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Friday, 1 January 2021

Greece from far away

My blood pressure as measured soon after the June 2016 Referendum on leaving the EU

On a day in June 2016 I was the subject of one of many research projects into healthy ageing at QE Hospital 
"Your blood pressure's a little high" said one of the researchers.
She showed me her readings; in the hypertension range.
"That's odd. That's never been a problem for me"
"Well I need to point it out. Check with your GP"
"Gosh Emma, do you think I'm stressed by the Referendum result?"
"Could be." she said "We'll see how your blood pressure looks on your next visit next week"
Sunday lunch with the family - Oliver, Amy, Guy, Hannah and Linda. - weekend after the June 2016 Referendum. New potatoes from our allotment in Handsworth 

Three and a half years after the Referendum vote to leave the EU,  a friend posted on her Facebook page:

1st January 2021. MM: I wanted to write a Happy New Year message but ended up writing this instead. If you hate doom and gloom please scroll by. This is an X-rated post.
And so it comes to pass (weeping emoji's). We have woken up today no longer able to call ourselves EU citizens. And I am unspeakably sad. I don't know whether, in the long run the UK, will be better off in or out. I don't know whether there will be queues in Kent or food shortages in Tescos. But I do know that all of us who value that delicious sense of tumbling into a new culture, a new language, a new landscape have been left immeasurably poorer by the UK's decision to leave the EU. 
I speak for all of us in here who one fine day, wearing but a pair of skimpy shorts and an old T-shirt, clambered onto a charter at Gatwick to some random destination in Greece and drank so deeply of the delights of this beautiful country that we mysteriously find ourselves decades later sharing our (zoomed) βασιλόπιτα with children who speak two languages, in-laws who have never set foot on the green shores of Britain and Greek friends and colleagues who we hold dear in our hearts. 
We are heartbroken that the next generations will not know this. Those who already made it out of the gate will have their rights protected. The (richer) retirees will retire. The well-heeled will inevitably find a way. Some of our young will no doubt make it through the portcullis even after it clangs shut. But please allow us to shed a tear on this inauspicious day for all those who won't, and will never come to know what we know.

SB: Happy New Year, M. In your eloquent lament you write "But I do know that all of us who value that delicious sense of tumbling into a new culture, a new language ..." I know so well what you mean. I didn't so much 'tumble', given that my Dad - divorced post-war, then married to Maria in the lovely little church of Panagia Kapnikarea off Syntagma in Athens in 1949 - first invited me to beloved Greece when I was 16, during Easter 1957, and I, on my occasional stays with the 'Greek' side of the family in England was used to hearing my dad and Maria speaking Greek. I never looked forward to those brief childhood visits on which my mum insisted. Too much shouting and disorder and kissing and hugging among unruly half-siblings, though I liked being entrusted with a glass of wine now and then. It took four days, travelling alone on the Simplon-Orient from London, turning Balkan-wards after Venice, to get to Larissa where in the middle of the night this callow English youth, with a compartment to himself, was interrupted by a wedding party bursting in, joyfully noisy. I - a foreigner had the nerve to glare at them and ask them to be quiet. Instead of taking justified offence they laughed uproariously "Oh Englishman!" and had the effrontery to offer me a drink which I turned away. A few hours later I arrived in Athens…There, at dawn, on a low platform, the Greek side of my family awaited with joyous greetings and many disturbing hugs and kisses. Through a tiny window from the loo of Yia-yia's flat in Kolonaki I saw the Parthenon - no longer the familiar schoolbook illustration, the real place!.. ... ... Well! ... Two weeks later, when I departed from Greece, all had changed; changed utterly and forever, but that's another story, a good one. That first visit over 60 years ago was the start of an affair that I will take to my grave. You could say that 'some enchanted Easter' long ago, I saw Greece 'across a crowded room.' Even now, in dear Ano K, strolling or cycling on a small back road I hear a family, perhaps on a Sunday afternoon, laughing and talking under their veranda, and I'm possessed by an impish impulse to stroll over "Excuse me! Με συγχωρείς. Θα μπορούσατε να είστε λίγο πιο ήσυχοι!" They will laugh indulgently, even ask me to join them. I know that the UK leaving the EU can never efface - nor portcullis block - that 'delicious sense of tumbling' you describe so beautifully and which I still feel over and over when my old feet touch the soil of mother Greece.

James S, neighbour on National Opposition Street below our Democracy Street in Ano Korakiana: it’s exactly that Simon! The total mind opening of travel that Brexit seems so ignorant of!

Hi James. For people who have learned - or, in my case, taught against my will - to be happy the new border bureaucracies may bring temporary impatience, frustration and even misery, but love finds a way. I 'tumbled' (M's good word) into Greece long before the UK joined the EU, when post-war restrictions enveloped all Europe, customs examined our cases spilling out our belonging, transfers of cash were strictly limited. Through Yugoslavia I saw how the communist guards abused their own citizens, fellow passengers trying to cross their border (they were scowlingly deferential to me on my dad's diplomatic visa stamped in my dark blue passport). I was alerted by my father about the dreadful psychic scars of occupation and civil war in Greece - things that could not be spoken of, better forgotten. I've learned to accept - or, at least, to live with - queues, rationing, paperwork, inconvenience. I've been abused by immigration on arriving in New York, waited hours to enter Canada and Australia. I suspect from now - COVID restrictions notwithstanding - there'll be a couple of years of 'pain' as this bizarre event is sorting in the wash, but far worse pains have been surmounted in the past. I voted Remain, but I know other people voted to Leave the EU. who enjoy other lands beyond the English Channel as much as I.
The mainland of Greece across the Sea of Kerkyra from our home in Ano Korakiana 

I know about inventing paradise. Byron, Μπαϊρον, who came first in 1809 called her 'the wondrous land'; sailed to Greece in the brig Hercules in 1823, arrived at Kefalonia on the 4th August, to die at Mesolóngi eight months later. I first came to Greece, to Athens, by train via a three day stop in Venice - walking for hours, entranced, along damp paved alleys - in 1957, but in 1962 I sailed to Greece from England with a friend, my skipper Chris Jameson. In July we left Messina in Sicily. The first morning of our two day crossing on Danica ...
...bouncing and swaying on a swift etesian reach; came on our reverse, a sleek Greek frigate cutting smoothly through the cresting waves, heading west. In return to our salute, we saw a young sailor in perfect whites, almost sprinting to the fantail to dip her flag to us. My chest swells at the memory of seeing that lovely ensign falling and rising again in the seconds of her passing as though official Greece was saying "yasus" - just to us. 
That was 59 years ago. After that swift reach from Sicily. sunrise on the third day, the good wind abandoned our small vessel on a limpid mirror. The moment remains as dreamlike as at the time; glimpsing the forms of land melded to white sky and coppery sea - a way to the mainland of Greece between Kefalonia and Zakynthos into the Gulf of Patras. Next morning we made Byron's landfall. Shapes - north and south - that appeared and disappeared and might have been no more than dawn shadows - though we knew otherwise - lay before us. All day, in zephyrs, we sailed towards them, passed between, and anchored off Killini in Ilia where we rowed ashore to be sat at a table (my memory is flawed by so many photos of Greek tables and chairs), offered ouzikis and welcoming curiosity, before a polite policeman - reproached by our hosts - "po, po, po" - told us we were supposed to clear at Patras, but "please finish your conversation." 
170 miles from Piraeus and the city to which I’d determined to return.

I spent, as I recall, my first twenty five years in a fog of schooled and inherited insensibility, almost impervious to the wisdom of generous parents – English and Greek - who probably knew that, as perhaps for them, only time would tell me. 
In 1968 I was with the Greek side of my family again. They’d flown on to Greece. My dad wanted a car while we were there. Over four days I drove his small Hillman through Belgium, Germany, Austria, Italy and by ferry to Greece, sleeping one night in a field above the sea, a few yards from a winding road through olives. From Piraeus I took another ferry to join the family in Aegina. We returned to Athens for a day, where, with my diplomatic family, I attended a house party somewhere near Vouliagmeni, hosted by a man whose bald head I glimpsed for a few seconds, Colonel Stylianos Pattakos.
It was only in Detroit, married a year later, meeting American Greeks - and Greek exiles from the Junta - that I grasped the discomforting notion of ‘sides’;  of Greece as a polity, of animosities and moral positions, words and facts and opinions that left the paper-fragranced sentences of my superlative education – in one ear as others' thoughts, out of my mouth as words for conversation and essays, and out of the other ear, unedited. Though it seems so in memory, I could not have been quite that one-dimensional, except perhaps at my mother’s breast. My CV, by the time I was thirty, was enough to ease me into academia where, mostly fuddled, time did begin at last to tell and I began to listen.

It was 25 years before I came to Greece again.
After many years, return to Greece in 1995 with Amy, Linda and Richard

Standing in the cockpit of our Airbus (full of screens and no joystick) where passengers could – pre-9/11 – still be invited for a pilot’s glimpse of the world ahead, I stood behind my family, as with Linda, Richard and Amy, we flew high over the border of Greece; able to see, to port, the glow of Thessaloniki; ahead the greater glow of Athens; to starboard a moonlit Ionian Sea and far below, in inky blackness, clusters of tiny glittering diamonds - villages in the foothills of the Pindos.
“Children! There’s Greece”
In the dim cabin tears welled from my eyes with the delight – and the idea – of sharing ‘my’ Greece with my wife and children. I could not speak for a moment, and Linda, more English than I, was irritated at me. 

A third generation in Greece - our Amy with her cousins Natasha and Anna at sandy Pylos in 1995

*** *** ***
A decade later we spend months in Ano Korakiana on Corfu. Πέρα δόθε:

Winter 2009: The sun came up into a cloudless sky. It’s so bright and hazy, but for the crackle of awakened logs I’d mistake this winter morning for summer. Yesterday as we pottered on tasks I became so chilled I began to sniffle. By evening I was squeezing fresh lemons to mix with honey to warm in a glass. We’d been down to CJs Bingo Quiz in the evening, me in two under vests and long johns, to struggle with questions that were almost entirely about things in films and TV series. Our friend Trish, in CJs after cold day’s work cleaning charter boats at Gouvia, won. She was playing with Sally who runs CJs for Chrissie and John, also there - the latter cursing merrily to the delight of all. Trish is married to Dave, met at Ipsos Harbour in the first hour of our arrival in September 2006, who first raised our spirits as we surveyed Summer Song’s worn and musty interior, wondering if we’d been sensible buying her on ebay, sight unseen. “We’ll make a list” he said “Norman and Pauline loved that boat and she’s worth it”. And so she was and is. Dave keeps an eye on Summer Song – not only on the boat but also on the harbour politics that allow us to keep her safely berthed there. C remarked from far away on the Pacific coast. “Enjoy Corfu. Greece, no matter what, is a beautiful place to wake up in the morning" but I’m as superstitious as any atheist about reflections on the rewards of fortunae. 
'Greece, no matter what, is a beautiful place to wake up in the morning'
The names of people who rejoice in their luck are selected by a divine factotum and placed face-down on a gilded dish that passes around the table on timeless Olympus. Amid merriment, each God selects the human whose card is to be their post-prandial plaything. Here a brilliant climber says “There’s a window for the summit at dawn”; there a mother says “Our child is so perfect”; and over there a father says “There are police officers, a man and a woman, at the door. Must be about those parking fines”; and here a wife who says “no need to hold the ladder darling. Go and make us a cup of tea”; and there, in the deep ocean, an exhausted sailor says “We’re through the worst” but see this one, here’s a gem “The war will be over by Christmas”, but what about that popinjay Confederate General who said “They couldn’t hit an elephant at this dist…” Far below a fisherman on the Peneios and a woman waiting for a train at Litochoro know they hear, not the rumble of endless thunder reverberating among the peaks of Olympus, but laughter.
Good Friday picnic on a shore in Corfu. A fourth generation in Greece
In England in early January 2021 Greece seems remote - for all the continued contact via the social web. Here in the inner suburbs of Birmingham Lin and I are locked down under Tier 4. I am not to go further from our front door than our front garden. Linda - under 70 - can shop. Our neighbour, J, 'allowed to meet one other person outside', sat for a chat with me by our porch and passed the time of day. He works for Fareshare, one of the neighbours who've offered to shop for us if necessary.
Covid Tier 4. Restrictions from 00.01 Thur 31 Dec 2020
The weather is intrusively grey, wet, creating a world of pervasive sogginess that sticks to shoes hands and sleeves; which I can't avoid trailing into the house when I bring in logs, damp and stuck with rotting leaves, slimy too. I dry the wood in front of the stove before we can enjoy their warmth. Kindling I've even put in the oven for 30 minutes to get things burning in the mornings. 
Before the latest lockdown was announced I could cycle in and out of town, visit the rag market, buying a baked potato mashed with butter, salt and pepper plus a cup of tea, or a butter croissant and filter coffee eaten stood warily in on New Street. Wednesday morning I called in at the Birmingham Donor Centre in New Street to give blood. The first drop during the preliminary test for sufficient iron wouldn't dawdle down the green liquid filled test tube as it's meant, but Sarah - name off her tag - tried an alternative test. ""Yup, that's fine" "Phew". I lie in the plastic chair arm pierced skilfully almost painlessly to extract my very common 0 positive blood, but after a few minutes I'm being ministered to by three, no, four, nurses, urging me to squeeze my fist and wiggle my toes, as my blood's not coming out. "Oh no!" I think, but then "There we go! Fine now" says Margaret cheerfully. Privately I suspect the needle wasn't accurately placed in the vein.  After 10 minutes, I'm on my way, exiting through a world of masked donors and masked extractors, making another appointment in March - if I'm not breaking rules. Once home I get a text message thanking me for my blood. 
From Greece we've brought a lemon from one of our citrus trees, which, after two years barren, has fruit - - a generous load - following scale insect infestation affecting citrus, and now, other shrubs and trees, all Corfu. 
Perhaps our treatments have begun to work, as recommended by Sophia and Niko, neighbours, and Evangelina at the new Tzoulou garden shop. She recommended we spray a mix of Sivanto (2.5 m/l to 5l water) and Electro pesticide (ditto mix), to kill, and by resting on the leaves, break the life cycle of what she calls the ‘black spiny insects’.   
A lemon from Corfu back in Brum
Checking lemon leaves for citrus scale insects

*** *** ***
With some poignancy I travel 10 years back in my time machine to Ano Korakiana in February, when the village celebrated its annual Carnival ... February Carnivali, brightening the greyest chilliest and wettest day of the year. Part of the band in motley, military, priest and police, made 'oompa oompa' with drum and fife. The king enthroned, priapic with crown on his heart-covered float, accompanied by courtiers, male as female and other reversals of carnival, paraded upwards preceded and trailed by bouncing umbrellas, a phalanx of pink parasols, women in silvery wigs dancing up to the start of Democracy Street, twirling round a ribboned pole amid whistles, bangers and music.
Stopping and starting the procession gathered more people – some in masks, a long nosed Pinocchio, some as they were; streamers and confetti thrown from windows, hugging and greeting, planned and spontaneous, impossible not to smile and laugh in the chill wet. Up we went to the bandstand, round the carpark and back down the street in rain that poured from low cloud obscuring views to the sea. Nico and Sophia, standing by their front door, invited us in from the cold and wet for coffee and rich chocolates to meet their family.
“All the news is bad”
“Indeed it is” we smiled.
At 7.00 two hundred or so were gathered in the upper room of the Farmers' Co-op on the lower road to watch a demonstrably hilarious dialogue between two women we didn’t understand but clapped with everyone else. Then a formal reading by a top hatted master of ceremonies naming people in the village to theirs and everyone else’s amusement and applause.
Then a more disposable carnival king was carried out to the road and burned, with a bit of diesel to overcome the rain. Everyone began moving through a small door down short steps to the lower room to sit at long tables under a beamed roof. We were ushered to Leftheris’ family where dishes had been brought to pass with village wine in jugs, water and cola – lamb, pork, salad, cheese pies, olives, bread in chunks. As we tucked in along with every age, the dancing started with a band that created the mood of the evening, responded to people as they danced and sang – dances for couples became threesomes, foursomes until chains of us were stepping forward six steps one way, two back in that way that can’t help look elegant because the clumpers like me are carried hands held in the ring, six right, left two, unpausing until well after midnight the band made up of two guitarists, lead singer, keyboard and lighting mixer – played unceasingly. The dancing space was seldom empty. If not filled with pairs and chains, it was taken by men and women dancing solo amid clapping support, nimble and beautiful. I danced with Lin and in the circles – like Scottish reels.
“We all drank a lot of wine” said Katya when I saw her at the shop a couple of days later. As at a family wedding, wine added to the enjoyment; none crass. There was a break in the music around one in the morning. I thought we were going home, but after a few minutes, the room filled with lively chatter, the band came back with renewed energy. It wasn’t only the young on tables, though one couple danced with especial virtuosity, the young man - minutes previously in ballet skirt, tights and pigtails now entwined with a young woman who’d begun alone shivering her hips in the Arabian style. This duet had others joining in. The whole room floated on the music and swayed with the singing, happiness making us all even more good looking, and some especially handsome and beautiful. As the band said its goodbyes, an older lady led the Ano Korakiana song singing two line verses, unaccompanied, the chorus picked up by the moving circle. We walked home just before three-o-clock. “I’ve so enjoyed myself” I said “Me too” said Lin.
The song to the dance is a paeon to Corfu "Kerkyra, overflowing with greenery and beauty...into each and every corner and the seashore..." a list of all the green island's attributes 

Tuesday, 15 December 2020

Self-isolating for 10 days in Birmingham after returning from Greece

Waiting at Corfu Kapodistria Airport for a flight to Athens
At Corfu Kapodistria waiting for a flight to Athens

Over the better part of 2020 I've been able to access more information about the COVID-19 pandemic than has ever been available to any but experts about a pandemic.  Making sense of this information, that comes on the internet via tweets, emails, facebook, podcasts, radio, scheduled TV (remember that?), vlogs and many websites with access to a plethora of peer-reviewed research, is informative, fascinating, vexing and confusing. T S Eliot suggested in the 1930s - 'we are too conscious and conscious of too much'. Lin and I talk to each other, to friends and strangers and of course we experience directly the effects of government policy - in our case in the UK, in Italy and Greece and back in the UK where, having completed our Passenger Location Form, we are confined to our Birmingham home for 14 days, reduced a few days later to 10
Self-isolating at home in England warmed by wood I sawed and split in the summer

For my records I've selected two open letters sent, two and half months ago, to our Chief Medical Officers (CMOs) and, in one case, also to the Prime Minister and the Chancellor - though they've no doubt been advised on both. I can envisage presenting these letters to students of government policy-making and asking them to brief an imagined cabinet on the weight to be placed on either, or neither. I'd also remind the students of the global salad of impugned motives and ad hominem rudery directed at the signatories of these letters and their recipients. Scientific debate was ever thus. I was taught that long ago. I thought science revealed the truth. No. Scientists arrive at the best hypotheses to fit the available data. They defend these hypotheses against other scientists, themselves included. COVID-19 and the world wide web has allowed the scientific process to occur on a global stage with limitless audience participation.

Here's the first letter:

Covid-19: An open letter to the UK’s chief medical officers expressing 'concern about a second wave of covid-19'

Professor Chris Whitty; CMO, England
Dr Frank Atherton; CMO, WalesDr Gregor Ian Smith; CMO, Scotland
Dr Michael McBride; CMO, Northern Ireland
Professor Patrick Vallance; Chief Scientific Adviser

21st September 2020

Dear CMOs 

We write to express our grave concern about the emerging second wave of covid-19. Based on our public health experience and our understanding of the SARS-CoV-2 virus, we ask you to note the following: 

1. We strongly support your continuing efforts to suppress the virus across the entire population, rather than adopt a policy of segmentation or shielding the vulnerable until “herd immunity” has developed. This is because:

a) While covid-19 has different incidence and outcome in different groups, deaths have occurred in all age, gender and racial/ethnic groups and in people with no pre-existing medical conditions. Long Covid (symptoms extending for weeks or months after covid-19) is a debilitating disease affecting tens of thousands of people in UK, and can occur in previously young and healthy individuals.

b) Society is an open system. To cut a cohort of “vulnerable” people off from “non-vulnerable” or “less vulnerable” is likely to prove practically impossible, especially for disadvantaged groups (e.g. those living in cramped housing and multi-generational households). Many grandparents are looking after children sent home from school while parents are at work.

c) The goal of “herd immunity” rests on the unproven assumption that re-infection will not occur. We simply do not know whether immunity will wane over months or years in those who have had covid-19.

d) Despite claims to the contrary from some quarters, there are no examples of a segmentation-and-shielding policy having worked in any country. Notwithstanding our opposition to a policy of segmentation-and-shielding, we strongly support measures that will provide additional protection to those in care homes and other vulnerable groups.

2. We share the desire of many citizens to return to “normality”. However, we believe that the pandemic is following complex system dynamics and will be best controlled by adaptive measures which respond to the day-to-day and week-to-week changes in cases. “Normality” is likely to be a compromise for some time to come. We will need to balance suppressing the virus with minimising restrictions and impacts on economy and society. This is the balance that every country is trying to find—and every country is having to make trade-offs. This might mean moving flexibly between (say) 90% normality and 60% normality. We believe that rather than absolute measures (lockdown or release), we should take a more relativistic approach of more relaxation/more stringency depending on control of the virus.

3. Controlling the virus and re-starting the economy are linked objectives; achieving the former will catalyse the latter.  Conversely, even if policies to promote economic recovery which cut across public health objectives appear successful in the short term, they may be detrimental in the long term.

4. As evidence accumulates for airborne transmission of the SARS-CoV-2 virus, measures which would help control the virus while also promoting economic recovery include mandating face coverings in crowded indoor spaces, improving ventilation (especially of schools and workplaces), continuing to require social distancing, and continuing to discourage large indoor gatherings, especially when vocalisation is involved. With measures like these, much of society will be able to function effectively while keeping the risk of transmission relatively low.

5. As we move beyond the acute phase of the pandemic, it is important to restore routine medical appointments (e.g. for long-term condition review and patient concerns that may indicate new cancers). We believe that a combination of remote appointments (online, phone and video) plus face-to-face appointments with appropriate personal protective equipment will allow this to happen safely. We recommend a communication campaign to inform the public that the NHS is now open for most routine business.

6. In a complex system, we should not expect to see a simple, linear and statistically significant relationship between any specific policy intervention and a particular desired outcome. Rather, several different policy measures may each contribute to controlling the virus in ways that require complex analytic tools and rich case explanations to elucidate.

7. While it is always helpful to have more data and more evidence, we caution that in this complex and fast-moving pandemic, certainty is likely to remain elusive. “Facts” will be differently valued and differently interpreted by different experts and different interest groups. A research finding that is declared “best evidence” or “robust evidence” by one expert will be considered marginal or flawed by another expert. It is more important than ever to consider multiple perspectives on the issues and encourage interdisciplinary debate and peer review. While government must continue to support research, some decisions—as you will be well aware—will need to be made pragmatically in the face of uncertainty.  

We thank you for your continuing efforts to get us through the pandemic. 

Trisha Greenhalgh, Professor of Primary Care Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Dr Nisreen A Alwan, Associate Professor in Public Health, University of Southampton.
Professor Debby Bogaert, Professor of Paediatric University of Edinburgh.
Professor Sir Harry Burns KBE, University of Strathclyde and Past Chief Medical Officer, Scotland.
Professor KK Cheng, Professor of Public Health and Primary Care, University of Birmingham.
Dr Tim Colbourn, Associate Professor of Global Health Epidemiology and Evaluation, UCL Institute for Global Health.
Dr Gwenetta Curry, Lecturer of Race, Ethnicity, and Health, College of Medicine and Veterinary Medicine, University of Edinburgh.
Dr Genevie Fernandes, Research Fellow, University of Edinburgh and Action Team Member, Royal Society's DELVE Initiative.
Dr Ines Hassan, Senior Policy Researcher, Global Health Governance Programme, University of Edinburgh.
Professor David Hunter, Richard Doll Professor of Epidemiology and Medicine, University of Oxford.
Professor Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine; Past President, European Public Health Association; Research Director, European Observatory on Health Systems & Policies.
Professor Susan Michie, Director of UCL Centre for Behaviour Change, University College London.
Professor Melinda Mills, Director, Leverhulme Centre for Demographic Science, University of Oxford; Member of Royal Society’s SET-C (Science in Emergencies Tasking – COVID) committee; Member of ESRC/UKRI COVID Social Science Advisory group.
Professor Neil Pearce, Professor of Epidemiology and Biostatistics, London School of Hygiene and Tropical Medicine
Professor Christina Pagel PhD MSc MSc MA MA (Professor of Operational Research & Director of the Clinical Operational Research Unit, University College London.
Professor Maggie Rae, President, Faculty of Public Health.
Professor Stephen Reicher, Professor of Psychology, University of St Andrews.
Prof Harry Rutter, Professor of Global Public Health, University of Bath.
Prof Gabriel Scally, Visiting Professor of Public Health, University of Bristol.
Professor Devi Sridhar, Chair of Global Public Health, Edinburgh Medical School.
Dr Charles Tannock, Consultant psychiatrist.
Prof Yee Whye, Professor of Statistics, University of Oxford.

Arriving over Athens

...and here's the second letter, dated the same day

An open letter to the PM, Chancellor and UK CMOs and the Government’s Chief Scientific Adviser, 'calling for a targeted and evidence-based approach to the COVID-19 response' 

The Rt Hon Boris Johnson MP, Prime Minister
The Rt Hon Rishi Sunak, Chancellor of the Exchequer
Professor Chris Whitty, CMO, England
Dr Frank Atherton, CMO, Wales
Dr Gregor Ian Smith, CMO, Scotland
Dr Michael McBride, CMO, NorthernIreland
Sir Patrick Vallance, Government Chief Scientific Advise

21st Sept 2020

Dear Prime Minister, Chancellor, CMOs, and Chief Scientific Adviser,

We are writing with the intention of providing constructive input into the choices with respect to the Covid-19 policy response. We also have several concerns regarding aspects of the existing policy choices that we wish to draw attention to.

In summary, our view is that the existing policy path is inconsistent with the known risk-profile of Covid-19 and should be reconsidered. The unstated objective currently appears to be one of suppression of the virus, until such a time that a vaccine can be deployed. This objective is increasingly unfeasible (notwithstanding our more specific concerns regarding existing policies) and is leading to significant harm across all age groups, which likely offsets any benefits.

Instead, more targeted measures that protect the most vulnerable from Covid, whilst not adversely impacting those not at risk, are more supportable. Given the high proportion of Covid deaths in care homes, these should be a priority. Such targeted measures should be explored as a matter of urgency, as the logical cornerstone of our future strategy.

In addition to this overarching point, we append a set of concerns regarding the existing policy choices, which we hope will be received in the spirit in which they are intended. We are mindful that the current circumstances are challenging, and that all policy decisions are difficult ones. Moreover, many people have sadly lost loved ones to Covid-19 throughout the UK. Nonetheless, the current debate appears unhelpfully polarised around views that Covid is extremely deadly to all (and that large-scale policy interventions are effective); and on the other hand, those who believe Covid poses no risk at all. In light of this, and in order to make choices that increase our prospects of achieving better outcomes in future, we think now is the right time to ‘step back’ and fundamentally reconsider the path forward.

Yours sincerely,

Professor Sunetra Gupta; Professor of theoretical epidemiology, the University of Oxford
Professor Carl Heneghan; Director, Centre for Evidence Based Medicine, the University of Oxford
Professor Karol Sikora; Consultant oncologist and Professor of medicine, University of Buckingham
Sam Williams; Director and co-founder of Economic Insight

Professor Louise Allan (Exeter)
Professor Francois Balloux (UCL)
Professor Sucharit Bhakdi (JG University of Main)
Dr Julii Brainard (U. of East Anglia)
Professor Anthony Brookes (Leicester)
Professor Nick Colegrave (Edinburgh)
Dr Ron Daniels (UK Sepsis Trust)
Professor Robert Dingwall (Nottingham Trent)
Professor Fionn Dunne (Imperial Coll.)
Professor Kim Fox (Imperial Coll.)
Professor Anthony Glass (Sheffield)
Dr Andy Gaya (Consultant oncologist)
Dr Peter Grove (Former Dept Health)
Professor Matt Hickman (Bristol)
Professor Elizabeth Hughes (Leeds)
Dr Tom Jefferson (Oxford)
Professor Syma Khalid (Southampton)
Professor David Miles (Imperial Coll.)
Professor Paul Ormerod (UCL)
Professor Andrew Oswald (Warwick)
Professor David Paton (Nottingham)
Professor Hugh Pennington (Aberdeen)
Professor Barbara Pierscionek (Staffordshire)
Professor Eve Roman (York)
Professor Justin Stebbing (Imperial)
Professor Ellen Townsend (Nottingham)
Steve Westaby (Retired heart surgeon)
Professor Simon Wood (Edinburgh)

Appendix: Specific comments on the existing policy path

Any objective should be framed more broadly than Covid itself. To place all weight on reducing deaths from Covid fails to consider the complex trade-offs that occur: (i) within any healthcare system; and (ii) between healthcare, society and the economy.

Individual policy choices within the strategy should be informed by an evidence base. The absence of similar policy interventions to those now being implemented in the past, coupled with the novel nature of the virus, means there is limited existing empirical evidence to inform the effectiveness of said measures. This means most weight should be placed on: (i) analysing what is actually occurring in relation to the outcomes we are targeting; (ii) metrics that can be most accurately measured and reported; and (iii) robust evaluations of interventions imposed, to ensure they deliver actual benefits. We are therefore concerned about the sole reliance on ‘case numbers’ and the ‘R’ to inform national and local policies, as these metrics are subject to significant measurement and interpretation challenges (and further, neither is an outcome that matters to society).

The most pertinent epidemiological feature of Covid-19 is a greatly varying mortality risk by demographic. Mortality risk is highly age variant, with 89 per cent of Covid mortalities in the over 65s. Mortality risk is also concentrated in those with pre-existing medical conditions (95 per cent of Covid deaths). This large variation in risk by age and health status suggests that the harm caused by uniform policies (that apply to all persons) will outweigh the benefits.

Blanket Covid policy interventions likely have large costs, because any adverse effects impact the entire population. These include: (i) short and long-term physical and mental health impacts; and (ii) social and economic impacts.

In relation to health, the impact on cancer is especially acute. ‘2-week-wait’ cancer referrals decreased 84 per cent during lockdown. The impact of this alone has been estimated to be up to an additional 1,200 cancer deaths over 10 years (23,000 life-years lost). Cancer Research UK estimated there are 2 million delayed or missed cancer screenings, tests or treatments. The impact of this broader disruption is uncertain. However, estimates indicate it could be as high as 60,000 lives lost.

In terms of the economy, the OBR’s forecasts are for unemployment to reach 11.9 per cent by Q4 2020. As of July 2020, net debt had risen to £2 trillion for the first time, and public sector net debt is expected to be 106.4 per cent of GDP at the end of the year.

Set against the high costs of these policies, their effectiveness in reducing Covid deaths remains unclear. Focusing on the UK, there is no readily observable pattern between the policy measures implemented to date and the profile of Covid deaths. Caution should therefore be exercised in any presumption that such policy measures will successfully lower future Covid mortalities.

In light of the above, our strategy should therefore target interventions to protect those most at risk. For example, Germany’s case fatality rate among patients over 70 is the same as most European countries. However, its effective reduction in deaths is based around a successful strategy of limiting infections in those older than 70.

Finally, behavioural interventions that seek to increase the personal threat perception of Covid should be reconsidered, as they likely contribute to adverse physical and mental health impacts beyond Covid. Consideration should also be given to whether policies that are intended to ‘reassure’, may in fact reinforce a heightened perception of risk. Providing the public with objective information on the actual risk they face from Covid-19, by age and health status, would be preferable.

Athens Venizelos Airport - walking to departure for England

"So what's your opinion, Simon?"
"My very humble opinion?"
"I am as confused and uninformed - for all my listening and reading - as a serf aware of the growing spread of the great pestilence in the middle of the 14th century. And, you know, historians are still arguing about the Black Death!'
"How about a more arrogant opinion?"
"I'm glad I don't have to have one"
"Oh go on!"
"I thought I had a reasonably appreciation of what was going on with this strange virus in the middle of the year. Now I am confounded. Don't get me wrong. I still have opinions but I have less confidence in them."
"So how would you judge that exercise you were suggesting, asking students to do a briefing to government, on the basis of those two letters?"
"I'd love to try it out. It's not much help but I am tending to go along with the words in that first letter:" 

In a complex system, we should not expect to see a simple, linear and statistically significant relationship between any specific policy intervention and a particular desired outcome. Rather, several different policy measures may each contribute to controlling the virus in ways that require complex analytic tools and rich case explanations to elucidate. While it is always helpful to have more data and more evidence, we caution that in this complex and fast-moving pandemic, certainty is likely to remain elusive. “Facts” will be differently valued and differently interpreted by different experts and different interest groups. A research finding that is declared “best evidence” or “robust evidence” by one expert will be considered marginal or flawed by another expert. It is more important than ever to consider multiple perspectives on the issues and encourage interdisciplinary debate and peer review. While government must continue to support research, some decisions—as you will be well aware—will need to be made pragmatically in the face of uncertainty.  

Linda: "So, basically, that involves governments doing whatever they like" 

"What puzzles me is that I can discern no plausible connection between governments' policies on Covid-19 and their effects, other than to cause delays in the progress of the pandemic ... A puzzlement that confirms my sense of being like a serf in the century of the great pestilence*" (continued on p.94)

23/12/20. An old friend, Ian Coghill (once an environmental health professional) commented: Delaying the progress of the pandemic has been the only outcome of the government's policies. It was probably the only practical one in a free country. Nor has it been a waste of time. It has largely prevented the acute care system being overwhelmed and has allowed time for potential vaccines to be produced and deployed.

29/12/20. We are not only 'locked down', but 'locked in' to a situation that has no end. The Black Death lasted 7 years. Other bubonic epidemics involved slightly shorter ordeals. The 'Spanish' flu lasted three years. CD-19 will last longer, with reverberating collateral damage in other sectors and to many other people. I can't see how any government can moderate lockdown. The virus can recur in those who've had it, Vaccination - touted as the light at the end of tunnel - does not reliably stop people getting the disease or transmitting it. Restrictions on social end economic activity are widely supported among electorates and by opposition parties in government. Many complain that present and suggested restrictions are not stringent enough and too late. 

5/01/2021. Listening to the radio last night I thought I heard .... "I am speaking to you from the cabinet room at 10 Downing Street. This evening guided by every sensible scientist in Europe I handed the Coronavirus and its mutations a final note stating that, unless we heard from them in the near future, that they were prepared, at once, to withdraw themselves from everywhere by 11 o’clock, a state of war would exist between us. I have to tell you now that no such undertaking has been received, and that consequently this country is now in a state of lockdown forever." 

Our daughter reports our grandchildren delighted in proportion to their parents' dismay 

*The Black Death

Friday, 6 November 2020

Locked down in Greece

At noon, Thursday 5th November, I sat, face-masked, in the Ano Korakiana baker's shop on Democracy Street, with Theodora behind her counter. I bought a cheese pie and ate it - temporarily unmasked with her permission - while watching the latest lockdown broadcast from the Greek PM, Kyriakos Mitsotakis. 
There'll be lockdown across Greece from 0600 Sat 7th November until Monday 30th November 2020. To get permission for various - 'essential' - activities out of the house I shall need to send an SMS from my mobile to 13033 (free of charge). I'll have to re-activate my Greek mobile as a friend, just returned to England from Ano Korakiana, has messaged me to say it's no good texting an SMS 0030 13033. "It won't work, as we found out with the earlier lockdown in the Spring"

My SMS, when it works, must list one of six activities followed by my name and home address in this format:

<X (1-6) space First name space Last name space Address>

1. Go to a chemist or visit a doctor.

2. Go to a supermarket or mini market if food cannot be delivered.

3. Go to the bank if EFT isn't possible.

4. Travel to help someone in need or to accompany underage students to/from school.

5. Go to a funeral or other ceremony.

6. Physical exercise outdoors or movement with a pet, individually or in pairs, observing, in the latter case, 1.5 metres social distance.

The authorities reply to my SMS with a one-off code for my selected activity. The reply on my mobile can be shown, if I'm stopped by the police. If I'm doing something different from the authorised activity I can be fined. I must also have ID/Passport with me. Masks are to be worn outdoors as well as inside shops and other spaces other than home. We may not visit anyone or travel anywhere if that activity doesn't fit in the 1-6 categories. - the same situation as for the strict Greek lockdown earlier this year. Justifying his decision with a host of statistics and charts demonstrating the impact of Coronavirus on Greece and the rest of the world, Mitsotakis said 'These figures are non-negotiable!" The little serf in me reacts with respect to such an assertive affirmation. 

Το Σάββατο στις 6 το πρωί ξεκινά το πανεθνικό lockdown και ο περιορισμός των μετακινήσεων. Οι πολίτες θα πρέπει πλέον να στέλνουν SMS στον πενταψήφιο αριθμό 13033 ή να έχουν ειδική γραπτή βεβαίωση.  

Please note that the use of a mask is mandatory everywhere with the exception of people exercising by themselves. I take this to mean that if I cycle - only a short distance from home of course - for exercise, I needn't be masked. It would make such 'exercise' easier. Ditto walking or jogging alone. I will have a mask swiftly to hand in case of encounters with another person while otherwise on my own with completed permit (and ID) to participate in activity number 6.

*** *** ***

The anniversary of the death of our neighbour, Adoni, will be celebrated on Saturday 7th November at Paraskevi Church at the foot of the village, a kilometer from our house. As Adoni was an officer of the police of Corfu Port there will be his colleagues present. We shall walk there. Our SMS permits will be requested:

5 (space) Simon Baddeley (space) Ano Korakiana

5 (space) Linda Baddeley (space) Ano Korakiana

Wes, our neighbour, has printed out several paper forms (Greek with English translation) for us. These  can be downloaded from the web, completed in writing, and taken with us if we go out. Mustn't forget to have passports or other IDs to hand.  

Back numbers

Simon Baddeley