not be enough.

February 10


[1] Register of Bishop Ralph of Shrewsbury, Somerset Record Society X (1896), 555-6, cited in Rosemary Horrox, trans. and ed., The Black Death (Manchester: Manchester University Press, 1994), p. 112. Despite his title, Ralph, formerly Chancellor of the University of Oxford, was Bishop of Bath and Wells, where he was described by the Dictionary of National Biography as “a wise and industrious bishop, learned and extremely liberal.”

[2] D. Wilkins, Concilia Magnae Britanniae et Hiberniae (1739), vol. II, p. 738, cited in Horrox, Black Death, p. 113.

[3] Mark Harrison, Disease and the Modern World. 1500 to the Present Day (Cambridge: Polity, 2004), p. 189. See also, Mark Honigsbaum, The Pandemic Century. A History of Global Contagion from the Spanish Flu to Covid-19 (Penguin: London, 2020), pp. xiv-xv, 280.

[4] Pope Francis, in conversation with Austen Ivereigh, Let Us Dream. The Path to a Better Future (London: Simon and Schuster, 2020), p. 35.

[5] Wilkins, Concilia, III, pp. 100-1, cited in cited in Horrox, Black Death, p. 120

[6] https://www.churchofengland.org/about/policy-and-thinking/our-views/environment-and-climatechange/why-you-should-act.

From David Vincent in Shrewsbury, UK: Hitler, Shipman, Satan and Mengele

February 9. The sense of optimism as the vaccines are rolled out is colliding with the battle weariness of medical staff.

Rachel Clarke published the first book-length account from inside an intensive care unit.* Its anger with the government and anguish at the bleak and lonely deaths suffered by covid victims was balanced by a joyful account of the sense of community that the pandemic had created. Writing about the first wave last Spring she discovered something new:

“Not once in my lifetime have I seen anything like this grassroots eruption of improvised altruism. Communities coming together, the young and healthy offering to shop for those shielding, restaurants delivering mountains of takeaways to overworked hospital staff, everywhere the desire to be useful, to do something, to make it better, to help out. It startles and thrills me. There is no such thing as society. We do have more in common than divides us.” (159-60)

Nine months later she has written a newspaper article clearly exhausted by her continuing labours on wards that are still operating at peak capacity, and overwhelmed by the hostility of covid deniers and anti-vax campaigners. “I’ve been called Hitler, Shipman, Satan and Mengele for insisting on Twitter that our hospitals aren’t empty,” she writes. Inside the hospital, all is joint endeavour :

“Outside, on the other hand, the virus has once again carved up the country into simmering, resentful, aggrieved little units. It’s too old, too cold to be doing this again. One way or another, lockdown hurts us all. But instead of unity, community and a shared sense of purpose – that extraordinary eruption of philanthropy last springtime – we seethe like rats in a sack, fractious, divided…In short, we have reached the point in the pandemic where what feels like armies of trolls do their snarling, misogynistic utmost to silence NHS staff who try to convey what it’s like on the inside. Worse even than the hatred they whip up against NHS staff, the deniers have started turning up in crowds to chant “Covid is a hoax” outside hospitals full of patients who are sick and dying. Imagine being forced to push your way through that, 13 hours after you began your ICU shift. Some individuals have broken into Covid wards and attempted physically to remove critically ill patients, despite doctors warning that doing so will kill them.”**

So what now of the new sense of togetherness and joint endeavour? There are two destructive factors at work. The first is simply extreme tiredness, both physical and emotional, and explains why the NHS and the Government have been so desperate to bring down the levels of hospitalisation in the second phase. In Clarke’s book, which ended in April last year, the long hours were compensated for by excitement at the drama which she had volunteered to join, and by her justified pride at the way in which the entrenched procedures of hospital medicine had been revolutionized in the face of the crisis. But now it has just gone on too long.

The second is a product of the incivility of contemporary protests, which draw their language from un-moderated social network sites. A community is not a thing, but a set of relationships embodied in discourse. There is a need to interrogate official statistics, up to and including the current debate about vaccine effectiveness. There are quiet reasons for vaccine hesitancy, from inherited folk beliefs to fear of needles. What so demoralizes overstretched medical staff are the ease and frequency with which dissent becomes face-to-face aggression.

Those working in emergency medicine have always had to deal with ungrateful, shouting drunks. I was once in an A and E unit with a slightly injured child late on a Friday evening where there were more police than nurses in the waiting room.

But now the pubs are closed. The verbal violence is coming from those who respect nothing except their own views, and accept no constraints on their expression. It is not to be borne.

*Rachel Clarke, Breath taking. Inside the NHS in a time of pandemic (London: Little, Brown, 2021). **https://www.theguardian.com/books/2021/feb/06/ive-been-called-satan-dr-rachel-clarkeon-facing-abuse-in-the-covid-crisis?CMP=Share_iOSApp_Ot

From David Vincent in Shrewsbury, UK: Going to the races

Ludlow races

February 6. On Tuesday evening we drove down to Ludlow race course for our covid vaccination.  No horses, no riders, no vets, just teams of volunteers in a couple of marquees, remarkably cheerful towards the end of what I was told had been a twelve-hour day checking identities and administering jabs.

We waited in lines of spaced seating.  None of us in our first youth, and all of us, it now strikes me, white. This was rural Shropshire, and should come as no surprise.  A county which voted decisively for Brexit immigration controls has in fact very few migrants.

But with the new finding that white over-eighties are twice as likely to have been vaccinated as black, there is a fresh concern that the BAME community is not participating in the vaccination programme.*  There are similar worries about medical staff who have been offered the vaccine.  The Health Service Journal reports that at the Guy’s and St Thomas’ Foundation Trust in London there has been “substantially lower covid vaccine uptake among its black African, black Caribbean and Filipino staff so far.”** Challenged about these discrepancies, the minister in charge, Nadhim Zahawi, took a glass 85%-full line, stressing the large numbers who had taken the vaccine, and admitting that the Government was not fully recording those who had not done so.

Since the pandemic began there has been opinion-poll evidence from many countries about the scale of what are now politely described as “vaccine hesitants.” The latest survey finds that nearly 40% of the French and 23% of Germans say they will definitely or probably refuse a vaccination***  I have always been cautious about these reports.  No one ever died of giving a negative response to a pollster.  It’s easy enough to unload grievances against politicians, health services, big pharma, when, as is still the case in Germany and France, the issue is largely hypothetical. 

One positive consequence of these widely-reported figures is that they have provoked governments, health providers, community leaders and celebrities into launching educational programmes to counter on-line anti-vax propaganda. The British government has set aside £23m for this purpose. Unfortunately, according the Centre for Countering Digital Hate, anti-vax social media in the UK have also redoubled their efforts now that the choice has become real.****  

It comes down to a question of speed. 

There is a large body of literature on the centuries-old anti-vaccination movements, and on the pervasive presence of malign channels of communication.  But we do not have the time to continue debating the excessive individualism of the modern world.  The current higher BAME mortality rate is going to increase dramatically if we have to wait for generations of folk remedies to be challenged, or for the community’s mistrust of the NHS and agencies of authority such as the police to be overcome.  Equally it is a fantasy to suppose that the main digital platforms are going to deny themselves the advertising revenue generated by alternative covid cures any time soon.

This is why the most effective response to the present dilemma may be that adopted by doctors in Liverpool. They are treating vaccine resistance by BAME groups as an immediate practical matter.  It’s no good, they argue, depending solely on large-scale venues which, like Ludlow race course, can be a long way from where people live (though to be fair the race course had organised a special bus service).  Instead they have started pop-up vaccination centres in local neighbourhoods.  Rather than waging war against social media in general, they have engaged with channels of communication up and down particular streets.  And if particular groups do not trust representatives of white society, alternatives have been sought. 

According to a newspaper report, “Dr Cait Taylor, a GP who is joint clinical director of the Central Liverpool primary care network, decided she and other white medics would not be giving the inoculations. Instead, they put a call out for medical students from BAME backgrounds, offering £10.21 an hour for Urdu and Arabic speakers. ‘We wanted to inspire confidence’ she said. ‘People felt more comfortable there than at a GP surgery where you might be met with a white receptionist, or a white vaccinator, or a doctor who doesn’t explain things to you properly, or doesn’t know your language.’”*****

 Cait Taylor concludes, “the message we’ve got loud and clear from local communities is: come to us and we’d love to take the vaccine, thank you very much.”  As should have been the case from the outset with the test and trace system, as much of the delivery as possible should be left in the hands of health professionals who know and are known by the neighbourhoods they are seeking to assist. 

 *https://www.theguardian.com/world/2021/feb/04/black-over-80s-in-england-half-as-likely-to-have-had-covid-vaccine?CMP=share_btn_link

**https://www.hsj.co.uk/acute-care/exclusive-fewer-black-and-filipino-nhs-staff-vaccinated-amidhesitancy-concern/7029397.article

***https://www.theguardian.com/world/2021/feb/04/covid-vaccine-refuse-france-germany-us-quarter?CMP=share_btn_link

**** https://www.bma.org.uk/news-and-opinion/pushing-back-tackling-the-anti-vax-movement

*****https://www.theguardian.com/world/2021/feb/04/inspiring-confidence-liverpool-gps-tackle-the-vaccine-race-gap