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

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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

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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

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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

From David Vincent in Shrewbury, UK: Stoats and Weasels

January 12. Badger, Rat, Mole and Toad would be deeply concerned. As a result of the enforced absence of humans from the National Trust property of Plas yn Rhiw on the Lleyn Peninsular, it is reported this week that stoats and weasels have moved out of the wild wood and have been seen in the gardens around the house.

The effect of successive lockdowns on the natural world have been complex. In broad terms, the story is one of an initial impact followed by a slow return to the prevailing crisis. There are many accounts of the sudden pleasures afforded by the cessation of noise and pollution. Here, for instance, Tobias Jones writes of Northern Italy in mid-April, at the time a global hotspot of the virus.

“I live in Parma, but despite the profound anguish here in Italy, it also feels, paradoxically, as if the world has come right in some way. With our despoiling suddenly stopped, wildlife is returning with innocent ebullience. Bottlenose dolphins have been playfully leaping in the waters around Venice. The canals are so crystalline that swans, and shoals of fish, have returned. Hares graze undisturbed in parks in Milan. Deer have been strolling the golf courses of Sardinia and paddling along sandy beaches. Mallards are bathing in Piazza di Spagna and birds have been nesting in the crooks of closed-up, disused wing-mirrors… In some ways it’s like a blissed-out stoner’s dream of what the world might be. The “Pianura Padana”, the flat plain of the Po valley, usually has some of the worst air pollution in the world. The air is now perfumed by spring. You can see the mountains. Two weeks ago we were singing Rino Gaetano’s The Sky Is Evermore Blue from our balconies.”*

Professional naturalists like Helen MacDonald sniffed that such wildlife had always been around, but no-one noticed it. Nonetheless the glimpse of what could be a new normal was at once a relief from the pandemic and a promise of what might in the future be possible.

The true measure of the pandemic year comes in the newly-released figures for the global temperature in 2020. It might be expected that with an overall fall of 7% in fossil fuel burning there would be at least a temporary decline. Instead, the year registered the joint highest temperature on record, shared with 2016. All that has been avoided as a consequence of the pandemic is a new highest figure in its own right.

In the short term, there are few positive signs. Road traffic has returned to or exceeded 2019 volumes as soon as restrictions have been lifted. London and other cities have not rediscovered the birdsong-rich silence of the beginning of the first lockdown. Plane travel is set to resume at pre-pandemic levels whilst trains and buses are unlikely to recover for the foreseeable future. As factories recommenced production after the first lockdown, pollution in China rapidly reappeared. In developed countries, long-nurtured reforms were postponed whilst governments grappled with larger problems. In Britain the introduction of Clear Air Zones was halted in Manchester, Birmingham, Leeds, Bath and other cities. There was a general reprioritising of government activity away from the green agenda to more pressing, and more expensive, responses to the medical emergency. In the developing world, the collapse of eco-tourism defunded programmes for protecting wildlife.

Where there are grounds for hope over the last few months it is mostly in changes which have little or nothing to do with the health crisis, particularly the continuing sharp falls in the cost of renewable energy and the rapid adoption of electric vehicles.

The specific impact has to be measured not in figures but in states of mind. All over the developed world people in cities as well as the countryside have been afforded a real-time preview how nature could look and sound if human populations exercised better control of their activities.

And after a Trump-led decline in confidence in the potential of global co-operation, the borderless engagement with the virus, including the scientific endeavour of vaccine development, has renewed optimism about the potential of human collaboration to respond to the climate crisis. The pandemic itself will not generate change. It will require ambitious planning over the long term.

“… the Badger settled himself into an arm-chair, and said, ‘Well, we’ve got our work cut out for to-night and it will probably be pretty late before we’re quite through with it.’”

*Tobias Jones, Guardian, 12 April, 2020.

From David Vincent in Shrewsbury, UK: Baroness Barran and the Epidemic of Loneliness

January 8. The Guardian runs a piece on loneliness over Christmas:

“A volunteer phone call service for older and vulnerable social housing residents and a homemade Christmas food delivery service are among a number of initiatives being singled out for praise as the government announces a £7.5m fund to tackle the epidemic of loneliness in England.”*

It’s the kind of story that makes you want to give up as a writer altogether.

Last Spring I published a book whose penultimate chapter sought to outlaw forever the phrase “epidemic of loneliness” which was then in widespread use and fuelling what Fay Bound Alberti described as a “moral panic”. I reiterated my arguments in sundry interviews and blogs.

At the time it seemed as if history was on my side. The casual use of a medical term as a metaphor for a social condition surely could not survive the arrival of a real epidemic. In reality, severe loneliness was nowhere near as prevalent as was claimed, and it was in no sense an infectious disease. There could be no vaccine against it (though there are continuing reports of attempts to find a pill to reduce loneliness).

But here, eight months on, with Covid running rampant, the phrase leads a story in a reputable newspaper with no attempt at authorial distancing. Ed Davey, leader of the Liberal Democrats, never the brightest candle on the parliamentary Christmas cake, is elsewhere quoted as saying that the covid pandemic has “created a silent epidemic of loneliness”,** forgetting that such an “epidemic” originally preceded the pandemic. As has been the case throughout, the Office for National Statistics scores for ‘often/always’ lonely have barely moved. The latest figure, released today, covering the Christmas period of 22 December to 3 January, is unchanged at 6%.***

In part it is just lazy journalism by the Guardian, copying across the language of press releases. More broadly it is a legacy of the Government’s initial loneliness strategy published in 2018,**** and the concomitant appointment of the world’s first “loneliness minister”, now Baroness Diana Barran, who is lodged in the Department for Digital, Culture, Media & Sport [Who she? Good works on domestic abuse, but perhaps most notable for her father, no less than Count Cosmo Diodono de Bosdari – straight out of The Leopard] Then as now, there is a vast mis-match between ambition and investment. In 2018, £20m was to be spread round various projects to achieve a reconnection of British society. In the new initiative, pocket money is to be spent “bringing society and communities together” in the midst of a crisis where the standard currency for state intervention is counted in billions.

The founding strategy was reviewed in January 2020.***** The Department was still working on measuring the problem, stated to be “somewhere between 6% and 18% of the population” (p. 3), a gap of about eight million lonely people. It reported on various small-scale ventures designed to “celebrate and better support organisations who work tirelessly to help people build stronger connections and develop their sense of belonging.” Looking forward, just as coronavirus reached our shores, the review promised that “The Minister for Civil Society will continue to lead this work and to chair the cross-government Ministerial Group on Tackling Loneliness, ensuring government commitments are delivered and built on so that far fewer people feel alone and disconnected over the next decade.”

There is a certain charm in the survival of this kind of misty goodwill at a time when everything is more desperate and much, much more expensive.

It is also simply a distraction. The main causes of searing loneliness are systemic failures in mental health care, inadequate access to GPs and hospitals especially by those with disabilities, declining community services, both professional and voluntary, and material deprivation including housing. The only short-term counter to these pressures during the pandemic has been greater neighbourhood engagement with the lives of those separated from each other by lockdown and shielding, and increasingly sophisticated use of the connecting technologies of communication.

In the short term, the balance sheet has yet to be drawn up. Beyond the pandemic, the solutions will only be found in large-scale structural reforms.

* https://www.theguardian.com/global/commentisfree/2020/dec/20/pandemic-behavior-coronavirus-plague-defoe?CMP=Share_iOSApp_Other

**https://www.theguardian.com/society/2020/dec/05/poll-reveals-scale-of-home-alone-christmas-in-the-uk-this-year?

CMP=Share_iOSApp_Other***https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/bulletins/coronavirusandthesocialimpactsongreatbritain/8january2021.

****HM Government, A connected society A strategy for tackling loneliness – laying the foundations for change (London: Department for Digital, Culture, Media and Sport (October 2018).

*****https://www.gov.uk/government/publications/loneliness-annual-report-the-first-year

From David Vincent in Shrewsbury, UK: One flag or two?

January 7.  In Zoomworld, we have all become conscious of the backgrounds behind our heads as we talk. 

Bookcases are the default for those whose business is words, but then which spines should be in view (not my Elmore Leonard collection, safely out of sight in a bedroom), and for regular dialogists, should there be occasional changes on the shelves to indicate that they are more than wallpaper?

You may be certain that serious thought has been given to the sets in front of which we are addressed by our political masters.

Boris Johnson’s handlers long ago determined that a rather dull, bookless room in Number 10 should be enlivened by two union jacks, identically furled so that the bright red of the cross of St. George is prominent.  Apart from the panelling in the room and a slogan tacked to the podium, there is nothing else to inform the eye. The clearly brand-new flags convey the principal message.  Never mind that Johnson and his Government, through Brexit and the clumsy handling of Covid negotiations with the nations have done what may be irreparable damage to the Union.  Shame was surgically removed from Johnson’s psyche long before he became a public figure. 

Thus on Monday the third lockdown is announced from Downing Street with the two flags just to the left of his podium as the Prime Minister looks at the camera.  At a subsequent news conference they are placed on either side.

We live in a democracy.  Johnson’s broadcast is followed a day later by a response from the Leader of the Opposition.  Here again the set has been carefully designed.  Behind Keir Starmer’s head and shoulders is a dark screen to minimise any distraction.  The only other object on view is, again, a union jack, also on his left side.  It looks exactly like Johnson’s, freestanding on its pole, once more furled to foreground the cross of St. George.  It is clearly unused, very definitely not a banner that a trade union once marched behind, or that had been waved on a barricade, shot through with bullets by the forces of reaction.

So what does Starmer’s flag mean?

Most obviously that the Party is desperate to escape the label of unpatriotic that was hung around Corbyn’s neck, most notoriously when he failed to blame the Russians for the Salisbury novichok poisoning.

More generally that Starmer sees his role in the midst of the pandemic as a loyal echo of the official message.  In a five-minute address he makes only the most generalised criticism of the Conservatives.  “There are serious questions for the Government to answer”, he says, furrowing his brow, mentioning the wasted 22 billion on testing, and the recurrent delays in announcing actions.  But, he concludes, “whatever our quarrels with the government and the prime minister, the country now needs us to come together”.  Most of the speech repeats Johnson’s vaguely uplifting call for a national endeavour.  It ends by appropriating the Queen: “We will recover.  We’ll rebuild. We’ll see each other again.”

There is a recognisable short-term strategy at work, and without question the country needs a collective effort, as Johnson and/or Starmer puts it, to win the race between the vaccine and the virus.

But it will not do.  If we are to end this crisis with any sense of forward propulsion, Starmer has to ride two horses, wave two flags.  The delays reflect the incompetence of a government recruited from Brexit loyalists and led by a serial liar.  The maladministration, from PPE shortages to testing scandals, to the likely failure of the vaccination timetable, is a product of a semi-corrupt faith in the private sector and the hollowing out of local democracy.  The immense variations in every aspect of the pandemic experience, from infection and death rates to coping with school closures, are a consequence of decades of  growing inequality which have urgently to be reversed.  If the union jack is waved, there must be some sense of how the loyalty of the Scots in particular can be regained by a party whose representation north of the border has been all but wiped out. 

In the midst of the Second World War, Churchill viewed any attempt to plan for peacetime as a distraction from the fight with Hitler.  But in 1942, when victory was far from certain, Beveridge wrote his plan and Labour won the 1945 landslide because the Tories were, rightly, not trusted to implement it. 

We need to come out of this national struggle with a vision for the future already conceived and articulated.