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

From David Vincent in Shrewsbury UK: Truth-telling

February 4. There is published today a new book by the journalist Peter Oborne: The Assault on Truth: Boris Johnson, Donald Trump and the Emergence of a New Moral Barbarism.*

“I have been a political reporter for almost three decades,” he writes. “I have never encountered a senior British politician who lies and fabricates so regularly, so shamelessly and so systematically as Boris Johnson.”

The standard response to this kind of exposé, however well conducted, is that lying is priced into the Johnson brand, and here he is, world king with an eighty-seat majority and his party still ahead of Labour in the opinion polls.

Covid-19 has, however, created a new and more urgent response to Johnson’s mendacity.

Also just published is a report from the front line, Breath taking. Inside the NHS in a time of pandemic, by Rachel Clarke.** It describes the experiences of a doctor during the early months of the outbreak. Clarke was a television journalist before retraining as a doctor specialising in palliative care. When the crisis broke, like many others from different medical disciplines she volunteered to an intensive care unit in a nearby hospital.

A theme throughout her book is the enhanced importance of truth in communicating with seriously ill patients:

“When drugs run dry, when cure is no longer an option, I deal in words like my patients’ lives depend on it. Words build trust, allay fears, dispel myths, inspire hope. They clarify, challenge, encounter and console. Words leap beyond the constraints of masks and gowns and gloves and gowns. Titrated carefully, dosed just right, words can take a dying patient all the way from the depths of despair to a place of home and even serenity… It follows that doctors have a duty to use our words with exceptional care. We are nothing if our patients cannot trust us. Above all, our words must be our bond.” (p. 212)

Other accounts emerging from intensive care units stress the urgency of what may be final words.

An anaesthetist writes of his experience preparing a patient for a ventilator:

“‘I need to phone my family,’ she gasps. I nod and say OK, almost shouting to be heard over the noise of the alarms. The patient tries to talk to her family on FaceTime. She is extremely breathless and looks like she is dry drowning in thin air. Tears pour down her face. I hear someone on the phone crying and saying ‘I love you’ … While we are pre-oxygenating her, I take off her CPAP hood and lean closer. ‘We’re here to look after you. Everything will be OK.’ I stop talking because I think I might cry. I worry she is dying. I hold her hand. She squeezes it and I squeeze hers back.”***

Every word, however brief and obscured by machinery, masks or bad phone reception, is freighted with a lifetime’s meaning.

An individual or institutional crisis places an additional premium on truth. Stressed and exhausted by her days on the ward, Rachel Clarke was enraged by the casual, self-regarding misrepresentations in Boris Johnson’s daily press conferences. She knew just what was happening in the hospitals, how much worse matters really were for both patients and staff.

“I never wanted Red Arrows, medals or minutes of silence” she writes at the end of her book: “Like my colleagues, my needs were more prosaic. Really I just wanted honesty from those who rule us.” (p. 216)

*(London: Simon and Schuster, 2021)

**Rachel Clarke, Breath taking. Inside the NHS in a time of pandemic (London: Little, Brown, 2021).

***https://www.theguardian.com/world/2021/jan/31/im-an-nhs-consultant-anaesthetist-i-see-theterror-in-my-covid-patients-eyes?CMP=Share_iOSApp_Other

From DavidVincent in Shrewsbury, UK: Monuments

Monument to the Great Fire of London

February 2. “History”, writes the Guardian columnist Jonathan Freedman, “suggests we may forget the pandemic sooner than we think.”*

He is commenting on the milestone of 100,000 covid deaths in the UK.

Freedman begins with the point I made in my Computing the Sorrow post last week: “So far, the act of remembering has been deferred or even forbidden. Second only to the deaths themselves, perhaps the greatest pain the coronavirus has inflicted has been its denial of the right to say goodbye.” But his subsequent argument that thereafter there may be no collective memory seems at best premature and in most respects open to question.

He repeats Laura Spinney’s observation that there are no public memorials to the 1918-19 Spanish flu epidemic which killed probably between fifty and a hundred million people, in contrast to the current covid global death toll of 2.2 million in a much larger population.** This is to confuse monuments with memory. London erected a column in honour of the Great Fire, not the Plague a year earlier, but two generations later Defoe wrote his Journal of the Plague Year for a readership still traumatised by the epidemic.

He states that the “facts” of pandemics can “take years to emerge”, noting that initial estimates of the 1918-19 outbreak were decades later revised sharply upwards. But thanks in particular to the Center for Systems Science and Engineering at Johns Hopkins University, this has been a minutely calibrated disaster. There remain some variations in how covid deaths are measured in different countries, but there is not going to be some subsequent recount which adds tens of millions to the death toll.

More broadly he draws a contrast between military and medical narratives. “Wars offer a compelling, linear story”, he argues. “There are causes and consequences, battles, surrenders and treaties, all taking place in a defined space and time. Pandemics are not like that.” As I argued in an earlier post,** set against the other great misfortunes of our time, particularly inequality and climate change, the pandemic does have a plot, with a beginning, middle, and a now somewhat delayed ending. This is why the most influential accounts of such events, those of Defoe and Camus, have taken the form of conventional novels. The dynamics of inequality, as Thomas Piketty has shown, can be traced at least as far back as the late eighteenth century and have no resolution in sight. Equally the destruction of nature commences with the industrial revolution and to take the most optimistic view, will not be overcome for decades.

Freedland’s final point is more fundamental. A viral infection is unlike a world war. “Crucially,” he writes “a pandemic lacks the essential ingredients of a story: clear heroes and villains with intent and motive.” There is an obvious truth in this. The ultimate cause is bats, not people. Covid infections occur by chance, carelessness or neglect, and for all the errors of a Trump or a Johnson, the event as a whole cannot be blamed, except by conspiracy theorists, on individual or collective malevolence.

And yet, as in the stories of Defoe and Camus, the accounts emerging from the pandemic are full of personal courage and achievement as well as individual and institutional shortcomings. In the midst of the struggle it is fruitless to determine how countries will revise their national narratives in the aftermath of so seismic an interruption to their affairs. It will in the end be a matter of choice rather than historical inevitability.

We can remember and then act, or we can forget and then repeat the failings of human agency in this pandemic. We can keep in front of our minds the lessons learned about collective endeavour in the national health service, in science laboratories, and in communities up and down the country. Or we can allow the incompetence and self-interest of politicians and the private sector to be buried with the victims.

*https://www.theguardian.com/commentisfree/2021/jan/29/history-forget-pandemic-spanish-flucovid?CMP=Share_iOSApp_Other

Laura Spinney, Pale Rider (London: Penguin, 2017), p. 291.

**’Pandemics and Plots’, October 19, 2020

From David Vincent in Shrewsbury: The doctor will not see you now

January 29. I cannot remember the last time I had a face-to-face conversation with my doctor. Probably in 2019, perhaps earlier.  To know how he and his profession are managing in the pandemic I turn to the new account by an Edinburgh GP, Gavin Francis.*

Francis and his publisher, together with the Wellcome Collection, deserve praise for getting the book out while the crisis is still in full flood.  Inevitably there is a cost in coverage.  The narrative ends in the autumn of 2020, before the third surge in infections and deaths.

Throughout Intensive Care, Francis is concerned with the consequence of talking with patients only by phone or through masked faces:

“As GPs we’re taught to value the subtleties of human communication – to glean as much from what the patient doesn’t say as from what they do say. As trainees we have to submit videos of our consultations to demonstrate how carefully we attend to body language, to silences, to the way patients hold or evade eye contact.” (p. 56)

My surgery is located in a nearby large village. In common presumably with all practices, its switchboard has been greeting callers with a recorded message explaining that only telephone appointments can be made; the doctor will then decide whether it is necessary to see a patient in the surgery or at home. If you stay online, you then get a recorded message purchased from some third-rate utility:  “Your call is very important to us. Please wait for the next available agent.” This week, however, there is an additional message which I encounter when I ring to renew a prescription:

“Our phone lines are very busy due to the volume of calls we are receiving about the covid19 vaccine. The NHS is prioritising vaccinating those people who experts have agreed would benefit from it the most. We will let you know when it is your turn to book you a vaccination. If would like more information about the vaccine, please visit http://www.nhs.uk/covid/vaccination. If your query was about the covid vaccine, please hang up now.”

So not even a someone to talk to on the other end of the phone. Rather implied censure for making the call in the first place. Clearly this is a surgery under stress. But it is possible to suggest another response which acknowledges that:

• receiving the vaccine is for vulnerable groups by a distance the single most important event, medical or otherwise, that they are facing;

• at this moment, potential recipients are being treated differently in different regions and you well may know of people in similar circumstances who have already been vaccinated;

• in so large a project there must always be an apprehension that as an individual you may fall through some bureaucratic crack;

• over your lifetime you have been used to treating your GP surgery as your portal for all health enquiries, and that being re-directed to an impersonal website offers little comfort.

In the concluding discussion to his book, Gavin Francis is preoccupied with the defects of non-face-to-face medicine, necessary though it may be in the crisis:

“As time goes on, and if telemedicine prevails, those relationships forged in person will become more remote, and the medicine GPs practise will become more perfunctory, based on the avoidance of being sued rather than on what’s best for the patient. Those conversations would be not ‘consultations,’ but triage, fire-fighting, damage limitation. It’s difficult enough to engage with the unique complexity of another human being’s suffering in ten or twelve minutes when sharing the same space, but on the telephone it’s near impossible.” (p. 191)

With doctors, as with so much else, the meaning of this pandemic will not just depend on the temporary expedients that are adopted. Rather the question is which emergency devices are rescinded the moment the crisis is over, and which are allowed to persist, whether out of inertia or institutional self-interest.

 * Gavin Francis, Intensive Care. A GP, A Community & Covid-19 (London: Profile Books and Wellcome Collection 2021).

From David Vincent in Shrewsbury, UK: Computing the Sorrow

Computing the Sorrow

January 27.  Boris Johnson says it is ‘hard to compute the sorrow’ after the official covid-19 death rate passes 100,000 in the UK.

In fact there is a perfectly simple calculation that can be made. Grief professionals work on the basis of at least five bereaved people for every death.*  On current figures that gives us a population of half a million in the UK facing a lonely future.  If we take the more accurate figure of those dying with covid-19 on their death certificates, the number is already 600,000.  Globally there are now 2.21 million deaths, generating a population of over 11 million coming to terms with traumatic loss.

Estimating the length of the sorrow is a more difficult task.  There seems to be an inverse ratio at work: the more rapid the event of dying, the more extended the process of grieving. 

The struggle to come to terms with a loss begins more uncertainly and is likely to proceed more slowly than is the case for non-pandemic bereavements.  In this sense Johnson was for once correct in his account.  It will be a long time before we can take a measure of the suffering generated by a death rate that is the fifth highest in the world, and the second highest as a proportion of the population.

A recent review of the first tranche of academic papers on covid-19 bereavement summarises the difficulties facing the relatives of victims:

“There is sometimes little chance to say farewell in accustomed ways, or to observe cultural or religious mourning practices; there may be regrets or anger about the possible preventability of the death. A persisting difficulty has been noted: social isolation has brought with it the lack of physical support from family and friends or physically-present spiritual support, reflecting sometimes severe societal disruptions in general. Such distancing can intensify feelings of loneliness that is part of any bereavement experience, even without isolation orders in place.”

“In the face of such difficulties,” the paper concludes, “one might speculate that letting go, finding a place for the deceased in ongoing life, relinquishing the old ties/bonds and moving on may not be tasks that can yet be dealt with.”**

The established rituals of bereavement, whatever they may be, work on the basis of manageable numbers.  Defoe’s account of the 1665 plague stands for every pandemic:  “It is here, however, to be observ’d, that after the Funerals became so many, that People could not Toll the Bell, Mourn, or Weep, or wear Black for one another, as they did before, no, nor so much as make Coffins for those that died.”***  In our own event the pressures are compounded by regulations designed to prevent the spread of infection.  No more than 30 socially distanced mourners can attend an English funeral, and only six can gather at the wake (but none in Wales and Scotland).   

Every manual on bereavement stresses the importance of listening to those who are left alone, which becomes more difficult as physical encounters are limited.  The comfort of touch is frequently out of reach.  The small pleasures that can provide escape from the intensity of grief become unobtainable.  Those whose lives have been shattered have difficulty occupying the centre of their own dramas when all around them are competing narratives of loss.  The novelist and counsellor Rebecca Abrams, in a training seminar for Cruse, the leading bereavement charity, stresses how the young in particular, accustomed to talking through their crises with networks of friends, find it difficult to commence their mourning.****

There are compensating resources.  There were already in existence a of range of organisations, including Marie Curie, Cruse, Sudden, The Loss Foundation, The Good Grief Trust, the Samaritans, Supportive Friends, with established bereavement methodologies and networks of volunteers, although most of their work has had to become virtual.  Social networking more generally has never been as important, especially amongst the young who are already accustomed to working through their problems online.

Medical researchers are drawing attention to a bodily ‘long covid’, where a range of often serious conditions persist after the initial symptoms have been overcome.  Amongst those who have lost people close to them, as well as health workers exposed to post-traumatic stress disorders, there is also going to be a long covid of the mind, which may in turn have further physical outcomes.

The army of the bereaved will be living amongst us for years to come, patching together their recovery as best they can.

*Julia Samuel, Grief Works.  Stories of Life, Death and Surviving (London: Penguin Life, 2017), p. xii

**Margaret Stroebe and Henk Schut, ‘Bereavement in Times of COVID-19: A Review and Theoretical Framework’, OMEGA—Journal of Death and Dying 82, 3 (2021): 500–522, 501.

*** Daniel Defoe, A Journal of the Plague Year (1722; London: Penguin, 2003), p. 164

****Rebecca Abrams and Cruse Clinical Director, Andy Langford, recorded as a webinar on 5 May 2020.https://www.cruse.org.uk/training/covid-19-different-kind-grief.

From David Vincent in Shrewsbury, UK: Otherwise

January 24.  This is in response to Anne’s vivid account of heat and drought in Australia.  It is otherwise on the other side of the world.

The picture was taken from the bottom of my garden as the snow fell this morning.  In the background, grey beneath the heavy clouds, is the River Severn in flood.  Heavy rainfall in the Welsh hills has sent it over its banks for the second time in a month.

Nothing changes as a consequence.  The land below us constitutes a run-off for excess water, preventing flooding downstream in Shrewsbury.  To keep its cattle safe, the farm opposite us has erected a fence across the field just above the highest level which the river normally reaches.  In a week or so it will have dropped ten feet, back within its course. 

In normal times, a snowfall would create a temporary lockdown in the village, until the farmer who holds the contract from the Council starts up his tractor and clears the lanes.  But we are already locked down; no plans to go anywhere.  It might as well snow until Spring.

All we can do is enjoy the view.

From David Vincent in Shrewsbury, UK: On Death and Dying

Image preview
Elisabeth Kubler-Ross

January 20.  Last Sunday, my friend and colleague John Naughton, in his endlessly wise and informative daily blog, Memex1.1, appropriated the Kübler-Ross five stages of dying model in order to frame a coruscating attack on the political mismanagement of the pandemic both here and in the United States.

He addressed Denial, Anger, Bargaining and Depression, concluding with Acceptance:

“We’re nowhere near that yet. People still haven’t grasped that there’s no going back to the way we were. That past is indeed a different country. It’s also a country that was heading straight for climate catastrophe. So every time someone talks about a “return to growth” you know that the reality of what lies ahead hasn’t yet been appreciated. The only kind of growth worth having post-pandemic is a greener, carbon-neutral one. And the only question worth asking is: could we create such a future?”

The piece caused me to take down from my shelves the original, enormously influential book, On Death and Dying.  Since its publication over half a century ago, the notion and labelling of the five stages has been the subject of widespread debate.  The hospice movement, which Kübler-Ross did so much to inspire, no longer uses them.  But re-reading the text highlighted some basic truths about dying in the pandemic.

Kübler-Ross’s opening premise was that “dying nowadays is more gruesome in many ways, namely, more lonely, mechanical and dehumanized.” (p. 21)*  Despite the major improvements in palliative care since 1969, the technologies of medical intervention have become still more impersonal, the patient yet more subordinated to the authority of doctors and the routines of hospitals.

Her insistence that fear of death can only be effectively countered if the issue is explicitly considered  by those not yet dying, remains entirely valid. “It might be helpful” she writes, “if more people would talk about death and dying as an intrinsic part of life just as they do not hesitate to mention when someone is expecting a new baby.” (p. 150)  A beneficial outcome of the pandemic tragedies may be a new era of public engagement with what in most social settings remains an unvisited land.

However debatable the particular issue of ‘stages’, there can be no questioning Kübler-Ross’s central premise that it is the responsibility of all those working with the dying to be informed, caring listeners and that the reactions of those enduring a terminal illness are in their different ways rational and comprehensible.

The departure from the present crisis lies in the context of how this listening takes place.  The book begins by listing the changes that separate modern medicine from the past, including significant therapeutic interventions, increasing life expectancy, and the absence of pandemics.  The return of mass infection and death has fundamentally altered a basic assumption of the book.  “If a patient has had enough time”, Kübler-Ross writes, “(i.e., not a sudden, unexpected death) and has been given some help in working through the previously described stages, he will reach a stage during which he is neither depressed nor angry about his ‘fate.’” (p. 123).

The whole enterprise assumes the resources of a well-found (American) hospital, with teams of professionals including not only doctors and nurses but psychiatrists, social workers and chaplains, ready and able to spend long periods communicating with the patients as their disease takes its course over months or years.

The essence of dying with Covid-19 is that neither patients, nor their families, nor the staff of hospitals or hospices have remotely enough time to work through any sequence of emotional expression or support.  The common experience of those who are infected is for little to happen for the first few days, and then for the unlucky minority there is a sudden descent into breathlessness and other symptoms which leads rapidly to an intensive care unit.  Even if they ultimately survive the mechanical ventilators, they will have been unconscious throughout that part of their treatment.  Hospital staff are overwhelmed by the sheer pressure of numbers, radically reducing staff/patient ratios whilst at the same time trying to stand in for the presence of next of kin excluded by quarantine regulations.

It is the absence time for death and dying which more than the pathogens and the remedies most connects the Covid-19 pandemic with the flu and plague outbreaks that preceded it down the centuries.

Those on the front line have not given up on the challenge.  In the collection of radio podcasts, Letters from Lockdown (broadcast by the BBC PM programme), there is a particularly fine piece by a doctor which focuses on the multiple uses of her mobile phone.  It gets used to keep in touch at speed with staff around the hospital, to take pictures of the property bags of deceased patients, to relieve stress by playing music when in bed after an exhausting shift, and to provide at least a small window of communication to dying patients:

“my phone has been placed next to an old lady’s ear, on her pillow as she drifts into unconsciousness, breathing with shallow, irregular gasps, with hopes and promises  from her daughter, hoping that her mum will be able to hear her final words of love, even though she can’t be there to say them.”**

*Kübler-Ross extracts from: Elisabeth Kübler-Ross, On Death and Dying (1969: New York: Touchstone, 1997).

**Dr. Lisa Linpower, ‘Through My Phone’, Letters from Lockdown (London, Chatto and Windus, 2020), p. 171.

From David Vincent in Shrewsbury, UK: Who goes first?

Lord Sumption. Wrong Again

January 18.  It’s getting nearer.  Last week a 93 year-old friend and neighbour was vaccinated.  Today it is announced that my cohort, the 70-plus and clinically vulnerable, are to receive invitation letters (in fact this morning’s post brings only a bank statement and the latest edition of the Journal of Cultural and Social History, ojoy).

Despite earlier fears, this is a party which most of us want to attend.  The latest survey conducted by the Office for National Statistics (ONS) reveals that 86% of the population said they were ‘very or fairly’ likely to accept a vaccination in the period 7-10 January, up from 82% in before Christmas.  Most of the remainder were either uncertain or had already had it.  Only 3% responded that they were ‘very unlikely’ to take one, the same figure as those who by then had been vaccinated.*

Given the inescapable presence of hard-core conspiracy theorists in any population, this is as near to an general acceptance in principal as might be achieved at this stage in the process.   I argued in an earlier post (‘Anti-Vax’, July 7) that the numbers unloading to pollsters their grievances against the state, research-based science, big pharma, transmission masts, were likely to shrink once the hypothesis became a reality, and this appears to be happening.

According to the official timetable, the priority groups are to be vaccinated by mid-February, with the whole of the population gaining protection by September.  There remains a question of whether this is the most sensible strategy.

We don’t need to endorse the view of our old friend Lord Sumption, who is in more trouble this week for mis-construing the obvious and mis-describing the reality.  He argued in a current affairs programme yesterday that the elderly were “less valuable” than the young, elevating simple arithmetical fact that they have fewer years to live into a profoundly unacceptable dismissal of their lives.  And as with others opposing the lockdown regime, he was factually plain wrong in claiming that the restrictions on socialising do not reduce infection across the population.**

The more interesting question is whether the young should be left to last.  The 70-plus is not the most infected section of the population, and therefore not the most likely to infect others.  We  received last week a communication from Shropshire Council indicating that the rate for the elderly in the county is half that of the 20-29 age group.  Nationally the ONS finds a similar distribution, using slightly different age-bands.  On January 2, 3.16% of the 15-24 age group tested positive, with a steady decline across the cohorts to 1.06% for the 70 and over.**

At face, these disparities are not surprising.  The retired do not need to go out to work, and less likely to be found in shopping precincts, bars and all-night raves.  My frail elderly neighbour who has now received his vaccination has been wholly locked down since the end of March, irrespective of the fluctuations in the official rules and advice.  He is absolutely no threat to anyone else.  The same is pretty much true of my household.  Where they have gone out of doors the 70-plus were found by the ONS to be more likely than the 16-29 cohort to answer positively to the question ‘have you avoided physical contact with others when outside the home?’***

Furthermore the young appear to be suffering psychologically more than the old.  The current ONS ‘overall, how satisfied are you with your life nowadays’ score rises steadily from 5.9% for the 16-29 cohort to 7.3% for those now due to receive their vaccination invitations.  There is an even sharper disparity in the loneliness measure, ranging from 13% to 5% for the same groups.****

So the young are having a tougher time and are more likely to catch and transmit the virus.  Why not vaccinate them first?

The short and irrefutable answer, pace Lord Sumption, lies in the age-specific rates for hospitalisation and death, together with the obvious need to keep fit those caring for the ill and the elderly, and to prevent the NHS from being overwhelmed to the cost not only of Covid sufferers but those with any other serious illness.  But there is a price to be paid for this strategy.  Assuming the vaccination roll-out continues as promised, the mortality rates will fall much faster than those for infection. 

It really will be the autumn and not the spring before it will begin to be safe to resume anything like our normal lives.

*https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/datasets/coronavirusandthesocialimpactsongreatbritaindata, Table 12

** https://www.theguardian.com/law/2021/jan/17/jonathan-sumption-cancer-patient-life-less-valuable-others

***https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/latest

*****https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/datasets/coronavirusandthesocialimpactsongreatbritaindata, Table 7.

From David Vincent in Shrewsbury, UK: The Exception

Image preview
Knightsbridge Circle

January 15.   The Government has taken, or has had forced upon it, a decision of principle.  The Covid vaccines are not on the market.  The rich cannot buy immunity.

There is a sense, indeed, in which the vaccine programme offers a temporary reversal of the pattern throughout the pandemic of the poor suffering more than the prosperous.  Many of the staff in the NHS and care homes who are now at the head of the queue are amongst the relatively low paid who have been most at risk in recent months.  

Initially it looked as if the wealthy were to be punished for their self-indulgence, as holiday-makers skiing in northern Italy came back to Britain with the virus.  But as it became embedded across the population, the most vulnerable were those who could not afford to work at home, or who lacked adequate domestic space, or who had acquired underlying health conditions though decades of poor diet and inadequate health care.

Now all were to be equal in the programme.  However, the Government reckoned without the culture of the rich.  The Daily Telegraph, where else, has just reported on the offer being made by the private concierge service, Knightsbridge Circle, which charges a basic £25,000 a year for membership.  It looks to be worth every penny.  “A carefully curated membership”, says its website, “ensures that clients receive unparalleled access to the very best of everything that life has to offer.”

This includes jumping the vaccination queue. 

The founder of Knightsbridge Circle, one Stuart McNeil, explained to the Daily Telegraph the recent addition to his service: 

“the inoculations are already well underway, with members based both in the UK and abroad flying out for vaccination holidays, many on private jets. ‘It’s like we’re the pioneers of this new luxury travel vaccine programme. You go for a few weeks to a villa in the sunshine, get your jabs and your certificate and you’re ready to go,’ says McNeill, who assumes that many such members have flown out under the business/education trip exemption. ‘Lots of our clients have business meetings in the UAE.’”

The cost for a curated member is certainly manageable:

“While the potential upper end cost of such a trip is mammoth, McNeill approximates a cost of around £40,000 for a month-long trip to Dubai with first class Emirates flights, meet and greet, accommodation in a sea view Jumeirah Beach apartment, vaccination and membership for two.”

But, dear reader, you ask, is this not illegal?

Well yes, but then again no, but then again it depends on whether Priti Patel wants to enforce her own laws.

It is certainly illegal to take flights for pleasure.  The wording of the new lockdown is clear enough: “You must not leave or be outside of your home except where you have a ‘reasonable excuse’. This is the law.” However, a “reasonable excuse” includes “work, where you cannot reasonably work from home.”  As it is well known that the super-rich live in hovels without desk space or internet connections, it is of course necessary for them to go out to earn their weekly pittance.  As for distance, the rules also say, “if you need to travel you should stay local – meaning avoiding travelling outside of your village, town or the part of the city where you live.”  The UAE, as we know, is just next door to the City of London, particularly when you have a private jet.  No problem.

What is so heart-warming about Stuart McNeil is that he has not lost his moral compass in supplying this service.  According to the article, he “is keen to note that Knightsbridge Circle has not vaccinated anybody under the age of 65.” “We still have a moral responsibility to make sure that people that really need it get it, and that’s what we’ve been focusing on.”  

Yes, you read that last sentence correctly.  McNeill’s only regret is that the Government has yet to make the vaccine available to his private clinic in Harley Street: “I’m really keeping my fingers crossed that Boris allows us to do this.”

It can only be a matter of time.

From David Vincent in Shrewsbury, UK: Home Entertainment

Image preview

January 14.  “UK lockdowns fuel record year for home entertainment spending” runs a headline.* 

A total of £9bn was spent during 2020 on digital home entertainment services in the UK.  The biggest winners were video channels such as Netflix, Amazon Prime and Disney+ whose sales ‘surged by 38% year on year.’

That these companies and their share price have had a good pandemic comes as no surprise.  2020 constituted the perfect conditions for their market.  For three quarters of the year their main rival, the cinema, was either subject to distancing regulations or closed altogether.  Other entertainments outside the home were similarly constrained. 

In such circumstances it must be questioned whether ‘surged’ is too strong a verb.  When the UK Covid death rate grows from 2 on 7 September 2020 to 1564 yesterday, that’s a surge.  The performance of the home entertainment industry looks by contrast to have been comparatively modest.

The pandemic struck a market that was already growing rapidly.  During 2019 the number of UK subscribers to Netflix grew by 13% to 11,470 million.  That the rate of acquisition of new customers was three time higher the following year is the least that might be expected given the temporary destruction of its main area of competition. 

There are perhaps two explanations for this limited expansion.

The first is that like so much of domestic consumer spending, the main patterns of behaviour were in place before the pandemic struck. The media analysist Omdia concludes that the performance of Netflix had “exaggerated already existing and underlying trends”,** which is probably true across the piece.  My household had already acquired an internet-connected television and decided what it wanted to subscribe to.  The only addition during the year were the art-house channels of Mubi and Curzon cinema, which we only occasionally watch (though we have discovered the strange and wonderful films of Roy Anderson).  As with so many digital services, the graph of growth must flatten as penetration of the market nears saturation. 

The second is that we all responded to successive lockdowns with greater effort and ingenuity than might be expected.  We did not just slump in front of the box with a drink in our hand.  We took walks, we worked in the garden while the light lasted, and we addressed projects around the house.  Amongst the recently published financial reports is one from Kingfisher, the leading DIY supplier through brands such as B&Q and Screwfix.  The newspaper headline in this case is “Lockdown DIY Craze.”***  Over the two months between 1 November to 9 January, sales were 16.9% up over the same period the previous year.  Again the report is subject to journalistic over-excitement.  An increase of a sixth is no “craze”, but it does indicate a desire finally to undertake long-standing home improvements [see my post “Two Panels”, 26 November].

We also have some information about what we chose to watch on our television sets during 2020.  The most popular video, boxed or downloaded, was Frozen II, with sales of 973,000.  This suggests a market driven by children, or by parents driven to distraction finding them something to do.  I have yet to encounter this film, so have no explanation for its success.  Instead I ask my oldest granddaughter, now eight years old, to compare the sequel to the original.  She writes:

“yes I have watched it and I do think that it is a little bit better than the first one because it has quite a lot more to it and so it is a bit more exciting. There is also a little bit of a mystery in it because they have to find out what happened to their parents and how they met. There are also lots of different elements to the story, more people and more adventures and more mysteries!”

Better get a copy!

*https://www.theguardian.com/media/2021/jan/08/uk-lockdowns-fuel-record-year-for-home-entertainment-spending?CMP=Share_iOSApp_Other

**https://www.telegraph.co.uk/technology/2020/12/26/12-million-britons-sign-streaming-lockdown/

***https://www.theguardian.com/business/2021/jan/12/bq-owner-says-lockdown-diy-craze-boosted-festive-sales