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!”

The COVID Chronicles – 5

Geneva, 23 November, 2020

In 1797, an English physician named Edward Jenner reflected on the widespread observation that milkmaids were generally immune to smallpox. He undertook an inoculation or “variolation” (later to be termed  “vaccination”) from a cowpox pustule on a milkmaid’s hand into the arm of a young boy called Phipps (the son of Jenner’s gardener.) This prevented Phipps from contracting smallpox later when Jenner exposed him on multiple occasions to the much-feared disease. The experiment proved successful in a further 23 cases. And all this with no understanding of microbes! Jenner sent a paper to the Royal Society that was never published. But word was out. 

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James Gillray’s 1802 caricature of Jenner administering his cow pox vaccine also depicting the rumours that anyone so vaccinated would develop cow-like features. Copyright: Getty images

The practice spread rapidly around the world despite criticism that included sanitary, religious, scientific, and political objections. By 1802, an active Anti-vaccine Society stoked fears – rational and irrational – about the smallpox vaccination. The UK government would later pass the Vaccination Act of 1853 making compulsory the vaccination of children aged less than three months; this spawned the Anti Compulsory Vaccination League. Serious outbreaks of smallpox in the USA toward the end of the 19th century were tackled by vaccination campaigns that were in turn opposed by activists. The Anti-Vaccination Society of America was founded in 1879. Needless to say, a global coordinated vaccination campaign eventually allowed the World Health Organisation to declare the eradication of smallpox in 1980. 

The Financial Times reported last week that on the day that Pfizer and BioNTech announced the development of a vaccine that effectively protects against COVID-19, shares in Pfizer rose by 7% and Pfizer’s Chief Executive, Albert Bourla, sold US$5.6 million of his own stock. In trying to understand whether this was legal, whether this indicated Mr Bourla’s lack of faith in the product or whether he was expecting imminent emergence of competition – that would then drop the value of Pfizer’s shares – I found myself sliding down a rabbit hole into the kaleido-warren of high finance.

It’s obvious where I’m going with this. In the months to come, the world news in relation to the COVID-19 pandemic will be dominated by the development, production, distribution, administration and effect of the vaccine and opposition to it. This media hot topic will inevitably coincide with and be linked to an ever-increasing number of COVID-19 cases in the USA and how the outcome of the extraordinary election there plays out.

The bases of reservations about or total opposition to COVID-19 vaccines are many and varied. The vaccine is not safe. The vaccine is not needed. The vaccine is not effective. The whole exercise is too expensive. You can’t trust doctors and scientists. Vaccination is one big scam run by pharmaceutical companies. Vaccination should not be compulsory. Governments can’t be trusted. The WHO is corrupt. Vaccination is not natural. Vaccination runs against God’s order. Vaccination is the means for governments to insert microchips into our bodies. There are others more competent than me WHO have ready answers to all the above. 

The voices of those against the vaccine will become all the more powerful via blogs, on-line news and social media. Disinformation and conspiracy theories spread and can take on a life of their own and so become credible. Here we arrive at what I want to say in this blog. Be very careful with respect to what you read, hear and believe about COVID-19 vaccines. Knowing about the Dunning-Kruger effect may help you.

We all like to read stuff that resonates with what we already believe but most of us have the capacity to put our own beliefs into question when presented with reasonable counter-arguments. The Dunning-Kruger effect is when people with low ability tend overestimate their ability. Thus, some people may believe they are superior because they are unable to recognise their lack of ability. Dunning summed it up as “If you’re incompetent, you can’t know you’re incompetent … The skills you need to produce a right answer are exactly the skills you need to recognize what a right answer is.” It follows that intelligent people have the ability to question whether they have the right answer. Those who do NOT ask themselves whether they have the right answer are susceptible to having their self-overestimation reinforced by interacting with others who also have not asked themselves whether they have the right answer. Think extremist politics, devotion to ultra-religious creeds, biker gangs etc. (If you’ve read this far you are probably not subject to the Dunning-Kruger effect!) It goes without saying that the internet in all its forms unleashes one great accelerator of the Dunning-Kruger effect. In relation to the subject at hand, it potentially allows equal voice to the leading public health scientists of the day and Elvis-says-NO-to-vaccines. This is just one example of what Barack Obama recently referred to as “truth decay.”

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Donald Trump blasted his way into the MMR vaccine / autism debate. On 4 September 2014, he tweeted “So many people who have children with autism have thanked me – amazing response. They know far better than fudged up reports!” Just before the 2016 US election, I flew to my hometown, Norwich, in the UK. I jumped into a taxi. The driver seemed like a nice guy. We got talking. It was soon apparent that he admired Mr Trump. The soon-to-be-President Elect’s intelligence was, apparently, evident by what he had to say about vaccines. I nodded. The subject turned to Brexit. Unsurprisingly, my driver was all for it. Fair enough. Just before we got to my destination, he said, “I see it like this… Britain ruled the world before we were part of the European Union. Britain won’t rule the world again until we leave the European Union!” I paid my fare and got out of the taxi. I stood by the roadside, stunned. How, I asked myself, do people come up with ideas like that and feel comfortable voicing them to strangers? I know now: the Dunning-Kruger effect.

The COVID Chronicles – 4

Geneva, 17 November, 2020

Kylie Minogue has set new chart records with her latest album “Disco.” She says that recording the vocals at home was “a lifeline” during the lockdown. The petite Australienne becomes the first female artist to have a number one album in the UK in five separate decades. Go, Kylie!

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Photo: Getty Images

Not many people outside the UK will be familiar with the name Tony Blackburn. Don’t worry! In the mid-late 1970s my summer holiday job was selling ice creams out of a Ford Transit. The van’s roof was a huge fibreglass vanilla cone with a Cadbury’s flake protruding at a racey angle. My ultimate Pavlov-kiddy-drool attractor was a chimed version of Popeye-the-Sailorman and I was quite the boy around the housing estates of my hometown, Norwich. BBC’s Radio One pumped out the songs of the day and Tony Blackburn was the bright young DJ who led the nation’s taste in popular music. I will survive. Don’t go breaking my heart. Boogie nights. Heaven must be missing an angel. Crocdile rock. Stayin’ alive. You’re the first, the last, my everything. Dancing queen. Our Tony peppered his show with jokes such as “What happens when the ducks fly upside down?….They quack up!” and “Why are there no aspirins in the jungle? ….. Because the parrots eat ’em all!” He had the infuriating habit of talking over the songs but the nation forgave him because he seemed like a nice kind of bloke. No surprise that he loves Kylie’s new album. The surprise is that he has revealed a piercing insight into our covid-weary psyches. Whilst admitting he can’t dance – and at 77 years, has no intention of learning – he reckons we will all be so desperate for good times after this dark year that we’ll step back in time and back into the clubs. We’ll be looking for music that makes us really happy and gets us on the dance-floor. Yes, disco is back! I hope he’s right. It was a great era and I like a good tune.

Taking us one step closer to better times is, hopefully, THE Vaccine. We’re all clutching onto this piece of positive news. At last, there is light at the end of the tunnel and, my…. How the tone of things has changed from the doom-laden to the cautiously upbeat. There are of course many issues such as production of the vaccine in sufficient quantities, the logistic challenges, who gets priority treatment and, of course, the cost. There are other broader questions about the implication of a COVID-19 vaccine. When can we stop disctancing and mask-wearing? Will jobs and businesses bounce back? Can we begin to think about taking a holiday overseas? In other words: when will things get back to “normal”? Meantime, we still have a pandemic to manage and there remain many unknowns.

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Take a look at a map published by the Swiss authorities of the number of COVID-19 cases per 100,000 population for the different cantons of Switzerland. The darker the colour, the more cases. In the Canton of Geneve where we live (the dark most westward protrusion) nearly 6% of the population have tested positive since 8 June. Ouch! I believe these statistics. It’s the sort of thing the Swiss do with great attention to rules, routine and detail. Surprisingly, the dark areas coincide precisely with the cantons that are French-speaking (and broadly with the major wine-producing cantons!) I’m not really sure what to make of this. To my knowledge, nobody has commented. Anyone out there with an idea?

The USA has more COVID-19 cases than any other country. Using the Johns Hopkins data, I thought it would be interesting to look at something else that has slipped by with little comment; that is the comparison between the USA (now more than 140,000 cases per day) and ….

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USA cases per day. Source: Johns Hopkins

….. China! The source country  – with the world’s largest population – that has barely shown a resurgence and is currently running at less than 100 cases per day. 

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China cases per day. Source: Johns Hopkins

If the data are to be believed – and I believe they are because it would be difficult to hide millions of affected people from a global media ready to pounce – China has nailed this pandemic through a system of immediate isolation of those infected and strict imposition of social distancing measures. This has been reported in an article entitled “China’s successful control of COVID-19” by Talha Burki in the Lancet. The report makes for interesting and sobering reading for those supporting lockdown. This diplomatic extract says it all: “In China, you have a combination of a population that takes respiratory infections seriously and is willing to adopt non-pharmaceutical interventions, with a government that can put bigger constraints on individual freedoms than would be considered acceptable in most Western countries.” The author adds “Commitment to the greater good is engrained in the culture; there is not the hyper-individualism that characterises parts of the USA.” It seems that tough measures are effective. Those against lockdown should note that the Chinese economy has reportedly bounced back from its early lockdown with growth of 4.9% in the third quarter of the year. 

Here we are again: the big political tug o’ war between an effective public health response versus individual freedoms and economic well-being. What is new is that we have a much better idea of what is at stake. We might eventually find that an effective public health response is a precursor to a brisk economic recovery. This does not bode well for the USA where the adoption or not of strict measures has fallen according to pre-existing political fault-lines. “There will be no lockdown! We must keep the economy going!” yells Mr T.  When faced with a crisis that affects every human being on the planet, isn’t it possible for our leaders to cooperate with responsible agencies, to act together and just for once to put their own political wumpsy-dumpsy aside? Yeah, I know. Dream on! 

Within a few days of the announcement of the Pfizer / BioNTech vaccine, the anti-vaxxers kicked off. I heard one interviewed who said “I don’t trust it. It’s been rushed! I don’t think it’ll be effective!” Over the next months, look out for this crew. Social media has given them a powerful collective voice and they snag politicians easily. I’m always mystified by what people believe, despite the science, and how they claim others believe the same thing. In relation to the widespread belief that planet Earth is flat rather than spherical, I heard that the Flat Earth Society (it really exists!) claims global support.

As I finish up this edition of the COVID Chronicles, Dustin Johnson is tapping in his final putt of the COVID-19-delayed 2020 US Masters. He simply stormed around the wet Augusta National course and away from the rest of the stellar field with a record 20 under par. The event, for once draped in autumn colours, has never before been played without spectators.

The COVID Chronicles – 3

Geneva, 10 November, 2020

We’re back in sort-of-lockdown in Geneva; it is one of the most seriously affected cities in Europe. It is quiet but not the eery quiet of March. There are still jet streams in the crisp November sky. Businesses and construction sites are at work. Restaurants and cafes are closed with some offering takeaways. People are out and about but they don’t have the same anxious air about them. I have the impression that this second time around we are calmer; that we have a better idea of what we are dealing with. One thing is sure: no annual trip to spring time New Zealand to hunt out those big brown trout. As we slide from autumn into winter here, I figure I’ll have time to write up these chronicles and maybe do a bit more painting.

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African masks have always fascinated me. Their full meaning may well be beyond my reach but I am always struck by how expressive of emotion they can be. I used a variety of on-line resources for this picture; I worked on it with bad back (see below) during the extraordinary waiting days of the US election. My thoughts must have run from my time working in Africa to the slave trade to the history of black people in the Americas, to the Black Lives Matter movement and finally to what the election result could mean for the whole race thing. I thought the two masks might represent how many people in the world would be feeling before and after Biden’s count passed the necessary 270 to get him into the White House. 

In relation to the COVID-19 situation in the US, I came across a truly remarkable video-graphic made by Dan Goodspeed. It shows, by state, just how the great political divide in the US determines the speed with which the pandemic has taken hold depending on whether the state in question was Republican or Democrat before the election. Yes, the political leaning of people is a major factor affecting their COVID-19-related behaviour both at personal and community levels. Perhaps this is data telling us what we already knew? On this side of the Atlantic, the UK’s Brexit Party is planning to rebrand itself as “Reform UK.” According to the party’s leader, Nigel Farage, the central drive of Reform UK will be anti-lockdown. He claims we’d be best off if “we learn to live with it, not hide in fear of it.” No surprise then that we saw Mr Farage on stage supporting Mr Trump at pre-election campaign rallies.

Apologies! It’s difficult to get away from the politics of it all just now. Much closer to home, I’ve had a bit of a week! My wife and I were due to play golf last weekend at our club just over the border in France. The number of COVID-19 cases increased so rapidly around here that the course was closed and we couldn’t cross the border anyway. This put a large black cloud over my normally sunny disposition that was already and rapidly becoming less sunny as the news of the pandemic’s resurgence really hit. However, another diversion was on offer as compensation. Saturday television ran the postponed and crowdless final three matches of the Six Nations Rugby and the first ever European PGA Cyprus Classic golf tournament. Normally an active chap, I found that lying slumped on the sofa for several hours came naturally and was indeed quite enjoyable. It kept the lurking curmudgeon in me at bay. Unfortunately, my lumbar spine was held for the duration in ill-advised flexion. And so, at the end of this telly-fest, I got up … well, I didn’t get up because I couldn’t. My back was painfully locked. I spent three days staggering around grabbing at chairs, doors and my lovely wife for support. My doctor had some difficulty believing that I had done my back in lying on the sofa watching sport. Being a good egg, he nevertheless prescribed some very expensive (even by Swiss standards) medication that seems to be taking effect. Later, when filling in the medical insurance e-claim form, I noticed a new box to tick: “Is the sickness related to COVID-19.” Interesting question! I followed my condition’s chain of causation back; logic dictated that I tick the box.

This last weekend was the Houston Open Golf. It was won by a charming young Mexican: Carlos Ortiz. Notable also and surprising was the large crowd of spectators; they stood shoulder to shoulder and only about fifty percent were wearing face masks. Well, it is in Texas (Republican.) 

The non-golfer may be interested to know that the upcoming week is the big one of the year. Tiger woods (you will have heard of him) will be defending his US Masters’ title at the iconic and immaculate Augusta National Golf Club. Augusta is in Georgia. (Newly and only just Democrat!) We’ll see what the crowd is like.

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I painted this layout of the Augusta course on a large American flag in 2012. That year, Bubba Watson, a good bible boy, navigated his little white ball safely around “Amen corner” (upper right… lots of water!) He went on to win this title for the first time and, touchingly, burst into tears. I offered this painting as a prize in a local golf competition. The lucky lady who won it was thrilled but had difficulty getting it into her car. I saw her again last year. “Hiya! Still got the Big Bubba painting?” I asked. “Yes, of course!” she replied. “We love it! It’s hung on the wall of our bike shed!”

Just as I finish writing….. News comes in that Pfizer and BioNtech have finalised a trial that shows their new COVID-19 vaccine is 90% effective. The stock markets go crazy. Politicians claim credit. Public health experts are “optimistic” but can’t help sounding a bell of caution. The BBC’s disinformation and social media reporter, Marianna Spring, emphasizes that this is not a way for Microsoft boss Bill Gates to secretly insert microchips into people so they can be tracked. I wonder what Florence Nightingale would have thought of all this?