The COVID Chronicles – 8

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.

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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. 

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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.

The COVID Chronicles – 7

Geneva, 5 December, 2020

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Anti-lockdown protests in Melbourne, Australia in early November. Source: Noosanews

We all have a bit of the “don’t mess with me” mentality. We are intolerant of people in our space or causing us the slightest inconvenience. We get stroppy; some more than others. Political parties feed off “don’t mess with me;” some more than others. However, if it serves a greater good, we tolerate being messed with; some more than others. What has surprised me is how the pandemic has brought out the “don’t mss with me” in so many people who seem unable to comprehend that the greater good of an effective public health approach must engender collective measures. The lockdowns and other social distancing measures are seen as an attack by government on individual freedoms, a personal affront and, it follows, ineffective.

In the COVID Chronicles 6, I described the no-nonsense, calm approach of the Swiss to the main issue for all of us: that is, the big balance that weighs an effective public health response against the social and economic impact of lockdown and other social distancing measures. Quite a contrast to the political and “don’t mess with me” argy-bargy in the UK about how, where and when anti-COVID-19 measures should be imposed. If I could show that the first UK lockdown avoided two million COVID-19 cases with their inevitable burden on the health services and 70,000 deaths, would the on-going imposition of lockdown and / or other social distancing measures be more digestible and less contentious? Could we not work towards a cooler judgement of weather such measures are “worth it”? You may well wonder how I’ve arrived at these figures. With some trepidation…. here goes….!

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UK cases per day. Source: Johns Hopkins
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UK deaths. Source: Johns Hopkins

Above are the UK stats for COVID-19 cases and deaths per day according to Johns Hopkins (who collate each countries own reported stats.) To date, the UK has reported a total of 1,633,744 COVID-19 cases and 58,545 related deaths largely distributed between two peaks. Similarly, other western Europe countries, Australia and Canada show two peaks. Current declining cases and deaths are due to re-imposition of a variety of measures all of which curtail our lives to an extent.

Given the graphs for the global cases and deaths per day (see below,) it would be reasonable to assume that in the UK, without the first lockdown beginning in March, the epidemic curve for daily cases would have continued to rise through April and beyond. The curve for daily deaths would have risen but disproportionally less so for reasons that remain unclear. The same assumption could be made for other countries with two peaks.

In the UK, the first peak of cases per day is on 10 April and the second on 17 November. This gives a “inter-peak” period of 191 days. A line drawn between the first and second peaks of these curves would represent a minimum of cases and deaths without the first lockdown. If we assume that the below-the-line average for those 191 inter-peak days would have been around 1,200 cases per day and around 400 deaths per day, we arrive at 2,292,000 cases and 76,4000 deaths. Therefore, the minimum number of cases and deaths avoided in this 191 day period are given by the 2,292,000 cases and 76,4000 deaths minus the reported 1,303,000 cases  and 42,000 deaths respectively for the same period. This gives us 989,000 cases avoided and 34,400 deaths avoided. The same calculation can be made for any other country showing two peaks.

But, of course, epidemic stats follow curves and not straight lines. This means that the reality of what would have happened over the 191 day inter-peak period without lockdown would have been represented by a curve in the form of one bigger peak. We will never know the full height or width of this bigger peak. Nevertheless, the figure of the below-the-line cases and deaths avoided as calculated above must represent only a fraction of the cases and deaths that would have been. In reality, double this would be a good shot. Maybe we’re looking at two million cases and 70,000 deaths avoided by the first lockdown? So there!

Politely worded disagreements based on existing data and reasonable assumptions are welcome. 

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Global cases. Source: Johns Hopkins
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Global deaths. Source: Johns Hopkins

The COVID Chronicles could also chronicle the more bizarre opinions I’ve read about anti-COVID-19 measures. How about this one? In several locations in nearby France: “Slaves and their children are masked and vaccinated!”

The COVID Chronicles – 6

Geneva, 30 November, 2020

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There is quite a COVID-19 storm brewing on the other side of the planet. The 53-strong Pakistan cricket squad flew into Christchurch, New Zealand for a series of international matches. Whilst doing time in their isolation facility, six of the visitors have tested positive. They were caught on CCTV breaking distancing protocols by givin’ the tea bags heaps outside their own single rooms. They are being threatened with a return flight having not bowled a single ball. There is outrage on both sides. Former Pakistan fast bowler Shoaib Akhtar youtubed “I want to give a message to New Zealand cricket board that this is not a club team, it’s Pakistan national cricket team. We don’t need you. You are talking about Pakistan – the greatest country on the planet – so behave yourself…. Be careful next time.” Well, that’s telling ‘em! New Zealand has shone bright throughout the COVID-19 pandemic by being one of the few countries to have controlled transmission of the virus. Since mid-May, they have had only a scattering of cases exclusively among isolated international arrivals. So I am totally baffled as to why – just in the name of sport – this number of people are permitted to enter NZ from a country with patchy public health infrastructure that is reporting nearly four thousand cases per day and rising. Yes, indeed! Be careful next time!

The international news is currently dominated by COVID-19 vaccines and pre-christmas relaxation of social distancing measures. The debate about the origin of the virus in Wuhan, China seems to be on a back burner. It (the debate) will come back at some stage.

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COVID-19 cases per day: Italy. Source: Johns Hopkins

Italy was the first European country to be hit hard by the pandemic. As lawyers place the best understanding of facts in the context of law, so science places new findings in the context of the best understanding of facts. Enter a study that drew brief attention in April but is now published for review. Giovanni Apalone and colleagues have reported that people in northern Italy were exposed to the virus responsible for COVID-19 as early as September 2019. More than a little surprising! If true, emergence of the virus in Italy predates the presumed beginning of the Wuhan outbreak by at least two months. These findings do not fit easily into “the context of the best understanding of facts.” Can this really be correct? Can this be explained by laboratory error or – somehow unlikely – are we looking at fabrication of facts? The scientific community seems to be doing the stunned mullet on this one. As I said in the Lockdown Diary on 12 April, getting to the bottom of the origins of the virus in and its spread outside China will require a neutral stance, a ton of diplomacy, the best of science, the coolest of heads and time. In all things COVID-19 – related, there’s a message here for trigger-happy journalists, political opportunists, social media cheap-shots, conspiracy theorists, antivaxers and Dunning-Kruger positives. Good science takes time and the truth will out in good time.

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Living in Switzerland can lack excitement. Everyone here just gets on with things in a democratic no-fuss way. For the expat, the Swiss respect for law and order brings advantages beyond living in a clean, safe and exceptionally beautiful country. The weekend before this second lockdown, my wife and I rented a campervan and spent an autumnal rainy weekend near the charming town of Interlaken. When the clouds cleared, the Alps towered above us. The lakeside camp site was immaculate.

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It was also very, very quiet. No wonder given the site’s rules that constitute local by-law. I just love it… especially indeed the prohibition whatsoever of any particularly annoying games and the like!

So, despite clocking up some of the worst COVID-19 stats per capita in Europe, the Swiss have dealt with the pandemic in their own way. The first lockdown was accepted. To my knowledge, there was little disagreement; we saw no anti-lockdown demonstrations. With the current resurgence, the national authorities have decided that a second lockdown must be avoided. They have imposed a rule on the number of people who can meet socially, made masks mandatory in any enclosed public space and appealed to the weight of citizens own responsibility. This approach seems to be respected and, looking at the stats, effective. The feeling is that, yes, worrying and inconvenient as it all is, we are in safe hands.

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And here are the safe hands. The ultimate decision-making body in Switzerland is the elected seven-member Federal Council. (Note: they are hardly household names.) Each member is responsible for one ministry and decisions are usually arrived at by consensus. The Council’s Presidency rotates on a yearly basis. That’s right, there is no Head of State in the usual sense. It’s not a political system that naturally selects the alpha male personality and to cite the late Ruth Bader Ginsberg, “Wherever decisions are made, there has to be women.” I have the utmost respect for this system. It means that the Swiss response to the COVID-19 pandemic has not become mired by party politics or yobbobabbled into wibblewobbleland by one clueless male leader as we’ve seen elsewhere (well… in the US.)

The sudden spike in cases here in Geneva four weeks ago meant “non-essential” businesses in town have closed temporarily; a measure permitted by the Federal Council. Whilst those affected are obviously unhappy, they accept this has to be done. A local feature in this week’s Tribune de Geneve is that a rugby team (I didn’t know they had one!) is helping out by doing the shopping for the elderly.

The other day, I heard about a Swiss couple who had concerns about their apparently normal and happy five year-old boy because he had never uttered a word. They took the boy to a paediatrician who, after a battery of sophisticated tests, asked him directly why he had never spoken. “Because,” replied the boy “Until now, everything has been perfectly satisfactory!”