Corona Diary Part 5. Thursday April 16th to Friday April 24th

Thursday April 15^th

After a momentary rain shower the weather steadily brightens until it is just as lovely as every previous day of this lockdown.  A colleague in a major London hospital tells me that Covid admissions have plateaued, but that they have a number of staff members in Intensive Care, which is upsetting.  He is a cardiologist and they have noted far fewer ‘primaries’ (acute MI, or heart attack).  These are patients with acutely blocked coronary arteries who need  (primary) emergency angioplasty.  This is borne out by Government figures today which show heart and cancer presentations are down – and this will result in considerable collateral morbidity due to the virus.

In the meantime, 861 new deaths are announced today bringing the total UK death toll (in hospital) to 13,729.  The graphs still show linear increase in deaths, though hospital admissions due to Covid-19, particularly in London, have gone down.

It’s beautiful day and we enjoy a bike ride.  On a bicycle, particularly on roads, the distancing from everybody else is excellent – surely one of the best ways of exercising but keeping one’s distance?

Like many, particularly those who have experience in medicine and medical statistics, I have been thinking hard about the UK approach and I have come to the reluctant conclusion that bad logistics, and an incorrect scientific approach have done us a disservice.  The undoubted knowledge and the gravitas of Professor Chris Whitty and Sir Patrick Vallance have, I think, misled us in our thinking.  They are not entirely to blame, presumably the entire COBR committee  and/or the SAGE (Scientific Advisory Group for Emergencies) committee is culpable.  The Government are not to blame apart from their poor logistical response.  We now have a huge 4000 bed hospital – The Nightingale – in London without very many patients, and a dearth of other measures and strategies to control the outbreak.

We had a huge switch in emphasis when we stopped testing people outside hospital.  In any epidemic, identifying those carrying the virus – even if minimally symptomatic – is the key.  Failure to ramp up testing, and focussing on testing in hospital (when it’s fairly clear who are the Covid-19 patients) has meant that opportunities for ultra-strict quarantining and isolation have been lost.  PPE, irrespective of what type has been worn, seems to have been ineffective in preventing front-line staff from being infected.  There has been no real co-ordinated contact tracing and testing effort either.  Contact tracing has in the past been the cornerstone of detection, prevention, and in other diseases (I recognise there is none in this disease), treatment.  This approach worked well in controlling TB, and in preventing spread of STD (sexually transmitted diseases) and latterly, AIDS.  Even though there was no treatment available for AIDS for some years, the PPE was obvious and instantly procurable – the condom!  Failure to test and prevent in Covid-19 has been clearly evident in the case of patients discharged from hospital back to Care Homes without testing – and a rampant march of Covid-19 cases and death has been the result.

The august professors would no doubt point to the decline in admissions with Covid-19 as evidence that their strategy is working, but at the cost of somewhere north of 20,000 deaths (taking into account the excess mortality outside the hospitals), and no other policy than to ‘wait it out’.  Other countries with better approaches, following what I have outlined above, have seen far fewer deaths (South Korea and Germany – it has emerged today that China is probably concealing the true extent of the mortality there).

Friday 17^th April

Hard for any readers to accept this, but I made no entry today – so busy!  But the biggest change today was the weather.  For a few hours this morning we had drenching rain which is good of course for most things, and certainly must have reduced footfall outside.  The air has been cleared of the ghastly ‘yellow dust’ which residents of Poole and Bournemouth have to suffer at this time for year because of our predecessors’ strategy of planting pine trees throughout the area.  Then they promoted the idea of rest, sea air, and the scent of the pines as a panacea for all manner of things, not least tuberculosis, which is almost certainly the reason Robert Louis Stevenson came here.  When I spent a summer (1970!) working in upstate New York, at Saranac Lake, I discovered that poor RLS also spent time there – attracted by the famous TB sanatorium on the lake.

But RLS also came to mind too because the Film Club decided to watch the NT Live broadcast of Treasure Island.  This was so dire we had to discontinue watching it.  I thought things might turn bad when we were treated to some ‘on trend’ transgendering – both Jim Hawkins and Dr Livesey.  I couldn’t understand why Jim’s mother had turned into her ‘Old Granny’.  ‘Not so much of the old' was the rejoinder…  Oh dear.  I was forced to give the book an airing and show Lindsay the exquisite prose of the original.  We therefore returned to The Crown (Liz and Phil not getting on so well and Suez in the offing).  The film club had briefly met in the afternoon to watch ‘Those Magnificent Men in their Flying Machines.’  As Lindsay observed, the pictures that we thought wonderful in the past just don’t stand up to the test of time (for the most part).  It’s cheesy, stilted, predictable, and not very funny.  The best part is Ron Goodwin’s score.  We turned it off to turn over to the Government’s Covid briefing.  This was given by the calm and assured Alok Sharma, business secretary.  The mantra does get a bit predictable, ‘Stay home; protect the NHS; Save lives.’  But as I’ve indicated above, I think they are being wrongly advised.  Rigorous (and multiple if necessary) testing, contact tracing, complete isolation of both symptomatic and asymptomatic patients.  I will write more tomorrow.

Saturday April 18^th.

I am writing more, it is today, and a continuation of the above.  Slightly overcast, rain during the night queues round the block at Tesco’s and M&S when I walked up to Westbourne.  Delivered a newspaper to a ‘locked down’ friend.  Stood outside his window without him noticing while he played the Schubert A_b impromptu.  Lovely.  Only a few notes that escaped Schubert’s notice when he penned it in 1827.

There was a good discussion (for once) on TV news this morning.  A fairly distinguished academic GP from Oxford, Trisha Greenhalgh, spoke to the proposition that we should all be wearing masks.  Although the evidence is mixed, she had ultimately been swayed by the very impressive laser light imaging of droplets from sneezes and the distance they carry and felt they should be worn.  However, an equally impressive doctor from Scotland (who I think was Jason Leitch, National Clinical Director) pointed out that if symptomatic (e.g. coughing and sneezing) one should not be outside at all and the safest barrier to prevent infection was one’s own front door.  The evidence therefore indicates that staying home and washing one’s hands are the best preventive strategies.

There is an impressive paper from Hong Kong, showing how they responded early and firmly (sorry, Boris and the Team), and achieved far better control than we have.

See: nejm.org/doi/full/10.1056/NEJMc2009790.  If the link doesn’t work search Dr Gabriel Leung, ‘From a sprint to a marathon in Hong Kong.’

Another paper that is worth reading is ‘Not a Perfect Storm – Covid-19 and the Importance of Language’, by Allan Brandt and Alyssa Botelho published April 16^th in the New England Journal of Medicine.  They say:‘…many commentators have described this emerging pandemic as a “perfect storm” – a vastly overused characterization that evokes a sense of anomaly and unpredictability.’  ‘The repeated emergence of new zoonotic infections…  … underscores the reality that global epidemics should be expected and their harms anticipated.’  Need I say more?

Finally, before it passes into forgotten episodes, it’s worth documenting a very heavy thread that emerged the other day from Twitter.  Apparently, the Editor of the Economist alleged that Boris Johnson’s illness was much milder than reported, and that it had been a strategy to garner sympathy.  Understandably there was an avalanche of criticism, many writing to say they had cancelled their subscription to The Economist.

Sunday April 19^th

Weather good again.  Today’s review of Covid-19 deaths shows 596, down from the previous day of 888, but likely due to the weekend and fewer recorded deaths reaching the authorities.  Total in-hospital deaths now 16,060.  Lindsay has a school reunion by Zoom.  The most striking report is from her friend Lynne in Long Island, NY.  They are literally terrified.  Friends seem to be dying all around them.  They don’t go out.  They have everything delivered.  Even after delivery they leave everything on the porch for at least 24 hours to enhance virus dissolution.

There is much scientific discussion today, and interviews with a Professor of Vaccinology.  But there are at least 70 groups worldwide working on a vaccine for coronavirus.  There’s no good indication of who will win this race, and how implementation will happen.  Another topic deals with antibodies in recovered patients.  I have seen two diametrically opposed views.  One states that old people do not produce antibodies as well as young people.  Another seems to indicate that the reverse is the case – young recovered patients have low titres of anti-coronavirus antibody.  An immunologist suggests that this may be because young people produce virus-specific small lymphocyte killer cells rather than free antibodies.

Slight disappointment on the TV this morning where David Attenborough is being interviewed by Andrew Marr, when he refers to previous pandemics and says that the ‘Great Plague’ was caused by a virus.  (It is of course a bacterium, Pasteurella pestis, since reclassified as Yersinia pestis.)  David Attenborough is of course widely regarded as omniscient.

The film club reconvened, but one member seceded.  The event was the 25^th Anniversary celebration of Phantom of the Opera, recorded in 2011.  Lindsay didn’t watch it, having very special memories of having camped on the pavement in the West End to see Michael Crawford in the original cast.  I have never seen it; I usually avoid musicals, but it was terrific.  I read that the sinister organ riff was allegedly ripped off from a Pink Floyd number; not the first time that Sir A L Webber has been accused of plagiarism, though he has defended actions in the past successfully.  Anyway, it was great.

Walk on Parkstone Golf Course and another The Crown this evening.

Monday April 20^th

I’m struck when reading my first post how much like Edgar Allan Poe’s Masque of the Red Death we were.  We gaily went on our way, ignoring the warning signals, when suddenly, the Red Death was upon us.  Not so inappropriate a name for a plague originating from the People’s Republic of China.

The weather is back to a high pressure system, but with rather cold north-easterly winds.  Out of the wind it is pleasant enough to sunbathe in the garden.  The death toll is again reduced, 449 for the last day (total now 16,509).  Late last week daily mortality was in the 800s, but the last two days have been 569 and 449.  Possibly encouraging.  But there doesn’t seem to be any strategy other than ‘social distancing’.  Professor Richard Peto is one of the statisticians interviewed on the Today programme (much better than our TV, which as mentioned before, focuses on human interest stories, and of course in the time of Corona there are plenty of those).  Peto has a brain the size of a planet and is a highly original thinker.  Unfortunately the discussion is cut short, but he makes the point that a snapshot of testing is no good – multiple tests in the same people will be necessary.  He also points out that the situation is ideal for experimental sampling, focused perhaps on one town, to get real facts about the spread.

Otherwise, it’s a circular walk through Bournemouth Gardens and along the beach, and more of the Crown.

Finally, an excellent and funny article by Michael Hogan in the Telegraph asks ‘Parlez-vous corona?  Brush up your “lockdown lingo”…’  An example:

Quarantinis: Experimental cocktails mixed from whatever random items you have left in the house.  To be sipped at “locktail hour”, which gets earlier with each week.

I will try and slip some of these into future blogs…

Tuesday April 21^st

Can’t sleep.  Up at 0500 doing useful jobs.  Supergluing Lindsay’s magnetic disc back into a magnetic earring.  Playing guitar.  Writing blog.  Reading scary article in the Economist about how the 21^st Century is going to be China’s century and emphatically not Britain/USA.

The day sweeps past as others seem to – at record speed.  I’m successful in under-achieving in the under-achievements I want to tackle.  Another beautiful day.

Early evening, we drive a short distance north of here, then walk; down a lane we have discovered where the wild garlic grows – what is it Shakespeare says about ‘I know a bank where the wild thyme grows…’?  No ‘sweet-musk roses and with eglantine’ here.  What is eglantine?  But it is shady enough and moist enough for wild garlic to flourish.  We walk on to the Stour Valley path.  It is a lovely evening.  At a small weir a swan upends itself into the turbulent stream, while a little egret watches from a perch in a tree.  I have never seen an egret in a tree before.

H.M. The Queen is 94 today.  It passes without the usual gun salute.

Wednesday April 22^nd

Another beautiful day.  This weather seems something of a penance; a whimsical game that the Good Lord is playing with us to reward us for our hubris.  (I should acknowledge that I have very little to no confidence that any God is really taking an interest in us – whether Allah, Zoroaster, Jehovah, Jesus’ Dad, or any of the thousands of deities that seem to complicate Hinduism.  I refer you to Richard Dawkins).  In this I am obviously unlike Donald Trump’s new press secretary who is mentioned in dispatches this morning about Trump’s new blanket ban on immigration edict.  Having noted her name, Kayleigh McEnany, which seemed improbable enough [the only Kayleigh I know is Peter Kay’s colleague in ‘Car Share.’], I had to look her up.  An impressive CV, fabulous figure, blonde, young, similar looking sister, you know that All-American cheerleader style – she looks very much the Donald’s type.  On Twitter, she seems to be much given to many Christian messages of cheer, especially over Easter.  How can anybody that intelligent be persuaded of the merits of Jesus’ Dad over any one other of the numerous deities on offer?  Dawkins makes a plausible case for a correlation between intelligence and Atheism, but that might be taking it a bit far.)  To return to the weather.  I think I should precede every diary entry with just ‘ABD’ instead of another beautiful day.

Surprisingly, I have something in my diary for today.  Having lost a bit of filling from a tooth a few weeks ago and tried to get an emergency repair kit, unsuccessfully, my dentist meets me at 1pm in his car park and gives me the stuff.  Tricky putting it in yourself, especially into a lingual lower left seven cavity.  The other main activity in the morning is washing the garlic leaves in a large cold bath and then whizzing them round in a salad spinner.  The end result is an excellent pesto, with olive oil, pine nuts, and grated parmesan.

Evening finds us back walking in North Bournemouth, by the banks of the Stour.  Yesterday evening’s egret has now taken the place of the swan in the weir.

Depressing suggestions that social distancing could last a year come from the advisers in this evening’s briefing.  This brings on the feelings of the ‘Coronacoaster’ – ‘the ups and downs of your mood during the pandemic.  You’re loving lockdown one minute but suddenly weepy with anxiety the next.’

(Please note I am trying to utilise at least one element of Michael Hogan’s Lockdown Lingo article each day, and I may not specifically reference him in the future).

Last act of the evening.  The Crown (of course).  That slippery so-and-so HRH The Duke of Windsor and his Nazi sympathies.  I had never heard of the Marburg Files.

Thursday April 23^rd (St George’s Day)

ABD (Another Beautiful Day)

Wild garlic soup now available.  Still, fortunately for us, no ‘Miley’ or ‘Billy Ray’ (Cyrus = Virus).

I break out a bar of soap in the bathroom which is embossed with the name of a lovely hotel we stayed in in Oman.  People criticize the removal of such items from one’s hotel, but on this occasion it reinforces a wish to get back there as soon as possible (!) and is therefore highly successful advertising.  Part of me wonders whether we will ever get back there, or even abroad, ever again…  A sense of ennui and the mild depression which indicates that one’s life (of which there can’t be too much left), is slipping by.  It would be nice to jump on a boat, take a picnic around Poole Harbour to the back of Brownsea Island and sit in the sun with a glass of chilled white wine…

In the death notices yesterday was an entry of the passing of Professor Tom Prankerd.  He was my first chief in my first housejob at UCH, and highly influential to my career.  He had a distinguished career in Haematology, but was also a good physician, as many haematologists were in the distant past.  His original research, carried out in the 1950s, was on the role of the spleen in removing senescent red blood cells.  When I returned from working in the USA to start my clinical training, he allowed me to continue my research in his laboratory.  It concerned the phagocytosis (cells ‘eating’ objects or other cells) by monocytes isolated from peripheral blood, and the reasons this might occur.  Sadly, it was rapidly superseded by more sophisticated isolation techniques and I went back to studying clinical medicine.  It seemed inevitable that I should work for him as House Physician.  This was a traumatic job, looking after people, many very young, with leukaemias and lymphomas.  After a while, I was having nightmares, of a vague threatening kind – not necessarily involving my patients.  In addition, like most of us, I was ‘living in’ the medical staff residence, and living work every day and all day.  (Nowadays people would use the ghastly term – 24/7).  A school friend rang me and said that we should get out together and go to the theatre.  He had a brilliant idea: both of us had a crush on Judy Geeson, the actress.  ‘Let’s go and see her on stage; she’s in the new RSC production of Titus Andronicus’.  Great idea.  Neither of us knew anything about the play.  But T.A. is the bloodiest of Shakespeare’s plays, and there is doubt that he actually wrote all of it.  Judy played Lavinia, who was raped and had her limbs and tongue cut off in Act 1, and thereafter crawled around mumbling meaninglessly.  It was a relief to get back to leukaemias.  I see from my programme that a younger Patrick Stewart was in the production.  I also see from feminist analyses of the play that Lavinia is an ‘enduring presence, key to the play, and a reminder of woman as victim.’  On the other hand I believe that her presence is analogous to the ghost in Hamlet – a spur to revenge in a classic Jacobean revenge play.

Tom Prankerd was a very humane character, with a wide knowledge of medicine, and later became Dean of the medical school.  After I had finished my surgical job at Basingstoke District Hospital, I was for a while an SHO at the Royal Marsden Hospital, and went to see him back at UCH for some career advice.  I turned up near the end of his lymphoma clinic, and as the last patient left I went into his consulting room to find him looking drained and tired.  ‘Don’t go into the Cancer business, my boy,’ was the main advice I remember from that interview.  He, and a protégé of his, John Fletcher, who I worked for in Nottingham, were some of the last general physician haematologists.  After this, haematologists had no beds and no general medicine input, until the era of intensive leukaemia therapies and bone marrow transplantation.

Tom had an occasional wicked sense of humour.  During my second year I was desperately ill with glandular fever (‘mono’).  I spent a month in UCH as a patient, on the ward where I would eventually be HP.  Eventually, a secondary streptococcal throat infection was diagnosed and the intensely painful intramuscular benzylpenicillin injections were commenced.  Prior to this, and with an impressive high swinging fever visible on the chart at the end of the bed, Tom Prankerd and his huge entourage of ward round attendees stopped briefly at the end of my bed.  ‘What’s the matter, Andy?’ he asked in his slightly high-pitched voice.  As I croaked out what my diagnosis was, he said loudly; ‘Oh, is that all?  Looked like G.C. to me old boy!’  (G.C. is polite medical terminology for gonococcus, the cause of gonorrhoea).  Once, during a ward round, he asked me to check the optic fundus of a patient.  I was good at fundoscopy – all medical students at that time were required to buy an ophthalmoscope and to use it on every patient.  Those days are gone now.  He became impatient; I think he wanted to know if there were retinal haemorrhages in a patient with a very low platelet count.  ‘Hurry up, Andy, you’re wobbling about all over the place.’  ‘No sir’, I replied.  'I am constant as the northern star, of whose true-fixed and resting quality there is no fellow in the firmament.’  ‘Bloody Hell!’  Came the reply; ‘This boy knows his Shakespeare.’  I became the 'Shakespeare Wallah', and was asked frequently thereafter whether the bard would have had anything to say in this circumstance.  I couldn’t let him know that Julius Caesar had been my ‘O’ level play, and that I more or less knew it by heart – but that was the only one I knew, apart possibly from Hamlet which was the school play a little later on.  I wish I had been the famous surgeon who produced what was probably the most apposite and witty Shakespearean quotation in the history of medicine: stopping to inspect a patient whose circumcision had been not that expertly carried out by the registrar the day before, he observed: ‘There is a destiny that shapes our ends, rough-hew them how we will.’

Tragedy struck in Tom Prankerd’s later life when two of his children, visiting their brother in Rhodesia, were killed by bandits who stole their car.  Many years later I got to know him again in his retirement in Milton Abbas, Dorset, and he was briefly a patient of mine with a cardiac issue before he moved to Stinsford and I transferred his care to the new cardiologist in Dorchester.  So, it is with sadness and respect that I remember him…

Friday 24^th April

ABD.

We walked on the sea front promenade last night.  I feel twitchy about this because there are too many people for my liking.  Bicycles whizz past with no warning.  One idiot came right between Lindsay and I, brushing our sleeves.  In addition there are lots of ‘coronarunners’, passing close by, breathing so heavily that the extra oomph in their exhalations could propel an unfriendly virus much further than if they were gently walking.  These people and the cyclists are now known as ‘Space Invaders.’

Today a bicycle ride up through north Bournemouth to the Stour Valley way and along the trails to Throop, Holdenhurst, Christchurch, and Hengistbury Head.  I will leave you with some images of England in springtime.  One in particular is poignant – the Priory at Christchurch, which has been standing for over 900 years.  What events have passed since it was built?  It has seen everything.

Passing over the footbridge with the ‘Welcome to Bournemouth’ sign over it, I’m struck by how many cars are racing into Bournemouth at 1.20pm on a Friday afternoon.  Seems like the traffic figures from the Government will take a jump.

Deaths from Covid-19 are slightly up compared to yesterday, but prior to that they had fallen for three days in a row.  'Confirmed cases' remains a flattened curve, and 'daily cases' has shown a substantial drop.  It looks like peak daily death rate was reached on April 10^th.  On CNN this morning, a US medical epidemiologist was lamenting how the USA had missed the boat at a time when case diagnosis, strict quarantine, testing and contact tracing had been possible, the United States, much like Britain, had been dozing, or in the words of some commentators ‘Sleepwalking into a Crisis.’  As the epidemiologist said, 'We are now left with the extremely blunt instrument of shutdown and social distancing.'

Only possible bright news on the horizon is that socially-distanced sports, like angling, golf, and bowls (lawn bowls for the US readers), might be ‘unlocked’ first.

Before the images, there is an interesting paper published online today in the New England Journal of Medicine.  The accompanying editorial will give you all the information you need to know:

Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19, by Monica Gandhi, Deborah Okoe, and Diane Havlir.

They analyse why Covid-19 (SARS-CoV-2) has been such a successful pathogen, infecting approximately 2.6 million people, whereas the original SARS in 2003, was limited to about 8000 cases.  The reason lies in the RNA virus multiplication and shedding, which in the current outbreak is from the upper respiratory tract, and in  SARS-CoV-1 was in the lower respiratory tract, and therefore much less amenable to being coughed or sneezed out into the atmosphere and onto other people.  Testing of asymptomatic personnel is therefore essential to prevent spread – AND WE ARE NOT DOING THIS!

Here’s to a better April 25^th et seq.

Christchurch Priory - 900 years old and still going strong

Beach Huts at Hengistbury Head

The English springtime - wisteria at Wick Village

"Just now the lilac is in bloom, all before my little room"

Late evening looking towards Old Harry Rocks

Old Harry

Corona Diary Part 4: Saturday April 11th to Wednesday April 15th

Easter Saturday, April 11^th

If only we could have February’s weather back again – at least for a short while.  It remains beautiful.  Extraordinary how Parkinson’s Law of Social Distancing operates – the day seems to vanish before us and before we know it the time has marched around to 5.30pm and it is time for our walk.  We might be getting fitter; in what seems like no time at all we cover four and a half miles.  By the time we reach the beach it is fortunately quiet.  One of our lovely cardiac nurses from Royal Bournemouth CIU jogs past and we exchange a few (socially distanced) words.  Good to see that the team is looking well and seemingly standing up to the present crisis.  There are still a few idiots around who obviously don’t think it matters if their dog runs right up to you, especially as they have one of those pelota-like ball hurlers with a dog saliva covered ball in evidence.

We walk back up Alum Chine, and do something I have intended to for years, but never have – visited the site of Skerryvore, the tiny miniature garden in Westbourne on the site of Robert Louis Stevenson’s house, where he lived from 1885-1887.  It was while he was here that he wrote Kidnapped and The Strange Case of Dr Jekyll and Mister Hyde.  The house was destroyed during a German bombing raid in 1940, and all that remains this evening is a rather overgrown plot (opened as a garden by Bournemouth Council in 1957) with some nodding white harebells, while a woman of middle European appearance talks animatedly into a mobile phone and a bored looking little girl scratches a stick in the dirt.  In another part of the garden a middle aged jogger with a 1960s hippy hair-do and a headband does some stretching exercises.  And so to home.  Another episode of The Crown, and at last, Queen Elizabeth is crowned.  The Duke and Duchess of Windsor watch on a tiny TV screen while throwing a party in Paris.  Alex Jennings, who looks uncannily like the Duke, has some marvellous lines.  The acting is generally excellent.

The previous evening, we did indeed return to ‘Jane Eyre’ and this production left me with the feeling that it was three hours of my life I would never get back.  ‘Reader, read the book.’  (Sorry, wrong author).

Sunday, Easter Day, April 12^th

‘What is this Life, if, full of care

We have no time to stand and stare?’

Except that we are not supposed to ‘stand and stare’, but to carry on walking.

But as a child, growing up, at least in part, in Wales, W.H.Davies was dinned into us as a Folk Super Hero, an itinerant who celebrated the beauties of nature.  We had to learn that poem by heart in school in Fishguard.  Friends post pictures of bluebell woods (they do live in the country and claim that they are on the regular walking route).  It induces a faint sense of envy however.

I did return to Burma ‘44 and am now more than half-way through it.  It is certainly a superb historical document, though still somewhat dry.  I am just about to read about the ‘Battle of the Admin Box’, an action which I had never heard of until a few weeks ago, but in which a friend’s father was involved.  He has mentioned that his father’s experiences in this theatre resulted in nightmares to the end of his life.  Nowadays we knowingly refer to this as ‘Post Traumatic Stress Disorder’, PTSD, but it remains the same wherever you are.  PTSD will undoubtedly be a significant problem among healthcare personnel after the coronavirus outbreak is over.  With regard to Burma, I do wish that the book we are reading is the superb ‘Quartered Safe Out Here’, by George MacDonald Fraser, author of the Flashman novels.  I read this soon after it came out in 1993.  It’s immensely readable, much like Spike Milligan’s wartime series of autobiography, and tells of Fraser’s experiences as a 19-year-old private in the Border Regiment in Burma 1944-45.  The title is of course ironic, and a reference to the 1890 poem ‘Gunga Din’ by Rudyard Kipling, which in this post-colonial era we are really not allowed to mention, let alone read.

Our exercise today was a bicycle ride.  During this we passed the superb statue outside the RNLI depicting the lifeboatman saving a seaman.  On to Poole Quay, where the superyacht ‘Here Comes the Sun’ is currently moored and mothballed.  This 83m yacht is truly extraordinary.  The given name of the owner would suggest that he is Russian, but presumably not resident on the yacht!  More yachts for mothballing are expected later.

More of The Crown this evening.  Poor Princess Margaret and her romance with Group Captain Peter Townsend were the main subjects…

Easter Monday, April 13^th

A bright, mostly sunny day, but now with the promised very chill northerly wind.  A jigsaw preoccupies me for far too long, but there is time for reading as well.  Also time to look at the possibilities of therapy for SARS-CoV-2.  Most experts think a vaccine is a very long way away.  The NEJM (New England Journal of Medicine) publishes an article about the compassionate use of a new drug, remdesivir, in seriously ill patients with Covid pneumonitis.  In an uncontrolled trial it appears to be beneficial.  The drug is an RNA polymerase dependent adenosine nucleotide analogue.  In other words it mimics one of the bases inserted into the nucleic acid chain of RNA, and seems to result in premature termination of the RNA synthesis in viral infected cells.  It was first developed by Gilead Sciences in California as a likely agent for treatment of Ebola and Marburg virus infections.  Reading the history of Gilead Sciences certainly gives one the impression of a Tech Company with an impressive list of meaningful contributors, including Nobel laureates.  Production is limited, and the company have announced that it will now only be available for use in a controlled trial.

Also interesting over the weekend has been the finding that patients with Covid-19 pneumonitis tolerate much lower oxygen saturations than was thought safe previously.  One intensivist likens it to measuring blood saturations in otherwise healthy people at altitude.  We know that carbon dioxide is an extremely small and very diffusible molecule, and that in subjects without airways obstruction elimination of carbon dioxide is rarely a problem.  So with Covid-19 patients, the CO₂ elimination appears to happen without any retention, and hypoxaemia is the main concern.  As such it would seem that the key factor in treatment is increasing the supply of oxygen, and invasive ventilation should be the last resort.  In 2007, when visiting the Nepal Himalaya, I met an American doctor who was walking with his children.  He had been concerned about the susceptibility of children to altitude sickness and had brought his own personal saturation monitor.  At about 3800m he recorded their saturations (and his own) at 83%.  Normal is 98 to 99% at sea level.  All were asymptomatic.

A colleague who I spoke to today told me that they have learned that the most important people to give the masks to are the patients!  Seems self-evident but turns out to be important to reduce infectivity.

An incessant inbox of WhatsApp jokes, videos, and cartoons seems to be without end.  Some are funny, but not all.

Another episode of The Crown.  Winston Churchill’s stroke.  Preceded by a little escapism – the film of Paddington – surprisingly good.  Cuddly and comforting for the Covid season!  The film club seems to have been temporarily disbanded, and Lindsay and I often pursue our own watching preferences.  Lindsay has started in on the new Julian Fellowes series, ‘Belgravia’.  Victoria Coren-Mitchell, writing in the Telegraph recommends ‘Gentleman Jack’ which she says is ‘Like Belgravia, but with more lesbian sex scenes.’

Tuesday April 14^th

Another sunny day, but chill.  Same northerly cold wind.  The main topic on the news this morning is Care Homes.  The newshounds are keen to say they are ‘being airbrushed from the figures.’  An alert young man from the ONS (Office of National Statistics) is interviewed by Victoria Derbyshire, who is unused to having so much maths thrown at her first thing in the morning.  We do not know for sure whether deaths in Care Homes are due to Covid-19; this is unsurprising.  As some will know, when filling out a death certificate, there is a section 1a – Cause of Death.  Then Section 1b – ‘Other disease or condition, if any, leading to 1a.  There is a section 2 – Other significant conditions CONTRIBUTING TO THE DEATH but not related to the disease or condition causing it.  According to Nick of ONS, 21% of care home deaths mentioned Covid-19, though he did not say whether this was in 1b or 2.  In London this figure is nearer 50%.  He stated that the observed versus expected death rate in Care Homes was around 50% higher than normal, in the week up to April 3^rd (there is a lag in reporting and validation of deaths in Care Homes).

So, the media are now in a feeding frenzy of conspiracy fever.  ‘Many more people are dying from Coronavirus than the Government would have us believe’ is the general proposition.  In fairness, neither the Chief Medical Officer, nor the Chief Scientific Officer have sought to gloss over these figures.  Sir Patrick Vallance repeatedly points out in his briefings that deaths in hospital, validated, and in Covid-19 proven cases, is the statistic that the COBRA team is relying on to establish whether current social distancing measures are working.  Reporters should be very wary in relying on death certification.  Investigation after investigation has shown that the cause of death is inaccurate in up to 50% of cases; at least up until the present Coronavirus era.  Let me give you an example – and I need to be careful here because of possible identification.  A medical colleague was known to have bilateral carotid artery stenoses (narrowings).  During his normal medical practice, a patient left his consulting room.  He did not appear to call in the next patient.  After a short while the receptionist went to his room to find him stone dead.  His colleagues certified the death as due to ‘Stroke’.  We know (from the Framingham study in Massachusetts) that the most frequent cause of death in subjects with bilateral carotid stenoses is myocardial infarction (heart attack), because ‘furring up’ in one vessel predicts furring up (atheroma) in other vessels.  Death in this instance is commonly instantaneous – as in the case I have described.  Any doctor or nurse who has had the misfortune to observe death in stroke will immediately recognise that what was described above is not the mode of exitus in such patients.

A digression:  Professor Keith Simpson, forensic pathologist, used to lecture to us at UCH.  He was a superb lecturer.  Forensic pathology lectures were, of course, packed.  His lectures and indeed some of his slides, could not be given now, even to medical students; political correctness being one reason.  His lectures were often filled with spooky dramatic effects, where he would drop his voice to a low hushed tone.  One such case involved a not particularly able country GP, who was widely recognised to be such.  A female patient, in her fifties, was fit and apparently well, though known to have mild rheumatic valvular heart disease.  She died suddenly.  After some thought, the GP consulted a textbook to see if he could find a plausible cause of death, and wrote on the death certificate ‘Cause of Death – 1a Heart Failure, due to 1b Ball-valve thrombosis of mitral valve.’  As many will know, this event, where a significant sized clot forms in the left atrium behind a diseased mitral valve, is an incredibly rare cause of death, even in known rheumatic heart disease.  At this point, Simpson dropped his voice: ‘After a few weeks, there was talk in the village.  Her relatives had a business which was said to be in financial difficulties.  The death was regarded by many as “too convenient.”  Eventually, after various representations had been made to the police, permission was given to exhume the body to perform a post mortem examination.  Most exhumations take place at night, to avoid upset, especially in a small community.  “It was a cold wintry night.  I wore my gum-boots.  If you are going to be a forensic pathologist you must always invest in a good pair of gum-boots.  Together we trooped down the little lane which led to the churchyard.  Under a tent, we identified the plot and retrieved the coffin (here a slide of the lid of the coffin with the inscription on a brass plate).  I returned to the local hospital mortuary, where I opened the chest and examined the heart.  (Voice even lower).  What do you think I found?  (Slide).  A ball-valve thrombus obstructing the mitral valve leading to almost instantaneous death from acute heart failure!”  Great story.  The recounting doesn’t do the tension or the theatrics of it justice.  When one looks at Keith Simpson’s entry on Wikipedia, it seems surprising that he was never knighted.  He must have offended someone…

I apologise for medical navel gazing – but a few of my readers have said they are interested in the scientific parts.

Total deaths in UK announced today (data from April 13) is 11,329, but daily new cases and daily new deaths have reduced in the last few days.  We will need to be sure that this is not a reporting quirk caused by the Easter weekend.

Wednesday April 15^th

Another beautiful bright and sunny day.  Priorities go like this:

1.  Check the news
2.  Make Lindsay a cup of tea and self a small glass of orange juice
3.  Get up.  Have a light breakfast.  Make coffee in an Italian Moka pot.
4.  Desperately try to find a better news programme than the BBC.  You probably want some justification for that statement.  How long have you got?  (A long time, Ed.)  Try CNN for a while which at least mentions other countries in the world for a time.  Give up.
5.  Finish a fiendish jigsaw.  Probably not so bad as the one I bought when we visited the Pollock-Krasner house on Long Island a few years ago – Pollock’s ‘Convergence.’  This is next on the jigsaw list.  Still, we should have time…
6.  Guitar practice.  In our moves within the last year my guitar footstool went missing.  I have found that the combination of the hardback of Stephen Fry’s Heroes (477 pages), Earthly Powers by Anthony Burgess (649 pages), Shantaram (paperback by Gregory David Roberts, 933 pages) brings the foot support to the required height.  I am working on the Bach 1^st Cello Suite Prelude – not bad, but then I learned it in my 20s; and have picked up again Sylvius Leopold Weiss’s Passacaglia; not so good.  But beautiful.  I suggest searching YouTube and listening to Julian Bream playing it.  So fluent.
7.  Virtual coffee morning with friends and neighbours.
8.  Ring Care Home where my father-in-law spent the last three and a half years of his life to enquire how they are getting on.  Of course we can’t visit them at the moment, but they do feel like family after all that time.

For some reason, the BBC prefers to take the easy option of ‘Talking Heads’ where interviewees can give their perspective on how they have been ‘forgotten’, or ‘airbrushed from the statistics.’  Some of these cases are indeed very sad, and appropriate tribute must be paid to someone who reads a letter of love and farewell to someone dying alone in a Care Home, but for example, the Beeb spent about 10 seconds on President Trump’s decision to withhold funding from WHO (which is almost certainly partly a wish on his part to deflect blame from himself), and then reverted to the talking heads style of interviews.  What we would really want is a few minutes of thoughtful and considered analysis of what WHO is, how much its budget is, how it spends its funds, and what its role in the current pandemic is – and whether it has fulfilled that role appropriately.  Perhaps someone will think to investigate this in time…

I’ve reached the page in Burma ’44 which deals with my friend’s father’s part in the battle of the Admin Box.  As the British 25^th Dragoons in three US-made tanks (superior anti-tank armour) advanced across open paddy, two were hit badly and freakishly, resulting in fire and death.  My friend’s father helped to pull survivors out of the burning wrecks.  Strange to think that had it been his tank which had been hit, we would not know the family at all – they would not exist.  (Pages 240 and 241 if you are interested).

Another friend has sent some ‘funnies’ to look at, many of course unfunny, but surprisingly two of the most interesting and apposite quotes I’ve seen for some time*:

*But see below.

F Scott Fitzgerald, in a letter to a friend in 1920, while quarantined in the South of France during the ‘Spanish Influenza’ outbreak:

‘Dearest Rosemary,

It was a limpid dreary day, hung as in a basket from a single dull star.  I thank you for your letter.  Outside, I perceive what may be a collection of fallen leaves tussling against a trash can.  It rings like jazz to my ears.  The streets are that empty.  It seems as though the bulk of the city has retreated to their quarters, rightfully so.  At this time, it seems very poignant to avoid all public spaces.  Even the bars, as I told Hemingway, but to that he punched me in the stomach, to which I asked if he had washed his hands.  He hadn’t.  He is much the denier, that one.  Why, he considers the virus to be just influenza.  I’m curious of his sources.

The officials have alerted us to ensure we have a month’s worth of necessities.  Zelda and I have stocked up on red wine, whiskey, rum, vermouth, absinthe, white wine, sherry, gin and lord, if we need it, brandy.

Please pray for us.’

And:

Samuel Pepys’ Diary, London, 1664:

“On hearing ill rumour that Londoners may soon be urged into their lodgings by Her Majesty’s men, I looked upon the street to see a gaggle of striplings making fair merry, and no doubt spreading the plague well about.  Not a care had these rogues for the health of their elders!”

EXCEPT THAT THIS IS NOT BY SAMUEL PEPYS!  THERE IS AT LEAST ONE CLUE IN THE TEXT – CAN YOU SPOT IT?

It rings true though!

And, sadly, the Scott Fitzgerald is also fake, though the author, Nick Farriella, clearly stated this:

https://www.mcsweeneys.net/articles/this-side-of-paradise-a-letter-from-f-scott-fitzgerald-quarantined-in-the-south-of-france

I speak to a friend who runs a Care Home, which is part of a large national network.  She says that they have no Covid-19 cases, that the ‘Network’ have been fantastic, but she doubts that without the clout of a big organisation they could have achieved the PPE needed for their staff.  She feels very sorry for the staff of small privately run institutions.  The Government and Local Authority response to them, for example, extended to one box of gloves.  We agreed that the Government’s will and intention is not in doubt, but that the logistics are terrible.  A number of their staff are self-isolating, and testing will be helpful to get them back to work in due course.  Parenthetically, she states that she will be boycotting Tesco’s henceforth.  Despite providing badges for all staff indicating they are care workers, Tesco has refused to honour these and therefore they cannot shop during the protected hour.  Sainsbury’s and Waitrose have been sympathetic and have supported them.

And surprisingly, the morning has gone.  Time for some family Facetime or Whatsapp time…

I note that the lengths of each section of this Corona Diary are relatively similar.  This one is a little shorter than the others, so one final observation: a few weeks ago, I remember seeing one entry only of a Covid-19 related death in the Daily Telegraph Obituary column (the big one, not the death notices).  Now it seems they come thick and fast.  The latest and for many one of the saddest is that of Tim Brooke-Taylor, gentle humourist, who has been part of our lives for so many years.  It was only in January of this year that Lindsay and I attended the recording here in Poole of the hugely funny radio show ‘I’m sorry I haven’t a clue,’ when Tim was on excellent form.

Let me leave you with some pictures taken on our (allowed) daily exercise walking down Bournemouth Gardens.

And the latest completed jigsaw!  Poole Quay in the 1950s:

Corona Diary Part 3: Wednesday April 1st to Friday April 10th

Wednesday April 1^st

Lindsay’s birthday today.  Bright and sunny again.  Nati has thought to have a patisserie delivery from Mark Bennett.  What a good idea.  Long Facetime with various family members and my Aunt, aged >90 rings from Cambridge with good wishes.

To take up where the Stop Press finished last time.  Lindsay’s cousin lives in Lancaster, Pennsylvania, USA.  He’s in touch with birthday good wishes.  He tells us that we might be pleased to know that liquor stores are closed, but gun shops are regarded as ‘essential businesses’ and they remain open.  Confirmation comes from family members returning to Canada, driving through West Virginia, who find it difficult to find a food store open, but find plenty of outlets for guns and ammo doing a roaring trade.  Presumably one has to defend one’s stash of toilet rolls somehow.  Scary footage is seen on the UK news of US paramilitary militias, training in secret, in case there is a ‘breakdown in law and order.’

The film club watched ‘Made in Dagenham’ last night (released 2010).  It tells the story of the 1968 women machinists’ strike at the Ford factory.  Hard to comprehend that at that time Ford UK employed 55,000 men on the Dagenham site, and only 187 women.  An excellent film.  Sally Hawkins is superb as the machinist plucked from the factory floor to represent the women.  The late Bob Hoskins is also very good as the Trades Union representative.  I loved his exchange with the trades union bosses:

Union Boss:  As a union we have to remember who comes first.  The Communist Party.  And Marx himself said “Men write their own history.”  That’s “men”, Albert.

Albert (Bob Hoskins):  But didn’t he also say “Progress can be measured by the social position of the female sex.”?  Or was that a different Marx?  That was Groucho, was it?

Thursday April 2^nd

A rather grey day.  The mother of a friend of ours died last week.  At 0930 she will be cremated with no-one in attendance.  Lindsay walks down to Bournemouth gardens at 0920 to think about her.

Substantial increase in UK cases and deaths yesterday – deaths jumped by 563 to 2352 and total cases reached 29,474.

And now, something of a confession:

In nursing homes up and down the country, hundreds, no thousands of elderly people sit, gently nodding in easy chairs.  Some of these are mentally alert, interested in day to day affairs, reading, interacting with relatives.  Many of them are empty shells, no longer interested in anything, propped in front of televisions which hawk the usual daytime trash, and awaiting the next meal of slop and the subsequent assistance with toileting.  Unlike our treatment of animals, we have no known ethical way to allow these poor folk to exit the world with dignity.  I’m sure many of us have heard the confused screams of pain from some of these poor people as they are turned in bed, or helped off commodes, the muscle and fat which once insulated them from bony discomfort having long since disappeared.  When we first heard the news from China about coronavirus, it seemed clear that only the oldest and most fragile victims were dying.  Did you – for a moment – have that Machiavellian thought that for once a natural illness, one of the ‘thousand natural shocks that flesh is heir to’ might not be doing a disservice to many of these husks of humankind?  I know that I did.  But as time has gone on, it has become clear that despite the statistical data predicting a higher death rate in the elderly, the Covid-19, or SARS CoV-2 to give it the new correct title, does not discriminate particularly in whom it kills.  Yesterday we heard of a 16 year old girl in the UK who died, and this morning it’s reported that a 3 month old baby in the US has died.

To digress into science.  Death in Covid-19 is due to respiratory failure secondary to massive macrophage infiltration (macrophages are cells which mobilise in the immune response, produce active compounds to cause inflammation, and ingest foreign material) into the lung alveoli (small air spaces).  This is apparently driven by a cytokine – Interleukin 6.  It’s interesting that oestrogen is a natural inhibitor of IL-6, which may explain the much lower rate of severe illness in women.  Antibodies to IL-6 have been produced in an attempt to treat many inflammatory conditions, but it is unclear whether they may play a role in Covid-19 therapy.  It is of course a truism that we have never found a cure for the common cold, and many common colds are caused by coronaviruses.  Perhaps a by-product of the pandemic will be a treatment for the common cold.

In the news this morning – a plane load of supplies including protective equipment arrives from Russia into the USA this morning.  What a coup for Putin.  US physicians lament the same issues as the UK again; not enough PPE; not enough ventilators; not enough testing.  The UK government, rightly it would seem today, is being criticised for not getting up to speed with testing.  This has been a major Achilles heel of the UK’s preparedness, or indeed lack of preparedness, or organisational skills in this crisis.  News has emerged of a pandemic review some three years ago called Exercise Cygnus which we failed dramatically, and which was hushed up.  The exercise took place in 2016 and the final report in 2017 was apparently too apocalyptic for the Government and NHS England to contemplate, so its findings were never published.  In this modelling, the same issues were identified as we are seeing now.  The virus example in Cygnus was an influenza virus – considered to be H2N2 – with the same complications – illness occurring in frontline staff, inadequate beds, inadequate ventilation facilities, inadequate mortuary storage.  It’s thought by some that the previous dire predictions for Swine Flu in 2009 came to naught, and therefore it was assumed that Cygnus was an overreaction to something we could deal with.  The truth will undoubtedly come out eventually.

In the meantime Sweden continues to be the most relaxed country in the world as regards social distancing.  Only in the last few days has gatherings of over 50 persons been banned.  There is opposition to this policy among some scientists.  A Swedish sociologist however points out that Swedes are used to social distancing – it’s their normal behaviour.  In addition, the country has the largest proportion of single people living alone in the world.  Rarely do they make physical contact when greeting one another, unlike many Southern European countries.  There are signs however that all this may change as the death rate increases.

April 1^st has come and gone, with some good April Fool’s stories.  A friend posts a picture of a huge gathering – the strapline is ‘March to Stop the Spread.’  The same friend posts spoof pictures of the General Medical Council registration certificates for various retired doctors whom we know.  Great laugh!  Only a few hours later does one of them bother to check and finds that it is actually true.  Without asking the GMC has just restored him to the register…

Friday April 3^rd

The film club watched the free transmission last night of the National Theatre’s production of ‘One Man, Two Guv’nors’, their reworking of the Carlo Goldoni play ‘The Servant of Two Masters’, a farce written in Italian in 1745.  Although it is nearly 10 years since we saw it, it is very very funny, with a substantial amount of clever slapstick humour.

Later in the day, an e mail arrives for me from the GMC.  In the second wave of restorations to the register I am now reinstated as a consultant cardiologist and physician.  Whether they will need me remains to be seen.  Late evening walk on Talbot Heath, which is fairly quiet, fortunately.

Saturday April 4^th

Another sunny day.  For our exercise today Lindsay and I take to the smallest roads we can find to do about 16 miles of cycling.  There is not much else to report.  Cases and deaths continue to accumulate – 4,313 confirmed in-hospital cases of Covid-19 have died, an increase of 708 on the Friday figure.  These should be taken in context with the total number of confirmed cases being put at 41,903.  This suggests that the in-hospital mortality is around 10%.  Not quite Ebola severity (15 to 90%; average 50%) but bad enough.  Ebola is in the news too.  In the 2014 outbreak, a successful vaccine was developed and some experimental drug treatments were at least partially successful.  Naturally, with the cessation of the outbreak, the firms working on these projects mothballed them because of the lack of any likelihood of commercial return.  Now they are back in development and trial.

There is good news this weekend of the turnaround in production of ventilators and CPAP machines.  Many engineering companies are helping to produce these in double quick time.  Even Burberry have turned their resources from fashion clothing to making hospital gowns.  Lindsay hopes that they will at least have a little of the tell-tale check pattern on the garments.  Less good news is that Premier League Footballers seem reluctant to take much of a pay cut.  99% of the population finds this hard to swallow – after all they aren’t even playing any football!

A sobering note arrives today.  My consultant at Royal Bournemouth Hospital writes to tell me that I am at high risk if I should acquire Covid-19 (presumably due to my IgM paraprotein) and I should practise social isolation.  I still hope that I should be able to contribute medically, even if only by teleconferencing.  Another pseudo-Machiavellian thought intrudes.  Since I am 72, and have by and large had a very rich and enjoyable life, shouldn’t it be me and others like me who become the cannon fodder on the front line?  A more practical response comes from another part of the brain (!) – at age 72, if you become ill you are far more likely to need ventilation and a prolonged hospital stay and will put extra strain on the NHS and your colleagues.  A further thought – what if they triage me to ‘no escalation of therapy.’?!

Enough for Saturday night.  Apart from more fatuous and frankly insulting remarks from Donald Trump.  He has stopped the company 3M from making masks and protective equipment for Canada and for South America.  He has also diverted 200,000 masks intended for Germany, and has threatened to invoke the Defense Production Act, first used during the Korean War, which is intended to force companies to work for the US Government.  I’ve mentioned Trump at length before.  Every day seems to bring some new action which inspires incredulity.  Interestingly though, a photograph of a Chinese hospital worker wearing a mask clearly stamped with 3M leads to the discovery that up until now, much of the 3M protective equipment has been made in China.  I wonder if President Trump will repatriate that and MAGA (Make America Great Again).  Or should that be ‘Make America Grate Again’?

Sunday April 5th

Sunday is of course now hard to distinguish from the other days of the week.  Our main exercise today is taken in the late evening – a walk around all 18 holes of Parkstone Golf Club.  Total distance 3.9 miles; time 1hr 11min (quite pleased with that).  Lindsay is disbelieving; ‘But when I’ve seen your Strava after a round of golf it’s 6 or 7 miles.’  Hmm, er, there’s a reason for that…

We are back in time for the Queen’s speech to the nation at 8pm.  This happens extremely rarely, and is widely seen as inspirational.  It’s sad (personal view) that the press are aware of what she is going to say days beforehand and we have already been told much of the content of her speech, thus diluting its impact.

In other stories, there is extraordinary coverage and footage of some completely moronic individuals who have attacked and set on fire a 5G telephony mast.  Apparently there has been some bizarre rumour circulating on Facebook or Twitter that these are somehow responsible for Coronavirus.  Amanda Holden, a TV person known for her beauty rather than her brain has given some credence to this by retweeting a petition against 5G masts.  She hurriedly withdraws it.  More importantly, Boris Johnson, the Prime Minister, has clearly not recovered from Covid-19, is still pyrexial after 10 days, and is admitted to hospital.  Somewhat worrying.

The film club decided to revert to box sets this evening and watch the first episode of ‘The Crown’.  Good stuff.  George VI is shown smoking at every opportunity.  Two interesting facts not mentioned in the episode:  George first acquired the cigarette habit as a naval cadet at Dartmouth and clearly suffered from stomach ulcers even in his teens.  Most of the Royal family prior to the present generation died from the effects of smoking.  Contrast the lifelines of two sisters – Elizabeth (non-smoker) and Margaret (heavy smoker).  Secondly, a famous part of medical folklore took place in a room in Buckingham Palace (specially converted into an operating theatre), where the surgeon, Sir Clement Price Thomas, having performed a pneumonectomy, turned to his assistant and said; ‘Sew up the chest.’  ‘But Sir, it is the King.’ came the reply.  Whereupon ‘Clem’ turned to him and said; ‘I haven’t closed a chest for the last 25 years and I’m not going to start practising on the King.’

Monday April 6^th

Apart from Mr Johnson’s admission to hospital, the main news today concerns the Scottish Chief Medical Officer, Dr Catherine Calderwood, who has resigned from her post after being found twice to have disobeyed her own injunctions to ‘Stay Home’.  She visited her second home two weekends in a row, and was spoken to by the police about her unnecessary travel.  She is 51 and her bio states that she is a gynaecologist.  This leads me to muse on how it is doctors manage to get into such influential posts, when most of us are content to try to be the best doctors in our field.  In some instances, it is flagrant disregard of the posts they were appointed to – spending time on committees and vital meetings in the hierarchy of medicine.  Or doing distinguished research and then absenting oneself from the lab to talk about the results all around the world.  One wag once asked whether the collective noun for academics should be ‘an Absence of Professors.’

There has been some rain in the night but it remains rather a lovely day.

When one considers how rapidly this Covid-19 has spread around the world, I spare a thought for somebody whom I never met, but was nonetheless hugely influential in medicine (unlike some lady gynaecologists in Scotland).  This was Professor Brian Maegraith, Tropical Medicine Specialist, and for many years head of the medical school in Liverpool.  He it was who first drew attention to what he called the ‘Great Vector of Tropical Disease’ – his first lecture slide after this announcement was a picture of a B747 aircraft.  Now the long haul jet is the vector of the most serious illness to affect us in the modern age.  Not only can the carrier of a disease be on the other side of the world in less than a day, but as Maegraith pointed out, it can bring the non-human vectors of disease too.  For some years, there was puzzlement at the number of deaths from malaria which occurred in Paris – in people who had never been abroad.  Then it was realised that all of these deaths occurred within a few miles of Orly airport.  The anopheles mosquito, dispersed from the aeroplane, travelled a short distance before biting its nearest victim.  Nowadays, relevant flights ask you to cover your eyes before they spray insecticide after the doors are closed.  But there is no magic insecticide to kill the infections that humans carry within themselves, such as SARS Cov-2, to give the Corona virus its proper name.   Professor Maegraith wrote a seminal paper, published in the Lancet in 1963, entitled ‘Unde Venis.’  The translation from the Latin is ‘Where have you come from?’  This not only illustrates the nub of tropical medical diagnostics in two words, it also shows us that Prof Maegraith was a highly educated man who had read the Satires of Juvenal in the original Latin.

And this evening, after the second episode of the Crown, news comes that Boris Johnson has been admitted to St Thomas’ ITU.

Total UK deaths from Covid-19 - 5,373, increase from previous day 439.  This is the third day in a row that the number of deaths has been lower than the previous day (but just a quirk – see below).

Tuesday April 7^th

I saw a death notice in the paper yesterday of somebody I only met a few times, who had died aged 81.  He was the son of a man who had once been my father’s boss in the Admiralty in Bath.  I am sure he had no recollection of me whatsoever, but being 9 years older than me, when I first met him at the age of 5 or 6 and he was about 14, he seemed impossibly special, with a wonderful collection of grown up children’s toys – Meccano, model aeroplanes, etc.  Following these meetings, we were posted to Malta, and I never saw him again.

Sir James Mackenzie, who has good claim to be dignified with the label of ‘First Ever Cardiologist’, used to study the obituary column of The Times, as a way of obtaining follow up on his patients.  He it was who first recognised the grim significance of the ‘pulsus alternans’ as a bad prognostic sign in patients with heart failure.  In one of his textbooks, the appendix is a huge collection of case vignettes.  After identifying the gloomy outlook in one patient whom he observed to have this sign, he wrote baldly, ‘Soon after this I saw from The Times that he had died.’

Another beautiful day.  Our exercise today is a bike ride, exploring little known cycle trails within the purlieus of Bournemouth.

The evening is allocated to another episode of ‘The Crown’.  Part of the episode was related to the attempts of Lord Louis Mountbatten to change the name of the Royal House from Windsor to Mountbatten.  The argument ran that only the male scion of the King would necessarily be a Windsor, and the Queen should take her new husband’s name.  Such machinations were typical of Mountbatten, who on the face of it was a decorated war hero, but in truth was a philandering and manipulative individual who relied on his intelligence, drive, and his undoubted charisma to wheedle his way into the corridors of power.  A recent biography of him has some enjoyable quotes: ‘Edwina and I spent all our married lives getting into other people’s beds’ he said at one point.  An indication of the deviousness of his character is given in Field Marshal Sir Gerald Templer’s remark to him, ‘Dickie, you’re so crooked.  If you swallowed a nail you’d shit a corkscrew.’  Not mentioned in the Crown (because not entirely relevant) is his status as a war hero, in which he brought the damaged destroyer, HMS Kelly, back to safety after being torpedoed off the Dutch coast.  Subsequently the ship was sunk during the Battle of Crete.  Despite suggestions that Mountbatten needlessly gave away the position of his vessel, his reputation, like Teflon, was unsullied and indeed enhanced.

Wednesday April 8^th

Another perfect day.  After our cycle ride we have relaxed, though we will wait until later to walk on Talbot Heath, which is almost deserted toward sunset.  The PM remains in ITU, apparently only on oxygen, and not on assisted ventilation.  There are many more Covid-19 deaths, up by 938 in the last 24 hours.  A particular puzzle is the continuing low death rate in Germany, compared with other European countries.  A journalist during the daily briefing suggests that this is due to more and better testing in Germany.  The answer is, unfortunately, we don’t know.

Thursday April 9^th

A beautiful day, very little wind.  Sunbathing weather.  This is Maundy Thursday.  Very little to report.  Our only exercise is in the evening with a walk on Parkstone Golf Course again.  The National Theatre streams its production of Jane Eyre this evening.  Quite an oppressive story.  Good theatricality, but not a barrel of laughs (yes, I have read the book).  Despite the period clothing, it jars slightly when Mr Rochester falls off his horse and says ‘Fuck’ twice.  Given the general public state of depression we call a halt after the first half and will give it another go tomorrow.  The PM is now out of Intensive Care which is good news.  More deaths, inevitably.  I receive a phone call from Poole Hospital Occupational Health who express reservations about any role with patient contact.  Seems reasonable.  Weather forecast is even better for the weekend.  Video clip on the news this evening of police stopping two lads driving into the Lake District with a canoe on the roof of their car!  Haven’t they heard the news?

My musical education is coming on.  I now have time to listen to most of the ‘Composer of the Week’ series with Donald Macleod (no relation).  In a piece by Schubert he states that ‘Schubert here used the “Mannheim Skyrocket.”’  This is a rapidly ascending broken chord, often with a crescendo.  The Mannheim School (1740s to 1770s) influenced a number of composers including Mozart and Beethoven.  I’ve found the programme a very good way of going to sleep.  Donald Macleod has a gentle mellifluous voice, and after his introduction, the music can lull you off extremely well.  Particularly useful since we aren’t getting quite as much physical exercise as we used to.

Good Friday, April 10^th

Another beautiful day.  The police have a hard job of trying to reduce numbers in beauty spots today.  The Prime Minister is still at St Thomas’s Hospital, though now out of Intensive Care.  Objections from several friends at major medical centres when St Thomas’s is described on the BBC as ‘the best hospital in the country.’  A small digression about St Thomas’s: after my first summer in the USA, working in a research facility in Upstate New York, a fellow student who was studying at Downstate Medical Center in Brooklyn, came to do an elective in London.  After a week or two, he asked me, in all seriousness; ‘Andy, is it essential to have a double-barrelled name to get a job at Saint Thomas’s?’

Deaths yesterday in UK rose by 881 to total 7,978.  Johns Hopkins University in the USA estimates world death toll now exceeds 100,000.

Sorry about the gloomy statistics but this is a Corona diary.

As readers (if any) will realise, I am typing my diary and putting off my return to the Book Club’s chosen book of the month – Burma 44.  Somehow or other, although I have great admiration for ‘The Forgotten Army’, fighting the Japs in the jungle doesn’t seem to have much allure while we are fighting the present ‘Yellow Peril’ – a not inappropriate name given the source of the virus.  Truth to tell, I have been a little disappointed in our Book Club (though I realise that some of its members will read this).  It seemed a great idea – mostly, if not all, retired male medics; a counterblast to the innumerable women’s book clubs, and a way of being introduced to some books or authors whom one had not read.  But with a few exceptions, the books have either been what one might call ‘Boys’ Own Paper’ stories, or history books, and I’m told that the next book in the pipeline from the one person who has not selected so far is also a WW2 book, as was the one before Burma 44.  Did you know (I expect you did), that 93% of book clubs are women’s book clubs?  An article by Kristin Hunt quotes a character from a novel called ‘The Middlesteins’ who says, ‘What’s the point of having a book club if you don’t get to eat brownies and drink wine?’

So that’s the news on Good Friday, April 10^th.  And I am going to publish this and then go and read Burma 44; promise.