Thoughts from Pontevedra, Galicia, Spain: 26.2.21

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

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

- Christopher Howse: 'A Pilgrim in Spain'

Thoughts from Pontevedra, Galicia, Spain: 26 February 2021

Covid

Looking back . . . Below is another - UK biased but excellent - overview from MD of Private Eye. One valid point he makes: The greatest problem with a lockdown which has lost its rationale is that people will progressively ignore it and ultimately defy it. We will then have a rule of law crisis. No government should ever get into that predicament.

Looking forward:  EU leaders have agreed to introduce vaccine passports by the summer. Britons dreaming of a beach holiday in the Mediterranean can start planning the trip after. Post-June holiday reservations in Spain are said to be ‘soaring’.

 

Cosas de España

If you want to know where the (disgraced) ex king is hiding out, click here. 

Good News:-

1.  According to the United Nations' Conference on Trade and Development (UNCTAD)SPAIN is better prepared for the global expansion of new and emerging technologies such as 5G, Artificial Intelligence and Big Data than giants like Russia and China, .

https://www.thinkspain.com/news-spain/32714/spain-beats-russia-and-china-in-world-digital-development-says-united-nations

2. A Spanish airline has made it into a list of the World's Best Airlines. Not, not Iberia - don’t make me laugh - but Binter Canarias, serving the Canary Islands.

3. Has Utrera’s ancient synagogue been found, after more than 500 years serving other purposes?

 

Cousas de Galiza

We’ve been waiting  30 years for a high-speed train link to Madrid. So, we probably won’t get excited about the news that: Spain and Portugal have agreed to re-launch the project of the high-performance train between Vigo and Porto(Oporto). 

I saw a new sign in the woods yesterday posting me to Outeiro Giestoso. I didn’t know outeiro (hill/knoll) but figured giestoso came from giesta and that the latter was related to xesta, the Galician word for the brush called ‘broom’ in English* but I could find no one local - in a survey of 2 - who recognised it. I eventually found giesta in a Portuguese dictionary, showing the influence of that language in at least this bit of Galicia. Along the way, I discovered that retama is the Spanish word for ‘broom’ and that it features large on the logo of the Galician Rugby Federation. Which is nice to know.

* Note ‘broom’ and ‘brush’ . . .

The UK

A Scottish study  of the AstraZeneca vaccine is said to have produced ‘spectacular results’. I don’t suppose this will get much exposure in the EU media. Because . . .

The EU   

Sceptical Europeans are turning up their noses at the AstraZeneca vaccine, despite the fact that studies from countries which have begun using it, including the UK, have shown it provides substantial protection for adults of all ages.   The scientific message has also been mangled through hostile briefing. See here. 

As AEP has said, EU members could well pay a high price for this politically-motivated campaign against the vaccine.

The Way of the World

Lady Gaga has offered a $500,000 reward for the safe return of two French bulldogs stolen 

after her dog walker was shot in Los Angeles. 

May I remind you that this breed is very high on my list of the World’s Ugliest Deformed Canines.

 

Languages

I was going to say that, unlike English, Romance languages have the problem - in these woke times - of how to end the dominance of male forms. But, of course, both German and Dutch have genders as well. And Icelandic, I  believe. Though I don't know about the other Teutonic languages of Scandinavia. [Stoppress. A Swedish friend here tells me that her native tongue has 2 genders. But 'these are 'common' and 'neuter'. So, no masculine and feminine.]

Anyway, here's a bit on the almost laughable French approach to this problem. I'm aware things are taking place here in Spain too but I'm not up-to-speed on the details:-

New, unpronounceable mouthfuls are written. So, chers étudiants, or “dear students” in the traditional plural, becomes: cher·s étudiant·e·s. Chers collègues (dear colleagues) becomes Cher·e·s collègues. More here.

Finally . . . 

I mentioned Bromborough yesterday. A friend there lives in a street at the top of which there’s a wall made of the local red sandstone. In this there are several grooves said to result from medieval archers sharpening the points of their arrows there. A beautiful story to go with a beautiful stone.

I see I wrote about this in 2014: I'm staying with friends in a road called Mark Rake in Bromborough. Each of these names is ripe with historical meaning. 'Mark' originates in the grooves made in the red sandstone walls at the top of the road, where archers used to file their arrowheads. 'Rake' is an old Norse word for 'path to the fields' and Bromborough is the site of the important battle of Brunanburh in 937, in which the Anglo-Saxon king, Athelstan, defeated the combined armies of the Vikings and their Irish and Scottish Celtic allies. One historian has described this battle at "the moment when Englishness came of age" - 129 years before some other Scandinavian descendants arrived from Normandy to obliterate it again

COVID: Progress report 

The UK has made impressive advances, not just in the creation, manufacture and roll-out of Covid vaccines (15m and counting) but also on finding drugs to treat established disease. 

The UK Recovery Trial found the cheap steroid dexamethasone reduces risk of mortality by 20% for those on oxygen and 35 % for ventilated patients. The government-funded REMAP-CAP trial found that two drugs normally used to treat rheumatoid arthritis - tocilizumab and sarilumab - reduce the relative risk of death for patients entering intensive care by 24%. And the combination dexamethasone and tocilizumab reduces ITU mortality by up to 40%. 

We have improved ITU management and ventilator use, and developed early warning systems to spot Covid patients deteriorating outside ITU and at home. The use of pulse oximeters can spot patients with dangerously low oxygen saturation even when they appear well. The NHS has made vitamin D supplements free for those at high risk of Covid, in the hope of improving general health and immunity. 

Compliance with masks, hand-washing, social distancing, isolating, quarantining and lockdown rules has endured, the NHS Covid App has been downloaded 22 million times and we have the world's most expensive test and trace system. Yet despite all the effort, cost, sacrifice and progress, we have been unable to stop 120,000 people dying from Covid, nor the economic and educational carnage that has accompanied it. Might it not have been better to keep the virus out at our borders? 

Keeping out the variants 

MD predicted that effective vaccines might yet save Boris Johnson's career, and the Tories are indeed ahead of Labour in the polls despite the grim death toll. The variants too are a political convenience. 

There is no doubt the Kent variant has done a lot of damage and needed to be suppressed. It thrived in the UK because of our poor controls, and when it took off in December - as respiratory viruses tend to - it provided a much-needed excuse for Johnson to reverse his risky three-household Christmas gathering. 

Alas, the last-minute "mutant on the loose" message provoked panic and some people fled London and the South-east spreading the new variant nationwide. Others felt it was too late to change plans Johnson had recently assured them it would be "inhuman" to cancel. For five weeks from 6 January, we had more deaths most days than Australia has had in the entire pandemic. My Aussie relatives are aghast at our incompetence. Yet the variant is more likely to cop the blame than the government. 

Playing the fear card 

The "fear of variants" can now be used to sanction all the strategies the government should have put in place a year ago. Strict border control, stricter testing and tracing, suppression of infection rather than letting it simmer and - hopefully -better support for the poor, who suffer the double whammy of most harm from Covid and most harm from lockdown. 

Had we done this a year ago and kept infections low, we might not be in lockdown now. Vaccination will be a big help this time around, and variant fear has spawned scary Covid adverts and is making more people stick to the rules and come forward for vaccination. It's also allowed the government to up the threats. Lie about your sneaky Algarve getaway and you could outstay a prison-full of sex offenders. 

The cons of fear 

Fear of Covid is inevitable, especially in a country that has handled it so badly. The virus may kill around 150,000 of our citizens by the time this outbreak ends, and many more survivors will be left with a lifetime of ill-health. Alas, fear is also very bad for mental health and immunity. 

Never-ending workload stress and death exposure may lead to even more NHS and social care vacancies. Many frontline staff were not given correct PPE and a recent BMA poll found that only a third of doctors feel protected at work, leading to deep-seated anger and anxiety. No one should be exposed to a biological hazard at work without the best protection. A public inquiry must investigate. 

MD works in paediatrics, hence my repeated concerns about non-Covid harms and what we are doing to our children. Traumatic stress is far more likely when children don't perceive the world they live in to be safe. The unremitting daily death tolls and graphic ITU films may help compliance with the rules, but not emotional recovery. We now have variants to worry about too. 

After 3 lockdowns and record deaths, it will take all Johnson's communication skills to convince people that fear of variants and the virus can be switched to "it's safe to go back to school" and "it's safe to summer in Skegness". His only hope of doing that is to get infections to a very low level and keep them there with mass vaccination and much-improved test and trace. In time, a less virulent variant may ride to the rescue. 

Variants happen 

Variants are nothing new. As MD pointed out last March, the virus is "merrily mutating" and exists only to spread and reproduce. Our capacity for genomic sequencing is extraordinary, and we have already spotted more than 4,000 variants. The trick is to stop those selected to dominate, as they are more infectious or vaccine-resistant. 

Variation may work in our favour, if the dominant strain becomes no more virulent than seasonal flu (the current strains are 5-10 times more deadly). We could then live with it as we live with flu, vaccinating the most vulnerable and those most likely to spread infection each year, but never eradicating it. Or it may be that the challenge of vaccine evasion leads to more virulent variants that need to be quickly detected and suppressed. Either way, we will be heavily reliant on a properly functioning test and trace system.

For now, expect lots of small, scary variant sequencing and vaccine studies to pop up all over the world. What you need to know is that the vaccines currently available in the UK appear effective against the variants currently dominant here, and if the variants change, the vaccines can be tweaked. 

My advice is to get your vaccination as soon as it's offered. You may get side effects, which show your immune system is responding, but nearly all go in 24-48 hours, and a single jab appears to provide good protection against severe disease and death 3 weeks later. You may still get a milder infection, but that's much better than hospitalisation. The gov.uk and NHS websites have information on vaccine trials, types and contents, and what to do and expect after vaccination. 

When will lockdown end? 

Johnson has 2 choices. The riskier one is to end lockdown when everyone in the highest risk categories has been offered a vaccine, with a few weeks to pass for the effects to kick in. The cautious one is to do the above and wait until infections are at a level that test and trace can properly control - say, 1,500 a day - which gives the best chance of preventing future variant waves. Teachers, parents and pupils also need to be convinced that schools are safe from 8 March. 

Testing will be crucial, but there is only any point if you act on the results, which means supporting people to isolate. Indeed, it is not ethical to test people without supporting them to do the right thing. Infections have always been highest in areas where people can least afford to lock down, so the expertise of local authority and NHS staff will be essential to find contacts and help them with advice and financial support. Technology can help - we can do backwards and forwards contact tracing with genomic sequencing of every positive case. But trust in those delivering the service matters, and public servants are generally more trusted than temporary workers in private companies.

As MD noted at the start of the pandemic: "If you don't measure, you can't manage. And you can't fight a virus if you don't know where it is." Both rapid lateral flow tests and slower PCR tests have a role, but all new tests need to be properly evaluated rather than just rolled out. And before we launch into hideously expensive mass "moonshot" testing of everyone, with its attendant false results, we need to fix the basics of breaking all the chains of transmission from people who actually have symptoms. Tests should be easily available to anyone with a newly runny or blocked nose, sore throat, hoarseness, muscle pains, fatigue and headache, in addition to cough, high temperature and changes in taste and smell. 

Pandemic reform 

Is a pandemic the right time, and excuse, for another reorganisation of the English health service? The government already announced the abolition of Public Health England (PHE) last August, when it hoped the pandemic was over, to be replaced by a National Institute for Health Protection, to stop future pandemics. Noted pandemic prevention expert Dido Harding was installed as "interim executive chair", as if she didn't have enough to do trying to sort out NHS Test and Trace. 

This gave a clear signal that the over-centralised PHE (a Tory creation) was most to blame for pandemic failures, and not politicians or Harding. Whether the overloading of Harding or the destabilisation and demoralisation of 5,500 PHE staff played a role in the ensuing poor management is hard to judge, but it can hardly have helped. So why is the government proposing further reform of the NHS, the one part of the pandemic response that has shone? 

Long time coming 

These reforms have been coming since the Tories realised their Health and Social Care Act 2012 was a disaster, but they needed pandemic cover to ditch it. Health secretary at the time Andrew Lansley was repeatedly warned (eg by MD on Question Time) that feeding the NHS even more to the market would splinter it and patients would fall through the cracks between hospitals, GP practices, community services, social care and public health services. Ten years of austerity hardly helped. 

Before the pandemic, NHS waiting lists and health and care staff vacancies were at an all-time high, scandals and whistleblowers were still being suppressed, and no one seemed to be accountable or in charge. There were specific warnings in 2011 that fragmentation of public health services would make us poorly prepared for a pandemic, and here we are. So there is a clear rationale for the right reform. 

Hail Hancock 

The best part of the proposals is that "the NHS should be free to make decisions on how it organises itself without the involvement of the Competition and Markets Authority". Instead, the proposed reform reinstates power to the health secretary, which makes sense for a tax-funded service. But it makes it all the more important to install a wise, compassionate, scientifically literate leader, or we could end up with another Lansley, beavering away on an immensely complicated, cunning plan that doesn't work. 

Hancock's new powers and capacity to meddle with the NHS would be considerable. He could replace NHS CEO Simon Stevens with Dido Harding. He could continue to buy goods and services (pandemic or otherwise) from his friends and contacts. He could sell our data. He could push more money into pet projects even if they had no evidence base or NICE approval. He could get rid of NICE, the Care Quality Commission or even NHS England itself, possibly without primary legislation. And he could offer Serco, Sitel, Capita and a horde of management consultants a share of the tax pickings. Just as the Covid Act has allowed the government to make almost any emergency resource allocation decision without scrutiny or tender, Hancock will pick up this baton. 

Stevens's big idea behind the reforms is to join up the NHS, public health services and social care into regional integrated care systems by statute, which hopefully will mean these vast chunks of care will stay public and can't be outsourced. Whether they will be transparent and accountable, help pandemic recovery, resolve urgent problems with staffing, social care and health inequalities, and deliver the myriad lefty promises Johnson made to get elected, we shall see. Stevens is due to stand down soon. The competence of his replacement is crucial. And a lot depends on Hancock. Has his pandemic performance earned him the right to more power?