Sunday 23 August

After months of other cancellations and weeks of uncertainty regarding ‘air bridges’, it was a relief and delight to finally get to Italy last week, where it’s immediately apparent how much more seriously the COVID19 risk is being taken. Mask wearing is obligatory inside various venues and on public transport, temperature ‘guns’ are in frequent use, hand sanitizer is everywhere and every alternate seat on buses, trains and in public spaces is marked out of use. The notices are mostly in Italian (Non sediete qui – do not sit here) but the message is nevertheless clear. For various countries air passengers have to complete paperwork declaring themselves COVID free and the normally disorganised Verona airport was quiet, with frequent reminders in both Italian and English about distancing and the correct way to wear facemasks. Return to Gatwick and there are no such requirements, yet the government continues to project its own incompetence onto countries with far fewer COVID cases than the UK. The most worrying aspect must be the lack of procedure for keeping tabs on those meant to be in quarantine: apparently only one in four is followed up, whereas in some countries passengers are immediately taken to a government-designated venue to make sure it happens.  

The tourist tax in Italy has often made me wonder why the UK doesn’t do the same thing – a no-brainer, surely. It could be this would have happened anyway but the regular sight of municipal cleaning services ensured the place was always spotless and litter-free. There was talk of such a tax being introduced in Bath but I’m not sure if that ever came to anything. Some UK seaside resorts could have benefited from a daily tax, to fund the clearing away of the vast amounts of litter left behind on beaches and open spaces.

During the last week something strange (statistical manipulation?) seems to have happened to the UK death toll, now quoted as just over 41k when last time I looked it was nearly 47k. I was told by a fellow tweeter there was a revision to remove deaths over 28 days after a positive test (‘ie to massage the figures’) and by another that the 65k excess deaths still stands so why bother with the massaging? Alas, some will still be taken in: ‘the government can put out significantly lower figures which will, in many minds, muddy the waters. Not everyone spends as much time on this stuff as we do, and that’s what the government is counting on’.

But one government debacle after another could have allowed less ministerial time for these statistics, in a week during which (is this a record?) responsibility abdicating ministers have been busy throwing both Public Health England and Ofqual under the bus. It seems extraordinary that ministers, science and medical advisers are trying to reassure parents that it’s safe to send their children back to school, as many will, after the pandemic mismanagement witnessed over the last 5 months, have little confidence in the government’s ‘confidence’. Meanwhile, appointing Baroness Harding as head of the new public health organisation will seem extraordinary to many, given the transparent cronyism and her poor performance in the TalkTalk and test and trace roles. Since the new National Institute for Health Protection (NIHP) is expected to focus on ‘preparing for external threats like pandemics’, we have to wonder what’s happening about the rest of the public health role, such as ill-health prevention. And yet the government still continues to use the ‘world beating’ descriptor for one ill-thought out policy or another, especially outsourced track and trace, which has failed to reach nearly half of potentially exposed people in England where COVID infection rates are highest. 

Perhaps the worst example of cronyism emerged during a recent Today programme interview with health minister Edward Argar, who defended Serco’s appalling record while trying to play down the fact that he had been head of PR there.

By now many will be aware of Health Secretary Matt Hancock’s enthusiasm for tech and apps but the medical profession has expressed disquiet recently at the intention to make in person GP consultations a relative rarity and for most to be carried out virtually. The letters of two GPs to The Times were reproduced in The Week, making clear the worrying downsides of ‘Zoom medicine’, the main point being that doctors need to use all their senses (including the 6th sense gut feeling) when seeing a patient, such as gait and demeanour etc. One cited two cases (in her practice alone) of women presenting with abdominal pain, only to find that lack of awareness or ‘deep psychological denial’ had led to them not realising they were in the advanced stages of pregnancy. This GP thought that a telephone or video consultation could have resulted in these women being prescribed meds for irritable bowel syndrome, perhaps, only to get a shocking surprise weeks later on going into labour. The other GP quoted former leading paediatrician Sir James Spence, who said: ‘The real work of a doctor is not an affair of health centres, laboratories or hospital beds. Techniques have their place in medicine, but they are not medicine. The essential unit of medical practice is the occasion when, in the intimacy of the consulting room or sick room, a person who is ill seeks the advice of a doctor whom he trusts’. This might be a good quote for a news presenter to use when interviewing ministers about what could be a damaging approach to cost cutting in the NHS.

One area, however, where a digital service is proving necessary and is apparently liked by patients, is a trial COVID recovery service based at Barts Hospital in London. Last week the i newspaper carried a special feature on post-COVID illness, suggesting numbers affected to be as many as 600,000. Clinicians generally have been surprised by the numbers of COVID patients still experiencing debilitating symptoms months after hospital discharge, one study estimating the numbers at 10%. The main symptoms of ‘long Covid’ are shortness of breath, extreme fatigue and mental health difficulties such as anxiety, depression and post-traumatic stress. This is very worrying, not only for the patients and their families but also for adding to the NHS burden. Although it’s now clear that being male, obese and of an ethnic minority background are predisposing factors for COVID, doctors are still trying to establish what the risk factors for ‘long COVID’ are. As rehab services are ‘thin on the ground’, let’s hope that the Barts trial will get the necessary funding to be rolled out more widely, so that those suffering such an aftermath can get the help they need. The mental health issues, though, will often need more than an app is able to provide.

Economist, broadcaster and journalist Tim Harford, known to Radio 4 listeners to his percipient debunking of statistical errors and opacity in the programme More or Less, recently wrote in the Financial Times about a subject many will have been wondering about: why we fail to prepare for disasters even when we know they’re on the horizon. ‘You can’t say that nobody saw it coming’, he begins, citing the 2005 Hurricane Katrina and the damage inflicted on New Orleans. Regarding pandemics, several warnings were given (and what about the UK’s own 2016 Cygnus exercise, the simulation exercise carried out by NHS England to estimate the impact of a hypothetical H2N2 flu pandemic?) but then there’s a ‘collective shrug of the shoulders’. Harford suggests a number of reasons for this reckless and senseless reaction, including ‘wilful blindness’; inaction in the face of danger psychologists call ‘normalcy bias’; the herd instinct tendency to take the cue from others, so if they do nothing there’s an illusion of safety in numbers; egotistical ‘optimism bias’, whereby people see the disaster as befalling others and not themselves; and ‘the limitless capacity for wishful thinking’.

A good number of us may argue that it’s the job of those in power, our elected politicians, to take charge and to anticipate and plan for such events. Harford could be seen as excusing them when he says ‘but the same mental failings that blind us to risks can do the same to our leaders…..powerful people feel sheltered from everyday concerns’. You can say that again. He does have a point, though, in reminding us that being prepared would have involved a huge diversion of resources from an already struggling NHS. (But then the reason it’s struggling is having been starved of adequate funding for years). He finally asks if we will be any better prepared for the next pandemic. Surely it will be shocking if we’re not, having witnessed and analysed the widespread socioeconomic and psychological impacts of the last few months’ failures.

There’s at least one book attracting a great deal of attention at the moment, reviewed in several papers and serialised on Radio 4. In The Week writer Ysenda Maxtone Graham explains that when her book (British Summer Time begins: the school summer holidays, 1930-1980) went off to the printers in February, she wouldn’t have been able to anticipate how very pertinent its subject matter would be. ‘Little did I guess, that, thanks to the pandemic, we would find ourselves in 2020 living through a British summer of unglamorous stasis very like those of 50 or 60 years ago’. The replacement of holidays abroad this year (apparently only one in ten Brits are taking a holiday outside the UK) with what some are calling the ‘staycation’, means British resorts are coming more into their own, building on a trend which started with the post-2000 gentrification of faded south coast towns like Margate. To those of us who grew up in the 1950s and 1960s, the territory described is both distant and familiar, conjuring images of: buckets and spades; building sandcastles on a rainy beach; granddads dozing for hours in their deckchairs; Thermos flasks and egg sandwiches; the inimitable hiss and roar of the old steam trains or, if yours was a car-owning family, kids being got up at the crack of dawn as dads were determined to get going early ‘to beat the traffic’.  Maxtone Graham interviewed hundreds of people for her book, including figures like Labour veteran Dennis Skinner, the PM’s sister, Rachel Johnson, and writer Jilly Cooper. A key point she makes is that this was a pre-internet and pre-Iphone world which assumed thrift and its capacity to enhance appreciation, which she believes the pandemic has returned us to. (Of course, some have always had to be thrifty, but you get the general point that ‘We, who have never been a thrifty generation, have rediscovered the old-fashioned pleasures of thrift’. I really hope the book does well and that it’s read by younger people as well, not just those who experienced these times.

Finally, amid strong feelings about the wearing of masks and debate about some kind of system for indicating an exemption (eg on health grounds), you have to admire or condemn the chutzpah of Hollywood online influencers, who defended their decision to hold a mask-free party for 70 TikTok stars by saying that fixing and attending parties was their work – ‘our jobs are to entertain people’. Since enforcement is so feeble here in the UK, imitators might well get away with such an excuse, but it wouldn’t wash in Italy, France or Spain.

Published by therapistinlockdown

I'm a psychodynamic therapist in private practice, also doing some voluntary work, and I'm interested in the whole field of mental health, especially how it's faring in this unprecedented crisis we're all going through. I wanted to explore some of the psychological aspects to this crisis which, it seems to me, aren't being dealt with sufficiently by the media or policymakers, for example the mental health burden already in evidence and likely to become more severe as time goes on.

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