Geneva, 25 December, 2020

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Yes, it’s come to this…. Home-made Christmas cards! My golfing friends may – or may not – appreciate my little contribution to seasonal cheer. But then, I guess right now, we need all the cheer we can get.

It was Christmas day of 1981; not long after beginning my first job after qualifying as a doctor. I was on-call for the surgical wards at Addenbrookes Hospital in Cambridge. The staff nurse called me to say that one of our patients recovering from surgery – let’s call her Maisie – had an irregular heart beat. I went up to see her; her bed was empty. Maisie, a good old Fenland character, was clearly not bothered. I found her in the TV room glued to the BBC’s newest production of the nativity. “Hello, Maisie” I said, “Nurse wants me to check your heart beat. I’ll just do a test. Is that all right?” Maisie kept her eyes on the screen. “Whatever you say, doctor! But coz I can’t go to church like what I usually do, I want to watch the nativity.” I untangled the wires of the ward’s electrocardiogram, applied the pads to Maisie’s wrists and ankles and switched the machine on. I glanced at the TV; a tired and obviously pregnant Mary rode a donkey; Joseph walked alongside. “Are you enjoying the nativity there, Maisie?” I asked. “Oooh, it’s lovely!” she replied. The electrical impulses of her heart beat appeared regular and normal on the small screen; obviously, any irregular beats had been transient. Nevertheless, I thought I would let the ECG run for a minute or so. “Who’s that?” Maisie asked pointing a gnarled finger at the screen. “That’s Mary and her betrothed, Joseph. And it looks like Mary’s pregnant, Maisie!” We both chuckled. “And she was a virgin!” I added. For the first time, she looked up at me. A question was clearly forming in her mind. “Good catholic girl was she?” She cackled. “Well, I’m not sure they had catholics in those days!” I said. “When was this then?” Maisie asked. I wasn’t sure whether she was pulling my leg. “Well, Jesus was born one thousand, nine hundred and eighty-one years ago, Maisie.” Her eyebrows raised. “Oooh! And, what…. on Christmas day?” Her heart beat remained steady and regular. “Poor Jesus. I’d hate that!” she continued. “I got a nephew who was born on Christmas day and he only gets one lotta presents each year coz everyone does his Christmas present and birthday present together. Thats’s real cheap, I say!” Maisie, it seemed, was not pulling my leg. After scenes of shepherds and kings truckin’ along, the viewer was taken through a jolly busy way-side inn and into a stable. Mary was lying in some straw and well into her labour. A close-up of Joseph’s face revealed no little agitation. “Oooh! The anxious father!” exclaimed Maisie. I said nothing. Soon, Mary was crying out in pain clearly about to deliver. Maisie’s mouth hung open. Her heart rate, whilst still regular, had now picked up somewhat. Turning to me with eye’s wide in wonder, she asked “Do you think it’ll be a little boy or a little girl?”

Few young docs end up where they thought they would. In 1981, I was wondering if I had what it takes to become a consultant vascular surgeon. I went on to get a surgical qualification but abandoned ship (the UK’s National Health Service) to work for a number of years as a field surgeon for the International Committee of the Red Cross. I then became the medical adviser to the ICRC on issues relating to violence and weapons; a role in which I inevitably found myself in the domain of international mechanisms preventing the development, production and use of chemical and biological weapons. In the mid-1990s, I had the good fortune to meet a charming and brilliant American scientist by the name of Matt Meselson. (Matt together with Franklin Stahl performed what has been described as the “most beautiful experiment in biology.” After the double-helix structure of DNA had been proposed by Watson and Crick in 1953 , Meselson and Stahl, in 1958, established how DNA replicated itself.)

Matt dedicated a large part of his professional life to the scientific aspects of preventing the use of chemical and biological weapons and did probably more than anyone to promote within the scientific community the importance of the 1972 Biological Weapons Convention. He and I often engaged in discussions about the worrisome spectre of a whole new generation of microbes and toxins both natural and man-made. He was far-sighted. Finding ourselves in a workshop here in Geneva, we shook hands warmly. He said, “You know, Robin, we’ll see the day when we don’t shake hands anymore. We’ll be bumping elbows. It’s inevitable.” We’ve bumped elbows since. I am sure Matt would have wise counsel for the team investigating the origin of the virus responsible for the COVID-19 pandemic.

Us Brits have a quaint but important tradition at Christmas dinner: cracker jokes. These are written on little pieces of paper that fly out of the exploding Christmas cracker. The jokes are so bad that, when read out, they predictably generate a disappointed groan from everyone sitting around the turkey-laden table. The idea is that squabbling families stop squabbling for just a couple of minutes because they are all unconsciously united against the unknown author of the awful cracker joke. As PG Wodehouse would say, it’s about the psychology of the thing. So… Covid Cracker jokes…….. The year 2020 has been awful. It’ll end in tiers! (UK only!) .. or .. What does the Trump family do for Christmas dinner? They put on a superspread!

Merry Christmas everybody! But if you’re in Switzerland, no singing!

Gotta love the Swiss! The above is from the government’s Covid info site. 

See y’all in 2021.

Geneva, 19 December, 2020

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David Attenborough has been involved in nature broadcasting for more than 70 years. He is a truly remarkable and inspirational man who, at 94 years-old, has written a truly remarkable and inspirational book “A Life on Our Planet.” I have just finished reading it. Attenborough wags a very authoritative finger at homo sapiens for how, through a perceived need for continual economic growth, we have pretty much destroyed our habitat and that of millions of other species. He provides ample evidence of a looming catastrophe. Given this, he nevertheless offers solutions and even hope. He neatly draws together what needs to be done from an ecological point of view (including an argument for a more plant-based diet,) the imperative for a total shift in how we think of the economy (looking beyond GDP as the sole value of the well-being of a nation) and a human future that is equitable and sustainable. If I were a wannabe politician eyeing the long term, this book would leave me with three words to work into speeches. People, Planet and (not only) Profit.  

The boost to our spirits on hearing that COVID-19 vaccines are soon coming on line has been short-lived. The pandemic news has just got a whole lot more complicated and, I fear, worrying. Burgeoning case numbers with associated deaths continue in the US. In the UK and Germany there has been a sudden rise in cases despite lockdown measures. School closures are fiercely debated. We hear that the virus responsible has mutated and may be even more transmissible than before. (Apparently, this is what coronaviruses do. In evolutionary terms, such a virus is much more interested in transmission between its hosts than killing them.) On top, the WHO and China have agreed that an international investigation team will be sent to Wuhan where, supposedly, the virus responsible for COVID-19 first emerged.

And of course, it’s getting to that time of the year. I detest the rampant consumerism that traditionally takes over our lives at this period. Otherwise, I neither like christmas nor dislike it. I just go with the flow. I’m always baffled by how much importance we put on Jesus’s birthday. Christmas in the time of COVID-19 is lining up to be more baffling still. It seems that politicians want to curry favour by allowing us to go shopping and get together with our families in full knowledge that these activities are likely to compound the spread of the COVID-19 virus. Predictions of a new year resurgence are both believable and serious given that case numbers surged in the US as a result of family gatherings for Thanksgiving in November. 

I realise that this may all be just too gloomy. So just for grins and giggles, why don’t I populate this black scenario with some online snippets that I’ve found about the economic impact of the pandemic to date. I do not present this material with any expertise in economics.

These unemployment figures are heart-breaking. Unemployment has spiked like never before in the US and the UK. By contrast, here in Switzerland, it is reported that those claiming unemployment benefit rose from 2.5% to only 3.2% in the 2nd quarter of the year. 

Are the stock markets holding their own? 

The markets took quite a hit in March but seem to be getting back on track. Apparently, I am not the only person mystified by this recovery. My friend Tom, who knows about these things, is not sure that this market confidence is sustainable. He’s convinced that the world of high finance is yet to be truly tested by the economic impact of the pandemic.

The most sobering of all is a World Bank graph I found yesterday.

This shows that the proportion of countries that will be in recession in 2021 as a result of the pandemic will be over 90%. This is higher than any past recession including the great recession of the 1930s.

In a global financial crisis, I’ve heard it said that two traditional financial refuges are the Swiss Franc (yay!) and gold. The US dollar has tumbled in relation to the Swiss Franc. (The US now accuses Switzerland of manipulating currency markets.) Gold dipped when the pandemic first hit but in August this year, dollars per ounce of gold hit an all-time high.

This morning, I listened to the third 2020 Reith Lecture “From COVID crisis to Renaissance” delivered by Mark Carney, former Governor of the Bank of England. His theme for this series of lectures is that leaders should reassess “value” beyond pure economic terms. Other more subjective values should be taken into consideration such as fairness, the health and wellbeing of people and the ecological impact of all our activities and lifestyles. He describes the impact of COVID-19 pandemic as the “bill arriving” for lack of resilience preparation, propagating inequities within society and failure to recognise that essential workers are exactly that: essential. The economy was put on “life support” whilst a public health response was mounted. This response has required an unprecedented intrusion into our lives by government. However, Carney points out that this does not indicate that a trade-off exists between the public health response and maintaining a strong economy. Our health, wellbeing and health services should be considered as one set of values and that the economy – another set of values – will not improve until an effective public health response has been put in place. The value to the nation of health workers and, it follows, deaths avoided does not readily translate into economic figures and so should not be sublimated to GDP as a result.

Carney also underlines how the pandemic has hit certain socio-economic groups harder than others. Therefore our ultimate response must engender effective public health measures, addressing societal inequities especially with respect to living standards and education together with plans for an economic recovery. Finally, Carney claims that a similar approach must be adopted by leaders with respect to climate change; something he will be talking about next week.

It seems that Mr Attenborough and Mr Carney are heralds singing off very similar song sheets. If the challenge of addressing COVID-19 helps us face the challenge of climate change then the mantra of any political “renaissance” has to be People, Planet and (not only) Profit.

Geneva, 10 December, 2020

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We recently dug out a long-forgotten chess set and gave it a go. Chess is a truly wonderful thing. It may be the only board game that does not carry an element of luck; to win or to lose is totally determined by mental abilities.  

In the first lockdown, I noticed that the corner of a nearby park normally dedicated to open air chess was deserted and commented that, over the years, I had only ever seen men playing there. I had a stab at why the game holds less attraction for women. 

Many have turned to chess this year. The evidence is that eBay has seen chess sales going up by 60% after the onset of the pandemic. According to a spokesman for the International Chess Federation, on-line chess was already booming due to the confluence of live streaming technology and video game culture. At the beginning of the year, as many as 11 million chess games were played on-line every day; when the pandemic hit, this grew to more than 16 million games per day.

Like many others, I first subscribed to Netflix this year. Forbes has reported that the television streaming giant gained 26 million new customers in the first half of this year. The pandemic has precipitated the company’s biggest ever growth spurt. One its most successful productions is a screen adaptation of Walter Tevis’s 1983 chess novel, the Queen’s Gambit. The October debut of this absorbing miniseries came hard on the heels of the lockdown chess revival. The spokesperson for eBay reported another 215% increase in sales of chess sets and accessories since the first episode.

The story of the Queens Gambit is about a young American girl, Beth Harmon, born with a natural gift for chess. As a teenager, she goes on to beat the Soviet Union’s World Champion, Vasily Borgov. However, it is not the against-all-odds-feel-good watching that one would expect. The story encompasses grief, loneliness, drug addiction and alcoholism on the part of the main protagonist. 

Another Netflix blockbuster is The Crown. Its success rides on the endless and world-wide (and for me inexplicable) fascination for the British royal family. It must be the first TV or film production in which, at every stage, the viewer is constantly asking themselves “Blimey, did she really say that? Nah, he wouldn’t have done that, would he?” Basically, it is one great lavish very entertaining soap based on some facts and with characters who happen to be royal, instantly recognisable, privileged and rich beyond imagination. Unfortunately, by watching, the viewer becomes complicit in the passing off of many fabricated scenes as history. The Crown should carry a fiction warning.

The issue of mental health is upfront in this series as well. It turns out that two distant cousins of Prince Philipp were incarcerated in an asylum from a young age. Princess Margaret’s drinking and suicide attempt are highlighted along with Diana, Princess of Wales’s bulimia. Warnings of scenes relating to an eating disorder precede some episodes.

These two series make for great television for when one has to stay at home. They prompted me to search around for any valid information about the mental health impact of having to stay at home because of the pandemic. 

The BBC has spoken to experts who predict that those already subject to obsessive-compulsive disorders may become chronic “germaphobes.” Anxiety will be exacerbated among those who already suffer high anxiety levels.

Antonis Kousoulis and colleagues published a review of existing evidence of the mental health impact from past epidemics and pandemics. They emphasise that the many mental health issues likely to arise from this pandemic must not be ignored. They warn that isolation and social distancing may increase the likelihood of alcohol and drug misuse and online gambling. They predict “a higher concentration of social determinants” associated with self-harm and suicidal ideation; these determinants include stress, financial worries and relationship discord.

Ann John and colleagues have recently reviewed all studies with respect to suicide rates during the pandemic. Whilst many predictions of increased rates of suicide have been published, it turns out that in high income countries, the suicide rate is unchanged and might even have fallen.

A British law firm, Stewarts, who specialise in divorce, logged a 122% increase in enquiries between July and October, compared with the same period last year. A charity, Citizen’s Advice, reported a spike in online enquiries about how to end a relationship. In the US, a major legal contract-creation site, Legal Templates, recently announced a 34% rise in sales of its basic divorce agreement as compared with last year. Couples married in the previous five months are responsible for 20% of sales. 

There have been a number of articles predicting an increase of domestic abuse, mostly of women, during lockdown. Those already vulnerable to domestic abuse are, apparently, likely to suffer further because of living in isolation with their potential abuser. The data confirming these common sense warnings seem to have two sources. The first is a study in one hospital in Massachussets, USA that reported a doubling of radiologically confirmed domestic abuse cases as compared with previous years. The second is a massive surge in calls to Refuge, a dedicated UK charity helpline. There are multiple on-line references to a UN report of a 20% global increase in domestic abuse during the pandemic. I cannot find the source of this. To arrive at this figure reliably would involve a huge, complex and time consuming study. 

With respect to drinking habits, all data point to increased on-line and carry-out sales of alcohol during the lockdown. Obviously, because people are not going out, they are drinking more at home. I got nowhere in researching how this might eventually translate into heavier drinking or alcoholism. For me, it’s best summed up by a conversation with two friends during the lockdown. We recognised that the question “Shall we open a bottle of wine this evening?” had given way to “Which bottle of wine shall we open this evening?” 

All to say, whilst we battle this extraordinary global emergency, we can predict and should all be aware of its mental health implications. As yet, though, we have barely any quantifying data.

In January this year, Netflix streamed a series of documentaries entitles “Pandemic: How to Prevent an Outbreak.” Yes, in January! Wow! Now that we’ve finished the Queen’s Gambit and the Crown, we might watch Pandemic. It’ll be fascinating to see if they predict the need for lockdown and a risk of accompanying mental health issues. 

I hope all readers of these Chronicles are as healthy and happy as possible under the circumstances. Go well. Be wise.