This last week will be memorable at least for the formal announcement of the long awaited roadmap out of lockdown, widely leaked beforehand. It attracted criticism from some health experts and teachers for focusing on dates rather than data despite declarations to the contrary, and for allowing all schools to reopen at once on 8 March. This does seem very risky, with unvaccinated teachers and parents expected to test their children without this being compulsory. #lockdown4 has already started trending on social media. Some aspects of the plan again demonstrated how out of touch the government is, eg permission after 8 March to ‘meet one other person for coffee’ when people have been doing this for weeks. In local parks every bench is occupied (when rules dictate no sitting down), there’s much mingling around cafes, toilets and playgrounds and no sign of any officialdom or enforcement. Ministers and policymakers keep telling us it’s too early to relax and we must stick to the rules, but they don’t put themselves about to see what’s actually going on in communities. Around here at least, the roadmap and spring weather seem to have imparted a feeling of optimism, people becoming demob happy, understandably suffering from lockdown fatigue after a year of this, on and off. When many are already experiencing anxiety and other mental health challenges due to the pandemic and lockdown, the last thing they need is uncertainty over the management of vital health services.
Palliative care doctor and broadcaster Rachel Clarke tweeted: ‘So either we’re being set up (again) for date-driven disappointment, or the prime minister intends to ignore the data to stick to his arbitrary timetable. This is the exact opposite of what “data not dates” means. It risks raising people’s hopes, only to dash them. Again.’ A Radio 4 listener added: ‘London School of Hygiene and Tropical Medicine thinks mass return to school will push R rate above 1. Might they know something here, Boris? Words like ‘medicine’ and ‘school of’ might be a clue?’ Yet another gave a list of what they thought should actually feature in the roadmap (or not): ‘No schemes encouraging everyone into restaurants; schools opened gradually; help for the ‘Excluded UK’ (freelancers who received no financial support from the government); steps to make schools safe (since no measures were adopted during lockdown); Boris’s resignation; public and criminal inquiries so we can learn lessons’.
Guardian sketch writer John Crace painted a rather different picture of the Prime Minister this week, perhaps a more measured and less ebullient than his usual persona despite the date-heavy roadmap and ‘a return to normal’ promised for 21 June. ‘Somehow the use of “hope” and “irreversibility” in the same sentence didn’t inspire much confidence that the government totally believed in its own roadmap. But it would have to do….Better late than never, we saw a Boris who could pass as sane. Someone who could cope with the certainty of uncertainty. Someone who appeared able to learn from his previous gung-ho approach. Who would have thought that possible?’
As suggested last week, at least two further factors could slow down lockdown easing: continuing vaccine hesitancy in some quarters and high infection levels in deprived areas, which should concentrate minds on the real problems of inequality. According to new research by the Policy Institute at King’s College London in collaboration with the UK in a Changing Europe, commissioned to inform the Institute for Fiscal Studies Deaton Review of Inequalities, ‘Britons across the political spectrum care about disparities between deprived and better-off areas, chiming with the government’s focus on ‘levelling up’. This sounds positive but it’s hedged around with four other major findings which suggest that doing something about this will be much more challenging. The researchers found that Britons, due to ‘an emphasis on hard work and ambition’, lack sympathy with those who lost their jobs during the pandemic, and that their longstanding views on inequalities hadn’t shifted that much during the pandemic. Based on a nationally representative survey of over 2,000, the authors claim that this is ‘the most comprehensive examination to date of attitudes towards different types of inequality in the context of the coronavirus crisis’. Separately, the Runnymede Trust think tank has urged the government to implement door to door vaccination in deprived and ethnic minority areas because of the difficulty some may have in getting to vaccination hubs and a conviction that the country shouldn’t be divided into ‘vaccine rich’ and ‘vaccine poor’ areas.
Another serious issue adding generally to the Covid burden is Long Covid, many patients suffering long term physical, mental health and neurological symptoms post-Covid. Someone who’s made a special study of this, having experienced it herself, is Dr Nisreen Alwan, Associate Professor of Public Health at the University of Southampton. She writes a blog about it for the British Medical Journal, amongst other things urging the setting up of proper patient registers so that there’s a record of numbers affected and how, meaning that this phenomenon can be measured and coded within electronic clinical systems. Although Long Covid is better recognised now, it’s still being overlooked in some quarters and the risks not being taken as seriously as they might by the public and politicians. It’s a serious business. ‘Covid-19 leads to severe morbidity and organ damage in some people. NHS data analysis of 47,780 hospitalised patients with covid-19 (with 43,035 non-ICU patients) shows that within a few months of discharge, 29% got re-admitted to hospital, and 12% died. They had higher rates of heart, liver, kidney disease, and diabetes, compared to matched controls not diagnosed with Covid19’.
Dr Alwan also suggests that additional statistics need to be collected, ‘informing our pandemic response and research priorities – not only deaths, hospital admissions, and positive tests statistics. These could include: proportion of people not recovered within 4, 8 and 12 weeks among those infected; proportion of people with complications and organ damage following Covid19 infection; proportion re-admitted to hospital following discharge; proportion off work due to Long Covid and/or Covid19 complications; proportion recovered from Long Covid’. She recently tweeted: ‘Long Covid is not an afterthought. It’s not a subheading. It’s THE story. Between 1 in 10 and 1 in 3 people who get Covid don’t recover for months (yes- even not knowing the exact figure is quite telling). It really blows my mind how this is still considered a marginal issue’.
Meanwhile, actress Gwyneth Paltrow, now equally famous for her Goop website which promotes the use of questionable substances (some would call quack remedies) for health maintenance, came in for some flak this week. The site’s opening spiel reads: ‘We operate from a place of curiosity and nonjudgment, and we start hard conversations, crack open taboos, and look for connection and resonance everywhere we can find it. We don’t mind being the tip of the spear—in short, we go first so you don’t have to. We’re glad you’re here’. As on previous occasions, it doesn’t sound as if she’s touched on much ‘connection and resonance’ in medical circles, certainly regarding Covid. Professor Stephen Powis, national medical director for the NHS in England, warned that those including ‘influencers’ are being irresponsible and spreading misinformation by suggesting solutions which were not evidence based. He said: ‘Like the virus, misinformation carries across borders and it mutates and it evolves…We need to take long COVID seriously and apply serious science. All influencers who use social media have a duty of responsibility and a duty of care around that’.
Although it’s long been suspected, it’s shocking to learn how hospitals, which we should be able to equate with safety, have been the source of Covid in numerous cases. No wonder people are scared to go to A&E, even more to be admitted for treatment. Someone who lost their father very quickly in this way contacted
Covid-19 Bereaved Families for Justice group, and found that many of its 2,600 members were grieving for relatives who they believe contracted Covid in hospitals.
‘Figures published by NHS England suggest that 39,088 people were likely to have been infected with Covid-19 in hospitals between 1 August last year and 21 February 2021’. It would be unfair to lay the blame entirely at the NHS’s door, though, since we know what pressure they have been under and how poorly and inconsistently supplied they’ve been with PPE.
On PPE, many have complained this week, including to Radio 4’s Feedback programme (which purports to hold the BBC to account on behalf of radio listeners), about lack of coverage of the shaming court judgement last week on the Health Secretary and his conduct over PPE contracts. Sadly, many will be taken in by government’s dismissal of the judgement as simply about late notification of contracts ‘in the middle of a pandemic’, when the serious issue is about the suspension of normal tendering procedures and the granting of contracts to those with connections to the government. In not reporting malfeasance, instead focusing on the Scottish Parliament shenanigans, the media are colluding with the government to hush up the unacceptable. Since March 2020, The Citizens (committed to investigating and holding organisations to account) found that at least £21bn has been spent by the UK government in their pandemic response. £5.3bn of this (25%) went to just 1% (10) of the 990 companies that won contracts.
As if Health Secretary Matt Hancock didn’t have enough to be embarrassed about after last week’s court judgement, it emerged that the medicines regulator (the Medicines and Healthcare products Regulatory Agency) was investigating Hancock’s friend who had been awarded a £30m contract. Despite the BBC’s reluctance to cover such issues in its radio and tv output, at least it does on its website, and it tells us the regulator is investigating Hinpack, the company of Hancock’s pub friend Alex Bourne, which had been contracted to produce vials for Covid testing despite having no experience of producing medical goods. In some media sources articles have carried a picture of Bourne and Hancock, grinning broadly and pulling pints behind the bar, yet Hancock insisted he had ‘nothing to do with that contract’. MHRA has not disclosed the reason for the investigation.
Ministers seem to be increasingly occupying a parallel universe, for example Hancock’s expectation of gratitude. On ITV’s Good Morning Britain acerbic host Piers Morgan asked Dr Rachel Clarke ‘When you heard Matt Hancock demanding to be thanked, how did it make you feel?’ ‘I just felt that was disgustingly disrespectful to the families of over 130,000 people who have died from COVID in this country’ was the response.
During the week I attended a virtual conference (The Pandemic and Privatisation) run by Health Campaigns Together, which aims to keep the NHS in the public sector and stop privatisation by stealth. The recent NHS White Paper sells the proposed reorganisation as about streamlining, giving the government more direct control and removing ‘bureaucracy’ (aka proper scrutiny) and the need to put contracts out to tender, giving the impression of curtailing privatisation when this is anything but the case. For several weeks now clinicians and campaigners have revealed the worrying takeover (not covered by the media) of a GP practice network representing over 500,000 patients by US health insurance provider Centene Corporation. A clinician tweeted: ‘We love the NHS, they said. NHS staff are heroes, they said. NHS forever, they said. All the whole quietly siphoning huge tranches of NHS care into US corporate hands. Please RT if you won’t stand for it’.
A concerned group of clinicians, academics and campaigners have now written to Matt Hancock, asking him to authorise an investigation by the Care Quality Commission. ‘Operose Health, a UK subsidiary of Centene, has recently taken over the privately owned AT Medics, which was set up in 2004 by six NHS GPs and runs 37 GP practices across 49 sites in London. Operose already operates 21 GP surgeries in England. Objectors are concerned because they claim the change of control was approved for eight practices in the London boroughs of Camden, Islington and Haringey in a virtual meeting on 17 December that lasted less than nine minutes, during which no mention was made of Centene and not a single question was asked’. These events indicate a worrying lack of transparency and most patients will have no idea this is going on.
Professor Allyson Pollock said: ‘What we’re really worried about is changes in the model of care and quality of service, especially in areas of high deprivation. Practices may employ fewer GPs – and they may bring in substitutes for GPs like pharmacists and nurses – there may be cuts in services and reduced access, for example, closures of branch surgeries’. Predictably, NHS and Department of Health and Social Care spokesmen said that health commissioners had approved the transfer and that robust procedures were followed. We have to ask how much more NHS privatisation by stealth could be on the cards if this could happen so easily and without patient consultation.
The debate continues as to whether specific occupational groups, such as teachers, police officers and supermarket workers, should be moved further up the vaccination priority list. The JCVI (Joint Committee on Vaccination and Immunisation), which seems to me increasingly in thrall to government rather than being independent, having changed its mind about those with learning disabilities, is still sticking to its guns on adhering solely to the criterion of age. This seems rather rigid and insufficiently nuanced, as it’s clear that these occupational groups come much more into contact with the public than the older age groups being vaccinated now. Most people in these groups probably wouldn’t mind waiting just a bit longer for their vaccination if it means frontline workers get the protection they need.
Meanwhile, the concept of ‘vaccine etiquette’ has come to the fore, and a new word has been coined: VOMO (based on FOMO, fear of missing out, in this case on the vaccine). We’ve been hearing examples of some seeming to jump the vaccination queue and now Sir Richard Leese, the head of Manchester City Council, has said people were ‘fiddling the system’, for example pretending to be social care staff in order to dishonestly make their way into priority categories, thereby taking a slot away from someone in greater need. ‘Pete Lunn, the head of behavioural research at the Economic and Social Research Institute, an Irish think tank, said cheating or perceptions of cheating could undermine trust in the system. ‘If people perceive a system to be unfair, they will often withdraw from it even at cost to themselves. It is important that the system is fair and seen to be fair’. This issue of trust in the system is an important point in its own right but even more so given the need to counter vaccine hesitancy. This week our monarch weighed into that debate, suggesting that antivaxxers and hesitants should think about others rather than themselves. ‘Queen’s shock message: do your duty…get the jab’, screamed the Daily Express’s front page on Friday.
The Times reports on an issue which has raised its head again, some questioning the timing of ministers’ focus during a pandemic. The Black Lives Matter movement brought much more to the fore the debate about our heritage, how it’s marked and celebrated (or not), notably the strong connections many institutions have had with colonialism and slavery. In recent years more institutions, including the National Trust, have been openly acknowledging these links but now it seems the government wants to revert to the previous status quo. They seem to see portraying a more honest and rounded history of this country, ‘warts and all’, as ‘denigrating Britain’. Culture Minister Oliver Dowden recently met representatives of 25 organisations, including the National Trust, English Heritage and British Museum and ministers now plan to establish a working group to ‘draw up guidelines for heritage bodies to implement a “retain and explain” policy for contested monuments’. Some heritage professionals now fear that their funding will be dependent upon complying with these guidelines. It’s good that the National Trust isn’t dependent on government funds but there is quite a polarised debate within its own membership, some applauding the wider portrayal and others complaining that the Trust is moving away from its original purpose and this agenda interferes with visitors’ desire for a nice day out with tea and cake.
The Germans, always good with words, especially long compound nouns, haven’t let us down during the pandemic. The Guardian reports on a new list from the Leibnitz Institute for the German Language which includes more than 1,200 new German words coined during the last year when the annual average is around 200. There’s something about German which enables nuanced experiences to be captured in a succinct way English at least doesn’t lend itself to – think of Schadenfreude and Weltschmerz, for example. Some of the key new entrants must be coronamüde (tired of Covid-19), Coronafrisur (corona hairstyle), Coronaangst (when you have anxiety about the virus), Impfneid (envy of those who have been vaccinated), Kuschelkontakt (cuddle contact) for the specific person you meet for cuddles and Abstandsbier (distance beer) for when you drink with friends at a safe distance. Some will be pleased to see the UK’s Covidiot also in the German list.
The Institute’s compiler speaks of the importance of being able to name experiences. ‘When new things happen in the world [we] look for a name. Things that do not have a name can cause people to feel fear and insecurity. However, if we can talk about things and name them, then we can communicate with each other. Especially in times of crisis, this is important. Language has a strong power. We see again and again how important it is to formulate precisely and to be very careful about which words we choose. Words not only convey content, but can also convey emotions and feelings. And speakers should be aware of that’.
Finally, you may be interested to watch this charming 21 minute film, My Brother’s Keeper, BAFTA longlisted for British Short Film 2021 and directed by Laurence Topham. It features the unlikely friendship which grew between a former Guantánamo detainee, Mohamedou Ould Salahi, and his guard, Steve Wood, changing both their lives, and their reunion in Mohamedou’s home city of Nouakchott, Mauritania, 13 years after their last meeting. Mohamedou was suspected of being involved in the 9/11 bombings and was taken from his home in 2001 and incarcerated for 14 years without being charged. Coinciding with this documentary is a Golden Globe nominated feature film, The Mauritanian, based on Mohamedou’s bestselling memoir Guantánamo Diary, starring Tahar Rahim, Jodie Foster, and Benedict Cumberbatch. This definitely sounds like the kind of film best seen in a cinema rather than streamed at home.