CORONA/WAR DIARY CHAPTER 27/CHAPTER 1 - FEBRUARY 8th 2022 to MARCH 10th 2022.

 

TUESDAY FEBRUARY 8th, 2022

 

Time to record the first swim since New Year’s Day.  Freezing – well, it was 8 degrees C.  Just for the record, you understand.  Nothing else to add.

 

MONDAY FEBRUARY 14th, ST VALENTINE’S DAY

Valentine cupcakes, courtesy 'Maggie the Seaside Baker', q.v.

Advice and a 'handshake' from Maggie the Seaside Baker

 And I have Covid.  After nearly two years, at last, it has come to this, or at least come to me.  The Omicron variant (which I suppose I have – I have not lost my sense of taste or smell) is rife, and it may become harder to miss it than escape it.  Almost certainly acquired at our recent book club meeting (a member recalled that this person, whom medically we call the ‘Index Case’ (!) had such vigorous views on the ‘Fall’ biography of Robert Maxwell, that phlegm and spittle might have landed on the cheese board, which is an unpleasant thought, but it was not I that thought it).  The index case was asymptomatic, but symptomatic the next day.  Two days later I noted a dry cough, and tested negative.  Three days later the cough was incessant, with headache, malaise, and some fever, and the lateral flow test strip lit up like a beacon, as they say, within minutes of the pregnant droplets falling upon the well.  Two rather rough days and nights followed, but I am on the mend.

Bingo!

Google knows where you are and what you are doing.  Evidence that I did isolate for the period when I was Covid positive.

 

There were two images that came to mind.  The first being the Edgar Allan Poe short story, ‘The Masque of the Red Death’, where Prince Prospero, his Kingdom devastated by the pandemic of the Red Death (evidently a sort of haemorrhagic fever, such as we know as Lassa or Ebola), takes 1000 of his healthy high born courtiers and subjects into his Royal Apartments and bids his armourers seal and weld all doors.  Of course (spoiler alert), the Red Death gets in.  Perhaps, for Prince Prospero, one should substitute the name Jacinta Ardern, Prime Minister of New Zealand?

 

The second, more subtle illustration, is from Dylan Thomas.  ‘In Country Sleep’ is one of his later poems.  In the poem, written in Italy, and generally thought to be addressed to his daughter Aeronwy, ‘the Thief in the night’ threatens to get in, no matter what precaution one takes.  In the first stanza, the Thief is described in nursery rhyme terms as the ‘wolf in a sheepwhite hood’, but later, more specifically, ‘Be you sure the Thief will seek a way, sly and sure’.  And, ‘Ever and ever, he finds a way, as the snow falls, As the rain falls, hail on the fleece…’  These lines sound a little prosaic, taken out of context, and without that wonderful voice reciting them.  Do listen to Dylan reading it.

 

Who is the Thief?  Multiple critics have attempted to answer this, with surprisingly different results.  Who am I to better their attempts!?  Thomas himself gave several interpretations, sometimes depending on whether he was feeling paranoid about Caitlin’s possible dalliances, or whether he was drunk.  Paul Ferris, in his biography of Thomas (p212) rehearses some of these.  But generally, the Thief is assumed to be Time or Death.  We know that Thomas took his compositions very seriously, at least at this stage of his life.  The working sheets for a poem written at a similar time, ‘Over Sir John’s Hill’, are complete, are preserved in Harvard College Library, and run to 47 sheets of paper, and this poem is less than two-thirds the length of ‘In Country Sleep’.

 

So, at last, the Thief of Covid-19 has found a way, and it doesn’t profit to imagine whether my illness would be different if I hadn’t had a total of four vaccinations.  It was unpleasant enough…

 

So much for the self-indulgence of talking about oneself.  As for Dylan Thomas, and attempts to analyse him, best to leave the last word to Cyril Connolly: ‘At his best he is unique, for he distils an exquisite mysterious moving quality which defies analysis as supreme lyrical poetry always has and – let us hope – always will.’

 

The reader will realise that I have had, for many years, a huge affection for the poetry of Dylan Thomas.  It’s interesting that his contemporaries were also attracted to him, despite his many faults.  He borrowed and never paid back; he stole; he was frequently drunk and incapable; he was faithless; he told lies.  His first poem, at least the first poem for which he was paid, he sold to The Western Mail, and is entitled ‘His Requiem’.  Many years later, in 1971, someone found the poem, written by a Miss Lilian Gard, in a ‘Boy’s Own Paper’ of 1923.  Perhaps it is because I first heard of him, when at the age of ten, I was condemned to, or granted the benison depending on your point of view, of living in Fishguard, in rural West Wales from 1958 to 1961.  Richard Burton promoted Fishguard as the inspiration for ‘Under Milk Wood’, and directed his film version of the play there.  The film crew took over the last little cottage on Lower Town quay and converted it into Blind Captain Cat’s cottage (where Peter O’Toole sat).  The townsfolk complained of the disruption, but at least the Ship Inn did well out of the heavy drinking actors.  A note signed by Burton and others states that on a certain date (1970 or 1971?) the cast and crew drank the pub dry.  Burton was also kind enough to write in the visitor’s book at Fishguard Bay Yacht Club that it compared favourably with the Royal Thames Yacht Club.  As regards the location of Llareggub, it seems more likely that New Quay, north of Cardigan was the inspiration, though the many churches and chapels of Fishguard, and his origins in Swansea are also possible amalgams of the town.  But in 1958, few in Fishguard, five years after Thomas’s death, had a good word to say for him.  Now regarded as one of Wales’s finest poets; at that time he was regarded as something of an embarrassment.  Naively (aged 11) I asked a dinghy sailor at Fishguard Bay Yacht Club, why his super-fast fibreglass dinghy, with which he won all the races, was called ‘Polly Garter’.  ‘Because she’s no better than she ought to be’, he replied.  My mother refused to explain this.  It stimulated an obvious attraction for the creator of Polly Garter.

 

I return to an issue that remains the elephant in the Covid room – ever since the location of its origin emerged, or even since Donald Trump referred to ‘The Chinese Virus’, a possible clue as to the correctness of the laboratory-created virus theory has always been that the nearest animal relation of the virus carries a genome similarity of only around 95%, whereas other viruses passaged through and identified in animal species tend to have a much closer homogeneity to the virus responsible for epidemics or pandemics.  So to create the SARS-CoV-2 virus implies a substantial, and possibly engineered difference in the nucleotides coding particularly for the spike protein.

 

The most recent piece of the jigsaw comes from an unlikely source, as reported by the Daily Telegraph (Sarah Knapton).

 

The University in Budapest had soil samples taken in Antarctica in 2018 and 2019.  In December 2019, these were sent to Shanghai (Shangon Biotech) for genetic analysis.  The samples were subsequently found to be contaminated with a previously unknown variant of SARS-CoV-2.  This variant has a genome which shares features with both the nearest previously known bat coronavirus and the earliest Wuhan strain.  Other findings in the samples contain hamster and monkey DNA traces, perhaps pointing to growth of the virus in animal cell lines, such as would be undertaken in a laboratory.  Sangon Biotech is often used by Chinese researchers for sequencing.  If the work was undertaken before the end of December 2019, this finding would be evidence for a laboratory leak.  If afterwards, it might just be contamination, as scientists in Wuhan struggled to identify the virus.

 

Monday February 21^st, 2022

 

This is the first day that I have felt substantially better, and the lateral flow test is pristinely negative.  A little stroll round Whitley Bay and back.  Still very windy.  We have had three named storms in the last four days – Dudley, Eunice, and Franklin.  Most of these major depressions move further northwards than Poole, but Eunice was unusual in having its highest wind strengths on the south coast.  122mph gusts were recorded at the Needles, Isle of Wight.  Some major branches down from trees and a lot of debris, but otherwise the new house stood up to it.

Fun in high winds in Poole Harbour

 

My illness, from which I am still fatigued, has at least allowed me to read the new biography of George III, by Andrew Roberts, a recent birthday present.  Weighing in at over 750 pages including the notes and bibliography, it is a welcome re-evaluation of George III and his role in 18^th and early 19^th century politics.  During almost all of his reign, Britain was at war with somebody, whether France, Spain, the American Colonies, or other sundry nations such as Denmark.  Mindful of what had happened to Charles I, George was careful not to overstep his Royal prerogative, though this also allowed him to put blame on his ministers and parliament, who with the exception of the Pitts, were generally hopeless.  The corruption, and the violence and rioting which characterised the time, were appalling.  (The Police Force was not established until 1829).  George was one of the few Hanoverians who was guided by moral principles.  He was lucky to escape hurt during various riots, and also survived several assassination attempts.

 

Perhaps most interesting to me was the reassessment of George’s illnesses.  Soon after I became a medical student, the papers and book by Dr Ida Macalpine and her son, Dr Richard Hunter, provided what seemed to be conclusive proof that George suffered from acute episodes of  (variegate) porphyria.  I believed this theory, even to the present day.  Alan Bennett’s play, and Nicholas Hytner’s film promoted this too.  But meticulous re-examination in 2010 by Dr Tim Peters and Dr D Wilkinson strongly suggests that George suffered from acute hypomania – what we would now call bipolar disorder.  I can’t do better than quote from the abstract of their vigorous rebuttal of the Macalpine/Hunter theory:

 

‘The diagnosis that George III suffered from acute porphyria has gained widespread acceptance, but re-examination of the evidence suggests it is unlikely that he had porphyria.  The porphyria diagnosis was advanced by Ida Macalpine and Richard Hunter, whose clinical symptomatology and historical methodology were flawed.  They highlighted selected symptoms, while ignoring, dismissing or suppressing counter-evidence.  Their claims about peripheral neuropathy, cataracts, vocal hoarseness and abdominal pains are re-evaluated; and it is also demonstrated that evidence of discoloured urine is exceedingly weak.  Macalpine and Hunter believed that mental illnesses were primarily caused by physical diseases, and their diagnosis of George III formed part of a wider agenda to promote controversial views about past, contemporary and future methods in psychiatry.’ (History of Psychiatry, 2010)

 

The appendix to the present work demolishes the porphyria theory completely.

 

Of some interest, in view of my previous comments about rapacious doctors, is the account of the various famous physicians who controlled and maltreated the King in 1765, 1788-9, 1801, 1804, 1810-20.

 

During the King’s last illness, the most famous physician of his time, and even to this day the longest serving president of the Royal College of Physicians, Sir Henry Halford (PRCP 1815-1844), together with Sir William Heberden, Henry Dundas, and Henry Reynolds, were chiefly in charge of the King’s care.  Four major works on the treatment of insanity were published between 1806 and 1809, yet when questioned by parliamentary committees, it emerged that these distinguished physicians had read none of them.  Halford in particular was doctor to four monarchs, including Queen Victoria.  A medical historian (Sir Roy Porter) wrote: ‘So suave was his bedside manner, that some aristocratic women were said to prefer dying with Sir Henry than living with lesser physicians.’

 

Robert Willis, having some experience of treating the insane, is treated relatively kindly by Alan Bennett in his play.  Yet a ditty of the day went:

 

The King receives three doctors daily –

Willis, Heberden and Baillie:

Three distinguished clever men,

Baillie, Willis, Heberden;

Doubtful which more sure to kill is,

Baillie, Heberden or Willis.

 

(Quoted by Roberts from a British Medical Journal of 1914)

 

Finally, it should be noted that the doctors continued to charge huge fees.  By the time the King died (January 1820), the amount spent on them since January 1812 totalled £271,691 and 18 shillings (almost £34 million in today’s money).

 

The last time I was ill for so long a period was a genuine episode of influenza, which prostrated me some thirty years ago.  It allowed me to read ‘The Lord of the Rings’ in an uninterrupted sequence.  I had been looking forward to it, having read The Hobbit many years prior.  In the event, although the story started well enough, I found it tedious, and nothing like as enjoyable as The Hobbit (could it be that reading the one in one’s teens and the other in one’s 40s had something to do with it?).  It was during my time in Cambridge, in the late 1960s, that TLOTR became a cult.  There was a club which called itself ‘The Hobbits’ and to get into it one had to be interviewed and answer correctly searching questions at random from the books.  Life seemed too short, especially when studying Medicine, and Groucho Marx’s remarks about clubs come to mind.  I do remember a very successful discotheque during my time there called ‘The Desolation of Smaug’.  Well, anybody who can read TLOTR which contains a geographical feature, key to the story, called ‘The Crack of Doom’ without breaking into ribald laughter ranks in the same category as Charles Dickens’ readers, of whom Oscar Wilde wrote, ‘One must have a heart of stone to read the death of Little Nell without laughing.’  I have sympathy with the Oxford don (Professor of English, Hugo Dyson) who, in the Merton SCR, listening to Tolkien declaiming his latest passage from TLOTL, said, ‘Oh no; not another fucking elf, Ronald?’

 

Thursday February 24^th

 

The above seems rather trivial, compared to the news today.  I have not felt so uneasy since Nine-Eleven.  Vladimir Putin, or rather Russian forces at his command, has invaded Ukraine with simultaneous attacks using helicopters, aircraft, and missiles, aiming to neutralise any Ukrainian armed response.  Images show Russian military vehicles crossing borders without any attempt to stop them.  After 22 years in power, as one correspondent stated this evening, with effectively no opposition, Putin considers himself invincible and it appears he has a Messianic mission to avenge Russia’s humiliation of the 1989 fall of the Soviet bloc.  As mentioned before, Ukraine is a NATO partner, and not a NATO member, so there is no armed response from the West.  But it seems likely that Putin may target Poland or the Baltic states next, and they are among the 30 members of NATO.  The response from the UN is predictable – a rather pathetic ‘Please Stop’.  Sanctions are being announced, with the USA response expected later tonight.  These will not have any short term effect however.

 

So, relegated to the second division are discussions about Partygate, and even Covid has taken a back seat.  Prince Andrew can relax for the first time for months.

 

The charming Laura Kuenssberg has tweeted that now Tories are worried about mass immigration from Ukraine… later in the day however she seems to be covering the story in a more considered manner, though she has jumped on the news that many MPs including Tories do not think the sanctions against Russia go far enough.  In my own cynical way I wonder whether Putin has delayed striking against Ukraine until now to allow his Russian athletes, masquerading as ‘Russian Olympic Committee’ to win all their medals at the Winter Olympics.  (Note added 3.3.2022: there is a credible intelligence source suggesting that President Xi had been in touch with Putin over exactly that scenario).

 

Feel a bit rough again post Covid, with a sore throat.  Time for bed.

 

Thursday March 3^rd, 2022

 

It has been a week of unremitting horror in Ukraine.  At times in the past I have counted my blessings, relieved to have lived such a long life untainted or unthreatened by war.  I have idly wondered how my parents felt – my father at just 21, my mother at 19, when the Second World War was declared; their lives altered irrevocably by one madman.  And now here we go again.  This is the iPhone war, the TV war, and awful images are now commonplace.  During my life we have had single, powerful, and frozen in time images to tell us that war was taking place – the little girl running naked down the road in Vietnam after a napalm strike; Syria, Afghanistan, the Falklands, and many others.  These seem to recede into the distance compared to what is now going on in Ukraine.  Already, one week in, one million people have fled the country.  Males aged 18 to 60 are not allowed to leave – their families joining the 40 kilometre queue at the Polish border.  Putin speaks bizarrely of ridding the country of Nazis.  Many feel that his personality has changed; some question his appearance as evidence of some inner pathology.  A Matt cartoon last week in the Daily Telegraph shows a sign outside the city of Salisbury – ‘We warned you about him’.

 

At the Bournemouth Symphony Orchestra concert last night, the CEO read a message from our Ukrainian chief conductor, Kirill Karabits, thanking us for our concern for his country.  The lights changed to blue and yellow.  Kirill is in France at the moment, but is due to conduct here in Poole in two weeks’ time.

My wonderful original 1960s purchase of the DG 12" LP of Sibelius violin concerto.  Worryingly, Finland is not a member of NATO

 

As I write this evening, it seems that Putin’s tactics have changed to an altogether more barbaric strategy.  His forces bogged down on the ground, he has resorted to pulling back and just raining destruction on Ukrainian cities – indiscriminately targeting residential areas.  Russian involvement in Ukraine before, and in Syria has focussed on completely levelling the cities.  Safe, many miles away, his commanders can merely press the button and send cruise missiles or other ordnance in to destroy.  It seems possible that President Zelensky will call for surrender rather than allow so many more defenceless Ukrainians to suffer.

 

Meanwhile, in the United States, many, many miles away, President Biden gave his State of the Union address.  He was applauded for promising to help Ukraine, but to many critics he appeared fuzzy, and did not help himself by saying ‘Putin… will never gain the hearts and souls of the Iranian people.’  Conservative commentator, Ann Coulter, observed ‘That’s a relief!’  More than half of Americans polled by ABC News/Washington Post do not believe that Biden has the ‘mental sharpness it takes to serve effectively as President.’

 

It seems to me that Ukraine’s invasion is entirely analogous to Hitler’s invasion of the Sudetenland, part of sovereign Czechoslovakia, on the pretext that many native Germans lived there, and that it should be Germanized again.  At that time, our line in the sand was Poland, and only when Hitler invaded Poland did we declare war.  This time it is the Baltic States and other members of NATO (or OTAN) in Europe.

 

I had so many other things to write about – the detection of the antianginal drug trimetazidine in a urine sample of a 15 year old Russian ice skater; a remarkable observation about cricket; more about Dylan Thomas – but these will have to wait.

 

Parenthetically, it seems reasonable however to mention Covid.  A paper in the New England Journal of Medicine, today, March 3^rd, is a review of the efficacy of vaccinations against the Omicron variant – and it is nowhere near the effectiveness displayed earlier to the first coronaviruses.  There is some protection, but with various combinations of primary and booster doses, it’s difficult to tease out which is best.  Protection is at best around 60%, and has been shown to wane with time.  It seems to bear out my experience.  I still have paroxysms of coughing, and sleep late most mornings.  (Added note: further NEJM papers bear this out in other countries – omicron is less well protected against, but nonetheless there does appear to be protection against serious illness and death).

 

Yet again, the Wuhan story has been re-examined and some scientists have suggested that the origin was indeed the Wuhan wet market.  The paper has not been peer-reviewed and will obviously bear further assessment.

 

Sunday March 6^th

 

More articles questioning how on earth we were so gullible as to allow London to become ‘Londongrad’ for so many corrupt Russian businessmen.  Party donations, visas for sale, a process it seems dating back to John Major, but just in case any left wing readers feel reassured, substantially endorsed by Tony Blair and his successors.

 

Cold, bleak winter sunshine.  Strong north-easterly winds.

 

This next paragraph may jarringly intrude, but for many, the death of Shane Warne, cricketer, greatest leg spinner of all time, from a suspected heart attack at the age of 52 has come as a massive shock.  Rodney Marsh, greatest Australian gloveman, has also died from a heart attack.  Warne lived life to the full, but his diet of junk food and cigarettes obviously caught up with him.  As another evidence of the naivety of successive generations about history, a friend recently told me that his grandson asked him, ‘Dad, what franchise did Donald Bradman play for?’  I am not going to go into the details of that for American or Canadian readers, only because it would take too long.  They may guess from his dates of birth and death – 1908 to 2001.  Note to American readers – cricket is our baseball, though there may be a social class difference.

 

I feel very sorry for all the Paralympic athletes.  Apart from the occasional minor news item that tells us somebody from GB has gained a medal, the interest in the Winter Paralympics must be almost zero.  The BBC does not cover it – it appears on Channel 4 in the middle of the night.

 

Covid is no longer the main topic of conversation.  Whitty and Valance, so important in the early pages of this diary, are nowhere to be seen.  Instead, current and recent figures from the Armed Forces deliver our briefings these days.

 

This diary will now become the ‘War Diary’, not the Corona Diary.  Will it ever see the light of day?

 

Thursday March 10^th

 

The war has continued for two weeks.  The obscenities of it are almost unspeakable.  An image of a small girl in a pink padded jacket lying dead in the gutter.  Yesterday the airstrike or missile strike of a hospital for mothers and children.  How long can the West tolerate this?  The fear of escalation and the fact that we have no commitment (officially) to Ukraine stops a European/NATO/US response.  I still think this is the Sudetenland moment and there will be more to come.  It is remarkable how many BBC reporters seem to be in Ukraine (chiefly in Kyiv, though also elsewhere).  The unmistakable New Brunswick tones of Lyse Doucet who seems to be in every war zone.  We also have the familiar sound of Fergal Keane.  A dedicated reporter, and highly respected, Keane nonetheless possesses the ability to lower one’s spirits just in the tone of his voice.  I am sure if he read P.G. Wodehouse to us it would sound equally depressing.

 

A moment of history yesterday – Volodymyr Zelensky, Ukrainian President, became the first head of state to address parliament in person, by satellite link.

 

It is very hard to focus on other matters.  I had to look on my phone for some pictures to remind us that life goes on, so here they are.  Some daffodils, the early morning sunlight shining through; boats on the hard at the Royal Motor Yacht Club, waiting for Easter and launching.  Our Ukrainian flag flying from our flagpole.  Is this just bourgeois breast beating or a meaningful symbol of solidarity?

Spring approaching

'Weapons of Happiness', yachts awaiting Spring launching, R.M.Y.C.

Carp, Luscombe Valley lakes, Parkstone G.C., Poole

Our Ukrainian flag - solidarity at least

Some years ago, inspired by all the boats of various shapes and sizes that one can see in various drives and in front of houses, I felt that I should create a montage of the more colourful craft, and enter it into the Royal Academy Summer Exhibition under the title ‘Weapons of Happiness’.  The title is taken from an awful play by Howard Brenton which I went to see at the National Theatre many years ago.  Apart from its left wing sermonizing tedium, and the fact that a motorcycle appeared on stage, I remember nothing of it apart from the clever title.  I believe it comes from the Bible: ‘All the bright weapons of happiness wait only for a sign’.  Apposite to the war perhaps, but in my context it contains the pregnant happiness that awaits the launching of boats in the springtime.

 

Research fails to find the biblical quotation; I only remember the context from Brenton’s introduction in the programme.  If it is not from the Bible, perhaps it could be Karl Marx?  Brenton is or was a Marxist.  Research also indicates that the cast was stellar – Frank Finlay, Julie Covington, Michael Medwin, Bernard Gallagher.  It was the first new play commissioned by the National and premiered in July 1976.  David Hare was the director; Peter Hall the artistic director.  My view of the play is shared.  Most reviews were unenthusiastic.  It has only been revived once, in 2008, in a peripheral theatre, and was not well-reviewed.

A propos of 'Google knows where you are', I received this heatmap of my wanderings over the last several years - golf in Ireland, cycling the North Coast 500, cycling the Hebrides, walking the North York Moors, walking in Cornwall.  Parenthetically I wonder - does Vladimir Putin have a similar heatmap?  And might it be useful?

 

At this point, unless some other important issue comes forward, I think it appropriate to cease my Corona diary.  I will continue to write a diary/blog.  In a more skeletal form it may reappear.

 

I close by giving you two meaningful entries from newspapers, in 1853, and 1969 respectively.  Do not read the name of the first correspondent until you have read the article:

 

‘…These vital interests should render Great Britain the earnest and unyielding opponent of the Russian projects of annexation and aggrandisement…Having come thus far on the way to universal empire is it probable that this gigantic, swollen power will pause in its career?  With the Albanian coast … she is in the very centre of the Adriatic … It would appear that the natural frontier of Russia runs from Danzig or perhaps Stettin to Trieste.  As sure as conquest follows conquest and annexation follows annexation, so surely would the conquest of Turkey by Russia be only the prelude to the annexation of Hungary, Prussia, Galicia and the ultimate realization of the Slavonic Empire.  The arrest of the Russian scheme of annexation is a matter of the highest moment.  In this instance the interests of democracy and of England go hand in hand.’

 

From the New York Tribune, 12 April 1853, by its European correspondent, Karl Marx.

 

This was written shortly before the start of Crimean War, an anti-Russian alliance of Great Britain, France, the Ottoman Empire, and Piedmont-Sardinia which achieved eventual victory, at some cost.  The Treaty of Paris (1856) effectively barred Russian warships from the Black Sea.  Putin seems to have a long memory.

 

And with regard to military or national leaders, perhaps Putin should also take note from two entries to The Times, on 3^rd September 1969, in the In Memoriam section.  Depending on the results of his current incursion into Ukraine, will he be regarded in the former or the latter category?

 

 

Oliver Cromwell, 25^th April 1599 – 3^rd September 1658.

Lord Protector, 1653-1658.  Statesman, General and Ruler.

            ‘Let God arise, let His enemies be scattered’.

                                                                                                -Psalm 68, verse 1.

In honoured remembrance.

 

 

Cromwell. – To the eternal condemnation of Oliver, Seditionist, Traitor, Regicide, Racialist, proto-Fascist and blasphemous Bigot.  God save England from his like. – Hugo Ball.

 

 

I freely confess that I found these entries in my copy of the Commonplace Book of John Julius Norwich, 1971.

 

Those who are interested in following someone with a huge amount of experience, an ex-Diplomat, non-partisan commentator (though you might not think it from her contempt for the current government), should take a look at the writings and Tweets of a distant ‘friend of the family’, Alexandra Hall Hall.  Her hashtag is:

@alexhallhall.  What she says is usually worth reading…  She has far more international experience and far more intelligence than virtually any inhabitant of the ‘Mother of Parliaments’.  Even that title is a misnomer, if you visit Iceland and go to Thingvellir, the true Mother of Parliaments.

 

Good bye.

 

Andrew McLeod

 

 

 

 

 

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