Saturday 9 May

There are almost no words for the announcement that, from the end of May, incoming air passengers will be quarantined for 2 weeks, something which should have been implemented months ago.

As posted here earlier this week, there was always the possibility of the contact tracing app being challenged in the courts because of privacy concerns. Now, in what could be quite some climb-down, we hear the government is seriously considering switching to the Apple/Google decentralised model. If this comes to pass, will the payment which will have already been made to Ben Warner’s brother’s company be rescinded? Or will that be another bad debt like so many other examples during the last few years?

As the lockdown debate continues throughout the Bank Holiday weekend (and many more people out and about than there were), there’s mounting pressure for a more nuanced approach to prevent further unnecessary mental distress. I don’t think there are clear figures for the UK yet but for Australia we hear modelling from the Sydney University’s Brain and Mind Centre predicts deaths linked to suicide would be more than four times those directly caused by coronavirus. It’s also well-known that much mental distress will be experienced behind closed doors, people not necessarily publicly acknowledging it. Age UK and various MPs have said there can be no justification for keeping the over-70s at home while other age groups are given more liberty unless there is clear medical advice. I wasn’t expecting to be quite envious of the Welsh if they’re soon to be allowed access to libraries and recycling tips! It’s essential that we  encompass some risk in life, because life itself is a risk and not doing so constitutes existing rather than living. Writer and academic A L Kennedy spoke last night about the perception of risk.

What did you think of the Queen’s VE Day message? Whether you’re a royalist, republican or some way in between, these broadcasts are quite powerful, partly, perhaps, because we can derive more reassurance and psychological holding from our monarch than our elected leaders. “Never give up, never despair – that was the message of VE Day”.

There were certainly mixed views about this event and it’s sobering to be reminded of the connection between VE Day and the crisis. A Today programme listener tweeted: ‘The veterans we honoured yesterday are the same ones we are failing to protect in care homes, dying as a result of lack of PPE and testing’.

In the context of the need to keep pollution down, social distancing lasting for another 12-18 months at least and the urgent need to enable alternatives to public transport and the car, measures like widening of pavements and more cycle lanes are being planned. But a key point captured by some including natural world writer Rob MacFarlane is that this isn’t ‘just’ about travelling – it’s about the much wider opportunity to redesign our cities, one we should seize. The BBC reports that just 9% of people want a return to pre-lockdown life. Although habit change is difficult, ‘the crisis has transformed behaviours overnight’. This sounds genuine and not the comment of an opportunist: “We’ve got this really precious moment to change how we live and we can’t let it slip between our fingers. Let this tragedy re-define, in a positive way, what living in cities is about,” (Will Butler-Adams, the CEO of UK bike manufacturer Brompton).

There are three radio programmes later you might find interesting and if you miss them at the time you can catch up on BBC Sounds. One is the regular (only 15 minutes) Profile series on key figures, tonight’s being New York governor Andrew Cuomo, who’s gained more public recognition for his honest and humble COVID stance, in contrast to that of POTUS.

The second is the series featuring the Poet Laureate, Simon Armitage, talking to other artistic figures in his shed – tonight Anthony Gormley. These conversations always sound so natural and engaging you wonder if Armitage already knows his interviewees or can just relate to them and draw them out immediately, although some will need less drawing out than others.

In the third, highly relevant because so many are complaining of it and the ‘I’m bored’ hashtag is trending on Twitter, comedian and performance poet Phil Jupitus explores and reframes the concept of boredom. ‘So do we still need to be bored? And what would we miss if we did eliminate boredom completely from our lives?’ Should be thought-provoking.

Finally, we must be relieved to hear that after a dispute lasting months, the prestigious Forbes magazine has now conceded to recognise rapper Kanye West as a billionaire. (Although West had been featured on August’s cover the accompanying profile had apparently not acknowledged his wealth). Nothing like having a sense of priorities!

Friday 8 May

Following what many found mixed messages about lockdown strategy over this long weekend, not to mention the PM’s absence from last night’s Downing Street Briefing, heads of police forces have confirmed that lockdown is slowly ‘ebbing away’. They reckon there’s about a 10% increase in foot and road traffic compared with the start, and that they won’t be able to police it this weekend. A south of England chief said ‘The public are getting tired’ – a key point because behavioural scientists (if they were asked) might say that 6 weeks is the limit of people’s tolerance given confused policy on most aspects of this crisis strategy. Dominic Raab nevertheless stuck to his script, which is making less and less sense by the day because people are seeing a change, reinforced by the press: “As we enter another long bank holiday weekend I think the message is very clear: follow the guidance. There is no change today in the guidance or in the rules, but the prime minister will set out a roadmap on Sunday.” Some descriptors said to be characterising the ‘roadmap’ are modest, small and incremental, thought to show the government’s nervousness about it, suggested one commentator. Just see what happens around your way over the weekend – lockdown has been ebbing away for some weeks now. 

I’d imagine quite a few were shouting their radios and tellies during last night’s broadcast of Question Time. Writer and broadcaster Afua Hirsch was impressive, putting environment minister George Eustice’s poor performance even more in the shade. He couldn’t defend the government’s record (the predictable subject of the first question, asked by Margaret), kept resorting to the now risible ‘ramping up’ cliché, and couldn’t explain how the contact tracing app would work even though it’s currently being trialled in the Isle of Wight. After the panel’s contributions Margaret was asked by Fiona Bruce whether she was now satisfied and the response was a one word ‘No’.

Although the PM’s approval rating has declined since the start or lockdown (67% to 52%), it seems a substantial number still see him as managing the crisis well in the face of solid evidence to the contrary. Could this be one of the reasons, besides a reluctance to criticise authority? And reluctance to have doubt cast on their judgement if they voted for him?

Radio presenter James O’Brien tweeted: ‘So many people remain incapable of contemplating the possibility that Boris Johnson has been appallingly negligent & dishonest about *this* because it would mean they had to accept the possibility that he had been appallingly negligent & dishonest about *that*.’

Re the contact tracing app, which has raised privacy concerns, an interesting piece on Bloomberg Opinion by Andreas Kluth (If we’re going to build a surveillance state let’s do it properly) captures the dilemma most countries are facing. This is ‘balancing individual freedoms with the need to collect data’ (and at least one on BBCQT said we must sacrifice the first in order to save lives via the second). Kluth suggests we need a hybrid model, avoiding the extremes of ‘US libertarianism and Chinese authoritarianism’, citing the example of Taiwan, which is using ‘participatory self-surveillance’. In this model, citizens voluntarily partner with the government in a two-way information exchange, top down and bottom up (and it’s surely bottom up we are missing here), so that everyone’s involved in a joint enterprise of data capture and use. Kluth sees the only real alternative to this as ‘interminable lockdowns that rob us of more freedom’. Can anyone see participatory self-surveillance happening here? Even if the idea got public support, it seems unlikely that such a centralised, command-style government would take it up.

To what extent is VE Day being used to deflect from shambolic pandemic crisis management? Quite a bit, it seems, if media coverage is anything to go by. No doubt later there’ll be substantial coverage of fluttering bunting, distanced gatherings, singing and so on, but my mini research poll suggested little appetite for it. Some respondents declared themselves patriotic, planning to drink champagne, but mostly the feeling was that it would be tasteless to celebrate amid so many COVID deaths. It seems important to quietly recognise the sacrifices so many made during WW2 but many won’t feel like partying. A small group of neighbours here observed the two minute silence at 11 am and that feels enough. “The people who thought least celebrated most and the people who thought most celebrated least”, observed Max Hastings on BBC World at One.

The latest piece of programming on Coronavirus fallout is one focusing on the economy, asking what damage are the pandemic and lockdown doing to the economy and what could happen next? ‘David Aaronovitch explores the economic impact of physical distancing on business, whether our fast expanding national debt is sustainable and the threat posed by declining consumer confidence on our economic recovery. Does history offer a guide as to how and when people should return to work and government support be turned off? And what will our economy look like when the lockdown is eased?’

Health Science Journal reports that Care Quality Commission data now reveals that deaths of patients detained under the Mental Health Act are running at five times the rate of 2019, half due to the virus. This confirms the fears expressed anonymously recently that psychiatric wards were especially difficult environments, because of lack of PPE and patients’ lack of capacity meaning they wouldn’t understand why they should distance, receive no visitors and have no leave. 112 died between March and May (in hospital and the community), compared with 56 deaths during the same period of 2019, 61 deaths in 2018, and 70 deaths in 2017.

Dr Kevin Cleary, deputy chief inspector of hospitals and lead for mental health said: “That a number of people detained under the Mental Health Act have died from suspected or confirmed coronavirus is a particular worry as these are some of the most vulnerable people in society.”

On the theme of mental wellbeing again, what’s known as the gratitude exercise (or similar) is very helpful to engage with, although it might sound a bit cheesy if you haven’t come across it previously. It basically means thinking of and appreciating 5 -10 things in your day which have been positive, however small. It’s common to overlook small things and maybe think nothing good’s happened today, but reflecting for a few minutes will usually throw up at least four or five, such as someone smiling at you while out walking/shopping or whatever. Today I had at least three good things before lunchtime: someone buying me a pasteis de nata (Portuguese egg tart); getting a good view of the recently hatched baby coots because the hen bird was off the nest for the first time during my visits; and sniffing a delicious lilac not far from home, discovering the gardener was a nodding terms neighbour and having a good conversation about gardening and other things. Hoping to have a few more before the day’s out!

Finally, The Week tells us that the Oxford English Dictionary has added another print run in order to include COVID-related terms which have come into common usage. These include ‘social distancing’, ‘personal protective equipment’ and ‘flatten the curve’. Separately, social media have listed about 20 soundbites, including ‘ramping up’, ‘straining every sinew’, ‘working around the clock’ and ‘following the science’.

Thursday 7 May

Speculation about today’s and Sunday’s announcements on lockdown strategy has led to  #Keepthelockdown  trending at no 1 on Twitter, while many media sources and politicians are calling for its end or phasing out, for the sake of the economy, mental health and so on. There’s concern that the government wanting to convey an impression (delusion?) of progress (via lockdown end) will undermine public safety, not to mention lead to mixed messages and confusion. One frustrated individual tweeted:  “Lockdown” is expected to be extended today by another 3 weeks. But on Sunday, restrictions will be partly relaxed, apparently. Will we still be in “lockdown” after that? If so, what does “lockdown” even mean? If not, wtf does the government think it is doing?’ The key thing we need right now is clear messages based on scientific consensus, not vague statements allowing the government to abdicate responsibility further down the line. The ‘messages’ of the today’s Downing Street Briefing (minus the PM again) weren’t found clear, especially by Beth Rigby of Sky News, who suggested the public would be confused by not having firm guidance before the Bank Holiday weekend. The existing guidance is supposed to remain but suggestions of sunbathing and picnics being amongst Sunday’s possible lockdown relaxation measures, plus the fine weather, could result in confusion and people jumping the gun.

More than a fortnight after the Turkish supply of PPE debacle, it has emerged that all of the 400,000 protective gowns that eventually arrived were impounded after being found not to conform to UK standards. Despite official sources claiming that all clinical staff have the PPE they need, a British Medical Association survey revealed that almost half of England’s doctors have sourced their own PPE or relied on a donation when none was available through normal NHS channels. Niall Dickson of the NHS Confederation is one of (probably) many stressing that rhetoric must match reality, that it’s better to promise less and deliver more than make over-confident claims which then fail, because this undermines public confidence. That’s putting it mildly. Alluding to another kind of opacity, the often apoplectic but forensic Piers Morgan tweeted earlier: ‘The UK Govt has banned any ministers from appearing on GMB after a series of them made complete fools of themselves in the face of basic & important questions. This is a pathetic & cowardly response to THEIR shameful incompetence’.

There’s naturally a great deal of interest and speculation about what sort of world will emerge from this crisis and an interesting piece in the Guardian focuses on the work of Austrian economic historian Walter Scheidel. In his book The Great Leveler: Violence and the History of Inequality from the Stone Age to the Twenty-First Century, he suggests that throughout history, pandemic is one of the only four events capable of bringing about greater equality. (War, state collapse and revolution are the other three). Re pandemic, he showed how the Black Death in the 1300s killed a third of Europe’s population and massively reduced inequality by raising the price of labour.

We’ve already seen evidence of the clash he predicts: between those determined to go back to the status quo (‘normal’?) even at the price of making inequality worse and those who want a reset. Because human beings struggle with uncertainty and Not Knowing, leading to a desire for false reassurance, there’s a strong pressure to go back to business as usual. “There will be a strong push to go back to growth to finance the huge deficits that governments have been racking up, so, if anything, growth will be more important than before. At the same time, if the effects of the pandemic polarise societies even more, there will also be stronger agitation for more progressive or distributive policies. It will be very difficult to reconcile those two motivations.”

Looking at the more immediate aspects of recovery, Peter Molyneux (chair of Sussex Partnership NHS Foundation Trust), whose blog appears on the NHS Confederation website, suggests a promising route based on mental health recovery principles. These are: connectedness, hope and optimism, identity, meaning and purpose, and empowerment. He makes a key point about trauma at both individual and societal levels, acknowledging the knock-on effects inherent in the overall system, and makes a compelling case for an overarching, systematic approach. (One of the most criticised aspects of government strategy so far has been its piecemeal and over-centralised nature).

‘We will need to understand the trauma that occurs in individuals and which affects populations, which will be experienced in different ways. The commitment in the Long Term Plan on population health will now need even greater focus on population mental health, both in terms of health and care and the economic and social impacts. Sussex is already being hit hard by the impact of the pandemic on Gatwick, as well as the cancellation of events which are the engine-room of the seasonal economy. This is affecting unemployment rates and will have a resulting economic and social impact on population health. 

This implies discussing how we can achieve a more systematic approach to population mental health. There are some fantastic examples of places where this is happening, but it is patchy and fragmented. So across systems, we need to co-produce with communities and wider civil society ways in which we can support individuals but also reduce some of the underlying causes of mental distress – and the unequal way in which this is distributed across populations and communities.’

It’s common now to come across tips on surviving lockdown and most of these are actually based on the useful wellbeing principles developed some years ago by the New Economics Foundation, a British think-tank aiming to promote “social, economic and environmental justice”. The five principles are Connect (with the people around you: family, friends, colleagues and neighbours at home, work, school or in your local community – mostly online at present); Be active; Take notice (be observant, look at something beautiful eg in the natural world, meditate); Keep learning and Give (in the wider sense of the word). It’s really helpful to do one or two things every day for both our mental and physical health and a current example I’ve not tried yet (but will) is taking a virtual museum tour – you can even ‘visit’ the Vatican. For ‘taking notice’ I’ve been visiting local waterways and woodlands, most of them a 90 minute round trip so a decent walk on top of the Joe Wicks live ‘PE’ sessions. (Incidentally, I gather the Wicks workouts and baking banana bread are now regarded as lockdown clichés but they’re good to do so I won’t stop!) Today I took my binoculars to the viewing platforms over the reservoir local birdwatchers had alerted me to. Nothing that exciting came into view but I’m told there are swifts, swallows, egrets and cormorants to be seen, so maybe another day….

Finally, consumer goods giant Unilever reports that its sales of products like shampoo and deodorant are significantly down since the start of lockdown, whereas household cleaning products are ‘flying off the shelves’. This suggests that some of the care we were formerly lavishing on our personal grooming is being diverted to our perhaps neglected abodes – maybe now Quentin Crisp will finally be proved wrong!

Wednesday 6 May

The COVID19 death toll has naturally focused more attention than usual on the ways death and mourning are observed. Funerals, now very restricted, have always been a way to mark an individual’s passing but in this extreme situation it could be argued that a much more public commemoration is called for. ‘It’s very weird how there’s been no collective mourning for all the dead. No television specials honouring them, almost no mention of them, nothing at all’, tweeted a Radio 4 listener. As is well known in the field of bereavement, what Freud called ‘the work of mourning’ will be arrested, suppressed or exacerbated by the absence of public ritual. Surely an acknowledgement and commemoration of those losses should be urgently considered, not just left till when the pandemic has run its course.

What a shame ‘Professor Lockdown’ Neil Ferguson let himself down and had to resign from SAGE because of breaching the lockdown he’d so strongly advocated. But perhaps, as is evident all around us, there’s a limit to people’s tolerance of lockdown, which has been gradually breaking down over the last few weeks, not to mention the persistent illogicalities like packed public transport and allowing in flights with no quarantining of disembarking passengers. Could this resignation mean we will now see more mainstream media attention directed to the deliberations of Independent SAGE?

“There has to be the development of a local based primary care, social care, locality based approach to this whole process of being able to continue to monitor infections”, suggested IS member Professor Deenan Pillay (UCL), in direct contrast to the government’s continued centralisation policy. This raises interesting issues about the nature of authority: if the de jure source is seen to be lacking people will look for de facto guidance elsewhere and perhaps Independent Sage will now come more to the fore.

Amid calls for a public inquiry on the government’s handling of the pandemic, statistician David Spiegelhalter said: “Well over 3,000 [of the excess deaths] weren’t labelled as Covid. So nearly a third were from something else. There is a continuing anxiety that many of these are due to the lockdown itself. The one thing we do know is that the health service has been hugely disrupted, not just in terms of routine care, cancelled chemotherapies and radio therapies and elective surgeries, but also of people with symptoms not going to hospital.” This is another area which seems to divide opinion: those wishing to avoid or delay scrutiny and reluctant to challenge authority arguing that we don’t have the full picture and that will only be possible post-pandemic, and those pressing urgently for an inquiry so that lessons can be learned now and used to inform how we go forward. It seems quite common to see comments eg on social media suggesting that the government ‘is doing its best’ and we should ‘leave them alone’ and ‘not whine’ – aka holding the government to account. Not surprisingly, one who presented the defensive argument was Home Office security minister James Brokenshire on the Today Programme – ‘now is not the time’ – allowed by presenter Justin Webb to get away with it.

There’s not much time before Sunday for the government to take this on board for its lockdown exit strategy but it’s positive that a more nuanced approach than the hitherto simplistic one has emerged from researchers at Edinburgh. They’ve suggested ‘segmenting and shielding’, based around relaxing restrictions on more than half of the population and beefing up protection for those over 70 and vulnerable people, eg their contacts being only carers and family members free from infection. These ‘shielders’ would be tested regularly and the entire strategy could be phased in over a 3 month period. It makes one wonder why such a sensible plan hasn’t been thought out before in government circles, especially bearing in mind that the policy of lumping together all over 70s, condemning them to many more months of isolation, has been very stressful for them. If this approach can be incorporated into the exit strategy it will provide some sorely needed reassurance.

Adding to private sector inroads already made into the NHS, it seems more privatisation by stealth is being facilitated by the pandemic. Doctors, campaign groups and academics have raised the alarm that Serco was being positioned to win a deal to supply 15,000 call-handlers for the government’s tracking and tracing operation. It’s also not commonly known that Deloitte, KPMG, Serco, Sodexo, Mitie, Boots and the US data mining group Palantir were given contracts to manage Covid-19 drive-in testing centres, the purchasing of personal protective equipment (PPE) and the building of Nightingale hospitals. These arrangements haven’t been scrutinised because special powers have been used to bypass normal tendering, awarding numerous contracts without open competition. It’s also been suggested that the move from individual NHS trust procurement to centralised purchasing will lead to more control by Deloitte and co. Surely this should have been raised at PMQs today.

The Guardian quoted Tony O’Sullivan, a retired paediatrician and co-chair of the campaign group Keep Our NHS Public, who said this was a “dangerous time” for the NHS, and that the “error-ridden response” from government had exposed a decade of underfunding. ‘Now, rather than learning from those errors they are compounding them by centralising decision-making but outsourcing huge responsibility for the safety of the population to private companies’. Labour MP Rosie Cooper and Health and Social Care Committee, said these contracts must have a sunset clause, enabling the arrangement to be reviewed after 3 or 6 months. Who knows whether these contracts have such a thing?

Health Secretary Matt Hancock is the Guardian’s parliamentary sketch writer John Crace’s subject this week. In a withering but funny article, he alludes to ‘the battle between his (Hancock’s) career and his conscience’….The career is still winning. But the gap is closing. Part of him longs to tell the truth. About the uselessness of his predecessor, Jeremy Hunt, who ran down the capacity of the NHS to unsafe levels. About the self-indulgence of a prime minister who prioritised celebrating Brexit and sorting out his private life over trying to make sure the country was prepared for the pandemic. Yet he can’t quite go there yet. So instead he attacked Allin-Khan for adopting the wrong tone. In time, he will see that it was he who got the tone wrong’. A major point he makes is Hancock seeming not to understand why he’s being challenged on the failings as he’s expecting to be congratulated on the 100,000 tests, when this has widely been seen as a meaningless goal. But his increasing tetchiness may also be due to being hung out to dry by his boss.

Finally, it’s positive that public libraries, a hugely undervalued community resource, are doing a roaring trade online, producing online content, answering queries and phoning elderly readers for a chat. An amusing Twitter exchange between librarians focused on interesting ‘bookmarks’ they’d found in books, including an After Eight mint still in its wrapper and a Blockbuster card (“a proper ancient artefact”). From librarianship days this brought back memories of the stories (mythology?) which grew up around this topic of weird bookmarks encountered in returned books, including a fish spine. Quite often, though, the less obvious ‘bookmarks’ don’t come to light until the next reader borrows them. Numerous library users will have found various items over the years, including old bus or train tickets, receipts and heaven knows what else. Feel free to let me know what you’ve found left in a library book!


Tuesday 5 May

Although some caution must be exercised because of different ways of handling statistics in different countries, it’s shocking to learn that the UK has overtaken Italy for the highest number of COVID-related fatalities in Europe – more than 32,000 according to the latest ONS figures released today. Although the causes are well known, especially the tardiness in addressing the crisis, several pieces of news this evening will reinforce them, eg the PM continuing to shake hands with colleagues after clinical advice to the contrary and 18m people being allowed into the UK early in the New Year and not quarantined. 

The contact tracing app leads the news, with some pointing out that it shouldn’t be called the ‘NHS app’ since it’s being developed not within the NHS but by the company belonging to the brother of a no 10 ‘adviser’ (Ben Warner). And why reinvent the wheel when the Google and Apple enabled ones already exist and other countries are using them? British exceptionalism again? As co-author of the legal opinion suggesting the app could be challenged in the courts on privacy grounds, QC Matthew Ryder told BBC Radio 4’s Today programme that the Government is yet to “present the evidence or the material it would need to justify the course it is taking”. He said the government is ignoring Information Commissioner’s Office advice, which suggested that a decentralised approach would best protect user privacy rather than the government’s centralised approach to this whole crisis.  

Former Health Secretary Jeremy Hunt told BBC World at One that people should download the app but some at least feel that lack of trust will be a disincentive. A listener tweeted: ‘It’s too late. They’ve already lost our trust in the contact tracing app by using their mates who developed the tech for Vote Leave and then centralising the data. They will never get that trust back’. This issue has also raised concerns at the possibility for use being made compulsory or least people being subjected to heavy pressure – could ‘recalcitrants’ be traced via their phone and made to use this app? Needless to say, loss of trust in our leaders (or politicians’ failure to instil it in the first place) will exacerbate pre-existing anxiety.

Regardless of how the Isle of Wight trial goes, it seems that two key challenges have yet to be navigated. One lies in the failure to pass NHS tests so far, according to Health Service Journal. ‘Senior NHS sources told HSJ it had thus far failed all of the tests required for inclusion in the app library, including cyber security, performance and clinical safety’. The second is that at least one data expert, Nyasha Weinberg (Research Fellow in Rule of Law Measurement at the Bingham Centre UK Constitutional Law Association), argues that the app needs primary legislation to provide safeguards and legitimacy.

Can such hurdles just be disregarded with the likely argument that there’s no time to address them? This issue highlights further the conflict between the needs to protect privacy and to urgently accelerate testing.

Another example of opacity is the news that coroners are effectively being silenced and hampered in their roles. The Independent reported that more than 100 health and care staff are thought to have died after contracting the Covid-19 virus. Although coroners will be able to investigate these deaths due to lack of PPE, they won’t be allowed to question national policy. This could risk hospital CEOs and GPs being unfairly blamed, leading to expensive litigation.  

Meanwhile, scientific opinion remains divided on the wearing of masks, this inconsistency being confusing and unhelpful for the public. Although a report from a multidisciplinary group convened by the Royal Society called Delve – Data Evaluation and Learning for Viral Epidemics – has considered the evidence and decided in favour of public wearing of face masks, other scientists disagree. Dr Ben Killingley, consultant in acute medicine and infectious diseases at University College London hospital, said: “The report is overly optimistic about the value of face coverings and it is incorrect to conclude that the evidence shows that face covering can reduce viral transmission in the community…There is in fact no good evidence that face coverings achieve this.”

It won’t help Brexit talks that a European body has criticised UK strategy, despite the PM’s claims of success. Andrea Ammon, director of the European Centre for Disease Prevention and Control (ECDC), suggested on Monday that the UK had yet to progress as far as the majority of European countries in tackling the disease. ECDC reckons that only the US exceeds the UK’s total of 186,599 confirmed cases and 28,466 fatalities, a death count second only to Italy. [Later news above confirmed that UK has now overtaken Italy]

Here are two radio series you might enjoy for some light relief, although the second could make you think about what it could be like returning to a pre-NHS health service if privatisation continues unabated. On Radio 4 the engaging music journalist Pete Paphides (married to writer Caitlin Moran) reads his autobiography (Broken Greek), which describes his childhood experience of selective mutism and the upheaval of his family’s enforced move from Cyprus to set up a fish and chip shop in Birmingham.

This adaptation of A J Cronin’s novel The Citadel makes for compelling listening, focusing on medical life in the 1920s. Wikipedia tells us: ‘The Citadel is a novel by A. J. Cronin, first published in 1937, which was groundbreaking in its treatment of the contentious theme of medical ethics. It has been credited with laying the foundation in Great Britain for the introduction of the NHS a decade later’.

Finally, during her recent Evidence programme for the BBC World Service, author and broadcaster Claudia Hammond coined a useful moniker for the state of COVID-related anxiety we are all experiencing at some level:  Coronacoaster. It might just catch on.

Monday 4 May

Delaying the lockdown exit strategy until Sunday will inevitably raise expectations as to its contents and impact so let’s hope it’s worth the wait. It will need to carefully balance the need to prevent further spread of COVID with the need to recharge the economy and to halt further lockdown collateral damage – loneliness, anxiety, domestic violence, unhealthy eating and drinking and so on. It can’t please the government that an increasing number of Conservatives (Steve Baker the latest) have been joining in the chorus urgently calling for lockdown ending.

It’s very interesting that, in view of criticism of the secrecy around SAGE membership and proceedings and alleged lack of independence, former Chief Scientific Officer Sir David King has set up an ‘independent SAGE’- its meeting streamed on YouTube earlier. Its own membership is the first thing Independent Sage tweeted (looks like a good cross-section of people including some public health experts, an area said to be underrepresented on SAGE).

We have to wonder if Dominic Cummings was watching this meeting – if not him, certainly some minions.

‘Great to see that this debate is so open and not hidden like the govt version of SAGE and COBRA’, said one contributor to the chat room. It’s thought this development prompted the government to reveal the membership of SAGE – what a result.

Meanwhile, Matt Hancock and colleagues seem to be putting too much faith in tech to tackle a major task which should have been tackled months ago, namely contact tracing. The new NHS COVID_19 app currently being trialled in the Isle of Wight is expected to yield faster results than traditional contact tracing methodology. But despite an article in The Times explaining that the app wouldn’t give any more data to tech giants ‘than they already have’, many will be uneasy about some access to location, potentially leading to more anxiety. It echoes the broader concern as to whether current incursions into our privacy being made to cope with the pandemic will be withdrawn later. A major weakness must be the app’s selectivity: not everyone has a smartphone and its success will depend on 80% of smartphone owners downloading it, which can’t be guaranteed at present. The fact that Hancock has been closely associated with the discredited Babylon GP at Hand primary care app will not inspire confidence, at least in some medical quarters. Nor will the suggestion that the new app is to be supplied by Ben Warner’s brother’s company. (Warner is one of the No 10 attendees of SAGE).

There’s more thought-provoking listening about mental health on the BBC World Service.  Now that a good part of the world has been living for a time in lockdown, presenter Claudia Hammond and her panel of psychologists and psychiatrists, including experts from China and India, answered the audience’s questions on the impact of the pandemic on mental health. The huge effect of continuing uncertainty was a substantial theme. Whereas some of the coping advice is fairly obvious and has appeared in various places, it was interesting to hear one psychologist state that those who have already navigated adversity and challenges during their lives will generally cope better than those who haven’t. Also that as many as 17% of the population suffer from health anxiety (formerly known as hypochondria), living in a state of hyperarousal and likely to be more seriously impacted than others.

As the country gears up (or doesn’t) for the VE Day celebrations on Friday, we could be wondering who will mark it. There’s a Facebook suggestion going around that we all set up tables, chairs and drinks outside our houses, which could be done with distancing, wear red, white and blue and decorate our houses similarly. Someone who experienced VE Day itself described the atmosphere as ‘delirious’. We might not feel quite so exuberant this time round but it could be good for community engagement and some kind of national esprit de corps, provided it’s not recruited cynically by the government to deflect from their failings, for example by making inappropriate comparisons between VE Day and ‘getting through’ this pandemic, aka ‘battle’ or ‘war’. Opinion seems divided as to whether this is a real cause of celebration, acknowledging the sacrifices made back then, or jingoistic nonsense keeping us stuck in the past. But it could at least prove an innocuous way of escaping COVID gloom for a few hours, therefore a ‘good thing’.

‘Lockdown is really messing with my mind’ read one tweet. ‘I’m presently fighting back the tears at the thought of singing “We’ll meet again’ with my neighbours on Friday night’! This reminded me of having had to learn this song as part of a tap dance show years ago but the lyrics didn’t stick.

Finally, an interesting quote to ponder from Japanese author Haruki Murakami, via Inner Space: “And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about.”

Sunday 3 May

It was good news that at the Downing Street briefing last night, Communities Secretary Robert Jenrick announced key measures to address domestic violence, modern slavery and homelessness, although some critics are saying they aren’t enough. A task force led by former homelessness Tsar Dame Louise Casey will work on ways of helping rough sleepers and £76m will be given to DV and modern slavery charities. Two concerns about this: it’s not being implemented quickly enough to prevent more DV incidents and fatalities, and putting the voluntary sector in charge is unfair pressure and doesn’t facilitate an overview of the work.

More attention is now being directed to health inequalities as a factor in COVID risk. Marked reductions in council budgets during austerity led to cuts in vital public health spending, affecting mental health work as well as other areas. The damaging thing about this is that public health work is preventative, so its lack will result in worse problems further down the line. Public health expert Professor Kevin Fenton (leading a government review into BAME risk factors) draws attention to ‘sobering findings from a new Institute of Fiscal Studies report (The Deaton Review – Are some ethnic groups more vulnerable to COVID-19 than others?), showing that Black African COVID deaths are 3 times higher than those in white Britons, saying that ‘we must also look beyond the data to understand and address the life experiences, social, economic and structural factors driving these differences.’

Views on the lockdown are becoming increasingly polarised. An Opinium survey for The Observer found at the end of last week that 17% of people think the conditions have been met to consider reopening schools, against 67% who say they have not been, and that they should stay closed. Nevertheless, there’s a groundswell of protest against lumping together of all over 70s into a further period of lockdown (‘indiscriminate targeting’), when it’s clear that many over 70s are fitter than some in their 40s and 50s. This damaging conflation of age with incapacity needs to be addressed urgently otherwise people will start to make their own decisions, further breaching the already fragile lockdown. The conformity associated with the older generation has limits. Max Hastings in The Guardian said: ‘Britain has not been exceptional in much, except in its refusal to inform and debate with the public over lockdown. It has behaved like an old-fashioned centralist bureaucracy, with ministers and officials mouthing slogans and giving orders. ” Such an approach can add further to general anxiety, because of the feelings of powerlessness it gives rise to, a very clear undermining of autonomy.

Meanwhile, it’s interesting that Spain, allowing people outside for the first time in weeks, is age-segregating these exercise times. This might be a good idea, to help prevent people being mown down by large numbers of cyclists and pavement pounders.

A lockdown exit strategy is expected to be announced on Thursday but some say it’s already broken down and there’s plenty of evidence in some areas to confirm that – busy roads, little or no distancing in shops, people congregating and many more around in streets and on buses than weeks ago. Better understanding of the rise in mental health difficulties during lockdown, including a significant rise in problem drinking, means behavioural scientists could be forced to conclude that 5-6 weeks is the limit of people’s tolerance of such unprecedented restrictions.

Robert Jenrick said ‘the second phase’ of their ‘battle plan’ will be addressed ‘with the same energy, determination and commitment to this effort as the first’, a statement which might not inspire confidence in all quarters. The Guardian yesterday cast a cynical eye over the entire Downing Street Briefing strategy, down to the repetition of the same soundbites including the now classic ‘straining every sinew’.

Another programme on COVID19 fallout should be worth tuning into tonight at 8 pm – ‘The decisions being made now by our politicians, our doctors, our scientists and business leaders will affect us all for years to come. Tom Chivers (science writer) meets with leading experts and asks whether the cure is always worth the cost’.

Ending on another nature note, it was pleasing on visiting the nesting coots this morning to see both sets of eggs have now hatched. Interesting that the food I threw in was gobbled up immediately by the male bird. Despite managing to get some near or close to the first nest the female didn’t budge, obviously reluctant to expose the chicks for even a moment. I’m looking forward to seeing them on the water, hoping they survive until then.

Saturday 2 May

As the death toll now passes 28,000, I’m still appalled by Matt Hancock’s disingenuous and self-congratulatory spiel at yesterday’s Downing Street Briefing. Having made the arbitrary 100,000 tests a day target a key goal, ‘a massive achievement’ based on massaged statistics, there’s apparently still no understanding that this is only one aspect of an uncoordinated approach. Experts are saying it’s meaningless without contact tracing and an overarching approach focusing on local public health teams rather than being directed solely from Westminster. Despite much criticism, it doesn’t seem that the Health Secretary has yet been seriously challenged by the media on this misrepresentation. Another major claim, that we’re now ‘past the peak’, has been challenged by experts, on the basis that we don’t yet have the full set of figures from the Office of National Statistics which would lead to that conclusion.

You’d probably have to be of a certain age to fully appreciate this tweet. Some might even remember the advert’s tune!

‘Welcome to the #DowningStreetBriefing sponsored by Fudge, a finger of Fudge is just enough to fudge Covid19 the test figures’.

Meanwhile, the lockdown exit issue is attracting mixed opinions, sections of the population and businesses understandably champing at the bit to get going again, but many others appreciating the extra time and peace to not rush around, to enjoy reading, listening to music, meditation and the natural world around us. Research has shown that proximity to nature is good for our mental wellbeing, enabling calmness and tranquillity. This time of year especially lends itself to such experiences, as so many trees and plants are coming into bud and blossoming. It’s very pleasing to see three white and scented irises unfurling in my little garden, surviving yesterday’s downpours and hailstorms. For the past month, I’ve been visiting two pairs of nesting coots on a local waterway and it was marvellous today to see one lot had finally hatched, the tiny hatchlings peeping out from beneath the hen bird’s enfolding wings. Apparently, very few survive more than a few weeks because of various predators so I hope at least some of these do. It seems fitting, then, that tomorrow is International Dawn Chorus Day, ‘which celebrates nature’s greatest symphony around the world’, and BBC PM treated us to snatches of birdsong earlier – blackbird, robin and blue tit.

One of the things I like so much about Joe Wicks, the ‘nation’s PE teacher’ who hosts a daily workout during the week on his YouTube channel, is that he emphasises the mental health benefits of exercise as much as the physical ones, in an engaging and compelling way. I’ve come across so many people who’ve never exercised as adults because they were so put off by harsh and humiliating games teachers at school. Perhaps these live workouts (‘attended’ by so many all over the world’) might attract some of these people, as they were initially aimed at kids and now people of all ages are joining in, whole families doing it together. As Joe doesn’t do them at weekends, I’ve been catching up with the earlier ones I missed. There’s a surprisingly challenging exercise in the 24 March one I’ve never done at the gym – manageable but not easy. It involves alternately kneeling and standing at a reasonable speed, without using your hands. Harder than it may sound!

For a bit of light relief and if you’re not addicted to the Scandi noir on BBC4, you might like to catch up with this lovely film on BBC2 tonight, if you missed it when it was first released: The Guernsey Literary and Potato Pie Society. ‘In 1946 a London-based writer begins exchanging letters with residents on the island of Guernsey, which was German-occupied during WWII. Feeling compelled to visit the island, she starts to get a picture of what it was like during the occupation’.

Friday 1 May

As the 6th week in lockdown draws to a close, it seems that daily revelations of delay and incompetence in handling this crisis are adding to general anxiety. This is because we need to trust and believe in our leaders, authority figures who act as proxies for the early parental figures whose job it was to take care of us. When this psychological ‘holding’ is missing, anxiety can increase.

This obsession with the macho and arbitrary target of test numbers (which experts tell us this is meaningless without a broader approach including contact tracing) detracts from energy which could be better expended on other things. Further complications are that people can be carriers but without symptoms, meaning they would have no reason to seek a test, and ‘false negatives’, eg the unreliability of tests, all of which means we need a coordinated and nuanced approach, not the simplistic and uncoordinated one which has characterised strategy so far.

Reaching the 100,000 a day (with a bit of statistical massaging, which doesn’t equate to tests actually done) is being presented as a great success despite the terrible death toll. ‘By hook or by crook we will get it to 100,000 tests per day. But mainly by crook’, tweeted a BBCPM listener. Top bioscientist Sir Paul Nurse was impressive on Question Time last night re the government’s response to Covid-19, cutting very smoothly through the obfuscation of Transport Minister Grant Shapps:  “We could be doing better”, “We were totally underprepared for it”, “We should’ve prepared for it” “we’re “playing catch up”.

A Today Programme listener tweeted: ‘Continuous long-standing lack of transparency with govt actions/policies has led to lack of trust in what they tell us. So with testing … Is 100K tests carried out, or simply tests booked online + ordered home test kits? It probably doesn’t really matter, but trust does’.

One of the most daunting aspects of this crisis has to be the extensive collateral damage already being inflicted: business failures, mental health crises, struggling councils, closure of yet more care homes, and so on. There was already a social care crisis and now we learn that more care homes will be forced to close, due to COVID-related costs (eg the hugely increased cost of nursing care). It always seemed wrong to me and a risky business model for social care to be largely in the private sector. If you can overlook the irony, ADASS (Association of Directors of Adult Social Services in England) did capture a key realisation earlier, tweeting: ‘Important to hear Jeremy Hunt at the Commons Health & Social Care Committee, saying ‘If there is one thing we have learnt from this crisis it’s the importance of social care to our society. The challenge now and post Covid-19 is to prioritise, protect and re-imagine social care for the future.’

Local government isn’t in a position to make much headway, having had its central government grant severely cut for years, yet today housing and local government minister Robert Jenrick told journalists ‘’I’ve been very clear to local government that we will be standing behind them’. This coincided with the news that Liverpool City Council declared it was on the brink of bankruptcy and looking to file a Section 114 notice. [Part of the 1988 Local Government Finance Act, a 114 order bans all new expenditure, with the exception of safeguarding vulnerable people and statutory services. It is only issued ‘in the gravest of circumstances’]. There are so many services communities rely on their council for that they cannot be allowed to collapse – lack of trust in national government could then be coupled with a similar lack in local government.

Rob Whiteman, CEO of CIPFA (Chartered Institute of Public Finance and Accountancy) said: ‘This may require a temporary or new set of rules for local government finance. Councils may need to borrow in order to fund services – government should be underwriting what is needed to keep councils solvent as it is already doing for businesses and the NHS’.

Worsening mental health has manifested in the number of people seeking help, suicides and charity Rethink’s survey of more than 800 people living with mental illness showing that 80% felt their mental health was worse due to the impact of the coronavirus, 28% saying it was ‘much worse’. In a letter to the Guardian (30 April), pleading the case for sustained mental health investment, Danielle Hamm (Associate director of campaigns and policy) pointed out:

‘While necessary to prevent the spread of this highly contagious virus, lockdown is depriving people of the things that they need to stay well, from peer support groups to the routine of work and social engagements. We’re hearing from people who are not just feeling a lack of motivation or purpose but experiencing an increase in suicidal thoughts, or deterioration in their health to the point they require urgent intervention to manage paranoid delusions or psychosis’. This reinforces the debate as to whether lockdown could be as damaging to people’s health as the risk of the virus.

One of the most interesting COVID news items must be Cambridge statistician David Spiegelhalter’s, effectively about the rise in risk aversion. He suggests people are over-anxious, as 60 % of those surveyed by IPSOS Mori said they’d feel ‘uncomfortable’ about going to bars, restaurants and on public transport and two thirds would about attending a large public event like a concert or sports fixture. The academic said Britain will need a public information campaign to persuade people to ‘start living again’ because the government’s stay-at-home message has been “slightly too successful”. There’s an interesting debate to be had about personal risk management: some risk aversion is obviously sensible but too much (and there is often too much) curtails the capacity to grow and develop. 

Thursday 30 April

As the PM prepared to pick up the reins once more at the Cabinet meetings and daily press briefings, it’s become increasingly clear that the much-trumpeted 100,000 tests a day target is nowhere near being met by the end of April deadline. The latest figure was just 52,429 tests, for Tuesday. As this morning’s government interviewee on the Today programme,  Justice Minister Robert Buckland may have introduced a new entrant to the soundbite lexicon (alongside ‘ramping up’, ‘straining every sinew’, ‘flattening the curve’ and many others) – ‘working hand in glove’, somewhat ironic given the recent spotlight on PPE and single gloves being counted separately.

Labour’s Shadow Chancellor of the Duchy of Lancaster, Rachel Reeves, said the government has been “too slow” on testing, which is why “we are still way off that goal” of 100,000 tests a day. The whole of government need to take responsibility for this and start to get things right…Tests are not being carried out at anything like the scale the government promised and the government need to get a grip and get their act together.” It still seems surprising that part of this ‘getting a grip’ hasn’t taken the form of stopping flights or at least testing and quarantining disembarking passengers, as South Korea did at the start.

Professor Allyson Pollock, public health expert and director of the Newcastle University Centre for Excellence in Regulatory Science, smashed it on BBC World at One, clarifying that the government doesn’t actually have ‘a strategy’: testing doesn’t make sense without contact tracing and there should be local public health teams coordinating all this rather than the unhelpfully centralised approach directed by Westminster. No coordination = no strategy (shades of the Emperor’s new clothes syndrome). One tweeter suggested Professor Pollock for SAGE – great idea.

It was revealing hearing World about At One presenter Sarah Montague’s COVID19 test, which she recorded on her phone. The whole procedure sounded clunky and how absurd that she had to go in a private car and so far from her home. This effectively restricts mass testing and surely the kind of thing journalists could ask at the Downing Street Briefing and the public could raise during BBC Question Time tonight.

Not before time, politicians and experts have called for urgent action to create more space for walking and cycling during lockdown in the UK, and ‘to avoid a nightmare rise in traffic as restrictions on movement are lifted’. Although most councils haven’t acted yet, there’s increasing concern at the lack of time left to ensure viable alternatives to car use are available. It can already feel a struggle trying to do a decent walk or run because of the numbers of people doing the same thing and lack of etiquette (eg people walking two or more abreast, dominating a narrow path or pavement), forcing others onto the road and into the way of passing traffic. As exercise is so important for our mental health as well as physical, it’s imperative thought is given to these space creation measures.

BBC PM has just had an interesting piece about the British Library’s COVID Chronicles project, an electronic archive of COVID-related content people are invited to contribute to, so I’m going to let them know about this humble blog!

As the death toll was announced as 26,711 this evening, it seemed to me (and others) that the PM put in a poor and blustering performance at the Downing Street Briefing, starting with alluding to the UK’s ‘success’, based on the strange criterion of the NHS ‘not being overwhelmed’, never mind the shocking death toll. The response to the mental health question was especially lacking, eg ‘There are lines you can call’. For the zillionth time, services need properly funding and many of these won’t be staffed by qualified counsellors. The PM responded to Robert Peston’s question on strategy with ‘Broadly speaking, I think we did do the right things at the right times’. One indignant listener tweeted: ‘The families of 40,000 dead people would like to take issue with Boris Johnson’s “disaster having been avoided”. Also with the upbeat “Tigger” mood of the PM when briefing about mass deaths. He might have recovered from COVID19, thousands didn’t’.

Palliative care doctor Rachel Clarke summed it up:

“We have succeeded in avoiding the tragedy we saw in other parts of the world.” Did

Boris Johnson *seriously* just say this? 26k deaths. One of the world’s worst death rates. I care for these patients. They’re human beings, Mr Johnson. This is the definition of tragic.’

It’s very timely that tonight’s The Briefing Room on Radio 4 focuses on social care – 4,500 providers in a fragmented sector. Successive governments have kicked the social care can down the road for years – now COVID19 and the shocking number of deaths in care homes (one third of the death toll) means this cannot continue. Let’s hope the government is held to account on when we can expect that long promised Green Paper!