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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: 9 November 2020
09 November 2020 @ 11:45

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

Could an iodine mouthwash be a new weapon against coronavirus? One of the world’s leading authorities on infection in the mouth and nose believes the answer is yes. BUT: Sceptics say that the effect could last just a few useless minutes, and point to a mixed bag of results for the mouthwash against viruses such as colds. AND: Though the mouthwash is well tolerated, there may be unforeseen risks and little gain. Hey, ho. Research continues

Meanwhile, see the latest UK overview from Private Eye’s MD below, with details of Taiwan’s success. Which shames other governments

Living La Vida Loca in Galicia/Spain

Our ex king Chapter 4: The British connection . . .   It's reported that attempts to transfer funds from an account registered in Jersey - with a reported balance of nearly €10 million -  were recently detected by Spain’s anti-money laundering authority.

Cosa de España: Here's something that happened back in 2003 and possibly wouldn't happen now . . . I had a very Spanish experience yesterday, trying to get the guarantee for my mobile phone. There’s an obsession with paper and formality here. If I were working here, it'd surely drive me mad. As it is, I can bear it most of the time but, us with yesterday, I sometimes find it just too much. The sequence:-

1. Buy phone. Am told I need to come back in 2 weeks to get the guarantee 

2. Go back 2 weeks later and am told I need not only the receipt (which I have) but the instruction book from Siemens, which I don't.

3. Return (visit 3) to be told that all the documents have to be taken to the supermarket's central office (a hundred yards away) to get an "official receipt' issued. Then I've to take all the paper to the Information desk (100 yards more) to get the documents stumped and the guarantee issued.

4. Go to the office. The woman takes my papers and asks me for my ID number. This happens for virtually everything you do in Spain. I'm surprised no-one asks me for it when I put money in the pool machine. She goes away for 5 minutes and then gives me back my papers, stapled to the official receipt. 

5. I go to the Information desk. The guy looks through the papers and then tells me I need something which is missing

6. I explode and take back the papers from him. 

7. I go to the desk of the company which sold me the phone and demand help. The girl accompanies me back to the Information desk and the guy duly stamps the Siemens instruction book. 

So, something that would take 3 seconds (if that) at Dixons ("Here's your guarantee. Would you like to buy our phenomenally expensive 5 year extension?") has taken me at least an hour and generated a lot of frustration. And no-one seems to think it strange or ever says "I'm sorry you've had a wasted journey". It's as it they think that the whole point of time is to waste it, one way or another. It beats me how companies can afford (except through low wages) the costs which go with this inefficiency. I imagine it'll change when Spanish companies have to get slimmer after wages have risen to German levels.  

María's Falling Back chronicle, Day 55

The USA

Only in America?  A Woman has tried to sue Donald Trump for deceiving Christians and ‘dooming them to Hell’. She says Trump’s not a Christian because his actions are decidedly un-Christian. But, because he lied about being a Christian, other believers followed him, which meant they were sinning. And because they sinned, they’re now doomed to go to Hell. Which means she won't be able to love them for eternity.

Finally . . . 

PRIVATE’ EYE’S ‘MD’

The nuclear option 

Is a month of another lockdown long enough to get the virus under control in the UK? And how will we keep it there? Boris Johnson made no mention of fixing test and trace at his press conference, preferring to fantasise about imminent vaccines, better drugs and the army delivering 15-minute self-test kits to ''whole cities ... within days". But is there an existing route map out of the pandemic that avoids lockdowns, excess deaths and economic carnage? Step forward Taiwan ... 

The Taiwan way 

The Sars-CoY-2 virus may be rising again across Europe and America, but Taiwan hasn't had a locally transmitted infection for more than 200 days. This is all the more surprising given it's a crowded democratic island of23m people off the coast of China, with direct flights to Wuhan and many densely populated cities. 

Many residents live close together in apartments. In Sars 2003, it was the third worst affected country; yet in 2020, it has had only 555 confirmed cases and seven deaths, with no lockdowns and no second wave. 

Equally impressive, GDP is predicted to grow by 1.56% in 2020 and life is near to normal. On 8 August, Taiwanese singer-songwriter Eric Chou held a concert at Taipei Arena for more than 10,000 people, indoors and with no social distancing enforced. No outbreak followed. Sports, music, shopping, dining, drinking and dancing venues are at full capacity. How? 

The scars of Sars 

Taiwan began building an emergency response network for containing infectious diseases after Sars in 2003, which also originated in China and was more lethal than the current version but less infectious. As a result, countries closest to China bore the brunt, with Taiwan having hundreds of cases and 73 deaths. Hospitals had to be barricaded off. It became clear that unconstitutional emergency measures might be needed at the first signs of a pandemic and the habits of handwashing and mask-wearing became widely accepted, further reinforced by bird flu and HIN I outbreaks. 

Sunflower Movement 

They're used to living under high alert in Taiwan. Beijing has more than 1,600 ballistic missiles pointed at the island. In the spring of 2014, student protesters took to the streets in Taipei to express outrage at the incumbent KMT Nationalist Party's attempt to fast-track a trade deal with China. This "Sunflower Movement" continued into the 2016 election and helped the Democratic Progressive Party (OPP) win power, with academic Tsai Ing-wen becoming Taiwan's first female president. Public trust in her leadership has been crucial to Taiwan's pandemic success. 

Crack hacker 

Equally crucial to the country's success is digital minister Audrey Tang. Tang, a transgender civic hacker, was working in Silicon Valley when the Sunflower protests started but returned home to set up broadband connections and a digital strategy that helped the protesters win the political argument. On gaining power, the OPP appointed Tang as digital minister and used her expertise to crowdsource and share opinions to inform government policy- thus gaining public support for pandemic measures. 

Listen to whistleblowers 

When Chinese physician Dr Li Wenliang blew the whistle on the outbreak of a new Sars-like virus in Wuhan at the end of December 2019, his warning was reposted by a citizen on a Taiwanese civic network and taken seriously. In January, Taiwan set up a Central Epidemic Command Center (CECC) even before Wuhan went into lockdown. ft introduced travel restrictions and established quarantine protocols for high-risk travellers. Flights from Wuhan were suspended. 

Border control 

As an island nation, Taiwan realised immediate and lasting border control was the best chance of keeping the virus out. It was right. Today, and for the foreseeable future, it has a 14-day quarantine from all destinations for all arrivals, whether Taiwanese or foreign. There is "symptom-based surveillance" before travellers board flights. Arrivals can choose to go to a hotel for 14 days of physical quarantine or stay in their homes if they have their own bathroom and put their phones into the "digital quarantine", which tracks movements. They get US$33 a day as a stipend, but if they break the quarantine they are fined a thousand times that. Compliance is very high, as much from public support as fear of a fine. Taiwan provides meal and grocery delivery for those quarantining and friendly contact via Line 

Bot, a robot that texts and chats.  Track & trace, Taiwan-style 

Taiwan was ahead of the game going into the pandemic. In 2017, in response to the Ebola outbreak in West Africa, its centre for disease control developed a comprehensive, digital national contact tracing platform (TRACE). This was adapted for Covid in mid-January, and by the time the first infected person was discovered on 21 January it was possible to track the travel and contact history of every single patient. This kept the outbreak at a manageable level, allowing nearly all contacts to be traced, which in turn kept the numbers low- a virtuous circle, only possible thanks to immediate action before infections got out of control and widespread public support. The more successful track and trace is, the more public support it gets. People allow their phones to be tracked because it gets results. 

For each confirmed case, 20-30 contacts have been reached. 340,000 people have been under home quarantine, with fewer than 1,000 fined for breaking it - an impressive 99.7 compliance rate. As health minister Chen Shih-chung puts it: "We sacrificed 14 days of 340,000 people in exchange for normal lives for 23m people." 

Trust the people 

They have also been clever in Taiwan in situations where people are warier of tracing, such as nightclubs and bars. Based on work with HIV positive communities, they trusted venues to come up with their own contact tracing systems using codenames, single-use email or prepaid mobile phone numbers. This avoided data being sent to central government. 

Public trust is also high because digital networks are used to ensure transparency and information flows from the top down and the bottom up. Tang and fellow hacktivists have set up Taiwan, an online democracy and brainstorming site, to involve citizens rather than just dictating rules to them. Public involvement has improved the pandemic response and nurtured civic pride. 

The mask debate in the UK is hugely divisive, but in Taiwan they were rolling them off the production line and banning exports in January. Production increased from 2m to 20m a day. The aim was to have enough for everyone using a lightweight design that could be worn comfortably for a day. The vast majority of citizens comply. 

Humour, not rumour 

Taiwan has 3 pillars to its pandemic response: fair, fast and (surprisingly) fun. Rather than scaring the shit out of citizens with relentless killer virus death statistics, it uses humour: a cute dog called Zongchai, a shiba inu, which translates key messages into easily understandable pictures. For physical distancing, the caption says: "If you're outdoors, please keep two shiba inus awa y... If you're indoors, keep three shiba inus away from each other." Maybe you have to be there, but it seems to work. 

Humour is also used to stamp out fake news and conspiracy theories. One rumour, started by a toilet roll manufacturer, was that shops would run out because the same paper was being used to make face masks. Tang's team released a meme featuring Taiwan's premier Su Tsengchang semi-naked, with the caption: "We only have one pair of buttocks." It stated that the pulp in toilet paper was from South America and mask materials were all locally sourced. The meme spread much faster than the conspiracy; the ridiculous over-buying of bog roll stopped. 

National health system 

Taiwan has a well-funded and efficient single-payer health system covering the entire population. Unlike in the UK, citizens do not live in fear of accessing medical care in case they pick up Covid. In Taiwan there have been no waves of non-Covid deaths either. People with cancer and heart disease feel safe to seek help, and the health system is not overloaded. 

Suppress or simmer? 

Taiwan has a third the population of the UK so copying its suppression strategies would be more complex. However, Great Britain and Ireland are islands, and so could enforce Taiwan-style border quarantines but have chosen not to. New Zealand and Australia have much stricter border controls which allow citizens far more freedom within them. Local outbreaks still happen, but Victoria managed to suppress 700 new cases a day to less than a case a day. As they go into summer, the virus should be easier to control. 

The UK let the virus simmer over summer, rather than suppress it, with patchy testing and poor public compliance. So the second wave is much bigger than it needed to be. Hence the fears of NHS winter overload and another lockdown. But lockdown is like doing urgent heart surgery with a chainsaw. Don't do it and the patient dies quickly; do it and the patient still dies, but a little more slowly. How do you trade off the years of life saved from avoiding Covid with the years of life lost from suicide, poverty, domestic abuse, home heart attacks and other harms of lockdown? 

Can T&T be fixed? 

Suppressing a highly infectious virus that spreads without symptoms in sudden waves is extremely hard, and probably not possible without border quarantines to keep new outbreaks at a traceable level. Across Europe, T &T systems have failed to suppress a second wave. In the UK, £12bn has been spent on a largely outsourced system, but the message that local tracing gets better results is filtering through. 

More than I00 local authorities in England now have "tracing partnerships" with Public Health England. Blackburn with Darwen went live at the start of August and reached nine out of ten cases that the national system couldn't get through to; Calderdale council reached 86% of cases that otherwise wouldn't have had their close contacts identified. 

These partnerships should help provide financial and social support, and access to food or medicines. Local authorities know where their pockets of hunger and poverty are and urgently need the resources to tackle them. Local tracing is funded from a share of £300m government funding plus £8 per head for enhanced tracing and enforcement in areas in higher-tier restrictions. But it's a fraction of  what the private sector has been given. Local authorities must be fully funded to trace and support, with the help of local NHS and GPs, so when the numbers come down to a manageable level, we can keep them there. Next time we have to suppress, not simmer. 

Waiting for utopia 

Global herd immunity is the utopia of public health. It means enough people on the planet are immune to a disease, either via vaccine or exposure, to allow those who are still susceptible to travel freely without getting infected. Herd immunity could theoretically happen with Sars-CoV-2. And if we find a vaccine that works, we wouldn't have to vaccinate the entire population, just enough to keep the R number below 1. However, even when epidemics appear to have ended, they can fire up again quickly, and seemingly at random. No one is out of the woods yet. 

Herd resistance 

Many respiratory viruses mutate at random, which means immunity is never lifelong and vaccines are only partially effective and have to be repeated annually (eg for influenza). Even without vaccination, some people are more resistant to these viruses. Others are just better at washing their hands. 

The cold coronaviruses that infect humans give immunity that lasts from a few months to a few years, and Sars-CoV-2 may be similar. However, cold viruses are so common that enough people either have resistance to the current virus, or some cross-resistance from previous cold viruses, to hold infections in check. 

Sars-CoV-2 can be deadly, but was only the 25th commonest cause of death in the UK in August and is now the 11th. It may well be that most countries will end up in this state where the virus joins the many other causes of death each year, but not at a level that overwhelms the NHS. If we're all going to end up in this state eventually, the question becomes: how much damage are we going to do to ourselves in getting there? 

 

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



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