From John in Brighton: DNA

28 July

Potentially an existential issue – but not the double helix and its crucial role to life but rather the future of the restaurant industry. Within a fortnight of the hospitality services resuming, albeit with reduced numbers and other restrictions, restaurant hosts up and down the land bemoan those who book and then don’t materialise at the appointed time. I suspect this is not a new issue but more sharply focussed in these straitened and challenging times. The most outspoken was Tom Kerridge who had 27 no shows at his bar and grill restaurant on a single Saturday night. He emphasised that such selfishness could be the tipping point for the industry which is “already on the verge of collapse”.

Welcome to our world Tom. DNA’s, Did Not Attend, have been a perennial problem in the NHS for as long as I can remember. An outpatient clinic appointment is booked for a certain date and time but the patient is conspicuous only by their absence. Figures vary from place to place and between specialities but on average 8% of appointments (just under 8 million in 2017-8) are not honoured. With each missed appointment typically costing approximately £120 that represents around £1 billion to be coughed up. Not to be sneezed at (even with a mask on). Speaking on Question Time exactly five years ago Health Secretary Jeremy Hunt expressed a personal preference for charging patients for missed appointments. The complexity of administering this and, I suspect, political unpopularity led by the other Jeremy meant it went no further. At the same sitting he also denounced patients who simply failed to take their prescribed medications which is another chronic wastage – so be grateful Tom, at least people swallow your food. The year after Hunt’s rant the body termed NHS Improvement was set up and in a report on “Reducing DNA’s” cited clerical errors and patients forgetting as the commonest reasons amongst several. To counteract these factors many clinics asked patients to ring in and book an appointment personally and then followed later with a reminder text a day or two before the consultation….but sadly not a panacea and still appointments go to waste.

Another ploy in the NHS is to book one or two extra patients in expectation of the absentees – bad news if it’s neither raining nor the World Cup and everyone turns up. But that’s less practical in the restaurant trade and especially with enforced social distancing. And the NHS is not a business whereas a restaurant’s bottom line and staff livelihoods depend on maintaining income. The current white hope for NHS appointments is to give patients the option of booking and changing appointments online. If it works in hospitals then perhaps it could be an option in hospitality as well. But until then a more immediate potential solution is to ask for a deposit at booking with a full refund should cancellation occur at least forty eight hours prior to the meal. To no show with impunity is ignorant and rude – maybe a forfeit would concentrate the mind. Interestingly, but perhaps unsurprising, is that psychologists have demonstrated that people value things more if they have had to pay towards them. The only difficulty I can envisage is the client taken genuinely ill on the day of the booking.
At the end of the day surely a key factor is that both action and inaction have consequences and we all have a personal responsibility for “doing the right thing” as the Tory mantra so often tells us. The NHS may be free at the point of delivery but that doesn’t mean that financial considerations are irrelevant and we all need to use the service responsibly and judiciously. Equally the patrons of restaurants have a duty to respect those providing them with a service and whose livelihoods depend on it.

From John in Brighton: Shielding – To be or not to be?

20 June

How do you link “shielding”, a packet of biscuits and a sharp rebuke? The obvious answer is too much comfort eating but you’d be wrong. My daughter spotted gluten-free biscuits on the shopping list I gave her last week and leaving no stone unturned a third degree ensued on why (I’m not gluten-intolerant), who was coming over, indoors or out, how many people…? Definitely won’t be in the house I reassured her but had to hedge a bit that there might be two people. Cue for a reprimand and brief homily on safest option being total abstinence of any social contact. Floundering on the ropes I point out that since 5 June shielders can spend time outside with someone from another household. A bit of Socratic irony from my son “Do you trust everything the government says?” “Well no actually” and that’s as good as a knockout punch. Case won in favour of the prosecution.
Strictly speaking they are right and what is clear is that their sentiments are entirely well-meaning and out of concern for my health and welfare. But equally after nearly three months the shielding does take its toll and that’s despite my going out on my bike (with social distancing) to maintain my sanity. I’m blessed with a garden but even so the glorious weather exacerbates the frustration. And to rub a bit of salt into the wounds we see progressive relaxation of lockdown for swathes of people up and down the land. But perhaps that reinforces the importance of ongoing shielding – a second wave is always potentially waiting to pounce like an angry cat.
Some shielders and indeed some support groups talk of an increasing two-tier society and the shielders’ desire to return to some sort of normal life. There is speculation this week that imminent changes could include the abolition of the need for shielders to isolate at home from the end of July and based entirely on clinical evidence.. But let’s remind ourselves we are the “extremely vulnerable” (sic). I’m a pensioner with additional health risks and an article in The Guardian a month ago starkly demonstrated how age was a key risk factor. The over-65’s are 34 times more likely to die from Covid than those of working age and 88% of the deaths were in the over-65s. 
So I acknowledge my offspring’s concern and that extreme vigilance is still the only guarantee of safety. The down-tick of cases and deaths should not induce any feelings of security and the case is made for ongoing shielding – short term pain for long term gain one hopes. I haven’t claimed the food parcels nor the prioritisation at supermarkets – it’s much more fundamental than the “perks”, it’s trying to minimise risk and maximise survival. Prolonged isolation can impact mood and mental health and if I were following Socrates I might be seeking out the hemlock by now. Instead I’ll turn to the meditations of Marcus (Aurelius not Rashford although the latter is clearly wiser and more proactive than BJ) and I think his advice would be similar to the offspring. Better to be the also-rans in a two tier society and it’s the utmost caution for the foreseeable future – “Carry on Shielding” is the one they never made so where’s Kenneth Williams when you need him?

From John in Brighton: What a Load of Rubbish!

Rubbish on a remote Indonesian island

12 June. It was instilled into me at a young age that you don’t leave litter. I don’t recall so many public bins back in the 60’s and the message was clear – pack up your rubbish, take it home and bin it. On the face of it not difficult to understand or to execute so why has litter been a thorn in our side for as long as I can remember?.
Yesterday evening in a local park was an overflowing bin and litter strewn all around – a small vignette of a much bigger problem. One hot weekend last summer 23 tons of rubbish were collected off the Brighton and Hove beaches and the Council planned for a further 300 new bins over a stretch of about eight miles along the sea front. This included recycling so blue for plastic bottles and cans, maroon for glass and black for ordinary rubbish. Again I’d ask, what could be simpler? But there’s a sense of deja vu with the recent burst of hot weather and the beach near the pier had an ugly coating of nappies, wipes, takeaway items, cans and drinks bottles aplenty. Enough in fact for volunteers to fill twenty five bags of 5 Litre volume over about a three mile stretch. 
And it’s not just the beaches but also the parks. Preston Park, Brighton’s largest, might take park attendant Bill at least a couple of hours to clear after a hot day he tells us on the local radio. And last spring 500 bags of rubbish were collected from two of the main roads in Sussex the A27 and A23 – some may have blown in but the majority probably expelled from drivers’ windows. Yet go up on the nearby Downs and litter is practically non-existent as witnessed by a ten mile cycle this week and spotting one item. Perhaps this simply reflects a far lower number of people but I suspect also a different mentality. And maybe if you see no rubbish it induces you to follow suit, positive reinforcement even if there is no tangible reward..
I try to understand why people leave so much rubbish. Is it simply laziness or lack of facilities? Often bins are overflowing but isn’t the appropriate response to find another even if that means taking it home? Is it a perception that it’s somebody else’s responsibility to sort – “that’s what they’re paid for”, except that they aren’t and a lot of the clearing rests with volunteers? A lack of any civic pride – maybe it’s the band of London day-trippers who are solely responsible but I doubt it. Or just a lack of self-discipline, perhaps exacerbated by the restrictions of lockdown and the new-found freedoms nurturing a low-level anomie? But last summer’s findings predate Covid and imply a more chronic problem. Or maybe it’s quite simply the absence of any consequence – identifying culprits is practically impossible. Politicians repeatedly praise the adherence of the general public to the lockdown so the principles of self-discipline are well understood but regardless of rules and directives from on high arguably the biggest incentive there is avoiding a potentially life-threatening disease. No one dies from leaving a bit of litter………but fauna might. The plastic pollution of the oceans and its consequences have been highlighted in the last couple of years. Recently there have been reports of micro-plastics in rivers and affecting the bird life, not all of it from litter but it may contribute. And better still for the miscreant is the difficulty of policing litter louts – last year Brighton introduced a team of “litter cops” and the threat of a £300 fine but how can they effectively patrol a large area 24/7 although the threat might be a subliminal deterrent to some? After a leave of absence the enforcement officers re-emerged last week so I’m hoping for a cleaner city as the summer progresses but won’t hold my breath and I still question why such a measure is needed.
Education and Public Information Films have been tried – going back to the 60’s Roy Hudd did one. Then there was that catchy slogan “Find a Bin To Put It In” so I fear this may be as difficult to unravel as the Gordian knot and will remain an issue in another fifty years time. But it’s not all bad. Back to the 60’s and the footpaths were littered with faeces (usually canine)  but no longer.  An eighty quid fine surely helps to focus the attention but again I suspect the mindset and understanding the rationale is the most important thing. Again it begs the question as to how people generally comply with this but not so well with garbage disposal.

From John in Brighton: A Little Bit of Sugar ….May Damage Your Health

4 June

I felt some angst when BJ announced initial relaxation of lock-down two or three weeks back – the disease was still very active and surely the decline was because of lock-down and not coincidental. Immunisation has largely extinguished many serious infectious diseases but that is because of and not despite the vaccines. Brighton’s slightly alternative population means a lower uptake than in many areas and a few years back there was a little cluster of measles cases showing that the lid can burst open given half a chance.Nevertheless the government mantra was that all decisions were based on scientific advice and SAGE and its subgroups has some wise and well informed members so that was reassuring.
I thought I was shielding until the end of June….until last weekend when it was suddenly announced that even the two million or so of us deemed at high risk of severe illness can take the latch off the front door and venture out once a day albeit adhering to the guidelines. I can wash my hands, wear a mask etc but it takes two to tango and also to socially distance so there’s the first potential flaw. And there are still around 2000 new cases reported daily in the UK – almost certainly a significant underestimate as some are asymptomatic and others simply don’t get tested. So why the sudden change?
Maybe it’s a sympathy move as the mood music from the shielded was of feeling forgotten and ignored and so BJ et al felt an olive branch of a daily toddle and a bit of human contact would soothe our pain. You don’t need to be on SAGE to realise that’s no grounds for a decision. And here’s the rub – members of SAGE have expressed doubts about aspects of the relaxation policy. Here’s a taster of three: Professor Sir Jeremy Farrar, Director of the Wellcome Trust “Covid-19 is spreading too fast to lift the lockdown in England”, Professor Peter Openshaw of Imperial College “near unanimity among scientists in unlocking carrying real risks”. Professor John Edmunds of the London School of Hygiene and Tropical Medicine stated that this was a political and not a scientific decision. And all four UK Chief Medical Officers rejected BJs line of decreased viral threat and Chris Witty, the England CMO, said he’d vetoed the Government dropping the risk level from 4 to 3. I’m relieved that my anxieties are not unfounded and don’t reflect lockdown induced paranoia but equally even more concerned that once again the Government have “had enough of experts” and opted for their own route map.
Indeed it was quite entertaining to watch Dominic Raab ducking and weaving more than Frank Bruno ever did as Andrew Marr had him on the ropes. We are at Level 4 on the Governments’s own chart said Marr but we start relaxation at Level 3 – DR gets up on the count of eight explaining that we are transitioning from 4 to 3 so it’s OK to start. Mmmmm? And interestingly he didn’t specifically say they were following the science but took “independent advice” – who from – maybe that well-informed addendum to SAGE aka Dominic Cummings? But the gall – asked how many have so far been tracked and traced he had no answer but still stated that our system was world-beating!! Good job I took the toilet break before the programme started or I might have been wetting myself by now. Marr then asks him to spell out the special exclusion clauses in the guidelines as per DC lest we need to pursue these and guess what – nothing is proffered. Dominic’s trainer would surely throw in the towel at this stage. 
Excuse my cynicism but I perceive a DC effect. There has been great worry that the general public will simply follow his example and do their own thing regardless of government guidelines. I suspect that this is a BJ pre-empt, a sweetener partly to detract from DC as a headline but also to assuage the public wrath. There has been increasing concern in medical circles that sugar and not fat is the arch criminal in cardiovascular disease. Perhaps BJ needs to be warned that too much metaphorical sweetener can potentially damage your health as well.
And what will this mean for the future of this government which is already under serious scrutiny as having mismanaged many aspects of the corona outbreak? If ploughing their own furrow in the face of medical and scientific advice should result in a significant resurgence of cases and deaths and even a second lockdown then could there be irreversible loss of public confidence in the competence of BJ and his team?

From John in Brighton: Don’t think its all over!

31 May

Through the winter my cycling has been confined to the undercliff passage along the sea front but a few days ago I took my first ride of the year up on the Downs from the Jack and Jill windmills over to Blackcap just outside Lewes. The countryside is the summer schedule when the ground is dry and the wheels unclogged by mud. A bit later than usual following the floods of spring and the uncertainty over the Lockdown rules as it does involve putting the bike in the car for a short drive. The driest May for 176 years has sorted the first issue and Dominic Cummings the second. In the unlikely event of a challenge from the Fuzz – “Sorry Officer but my vision was a little blurry this morning and I’m testing it out”. The only potential flaw in my DIY optometry argument is that I’m not risking a 4 year old on the back seat. What odds I wonder would I have got from Betfred last October that by the time I returned to the summer routine the World would be engulfed in a pandemic? 5000 to 1 mate, worf a quid surely! No thanks, no chance, I’ll stick with the tangible – another bag of chocolate buttons.
The  car park is full but the Downs expansive enough and social distancing is not an issue. First skylark of the summer for me and sounding very blithe, clearly oblivious of the troubles of the World below. It was June 1820 that Shelley wrote his wonderful tribute to the “Bird thou never wert” and that was only fifty five years after the Great Plague killed about 100,000 including an estimated 15% of the population of London. About eight miles each way up hill, down dale with the highest point about halfway at Ditchling Beacon. A couple of landmarks are the i360 in the distance and the Amex glistening in the sunlight a mere mile or so away. I can make out the seagull pattern on the seats but without my binocs the cobwebs of the furloughed stadium are indistinct. Should I clarify with DC whether this means I’ve failed the eye test? It’s 87 days and counting since the last home game. Another 87 will be the 21st August and the new season should be kicking off – what odds will they give me for that? Do we update the jibe about the ref going to Specsavers  – “you need a drive to Barnard Castle”. Up on the Downs nearly everyone exchanges a pleasantry, usually just a “good day” and everyone seems cheerful but who knows if any of them has suffered personal pain and even loss in the last three months? Nearly everyone has some problem of varying degree in their lives so are they dissembling? We have been repeatedly told that we have turned to Nature to lift our spirits in the dark times and perhaps we’re all benefactors of this pastoral opium of “England’s green and pleasant land” to borrow the description of another of the great romantics. The return trip had an unscripted adjournment as  a short stone’s throw away is a kestrel hovering and I watch him pounce twice but to no avail but the third time I half make out something in his beak – I just hope it wasn’t a baby skylark. Do birds pine I wonder?  A little further away is a buzzard surveying the landscape in search of a slightly belated lunch. Harsh reminders that the wonders of Nature are counterbalanced by being red in tooth and claw…and beak….and with a touch of poetic licence at least for the time being Covid. The grim reaper can pounce in varied formats. 
Thursday it was back on the sea front and what a contrast. The beaches and esplanades were packed and cafes well patronised. People strolled along in groups and many seemed to make no attempt to adhere to the two meter ruling. The traffic is undoubtedly escalating week by week. It gave the impression that as relaxations are introduced there is already a perception to many that the virus is beaten and normality is restored. Perhaps the really good weather is paradoxically showing it’s downside and although we are encouraged to be outside that only applies if the rest of the guidelines are in lockstep. Perhaps if it were chillier or wetter many more would find it easier to stay at home. Stopping off at a shop on the return trip serves a sharp reminder of the ongoing risk – a ten minute queue to enter and a one way system round the store. These reality checks may have additional benefits to the raison d’etre of acquiring goods.
The reminder is rubber-stamped when I get home to watch the news – an additional 412 deaths recorded over the last 24 hours. You think it’s all over ? Certainly not.

From John in Brighton: My Brave New World

26 May

The World will never be the same again after corona. We must all have hopes for potential benefits that could result from this dreadful pandemic – community spirit, working from home, less pollution …. On a personal level I may emerge a bit more wired – currently in both senses but hopefully just the techno will persist. In a Q&A a few weeks back actor Michael Frayn described the iPhone as “surely one of the greatest peaks of human achievement”. Praise indeed! I’ve never owned one so I cannot confirm or refute his view. Indeed I’ve always had a slight resistance to technology compounded when I read of its addictive potential, cyber crime, concern over data privacy (maybe the denouement of Brexit would have been different if Smartphones didn’t exist) and reports that counter-intuitively the World of the techno age is in some ways more disconnected than ever. And my let-out clause was age, technology is a young person’s game – but Frayn is 86. In fact above all I think I still hanker for the halcyon days of writing a letter, the Encyclopaedia Britannica, Instamatic cameras and the trusty old red phone box or if it’s urgent sending a telegram. What do you get from the Queen nowadays when you clock up your century? An e-mail maybe, yuck!
Last week when out on a cycle I read a bit of graffiti  –  “Open Your Mind” and someone had added “But Not So Far That Your Brain Falls Out”. The vision, reminiscent of Monty Python,  amused me which is perhaps a bit of a worry but I’ll put it down to the current circumstances and pressures. Anyway my mind is ajar and my techno pendulum is swinging.  I marvel at how technology is increasingly entering the medical world. AI is beginning to read MRI brain scans and Moorfields Eye Hospital is using it to detect some retinal conditions. Mind-blowing. Antibiotic resistance is becoming a real worry and a  Harvard team have recently used AI to create a new antibiotic named Halicin which is effective against some highly resistant E coli bacteria. Apparently AI is currently pursuing anti-Covid drugs and perhaps they could turn their attention to a corona vaccine if the Oxford prototype is unsuccessful. I’m sure there will be an abundance of further developments. A little over 200 years ago the Luddites’ concern was that machines would threaten jobs so perhaps that’s my new counter argument – dole queues of highly trained docs. But Kenan Malik has blown that one making the case that machines will never (can you ever say never?) offer the ethical and humane aspect of care when their key skill is pattern recognition.
But returning to what is commonly called general-purpose technology and a more personal level last Friday there were a couple of baby steps on my road to Damascus. An hour and a half on Zoom connected to siblings as far afield as Brisbane and with crystal clear images and audio – thro’ gritted teeth I have to acknowledge that as extraordinary, unthinkable even a decade ago. Then in the afternoon online bridge – and as good as if we were physically in the same room. ….which we all but could be I am advised by the fellow players. All I need to do is buy a Smartphone and load WhatsApp – what’s not to like? And there’s my problem – it’s getting easier to maintain lock-down especially with BJ’s relaxation and Dominic Cumming’s amendments than it is to live without a Smartphone. I lack DC’s ability to create fairy tales and fibs and so……
I haven’t quite crossed the Rubicon yet but as I metaphorically trudge across Gaul I’ve got Italy in my sights. If I were a gambling man I’d anticipate being a fully fledged techno proselyte before we emerge from the black clouds of corona. Maybe even the darkest nimbostratus has a silver lining or will I be doubling down on my hankering? …

From John in Brighton: Two Baby-steps for Man

20 May. After seven weeks of “shielding” (a euphemism for imprisonment for the uninitiated) this last weekend represented a couple of baby-steps back towards normality for me. I’d better own up that I have dumped my shield numerous times – but only to cycle  ten miles along the seafront as I deemed the benefits to mental and physical health justified the miniscule risk. There was a positive feel – football was reappearing albeit German and with cardboard cutouts, Eurovision was all but cancelled (seriously good news) and the weather was set reasonably fair. But it was bumbling Boris’ baby-steps and a case of needs must that really did it for me.
First off meeting a couple of friends for coffee. Confession number two it was in the back garden not a public place but we’re not stupid and pursued social distancing so I feel not an inkling of guilt or worry. No hugging, not even a handshake. If it’s any consolation to BJ the nip in the air ensured that we stayed alert. After years of NHS guidelines and policies I conclude that those that work best are clear and concise with no grey zones and brief enough to be manageable, no one reads a series of fifty page documents. Two-thirds of the public find the government’s new rules unclear apparently. The lack of logic and confused messages from bulldog-spirited BJ and his cabinet of spaniels makes me think that we should use our common sense as our Pole Star rather than any parliamentary edict. Returning briefly to football I am reminded of a well known chant albeit less heard since VAR took the ultimate control “Yer don’t know what yer doin'”. Anyway bearing in mind that one difference between humans and primates is our better-developed language it was really good to have an hour and a half of conversation in vivo, a bit of culture to add to my already lengthy reading list and to share the machine-gun trill of a rather vocal wren. And in case you’re worried the boys in blue (is that a bit Sergeant Dixon era, should it be persons in blue?) were obviously too busy patrolling the beach to worry about any geriatric misbehaviour. 

Sunday’s baby-step was a case of needs must as the DIY click and collect system was unavailable. Not Wickes or B&Q but the arrangement whereby I click a list, daughter shops for it and we meet and I collect. Works a treat if you haven’t tried it and all for the price of a bar of chocolate and a few satsumas. But she was busy, so armed with my new-found liberation I opted for the elderly and vulnerable slot at Waitrose. A real life allegory unfolded in lieu of the deficiency of church sermons at present. Being my first visit in lock-down and because the queue bent invisibly round a corner I spent ten minutes oblivious to the formalities whilst hanging around the door. Come opening a woman bellowed at me that there was a queue – instead of just watching me couldn’t she have told me that before?

By this point it was half way across the car park, heart-sink…..But a kind lady with whom I used to natter  back in normal times agrees to let me in, the lady behind seconds the motion  and like a game of snakes and ladders I’ve shot up from 26th to 5th in the blink of an eye. My goal is to get round and out as fast as possible and the only potential hindrance is that “she who is aggrieved of queuing” is visibly surprised and put out to confront me – “how did you get in?” she asks clearly concerned that a grave injustice has come to pass.

What is the matter with some people? Doesn’t she realise she could be on a ventilator or using a food bank? But maybe she is stressed for some other reason and so I opt to stonewall rather than engage in messy discussion. Get to the checkout by 9.50 for a ten minute wait but I’m still only second in the queue. First is a young oriental lady and she turns and asks if I’d like to go first, almost insistent – presumably because I look suitably geriatric and vulnerable. Inculcated with the proprieties of queueing and so taken aback that anyone should make such a kind offer (unprecedented as per the current demotic) I decline despite her repeated offers. I’m out by ten past ten, no one sneezed or coughed on me and so hopefully all will be well. But the experience was valuable on two counts – got a few bits for sustenance and more importantly The Observer which was the primary purpose of the mission.  But an unanticipated spin-off was to experience the stark contrast of human nature between the angry and rude as opposed to the kind and considerate. It reminded me that the latter is the camp I need to be in. We’ve seen outpourings of community spirit during the loc-kdown and long may that live and on a small scale I hope to emerge a kinder person and for more than the seventy two hours or so that we reduce our driving speed after passing an accident.

It’s over fifty years since Neil Armstrong took his “small step for man” but with my two baby-steps I’m over the moon. I still have reservation that there could be a second wave of virus and will be very selective in any external activities but the tips are reopening in Brighton and the lure of clearing several crates of garden waste may be my next baby-step . Need to ensure that I stop it becoming a baby-toddle at this stage but if hairdressers get the kiss of life then the temptation may be too much.

From John in Brighton: Baby steps But Is It Too Fast?

13 May: All of last week we sought answers about relaxation of lock-down and for once the Government was of a piece. “You’ll have to wait and see what the Prime Minister says on Sunday” was the repeated mantra. This seemed like such a key moment of revelation that for once I made a point to listen in live…and it felt rather bathetic. An outline was put forward but we’d have to wait another twenty four hours till his next pronouncement for details.  
So what have we got? “Stay at Home” is ditched and now it’s “Stay Alert”. The OED offers two definitions for alert – firstly able to think clearly and be intellectually active so I’ll continue the bridge three times per week and add Soduku on the other days. Secondly to be vigilant and quick to notice potentially dangerous situations which means honing our skills in social distancing, washing our hands even more and politely asking anyone who coughs or sneezes to go and get tested. That kills two birds – public safety and Matt’s chance of occasionally hitting the testing (in more ways than one) target. Communities Secretary Robert Jenrick seemed to agree with much of my interpretation but added it also means stay at home as much as you can. Eh! So why not just stick with Stay at Home which people seem to understand and are largely abiding by? As Nick Cohen pointed out in The Observer most people share one common behavioural characteristic in that we don’t want to die and the daily rate of infections is well high enough to concentrate most peoples’ minds. We can go out for more than one dabble of exercise daily – I get that bit. We can meet one person from outside our household but two metres apart and in a public place. Why not in my back garden? Why only one considering you could cross paths at two metres with fifty people on the weekly supermarket visit? If possible work from home but if you can’t then you are encouraged to go back to work but not on public transport….and certainly not without a face covering. The videos of yesterday’s commuters showed considerable increases in numbers on the London underground and many with faces as naked as the Rokeby Venus. 
And why have the other three nations been more cautious in any relaxation and indeed the “Stay at Home” edict survives in all three? Does the virus really change its characteristics as it crosses Offa’s Dyke, Hadrian’s Wall or the Irish Sea? Are the Welsh, Scots and Irish different in their susceptibility to corona? I think not to all of those and any variations are simply down to an ideological basis, have no apparent logic and at worst could create some confusion.
I fully acknowledge that the decisions of when and how to exit lock-down are incredibly difficult and at some point the water must be tested and further changes determined incrementally or in reverse. I’m neither an infectious disease pundit nor an epidemiologist but I’m worried that although the government refer to the changes as baby steps the rather more nebulous Stay Alert and get back to work if you can may be more sweeping than first they seem. Even with social distancing maintained there is undoubtedly increased risk of closer contact than has been the case in lock-down. Indeed it is axiomatic that the current falls in new cases and deaths is because of the strict lock-down. Even so yesterday before the relaxation kicks in there were 3403 new cases and 627 deaths and bear in mind this is a likely underestimate as it only includes those who tested positive. The oft-quoted R(eproduction) number is between 0.5 and 0.9 so not far below the cut-off at 1.0 which is seen as the red line. In my humble opinion I’d be with the other Home Nations and keep a tight lock-down pro tem with perhaps some liberation of outdoor activity as my tentative neonatal step. It feels like a tug of war between health and the economy and I’d be adding my heft to the health side at present. Lives that are lost cannot be recovered whereas one can but hope that the economy can be resuscitated even if it is a long and slow process – Germany rose from ruin in 1945 to become the strongest nation in Europe. Secondly I worry that the push to start employment and business could be counter-intuitive in that if there is a second spike and reintroduced lock-down this could be a more lengthy and damaging process in the long run. Maybe I need to look on Amazon for a pair of rose-tinted glasses although I see that the BMA are also now suggesting that the changes could be too quick and risk a second spike.
I’m wondering who is driving this change. It was Professor Neil Ferguson who advised the government to stop their ill-judged policy of herd immunity and replace it with lock-down albeit belatedly but unfortunately he fell on his sword earlier this month after breaching his own advice. Who is now the main source of medical advice and on what evidence is the current advice being given?  Last week Matt Hancock seemed to be emphasising that the population’s health was the top priority in any planned changes and there should be no compromise that might induce risk. Yesterday morning to my surprise he was on Breakfast TV saying, and I quote, “that it is important that people can get back to work because there is a massive massive (sic) economic cost to what we are having to do for health reasons. And although I don’t like that I am absolutely determined to ensure that the health of the nation is protected”. Is Matt dissembling? Does he really support the importance of people leaving their homes to work or is he following BJ’s bulldozing party line? And is BJ taking a leaf out of Donald’s book? And we don’t seem to have heard from Dominic Cummings lately – has he had a part to play? I’d be interested in details of the process….
…and equally of how the Covid is going to respond to its newfound little window of opportunity.

From John in Brighton: It’s Thursday, it’s eight o’clock, it’s Clapadoc

It’s Friday, it’s five O’Clock, it’s Crackerjack! On a weekend when we look back 75 years we of a certain age only need to go back 55 for that gem of childhood TV. Albeit in very different circumstances we now have It’s Thursday, it’s eight O’Clock, it’s Clapadoc – the whole of the NHS in fact. And – a bit like the government care workers were added as an afterthought so it became Clap for Carers. Last week the turnout was low and I wondered if the gloss was wearing thin after seven weeks but a resurgence this week suggested otherwise. I suspect it was simply that a week ago it was bitterly chilly and the warmth of feeling this Thursday was pathetic fallacy after a day of bright sunshine. Let’s hope the waning virus doesn’t pick up any tips about a comeback in the weeks ahead giving a V sign (non-Churchillian) to BJ in response to any concessions he offers tonight..
As I recall the clap was initiated after a nurse went viral (perhaps it’s time to rename that phenomenon) as she tearfully reported how she shopped at the end of her shift only to find the stock-pilers had left aisles of empty shelves. The clapping extended into fundraising and a nigh-on hysteria as best shown by Captain – sorry Colonel – Tom raising over thirty million quid walking back and forth in his garden. That’s fantastic but it’s an extreme behaviour. Food donations poured in up and down the land along with various other goodwill offerings to NHS workers. The NHS has been the jewel in the country’s crown since it’s inception three years after VE day, one time envy of the World but perhaps a little less so of late and close to the hearts of the population. But Covid has driven that appreciation to another level.  Maybe it’s a genuine reassurance that every one of us is grateful that if afflicted the facility and expertise will be there for us and without a monumental invoice at discharge, maybe it’s sympathy for those working long shifts in sweaty and uncomfortable PPE or maybe anxiety and even guilt that others will be working at risk to themselves and their families because they haven’t got the PPE.  But Covid has also unveiled a large elephant which we’ve managed to brush under the carpet to date (there must be a cartoon there if someone’s not already done it). How often we hear of Matt referred to as Health Secretary but often minus the second half of his portfolio……and Social Care. As we salute the wartime generation and the gratitude we owe them,  many of the survivors live in care homes dependent on committed carers working under conditions at least as challenging in many ways as the NHS and paid at a lowly level. Sadly the staff have not received the government support they need and deserve despite Matt claiming that care homes had been a top priority since the start of the pandemic.  The evidence suggests otherwise.
Despite the public outpouring many of the NHS workers would not see themselves as heroes but simply doing a job. And indeed some are now acknowledging that they are in employment and can afford food which may contrast with the many who have lost their jobs and some are suggesting that perhaps food donations, albeit much appreciated, could be better given to those who are struggling and to food banks and the homeless. A detour to the nearest care home might not go amiss.
But what about the future?  In retrospect errors have been made and there will be lessons to be learnt in planning for future unpredictable health challenges. Regarding the NHS the progressive increase in funding is to be welcomed but against ever rising demand as the population ages and treatments and drugs become dearer so it’s running to keep up. Along the way there have also been “efficiency savings” – at what point does that euphemism become a cutback?  In a short piece in The Observer of 26 April Kenan Malik made the point that heroism stands out more in the context of lack of resources or poor conditions. This is well illustrated by the Brazilian Archbishop Helder Camara whom Malik referred to “When I give food to the poor they call me a saint. When I ask why the poor have no food they call me a Communist”. We need to ensure that our NHS is appropriately funded and settle for no less. And may the profile of care of the elderly and vulnerable come out of the shadows with staff given the facilities and support that they need and a fair wage. In February Dame Esther Rantzen et al made the case to BJ for a dedicated Minister for the Elderly – as far as I’m aware we await a response…..

From John in Brighton, UK – The Race is ON

The Race is On
It seems a bit of a contradiction to describe a potential lifesaver as a “silver bullet” but all hope of eventual total freedom from corona lock-down is vested in a vaccine. One word of caution – just as we can’t guarantee that the natural infection confers immunity and if so for how long so we should remain optimistic for the vaccine but be aware of potential limitations.
The pharmaceutical giant Astra Zeneca is collaborating to produce the “Oxford vaccine” if that is demonstrated to be effective – it is hoped some initial data on the trial may be available by mid June. But even if production ensues soon after that it will amount to a mere tens of millions of doses by the end of the year.

The race is on says the popular demotic as an effective vaccine is sought in all corners of the World. But having lost this year’s Grand National perhaps this could be a metaphorical equivalent. Having cleared with ease the minor fences to fast track the process we now confront the giant sixth fence Bechers Brook in trying to  develop a vaccine. How we’d cheer if we could hear Peter O’Sullevan’s commentary “…and the Jenner Institute is clear and leading the field as they head towards the seventh…”. But unfortunately that may not be the toughest of the hurdles. The ninth is Valentines and that’s finding the most effective collaboration in terms of production and finance between research  and industry although that should be facilitated by the “not for profit” agreements. Over that one but the fifteenth is arguably the toughest of the lot – the dreaded Chair. That’s the moral and ethical debate about who gets the vaccine first. For worldwide coverage billions of doses are needed. Two other pharmaceutical leviathans GSK and Sanofi are collaborating but the chief medical officer of the former estimates they could only produce enough for about 20% of the World population within a year. So how best to maximise production and distribute it fairly and irrespective of any ability to pay?
In March, it was reported that President Trump had approached a German company, albeit with a US citizen as its CEO, seeking sole access for the US when they develop a vaccine  – and offering significant financial incentives. Matt Hancock is under pressure to guarantee Britons having priority access to any UK developed vaccine. On the other hand last week Dominic Raab joined Angela Merkel, Emmanuel Macron, Melinda Gates and others to back the WHO proposal for equitable access worldwide. Welcome back BJ and good luck with sorting that one. His mate Donald, along with China, Russia and India did not offer their backing incidentally.
Everyone will have a view. Mine is that if UK expertise and investment in research has borne fruit then the British should get first….and second, third and fourth bites of the cherry. That may prima facie be against the principles of social justice and fairness that I endorse but here’s my rationale. Firstly, yes it is partially and perhaps selfishly that we must all yearn the day when our lifestyles return to a semblance of normality and our economy can be kick-started. The finishing post can’t come too soon. But secondly I implicitly trust UK research notably over the efficacy of the vaccine and also production standards in the UK are second to none whereas I might feel less confident if the provenance was overseas. And thirdly it mitigates against a logistical nightmare. If we were rationed a proportion of available vaccine there would be endless debates as to who would be prioritized, which services do we need to bring out of hibernation first and how long will everyone else have to wait. The old? Underlying health issues? NHS front-line or the oft ignored care homes? Or the dark horses with two risk factors like the obese males, could they be the Foinavons? And would it be morally wrong to allow those with means to buy the vaccine privately? Far better surely to complete immunization of our population and then distribute appropriately and generously to other nations.
And finally, I ponder whether we may confront another potential price for BJ’s other baby – Brexit? We have heard much about Exercise Cygnus in October 2016 which looked at plans in the event of a pandemic albeit flu. It never got published nor acted upon and my suspicion is that all efforts were channeled into Brexit following the referendum four months earlier. We missed out on securing PPE earlier this year in a joint procurement with the EU purportedly because we never got the e-mails which the EU has denied. Again, perhaps cynically, I wonder if this was not an ideological decision. Could we be on the threshold of a third Brexit payback?  With BJ now in thrall to Donald  he may well see vaccine sharing as a golden opportunity to consolidate The Special Relationship. Presumably we’d get a shed-load of disinfectant as quid pro quo.