Given the daily focus on the number of deaths from COVID-19, alongside a string of related statistics on hospital admissions, numbers in intensive care, deaths in care homes, I am struck by what has become our neglect of one acknowledged critical factor. Men are dying in substantially greater numbers than women. No doubt exact figures are disputable, but across Western Europe as a whole, for example, not far short of 70% of those who die are men. In Italy and Ireland the figure is 69%, in Germany it's 65%, in Spain 63%. Across the world the picture is similar: in China, for example, the figure is 64%. There is no such gender discrepancy in the number of persons who contract the coronavirus disease.
So what is it exactly that has struck me? The reality of the higher death rate among men became clear quite some time ago. Surprise was general and experts struggled a bit to come up with convincing explanations. Possibly it was related to more men than women remaining smokers. It was agreed that much more research would be needed once the pandemic was over. Fair enough perhaps, but for a moment let's just imagine that the figures were the other way round, and it was women who were dying in greater numbers than men.
Would the issue be shelved quite so readily and with so little fuss? I don't believe it. On the contrary, I'm confident the air waves and the newspapers, TV news, and Newsnight
and similar programmes, would be overwhelmed by female commentators demanding answers. There would be endless interviews with women professors and other experts talking about the status of women under patriarchy, misogyny, etc, etc. Okay, only a half-serious scenario, but I am surprised that the issue itself is receiving so little attention.
This issue, however, is of minor significance compared with what is emerging as the scandal of care homes. It is increasingly clear that since coronavirus struck, both the UK and Scottish Governments have been culpably negligent over the situation in our care homes. From the beginning, we have been provided with figures for the number of COVID-19-related admissions to hospital, daily death rates, and numbers in intensive care units. But until very recently, related deaths in care homes counted for nothing. I recall very clearly how surprised we all were weeks ago after hearing on Scottish news bulletins that deaths in a number of Scottish care homes had soared into tripple figures. However, little reaction from the relevant agencies seems to have followed. Meanwhile, the continuing refusal at a UK level to count care home deaths in the daily total, underlined the reluctance to take the care home situation seriously. It was as if a care home death was a second-class one.
The irony of all this is that around a half of care home victims of COVID-19, unlike those in hospital, would have been paying for what had become their right to die. Paying, but receiving second-class care in that, for example, their carers were less well protected with PPE, and fewer opportunities for testing were available. What the pandemic has demonstrated is the tragic mistake our country made in keeping separate social care and healthcare.
The two activities operate through contradictory systems: the NHS, as the name implies, is a national service free for all at the point of need, whereas social care has developed as a business enterprise run for profit. For as long as I can remember, our politicians have been talking about coming up with a plan to transform social care. But nothing has been done. The answer is obvious: we need a single system covering both social and healthcare. In light of the current care home tragedy, I suspect we'd be ready to pay for it.
Incidentally, I wrote this before listening to David Aaronovitch's Briefing Room
programme on BBC Radio Four on the same topic. I should have acknowledged that in-home care workers have suffered the same level of neglect as those in care homes.
excellent guidance on COVID-19 is not very reassuring about the management of the pandemic in the UK, or Scotland. That test, track and trace can probably now be reapplied effectively in Scotland is positive news. The bad news is the stubborn persistence of new cases indicating established reservoirs of the disease here.
There appears to be further bad news from the World Health Organisation in that that there may be no, or only limited, immunity acquired from having had COVID-19. My education was that science was based on observation. The information came first, so why was 'herd immunity' apparently even considered as a policy currently when there was no evidence to suggest it was likely to be effective?
The spread of the disease has been devastating for the vulnerable, particularly those in care homes. Professor Seaton posits that the capacity to test, track and trace simply wasn't there, and it would be refreshing if our political leaders acknowledged that if it was the case. He also makes the point that there is a great army of volunteers available to get this up and running. I see no evidence of that being put in place, despite the need having been identified weeks ago. Is the UK suffering from terminal political inertia?
Bill Patterson's powerful piece on the Fourth Horseman took me back to a time when I spent a few days staying at the leper colony at Kalaupapa on the Hawaiian island of Molokai. My wife, conducting research for her book, To All Appearances a Lady
, had been given rare permission for us to go there. I knew Robert Louis Stevenson had been to Kalaupapa in 1889 and I was keen to see the little settlement that had made such a powerful impression on him.
It is an extraordinary place, a triangular peninsula on the north shore of the island, guarded on two sides by deep, deep water with treacherous currents and vicious tides, and separated from the rest of Molokai on the landward side by the Pali, a rugged wall nearly 2,000 feet high that few lepers were able to climb. Kalaupapa is exquisitely beautiful, a visual paradise, and yet a prison filled with despair for much of its existence. It is owned now by its inhabitants, not the state – but soon, when the last of the lepers have passed on, it will become a US National Park. It is part-way there already.
Leprosy when Stevenson went to Molokai was a mark of sin, and the churches – which Stevenson was never a great fan of – rarely missed an opportunity to make that point. When the aptly named Reverend Hyde in Honolulu attacked the man who tended to the lepers, the Catholic Father Damien, Stevenson was prompted to write what may be the finest letter to the editor that has ever been written. Immensely articulate, Stevenson's intellectual evisceration of the Presbyterian minister was full of a cold anger I've never encountered anywhere else in his writing – and rarely in anyone else's.
Sadly, we are seeing the same kinds of scapegoats for our human and political failures in our dealings with this coronavirus – whether it's the bullying of a kid named Corona in Australia, or Donald Trump blaming the World Health Organisation for his own failures, or whether it's a nasty attack on an elderly Chinese Canadian in a convenience store in Vancouver. Somebody is to blame, and it's always someone else. It tells me that things tend to stay the same through the generations; that knowledge and wisdom are not cumulative. Humanity remains a long, long way from perfect. We seem to have to learn the same lessons over, and over again.
I look forward to Bill Paterson's sequel.
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