Health

The mayor of London, Sadiq Khan, is planning to install a statue of John Chilembwe in Trafalgar Square. Mr Chilembwe was a Malawian Baptist famous for, among other things, leading an uprising where the head of a Scottish farmer was chopped off and put on a pole. He is much revered in his home country for all this and his face has appeared on banknotes. In truth, Mr Chilembwe didn’t incite the murder of many people, in the great scheme of things. If the mayor is searching for a murderer who did punch his weight, he could do worse than hoist up a statue of Francisco Macías Nguema, the former dictator of Equatorial Guinea.

Where have all the GPs gone? Doctors were among the first to be double-jabbed, ahead of teachers in the queue precisely so they could resume seeing patients in the flesh. But while schools have long been back, GPs have retreated behind their laptops never to be seen again (at least not in the flesh). The stethoscope has been replaced by a headset — to the despair of patients with ailments that are hard to diagnose over the phone or via a laptop. In theory, GPs can claim normal service has resumed. In the pandemic the number of appointments almost halved to just over three million a week — in spite of attempts to keep healthcare running. The consequences of this drop can only be guessed at.

At Redwall Abbey Does fiction provide any guide as to the ultimate fate of Labour’s Red Wall? — Redwall Abbey was the setting for a series of children’s novels written by Brian Jacques between 1986 and his death in 2011. It revolved around the peace-loving creatures of Mossflower Wood who were forced to fight invading vermin. The first of the novels, called Redwall, featured an orphaned mouse who had become a novice monk and was forced to fight off an evil, one-eyed rat. At the end of the final novel, published posthumously, an otter and hedgehog emerged triumphant over the ‘vermin’ — a loose band of creatures which included rats, foxes, wildcats, magpies, rooks and crows. Critics complained that the plots were somewhat repetitive.

How do I know that Britain’s Covid crisis is over? The fakers are back. The hypochondriacs, the psychosomatics, the pseudo-fitters, the attention-seekers and the lonely. They’ve started to return to the acute medical ward where I work. They’ve been gone so long I actually almost missed them. This collection of patients, who take up time and resources inversely proportional to the state of their physical health, simulate symptoms for gain (malingerers), simulate/induce their symptoms for the pleasure of the sick role (Munchausen’s syndrome) or genuinely experience symptoms such as pain, seizures or paralysis in atypical ways with no physically identifiable or treatable cause (now vaguely termed ‘functional disorders’).

Soon, as the rates of coronavirus deaths and infections plummet, we’re likely to focus more on those who suffer what is being called ‘long Covid’ — yet the truth is we know very little about what precisely it is. Long Covid began as a quiet murmur in the background: anecdotal stories about symptoms which extended beyond the predicted 14-day recovery time. There’s no agreed definition, so it’s hard to say how many sufferers there are, but a survey from the Office for National Statistics suggests it affects as many as one in ten of those who have had the virus. As the second wave retreats, the number of people left with long Covid may exceed those currently infected with the virus itself.

Hippocrates prescribed it to allay lassitude, James Bond favoured it as a token of his manliness, and in less indulgent times Gordonstoun school insisted on it: the cold shower. And now it’s having a moment with the wellness brigade. (The very word ‘wellness’ used to send me screaming from the room: a Californian import, I was sure. Then someone pointed out that the word has been in the English lexicon since the 17th century, so that told me.) The proven physical benefits of exposure to cold water are impressive. A boost to the immune system, improved circulation, and a wake-up call to the body’s brown fat, which is apparently A Very Good Thing.

Is it ethical to lock us down again? This is not a facetious question. Over the past eight months, we have heard a great deal about the policies used to manage the virus, but very little about the ethics. This is a mistake. We should be asking how we can critically and reasonably strike a balance between conflicting values and interests. Yet even now, with so much at stake, this basic question on the ethics of our policies is not being properly asked. When it comes to public health, the ethical balance is simply expressed: how do you achieve a certain public health goal with the fewest restrictions on individual rights? If the goal is to reduce obesity, for example, then is it justifiable to tax sugar — and if so, to what extent?

Vice squad Donald Trump catching Covid-19 has concentrated minds on what happens if a US president dies in office. Normally, the vice-president will take over — which is why it matters who is on the ballot. In 1972, however, Americans had no idea who would end up president by the end of what should have been Richard Nixon’s second term. Nixon’s vice-president was Spiro Agnew, but he was forced to resign after pleading ‘no contest’ to charges of tax evasion. Nixon then appointed House leader Gerald Ford as vice-president. Ford became president when Nixon himself resigned before he was impeached over the Watergate scandal in August 1974. Ford lost to Jimmy Carter in the 1976 election and so was never elected by the American people in a national election.

How much should we pay to save life? The question is often viewed as distasteful: you can’t put a price on human life. But resources are finite. Even if the only purpose of life was to prolong it for as long as possible, there would be limits to healthcare affordability. So if resources are limited, how can their application be made fairly? And how can this logic be applied in a pandemic? One element when establishing a fair method is to consider life years saved rather than lives saved. This recognises that someone of my age (55), who has already enjoyed two-thirds of his likely life span, should be a lower priority for treatment than a child who has had barely a tenth of theirs.

You have to admit it, Operation Warp Speed is a good moniker. It’s the name for the American interagency programme, initiated by the Trump administration, to produce 300 million doses of a safe vaccine for Covid-19 by January. Who couldn’t get behind this all-hands national effort to defeat the virus and end the pandemic, excitingly named after the faster-than-light space travel in Star Trek? While we wait for clinical trials led by the University of Oxford and AstraZeneca in the UK, America warps ahead. Warp speed allows the Starship Enterprise to put aside the laws of physics. Vaccine development also has its own laws, or rather guides, that describe the way things usually happen.

What have we been witnessing these past few months? A worldwide crisis caused by the arrival of a new virus of exceptional virulence — or a crisis of awareness, in which incomplete information led to a wildly disproportionate reaction? Have lockdowns, face coverings and the rest saved millions of lives worldwide? Or have they had relatively little effect on the course of the pandemic, and ended up causing more harm than good? And why, so far, is Britain not seeing the surge of Covid-19 infections reported in Spain and France? What are we missing? We still know a lot less about Covid-19, and about viruses in general, than you might have been led to believe.

The best way (and with politicians sometimes the only way) to know whether people are aware they’ve made a mistake is seldom to put that question point-blank. A reflexive ‘oh no I didn’t’ kicks in. Do you honestly think, for example, that government ministers are privately confident that as Covid-19 swept the country, hospitals were right to send elderly patients back untested to care homes, even with the limitations to our knowledge at the time? Of course not. But something stupid about British politics appears to constrain them from saying so. Possibly, before trying to persuade us, they have persuaded themselves they were justified; and we all do this to some degree.