Saturday 2 January 2021

Happy New Year to all, or at least a better one than 2020, despite entering 2021 facing the dire situation of daily deaths approaching 1,000, a lockdown in almost everything but name, new variants running rife, overburdened and exhausted clinicians and medics’ concern about the policy to change the timing of the Pfizer vaccine second shot. A GP tweeted: Can I ask Matt Hancock to come & do a shift on our phones, ringing our 80+ patients to explain that their 2nd dose of vaccine has been cancelled? Our PCN needs to cancel 1160 appointments and rebook another 1160. At 5 mins per phone call, that’s 193 hours work. Not to mention the grief & anger’. Independent Sage’s Anthony Costello tweeted: A delay between first +second dose of Oxford AZ vaccine makes sense. But the Pfizer vaccine is different, the first RNA one, probably immunogenic for less time and Pfizer state ‘There are no data to demonstrate that protection after the first dose is sustained after 21 days’. Another tweeter observed: ‘Those people who receive one dose of vaccine 3 months apart are now actively participating in a unregistered trial’. It comes to something when even US medical adviser Anthony Fauci weighs in to condemn the policy change and now we hear GPs are taking the law into their own hands and continuing with the original scheduling of doses.

It seems unbelievable that Covid deniers and conspiracy theorists continue to undermine public health messages, one group even gathering outside London’s St Thomas’s hospital, shouting that Covid is a hoax. This, when there’s no falsifying clinicians’ accounts of what they’re dealing with and footage of ambulances queueing outside A&E departments. It therefore seems scandalous that the government and NHS won’t allow ICUs to be filmed: it would indeed further expose government pandemic management incompetence but could also help get deniers to get real and this is of the essence now.   

Dr Claudia Paoloni, a consultant anaesthetist in the NHS and president of the HCSA, said ICU staff may end up having to in effect ration who received care that could help them survive. ‘Our NHS just doesn’t have the beds to cope. Some areas will be overwhelmed in days. If ventilation capacity is exceeded, horrendous choices will have to be made over those who live and die’. In an extraordinary denial which will further undermine trust in the government, the Department of Health and Social Care said:‘There is no shortage of ventilators and we have enough oxygen to meet demand. Throughout this global pandemic we have done whatever it takes to protect the NHS and save lives, including ensuring everyone who needed a ventilator had access to one’.

Earlier this year, many of us hadn’t been personally touched by virus but this has changed now, with more and more people we know or know of being affected. I had my own brush with the possibility, having unusually become quite ill over Christmas and an NHS friend urged me to get tested. Whereas I was pretty sure it was just a bad cold virus, I dutifully booked a test, a palaver in itself when feeling wretched, and found it a pretty unpleasant and stressful experience: people shouting from behind windows and masks, unable to open the fiddly bags of test kit, all with different closures, the gagging-inducing swab and getting stressed about not being able to complete it. [It hadn’t been clear that it was self-test at this walk-in centre]. I felt myself getting quite emotional and apparently this is putting it mildly.

The only nice part was talking to the young instructor who said he’d ‘seen it all, people crying and panicking’ but he was ok with it, as it ‘helps build my character’. You can say that again. He was studying civil engineering and when I asked him if he could design a better procedure he said yes. Clearly a man going places. It then took three days of self-isolation (thank goodness for lovely local friends bringing a couple of things and providing some doorstep company for a few minutes) before a negative result, the news of which was marred by hearing about four close neighbours who had been or were currently very ill.

Scientists have been strongly urging a national lockdown since before Christmas, yet the government just responds by placing more areas in Tier 4, but as ever, with very little enforcement, except at predictable times like New Year’s Eve. The number of fines issued and parties broken up by some police forces on New Year’s Eve confirms the suspicion that people are feeling increasingly imprisoned, restriction fatigued and sceptical about restrictions actually working. Again we can wonder what happened about the Covid marshalls the government gave councils the funding to recruit. No sign of them.

Meanwhile, the thing separating us from lockdown (schools remaining open) has brought about two more predictable government U-turns, derided Education Secretary Gavin Williamson first deciding to delay the return of secondary school pupils then the return of London primary schools. We can predict a third U-turn before the end of the weekend, the Westminster government always behind the other three nations’ governments, which our PM regularly condescends to. Williamson still fails to understand why schools can’t just get on with the mass testing of other pupils next week. One head teacher, commenting on his media interview schtick, said she didn’t need him to point out that we’re in a global pandemic and how important education is. Teachers have had next to no warning to get the system up and running, and the promised ‘support’ turns out to be a quarter of one unit of army personnel per school. Although it’s a rolling competition between ministers as to which one is the most incompetent, Williamson seems to have won top prize this week. A Radio 4 listener tweeted: ‘Everything Gavin Williamson says is risible besides irresponsible and dangerous: amongst other things today he ministersplained schools reopening ‘policy’ by saying ‘we can’t sit back’. Precisely what this constantly behind the curve government has always done’.

The Prime Minister comes in for at least two demolition jobs this week, from the Guardian’s John Crace and Marina Hyde. Hyde effectively details how the PM’s emotional incontinence raises public anxiety, echoing the point of this blog, that if we cannot have confidence in our leaders our own mental wellbeing is undermined. ‘Should Johnson fail to toughen up and take himself in hand – a locked-on certainty, given the form book – then we are condemned to endure what might well be the worst months of the pandemic thus far, led by someone whose first thought seems always to be for his own emotions. “I hate having to take these decisions …”, “I deeply regret having to do this …”, “I do this with a heavy heart …” Once you’ve noticed the tic you can’t stop hearing it. If only he’d take back control of himself’. His constant playing of the victim card, interspersing every observation with how it makes him feel, is seen to detract from his true role as someone who should be leading from the front, shaping events as far as possible, not just belatedly reacting to them because he can’t bear to give bad news and just wants to be popular. ‘Time and again, Boris Johnson has so deeply regretted even the prospect of having to do difficult things that he hasn’t done them, meaning he has had to do even more regrettable things later’.

As one tweeter said: ‘Johnson was confident it would be over in 12 weeks, confident it would be over by Christmas, now confident it will be over by Easter. Confidence without competence is proving a lethal combination’.

John Crace’s demolition focused on the Brexit deal, widely presented as a good deal and the start of wonderful opportunities for the UK without detailing too clearly what these opportunities are and certainly not mentioning the numerous omissions. The frightening thing is that many without political awareness will believe the tabloid headlines as to the marvels brought off at the last minute. ‘Who would have guessed? When push came to shove it turned out that a bad deal was better than no deal after all. The first deal in history to put more barriers in the way of free trade than the one that preceded it. A 1,200-page treaty and 80-page bill that was granted a mere four and a half hours of what passed for scrutiny in a recalled House of Commons to allow it to become law before the end of the year. In most countries this would be called a farce: here in the UK we call it a return of parliamentary sovereignty’.

Some pretty staggering things were said during the debate, indicating those proponents’ occupation of a different planet, for example ERG Bill Cash comparing the PM to Pericles and Alexander the Great, the PM saying the UK would be the EU’s biggest friend and ally and Michael Gove claiming that businesses would benefit. ‘Smug, graceless, short of self-awareness – he somehow believes extra bureaucracy will make businesses “match fit” – and still prioritising point scoring over trying to bring the country back together’.

Meanwhile, the Guardian tracks what the Europeans think of it all in an article titled ‘View from the EU: Britain ‘taken over by gamblers, liars, clowns and their cheerleaders’. A Dutch think tank gets it in one by suggesting thatwhereas they’d previously seen the UK as ‘like-minded: economically progressive, politically stable, respect for the rule of law – a beacon of western liberal democracy’, this had now been seriously undermined. ‘I’m afraid that’s been seriously hit by the past four years. The Dutch have seen a country in a deep identity crisis; it’s been like watching a close friend go through a really, really difficult time. Brexit is an exercise in emotion, not rationality; in choosing your own facts. And it’s not clear how it will end’. Whereas this sounds rather sad, the Germans in their attachment to international law were said to be deeply shocked by the UK’s internal market bill. One commented on the PM himself (and it’s to be hoped that they realise not all Brits are like this):’Boris Johnson has always been seen as a bit of a gambler, displaying a certain … flexibility with the truth. But observing him as prime minister has only made that worse’.  

‘Others were more brutal still. In Der Spiegel, Nikolaus Blome said there was “absolutely nothing good about Brexit … which would never have happened had Conservative politicians not, to a quite unprecedented degree, deceived and lied to their people”. The “sovereignty” in whose name Brexit was done remained, essentially, a myth’ said a French think tank…. ‘It is history, geography, culture, language and traditions that make up the identity of a people…not their political organisation’. It is “wrong to believe peoples and states can permanently free themselves from each other, or take decisions without considering the consequences for their citizens and partners. ‘Take back control’ is a nationalist, populist slogan that ignores the reality of an interdependent world … Our maritime neighbour will be much weakened’.

Perhaps the most damning analysis comes from the German historian Helene von Bismarck, because it makes clear that Brexit is not the end of anything but one expression of damaging populism, the key constituents being ‘an emotionalisation and over-simplification of highly complex issues, such as Brexit, the Covid pandemic or migration, and a reliance on bogeymen or enemies at home and abroad….Populists depend on enemies, real or imagined, to legitimise their actions and deflect from their own shortcomings…If the EU has been the “enemy abroad” since 2016, it will steadily be replaced by “enemies within”: MPs, civil servants, judges, lawyers, experts, the BBC. Individuals and institutions who dare to limit the power of the executive, even if it is just by asking questions, are at constant risk of being denounced as ‘activists’” by the Johnson government. .. Everyone has political motives – except for the government, which seeks to define neutrality’. We’ve already seen this happening, haven’t we, as with the Windrush lawyers being described as ‘activist lawyers’? But no doubt this is just one example.

As we continue to hear bad news about the nation’s mental health, another stark statistic emerges, one which has been growing for some time. Eating disorders, especially in young people, have been on the rise for some time, yet specialist services are lacking and patients are often sent miles away from their families because of the shortage of beds. Hospital admissions for eating disorder patients have now risen by a fifth. ‘According to the latest NHS Digital data (England) there were 21,794 admissions for eating disorders among all age groups in 2019-20, up by 32% from 16,547 in 2017-18. Meanwhile, there were 4,962 admissions for eating disorders for children aged 18 and under in 2019-20, a 19% increase from the 4,160 admissions seen in 2017-18’. This is a very marked increase and symptomatic of the anxiety these patients are experiencing, besides isolation and lack of access to community services.

Dr Agnes Ayton, chair of the Eating Disorders Faculty at the Royal College of Psychiatrists, said: ‘Infection control and social distancing in inpatient units has also led to a reduced number of beds, so desperately-ill patients are struggling to get help. The government and the NHS must take immediate action to tackle this crisis’. The NHS response is always to suggest that more is being invested (not mentioning the cuts which have steadily taken place over the last decade). But now we’re hearing about ‘rapid access to specialist NHS treatment across England, which will provide access to early intervention, treatment and support’, so it will be interesting to see how that works out in practice as such services are often subject to worrying postcode lotteries.

As ever in the New Year we see a slew of articles and programmes which aim to analyse the previous year. While some of the ‘winners’ (eg supermarkets, Amazon and Zoom) and ‘losers’ (eg airlines, hospitality and ‘bricks and mortar’ retailers) will be obvious, given the extraordinary year many are glad to see the back of, there are others we could have overlooked or been unaware of. At the start of 2020, most could not have predicted big gains for gambling operators, crony PPE suppliers and losses or even ‘oblivion’ for entertainment venues such as cinemas. ‘And let’s not forget the estimated 3 million people, such as some self-employed, who have seen limited or no benefit from government measures to support businesses and jobs’. Who’d have thought the US oil industry could move for a while into negative pricing, or that supermarket staff, cleaners and delivery drivers would be appreciated as never before? In an article also covering wheeling and dealing, skulduggery and pay packets, key comings and going are noted, such as the departure of Mark Carney as head of the Bank of England, the incoming chair of John Lewis, Sharon White and the rising star of Rishi Sunak, who became Chancellor in February.

For once this time the New Year Honours list seems to have rightly focused on those who went beyond the call of duty during the pandemic, 15% of the list and a shame it wasn’t more. There were some media and political honours, only to be expected, but gratifying to see honours given to ‘public sector workers, including medics, teachers, local government workers, police officers and firefighters, recognised for making a huge individual impact’. Among those honoured are a former palliative care nurse who came out of retirement when Covid struck, a director of nursing for initiating safety procedures for fitting PPE, a woman who turned her pub into a shop, a retired policeman who came out of retirement to lead the volunteer effort across North Wales. What some will find ironic, if not hypocritical, is the PM’s declaration that ‘the outstanding efforts of those who had received honours was a welcome reminder of the strength of human spirit, and of what can be achieved through courage and compassion’.

Finally, it’s been gratifying that some readers have reacted to my proselytizing about the Walter Presents Seaside Hotel series on Channel 4. Here are some other programmes to recommend: the series of three documentaries on BBC4, Berlin 1945, which feature fascinating film footage and diary entries from differing walks of life, including an American airman, prisoners of war including a French surgeon, a Jewish woman in hiding, Berlin residents and how they experienced the Russian takeover of their city, and Russian and German soldiers.

Broadcaster Horatio Clare offers two beautiful soundscapes on Radio 3, one describing a pre-dawn walk towards Lindisfarne and the other a walk across the Wash, both accompanied by wonderful music, playlists included.

And something many will be looking forward to is the start of the 8th and final series of French crime drama Spiral, on BBC4 tonight!

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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