This is not a Covid-19 communique but rather a standard blog post. Don’t feel you have to read on. The reason for the change in emphasis this week is that Covid-19 events simply passed me by. The explanation is that I was engaged with the National Health Service (NHS), finally having elective surgery for an umbilical hernia. It has been a long road to get here, I am relieved to have it sorted.

I have always considered myself fit (but overweight), playing squash, touch rugby and running. A few years ago, I noticed I was developing bulge in my belly button. It was confirmed as an umbilical hernia. All the sources of advice: doctors and the internet recommend these occurrences need to be dealt with, and that means surgery. Two years ago, I arranged to have the hernia operation in Durban. It could have been a day surgery but, stupidly, I decided to spend the night after the operation in the hospital. It was that or go back to the flat. The surgery was straightforward, the hospital experience was not great. Unbelievably the morning began, at 05h30 am, with inappropriately cheerful nurses. I was on a men’s ward where all had more serious conditions and concerns, and felt somewhat fraudulent.

The original surgeon gave me options for the repair. I selected stitching rather than putting in a mesh. This was a mistake, as I realised, when the bulge reappeared some months later. This time I did more homework and consulted with medical professionals in Waterloo, Norwich, and Durban (as well as qualified friends). The consensus was it had to be redone, but with a mesh. In addition, I learnt I would have to wait at least a year before a surgeon would even consider reopening the wound.

Covid-19 meant that, after arriving in Norwich in December 2019, I have not travelled outside the UK or even on a plane for 14 months. (I am seriously tempted to go for a flying lesson as soon as it is permitted just to get in the air!) This in turn necessitated arranging to have the surgery in Norfolk. I began the process and expected to have to wait for at least a year. As it happens it was quicker than that, but my word it became a complicated process, and it has been an insight into the amazing NHS and how they function in time of crisis.

The centre for these surgeries in Norfolk is the James Paget Hospital. This is in Gorleston on the Norfolk coast, about 50 minutes (or 30 miles) away. The process involved visits for assessments, an MRI scan, a Covid test and other ancillary events. The surgery was originally scheduled for January 2021. However, the government unwisely relaxed restrictions in England at Christmas, and the number of cases soared. On 8th January 2021, they peaked at 68,192 up from just 12,386 on 12th December 2020. The hospital called me to say, regrettably, the surgery would be postponed. I expected this!

I was quite happy to wait, after all it was elective, and not urgent. The next, and unexpected development was the hospital called and offered me a date, at a private hospital in Colchester, some 60 miles away. One of the ways the NHS is trying to manage their waiting list is to outsource some procedures to the private sector. I declined the option and eventually heard from the local surgeon who said that the surgery could be scheduled for 2nd March. As an aside the number of new Covid-19 cases across the UK on that day was 6,411.

On the day, I had to get to the hospital by 7 am. Ailsa drove me down and dropped me off. I checked in to the day procedure ward and was wheeled into the theatre at 11 am. I had hoped it would be earlier. This delay was entirely my fault. When we got up, just before 5 am, I had a cup of tea with milk in it. Note to self: read the instructions carefully and follow them! I could have had water or black tea; it was the milk that was the issue!

Apart from extra hygiene precautions and wearing masks, the part of the hospital I was in appeared to be functioning normally. There is a separate terribly busy Covid section. The biggest obvious difference is visitors are not allowed at all. This makes for a very much quieter environment. The day procedure centre was active, but not manic and the nursing staff were caring, professional and calm. Everything went smoothly and, after passing urine, (a non-negotiable apparently) I was discharged in the evening. I left with a ‘goody bag’ of everything I needed for post-operative self-care.

My ‘N’ for hernia operations is now 2. The first was an incision while this second was done laparoscopically, through five places on my stomach. I had to take a few painkillers, far fewer than prescribed. Generally, I have been fine although getting up and lying down have been challenging. In addition, I was given about 10 preloaded syringes with blood thinning medication, to inject into my stomach. Not a pleasant process. I have been really impressed by the standard of service in the NHS despite the Covid-19 crisis. This also needs to be seen against the backdrop of a public sector pay freeze except for nurses, who have been offered a derisory 1%. They are furious, feeling it as a slap in the face, and I quite understand. I recognize the need for fiscal conservatism to pay for the Covid-19 response. It has cost billions, not just care costs, but also keeping families and supporting the furlough programme so people have jobs to return to. This stingy pay offer to core staff stinks.

I have taken several lessons from this experience. The first is to read and follow instructions carefully. Second is that the health service is amazing. Even when it is under immense pressure, people are seen and treated. At the same time as this was going on, the government is rolling out a vaccination campaign. I was able to go online and book both the appointments I need, the first on 12th March and the second three months later. My hub is the Food Court, in the currently shuttered, Castle Mall Shopping Centre in Norwich.

I do have a few quibbles though. The main one is about ‘joined-up’ thinking. The provision of a decent health system is part of the social contract, but the major challenge faced by humankind is climate change. I have been taken aback by the use of resources in the health service, much of which probably can’t be recycled. I was given 14 disposable syringes, each in separate plastic wrapping. It may be that there are no options! However the instructions and pamphlets were on recycled paper.

I have talked before about how fortunate I feel we are. We have a home, an income, and a family close at hand. The children are coping with this as well as anyone. My extended family are all OK, although no one is very happy. In addition to that, our environment is changing in two significant ways. First with regard to Covid-19, the numbers are falling, and the vaccination programme is working very well. Second, there are signs of spring. I can see the first leaves beginning to bud on the rose bushes and today we spotted blossom on the trees in the neighbour’s garden. It is still chilly but there are signs of spring.

This good fortune was brought home to me when we walked to a local shop to get some essentials and the Observer newspaper. The rule is only one person from a household should go in and so I waited outside. There is a ‘security guard’ at the entrance to make sure people wear masks and sanitise their hands. I think he is from Norwich. I started chatting with him and this is his story: he worked on cruise ships out of Fort Lauderdale in Florida and was also paid as an American Football Player. I know this may come as a shock to readers of this blog, but there is a league in the UK and Norwich has a team which he was part of before going off adventuring. He said he played in Australia, before going on to join a team in Vladivostok in Eastern Russia. Covid put an end to this, and I think he was lucky to get back to Norwich. I would never have known any of this. What a story. The next instalment will be interesting, and I am looking forward to it. End of personal stuff, some COVID-19 coverage next.

So where are we regarding Covid-19? The vaccination campaign has been extremely successful in the UK, but this is despite the government, not because of them. The number of cases globally is declining.

In the countries I follow closely: Canada, South Africa, the UK and the USA, numbers have plummeted. Why is this? Is it temporary? There are no simple explanations, yet. Healthline says:

“COVID-19 cases (are) decreasing, but experts aren’t sure why. About 12 percent of people in the United States have had at least one vaccine dose, but that alone wouldn’t explain why cases have dropped so drastically. The end of holiday get-togethers may be one reason why cases have continued to drop to their lowest levels since October in the US …. Vaccinations in the most at-risk groups could be helping, and many of the people who engage in behaviors that make them susceptible to COVID-19 may have already been exposed to the virus. If they got COVID-19 during one of the previous waves, they may have some degree of immunity. … (but) … The recent dip doesn’t mean we are in the clear. Cases could pick back up anytime, especially as new variants take hold”.¹

I won’t write a conclusion this week. The resources below set out a good summary of the mostly good news. The big issue is going to be around vaccine distribution. The writers of these pieces provide thoughtful analysis. People in the OECD countries are not vaccine averse, and the evidence is of good uptake. One question that has not been addressed, at least as far as I have seen is: do we need to vaccinate everyone?

Resources: Websites, Books, and Articles

The vaccine rollout is well covered at Think Global Health is an initiative of the Council on Foreign Relations in collaboration with the Institute of Health Metrics and Evaluation IHME at the University of Washington. Think Global Health is funded by Bloomberg Philanthropies.

The International Health Policies Network (IHP Network) is an initiative of the Institute of Tropical Medicine, Antwerp (ITM), run by the Health Policy and Financing Unit. It provides summaries of the main trends and key publications. It appears every Friday and can be daunting. (If you are reading this, friends in Antwerp why not release it on a Thursday midday?). The newsletter was launched in 2009.

Book: Daniel T Halperin, ‘Facing COVID without Panic: 12 Common Myths and 12 Lesser Known Facts about the Pandemic Clearly Explained by an Epidemiologist’, Gillings School of Global Public Health University of North Carolina, Chapel Hill. This will be reviewed next comunique.

Articles: Yuval Noah Harari, ‘Lessons from a year of Covid. In a year of scientific breakthroughs — and political failures — what can we learn for the future?’ Financial Times 26th February 2021.

Zeynep Tufekci, “5 Pandemic Mistakes We Keep Repeating: We can learn from our failures”, The Atlantic, 26th February 2021.

David Leonhardt, “Why has Covid’s toll been surprisingly low across much of Africa and Asia?”, New York Times, March 8, 2021.

1. https://www.healthline.com/health-news/covid-19-cases-are-dropping-we-talked-to-experts-about-why