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: 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: Counting Loneliness

September 28. Pandemics have always generated numbers.  Defoe structured his Journal of the Plague Year around the weekly Bills of Mortality which allowed him to track the progress of the disease from parish to parish across London in 1665.  We have the same ambition on a global scale.  Today’s figures are 32.85 million infections and nearly a million deaths.* 

Less directly we can consider quantified measures of physical or psychological suffering.  A number of university departments and other agencies set up funded questionnaire-based enquiries with great speed once the scale of the event was recognised.  These have delivered immediate information although they have often have suffered from the haste with which their sample populations were assembled.  Much the best source of information has been generated by the weekly reports of the estimable Office for National Statistics (ONS).  Instead of creating a fresh bank of interviewees, it addressed new questions to its ‘Opinions and Lifestyle Survey’, an established, weighted sample of the population. 

Amongst the issues measured by the Survey is the key experience of loneliness in the pandemic (solitude, the subject of my recent book, is almost never counted).  There is an obvious risk that repeated lockdowns are causing disruptions to social patterns leading to increased personal isolation.  Two basic truths are revealed by the tables, which apply not only to the coronavirus crisis, but to contemporary society more generally. 

The first is that the instance of ‘often/always’ loneliness, the category where real suffering is to be found, started at around five per cent of the population, and has moved, at most, by a single decimal point over the last six months.  Whatever else it is doing, the coronavirus is not making us much more lonely.  Five per cent still represents around one and a half million people of sixteen and over, and is to be taken seriously.  But in its most acute form, increased loneliness is not consequence of the pandemic.

The ONS then asks a question which previously had not been systematically addressed: the relation between loneliness and disability.  The results are striking.  Those not suffering a self-reported disability have an ‘often/always’ loneliness level of only 2.8% in the 8-18 July, 2020, sample, compared with an overall figure of 6.2%.*  By contrast the disabled show a level five times higher at 14.5%.  Separate categories of impairment display still higher scores – 19.7% for vision, 15.8% for mobility, 21.7% for learning, 24.7% for mental health.  It is not difficult to comprehend why these conditions should discourage or prevent levels of social interaction which individuals wish to undertake, or why they should make the experience of being alone so much more painful.  There may also be a reverse causal flow, with, for instance, mental health problems exacerbated by a lack of human contact. 

This confirms an argument I have made elsewhere, that those seeking to engage with loneliness across a broad front are missing the point.  The experience is above all a function of specific forms of impairment, each with their own dynamic, each with a set of pressure groups and campaigners, and each having a destructive interaction with austerity-driven health and welfare policies over the last decade. 

Here, as with other categories of suffering, the pandemic is exposing critical shortcomings in the provision of support for a range of disabilities, perhaps most importantly, mental health.  Loneliness, in this sense, is a proxy for wider failings in our systems of medical and social care. 

*https://www.theguardian.com/world/live/2020/sep/28/coronavirus-live-news-global-deaths-near-1m-as-india-poised-to-pass-6m-cases

**https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/datasets/coronavirusandthesocialimpactsondisabledpeopleingreatbritainmay2020

Add Mss on Counting Further to my entry on logs and panic buying, it is reported that Tesco has again begun rationing loo rolls, pasta and flour as shelves empty following the renewed lockdown restrictions.  When this crisis is over, it will be possible to count the evolution of public anxiety by constructing a loo-roll purchase index

From David Vincent in Shrewsbury, UK: Take a Pill

Big pharma is having a good war.  It is generally accepted that the only way of ending the pandemic is the discovery of a vaccine and its manufacture and distribution on a global scale by multi-national drug companies.  Everything else is just dealing with the symptoms.  Companies like AstraZeneca are making deals with governments around the world to make available the first vaccines to succeed in the current trials.  Never before have we been so aware of the virtues of their technological competence and organisational power.

There remain, however, areas where these companies stand to gain from the crisis in less welcome ways.  The widespread disruption to established patterns of social interaction has raised fears that loneliness may be on the increase.  As I have argued in earlier diary entries (especially May 27), the first batch of survey evidence suggests that acute loneliness, the kind that causes serious psychological suffering, appears remarkably stable in the pandemic at around five per cent of the population.  Nonetheless the preceding moral panic, which produced inflated loneliness figures of over fifty per cent and referred to a widespread ‘epidemic’, has gained in a new lease of life in a time when everyone’s relationships are under strain.

The drive to medicalise what is a form of failed solitude is partly a function of how political change works.  Pressure groups and concerned scientists have since the 1950s compelled governments to intervene in a growing range of private behaviours which have demonstrable physical consequences, starting with smoking, and, in recent days, finally causing the overweight Boris Johnson to commit his administration to tackling obesity.  Thus campaigners claim that loneliness has worse consequences than smoking fifteen cigarettes a day, or having too large a waistline.

As a recent newspaper report has revealed, the discourse has thrown renewed attention on the search for a loneliness pill.*  In Chicago, Stephanie Cacioppo, co-researcher with the late Stephen Cacioppo, is continuing work on isolating a pharmacological treatment for social isolation.  Another research group is investigating the prescription of oxytocin for loneliness sufferers.  Whether these pills are a self-sufficient remedy or part of a psychotherapy treatment, the prospects for the pharmaceutical companies are immense.  Whilst serious loneliness is a minority experience, the multiple transition points in late modernity mean that all of us at some point risk malfunctions in our social life.  The current pandemic in this regard merely highlights the fragility of the networks of personal relationships that we all seek to maintain.  If every time there is a failure of interaction, or a perceived danger of such an event, we could just pop a pill out of its foil sheet, how relaxed we might be, and how great the profit for the manufacturer.

There are of complex ways in which medical conditions, including mobility or communication disabilities, can impact on interpersonal relations.  Forms of acute depression can have a range of physiological consequences including damage to immune systems.  There is a longstanding debate about whether and in what form pharmacological treatments should play a part in psychotherapy.  None of these complexities are resolved by conceiving the existence of a loneliness pill or seeking to put one on the market.

Just as good solitude is a rest from the labour involved in effective social relationships, so bad solitude requires for its alleviation a wide range of public actions.  There is no pill that will resist the effects of the coming collapse in income and employment, or the continuing underinvestment in mental health and local support facilities.

*https://www.theguardian.com/lifeandstyle/2020/aug/06/loneliness-cure-pill-research-scientists?CMP=share_btn_link

from David Vincent in Shrewsbury, UK: Loneliness and Life Satisfaction

June 30. We are living through a time of drama.  Every week brings a new crisis, reported or anticipated.

History will record a belated response in the early days leading to thousands of avoidable fatalities, critical shortcomings in PPE, scandalous death-rates in care homes and amongst the BAME population, widespread failings in introducing test and trace procedures, the complete failure of the NHS testing app.  Today we have the return of lockdown in Leicester and later this week there is the predicted disaster of choosing a summer Saturday night to open all the pubs in England for the first time in three months.  And so it will continue in the face of a still unknowable virus and a government of still uncharted incompetence. 

And yet, if attention is paid to how people are feeling about the crisis, a very different picture emerges.  In my entry for May 27 I drew attention to the social surveys which have been launched at great speed in response to the coronavirus.  One of the larger enterprises, the UCL Nuffield Covid 19 Social Study, has now published four further weekly reports, displaying consistent data over three full months of the pandemic.*  The questions in the survey cover basic attitudes and emotions in the lockdown.  Each topic has its own trajectory since the last week of March, and its own variations by age, income, and living conditions.  But standing back from the detail, what is most striking is the absence of change over the period.

Graph after graph proceeds in an even line as each week passes, sometimes on a slightly upward trajectory, sometimes downward.  What is missing almost completely is the kind of volatility that we read in the headlines each day.  ‘Loneliness’ (see above) has been almost completely flat since the last week of March, unaffected by the recent marginal lifting of the lockdown.  ‘Life satisfaction’ has gradually risen from 5 to 6 on a 10-point scale [it should be 7.7].  ‘Happiness’ [you may not know what that is, but here it is measured by the Office for National Statistics wellbeing scale], has been at or just under 6, again on a 10-point scale, with very small fluctuations.  Levels of depression and anxiety have been higher than in pre-Covid times but have gradually declined through the Spring and early Summer.  Confidence in the English government showed one of the largest short-term changes, falling from 4.5 to 3.5 on a 7-point scale at the beginning of May, but has since levelled out. Notwithstanding this decline, willingness to comply with guidelines has barely altered, slipping over three months from almost 100% to just over 90.  The sharpest fall has been in worries about food security, which began at around 60% of the population and are now only a little above zero. 

The scale of the sample, which involves 90,000 respondents, inevitably has a dampening effect on variability.  Individuals who have lost their jobs, or have been ill, or have suffered serious bereavement, will scarcely report so uneventful an experience.  Nonetheless the absence of sudden change across the population in such fundamental areas as depression or life-satisfaction is a necessary corrective to the melodrama played out on the front-pages of the newspapers.

When the scores are broken down by issues such as income or living conditions, there are generally only minor differences.  In most categories the young are suffering more than the old, the poor more than the rich, but often the differences are small.  Much the largest variable on almost all issues is a prior diagnosis of mental ill-health.  Again the scores show little change over the period, but there are significant gaps between the graphs of the well and the unwell. On key issues such as depression, anxiety, loneliness and happiness, the mentally fit are between half and three times better off than those who entered this crisis already in trouble. 

According to a report by the charity Mind this morning, almost two thirds of those with a pre-existing mental health problem said it had become worse during the lockdown.**  When we consider where the effort should be placed in alleviating the consequence of the pandemic, the mental wellbeing of the population at the outset of the crisis will require particular attention.

* Covid-19 Social Study Results Releases 1-14

** https://www.theguardian.com/society/2020/jun/30/uks-mental-health-has-deteriorated-during-lockdown-says-mind?CMP=share_btn_link

from David Vincent in Shrewsbury, UK: Solitude and Loneliness

May 27 In my diary entry for April 8, I wrote that:

Enforced isolation has an ambiguous effect on the two experiences.  On the one hand it has made solitude a still more valued practice.  In families where the adults are working at home, the children are about all day long, the garden is small or non-existent, periods of solitary escape have become as desirable and unattainable as supermarket delivery slots … On the other hand, it has made loneliness still more threatening.  It becomes more difficult to make physical contact with such friends as the individual possesses.  Intermittent escapes from an empty home to shops, cafes, local libraries, public entertainments, are now forbidden.”  I concluded that, “Where the balance will finally be struck in these contrasting effects of isolation remains to be seen.”

Now the evidence is beginning to appear to answer this question.  The crisis has stimulated the creation of a number of major research projects across the social sciences, which have been planned, funded and put into practice in a remarkably short space of time.  One of the largest of these is the UCL Nuffield Covid 19 Social Study.  This is a questionnaire-based survey which currently has 90,000 respondents.  It is not a representative statistical sample of the population, but is large enough to generate substantial conclusions.  The research team, led by Daisy Fancourt and Andrew Steptoe, have a sophisticated grasp of the concepts and categories of mental health, and are publishing weekly bulletins of their findings.

The ‘Covid-19 Social Study Results Release 8’, on 13 May, was particularly interesting.*  Table 21 measured the incidence of ‘Loneliness’ on the industry-standard UCLA loneliness scale.  This was unchanged across the lockdown period at around 5%.  This is the same level as more cautious observers and social historians have projected across the entire post-war period, and about a quarter of the claims made in the Government’s current loneliness strategy.  Whatever else it is doing, the covid19 epidemic is not causing an epidemic of loneliness.

The team found that the condition was “higher amongst younger adults, those living alone, those with lower household income levels, and those with an existing diagnosed mental health condition.  They are also higher amongst women, people with children, and people living in urban areas.”  It was correspondingly lower than 5% amongst those over 60, those with higher incomes, those without mental health conditions, and those living without children.

Table 27, by contrast, measured ‘Activities missed during lockdown.’  At the top of the table, not surprisingly, were ‘Meeting up with family’ and ‘Meeting up with friends.’  Half way down was ‘Having time alone.’  This was the solitude measure.  The analysts broke down the emotion only by age.  The younger the respondent, the more likely they were to be lacking time alone.

What is really interesting is the volume.  Just over thirty per cent of the population were included in this category.

In other words, after an extended period of lockdown, solitude is being sought by six times as many people as are experiencing loneliness.

* https://mk0nuffieldfounpg9ee.kinstacdn.com/wp-content/uploads/2020/04/COVID-19-social-study-results-release-13-May-2020.pdf

from David Vincent, Shrewsbury, UK: Prime Ministers, Loneliness and Solitude

April 8. We are all of us having to adjust to the shocking prospect that the Prime Minister might actually die of Covid-19.  The historian in me struggles to find a previous case.  There have been examples in modern times of more or less concealed incapacitating (see Boris Johnson’s idol Winston Churchill, passim), and of sudden resignations following the diagnosis of a fatal disease  – Henry Campbell Bannerman in 1908 and Andrew Bonar Law in 1923.  Two leaders of the Labour Party, Hugh Gaitskell and John Smith, died in post, paving the way for the fortunate Harold Wilson and Tony Blair.  But not the nation’s leader at a time of absolute national crisis.  The nearest equivalent of such an event would be Pitt the Younger, who died in 1806 in the midst of the Napoleonic Wars (see also Spencer Perceval in 1812, though he was assassinated, and George Canning who expired in more peaceful times in 1827 after just 119 days in office).

Amongst the immediate responses was a curious tweet from Andrew Neil (note for non Brits: grizzled former editor of the Sunday Times and now the most feared BBC political interviewer.  In the recent General Election, Boris Johnson, alone of the candidates, refused to submit himself to an extended interrogation by him, which diminished his reputation as it enhanced Neil’s).  A reason, he said, why Johnson has proved vulnerable to Covid-19 was his ‘loneliness’ in Number 10.  It was not clear whether he meant social loneliness, given that Johnson has been living by himself in the flat above Number 11 while his pregnant partner self-isolates in the official country retreat of Chequers, or political loneliness in the Shakespearean sense of ‘Uneasy lies the head that wears the crown.’

Whichever is the case, it raises the question of the balance between solitude and loneliness in the present crisis.  The former, the tendency, as Johann Zimmermann wrote, ‘for self-collection and freedom’, has over the period since the eighteenth century become an increasingly valued an enjoyed condition.  The latter, which can be seen as failed solitude, the condition, as Stephanie Dowrick writes, of being ‘uncomfortably alone without someone’ has been a growing cause for concern in recent decades.

Enforced isolation has an ambiguous effect on the two experiences.  On the one hand it has made solitude a still more valued practice.  In families where the adults are working at home, the children are about all day long, the garden is small or non-existent, periods of solitary escape have become as desirable and unattainable as supermarket delivery slots.  The most basic form of solitude, taking a stroll out of doors, has become stigmatised or completely forbidden.  Walking the dog, for two centuries the most commonplace way of taking time out alone, has suddenly become a basic luxury.  A French friend tells me that Parisian dogs are becoming exhausted, as neighbours borrow them from their owners to legitimise exercise in the fresh air. 

On the other hand, it has made loneliness still more threatening.  It becomes more difficult to make physical contact with such friends as the individual possesses.  Intermittent escapes from an empty home to shops, cafes, local libraries, public entertainments, are now forbidden.  Access to medical or social services is yet more of a problem.  This outcome has been early recognised, and attempts are being made in functioning communities to identity those uncomfortably alone and provide them with necessary support.  And there is, of course, the ever-increasing use of digital connections. 

Where the balance will finally be struck in these contrasting effects of isolation remains to be seen.  At least we should emerge with an enhanced awareness of both conditions.