The Only Way is Up: getting the Covid-19 Vaccination

Two days ago, on Monday, 8^th February, I received my first Covid-19 vaccination. I feel moved to post an account of how I came to get it, how it was and how it felt afterwards because I was blown away by the positive response of others on social media when I posted news of my good fortune. 

I was at first a little hesitant to do the “I've had my jab” thing on social media, fearful that it might look rather smug and “look at me”. I sought the opinion of a wise and trusted friend who often shares my views on such matters, and she assured me that to post about it would be welcomed by many. She was right. I am a very small voice, but if enough small voices say the same thing, they become a loud and influential voice. I am pleased and proud to learn that vaccine take-up is so high in the UK, but worried that it has been low in certain groups. I hope that anyone reading this will be reassured that it's the right thing to do, for themselves and for everyone. We all owe it to each other to talk up the good news of this rollout, not least given how much else has apparently gone wrong here in the UK.

I was aware that the UK’s vaccination programme was going remarkably well, and that as a man of my age living with Type One Diabetes, I could reasonably expect to be called sooner rather than later. However, I was thinking maybe sometime in March. I was more anxious for others in my household, three of whom work in schools and two of whom are required to be there in person; I am in the fortunate position of being able largely to control my own exposure to others, although I have throughout the pandemic resisted the urge to hide away and attempt to eliminate all risk.

Then last Friday, my younger daughter, who has mild learning difficulties, received a call from our GP inviting her to come for a vaccination on the following Monday, at the end of the working day. We had not been aware that she was in Priority Group 4, but they explained that all with a registered learning difficulty are classified as such for vaccination purposes.

Great news, we thought, not least as her work as a welfare assistant in a primary school exposes her daily to risk.

Then on the day of her appointment, we got another call from the GP practice: they had more doses than anticipated, enough that if I and my wife were able to come along too, we could all three have our vaccinations. We are both in our early sixties, and of course I have an added background risk through diabetes.

The whole process, from notification to injection, exemplified all that is good about how the UK’s programme is working. It felt personal and local, and strengthened my sense that the vaccine rollout will prove to be UK Primary Care’s finest hour. Ours is a relatively large practice in a small town - Ash Tree House in Kirkham, Lancashire; we have been patients there since moving to the area in 1986. Over the years, the practice has been there through all our medical needs of those 35 years, and many of the staff, clinical and non-clinical, have been known to us through personal or other professional and personal connections. We have had many occasions on which to feel grateful for their work.

In the case of this vaccination, communication was by phone, and was cheery, concise and personal. Our appointment was at the clinic in Kirkham, a place familiar to us from when the children were little. Not an ideal venue for a mass vaccination programme, but the most suitable NHS building in the town.

On arrival, we were greeted by a man and a woman marshalling the Car Park in hi-vis jackets, wrapped up against the bitter cold and wearing masks; only when we got near did we and they realise that we were old and good friends, former neighbours with whom we remain in touch and with whom we still socialise - well we used to! Another great thing - volunteers doing their bit: they are both retired police officers.

They, and everyone whom we saw throughout the process, were friendly, upbeat and welcoming. A young woman from our practice (a member of the admin staff) was at the door, letting people in one by one from the queue shivering outside the building. She herself was clearly freezing, and had to repeat the same words to everyone, but did so with a cheery smile, an apology for the wait, and an apologetic tone that suggested she was well aware that her questions checking our status were almost certainly superfluous.

The Practice Manager who checked us in and showed us to the waiting area recognised me and greeted me by name - such is life in a small town community. Her manner, at the end of a long and busy day, when she and everyone had clearly been on their feet all day, was positive, welcoming and reassuring. There was, throughout the building, a palpable sense of togetherness and teamwork in a less than ideal setting.

After a short wait in a room carefully adapted with temporary screens for distancing purposes, we were called through to be vaccinated. My wife and daughter received their jabs from one of the GPs, I from a practice nurse. It was quick and painless.

Side effects? Yes, entirely as predicted, and no reason whatsoever for alarm or hesitancy. We all had some degree of flu-like symptoms: shivery, achy, and lethargic. But very much just the next day, and by now (the second day) I am fine, as are they.

And which vaccine? Ours was the Oxford AstraZeneca - very much the dominant and default vaccine in the UK at present, for well-documented reasons. I have to say I wanted it to be that one, for the very silly reason that I am genuinely proud to be a graduate of a university whose scientists have done so much to develop and bring this vaccine to us at such astounding speed. Not long ago, the pernicious spirit of Trump and Brexit was claiming that we had all “had enough of experts”. I always thought this was dangerous nonsense, and if there’s one thing the Coronavirus pandemic has taught us, it’s that we sure need our experts. And Oxford University, so often criticised as élite and out of touch, has done us all a favour by reminding us that we need expertise and excellence, we need élite places of learning, we need places that select the best, and it’s not entirely their fault if those who prove to be the best do not come from the broadest of social backgrounds – that is an issue for society to address, and I wrote about it here

So there you are: a positive story in a year of gloom. It is my fervent hope that I shall soon see loads of posts on social media of people I know having had their jab. I shall get the same pleasure seeing that as others appeared to get from mine, and it will reinforce the sense that we are, despite all the caveats and warnings, heading to a better place as the days start to get longer and warmer. And just as we so joyfully did at that Olympic Opening Ceremony back in 2012, let us celebrate and be proud of our NHS, and all who work in it. 

Thank you, NHS, Thank you, scientists. Thank you, experts.

I need an optimistic and upbeat song as a title – how about The Only Way is Up?

When will I see you again? - Diabetes care and the Pandemic

Six months and counting..... 

As we popped our Prosecco corks with the clock striking midnight last New Year’s Eve, none of us had any idea what 2020 had in store for us. We have now lived for half a year in a period of unprecedented collective anxiety for all but the diminishing number who remember the severe privations and genuine suffering of the Second World War. Our world as summer turns to autumn looks and feels shockingly different to that of last winter. The list of new words and concepts with which we have become familiar is lengthy, and we have all become accustomed to routines, behaviours and attitudes which would have seemed utterly alien to us on New Year’s Day 2020. 

What would I have thought of this selfie back in January?

Tens of thousands have died in the UK alone, and many, many more have suffered, either from the effects of the Covid-19 Virus itself or from secondary consequences such as delayed diagnosis, postponed or cancelled treatments and indeed subtle longer term psycho-social difficulties yet to be fully recognised or understood. 

It’s not exactly been the jolliest year of our lives, and as we enter autumn here in the UK, with the Virus better understood and to an extent better controlled than it was earlier in the year, we are nevertheless facing questions, anxieties and uncertainties well into the future. A life of carefree interaction with our fellow human beings seem a distant memory and an even more distant future prospect. 

For those of us living with other medical conditions like diabetes, there have been well-publicised extra layers of uncertainty, and I for one have found myself more concerned about my own welfare, more careful about my own actions and choices than at any time since my diagnosis almost 23 years ago. In many ways, we who live with diabetes have been very well-served: there has been wonderful support from healthcare professionals in the online diabetes community, who have transferred their habitual enthusiasm and energy to online versions of their normal activities; the diabetes charities have been excellent sources of information and encouragement, despite suffering from significant loss of income and of course the patient community has displayed mutual supportiveness and information-sharing as always. I have been thankful for the online connectivity which we now take for granted, and contacts made through the world of diabetes have been a source of friendship throughout these difficult months, for which I am enormously grateful. 

Before we feel too sorry for ourselves, it is worth pondering what a lockdown of similar extent and severity would have been like in the pre-internet days of the not-too-distant past: no WhatsApp groups, no video calls, no instant online sharing of information, memes and funny videos, no working from home, no remote learning. Even twenty years ago, that would have been the reality of a similar scale pandemic and lockdown. 

If nothing else, surely one of the positives of the pandemic will be to convince even the most grumpy luddites that the information age is an overwhelmingly good thing, and that smartphones, tablets and laptops are a modern-day blessing, a miraculous tool for social interaction and information sharing, whose obvious faults and disadvantages are not the fault of the medium itself, but rather of the human imperfections or evils of those who use them. 

I have taken great delight during the pandemic in chatting over the garden fence with my octogenarian next-door neighbour about stuff he has found on the internet, or how much he appreciated an online video consultation with his doctor. He recently told me that he had bought a Bluetooth speaker and had googled the origins of the word Bluetooth (a 10th Century Scandinavian King in case you’re wondering). I was also delighted to receive a Facebook friend request from another octogenarian neighbour who had signed up and stumbled across me on a neighbourhood group. I really hope that the pandemic will hasten the demise of the “digital divide”, not just in terms of the older generation but also in terms of those afflicted by poverty and deprivation. 

So the pandemic has certainly taught us to value the internet. 

Now I am an irrepressible optimist. It annoys those close to me at times, but I often genuinely find doom and gloom about stuff a greater burden than the stuff itself. And this is definitely true of the pandemic. I have become far more annoyed and frustrated about the epidemic of opinion from self-appointed experts than with the disease itself. So doom and gloom is not for me, and I am already starting to look for the good that can come out of this pandemic. It’s not easy, but that shouldn’t stop us all trying: I was moved to write this post having filled in a survey for Diabetes UK about my experience of diabetes care during the pandemic. 

Here’s the link if you haven’t seen it – a short and easy survey:

https://t.co/0z17jYg22v 

I must say that filling it in made me somewhat frustrated, not least because a few weeks ago I had attempted to get some information from my hospital concerning their plans for re-scheduling clinic appointments (my last was in early December), and I received a rather vague reply indicating that I was on a list for a re-scheduled appointment “in due course”. A follow-up enquiry about the potential use of video or telephone consultation was deflected in the classic bureaucratic manner “We are also looking into the option of using video consultation within our service however plans have not yet been finalised”, whilst my suggestion that they might consider using LibreView to share my data was ignored in a manner which suggested that I was proposing something truly subversive and revolutionary. 

Surely, diabetes care is a prime case for the rapid adoption of new ways of communicating and sharing that we have all taken on over the past six months. For a diabetes patient such as me, fortunate at the moment to be living well with Type One, a six monthly face-to-face at the hospital as well as an annual review with my GP is an unnecessary burden on the system, and arguably upon me. A five minute appointment with a phlebotomist at my GP could yield my HbA1c result, and, together with a look at my LibreView data, would form the basis of a discussion which could surely be just as effective remotely as it is in a hospital ten miles from my home. 

Now of course, there are multiple caveats. My own condition is, for now, good, but might not always be so, and there are aspects that cannot happen remotely. Nobody can check my feet, my injection sites, my eyes, and in many ways most importantly, my emotional welfare, over the phone or through a shadowy face on a screen. Some sort of triage could surely be applied to people with diabetes, such that those in most need would be seen face to face, whilst others would be seen remotely. And I am not proposing online only consultations: if we are seen six monthly, then surely an annual face-to-face, with an interim online in between, makes perfect sense. 

Above all, we must NEVER, in healthcare or elsewhere, allow on-screen interactions to replace face-to-face ones. Zoom, Facetime, Skype, WhatsApp or whatever are wonderful, but nothing can get near to replicating the multiple subtleties of human interaction: badly-lit faces in front of a bookshelf cannot convey body language, subtly raised eyebrows, non-verbal reactions, fear, anxiety, reluctant agreement, embarrassment. We are beautifully subtle creatures who thrive on our interactions with each other, and the human physiognomy is a truly wonderful and subtle thing. I for one am longing for a world in which I can once again see people in the real world, out from behind their masks and visors, or out from behind their webcams. I am very glad that I am retired from teaching, as I would have hated to teach from behind a mask, or to teach young people whose faces, whose reactions and responses are hidden by a piece of cloth. 

So please let’s try to take the best of what we have had to get used to during the pandemic, but also be sure to discard the worst as soon as it is safe to do so. I’ve had more than enough of zoom calls already. 

A Zoom Meeting of Diabuddies from across Europe and beyond

My enduring emotion is that of the Three Degrees song which forms the title of this post, and is a plea which applies to my healthcare team, just as much as to the many friends and acquaintances whom I am missing so much: When will I see you again?

"He ain't heavy, he's my brother" - who cares for the carers?

Photo Collage by my friend Lis Warren

It is self-evident to say that we are living through strange and troubling times: you need to be over 80 to have any significant recollection of the Second World War, so for most of us, the COVID-19 pandemic and its associated lockdown is by some distance the most significant, disruptive and worrying collective experience of our lives. We must, of course, be careful not to overstate its impact upon us or our own level of suffering and deprivation: those of us fortunate enough to have unaffected income, a home with outdoor space and the company of others, together with the means and ability to connect with others through the online world should not be tempted too much into the realms of self-pity.  The privations and worries of our grandparents in wartime were infinitely greater.

If we and our loved ones have not (yet) succumbed to the illness, all that has really happened to us is that we have stayed at home, saved a lot of discretionary expenditure on leisure activities and tended our homes and gardens to within an inch of their lives. My own extensive garden has never been so well tended, many of the boxes which were dumped in the loft or the garage when we moved house three years ago have been tidied and sorted, and many a neglected DIY task has been sorted. So despite occasionally feeling sorry for myself, reflecting on missed outings and holidays, friends and family not seen, I have (so far) little to complain about.

Yet for many, it is not so. In the UK alone, a horrendous death toll means that there are tens of thousands mourning the premature loss of a loved one, and tens of thousands more are still struggling to overcome the lingering and in some cases life-changing consequences of COVID-19.

And whilst I, and many others, have had to do no more than just stay at home and forego some discretionary pleasures, many others have seen their workload increase, their working conditions and practices changed beyond recognition and the level of stress and strain hugely increased.

There has been, quite rightly, much said and done to recognise the efforts of our so-called “key workers”, most obviously in the health and social care sectors, but also those who provide our essential needs - the shop workers, the delivery drivers, the teachers, the IT people who have kept the internet running seamlessly, the refuse collectors, those in the media who have kept us informed and entertained - the list is endless. The very least that the rest of us could do was to stand on our doorsteps every Thursday and applaud, however much that at times felt like a rather empty “look at me” gesture, akin to the way in which some feel compelled to modify their social media profile picture in response to some cause or other.

It is, of course, far too early for anyone to write the history of the pandemic, not least as it hasn’t even reached its peak globally, and remains a significant threat locally here in the UK. However, I hope that when we are able to look back on 2020 - let’s hope it is only 2020 - we may at least be able to see it as the start of a more caring society compared to that which appeared to have been evolving in the “take back control” and “America first” world of the past decade or so. Surely, if we have learned anything from the pandemic, it is that there absolutely IS such a thing as society, whatever the late Mrs T meant by her notorious “no such thing” line. We have seen a relatively young Prime Minister, the Heir to the Throne, the Health Secretary and the Chief Medical Officer all laid low by the infection in a manner which reminded us that in the face of a virulent disease, we are all in equal need of the expertise of doctors but equally the care and dedication of all who work in healthcare, from the consultant to the ward cleaner.

We are all links in a very long and fragile chain. Advanced human society is built upon each and every one of us performing a particular and specialised role, and therefore depending on others who perform another equally specialised role, and those upon whom we depend are often those whose role is most easily overlooked - until they are unable to do it.

I remember once hearing - on an “Understanding Industry” course - that in any organisation, the person whose absence is most immediately noticed is not the person at the top, but rather those supposedly at the bottom. In a school, the Caretaker’s absence would be immediately noticed, as it’s he or she who opens the building at the crack of dawn. A Headteacher could be absent for several days without any pupil noticing. In a hospital, the consultant surgeon cannot do her or his job if the laundry people haven’t provided clean scrubs. One could make similar points about every workplace or organisation.

Of course, we must not from this conclude that those at the top - the leaders, the experts, the bosses - don’t matter as much as the rank and file. Of course they do, and surely another thing that we have learned from the pandemic is that we have not, as some tried to argue at the time of the EU Referendum, “had enough of experts”. We need our experts and wise leadership more than ever.

But what we do all need is to CARE for and about each other.

There’s a commonly used Latin expression Quis custodiet…, abbreviated from Quis custodiet ipsos custodes which rightly asks “who keeps an eye on the guards?”, reminding us that even those who supposedly act in our interest should themselves be held to account.

Well equally importantly at all times, and especially of late, is “who cares for the carers?” It’s a very pertinent question: my son once put it very well by saying “Who gives Father Christmas a Christmas present?”

We are all enormously indebted to carers in the broadest sense at present, be they experts working on the longed-for vaccine, scientists and politicians trying to figure out what it is safe and prudent to do when, van drivers bringing our online orders, nurses and doctors tending the sick, pharmacists keeping us supplied with our life-preserving medication, charity employees and volunteers keeping their vital work going in the face of devastating loss of income, but equally importantly the millions doing their ordinary jobs: people like my son and younger daughter working in their schools or my elder daughter helping to keep a major university's life and vibrancy going in the post-corona world, or volunteers like my wife sewing scrubs and masks for the NHS, or a friend of mine who lives with Stage 4 cancer and is using her online voice to campaign for the resumption of full diagnosis and cancer care for others. Then there are also all those whom I have seen and heard just quietly doing their bit, maybe by helping those being shielded, sharing fun stuff online or generally just being kind. These, in the broadest sense, are the carers.

So we must all remember to care for the carers. They are not heroes, and they have no superpowers. They are just human beings, with the same frailty, doubt, guilt, imposter syndrome and anxiousness that we all feel at times. I was moved to write this post after seeing evidence of such things in the much-maligned but essential world of social media. I have in recent times spoken with friends who are on the proverbial frontline and I have seen from their social media posts, public and private, first-hand evidence of the stresses and strains of their lives and work. I have also seen honest online expressions of self-doubt from an eminent NHS consultant and from a friend who is a tireless and enthusiastic advocate for others living with diabetes, who suddenly found herself creaking under the strain. Equally importantly I have seen evidence of supportive acts of kindness towards these people: I have seen those who give care being cared for, and it is surely very important that we all remember that they too have their needs.

So this post is for the carers. It has been my pleasure and privilege in recent years to become friends with many who work in the NHS as doctors and nurses, thanks to my small involvement in the diabetes community, and I have watched in awe as these people - if you are reading this you know who you are - not just do their jobs, but go way beyond the call of duty to ensure that the rest of us are cared for.

My Latin teacher wife thinks that Quis curabit ipsos curatores just about works as a Latin motto for “who cares for the carers?” so there’s a good title, but being me, I also need a song title for this post. How about the Hollies’ 1969 classic He ain’t heavy, he’s my brother. It immediately came to my mind when I saw that much-shared picture of a black man carrying an injured white counter-demonstrator at the "Black Lives Matter" demonstration a few weeks ago. 

It’s a wonderful song, an entire sermon in 4 ½ minutes, all about sharing the burdens of others. 

He ain't heavy - He's my brother