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Thoughts from Pontevedra, Galicia, Spain

Random thoughts from a Brit in the North West. Sometimes serious, sometimes not. Quite often curmudgeonly.

Thoughts from Pontevedra, Galicia, Spain: 4 November 2020
04 November 2020 @ 10:34

Night’s candles are burnt out, and jocund day stands tiptoe on the misty mountain tops.

Spanish life is not always likeable but it is compellingly loveable.  

- Christopher Howse: 'A Pilgrim in Spain'*  

Covid 

Germany. A lockdown even there. 

It comes to something when the best overview - albeit only for the UK - comes from the satirical magazine, Private Eye. See the article below. Jump out comment: Lockdown is as a last resort that  proves you have failed in the basics of public health.

Living La Vida Loca in Galicia/Spain

New allegations of corruption against an old man who was once a much-loved young hero. Sic transit gloria . . .

I arrived in town at 12.30 yesterday, to face/hear the threatened cacerolazo in full swing, which went on until 12.45 and which was pretty noisy. But effective?

Elsewhere, the reactions to anti-virus measures have been more physical. As the government is said to be considering a 2nd lockdown from November 9, we could see a lot more of this.

Here in Galicia, a local paper tells us that: 60% of drivers re-offend but only a 3rd are fined. And that: More than 100,000 Gallegos admit to driving without a licence (and, thus, insurance). No wonder our premiums are said to be the highest in Spain. 

María's Falling Back chronicle, Day 50.

This looks like being a good read: Fascism, Freedom and the Spanish Civil War: The tragic idealism of the International Brigades, by Giles Tremlett. I’ll let you know.

The USA

The Democrats' failure to understand the nature of Trump's appeal has left us with this near-perfectly divided result. We will have the worst possible result. Even if Biden edges it, this election will be a pretty much perfect exemplification of the implacably divided state of the nation. If Trump barricades himself into the White House and drags the whole thing into the courts, the battle will break out in the streets as well and this will begin to look like civil war. He is already challenging the legitimacy of the process – as indeed he began to do weeks ago in anticipation of precisely this outcome. 

Perhaps only one thing is for sure right now  . . . Trump's repugnant behaviour will certainly become more egregious if he manages to win a second term.

What a divided nation. A paradigm for no one. A bloomless rose.

A curse on  both  houses?

The Way of the World 

What chance democracy? In the UK at least. See the 2nd article below.

Finally . . . 

As coincidences go, this was an apposite one . . . Reading my diary for late 2000, I noted that I had, indeed, laid small granite stones on the surface between the path and lawn back then. Which gradually disappeared below the sward. I also discovered that there'd been at least 4 leaks from this (relatively short) pipe, rather endorsing my vibration-against-the stones theory.

THE ARTICLES

1. Private Eye: A UK Overview, from the medical correspondent, 'MD'

We are not alone ... 

Like the UK, many countries are experiencing a second wave of Sars-CoV-2 infection, even Germany. It's hardly surprising as the virus spreads invisibly in the air and on fingers, often asymptomatically. It will wax and wane for some while yet, particularly indoors and in poor ventilation. 

In the first wave, the UK came near the bottom of the Euro league for preventing both Covid deaths and harms and non-Covid deaths and harms. There have been almost 800 excess deaths from heart and circulatory diseases in people aged under 65 since the pandemic began, perhaps because they were unable or unwilling to seek treatment. 

The latest analysis of 2I industrialised countries published in Nature Medicine put England and Wales second (behind Spain) in per capita excess deaths between mid-February and May, with a 37%  increase from the five-year average. Scotland was fourth. As the senior author, Professor Majid Ezzati, put it:  "We cannot dismantle the health system through austerity and then expect it to serve people when the need is at its highest, especially in poor and marginalised communities." The chance of the UK now topping any table for good performance in the second wave would be extremely unlikely. The best we can hope for is to faiI better.

An unbeatable virus? 

In January, MD thought a pandemic could be prevented because the SARS virus would behave like the 2003 version. I couldn't have been more wrong. Sars-CoV-1 was actually more virulent than its successor. But it was less infectious, and infections were easier to spot and contain because they usually involved obvious symptoms, and that is when most spreading occurred. 

This year's SARS is a bugger to control because some spread occurs pre-symptomatically and most of those infected have no or minimal symptoms and come to no or minimal harm. This makes it doubly difficult to identify spreaders and persuade them to make huge sacrifices for others that may involve considerable health and economic self-harm, and possibly job loss. 

Catch-a-virus 22 

If  a harmful, contagious virus gets out of control (again), you have to act. But your actions may not work or may do more harm than good. More people may die or be harmed from non-Covid causes than Covid, and lockdowns may worsen public health and immunity so people come to more harm if they do catch the virus. 

Worse, we don't have much solid evidence to support any course of action in the long term, or reliably predict the benefits, risks and alternatives. It's a huge gamble with no obvious winner. No matter what your favourite expert says (there are no true experts in pandemics; just expertise in myriad disciplines), decisions are riddled with uncertainty. The known unknowns arc overwhelming, never mind the unknown unknowns. It's the mother-of-all Catch 22s. 

Learning from the best 

To control a pandemic, you need a world class test and trace system and world class public compliance. We have neither. As a safety net, you need world class levels of public fitness, so more people make full recoveries from infection, and world class health services that can cope with a surge of infection without closing down the non-infection work. And you need a world class welfare state to help the long term sick and unemployed. As Boris Johnson has discovered, merely calling something "world class" doesn't make it so. 

The British position 

There are some things we should have fixed in the first lockdown (eg emerging with a fully functional, joined-up test, trace, isolate and support system) and  some things we couldn't fix that quickly. 

Waiting times and health and social care staff shortages were at an all-time high before the pandemic and have grown worse. We built all these amazing Nightingale Hospitals that could have been used as "fever hospitals" to allow the rest of the NHS to focus on non-Covid work, but we couldn't staff them. So they were barely used. 

The health of the nation is also poor. The virus is more likely to harm those with chronic disease and frailty, and there are 15 million such people in the UK. It is impossible to shield so many and, even if we could, many would refuse to be shielded. We are not China, but we do do lockdowns. 

The lockdown paradox 

Lock down is regarded as a last resort that  proves you have failed in the basics of public health. If you can't put out the fires of infection before they spread out of control, you flood an entire community, drowning those who can't swim. And the later you leave lockdown, the longer it takes to work. Non-Covid harms rise dramatically and people are so stir crazy by the time they get out, they ignore all the rules in favour of human company. 

We know this from lockdown number one. It did rapidly cut transmission for a short while, but now we're back where we started. Do we twist or stick, go regional or national? 

Regional or national? 

Labour's Keir Starmer is siding with SAGE and a two- to three-week national circuit-breaker lockdown for the whole of England, similar to the Welsh "fire-break" that adds the cherry of denying English entry from high risk areas. 

Boris Johnson favours a regional approach that is proportionate to the current levels of prevalence. Neither will work if they are introduced too late (SAGE advised a break on 20 September; Starmer's suggestion of overlapping with half- 

term is too late). More pertinently, if testing, tracing and pubic compliance don't improve dramatically, we'll be back where we started within a month of stopping. 

Meanwhile, Chris Whitty, England's chief medical officer, believes the regional tier system won't be enough, but has assured us that "we will be better at dealing with the virus next winter". 

Non-compliance 

Long before the Cummings effect, MD predicted that non-compliance would be the future key factor limiting our pandemic response. The British don't do what experts advise, certainly not in the long-term. Only a third of patients take their tablets properly; a third take them sporadically and a third hide them in the cupboard under the sink.

Research suggests that to improve compliance with health advice, people have to trust the person giving the advice, to feel involved in the decision making, and be given an honest appraisal of the pros and cons of any option. Advice has to be easy to understand and follow, and affordable. People have to believe they are benefiting. Did all that sacrifice during lockdown number one do more good than harm, or are we back where we started but a lot sicker and poorer? 

Pandemic compliance 

Pandemic compliance adds an extra level of complexity. People who arc struggling but at low risk of harm from the virus are asked to make huge sacrifices (eg lose their jobs) to prevent others being harmed. In doing so, they harm their families. 

People are more likely to comply if they're harmed by the virus or know someone who has been.just as smokers are more likely to stop after a heart attack. But the vast majority aren't harmed even if they do get the virus, so many people are finding reasons not to download the official NHS Covid-19 App, to isolate or to quarantine. Until this is addressed, all funher restrictions will fail in the long term. 

Role models 

Just as a smoking doctor is worth billions to the tobacco industry, a rule-breaking leader is the virus's best friend. US president Donald Trump's survival wasn't that surprising (the majority of 74-year-old men do survive). Far more surprising if his behaviour hasn't seeded super-spreading. 

In the UK, Margaret Ferrier MP and Johnson's chief aide Dominic Cummings have likely damaged the pandemic effort by refusing to resign after travelling with symptoms (and in Ferrier's case, a confirmed infection). 

Herd immunity mirage 

Herd immunity means getting the R number below I permanently, without the need for control measures. Generally, it requires a vaccine and even then you get outbreaks if vaccine levels drop, the virus mutates or immunity is only transient. 

The mirage of herd immunity often happens temporarily. Things seemed to go swimmingly in the summer when the R number was below I; but our over-confidence turbo-charged the second wave. Holidays abroad, Eat Out to Help Out, sending schools, universities and workers back all at the same time - the mirage soon vanished. 

Grounds for optimism? 

There have been widespread outbreaks across Europe but so far death rates haven't risen to the levels seen this spring. There is always a delay between the two; but it could be that those most vulnerable to the virus have already died (at an average age of 82.4 years in the UK) and there will be fewer deaths now. There will still be plenty of harm: the average age of those in hospital is 58, and many will survive with long-term ill health. Few if any patients were denied a ventilator in the first wave, but many health and care staff are feeling overwhelmed and exhausted going into the winter. Give them a virtual hug. And the right PPE. 

Get fit for life 

Nobody knows how this virus will behave in future, but we do know your chances of being harmed by it are higher if you have one or more chronic diseases and obesity. 

On 20 September, SAGE published a lengthy analysis of"non-pharmacological interventions", including the "circuit break". However, it completely omitted lifestyle modifications that not only would improve Covid recovery but would also reduce the risk of the far more common non-Covid harms (cancer, diabetes, heart disease, stroke, mental illness, etc). There is very strong evidence of health improvements from stopping smoking, cutting alcohol, better sleep, better diet, regular relaxation and exercise. No drug comes near to matching these benefits. For a fraction of the cost of containing Covid, we could have improved the health of the poorest: big increases in years of healthy living; fewer premature deaths from just about all causes. 

Risk communication 

Risk communication has been poor in this pandemic. Relentlessly focusing on a single cause of death leads to woeful risk management. Daily Covid deaths not only need to be presented in the context of deaths from other causes, but we also need to know the "years of life lost". 

Many of the excess cardiac death have been in the under 65s, but the average age of a Covid death is 82.4 years, above the average Iife expectancy. It may well be that Covid deaths have zero effect on average life expectancy, whereas the preventable non-Covid deaths from cancer, heart disease and miscarriage do. 

Isolation help 

Fewer than 20 % of people are isolating properly, and all other measures will fail unless we fix this. Individuals and regions simply will not comply if they struggle to put food on the table or fear losing work. 

Going door to door and supporting people to do the right thing is tough, demanding front-line work. Local authorities that have cracked it are using local people with contact tracing expertise and local knowledge. The exclusion of GPs from testing and tracing has been a huge error. The £I 2bn outsourcing bill invested locally could have delivered better results and left permanent structural improvements in public services. 

But this government prefers to fund the private sector and management consultants. 

Kindness and self-care 

The government clearly isn't capable of protecting your health, but you are. If you can, try to get outside, stay active, socialise safely, eat food that's delicious and nutritious, take vitamin D, have five portions of fun a day, relax and sleep well. If you live in a lower risk area, you might frequent local cafes, pubs and restaurants, but follow the rules. Well ventilated venues are safest. If you 're shitting blood or have a new lump, ring your doctor. 

If you don't have long to live, make up your own rules. 28,000 more deaths have happened at home this year, partly because people don't want to be separated at the end of life. Who can blame them? 

At 58, MD is the average age of a Covid hospital admission, and I'm taking all sensible measures to avoid infection. 

However, my personal risk of heart disease, stroke, cancer and mental illness is far higher. Life is about balancing all sorts of personal risks and then helping those who are less fortunate. For every decision, think: "ls it intelligent? Is it kind?" 

 

2. The dictators have taken over. Peter Hitchens

There was once a famous Chinese executioner so skilful with his razor-edged sword that crowds would pay to watch him behead criminals.  One day he came to a small provincial town where the authorities had given him a large fee to do away with a notorious killer. He entered the arena and made several elegant and delicate passes with his weapon. The condemned man sat gloomily before him, looking unimpressed with all this fuss. ‘Just get on with it!’ he growled.The executioner bowed politely, smiled and said softly: ‘Kindly nod, please.’ The murderer did so and his head, already parted from his body by a stroke of incredible swiftness, tumbled from his shoulders.

I think we in this country are like that condemned man. A terrible thing has been done to us but we have not yet realised it. It may even be that the British Revolution, a horror that this country has repeatedly escaped by good sense and natural conservatism, has actually taken place.

In a lecture of astonishing power and force last week, the former Supreme Court judge, Lord Sumption, revealed in sad detail what has happened to our country in the name of Covid.  I have placed a copy of it and a recording on the Peter Hitchens blog and I strongly advise you to read and watch it. It says that Parliament has been elbowed aside by Ministers who rule by decree.

Now, Jonathan Sumption is not just a brilliant lawyer. He is also a distinguished historian.  Last year he gave the BBC’s Reith Lectures, and they were the best for many years. If he has any politics I have no idea what they are, but he uses language with immense care. If he says this ‘has been the most significant interference with personal freedom in the history of our country. We have never sought to do such a thing before, even in wartime and even when faced with health crises far more serious than this one’, then you may be sure that this is so. When he says ‘Ministers are accountable to no one, except once in five years at General Elections’, you may be sure that this is true. This a complete breach with centuries of law and tradition, and who can say where it might end? When he points out that laws, backed by tyrannical, ruinous fines, are now made at televised press conferences and enforced by bluff by police forces operating far beyond their authority, then it is happening.  He accuses the Government of showing ‘a cavalier disregard for the limits of their legal powers’. This, he says, is how freedom dies. And behind it lies an astonishing, previously unnoticed seizure of economic power, which has made the entire Covid panic possible. 

By long tradition, Parliament has had ultimate control over the Government’s purse strings. It must permit major spending specifically. Without this power it is just a mascot or a toy.

That power has been abolished. Back in March, unnoticed by almost everyone, Parliament vastly increased the Government’s freedom to spend what it liked. The old limit, for emergency spending, was increased from a mere £11billion to almost £270billion a year.

I cannot say where or how this will end. It is my own growing belief that Johnson and Hancock do not understand what they are doing. Their decision to strangle our struggling economy once again in an alarmist shutdown is one of panic piled on panic and is visibly destroying the NHS they claim to be saving, as well as laying waste to those jobs and businesses they have not yet ruined or obliterated. I see them as two schoolboys on the footplate of an old-fashioned steam locomotive, clattering into deepening twilight, too scared to call for help, too vain to admit their error. They started it moving by accident, foolishly pulling and pushing at levers whose functions they did not know. Now they cannot find the brakes. The safety valves are blocked. The whistle screams, the pace gathers. Alas, the rest of us are trapped in the lurching, bucketing train behind them, unable to reach or influence them, let alone stop them.

 

* A terrible book, by the way. Don't be tempted to buy it, unless you're a very religious Protestant.



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