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 Some patients may have treatment withdrawn, even if they are slowly improving, to enable others to be treated, who have a “higher survival probability”.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Where care is withdrawn, patients will receive symptom management and end-of-life care for the dying.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.

Science and politics

What can science tell us about Covid? What should politicians decide, and what else should influence them? How are politicians helping, and how making the situation worse?

When the first casualties were dying of a new kind of pneumonia in Wuhan, science had a body of settled knowledge which would help humanity through the pandemic. This included knowledge about the immune, circulatory and respiratory systems, an understanding of what a virus was, how epidemiology could track an illness, how studies could give evidence of the effectiveness of treatments, how to assess evidence, and how to create and test vaccines, including a new kind of vaccine first used on covid. There was engineering knowledge of how to build ventilators and PPE, and medical knowledge of how to treat patients. There was behavioural science on how people might respond to the disease and to rules to combat it, and economic theory on how to mitigate the economic effects. By contrast the virus that caused the 1918 influenza pandemic was not discovered until the 1930s.

Scientists then began amassing useful knowledge about the pandemic. The virus’ genome was sequenced, and mutations have been sequenced since. Precise mutations can help show whence the virus is spreading. Studies showed how long viral DNA might last on particular surfaces, but also that infection via surfaces was rare, unlike with rhinoviruses. Infection was more likely through virions in aerosols or droplets exhaled. Tests were developed to test for current infection, or for past infection by testing for antibodies.

Common symptoms were found early: a fever, and a continual cough. Less common symptoms were documented later. Knowledge of how covid can affect people is growing.

Apps could show where people had been and when they might have had contact with an infectious person. There were the phones to run those apps, and the skills to write them.

Whether we should attempt to achieve herd immunity through mass infection is a moral issue. It is not acceptable to infect so many as would be necessary, when 1% of those infected die.

The rest is politics. Whether schools should be closed to restrict the spread of the virus is a matter of weighing different interests against each other. What businesses should close, and which remain open, is a political decision.

In London in December, people could go to the gym or the pub. That seems too risky to me, with people panting for breath, or talking loudly, and so spreading the virus, but it is a political decision to allow dangerous businesses to remain open, rather than compensating them for ordering them to shut, or forcing them to bear that loss. The pubs are shut, now.

It was a political decision whether people could meet in the open air. At one point, people could not meet their parents in their gardens, though it was outside and infection was unlikely.

Left wing politics is best for counteracting a pandemic. We need common action for the common good. It is unconscionable for the extremely rich to make money from such a natural disaster. People who lose wages should be supported, up to a certain level. Left wing politicians are better able to see how people will act for the common good: left wing politicians imposed a requirement to wear masks earlier, knowing that people would comply, for their own good and the good of the whole community.

The hard right Nationalist government in Britain was too selfish to govern well. When Dominic Cummings broke the lockdown rules, the Prime Minister should have sacked him, in order to preserve respect for the rules. They also had a craven desire for popularity, so promised we could celebrate Christmas together from about July, and kept making that increasingly dangerous promise until Saturday 19th December. As a result our borders are closed, and supermarkets are showing shortages in some goods, even before their catastrophic Brexit would have achieved the same result on 1 January. Their ideological desire that all testing should be done by private companies rather than public employees, and their corrupt enrichment of their chums, made the situation worse.

The sociopathic President Trump was only capable of seeing his own short-term interests, and Paul Krugman suggests he delayed action hoping the stock exchange index would reach the magic figure of 30,000, improving his re-election chances. His suggestions of injecting bleach may have been to get attention. Republicans used the pandemic to stoke a culture war, on the new Republican doctrine that doing anything which is not entirely selfish is Socialism, and Un-American. Their science denial, developed for so long, on Creationism, acid rain, the ozone hole, and the climate catastrophe, continued on Covid. The result is 300,000 deaths. This is the result of politics. Science can only achieve so much.

Covid solitude, and touch

My zoom social life is booming. I am in four international zoom groups that meet at least weekly, and drop in to others or attend occasional groups. Since March I have had so terribly few in person conversations, and not touched another human or been touched, but I see faces and hear voices more than I did last year. There are fewer Australians now it is Summer, but I meet Americans, Canadians, Irish people and others, and have deep conversation with my kind of people- wise, caring, articulate, sensitive, obvs; writers, performers, therapists.

With twenty-five tiny pictures on my laptop screen, I look round who is here and what I know of them. Some I might even call friends, and when people share deeply, personally, they move me; then I treasure these things in my heart, and see the person behind the tiny image. I look into people’s rooms. It is beautiful.

Many have cats- “fur-babies”- and I found myself staring at these images, the cat on the lap, thinking of cats who have deigned to sit on mine, seeing the finger scratching round the furry neck and imagining that touch- my hand, my neck.

Then I saw my friend with his granddaughter, a toddler, on his lap, and suddenly saw through his eyes- the back of her head, and its beautiful clean hair, the soft baby-shampoo smell, the wriggly unselfconscious joy of her. It was only a moment yet it was overwhelming, and the intensity of the feeling lived with me the rest of the day: joy so great it felt dangerous or frightening, joy that might overwhelm me.

Part of being frightened of going out is fearing the intensity of my own emotion, feeling unable to contain it and fearing what might happen if it leaked out. I go to the supermarket. Today the sky was cloudless, and I felt the sun on my skin as I cycled along, fast enough to get hot. I am not a mind, I am a human, embodied, and there is sensation from all over my body which brings delight. Right now there is the feel of the floor through my socks. Later, there will be the smell of citrus as I peel a clementine, the feel of it in my hands, the sight of skin, pith and segments, the sharp or sweet taste. A single fruit can be worth all my attention. There are things to delight my animal nature. But they do not include slight pressure from a hand on my arm when I meet another’s eyes, however deeply and personally we share, leave alone my bare skin against-

I read suggestions. If you spend time in the shower and give it attention, warm water flowing over head, back, belly, down the arms and trickling from the hands- it almost makes your nerves come alive, not as much as another human would but almost. Then there’s the hideous facebook algorithm, which shows certain of my posts to certain people. I had three comments and a like on a post an hour old, and shoddy little dopamine hits, which are no replacement for oxytocin. It is still compulsive.

I find myself thinking through the day of my next meal. I’m not overeating, as my trauma distraction response has never been food, but I think of the smells and sensations. It felt my choice was unbearable, overwhelming sensation and feeling or deliberately shutting it off and living in the grey dark, as I do much of the time. As I think of what to write next, I am squeezing my own hand.

I miss art. I went looking for 18th century Nativity paintings, it being Advent, and found this. Art on a screen is less than on canvas.

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.

Coronavirus vocabulary

Words I wish I had not had the chance to learn.

First, “coronavirus”. I had heard of colds caused by rhinoviruses, but before December had not registered the idea of a coronavirus as a core of RNA with a lipid shell covered in protein spikes which can penetrate cell membranes. A lipid is not soluble in polar solvents, like water, but soap or alcohol rips the lipid shell apart making the viral particle nonviable. Had you not studied biology or biochemistry, the word “lipid” might have passed you by, as it had me. Each viral particle is eighty nanometres across. The virus is “zoonotic”, an infection originating in other animals. There may be others, far worse, just waiting their chance.

The particular coronavirus is SARS-CoV 2, or Severe Acute Respiratory Syndrome Coronavirus 2, named after SARS, which was not only a syndrome, but a viral disease. A syndrome is a group of symptoms which consistently occur together, and I would say the viral disease should not be called a syndrome because we know the cause, one virus, and because its symptoms are hugely varied, from neurological disorders to “Covid Toe”. The disease is CoViD 19, Coronavirus Disease identified in 2019.

A “cytokine storm” occurs when your immune system, unable to contain the virus, goes apeshit. Much of the damage to your lungs, including the fluids which drown you or the substances which clog your lungs, making them like bricks, comes from your immune system rather than the virus itself. It is caused by the innate immune system, rather than the adaptive immune system which develops as you experience infections. I have read articles about T cells and B cells, but that is too much information, and I have forgotten it, even though I had heard of T cell counts related to AIDS, another syndrome caused by one virus. You can know the practicalities- wear a mask, wash your hands, limit in-person social activity, Trump and Johnson cannot be trusted to make worthwhile decisions about which risks people should take or where public money should go- without knowing about B cells.

How badly you are affected may depend on your initial “viral load”, the amount of virus you take in.

I started this post when I read that a test should be both sensitive and specific. A test is sensitive if it does not have too many false negatives. A test is specific if it does not have too many false positives. The two words together convey more information than “accurate”. Testing your temperature before you enter a building is neither. That reminded me of words I can never remember: the tolerability of a risk depends on its severity, how awful it is if it happens, and its likelihood or probability, producing a risk matrix. I hold the concept of the matrix in my mind, but not the words for its axes.

The new word I liked most was “fomite”. A fomite is an object which passes on infection: it could be a door handle, or a dictionary, any object where the virus may linger, still active, to be picked up by the next person to touch it. A huge variety of objects can be a fomite based on one specific characteristic which I never thought of before The Pandemic started. However I understand fomite transmission is unlikely, and most transmission occurs by breathing in droplets or aerosols- there is, I read, no agreed terminology– breathed out by an infected person.

The word “blog” comes from “weblog”, which was originally meaning a log of interesting pages the author had found. Here’s a page from Raphael Carter’s. Assiduous readers of my blog, who click all my links, will see that I have mostly linked The Atlantic. It’s a bit right-wing for me, and of course US-centric, but I find the range of articles fascinating, and it is at least “reality-based”, pouring scorn on the lies of the Trumpites. Would that everyone were reality-based! Lying and distraction are too profitable.

I depend on journalists. I read that initial research which showed that viral particles could remain on surfaces for days began with huge loads of virus, scores of sneezes per square inch, and the detection was based on finding the RNA, which does not indicate that the virus is infectious. As research continues, the consensus understanding will change. I am not even going to look at “pre-prints”, academic articles not yet peer-reviewed.

What new words have you picked up this year?

Black Lives Matter UK

Black Lives Matter.

On 4 August 2011, Mark Duggan was followed by firearms police from a meeting where he reportedly had collected a gun, according to the controversial “Operation Trident” focused on gun crime in London’s black communities. Three cars executed a “hard stop”, forcing his minicab to a halt. Duggan came out of the car. A police officer was shot during the incident, and officers told journalists that there had been “an exchange of fire”. The Daily Mail called Duggan a “gangsta”. However a week later the Independent Police Complaints Commission (IPCC) admitted one police officer’s bullet had passed through Mr Duggan and injured another. Two days after the killing, the police had not met the Duggan family, and they led a protest march to Tottenham police station. Police continued to refuse to meet with the family, and the protest became confrontational, eventually with rioting. In 2013 a coroner’s inquest interviewed dozens of witnesses, and in 2014 the jury concluded it had been a lawful killing, but also that the first bullet fired by an officer at Mr Duggan had injured the other officer. A year later, the IPCC published its report, saying Mark Duggan had thrown a gun onto grass seven metres away from the mini-cab.

The detailed Forensic Architecture report concludes that Duggan could not have thrown the gun. No officer gave evidence that he had seen Duggan throw the gun. Their video shocked me. My vague recollection of the case was that Duggan had had a gun, but there was no DNA link from the gun, wrapped in a sock, with Mr Duggan. I noticed in myself an initial desire to exonerate the police, and challenge the evidence which eventually led to a large settlement in the family’s unlawful killing action against the Metropolitan police. This is the desire to see society as basically well-functioning, documented by Sara Ahmed, which causes difficulty for complaints against the police, or about authority in any institution.

Sean Rigg wrote, performed and produced his rap album Be Brother B Good and volunteered at the Franz Fanon community centre in Brixton. He suffered bouts of mental illness. On 21 August 2008 he was arrested and restrained by Brixton police, and died shortly after. The inquest reported four years afterwards, and the family’s Justice and Change campaign site does not seem to have been updated since 2014. Rigg was fit, healthy and forty years old when he died. The inquest in 2012 concluded the way he had been restrained, “more than minimally”, had contributed to his death: his heart stopped after “unnecessary” and “unsuitable” restraint while lying face down. However in February 2019 the Metropolitan Police exonerated five officers of charges of failing to identify Rigg’s mental illness, excessive restraint, and giving false evidence to the IPCC and the inquest. In The Guardian, his sister Samantha Rigg-David described her “anguish”, says the subhead, and her courage in campaigning.

A man claiming to have Covid 19 spat and coughed on Belly Mujinga, a railway worker, and her colleague at Victoria Station in London. The British Transport police took no further action having decided there was insufficient evidence. She died on 5 April from Covid 19.

Naomi Hersi, a trans woman,

Touch

I have not hugged anyone since 6 March. The attention and touch to my bare skin yesterday moved me. Human fellow-feeling also moved me- texting can be beautiful- but I need reassurance of my value, and caring touch made me feel better. I will wring all the pleasure I can from the experience.

I saw my pulse was low, and did something about it: search to find if that’s a problem, phone the NHS, speak to my GP. She arranged the CCG. Then on Thursday evening I found myself thinking about it. Would I be OK? I analysed this. Possible heart problems are a thing people might be worried about, and worried people might think about the thing they were worried about. I had done all I could about it for the moment. So possibly I am worried. I’ve just looked up the difference between worry and anxiety: here it is. Worry is verbal, in the head. I used the word correctly, even though I could not have specified the difference.

Next day, I went to the surgery. Because of The Disease, you go in and announce your presence, then wait outside. Only where a physical examination is necessary do you see a professional in person at all. I chatted to a man of eighty, who arrived on an electric scooter. Someone was going to give him a lift, but had not turned up. He told me he was fed up, and made clear he meant he wanted to die. He had had a cataract operation in February, and when he went in they had told him they had to remove the lens. They really should have told him that before, as that is how you treat a cataract. Then they told him he could not drive for weeks, and now he has double vision sideways and all the opticians are closed. It is good to chat. He had been in the army for ten years, including during the Cuban Missile Crisis, a formative and terrifying experience for him.

A woman turned up in a mask. “That looks professional,” I said. It doesn’t have the vents or filters, she said, it’s from her husband’s work, and more a dust mask than an airtight mask.

I decided to identify this tree. I think it is a silver birch. Say if you think different.

The nurse, in an apron of plastic film, a hair covering, and a mask, chatted away as she fastened sticky contacts to my skin: chest, abdomen and ankles. That was the caring touch. It mattered, despite her latex gloves. She so misses touching. She is a huggy person. “Normal sinus rhythm,” she said, and the doctor confirmed.

Going without touch matters, as a human being, a primate, an animal; and it is how things are. I will accept it.

Then I went off for blood tests. I was challenged at the door: have I had a cough or fever in the last seven days? No, and not a headache, loss of taste and smell, or lesions on the toes either. The phlebotomist had to have a good dig around in my arm before finding the vein.

How can you just enjoy cycling? I realised I was pedalling along in a fury of resentment. I resented the wind, I resented the inclines, and when I was working hard I cudgelled myself to work harder. I should not need to drop a gear, here. No wonder I never want to go, though I get some pleasure when out. Yet the most memorable moment of the thirteen miles was stopped at a temporary traffic light, when I stood and looked at the trees. A worker approached the light, opened the metal box wired to it, apologised. Oh, that’s alright, I said. They may have been non-binary and I was keen to identify their assigned gender, just like a straight person probably would be. Something about the hip to shoulder ratio in the shapeless overalls made me think them female, but only the voice (goggles, hard hat) made me sure.

So today I decided I would enjoy the cycling. I looked at the gorgeous pink blossom on two trees. I looked at the many different greens on the foliage, and the shivering wide-leaved grass. I dropped a gear when I felt the need, and may have gone faster as a result. I praised myself for going up the inclines, and fully enjoyed going down. I thought of that resentment: only appreciation and love will do. “Love! Love! Love!” I cried.

I want views from another country, so tag this post Mauritania. Mauritania, in West Africa, has some fascinating rock art.

I have been reading about Covid

This is my new toy.

It is a pulse oximeter. It shines a light through my fingertip, senses it, and works out my blood oxygen level and pulse. I read about “Happy hypoxia”, so called because one is oblivious to it- because you feel breathless when you cannot expel CO₂, but Covid pneumonia allows you to expel CO₂ just not to absorb oxygen properly. So you are slowly starved of oxygen, but don’t realise it. I feel “silent hypoxia” is a better word, despite the loss of alliteration. You breathe more and more rapidly, straining your heart and lungs, but are unaware.

I read about that, and instantly ordered the oximeter. I hope I don’t need it- I may not catch the virus at all. But, unless civilisation breaks down, I should be able to give this particular piece of evidence to a doctor, saying my blood oxygen was below normal (normal is 95-100%) and might get into hospital on time. I also bought a thermometer to assess the severity of any fever.

Does vitamin D deficiency cause cytokine storms? There was some research in Trinity College Dublin, I think saying vitamin D might have something to do with them. A cytokine storm is when your immune cells stop recognising which cells are healthy and which infested with the virus, and start ordering them all to self-destruct, viral and healthy alike. So you drown in pus.

All this stuff is really horrible. Still, as long as you don’t overestimate the probability or severity of risk, it is better to know. Many people catch the virus without being intubated, and may recover completely.

In February I had no idea what a cytokine storm was. Vitamin D deficiency was a suggestion: there is evidence of correlation, and an explanation why vitamin D might be relevant is hypothesised, but the link was not proven (as I understand it). White people should spend more time in the sun. Then I read this. If vitamin D is a platitude cast in the faces of Black, Asian and minority ethnic people, as if this is a simple precaution and you’ll be alright, there is a problem.

I am a pretty straight kind of guy (gal, whatever) and depending on what experience you have of me you might decide to trust what I say here. And, it’s all second hand. I read something, I take it in partially, I remember it partially. I have no expertise, just the lay interest of an intelligent person with a lot of time whose friends may die. Like any other social media, it’s at best a less trustworthy source than Google will find.

I learned of hypoxia first in the New York Times, in an article by a doctor. It’s not peer-reviewed, and the evidence was anecdotal, but I felt it a reasonably prestigious source. You may trust others, and the trust is not wholly objective.

This blog has had views from 199 countries and territories. I would like views from Turkmenistan or Tajikistan, Mauritania, Chad or the DRC, to colour in more of the map, but I got fed up waiting for no.200, so I am celebrating with this header photo.

You may have noticed the pulse indicated in that photo was quite low. I googled, found the scary word Brachycardia, phoned my GP, and the next day (Friday 15th) had an ECG and blood tests. I have a normal sinus rhythm, so no need to worry unless I have sudden dizziness or breathlessness. Thank God for the NHS.

Arguably, I was foolish to buy the oximeter, or foolish to use it before the frightening possible moment when I had been feverish and coughing for a week, and was getting no better. I suppose I could have decided to take my pulse at any point, with or without it, but had not, and my feeling is that the low pulse is a sudden discovery rather than a sudden onset. In the event I may have given myself a fright without any reason. Just because 60 is normal pulse, does not mean that in me, in the absence of other symptoms, 47 is healthy enough. Yet, knowing of it, I am pleased at the ease of getting it checked.