When friends become enemies

It has all happened with such lightning quick rapidity that we are barely keeping our heads afloat in the sea of information, misinformation, rumour, whispers and projections about the course of coronavirus illness. We are not really used to exponential growth in infection rates. Well, in a manner of speaking we are. The common cold is transmitted in much the same way but has much less severe consequences. What I should perhaps have said is that we are not used to exponential growth in viruses as exquisitely nasty as this bug.

And the speed of transmission is the root of the problem. There is no time to develop a strategy, put it out for critical opinion, form working groups to draft a White Paper, amendments and implementation. None of that. While we are still coming to terms with the phoney war that exists at present, the virus is conducting a silent blitzkrieg on us. We are learning new facts almost by the minute.

Last week we did not know that the virus can live on surfaces for up to a week. That was a bit of a blow. Last week we didn’t have the genetic sequence of the virus. Now we do. And not a moment too soon.

Last week, we knew little about lock downs. That was something that happened in the Far East – China, Malaysia, South Korea. Those sort of places. Places with quasimilitary regimes that could enforce such drastic measures with guns. Not the kind of thing that happens in the West.

But the fundamental truth is that these measures seem to work. The war there isn’t over but there is at least the realistic possibility that the virus may be halted there. Drastic measures, sure.

We balk at these kind of measures in the West, in essence locking up entire populations of cities or, as in Italy, countries. But as the Italian prime minister said, in an almost valedictory tone, “there is no more time”. Without finger-pointing, the reason there is no more time is because they took too much of it in the early stages before they recognised the holocaust that was to follow.

Before anybody feels that this lesson has been learnt, let me urge vigilance not complacency. It only takes a couple of wrong decisions for any country in the early stages of this illness to descend into the same abyss. And when I say a couple of wrong decisions, they don’t even need to be wrong. Just late.

The UK government is broadly speaking still talking of containment. Just as the WHO was reluctant to press the button labelled “pandemic”, so does the UK administration cling to containment. The number of cases in the UK rose by 73 yesterday, the biggest single daily rise yet. This is not containment. Not by any standard. It’s time to bite the bullet. Whether you call it such or not, we are now in the “delay” phase.

So get on and make those decisions. Make them tomorrow when another huge increase in cases will turn public opinion against your “sit tight” approach. Action is needed now and action requires leadership. So show some.

The principal argument against Draconian measures is that they are considered to be disproportionate and likely to induce non-compliance if maintained for long periods of time. The feeling is that if we close the theatres, cancel football games and prevent rallies and marches, people will begin to resist such an imposition after a few weeks. This coincidentally will probably be at the time of peak mortality. Not a great time to give up on your only strategy.

I don’t really buy that. Every day the virus gains new footholds, creeps into areas previously untouched. More countries are added to the list of those infected. This is not a time for genteel moderation. It’s a time for all-out war on the virus. If we are going to prevent a collapse in our health service provision, that’s what we have to do.

Firstly, we need to self isolate. Those who can work from home need to do so. Secondly, wash your hands more than you would when you were a kid. Imagine your mum nagging you. Do it that much. Thirdly, if you are a member of the government, cancel football matches, theatre performances and all gatherings. If you are not a member of the government, just stop going to them. Big gatherings are ways of turning sparks into wildfires. One person sneezes on 10. A week later those 10 have infected 1000. And so on. Fourthly, and I’m a bit hesitant about this one, wear a mask. I don’t know if they are any use but they do at least reduce the likelihood of you infecting somebody else. And they act as a clear visual signal that you are taking this thing seriously. And that in itself is not a bad reason.

The biggest change I think is in our social customs. The Dutch Prime Minister gave a brief spiel in Brussels about not shaking hands and then promptly shook the hands of his deputy. It may have been a brief moment of farce, but it showed how strongly ingrained such behaviour is.

Over the last week I have seen very few friends or family and it has been a real conscious effort on my part not to greet them with the familiar hug, kiss on the cheeks, or handshake. They are my friends after all. What danger could they possibly be? And the answer is of course that they present every danger there is. Their very familiarity makes them dangerous. Trojan horses essentially. Unwitting assassins.

We are being stalked by an invisible enemy. It may be miles away. It may be on our doorstep. Or in our houses already. We don’t know. It will be another week before we know where it was amongst us.

So act now. Take the steps you can. Encourage those who can take bigger measures to do so. We are peering over the edge of a precipice at the moment. If we don’t take a step back, the virus will take the step forward for us. Act now.

Toilet roll wars

The last couple of days have seen complacency turn into blind panic as the UK tries to control the spread of coronavirus. The number of those infected stands at over 300 and the first five deaths are now recorded. Again we are “reassured” that the latest deaths were of old people with underlying health problems. Reassuring I’m sure, unless you happen to be an old person with underlying health problems. The government needs to make its messages a little less overtly Darwinist.

But even in these rather dark times there is still a sort of black comedy. What is all this nonsense about toilet rolls? The shelves are bare, as the toilet roll locusts descend upon the supermarkets. YouTube spills over with video footage of people fighting at the checkouts over loo rolls. The world is facing its biggest global health concern ever and people are brawling over toilet paper. You couldn’t write this stuff.

The emergency meeting of Cobra today was called to discuss next steps in the management of coronavirus (inasmuch as it can be managed). The government has, for administrative reasons as far as I can tell, pigeonholed the condition into four stages – containment, delay, mitigation and research. Of course it’s really only three stages since research is ongoing throughout. The tenor of the meeting today seems to be a desire to maintain the country on “containment” as a strategy before going to more Draconian measures once we enter the “delay” phase. At the end of the day it doesn’t really matter what we call the phases. That’s just a headline for the writers. Especially if the transition to delay is blurred as has been the case today with the advice that even people who are only slightly poorly should stay at home.

This seems hardly worth saying. Obviously people who are unwell should stay at home anyway, and especially so in this time of heightened awareness and sensitivity. Do you really want to be the one who brings coronavirus to your office? It’s amazing really that it was felt necessary to say this. However, this advice presumably is a substitute or an interim measure, intended to delay the transition to the delay phase if that makes sense.

To my mind we have a clear glimpse of the future, well about a week in the future, in the shape of events in Italy. Sensible measures that could have been taken, with minimum inconvenience, were not. The lockdown of 16 million people is the result. Locking the gate after the horse has bolted.

I can’t help feeling that this will, at best, have us chasing the game. We will always be one step behind the virus. If we want to defeat this thing we have to outrun it. That means taking uncomfortable measures. Cancelling football games, closing theatres, that sort of thing.

The principal argument against such extreme action (and I concede that this is extreme) is the damage to the social and economic fabric. After all there are only 300 cases in the UK. This is presumably why Mr Johnson today spoke of the government’s commitment to the right measure at the right time as he put it. I have little doubt that the stock exchange would wish to avoid such measures. I suspect however that the health service workers would rather we did. In any case, even if we do not take such measures now, we may be forced to do so in a weeks time. And by then they will be less effective.

I don’t envy the government in the slightest. They have a nigh on impossible task ahead of them, balancing public safety and economic stability. Either can compromise the other and, over the weeks ahead, we will learn who is the winner. If we get this wrong, it really will be a lose-lose situation. Ultimately it’s their decision. But if it was me, I would reduce the number and size of gatherings whether schools, universities, theatres or sports grounds. And I would impose a curfew. Italy shows what happens when you don’t.

Draconian? You bet.

Lies, damned lies and statistics

As we all try to make sense of coronavirus and what the resultant outbreak of Covid 19 means to us, we are bombarded by numbers without necessarily the skills to interpret those numbers correctly. And if that were not an adequate confounder in its own right, you can factor in sufficient additional caveats about data collection to render the headline numbers meaningless.

Let’s be candid about the numbers. What we all wish to know, in essence, is “Am I and my family going to survive this?”. Obviously it’s impossible to give any kind of real answer to that question. It’s essentially a game of roulette. Especially so in the light of the most recent number published by the WHO, which predicted an overall mortality of 3.4%. This is, to say the least, a terrifying number. The UK government is quick to say that the brunt of the deaths is amongst the elderly and those with comorbidities (that’s other illnesses in plain English).

I think this message is intended, in some way, to be reassuring. In essence “as long as you’re not old or already ill with other stuff, you’re gonna be okay “. Now, speaking as somebody who is, by the government’s definition, elderly and living with Parkinson’s and type II diabetes, you will understand that I am somewhat less than reassured. The tone of the message seems almost to suggest that I’m expendable. I don’t much like that idea.

But hang on there, let’s look at the statistics. 3.4% overall mortality? Broadly speaking they have divided the number of dead by the number of people known to be infected. There are any number of good reasons that mean that number may be wildly inaccurate.

Firstly, let’s get the scary ones out of the way, the number of dead is incontrovertible. But the number of those who are going to go on to die is a projection. The number of dead now reflects the number who were infected up to say a week ago. A much smaller number. On that basis, one would project the death toll to be much higher. That’s right, higher.

Bear in mind also that these statistics reflect the initial wave of infection for which the various governments round the world have made at least some provision, in the form of specialist units to deal with coronavirus. In the UK, these units at 30 hospitals have a hundred beds between them. The total known UK cases of Covid 19 stand at 164 currently. Obviously some will have recovered and gone home. But either way, we must be teetering on the edge of capacity. If not today then tomorrow. Once we have to start treating people in Portakabins or whatever, it’s likely the mortality will go up. I am assuming at this point that we do not have the Chinese capacity to build entire new hospitals in two days (incidentally wasn’t that amazing!) so we are stuck with what we have.

You could be forgiven for thinking the situation looks bleak. But it’s worth remembering that the numbers used by the WHO to calculate the death rate are subject to significant other biases. First and foremost, we don’t know the true rate of infection. All we know is the number of those infected amongst those tested. For the most part those tested and found positive will likely be sicker than the wider population. The fact that they have in essence self diagnosed by presenting themselves for testing indicates that they are among the more unwell. Unknown is the number of people with very mild symptoms who simply do not submit themselves for testing. In many cases this may reflect a degree of denial – the “it’s just a cold” mentality – with its attendant consequences. People out there with the symptoms of coronavirus but taking no precautions to protect the public, are putting people’s lives at risk.

We won’t know the true death rate until this is all over. We should not delude ourselves that this will be a matter of a few weeks. Pandemics don’t work like that. It’s more likely to be a year or thereabouts. Nobody knows.

In the meantime, let’s dispel a few myths:

“it’s just like the flu” – no it isn’t. And a friend of mine pointed out to me that many of those who say this have never had flu itself. We tend to upgrade the common cold to flu status in our heads, perhaps somehow to legitimise our truancy. Flu itself, true flu, is crippling. So don’t let’s downplay this.

“It’s just like the 1918 flu” – well, yes and no. The symptoms are quite different for a start but the overall mortality may be similar. Or worse.

“There will soon be a vaccine” – no, there won’t. Vaccines take time. Even the most optimistic figure I’ve seen suggests about a year for one to be proven effective. Obviously longer for sufficient to be manufactured. Most scientists suggest significantly longer. And remember also that even the annual flu vaccine is only partially effective.

To summarise, the WHO headline death rate is at best a guess. It could be out by an order of magnitude either way. The situation could be either better or worse. It still comes down to the fact that there is only one effective way of fighting this plague – self isolation and quarantine. That will reduce the risk of becoming infected and also the likelihood of spreading the illness. in this respect we each have individual and collective responsibilities.

We don’t know how this is going to turn out. But we know more about how it will turn out if we fail to take the precautionary steps we need to. And that doesn’t mean just buying toilet rolls. Get real.

Buying time

By the government’s own admission, the UK is moving from a “contain” strategy to a “delay” strategy. This amounts to a clear concession that containment of coronavirus is no longer working (if it ever was). Stronger measures are called for.

It was therefore particularly nonsensical to hear the Prime Minister state on television this morning that “One of the theories is perhaps you could take it on the chin, take it all in one go and allow the disease to move through the population without really taking as many draconian measures”. This is what happens when ministers speak without being adequately briefed. Does Mr Johnson have the slightest idea of what “taking it on the chin” actually amounts to? You can’t help but wonder.

Taking it “all in one go” means that health services would be swamped. Think of it as a wave. The same volume of water movement can amount to a slow tide or a sharp tsunami. The volume of water moved may be similar but the effects are very different. If we liken Mr Johnson’s “all in one go” approach to a tsunami, it doesn’t take a genius to work out the consequences. Intensive care facilities at hospitals will swiftly be overloaded. And by ‘overloaded’ I mean that there will be too few beds and too little specialist equipment to give the sickest patients even a fighting chance. We’ve all seen newsreel footage over the years, often during influenza times, showing patients on trolleys in corridors because there were insufficient beds. I experienced this recently myself – brought by ambulance into hospital following a car crash, I spent the first night on a trolley and much of the next day on the same trolley in a corridor. And that was in October, largely before the flu season.

Bear in mind also that coronavirus affects everyone and the government has even gone on record as saying that up to a fifth of the workforce may be off sick at any one time. That includes doctors, nurses and paramedics who are in the vanguard. In fact, with their greater exposure to coronavirus, it may be even higher. Even if the beds were available, they would be useless without the staff. All non-urgent operations and treatments would almost certainly be cancelled. They may have to be anyway. So let’s be under no illusion about what taking it “on the chin” means. It means a significantly higher mortality than would be the case if the timescale could be slowed or delayed. You don’t tell a heavyweight boxer to take it on the chin. You tell them to hang in there and avoid being hit. Then, as your opponent tires, things improve.

Forget taking it “on the chin”. Forget “all in one go”. These are stupid ideas and a testament to why politicians should avoid shooting from the hip.

There is only one approach to coronavirus that stands a chance of keeping the mortality rate down and that is to delay and slow the wave of infection. This is for two reasons. Firstly, a spread-out wave will put less burden on the health service. It’s conceivable that existing or moderately augmented staffing and equipment might just cope. I use the word “cope” loosely since there will still most likely be heavy casualties. But far fewer than with the “all in one go” strategy (if it can be called a strategy). Secondly, the longer we can delay the brunt of the infection wave, the more time that buys us to develop a vaccine. And ultimately a vaccine is our only way of dealing with this illness long-term.

Mr Johnson, of course, has to balance the sometimes conflicting needs of business and public health. Businesses collapsing because of coronavirus (FlyBe is today’s example) are a significant problem and, if you are a businessman, maybe an overwhelming concern. The Draconian measures to which Mr Johnson alludes, and is so keen to avoid, involve cancelling of sporting events, closing theatres, limitations on public transport and so on. These are indeed Draconian measures and the economic consequences will be far-reaching and long-lasting in all probability. However, the consequences of a massive and rapid epidemic of Covid 19, I would argue, will be far greater still, manifested in a hugely increased death toll.

We are, as the WHO has stated, in uncharted territory. But if we know anything at all about this virus, we know that it takes a while to show its hand. And by then, we find ourselves reacting to its moves, chasing shadows if you will. Our best bet, in my view, is to go on the offensive. Quarantine, quarantine and more quarantine. We need to throw everything we have at cutting off the reservoirs of infection. And that means Draconian measures. Not as something to think about over the next few weeks – that’s playing into the virus’s hands. We need to do it now. Acting now will buy us time later.

The elephant in the room

I like disaster movies. You know the kind – comets hitting the Earth, zombie apocalypses, maniacal baddies threatening global extinction. That sort of thing. But here’s the point. I like watching a disaster movie but not being part of one.

In case you haven’t already guessed, I give you due warning – this is about coronavirus. If you don’t want to know the score, look away now. Normal life is pretty much put on hold for the immediately foreseeable future. Coronavirus is the biggest health emergency to hit the world in the last… well… ever. In fairness, the 1918 flu pandemic probably runs a good second.

And the 1918 pandemic is the basic model upon which health service planning to contain the outbreak is based. Like coronavirus, the 1918 agent (H1N1) has caused death by bacterial superinfection (pneumonia). Moreover its timing, towards the end of the First World War when public health standards were lower and malnutrition prevalent, played a part in the worldwide death toll of around 40 million.

But coronavirus, ultimately, is not the same thing. It is complacent of us to believe so. The limited data available so far suggests that the elderly are particularly at risk from coronavirus, in contrast to regular seasonal flu which particularly harmed those at the top and bottom ends of normal lifespan, and the 1918 strain which affected working age people much more than expected. Coronavirus is what it is. And H1N1 it ain’t.

It’s easy to be fatalistic about this evolving pandemic. It’s easy to believe we are powerless in the face of this microbiological tsunami and all we can do is wait for the drama to unfold.

But that’s not true. There are measures we can take. Some of these are personal measures such as washing our hands properly and not sneezing on people. The things our parents taught us. In some ways, these measures are so simple that the public is resistant, feeling perhaps that deadly diseases need high-tech treatments. And wearing a face mask may do little to affect your chances of being infected but it will reduce the danger you pose to others, if you are already carrying the virus.

These are personal responses. And they are best supported by wider responses taken not by individuals but by government. We should be taking the only course of action which has been shown historically to help – quarantine. If you are not near other people and therefore not exposed to their coughs and sneezes, you are much less likely to catch coronavirus. That’s clear.

If you take away the route of transmission, the virus pretty soon runs out of ideas. So we should not be holding large-scale sporting events. We should not be going to concerts and theatres. We should not be going on cruise ships which are little more than giant floating petri dishes anyway – think how quickly norovirus goes round a cruise ship. We should think twice about getting on public transport.

We need to take all these steps. But this won’t be achieved by individuals choosing to skip the Watford-Liverpool game. Or whatever. This requires action at governmental level. It can’t be left to individuals.

It needs strong leadership and courage to think the unthinkable, to endorse extremes. China is showing the way on how to treat this outbreak. Sure the measures seem Draconian. Civil liberties are being flouted in the battle against coronavirus. There are restrictions on movement, forced quarantine and heaven knows what else. Extreme problems call for extreme solutions. But they’re working.

Normally I would be the first to cry ‘foul’. The first to complain about the loss of freedoms. But these are not normal times. Civil liberties are all very well but not when staring down the barrel of a gun. The preservation of civil liberties is of course admirable. But it may well come at the expense of a much higher death toll. And nothing erodes your freedom quite like being dead. For the moment, pragmatic survival beats principled extinction. This isn’t Braveheart.

As I write, and I can’t quite believe I’m saying this, I think we need to brace ourselves for some remarkable approaches to disease management. I’m pretty sure they won’t be attractive. I’m pretty sure they will seem extreme and we may question whether we are in a democracy. But they might, with our cooperation, just possibly help. I don’t think they will turn the tide against the virus but they might, just might, slow it down sufficiently that our health services can cope. They might even buy us the time to develop a vaccine. If not, they will be swept away in the wave of infection that follows. We have to fight.

Prefer to bury your head in the sand? That’s your choice. I prefer to think and to write about what I see as a global health emergency. I don’t believe one should panic – panic is counter-productive – but I do think one should be anxious. Also steadfast and determined.

Besides we haven’t got the time to panic. We face a stark choice. And we face it not next week, not tomorrow, but right now. The enemy stands unseen at our door.

But we are not powerless. We can take actions, both personal and wider, to minimise the risk to ourselves and to others. We’ve been here before. In 1940 all seemed lost. But actions taken by individuals and by governments combined to fight off the threat. The more you look at it, the more we can resist. In bacteriological terms, we really will fight them on the beaches.

The long unwinding road

Essays on Parkinson’s, research, advocacy travel and more by gentleman neuroscientist Dr Jon Stamford

Before you get the wrong idea, may I say that this is not explicitly a book about Parkinson’s. There is a whole bundle more stuff in it than that. Parkinson’s is a theme certainly – I have Parkinson’s and with the best will in the world it’s hard to shake off its influence on my daily life. But the book goes much beyond there. I have divided the book broadly into three years. This is mainly to give a context to some of the more ephemeral pieces that would otherwise not make sense such as the piece on Brexit in 2016. That probably gives you also a clear understanding that there will be some politics amongst the pieces. Don’t be put off. I have balanced it with other less knuckle whitening subjects. There is also a distinct whiff of nostalgia in some of the pieces as I recall my Yorkshire roots. And as if that was not enough on its own, I’ve even treated you, dear reader, to some of my thoughts on Wagner’s music. You lucky people.

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The greatest story ever told?

The Wagner scholar and philosopher Brian Magee once stated that great music was music greater than it could be performed, or words to that effect. In essence his thesis was that the music was greater than could be mirrored in a single performance. There were many different ways of interpreting the music, each equally valid, but none representing more than a partial view of the work.

Nowhere is this more true than in the work of Richard Wagner in general and, specifically in his colossal masterpiece Der Ring des Nibelungen. Even by the standards of Richard Wagner, and he wrote some very large operas, the Ring is monumental. A trilogy of operas with a preparatory vorabend, the work is on an unprecedented scale. The vorabend itself, 150 minutes without an interval, is longer than most operas. Most think of it as a tetralogy.

In the 140 years since its premiere at Bayreuth in 1876, no work has been more analysed, interpreted, misinterpreted, championed, vilified, adored, hated or studied than the Ring. One thing it has never been is ignored. Wagner’s music and especially that of this tetralogy stands as a monolith over the 19th-century, influencing philosophy, drama, music and politics ever since.

The music of Wagner has been adopted, or more accurately misappropriated, by politicians to their own end. Especially right-wing politicians. And there is no sadder association in this respect than with the ideology of Adolf Hitler. Wagner was no right-wing politician. He espoused left-wing ideals and revolution. Apart from his lamentable anti-Semitism, his politics were allied more with the left than the right. And even his anti-Semitism came second to art – the world premiere of Parsifal was conducted by Hermann Levi.

It is one of the greatest tragedies of mankind that a deluded Austrian corporal should have built his own perverted ideology on the flaws rather than the strengths of Wagner’s character. His mistaken grasp of Wagner’s key philosophy destroyed an entire world order. We should not be surprised that our perception of Wagner is tainted by this association.

Normally I would not discuss politics in the context of opera but the Ring is such political opera that it is impossible to ignore. At one level the tetralogy is a gigantic fairytale saga of gods, men, giants, dragons, dwarves and heroism. And the operas survive perfectly well as nothing more than that. It is easy to stage a production of the Ring that concentrates on the magic and good old-fashioned storytelling. For many, that is the way into the world of the Ring, an easy way of dipping one’s toes into the visual and sound world of Wagner.

But the Ring is so much more than fairytale. The Ring is a political drama. Alliances are forged, truths are told, friendships are betrayed on the altar of expediency, power is widely used and equally abused. The events of this mighty drama, stripped of their winged helmets and horns, are as relevant today as ever. The drama of Gotterdammerung has been played out in Bosnia, in Somalia, Rwanda and elsewhere. The Ring is as meaningful today as ever.

The Ring is also an exploration of human psychology. How are human beings motivated to take one course of action over another? What drives and urges determine action? How do people balance short-term and long-term benefit? Do human beings truly behave altruistically? Where does personal benefit end and collective good begin? How are choices made and factors weighed? All of this and more forms part of the fabric of the Ring.

Interwoven throughout this complex fabric of fairytale and politics is a very human story of love in its many facets. There is love at its most conventional, represented by marriage, on the one hand. There is the forbidden physical love of brother and sister. And there are all points in between. The Ring is as much an exploration of love as anything else.

To regard this tetralogy as somehow irrelevant to our current times is to betray, at worst, a fundamental lack of understanding of the work or, at best, a disinterest in life and its many features. There is no work of modern art to parallel Der Ring des Nibelungen.