Geneva, Monday 20 April 2020

I found an old copy of the Sun lying around; it’s dated 25 June 1348.

Ha! Not really! This is a page from the Millennium Edition of The Sun by John Perry and Neil Roberts. Published in December 1999, it is one of my most treasured books. It reports informatively on what would have been major news from the previous two thousand years but in the inimitable style we all love to hate. It begins with, inevitably, the birth of Christ (A STAR IS BORN Messiah claim as virgin has baby in stable – 26 December 1AD). It covers major events from then – see below – and moves seamlessly past the first real edition of The Sun on 17 November 1969 to genuine front pages (GOTCHA Our lads sink gunboat and hole cruiser – 4 May 1982) and (FREDDIE STARR ATE MY HAMSTER Comic put live pet in sandwich, says beauty -13 March 1986). Startlingly, it projects forward some decades (WE ARE NOT ALONE World leaders announce man has made first contact with aliens (ET Phones Home: Sun souvenir edition) 2 April 2040)

The Sun reported that, on 25 March of this year, Prince Charles tested positive for the coronavirus. (Charles tests positive for coronavirus at 71 and is self-isolating to keep him….OUT OF MA’AM’S WAY) Brilliant! How do they do it?

Advisory: Readers for whom English is not the first language may not appreciate these headlines. The Sun’s journalistic jingoistic front-page play-on-words is the stuff of legends. We understand that this might leave you scratching your heads in dismay. 

The Millennium Edition has some real gems. What about this from 19 June 1815?

On the long drives up to Scotland of yesteryear, we used to play a game “Guess The Sun headline.”  One of us would read the text of an article in a recent edition; the others then tried to make up the headline. After a few attempts, the published version was then read out; groans and laughter. None of us ever came anywhere close to The Sun’s wit and creativity.

Go on… give it a go! Here’s an article from 11 October 1034 about Canute, King of England. You’ll find the complete front page well below.

We are (that is, I am) already actively engaged in the Boris v. Donald sourdough starter competition. Here they are, fermenting-off just after their floury lunch. Can’t you feel the tension?

Bread-makers among you will notice with surprise that Donald is fizzing like a good ‘un after only 24 hours. Boris, meanwhile, has been gently bubbling for two weeks and has already delivered us two delicious loaves. I have an admission… I named my starter after the Commander in Cheat for a good reason. Because he has to catch up on lost time, I slipped my Donald a teeny-weeny bit of live commercial yeast just to give him a bit of a giddy up. Seems to be working! There’s no chance of my wife finding out; she doesn’t read my blog!  

The putting competition. I won today 3 and 2 with no missed putts! Yay! That’s me up 16 to 9.

Geneva, Sunday 19 April 2020

The writing of yesterday’s Diary was tough. A lot of stressy memories. A bad night’s sleep. I wanted to put it out of my mind today. So, it probably would have been best not to look at this morning’s news. Japan appeared to have the virus under control. Today, doctors are warning that the country’s health-care system could collapse amid a wave of new coronavirus cases. Officials say emergency rooms have been unable to treat some patients with serious health conditions due to the extra burden caused by the virus. This story just rattles me a bit more. I fear such reports will feature regularly in the next weeks. 

Inevitably, I was up early. I took a cup of tea onto the balcony. Another beautiful clear morning. If I look west towards the Jura mountains, I can just make out the CERN; the Large Hadron Collider guys who also gave us touch screens, solar panels and of course the Hypertext Transfer Protocol for the World Wide Web. Brainy stuff!  And where would we be in this lockdown without the web? Much more isolated and uninformed for sure.

I bet the godfather of the web, Sir Tim Burners-Lee, would never have imagined that making the interrnet searchable would permit the Rolling Stones to rock together from different locations in a global show of support for health-care providers during a pandemic. Yesterday, the Stones performed “You Can’t Always Get What You Want” during One World: Together At Home. (Charlie Watts’s air drumming was inspired!)

And then I looked east. The big smudge of an eye-sore that appeared last week on the Salève has today extended out further from the face… a bit like a black version of Sir Michael Jagger’s tongue!

 Take a look at where it was last week.

What is happening over the border in France? Maybe they’ve struck a coal seam.

Today’s putting competition: my wife was clearly inspired and didn’t miss a single 2.2 metre putt. She won 1 up. Total games: me -15; she – 9. 

Only very rarely do we argue. The discussion this morning about how we exercise Boris the sourdough starter, how we feed him and when we let him off the leash loafwards became really quite animated. As a result and to keep the peace, it’s been decided that I will have my own starter. Donald came into existence a couple of hours ago. His gas emission is quite impressive already. You can see where this is going. We are competitive on both golf course and lockdown putting mat. So…. the dough-off is foreseen for ten days hence.

Geneva, Saturday 18 April 2020

Let’s start with the lighter stuff before I tackle COVID-19 statistics, lifting lockdown and overloading health services.

Boris the sourdough starter went through a particularly troublesome transition from adolescence to adulthood; I was on the verge e-ordering a cattle prod! But he’s come up trumps and my wife made her first no-yeast whole grain sourdough loaf for our scrambled egg brunch this morning. Truly delicious! Hopefully we can find some white flour in the next days. It’s in short supply.

I’ve edged forward in the putting competition by winning 2 and 1 today; that’s 15 games to 8. I think the golfing goddess was distracted by the prospect of a trip to a nearby garden centre to pick up some sweet peas for potting up on the balcony.

I have noted in this Diary how the lockdown has coincided with an almost spooky spell of fine, dry weather that has lasted five weeks now. Today, we crossed the River Rhône just where it comes out of Geneva’s massive Lac Leman. There was no flow. This is unheard of at this time of year when the lake normally fills with alpine snow-melt. At the end of a hot summer, maybe.

So, COVID-19 statistics, lifting lockdown and overloading health services. I take this on with some hesitation; it is a subject too close to my heart. There are now two very clear schools of thought. One school believes that the number of cases of COVID-19 – with associated mortality – can and should be reduced by some variety of imposed lockdown until the pandemic shows signs of abating. Whether or not this happens and whether or not there is a resurgence of cases after lifting lockdown measures, time has been bought to prepare the health-care services and to protect them from overload as much as possible. We will all just have to shoulder the burden of the economic impact of the lockdown.

The other school of thought believes that the lockdown will not change the number of cases in the long term; it will simply delay their presentation. In other words the epidemic bell-shaped graph will have a lower peak but will simply spread over a longer period of time. The thinking is that whichever way we go, the pandemic will only pass when a sufficient proportion of the population is immune; by having had the disease or by vaccination. This school of thought points to the massive impact on the economy brought about by the lockdown that, ultimately, will outweigh the direct toll of COVID-19. The missing consideration here is that the time bought by lockdown measures serves to prevent overload of the health-care services.

Seeing as I am neither epidemiologist nor economist, I am not qualified to comment on the merits of the two arguments. I accept them both as valid. We won’t know what the right road is until we’ve gone down it. I do know that lifting lockdown before there are zero cases simply means moving policies from the first school of thought to the second.

However, there is one part of this story I am qualified to comment on: the overloading of health-care services. In my work as surgeon with the International Committee of the Red Cross, I have been involved in dozens of situations where there simply weren’t enough people or resources to address the needs of those who reached and needed a hospital. Try this. In this pandemic, policy-makers and commentators need to know what overloading health-care services actually means. It is not just about overworked heroes or scandalous lack of protective equipment or ventilators. To work – or attempt to work – in a barely functioning system at precisely the time when that system is required to function even better than normal can be devastating. 

If ever rational thinking about the capacity of health care is required by policymakers, it is now. A health-care service is an integrated system comprising infrastructure, people, their professional skills and, most importantly, their ethics. Overloading such a system easily finds its weakest links. The worst thing to experience is not the lack of equipment; it is to be rendered useless by one’s own and one’s colleagues physical and mental exhaustion; this precisely when you are needed most. Then the whole thing is worse if you have fears for your own safety. Believe me, it can come to the point that you simply don’t care. In brief, health care is not guaranteed when health-care services are overloaded.

Protecting health-care services in this pandemic means not only injecting resources but also, more importantly, buying time. Time allows systems to be tried, tested and to become resilient. This resilience permits the system to function effectively under overload; the physical and mental well-being of health-care workers can be preserved. Indeed, in my experience, if the system functions in an overload crisis, working within it can be a totally uplifting experience. 

The term “triage” is often applied to a situation where health-care services are overloaded. It is commonly understood to mean sorting patients by priority so allowing the system “to do the best for the most” or, in other words, to use the available resources in a way that can maximise the outcome for the patients as a group. This is not the whole story. What effective triage really does is protect and maintain the integrity of a heath-care system and the people working in it. Triage becomes easier and more effective if the health-care system concerned has the opportunity to practice it on multiple occasions. In this pandemic, health-care services need to be given the opportunity to try, test and improve their practice of triage. Spreading the burden of this pandemic on health-care services over time could avoid one massive and debilitating overload that could lead to a health-care service with no functioning personnel.

So here I nail my colours to the mast. Applauding our health-care workers is not enough. We have to protect them and buy them time, otherwise we may find ourselves without any effective health-care services.