Week in Review: Covid shines a light on everything

The coronavirus emergency is providing a weird form of political awakening. In every area of life, the response to it reveals deep truths about us and how we do things.

Maybe it's because it is non-political. If it were a political emergency - a war, say, or a sudden no-deal Brexit - people would retreat into their tribes and justify this or that according to whatever their loyalty was. But no-one has loyalty to covid.

Every so often, people try to twist it to an agenda - pretending that closing pubs is a betrayal of the British bulldog spirit or attempting to racialise the disease. But it's rare. For the time being, those efforts still seem like sad subplots rather than the larger narrative.

Instead, the political conclusions which emerge from covid feel deeply true and widely accepted, untainted by tribalism.

The economic response from the government, for instance, which is essentially to flood the economy with money in a bid to keep it at least half-alive, is a final and absolute refutation of the argument that the market knows best.

This isn't necessarily the case for the good times. During a boom, classical economists and right-wingers can still claim that the market performs most efficiently when left alone. But it is a defining acceptance that this does not operate during the bad times. When shocks emerge, state support is needed.

The same is true about the jobs we value. Last night people emerged from their homes to applaud NHS workers. It was a beautiful scene, the kind of thing you'd need a heart of stone to not feel touched by. But it is also in line with our traditional notions of value. More startling has been the emergence of less celebrated roles - the people who collected the rubbish, the tube drivers, the delivery services, the supermarket staff. They are now something new. They are key workers.

These are not the jobs we usually celebrate. It is almost like the feminist critique of traditional economics - that the system would simply stop working without the free domestic labour overwhelmingly delegated to women and then treated as if it were not economic at all. Now we see the same for the function of society. We never discuss these workers. But when they are not there, everything collapses.

Businesses are businesses. Their primary function is to make money. But that does not mean that they must be only concerned with profit and cannot have a moral dimension too. So we have also seen the ethical heart of many companies. Some have cast off their employees, or thrown homeless people out of hotel rooms, or refused to pay sick workers. Others have tried to help. The true nature of these operations has been on show. And customers will remember.

The same goes for people. Some fight in supermarkets so they can secure their ludicrous tower of toilet paper. But actually this is comparatively rare. Most of the food shortages seem to be due to people taking a little bit extra of what they usually get, which is entirely rational if they are being asked to shop less often.

In fact we are seeing huge surges of decency and kindness, of neighbours helping each other out, of people volunteering to help the NHS. Even that new email sign-off - 'stay safe' - replaces our usual goodbyes with a more genuine and heartfelt commitment to each other.

We all remember the post-apocalyptic films and TV shows right now - the 28 Days Later and Walking Deads. There's been a lot of them in recent years. And when London is deserted and people are stockpiling goods, it's hard to prevent your brain from locking into that narrative. All those films have one central question in them: what is humanity really like? And most of them reach pretty grim conclusions. The Walking Dead in particular seems to be based on the most negative conception of people imaginable.

But it's not true, or if it is we've no evidence upon which to believe it. Take a look at what is happening. We are all making tremendous sacrifices. The price the economy suffers will be paid back for years to come. We are accepting very substantial limitations on our freedoms and our pleasures.

And why are we doing it? Yes, a bit of it is for selfish or family reasons. We don't want to get sick and we worry most of all about the older people we love. But for the majority of people the risks of covid are quite moderate. This entire upheaval in our lives has one intention: to protect the vulnerable, to ensure that those over 70 or with underlying health conditions are shielded from the virus.

And that is not a local or a national thing, or even a cultural thing. It is a human thing. It is happening around the world. We have closed down planet earth. We made this sacrifice to protect those most at risk. And there is, no matter how grim this thing gets, something profound about that.

Things will eventually go back to normal. But when they do, we should not forget the things we're learning - about economics, business behaviour, people's actions, and about ourselves.

Ian Dunt is editor of Politics.co.uk. His new book, How To Be A Liberal, is out later this year.

The opinions in Politics.co.uk's Comment and Analysis section are those of the author and are no reflection of the views of the website or its owners.

Johnson already looks bored of the coronavirus

You get what you pay for. We elected an after dinner speaker for prime minister. And that was what we got.

But when you buy cheap, the real cost always reveals itself. There's a proper crisis now, the kind with a severe toll in human life, social change and emotional demand. And we've got Boris Johnson as prime minister.

He seemed frankly quite bored at Thursday's covid press conference. "I don't propose to spend a very long time at this particular one," he told reporters. "I don't want to weary you with these occasions." But that's not what he meant. What he meant was that he couldn't be bothered. He was tired of them.

It's just not very jolly and upbeat. It doesn't play to his strengths. He can't make a gag, or get away with pretending things will be simple, because the bleak and terrible reality of what is happening is apparent to everyone. He can't use it for personal advantage.

So instead, in his boredom, and in his assumption that people would feel the same way, he started to introduce arbitrary timetables. This should all be over with in 12 weeks, he decided. "I'm absolutely confident that we can send coronavirus packing," he said.

Except that's not right. The Imperial report showed this is going to be with us for a very long time, until we find a vaccine, which will probably be at least 18 months. There will be times that the anti-covid measures are relaxed, but when they are, the cases will creep up again, and they will have to be re-introduced. We will, in all likelihood, go through blocks of isolation, then have short periods of relaxation of the rules, then isolate again. This is long term.

No-one likes the idea of that. It is almost beyond comprehension. After what for most of us has been just a week or so at home, it's already starting to grate. It's particularly difficult for those with young children, and those who struggle with anxiety when deprived of social contact.

And it's going to get worse. Looking at our relative progress next to countries like Italy and France, we seem to be on the same course as them. We will probably also see the police cars with loudspeakers telling us to stay in our homes. Things will get scary.

You can understand that people will need some reassurance that there is a light at the end of the tunnel. But fake timetables are a fake certainty. They are the 'Get Brexit Done' of covid. They will dispel public trust in government messages once people realise they are not true.

They are also potentially a public health problem. One of the greatest dangers is that we face a second pulverising wave of infections once the controls are relaxed. And that is much more likely if you have a prime minister suggesting to everyone that "we'll get this thing done" in a few weeks.

It could have been worse. Johnson shares qualities with Donald Trump, but he is not quite Britain's Trump. He has not renamed coronavirus the "Chinese" virus and explicitly tried to manipulate it to a racist narrative.

But it could have also been very much better. France has not exactly covered itself in glory in its handling of covid before this week. But even there, Emmanuel Macron's speech to the nation stood in contrast to Johnson's efforts. "We are at war," he said. "The enemy is there - invisible, elusive - and it is advancing." There was clarity in the severity of the situation.

There was also help, in the form of waived social-security payments, utility bills and rent, alongside loans, job protection and unemployment pay. "No business, no matter what its size, will risk failure," he said. "No Frenchwoman or Frenchman will be left without resources." Britain had to wait considerably longer for similar measures.

He was able to end with "vive la republique, vive la France". Even now, embroiled as he's been in national disputes, the French president still has access to a reserve of national solidarity.

But most of all there was a sense of professionalism, of focus. Macron is not perfect, In many senses he is a disappointment. But he is at least someone who is capable of seriousness. And that makes it easier, in times of crisis and severe uncertainty, to follow a message and to have some degree of confidence in what is taking place in government.

We do not have that luxury. And that is not a coincidence. It is not bad luck. It is because of our choices. We elected a prime minister who does not speak in plain terms, but in winks and innuendo. A prime minister who is incapable of telling the truth. We elected a prime minister who is slow to assess political situations in any manner that does not reflect his own capacity for personal advantage. And we elected one who dealt in easy tribalism and traded in culture war to achieve victory.

So that's what we've got. The chat show guest. The after-dinner speaker. The cynical tribalist. The nation is on the operating table and he comes in at midnight, in black tie with the shirt untucked, half cut, and absentmindedly grabs a scalpel.

There's no getting rid of him in the short term. The most we can pray for is that he shows the foresight and responsibility - or perhaps the sense of political calculation - of perhaps forming a government of national unity, or a wise-heads council of former prime ministers, to oversee this thing. But that too is highly unlikely. We've got what we've got. And now we're going to have to live with it, at the worst possible time.

Ian Dunt is editor of Politics.co.uk. His new book, How To Be A Liberal, is out later this year.

The opinions in Politics.co.uk's Comment and Analysis section are those of the author and are no reflection of the views of the website or its owners.

Protecting the doctors: The reality of the equipment supply problem

The doctors are scared. So are the nurses, the staff and the cleaners. They have looked at Italy and they know what's coming.

"I'm not going to lie, a lot of people here are shitting themselves," one doctor says. "They don't quite know what to expect or how this is going to pan out. We are really going to see what some people are made of. I've seen a lot of horrendous things, but even I'm not sure how well I'm going to cope with all this."

Probably the most significant anxiety is around protective equipment. This is the kit handed to the medical staff treating potential or actual coronavirus patients. There is a widespread fear that doctors and nurses are simply not being given what they need to stay healthy.

"As front line medical workers, we don't have the confidence that we're protected," another doctor said. "We don't know what we are facing and we feel woefully unprepared. We don't feel safe. We'll do the job, but we're putting ourselves at risk by doing it. And if we get sick, there's less of us. It's another doctor down."

At the heart of much of this fear is a downgrade in the advice given to hospitals about the equipment.

The main transmission risk for covid-19 is through droplets. Someone coughs or sneezes, and the droplets produced can be breathed in. This is why the advice is to stay around 6 foot away from others and to self-isolate if you have a persistent cough.

The virus can also spread by people touching surfaces onto which infected patients have coughed or sneezed. If you then touch your face you risk transferring the virus from your hands into your mouth or nose.That's why so much of the advice on protecting yourself is about washing your hands and not touching your face.

For doctors handling potential or actual covid patients, the recommended protective equipment is therefore an apron, gloves, goggles and a surgical mask, of the type that you see everyone wearing when you go to hospital. It's basically just a splash-resistant barrier in case someone sneezes or coughs on them. Then they take off the gear after dealing with a patient, discard it, and get a new set for the next one.

But there is another danger for covid transmission in hospitals. It is through the generation of aerosol. These are tiny droplets that linger in the air. Aerosols are much smaller. They are light enough to stay airborne and therefore have a much higher chance of being breathed in. Because they are small, they can penetrate a surgical mask.

Several procedures in intensive care units generate aerosol, such as intubation, where a tube is inserted through the mouth or nose and into the trachea so a patient can be placed on a ventilator.

Anaesthetists are therefore at particular risk of aerosols, as they have to intubate patients for surgery. But so are many other staff groups such as frontline paramedics and teams dealing with cardiac arrests. When you press a patient's chest, you are pushing air out and there is briefly aerosol in the room.

There are also dangers for dentists. Almost all the procedures in a dentists, including anything involving a drill, the suction unit or the water spray, generate aerosol.

In these situations, the danger is not just for the person delivering treatment. Aerosol stays in the air for around three hours. So others going into the room afterwards could also potentially be infected. In intensive care units, where the air is replaced rapidly, this is less of a problem. But in normal rooms, like that of a dentist, it can be a threat.

Where aerosol is generated, a surgical mask is not enough. Doctors need masks with a fine filter which can catch the air particle. These are called FFP3.

At the start of the covid outbreak in January, Public Health England put out advice which stated that doctors handling coronavirus patients would need gloves, an apron, eye protection and FFP3. But since then, as we've learned more about the disease, that recommendation has now changed so that only health workers dealing with aerosol generation require the FFP3 mask and others are safe with just the surgical mask.

Most experts spoken to for this article were comfortable with the new guidance and believed it was the right use of limited resources. But many frontline staff are deeply suspicious of it. They are anxious that the guidance was changed because it is harder to get FFP3 masks.

They are also concerned about when medical situations change quickly. People can suddenly deteriorate and need a ventilator. The staff around them will have to act, but they'll only have a surgical mask.

There are other dangerous situations too. Covid sufferers who are giving birth through cesarean section, for instance, may suddenly need to convert from epidural to anaesthetic. And then again the same risk emerges.

Some doctors are torn. "For the majority of us, it's safe [to use only a surgical mask]," one consultant said. "Although intellectually I know this, when I am examining a patient coughing on me - with no idea of their status - and I'm in a flimsy plastic apron and surgical mask, I'm shitting it. Psychologically it's a nightmare."

Some experts broadly accept the guidance but remain anxious about it. Although the risk of transmission is lower in non-aerosol cases, it's still not zero. Medical staff are going to be experiencing repeated exposures, especially when things start to reach critical levels in the weeks to come. In an ideal world everyone in the medical profession working on the outbreak would be wearing FFP3.

But the trouble is that supplies are short and the FFP3 masks require testing to make sure they fit. They're designed to prevent particles being breathed in, so they can't just be chucked on the face. They have to completely seal the mouth and nose.

These tests come in a few different forms. You can put a hood on the person, place the mask on and then apply a sweet spray and check if they can taste it. If they can, it doesn't fit. Or you can set up an enclosed space, where you test for particles while the person talks, walks, looks left and right and so on.

There is a particular problem with finding masks for people with large heads and a more pronounced one - mentioned by several people - for female doctors with small faces.

There are lots of reports, from doctors from all over the country, about nightmarish wastes of time. They test two, three, four types of masks, and then find out the models are not available and are asked to test for a different type. Because the masks can't be reused, these tests also use up supply. Some doctors have resorted to buying them themselves by Googling the company in China.

Supplies of the masks come from three sources. The first is the government's pandemic stock. The second is the national NHS supply chain, which operates in each of the four nations. And the third is by NHS foundations. Hospitals can buy their stock through any of these three approaches.

Doctors working in intensive care units and anaesthetics are particularly worried. They are preparing for a massive surge in cases in the next few weeks and they do not have confidence that they have the FFP3 masks to deal with it.

There are also acute concerns about FFP3 masks for doctors rushing to deal with cardiac arrests.

The current guidance from the Resuscitation Council says that "full aerosol generation procedure PPE must be worn by all members of the resuscitation/emergency team before entering the room".

But these are fast moving events, where staff rush to the emergency in order to desperately try to save someone's life. Foundation year doctors are often there first, because they're younger. There'll also be a registrar and critical care doctor. At the moment, it's not likely that they'll have been tested for FFP3. This puts them in a terrible ethical position. What will they do? Not go in, and let them die? Or go in, and know they could become a vector of transmission?

Dentists seemed to have been completely hung out to dry by the government. They are self employed workers, who typically operate by conducting their business in a practice, which they do not own and over whose equipment they have no control.

They are generating aerosol all the time. They do not have FFP3 masks. It also puts patients at risk, because the aerosol can linger in the room.

The chief dental officer in England, Sara Hurley, hadn't bothered to offer any guidance for weeks, desite clarity from all the other UK nations. The British Dental Association started writing to her once every other day expressing "anger and frustration" that "dentists and their teams are being left to cope in the current frightening situation without the benefit of clear official advice".

Dentists across the country were extremely nervous. "It's not a selfish thing," one said. "I don't want a patient coming in and going out infected. I'm willing to take a risk to help people out who are in pain and need my help. But I don't want anyone else to be at risk by coming in."

And it's not just them, but the staff. "There's lots of worried and scared people. Support staff look to us and we don't have answers to tell them."

Finally this morning she clarified that non-emergency aerosol procedures should be avoided, sliding out an announcement which ended routine dentistry as we know it. Again, uncertainty was allowed to prevail, chipping away at confidence in the government approach.

There are widespread and extensive reports of other kinds of shortages.

Some hospitals have a lack of goggles. Intensive care doctors have resorted to making their own by using elastic bands to strap an overhead projector sheet to their face. Anaesthetists have resorted to buying visors in B&Q.

In general, doctors and nurses across the country are crying out about the lack of equipment they have. When you put out a call to hear how they feel about the working environment they are being asked to work in, a wave of outrage and fear comes back.

And that's the thing. That's why medical staff struggle to have confidence in what they're being told about equipment. That's why doctors' bodies like the BMA simply cannot say that they have confidence that their members are being kept safe. Because all around them there is evidence that they do not have the resources they need. The government response looks reactive, sluggish and opaque.

Medical staff need certainty and they need supplies. They will spend the next few months defending the public. In exchange, the public will need to defend them.

A Department of Health and Social Care spokesperson said:

"We will continue to give our NHS and the social care sector everything they need to tackle this outbreak and we have central stockpiles of Personal Protective Equipment. We are working closely with industry, the NHS, social care providers and others in the supply chain to ensure these medical products are delivered to the frontline as quickly as possible, helping minimise any risks to patients and staff."

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