A preamble: it seems that many have time on their hands and are short of reading material. I hope some might find this of interest. There is some medicine, some history, a timeline, and some trivia. If anybody finds any mistakes or errors please notify me and I will modify.
CORONA DIARY
16th March, 2020
A bit late onto this topic, but nonetheless there is still
much to write about.
In around 1970 or 1971, as we sat in the small lecture
theatre at University College Hospital (before the Clore lecture theatre was
built), in the old University Street building, lectures were given on
microbiology. The Professor of Virology
(I can’t remember his name, though I can picture him, a slightly overweight
individual, gentle manner, grey eyes, probably had significant underlying coronary
artery disease in retrospect) gave us lectures on basic virology, and we all
went out and bought the Jawetz paperback textbook 'Review of Medical Microbiology'. One thing was drilled into us while we were
discussing influenza. The history of the
original major pandemic, also called ‘Spanish Flu’, a disease which swept the
whole world and caused 50 million deaths was rehearsed, and we even conducted
an experiment using one of its deadly products, a surface protein called
‘haemagglutinin’ in the test tube. This
demonstrated unequivocally that red blood cells were agglutinated – clumped
together, blocking blood vessels and impairing oxygen transport. But the one clear message was – the next
pandemic is a case of ‘when’ and not ‘if’.
Subsequent to 1918/19 we have had several more major outbreaks, the 1957
‘Asian’ flu; the 1968 ‘Hong Kong flu’; the 2009 ‘Swine Flu’ epidemic. Back then we were told that the virus
probably originated in Asia, and that the reservoirs were most probably in
pigs, although it was clear that the original and most fatal virus was probably
of avian origin. All of this was quite
prescient at the time, and recently I have mused that it is sad that these
Professors are not around now to enjoy the fascinating events that are now
unfolding with coronavirus. There hasn’t
been any mention of what if any superinfection is occurring in the lungs of
affected patients. We’ve seen some of
the X-rays which do indeed look very nasty.
In earlier epidemics it was acute staphylococcal pneumonia, but nobody
seems to have mentioned this this time around.
A consultant I worked for in Nottingham told me that they had a protocol
in 1968 – any young person admitted with flu and respiratory symptoms was given
immediate IV flucloxacillin, an antistaphylococcal penicillin which only came
into use in the 1960s. A feature of
classic flu was the deaths of healthy young men – possibly due to dramatic
hyperresponsiveness of the immune system to viral antigens. Doctors in 1919 reported young people being
well at breakfast time and dead by teatime.
A remarkably scary scenario.
Opinions seem to differ on why it was called Spanish
Flu. The answer seems to be that there
was severe censorship and news blackouts in the countries engaged in fighting
the first world war, and that the first cases were reported from Spain. Almost certainly however, the virus jumped
from birds to mammals (probably pigs) and after transformation, infected humans
sometime around and after 1910. Again,
the source was probably China, though it may not have been. The first cases, at least the first recorded
cases, were in Kansas.
Influenza viruses differ from the Corona virus, though they
are both single stranded RNA viruses.
Corona is able to serve both as Messenger RNA and as a genome. In simple terms they use the cell’s own
synthetic machinery to manufacture, first, copies of themselves, and then
proteins. Otherwise, their common factor
is that they spread through person to person contact; droplets; probably
faecal; and what microbiologists love to call ‘fomites’. This was certainly a new word to us medical
students at the time, but essentially it means microscopic transmission
mechanisms – particles from skin, dirt from clothing, from fingernails, items
that we have handled. Fomites are inanimate
objects that can transmit the organism or virus causing disease.
As of this date we have come a long way from these early
reports from Wuhan, a city in Hubei province, China, sometime in January. The earliest infection seems to have been
recorded in November 2019. Inititally,
as you will all know, China tried to suppress this ‘bad news’ story, and the
widespread dissemination became apparent just before Chinese New Year, a time
when Chinese people everywhere migrate to celebrate with family and loved
ones. By the time the New Year
celebrations were cancelled it was probably already too late.
Having started the ball rolling, the Chinese authorities
were nonetheless quick to type, and genetically sequence the virus. Only South Korea seems to have acted with
precipitous speed in preparing an antibody test which was rapidly rolled out to
enable widespread testing.
March 22nd
Strange sort of Mother’s Day – what would we do without
mobiles, Skype, Facetime etc? But when
Natalie’s Mother’s Day card for Lindsay was slipped through the letterbox
yesterday it felt to me like the parcel of silks from London arriving in Eyam
in the plague year 1666 (see ‘The Year of Wonders’, superb novel about the
events of the bubonic plague in Eyam, and their decision, prompted by the
vicar, to self-isolate. The fatal plague
bacterium arrives in Eyam in fleas inhabiting a parcel of fabric from London).
Most of my concerns have now been echoed. The UK, like quite a few countries, is behind
with testing. A colleague currently in practice points out that it is not quite as simple as that. It’s pretty easy to identify a
Covid patient who needs hospitalisation (I’m thinking of buying my own oxygen
saturation monitor), but it’s not easy to identify NHS people who are ill and
haven’t recovered – are they still shedding virus? On the other hand, it’s clear that many
people are ill (or say they are) and are not being tested fast enough. The turnaround time has gone up because of
demand. In the near future it may be
that there will be an antibody test so that we can know if somebody has got it
and is a risk (IgM – acute phase immunoglobulin) or has had it and has
recovered (IgG only). There is a
generalised cry from hospitals that PPE (Personal Protection Equipment) is not
being rolled out fast enough, and there was a weepy ICU nurse on TV saying that
there was nothing at the supermarket after she had finished a 48 hour
shift. Irrespective of the veracity of
that work pattern, she doesn’t seem to have thought of e.g. buying frozen
fruit, or thought ahead properly.
The UK has been roundly criticised by other countries for
not taking this pandemic seriously. Its
stepwise response seems reasonable to me however. Every day Boris Johnson appears at a 5pm press
conference flanked by Sir Patrick Vallance, Chief Scientific Adviser, and by
Professor Chris Whitty, Chief Medical Adviser.
They are dispassionate and clear cut in their answers. Surely a ‘K’ in the pipeline for Chris Whitty
if we get through this.
In the meantime, one local doctor has a Lord High Executioner type list of some hospital consultants whom one might call ‘Flaky’, and
it’s interesting that virtually all of them are now ‘self-isolating’ at home
for one reason or another. This contrasts
that with my own feeling that I should be in there and helping, and in some ways
wish I could be (nothing from the GMC just yet – but maybe I missed the cut;
too old; retired too long ago (three and a half years), and maybe others have
been called upon. I don’t know whether
to be sad or pleased about this… I
sometimes reflect on the generations of doctors before us who have practised at
some time after 1919 who haven’t experienced a true worldwide pandemic. It’s new for everybody. Pandemic planning apparently took place in
2013 – how wrong they got it. On every
level, not least financial, with the paralysis of the systems of production.
It's interesting, after two months, to look at how we have
responded to the spread of Covid-19.
Here is a timeline, some of this taken from The Independent, some my
own:
Wednesday January 22nd 2020
Public Health England, responding to the news of an
explosion of cases in Wuhan, moves its risk level to the British Public from
Very Low to Low. Heathrow starts to
screen all arrivals from Wuhan
Wednesday January 29th
UK’s first two patients are identified. Two Chinese nationals staying at a hotel in
York become ill. A plane carrying
British nationals from Wuhan arrives at Brize Norton and passengers go into 14
day quarantine in Merseyside. This sort
of activity is regarded as a curiosity and we no longer think about it now
(late March) that the virus is well and truly in UK.
Thursday 6th February
Britain’s third patient who has been at a conference in
Singapore is identified. This 53 year
old is said to be a super spreader, linked with a total of 11 cases, five of
which are in the UK
Monday 10th February
Health Secretary gives doctors strengthened powers to detain
and quarantine people.
Sunday 23rd February
The Diamond Princess is quarantined off the coast of
Japan. A failure to rapidly evacuate
passengers gives it the status of a virus incubator. Four British nationals are repatriated but
are infected.
Friday 28th February
First British death (a passenger on board the Diamond
Princess).
Stock Market crashes.
Wednesday 4th March
Surge of Covid-19 in the UK.
Biggest one day increase – 34 – brings total to 87. Possible shutdown of Parliament
discussed. Italy announces shutdown of
schools and universities in response to evidence that it is the worst affected
European country. Virus has reached 81
countries; 90,000 confirmed cases; over 3000 deaths. Significant problem with skiers returning
from half term holidays in Northern Italy.
Thursday 5th March
70 plus year old woman first person to die in UK from the
disease. Now over 100 infected in UK.
Tuesday 10th March
Nadine Dorries, Junior Health Minister confirmed positive
for Covid-19. Six total deaths in UK,
373 tested positive.
Wednesday 11th March
WHO announces this is a pandemic.
Chancellor Mr Sunak announces £12bn aid package to help UK
cope with financial implications.
Friday 13th March
Confirmed UK cases of coronavirus rise by more than 200 in a
single day. London Marathon postponed;
Premier League football fixtures cancelled.
Sunday 15th March
UK cases pass 1000.
Health Secretary warns of long duration quarantine for the elderly. Alarm at escalating panic buying in
supermarkets.
Monday 16th March
First PM’s daily press briefing. Flanked by Chris Whitty, Chief Medical
Officer, and Sir Patrick Valance, Chief Scientific Adviser. People urged to work from home and avoid pubs
and restaurants. Whitty and Valance
quietly and calmly impressive.
Tuesday 17th March
Mr Sunak announces additional aid; loans, tax cuts, and
grants amounting to £330bn package. Sir
Patrick Vallance announces that as many as 55,000 people may now be infected
and a ‘good outcome’ would be if deaths in UK can be below 20,000.
Wednesday 18th March
Government announces that most schools will close from
Friday. Key workers’ children may
continue to attend.
Thursday 19th March
Numbers of deaths in UK up to 144, a rise of 40% in a
day. 3269 confirmed cases in UK. Sir Patrick Vallance advises against
socialising in pubs and clubs.
Friday 20th March
Historic escalation.
Pubs, restaurants, gyms, other social venues must close. Chancellor announces that up to 80% of wages
will be met by the Government.
Guidelines will be issued to doctors to prioritise who to save in the event
of shortage of beds or ventilators. Some
schadenfreude when one hears that the
EU Brexit negotiator Michel Barnier has Covid-19. Apparently (from his Twitter page) ‘doing
well.’
Saturday 21st March
Historic deal with private hospitals. They will be taken over to care for Covid-19
patients. UK deaths over 230; cases
(known) over 4000. World figures 270,000
cases, over 11,000 deaths. Decide no
point in drinking bad wine: open bottle of Bakestone Cellars Californian
cabernet. It was Jane MacQuitty who I
first heard use the phrase ‘Life is too short to drink bad wine’ but I suspect,
knowing Jane, a great self-publicist, that it was not original.
Monday 23rd March
No 5pm briefing due to COBRA (Cabinet Office Briefing Room A
– where crisis response meetings take place) meeting. At 8.30pm, Boris Johnson announces that
isolation will now take place. All
non-essential businesses must close. This
follows a weekend of beautiful weather when huge flocks of people congregate on
beaches and in public parks. West
Wittering car park closes after 2,500 cars turn up. Only workers unable to work from home must
now travel. Fines will be imposed. One period of exercise per day – away from
other people. This is often difficult
for some.
Tuesday 24th March
This is our first day of isolation. Building at Crichel Mount Road allowed to
continue, thank heavens. Selfish but as
our builder says, there will be huge pressure not to stop the construction
industry because so many workers are self-employed. Golf club send e mail to say that course is
closed until further advice can be given.
We are allowed out for one period of exercise per day. Beautiful sunny weather continues. Friend starts a virtual WhatsApp wine tasting
group. 7 Brunstead Place film club have
now watched ‘The Go-Between’ and ‘Bohemian Rhapsody’. We failed to watch ‘Lawrence of Arabia’ last
night because it lasts 3hrs 38minutes.
24th March 2020
A parenthesis. Julie
Burchill has written a wonderful article in the Sunday Telegraph today. I must quote some of it because most
journalism is ephemeral – that’s why journalists remain employed! The clue is in the origin of the name.
But firstly, I don’t know if you, like me, feel a slight
sense of unease with these talking heads of workers in the health service
addressing you in the sort of ‘we’re here for you’ type of broadcasts. They’re a bit like Party Political
Broadcasts. The majority of workers just
carry on, head down, doing it. ‘We do
what we do’ is a truism. I got tired of
the clip of the weepy nurse crying because the shops were empty after she had
finished a ’48 hour shift’. Sorry, I
don’t believe she worked that continuously.
Turns out she is vegetarian. She
obviously hadn’t thought ahead to buy some frozen veg or fruit (plenty
available). ‘Stop it, just stop
it.’ She pleaded. Without going into details, just to take the
example of stockpiling toilet paper, for thousands of years humans coped
without toilet paper… Get my drift? Another tedious news item was various celebrities,
most of whom I didn’t recognise, singing (from isolation in their multi-million
dollar Malibu properties), a line from John Lennon’s ‘Imagine’; a song that I
have also always been uneasy about (see below).
This was one thing that stimulated Julie to write.
And so: back to Julie.
I don’t think I can do it better than to quote her:
…’It could be worse: Smith could have joined the other
celebrities treating us to their own
stardust-sprinkled version of the ghastly John Lennon song Imagine.
I’ve had “issues” with this song forever, summing up
perfectly as it does Lennon’s weapons-grade hypocrisy. While encouraging hoi polloi to “imagine no
possessions”, he and his consort kept a whole apartment in the Dakota building
where they lived in New York for the exclusive occupation of their fur coats,
just to keep them at the right temperature.
Elton John nailed it in his autobiography: “The various apartments the
Lennons owned… were so full of priceless artworks, antiques and clothes that I
once sent them a card, rewriting the lyrics to Imagine: Imagine six
apartments, it isn’t hard to do, one is full of fur coats, another’s full of
shoes.”
In fact, Lennon was forever ready to take his non-specific
rage out on someone, provided, of course, that that person was powerless. In his actions – as opposed to his statements
and his songs – he exhibited largely selfishness and spite during his time on
earth.
…But scratch a showboating altruist and you’ll often find an
attention-whore; I know, because I’m one.
I get to show off in print and I’m good at it, but performers in other
areas can’t do their thing alone. It’s
driving them nuts that no one’s looking at them, hence Michelle Pfeiffer posted
a video of herself working out, while Bob Geldof rang up a TV show to announce
his own self-isolation.
It’s touching to look at celebrities and see how unconscious
they are of their vulnerability; George Michael, who knew about these things,
once defined a star as “someone with a little something missing, rather than a
little something extra”.
They need their fans – but their fans do not need them,
although they may momentarily enjoy their singing voices or good looks. When the famous attempt to parlay this
passing fancy into actual power, it falls flat; each time a celebrity urged
people not to vote for Trump or Brexit, it seems they caused another thousand
to do so.
And they will be heeded less than ever as we plunge deeper
into the plague year. Gadot said that
she had been inspired by the Italian videos of neighbours singing to each other
on their balconies; ironically, it’s this development that shows how
superfluous stars are.
It turns out that transcendence was just around the corner
all along – and we don’t need to pay for it.
Like the tree falling in the metaphorical forest, when a star smiles and
no “civilian” watches, does the star still feel happiness?
I’m sure we will see much more of them getting their
flashing-fix in the guise of giving something to the Little People before we’re
out from under lockdown.
But eventually even these most unrealistic of beings will
realise that the achievements of the rich and famous count for nothing in a new
world in which those who do the most arduous and thankless labour are – at long
last – the most honoured. We will look
back in wonder that we once called dress designers, “visionaries” and disc
jockeys “superstars”.
At a time singularly short of silver linings, this must be
one.’
Fortunately, black humour abounds to cheer us up. Some wag has announced that we are only three
weeks away from discovering what women’s true hair colour is…
Wednesday March 25th.
Another beautiful sunny day.
Garden work, cleaning off furniture after a long wet winter. Also cleaning windows. Lindsay finds YouTube film of George Formby. Further rise in cases and deaths. Halfway through the morning comes the
announcement that Prince Charles has tested positive for Corona virus, but has
“mild symptoms.” Wag posts picture of
Charles and Camilla on Facebook laughing their heads off in highland attire at
the Braemar gathering. Byline is,
“Elderly couple bring Corona virus to Scotland.
This irresponsible couple is thought to live in London and have a second
home in the Highlands.”
Surprise – Charles symptomatic on Sunday, tested on Monday,
given result on Tuesday. Another wag
says – “Why should you be tested if you’ve got symptoms? There are lots of asymptomatic Hollywood
stars who haven’t been tested yet.”
And while supermarkets provide special protected times for
NHS staff to shop, a WhatsApp doing the rounds goes as follows: “I said to the
Missus, ‘Come on Love, get this Nurse’s outfit on.’ She said; ‘What do you have in mind?’ I said, ‘Nothing, we need a loaf of bread.’”
Interview with Harry Redknap: “Coro Naviras? Yeah, ‘course I know ‘im. T’rrific little player.”
Deaths as of yesterday in UK are 422. Total confirmed cases 9529. Likely number much higher due to lack of
mildly symptomatic subjects being tested.
Over 82,000 cases tested but negative.
Still dramatic upsurge in the daily curve, nearly 1500 in last 24 hours.
Our 7 Brunstead Place film club has taken two evening to
watch the David Lean film of Lawrence of Arabia. Lindsay’s choice tomorrow. After watching LoA I’m not entirely certain
that the extraordinarily blond Peter O’ Toole was particularly good. Many intense looks, amazing blue eyes, and
dramatic received pronounciation (he came from Yorkshire and was once turned
down at school for a date by Barbara Taylor Bradford when he propositioned her
with ‘Eh Luv, would ya laik to go t’Pictures).
Gregory Peck in ‘To Kill a Mockingbird lost out to O’Toole when the 1962
Oscars came round. A more rounded
performance I feel.
Time for bed…
Thursday March 25th
I return to the subject of black humour. The general public are often horrified by
levity in the medical and nursing profession.
Many don’t realise that this is a coping mechanism, often necessary to
defuse an unbearably awful situation.
It’s a truism that laughing and crying are remarkably close together in
every sense. “I laughed til I cried.” Note the comment by Mark Twain; ‘The secret
source of humor itself is not joy but sorrow.
There is no humor in heaven.’
Even in the Nazi death camps, I was astonished to read of
the jokes told themselves by inmates. I
first became aware of this when I visited the then new Holocaust Museum in
Washington D.C. in about 1982. There was
a library section entirely devoted to the black humour that many who were dying
or went on to die created. Those who
wish can read a scholarly article by Whitney Carpenter entitled ‘Laughter in a
time of tragedy: Examining humor during the holocaust.’ (Easily found in online search. Warning: this is a serious article and is not
for everybody.)
Enough. Two little
parentheses from yesterday:
There is concern for the Rwandan and Ugandan gorillas. All reserves are off limits. The reason?
Apparently their DNA is 98% the same as ours. Food for thought.
It has emerged that the ski resort of Ischgl may have
covered up an outbreak for weeks, allowing infected individuals to return to
numerous European countries and spread Covid-19 before they admitted they had a
problem. It seems that the first cases
in the UK were brought in by a skier who socialised in the ‘raucous’ Kitzloch
bar and returned to infect the family and many others in East Sussex.
Another beautiful day.
Seems ironic.
One casualty of the ‘single daily exercise’. My daughter Katie. Tripped over a protruding flagstone while
running by the Thames. Severely bruised
and a probably broken nose, but in view of the lack of deformity she didn’t go
to A&E. Wise.
Finally for today’s bulletin, a very interesting scientific
observation from Holland. Dutch public
health scientists have been examining sewage effluents and extracting Coronavirus. They think this may be a very good way of
monitoring spread. For example, high concentrations
were found in the effluent from Schiphol airport.
