Health rationing and Covid

Over 30,000 people are in hospital in England with Covid. What does this mean?

The British Medical Association says doctors are stressed, anxious about their own health and that of their families, working more than normal hours and possibly beyond their competence in order to avoid serious harm. Final year medical students are fast-tracked, retired doctors are returning to practice. Doctors are working outside their normal specialty. The BMA drily states, “The skills of these professionals may not meet pre-pandemic expected standards of fitness to practise”.

The General Medical Council, appointed to govern doctors’ fitness to practise, reassures doctors that their careers will not necessarily be affected. They will take into account “the stress and tiredness that may affect judgment or behaviour”.

Hospitals lose their ability to admit patients for other matters. It is a terrible time to have a heart attack, stroke or cancer. GPs will be dealing with most health need, and so will cancel non-essential services, and use telephone or video consultations.

Where all facilities, equipment and staff that could be used to meet patient need are at capacity, “resource allocation decisions between individuals would become inescapable”. Rather than meeting individual need, the health service has to “maximise overall benefit”. This means refusing treatment to some patients. Normally, there is an “obligation to persevere in the face of an extremely ill patient”, leading to breaking ribs attempting to resuscitate a patient on ventilation. Some patients may have treatment withdrawn, even if they are slowly improving, to enable others to be treated, who have a “higher survival probability”.

It is lawful and ethical for a doctor to refuse potentially life-saving treatment where someone else is expected to benefit more from it. Doctors are not assessing the suggested value of a person to the community- younger or older, family responsibilities, work eminence- but their capacity physically to benefit. Individual doctors should be making these decisions according to rules set by their employers. The rules should be open and transparent.

Where care is withdrawn, patients will receive symptom management and end-of-life care for the dying. These decisions have a significant emotional effect on health workers.

Triage is a form of rationing of scarce resources. It sorts patients according to needs and probable outcomes. It can identify those who are so ill they are unlikely to survive, who will be given symptom relief. Priority “will be given to those whose conditions are the most urgent, the least complex, and who are likely to live the longest”.

These decisions should not solely be based on age or disability but likelihood of benefiting from available resources. Where patients cannot be admitted to intensive care they will not receive cardio-pulmonary resuscitation (CPR).

Where large numbers of people have apparently equal chances of survival and length of stay in ICU, at first there will be a queuing system- first come, first served. If patients are not improving, there may be a time-limited trial of therapy, and treatment withdrawn. In overwhelming demand, where a patient’s prognosis worsens care may be withdrawn.

Sometimes a patient’s contribution to essential services, where the workforce is severely depleted, may be taken in account. This means that sick doctors may be prioritized. Well, I would not object to that.

Hospitals are reporting shortages of oxygen. Blood oxygen saturation of 95% is considered normal, but in Southend the target was reduced, to 88-92%.

Cases in England are still rising, because of the Conservative government’s ridiculous promises of association indoors over Christmas, and failure to implement lockdown until after schools were opened on Monday 4th January. Deaths will continue to increase for four weeks. Hospitalisations will continue to increase for two weeks. Hospitals in London are overwhelmed. People who could have been saved with normal health resources will die.

The BMA’s FAQs are here. Their detailed guidance is here.

A target for our feelings

A Chinese man apologised for The Virus. Case closed? Unfortunately not.

He appeared sincere, and unleashed a wave of sympathy. No! Don’t apologise, people said, it isn’t your fault. You are not to blame. Do not feel bad. I can’t see how it would be his fault, unless he took the particular pangolin to the Wuhan wet-market. He is just Chinese, as if all Chinese people are responsible for the “China virus”. I hope not, because if so I am responsible for the British Empire.

He seemed sincere, though he could just be zoom-bombing, to find out how people would react. I had not seen him there before.

If he was sincere- it is possible-

we have all- seven billion of us, perhaps, or a good proportion of that- lost a huge amount this year. We have lost human contact, jobs, family, our understanding of the world and our place in it. Imagine, the whole world in mourning. Imagine waves of grief of people who have lost a colleague and suddenly their job is dangerous in a way it had never been before, or people who bought a house then lost their job, or people who have lost a child, or have brain-fog from long covid. Their pain is explicable. Now imagine people who are a little less secure than they were, who are not good with change, who don’t like the feel of masks on their face. They are mourning too, waves of grief, and their feeling is less explicable.

Feelings are best responding to the moment. You see them in animals. A dog gets angry, fearful or amorous and it deals with the problem immediately. The whole body responds. Two hundred million years of mammal responses, those etched-in brain pathways, and a few thousand years of civilisation do not equip us for emotional stimuli without a clear, immediate response. Angry- do a dominance display- other backs down- sorted. Sad- stop, rest, accept, move on. Now, instead, we get stressed.

Bad things have happened this year, and everyone is affected. Loss we cannot regain. Fear of loss we cannot certainly avoid, or not by some instant act like a mouse fleeing a predator. So we attach it to something. Anti-maskers attach it to Bad Law: there is a conspiracy to take our freedoms away, the virus is either a hoax or wildly exaggerated. I know one. Suddenly all that feeling sloshing about inside is explicable, and has a righteous outlet- shouting in Trafalgar square once a week, for the moment, it must be liberating.

We all know this. In other circs it’s called “kicking the cat”. A lot of HoBiT rage is misplaced emotion. You can’t shout at your boss so you shout at some harmless queer. And there is so much now. We have a pandemic to rage at, and lots of rules to say that feelings should be suppressed.

The people who told him not to apologise did not help. If he finds expressing guilt to Americans makes him feel better, why should he not? It could be catharsis, and attempts to manage it- “No, don’t feel bad”- might prevent that. He could be trolling for reactions, though.

Passion can be well directed. Someone might start a campaign. Anger can be fuel. Anger which cannot be used as fuel can be felt and acknowledged.

That we are all in mourning could bring us together or drive us apart. I want that Chinese man to be comforted, but want to hold myself aloof from the feelings he stirs up.

The Anti-maskers

I wear a face mask, because mask-wearing protects people from covid. I could not evaluate it for myself, I have to take that on trust, and here are two articles which persuade me to wear one. Cloth masks are imperfect but make a difference, I say, even if I could not explain perfectly what that difference was. It’s also the law, and public expectation, to wear a mask. I see a few face shields, and I imagine they are useless, as aerosol droplets small enough to float in air will go past them. I am aware of reasons not to wear a mask including lip reading, or the fear some will have with something covering their face. Masks are not perfect protection, but I think it’s on balance better to wear one.

It would help if we had a decent government. In the US, Trump is more concerned to stir division and win on 3 November than to save lives. In Britain, the government seems too concerned with image, its testing never matching its boasting, its rules seeming careless and arbitrary, also too concerned with appearance, not concerned enough to keep people’s livelihoods, sometimes too concerned with preserving capital values, intent on a damaging Brexit and turning Kent into a lorry park.

Ach, I am concerned with appearances too. I think we have an unpatriotic government, not concerned with the good of the British people, wanting to tear down regulation protecting us, damaging the bonds that bring society together, and I want to persuade others of that.

I need to trust, and the hard Right works against that. The febrile atmosphere they and social media create makes trust hard. And mask wearing is nuanced, as not seeing faces is sadness, even if you smile with your eyes, and they are not perfect protection.

In my spiritual, wisdom seeking, milieu, anti-vaxxers predate, and opponents of “Big Pharma”. I have given reiki myself, and it does people good. It’s OK to take a bit of reiki along with your chemotherapy, not OK to take reiki instead, and though again there is nuance- chemo may merely slow the growth of a cancer rather than shrinking it- I would prefer an oncologist’s advice to an aromatherapist’s.

So there we were, sharing feelings and wisdom, sharing ourselves, and in comes an anti-masker. She says she has a relevant degree, and resents being told she does not know what she’s talking about by people who have just read a few magazine articles (like me). Zoom chat lets her spread her arguments. She said mask wearing is a “Pantomime”, and that’s a wonderful word to dismiss it. Five say they agree. Two make comments which could be read either way. Three of us strongly challenge her.

for those who have been silenced or had anything held over their mouth then masks are about death

anyone who has ever been assaulted will know what it feels like to have masked strangers all around them and be unable to see their intent in the facial expressions

Er, um. I have been silenced, and assaulted. I get by, walking in the street, by not noticing others much. This makes sense, but she puts it too strongly. I would rather accept that some people are mask exempt. I don’t know if that person without one is exempt or an anti-masker- or has just forgotten to bring one.

one of the best things we can do for ourself and each other and the whole population is to support our own immune system.  Masks do not do that, mainly because they block our ability to expel infective agents.  All of us have Staph aureus in our systems – if that gets over grown, then it will make us very ill.  Many of us carry Streptococcus and if anyone has ever experienced what folks call ‘Strep throat’ you will know that it’s no fun.  If we interrupt these balances then we have problems – these are naturally occurring bacteria that will cause problems if we push them out of balance

I don’t believe, on balance, that bacteria I would usually expel will multiply on my mask and then be much stronger in my airways. If anyone can refer me to something authoritative on this, please do. I don’t want to dismiss it out of hand-

Even the woman who writes “We can’t let misinformation undermine science” takes herbal tea and ginger root for her immune system.

Yeats, again. The best lack all conviction, while the worst are full of passionate intensity. Anti-maskers can rile each other up in their web enclaves, and try to persuade others.

Also in that group an Indian woman talked of the poetry of Mirza Ghalib, “To Urdu what Shakespeare is to English”. I was sad that she felt the need to ask our permission, white people don’t. I found some in this ancient-looking website. He is really good:

On the subject of mystic philosophy, Ghalib,
your words might have struck us as deeply profound
and we might have pronounced you a saint …
Yes, if only we hadn’t found
you drunk
as a skunk!

—

Not the blossomings of songs nor the adornments of music:
I am the voice of my own heart breaking.

You toy with your long, dark curls
while I remain captive to my dark, pensive thoughts.

We congratulate ourselves that we two are different:
that this weakness has not burdened us both with inchoate grief.

Now you are here, and I find myself bowing—
as if sadness is a blessing, and longing a sacrament.

I am a fragment of sound rebounding;
you are the walls impounding my echoes.

—

All your life, O Ghalib,
You kept repeating the same mistake:
Your face was dirty
But you were obsessed with cleaning the mirror!

I want a nice, safe consensus on mask wearing, and that appears not to be available, though I heard of people shouting angrily at maskless strangers when I last went to the Swanston supermarket. Some of the propaganda sheets in the UK seem to be pro-mask for now. In Meeting, I had my wayward and disturbing thoughts, and they merged and mingled with my Awareness, stretching it, because it is not “My God”, but ours. Strange and disturbing things are part of how the world is.

1929.6.68 002

Reality-based caring

My friend, after research on the internet, concluded that the coronavirus could not have evolved naturally in bats or some link species, but had to have been genetically engineered. The thought made her miserable. Its release had to have been an accident, she thought, she could not see any reason why anyone would do that.

I don’t believe SARS-CoV 2 was genetically engineered. I believe it would be generally known if it were. I believe academia would ferret such things out, and publications I trust, such as the Guardian, New York Times, Washington Post, BBC, Atlantic or New Statesman would have publicised it. I have a high school education in physics and chemistry, and a lay interest in such writers and broadcasters as Jim Al-Khalili or Marnie Chesterton, so I have to take it on trust. I believe academia would debate that, and if it were true it could not be suppressed. I have read that the genome sequence shows that it was clearly not engineered, and can’t remember where.

And, the way human culture has evolved has caused the pandemic. It arose because of human encroachment into wild habitat, and exploitation of bush meat. It got a toe-hold because of the corrupt, terrified lower-ranking Chinese officials who threatened prosecution of Li Wenliang, the doctor who raised the alarm. I have no more reason to trust the Chinese investigators who, after Li’s death, recommended punishment for the officials who made Li withdraw his comments. The rule there seems to be “Don’t make us look bad- even in retrospect”. It rampaged through the US because their corrupt President knew it spread pre-symptomatically through exhaled aerosol droplets, and did not care. However there is not one person to blame, like a careless technician in a virology lab- we are all guilty, as Heinz Kiosk said.

Whether we react with sadness, anger or acceptance, there is huge communal and individual loss from CoViD- uncountable deaths, loss of jobs and businesses, economic depression. Possibly the thought of that terrible mistake lets my friend mourn it. Possibly I have not faced this great Fact of 2020 fully. My social life has improved, as people take to Zoom.

I wondered what Donald Trump meant by “radical left”, but he appears to attach the term to anything I would call “Reality based”. The Atlantic magazine prints conservatives such as David Frum, always introduced as George W. Bush’s speechwriter, and Anne Applebaum, who remains a small-state, low tax, respect for property rights conservative but a truthful one. The concept of “Reality-based” goes back to 2004, though the quote then seems to be about creating facts by concrete achievement- conquest, in that case.

“We’re an empire now, and when we act, we create our own reality. And while you’re studying that reality — judiciously, as you will — we’ll act again, creating other new realities, which you can study too, and that’s how things will sort out. We’re history’s actors . . . and you, all of you, will be left to just study what we do.”

Now, “creating reality” means pumping up QAnon.

Instagram’s QAnon Moms care deeply about children abused by Democrat paedophiles, and if I believed with them I would care too, enough to work very hard for Q+’s re-election as President. Now, Republicans seem completely mired in fantasy, but it was a long time developing, through their climate change denial, or use of the Laffer Curve to cut taxes on the wealthiest indiscriminately. Perhaps politics is a grim fight for group advantage, and those who pretend to idealism in the interests of the whole community are hypocrites or trapped in cognitive dissonance.

Do people care about their fellows? Most people think caring about others is an admirable trait. However we may see ourselves as caring, on evidence which is too easy. Does tweeting about Black Lives mean you care, or must you do something in real life?

I understand the logic of my radical feminist friend’s position on trans rights, just not its value. Trans women are men, therefore trans women in women’s space is as inappropriate as a forty year old in a children’s centre. She and her fellow campaigners don’t want to reduce the rights of the trans woman any more than the notional forty year old, but they should not be there. I don’t agree. If Sara Ahmed can be a feminist activist supporting trans rights, why can’t she? Could she step back from logic, and consider the advantages of trans inclusion? However she can campaign for the expulsion of trans women from the women’s spaces where we are, and claim not to be uncaring.

I last posted a week ago. I’ve been thinking of writing projects which are too ambitious to actually write, and writing for somewhere else. I can’t draw this post together, but it’s stuff I’ve been thinking about. Does caring do any good? Does it need to be Reality-based to do good? I think so, but not everything here argues for that.

Trans women need LGB people and cis women as allies

If a trans-excluder says that vulnerable women would be scared, seeing me in a women’s loo or changing room, I am silenced. My friends say, “Nonsense!” robustly, and I need that protection, because I am put into such a state of misery and fear that I cannot speak for myself. I just want to hide.

Saying I am dangerous, or that people reasonably fear me, is a threat, because it means that someone might feel justified in attacking me, to defend those vulnerable others. And, more, it raises echoes in me, of being the outsider, not accepted, which may be pre-verbal. It knocks the stuffing out of me. I am terrified. I lose all my energy.

So I am glad to have robust allies against the government’s plan to take away all protection for trans people. The pledge of the minister, Liz Truss, to “protect single-sex spaces” means working to exclude me, and a Tory peer’s extension of that principle to clothes-shops changing rooms show what they want. It is an emergency. Having caused thousands of unnecessary deaths, and repeatedly lied about the number of covid tests performed, they need out-groups for the populace to hate as our anger grows.

First up, the LGBT Foundation. This Manchester charity has been supporting and representing lesbians and gay men for over forty years. They have drafted an open letter to the minister for cis women to sign, to say they do not fear us. Please share it and get as many cis women- lesbian or straight- as possible to sign.

They point out, the language you have used is very similar to the anti-trans rhetoric used by transphobic hate groups and organisations such as Woman’s Place UK, Transgender Trend and the LGB Alliance. They say the evidence shows trans women are mostly harmless, and that medical treatment for trans youth is in the young people’s interest- as you would expect of medical treatment by NHS doctors. An actual, urgent feminist issue is that in covid lockdown intimate partner violence has increased, and they suggest the minister directs her attention to that instead.

We do not need protecting from trans people. Please focus on protecting us from the dangers that are killing women right now. If the Tory attack on trans people succeeds, they will come after lesbians and gays next.

This week, Liberty, Amnesty International and Human Rights Watch issued a joint statement. They say we are treated as outsiders without rights, and as always At times of crisis and political change, marginalised groups are often singled out for abuse and hate. We are not heard, but dehumanised, made to defend who we are. In Hungary, Russia and the US trans people suffer vicious attacks on our rights: We cannot allow this to happen here.

Trans men need allies too; but the attacks are different. Trans men are attacked as pitiable and mutilated, trans women as perverted and dangerous. Both are attacked as deluded. Allies point out the attacks are baseless.

A Covid timeline

Governments should have known the effects of Covid 19, and the UK and US governments should have acted earlier. Here are some relevant dates. I am also including some personal dates, for what I noticed and the state of denial I was in. Denial is forgiveable in citizens, but not in governments.

December 2019

1st: the symptoms begin of the man whose infection is the earliest laboratory-confirmed case.

16th: First admission to hospital.

31st: The Wuhan Municipal Health Commission confirmed 27 cases, and advised people to wear masks in public, and not to go to enclosed public spaces.

A report goes to the US Center for Disease Control.

January 2020

3rd: Dr Li Wenliang detained in Wuhan on charges of “spreading false rumours” which “seriously disrupted social order”.

10th: genome of SARS-CoV 2 published.

20th: cases reported in Thailand, Japan and South Korea.

23rd: China imposes lockdown in Wuhan. 25 deaths in total in China.

25th: UK government warns against travel to Hubei province, where the city of Wuhan is.

30th: WHO declares Covid 19 is a PHEIC, a Public Health Emergency of International Concern.

31st: Two cases of Covid 19 are declared in the UK. 259 deaths in total in China.

February

6th: First death in US, in San Francisco Bay area. However this is not announced until 21 April, based on post-mortem testing by coroner.

21st: Eleven municipalities in Lombardy locked down. First Covid death in Italy.

28th: WHO publishes report of the WHO China joint mission on Coronavirus Disease 2019. It reported that the disease was not airborne, but could spread in droplets in breath, and by fomites, which are inanimate objects touched by an infected person, which then infect others. Most clusters occurred in families. In Wuhan, 1800 five-person teams of contact tracers traced tens of thousands of contacts, of whom between 1% and 5% subsequently tested positive. Initially, the R₀ figure was 2-2.5. That is, each infected person infected 2-2.5 others. 6.1% of cases are critical: respiratory failure, septic shock, and/or multiple organ dysfunction/failure…Individuals at highest risk for severe disease and death include people aged over 60 years and those with underlying conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer.

First death known at the time to be of Covid 19 in US, in Seattle. 21 deaths in total in Italy. 2835 deaths in total in China.

March

3rd: In the UK, the Scientific Advisory Group for Emergencies advise against greetings such as shaking hands and hugging, given existing evidence about the importance of hand hygiene. However UK Prime Minister ABdP Johnson boasts, I was at a hospital the other night where I think there were a few coronavirus patients and I shook hands with everybody, you will be pleased to know, and I continue to shake hands. People obviously can make up their own minds but I think the scientific evidence is … our judgment is that washing your hands is the crucial thing.

5th: first death in the UK is confirmed.

6th: I meet a friend for coffee. We usually met monthly, and I proposed we meet in April. She thinks this won’t be possible. I am still in denial. In the coffee shop, there are boxes of tissues on the tables. Shopping, I note there is no spaghetti in the supermarket.

9th: All-Italy lockdown. All businesses except those providing essential services are closed. 463 total deaths in Italy.

12th: WHO declares Covid 19 is a pandemic. UK announces move from containment to delay strategy: no longer necessary to identify every new case.

13th: Sir Patrick Vallance, England’s chief scientific adviser, defends government policy saying it could lead to “herd immunity”.

16th: I meet a friend, who tells me that as he is 70 he and his wife will be self-isolating at home for the foreseeable future. I arrange to meet a friend in London on 22nd March. I am still in denial.

New York City in lockdown.

19th: pubs and restaurants closed in London. UK government downgrades Covid 19, meaning that a lower level of PPE is required to treat patients.

All borders and entry-ports in New Zealand closed to non-residents.

23rd: UK-wide lockdown announced.

25th: Nationwide lockdown in New Zealand. All businesses except essential businesses are closed.

26th: Regulations on UK lockdown published, and come into force.

27th: Johnson confirmed to have Covid 19.

28th: Mr Amjed El-Howrani, an ENT surgeon, is the first NHS doctor to die of Covid 19.

April

4th: Keir Starmer declared new leader of the Labour Party.

7th: Johnson in intensive care.

27th: My first experience of a covid-related con. The phone calls saying “We’re going to cut off your internet, go to this website” have stopped, but this call asked for donations for the WHO. As always, I pressed the button to speak to a person, and the woman was surprised when I said, truthfully and believing it, that donating to WHO would be a good thing in the pandemic. She told me a manager would phone me back to give me the account details, and I should pay either £199.99 or £299.

30th: official death statistics China 4633, Italy 27,967, US 63,856, UK 26,771.

May

8th: From 7 March to 8 May there have been 49,833 deaths registered above the five year average, in England and Wales.

10th: Johnson’s public speech, not to Parliament, saying people should go back to work. Stay Alert. Control the Virus. Save Lives.

11th: (Monday) Government clarifies they meant go back to work from Wednesday.

25th: Dominic Cummings gives a press conference at 10 Downing Street, and refuses to resign.

June

1st: further relaxation of restrictions. Most vulnerable shielding people told they can go outdoors. I don’t trust the government. Schools in England supposed to reopen: many do, some children return.

July

10th: I meet a friend for a glass of wine in her garden, for the first time since March.

I wrote this for social media debates on what was known and when. The WHO report is the moment when governments should take swift action. The UK death toll is the worst in Europe, higher than Italy’s, over 32,000, and I blame the UK government. In the week to 24 April there were 11,539 more deaths than the average for that week in previous years. This will include some people who did not seek medical treatment because of fear of going to hospital. Confirmed deaths from Covid 19 around the world were over 250,000. 22.5% of confirmed Covid 19 deaths in the UK are in care homes.

A government which does not believe in the value of government- to protect the people, to act for the common good- will not only be incompetent in acting, it will not understand what needs to be done or could be done. The British government has got rid of all its talent, which was not cravenly loyal to either Johnson or his destructive Brexit project, and shows worrying signs of caring more about appearances than reality: it claimed to reach its 100,000 tests a day target on 30 April, by counting tests which did not have a result communicated to a person tested, and the figure has dropped since. It would be better if they acknowledged that testing is important, and stated clearly what they were achieving, because when their pretense is stripped away they only look worse.

Additional deaths are the best way to find how many the pandemic is killing. The figures from the Office of National Statistics, for England and Wales not Scotland and Northern Ireland, for previous weeks are here. The figures for the official death toll, being UK deaths in hospital after a positive test, are here. How many deaths above the five year average were there in England and Wales?

Week to 13 March: 5 Covid deaths registered, 186 extra deaths.
Week to 20 March: 103 Covid deaths registered, 72  extra deaths. 258 cumulative.
Week to 27 March: 539 Covid deaths registered, 1011 extra deaths. 1269 cumulative.
Week to 3 April: 3475 Covid deaths registered, 6082 extra deaths. 7351 cumulative.
Week to 10 April: 6213 Covid deaths registered, 7996 extra deaths. 15,347 cumulative.
Week to 17 April: 8758 Covid deaths registered, 11,854 extra deaths. 27,201 cumulative.
Week to 24 April: 8237 Covid deaths registered, 11,539 extra deaths. 38,740 cumulative.
Week to 1 May: 6035 Covid deaths registered, 8012 extra deaths. 46,752 cumulative.
Week to 8 May: 3930 Covid deaths registered, 3081 extra deaths. 49,833 cumulative.
Week to 15 May: 3810 Covid deaths registered, 4385 extra deaths. 54,218 cumulative.
Week to 22 May: 2589 Covid deaths registered, 2348 extra deaths, 56,566 cumulative.
Week to 29 May: 1822 Covid deaths registered, 1653 extra deaths, 58,219 cumulative.
Week to 5 June: 1588 Covid deaths registered, 732 extra deaths, 58,951 cumulative.
Week to 12 June: 1114 Covid deaths registered, 559 extra deaths, 59,510 cumulative.

Between 7 March and 12 June, 48,218 deaths included Covid on the death certificate in England and Wales. There were 59510 deaths above the five year average.

More links:

14 April: NYT: New York ER doctor’s diary.
14 May (sic): NY Review of Books: Trump the Vector in Chief by Fintan O’Toole.
7 April: The Atlantic: Jacinda Ardern‘s leadership.
Ongoing: British experiences of working in healthcare.

Liz Truss and Anna Akhmatova

The world is changed utterly, since December, but one thing that continues is conservatives seeking out vulnerable minorities to hate, so as to spread division. Trans people, especially trans women and children, have been targeted by Liz Truss, “Minister for” (actually against) “Women and Equalities”. I will write to my MP.

Truss says she wants “Protection of single sex spaces”. She is lying. Gender Recognition has no effect on single sex spaces, which are governed by the Equality Act.

She wants us “Free to live our lives as we wish”- as long as we behave in increasingly constrained acceptable ways, restricted for the good of others. “Checks and balances,” she says. Oh, totally reasonable rules for the good of everyone. Ha.

And she says she wants to “protect” children and young people. Truss claims she is better qualified than specialist gender psychiatrists and endocrinologists to determine what is good for under 18s, and that is to make sure none of them have treatment to aid transition. She produces the Tory bugbear, the ordinary child hoodwinked by trans ideology rushing heedless into “irreversible decisions” to prevent trans children getting the care they need.

Meanwhile I went out for my daily exercise, and also wanted to take some photos of the eerie silent world we are now in. This out of town shopping centre would have been hoaching, but for covid 19.

And it was odd to see a Police Community Support Officer walking along this unmetalled road. We are allowed to be there for exercise, and I want to be there for time in nature, too, time with the birds and the lakes, to preserve my mental health. It is a lone young woman, I don’t think she’ll be arresting anyone, but she might be seeing if there were breaches of rules for a more heavy handed presence later. I saw her twice, both times studying a phone.

I am frightened, by a conservative government which handles the crisis badly, with more people dying of slow suffocation here than elsewhere in Europe, and with the deaths not accurately counted, but which still finds time to promote hate- quietly, subtly at first, with this new target. I am fearful for my vulnerable friends. And the world is beautiful. Never has the contrast been so sharp for me: it is always there, but it is so much stronger now.

Fear and loss.
Wonder and beauty.
Death and God.

Anna Akhmatova puts it beautifully:

Everything is plundered, betrayed, sold,
Death’s great black wing scrapes the air,
Misery gnaws to the bone.
Why then do we not despair?

By day, from the surrounding woods,
cherries blow summer into town;
at night the deep transparent skies
glitter with new galaxies.

And the miraculous comes so close
to the ruined, dirty houses
something not known to any one at all,
but wild in our breast for centuries.

I am afraid. I read a piece in the New York Times about how covid suffocates people so they don’t realise it, and immediately ordered an oxymeter. It is predicted to arrive in June. There is a small risk of my dying in the most hideous way, and a much greater risk for all the people I know who are over 70 or with certain conditions. Liz Truss chooses this moment to announce her campaign against trans people. Trans children must not be treated, as a political decision. Single sex spaces- No Transwomen!- must be maintained or extended. This is couched in terms of “protection”- protecting vulnerable women and children from the Trans Threat. I am more afraid than ever, and today the sunshine is beautiful.

---

I wrote that, and then thought, possibly I should give the minister the benefit of the doubt, until I hear more. In Scotland, the government offers a good reform, but still talks about single sex spaces. It is reassurance for the phobes rather than a serious threat to our rights. I am fearful and unknowing at the moment and it reduces my ability to trust. Then I remember she wants to stop treatment for children, and that is unequivocal. She trusts Daily Mail editorials over doctors. She trusts herself over specialist psychiatrists.

Leaving your house

No person in England may leave the place that they are living without reasonable excuse, during the emergency period. What might a reasonable excuse be? Some are listed in the regulations, but if you have to go out and a police officer challenges you, you can explain why and they must decide whether that is “reasonable”.

The regulations are reviewed every three weeks, so on 16 April Dominic Raab announced they would last a further three weeks, and may last months. He must also withdraw parts of the regulations, if those parts are found to be unnecessary. They will next be reviewed on 7 May.

The regulations are here. Paragraph 6 lists some reasonable excuses. Going to work is a reasonable excuse, including voluntary work, when it is not “reasonably possible” to work from home: even if the work is not classified as “essential work”. Shops are closed except those listed in schedule 2 part 3:  bike shops, laundrettes, dentists, and car repair shops but not car showrooms, are allowed to open. Businesses listed in part 2, such as hair salons, gyms and playgrounds, have to close. Theatres, concert halls and bingo halls, but not nightclubs, can open to broadcast a performance.

A friend can only attend a funeral if no family member or member of the household of the deceased will be there.

Giving care to vulnerable people is an excuse. Some vulnerable people are listed in paragraph 1- people over 70, “any person who is pregnant” (including trans men and non-binary people! Yay!) and any person with an underlying health condition, some of which are listed in schedule 1. So if someone is not included in that list, you might still argue they are vulnerable, and I think mental health conditions make someone vulnerable. Therefore I argue that visiting to talk to a depressed person is a reasonable excuse to leave your house. Isolation can make mental health conditions worse. Communicating electronically is not the same.

That is my argument for sitting on a park bench, or sunbathing in a park. Being outside is good for depression. There is class privilege here. I am articulate, and sound like a middle class person even if I do not always look like one. So I might try to persuade a police officer that I had a reasonable excuse for sitting on a park bench. Other people might not.

I argue if you go out with a reasonable excuse, doing other things incidentally is lawful. So the Northamptonshire chief constable saying that police could go through a shopping trolley to see all the goods in it were “basic necessities” (including pet food) was simply wrong. You can buy chocolate along with your tinned tomatoes and spaghetti.

The Crown Prosecution Service issued a practical guide on reasonable excuses. It says, There is no need for all a person’s shopping to be basic food supplies; the purchase of snacks and luxuries is still permitted. In general terms, a person has a reasonable excuse to visit the shops which remain open to customers under the Regulations. So even if you went to a permitted shop and only bought chocolate and alcohol, that might be OK, but I would stick in a pint of milk as well to be safe from police questioning.

The regulation says you can go out to “obtain basic necessities,” not “to go shopping”, so the guide says you could pick up surplus basic food from a friend’s house.

The guide says you can buy tools to repair a damaged fence, but not brushes and paint to redecorate a kitchen. That means they could actually look in your trolley, at the hardware store. Again, you could buy essential items, and also get non-essential items incidentally.

You can drive somewhere to go for a walk, they say, if you don’t drive longer than you are walking. This makes sense. If people from separate large towns go to a particular beauty spot, there is a chance for Covid from one town to pass to the other. It is a question of balancing risk. Other people will lawfully be going between the two towns. In France the distance you can go from your home to exercise is one kilometre. The guide says you can stop for lunch while on a long walk- or cycle ride, I would have thought- so they are imagining people being quite far from home.

The guide seems keener on interpreting the given reasons in the regulations, than considering other possible reasons, and possibly it takes a suspicious view. If someone has a row with their partner, and goes away to cool down, Moving to a friend’s address for several days to allow a ‘cooling-off’ following arguments at home is OK. This is explicitly under the “moving house” exemption. Moving out for a few hours, says the guide, is not OK. Possibly, they think people might use “cooling off” as an excuse for visiting friends whenever they wanted. Not every visit to a friend will be spotted by a police officer. But then people are going to allotments, which I think is reasonable, and they are not specifically mentioned.

I note the regulations specify to avoid injury or illness or to escape a risk of harm as a reasonable excuse- so if the house is on fire, or to escape a violent partner. Now it’s reasonable to state every excuse they can think of, perhaps, when drafting the regulations, but that this needs stated might indicate the police will question reasons not explicitly stated in the regs.

Don’t make mordant jokes to police officers. Irritated by delay, my friend once told a US border guard that the purpose of her visit was “subverting the government and constitution of the US”, and the official, with a weary sigh, said, “Shall we start again, Sir?” Don’t assume that the police officer is as forebearing. They may be angry and scared.

Before deciding you have committed an offence, police officer has to assess the evidence, which includes what you tell them. Therefore, they should believe you unless they have good reason not to. Cycling for exercise, I noticed a police van prominently marked ANPR. Then they consider whether your excuse is “reasonable”. If not they can tell you to go home, or take you home using reasonable force if necessary. If you are out without reasonable excuse you have committed an offence, and they can issue a fixed penalty notice. The penalty is £60, £30 if you pay within 14 days. The second fixed penalty notice is £120, the third £240, the fourth £480, the fifth £960.

This means that if an officer simply tells you what you should not do- don’t sit on that bench- they are giving advice, as they are allowed, rather than investigating an offence. Listening politely and saying as little as possible is a good tactic, in order to avoid such an investigation.

If a child is going out the police can order their parents to keep them in and the person responsible for the child is responsible for enforcement.

I don’t want to spread this disease. I have vulnerable friends and relatives. So we should all behave responsibly and not go out unless necessary, because going out might spread the disease. However there may be reasonable excuses for going out which the police don’t recognise.

Here’s a second world war poster to make us feel all British:

A Covid Death

Britain has a thousand deaths a day from Covid, because of Government incompetence, and in the US 7% of deaths had Covid-19 listed as a cause of death, from Trumpian incompetence, and I thought that by now everyone knows someone who knows someone who has died of this thing, and by the end we will all know someone.

On 27 March I met a man for the first time, in a Zoom social gathering. Over the video I saw a man in a mask deliver oxygen to his house- he needed it for health reasons unconnected to the virus, and I thought how vulnerable he was. He died on Good Friday. On Sunday I heard of some of his achievements, and why people admired and loved him. They knew him, I did not. He was over ninety.

It seemed to me when my father died his life was complete. I could think of him, his gifts, his career, two marriages, political work, and achievements, and feel admiration and gratitude and love. And this man (I don’t say his name here because it is almost to me like any other covid death) I can’t say that of him. Something killed him which first killed last year, which was not heard of before December. He would be alive, but for this randomness.

I feel more horror at the man’s death than that of Colin Morley. I knew Colin through Community Building, so we had shared some deep personal things, and in the sharing felt we were growing as human beings and as a group. I knew of Colin’s start-up, “Be the Change”, seeking to bring that growth to more people, and when he was killed in the London bombings of 7 July 2005, I had a slight personal link to that horror, though less than his family who loved him, less than hundreds of others.

The horror I feel at this death is my horror at what is unfolding. He would not have died if the rich did not flaunt their wealth by spending $150 on a pound of pangolin meat, whence the virus emerged, and if the Tory government could have stopped public gatherings a few days sooner, when it was clear what was happening in Italy and Spain would happen here. I met a friend for coffee on 6 March. The coffee-shop had boxes of tissues on the tables, and I was unsure whether covid caused a runny nose as well as a cough. I proposed we meet again in April, not really admitting to myself what was coming, and my friend knew that would be impossible. I would have hoped the British Government would have known too.

The Tories have caused untold deaths- only deaths in hospitals are yet known- by underfunding the NHS, and by cavalier failure to impose precautions timeously. We are social distancing too late. Johnson has been in intensive care because of his personal stupidity, shaking hands with covid victims and holding face to face meetings, and infected his partner and colleagues. The Tories have caused NHS workers to die by their failure to provide PPE.

In the gorgeous sunshine my life is comfortable. I cycled 9.5 miles in 45 minutes (280 ft of climb) and sat outside in the back yard reading. I am used to being alone, and while I would like to see friends am talking to more, actually, by screens. And the economy is sliding, the virus continues as a threat, the government still fails to test for it, and there is a tiny chance I could be one of those gasping for breath on oxygen in a hospital, alone and terrified. Intubation means a hard road of recuperation, learning to breathe again, coping with scars and wastage. And a chance I could get the virus and shrug it off in a week as a woman I know did.

I would feel a slight sadness at the man’s death, had it not been from covid. I would be sad for his partner (whom I have not met) and his friends whom I know. And I attach the death, it becomes a focus, for my own fear, my discomfort at uncertainty. My day to day comfort makes the threat seem distant, yet it is not, or I would not be affected by the death of a man whom I met once. I hear of his death and feel horror at the chance of my own.

I dislike the term “afterlife,” like “afterthought”. There is continuing life.

I wrote that I hoped Johnson recovered, and blamed him for his misfortune, and someone reacted with horror. “Shocking”, she said. “Appalling bad taste.” She could not make the distinction. I wish Johnson no harm, but I want him called to account for the deaths he has caused.

Quakers say, Accepting the fact of death, we are freed to live more fully. Blithely I denied it, and now face it. As always, my resistance to reality makes it more painful for me: I will not claim to have learned the spiritual lesson yet.

Covid dreams

My house is much cleaner than normal. I tidied away a lot of papers and stuff a couple of weeks ago, and have gone on a cleaning jag today, vacuuming crannies and crevices for dust. If a tiny particle can make a sufferer cough, irritating the airways further, I do not want my house as dusty as it was.

Eight percent of people over fifty coming down with Covid 19 need hospital treatment. My fear is that if I can phone and describe symptoms I will not be deemed sufficiently sick for transport or treatment, and if I can’t then I won’t be helped. And what that means for poorer areas without a fair hospital system horrifies me.

Oh I would like to talk face to face! I last had a friend over on Monday 16th. I like video calls, and now can attend Quaker meeting twice a week or even more- so I am having more conversation!- but I like hugs. Ministry is mostly guardedly positive- things are bad but we will be OK, quotes from 17th century Quakers- with occasional reminders of people who are particularly vulnerable.

And I think of people I know- people with MS, people over ninety, people who need oxygen to breathe even without 19. I fear for friends, I fear for people, I fear for myself. I am likely to suffer only minor discomfort, little more than any cold, but the worst possibilities are unthinkable. It is likely that someone I know will die of this thing.

The restaurants were told to close on Thursday 19th, and we were told to go into lockdown- only essential workers to go out to work, others can work from home if they can, stay at home but for one session of exercise daily and one shop weekly. Not having a freezer, and not always finding what I wanted, I shop more often. There are no rules yet on wearing masks. I don’t know the differences between masks, but with NHS staff angry about their lack of PPE, and the ENT consultant Amged El-Hawrani dying- he will not be the last- should I have a mask at all?

On Saturday I went to Asda, and was taken aback to find the front door locked. There was only one door in, round the back by the car park, and people were queuing quietly to be allowed in, one in one out, by the guards on the door. The aisles had arrows on the floor marking a one-way system, so we could keep 2m apart, and while I heard gallows humour a week before now it was silent. Again I could not get tinned tomatoes, but cooked with fresh tomatoes instead. I could not get basmati rice, but got brown instead, so that now I have got basmati rice I have 1kg of brown rice to use. Boil uncovered for 20-30 minutes, in six measures of water for each measure of rice, then drain, put back in the pot and cover to steam for ten minutes. It’s alright. This seemed to bulk out quite suddenly after 22 minutes.

I like worship on the net. I place the laptop on a table slightly to my left, and sit below my window, composed. Today, I sat in the sun for twenty minutes paying attention to my fear. Paradoxically, the desire for a crisis in which the British can show our mettle is the desire for a more ordered world: a world where priorities become clear, action becomes defined or predetermined, our feelings fit the needs of the moment. Actually, the crisis increases mess: we still have the same old problems in the same messy lives, but unaccustomed new ones- using kitchen roll as toilet paper, perhaps, or not knowing how to care for parents suddenly under such great threat.

There are horrors, on the net, such as video of overworked doctors and patients on ventilators. The New York Times quoted a website advising doctors on how to broach difficult topics with relatives- your beloved granddad is getting no better, so we need to take him off the ventilator so we can save someone else. So here is a sweet article by George Monbiot on people being creative and generous. I have The Mirror and the Light to savour, but at the moment I am rereading Bring up the Bodies. Here is Cromwell: in those huge hands Holbein places a legal writ, but that crease down the middle of it makes it look like a dagger.

I was moved to parody TS Eliot.

Johnson the Etonian, a fortnight dead,
had forsaken spaffing for bouts of coughing.
Those are pearls that were his lies.

We do not wish anything to happen.
Seven days we have lived quietly,
Zooming, and queuing at the supermarket,
Living, and partly living.

Let us not go, you and I
where society now sleeps upon the world
like a patient etherised upon a table
Let us not go through half-deserted streets.
In the room the women stay
With Covid, there is naught to say.

Is this the world changing, or the world’s strangeness revealing itself?