Care in the time of Corona
Shirin Jacob, Ålesund, Norway
It’s 7 AM. The cats are waiting for me outside the glass doors of our study. It’s our routine. Julius, the ginger, strives hard to get to me first. Both rescue cats, I have never heard him mew but he has a little sigh and a strong purr as I lean down to scratch behind his ears. Sofus, on the other hand, prefers the early morning no-touch technique. He follows me to the bathroom and jumps up into the sink and loves a drink of icy cold water from the faucet. He then likes to sit in the wet sink for a little think, whilst I must continue to observe the no-touch techique. He warms up over the course of the day. Sofus too had lost his ‘voice’ when found as a very small kitten but almost two years on, will emit a manipulative, plaintive meow either to indicate need to enter our bedroom for a lie down on my duvet or for a little prowl around our tiny store room. You never know, a mouse might be waiting. They are both ‘innekatter’ as we doubt that these two, frightened of their own shadows, would survive long outdoors.
They have no idea about Covid-19 but are loving our company. There is a routine to be maintained, religiously observed mealtimes, bird observation posts, imaginary mouse attacks on furry toys or power naps on various sofas and blankets. Sofus is a reincarnation of a football player. He dribbles balls, jumps high in the air to catch and brings back the ball at your feet for another throw. Julius finds the whole exercise incomprehensible, from the comfort of his favourite, large shoe box.
I was a ‘dog person’ and never had cats till I moved here. Sofus was my first cat. I learned to accept him as he is, the whole damaged, solitary, odd little black and white package. Gave up trying to change him, and applied my learning about dealing with ‘difficult’ people in my life. I changed my response to him and accepted that I might never receive any acknowledgement for my care. A lesson in unconditional love.
Julius, on the other hand, loves to be held and tickled. He has single handedly destroyed all the flower arrangements, bitten off the soft cactus leaves, pulled down the the huge, thriving Monstera in the bathroom, whilst narrowly escaping being hit by the falling pot. Decorative textiles are next best. The large Kuba textile on the back of the sofa has become a climbing frame and the beautiful new oilcloth from Annabel Grey has loving little kittykat claw marks over it. Unconditional love.
There was a particularly difficult day recently with some bad news. I cried whilst speaking to my girlfriend in Singapore. A black cat climbed onto my lap, looked into my eyes and made me understand that he loved me.
Hilary Q, North Norfolk
Our National Trust Joint Senior Membership cards arrived this morning. My husband commented that he hadn’t realised the cards give entry to properties in Scotland. He is despondent because he spends much of the year in Scotland, salmon fishing, all of which has been cancelled or put on hold. His first week of fishing this year was just before lockdown. He caught a beautiful fifteen pound springer (catch and release) on his last day on the Dee before returning home. Christina, who runs a B&B at Kelso with Bella, her ASBO border terrier, where Martin breaks his journey, literally shut up shop behind him as he headed for Norfolk. His lines are strung across the beams in the attic looking like an installation. They are there to lose their memories. This is not poetic. They mustn’t be left on their reels otherwise they may coil and tangle when casting!
Observations from the Orifice
John O'Brundall, Norfolk, UK
We are coming to the close of the fourth week of the shutdown due to Covid-19.
I am a practicing clinical dentist of over 45 years experience, working in primary care dentistry.
When Margaret approached me to contribute something for the Journal and how it might work, I was both excited and stumped, as I am hampered by dyslexia and have never written anything except clinical notes and examination papers since my school days. So this is a challenge and caused some careful thinking.
We are in uncharted waters from a professional point of view, which I will try and explain in brief, and try to offer practical advice, in a personal attempt to bring succour in a difficult situation.
Currently, I am trying to support the emergency needs of my wonderful patients, some of whom I have had the honour to serve for well over 40 years, as well as fielding pleas for help from people from an extremely wide area, contacting me through my Website, who either have no dentist or who are unable to get help or advice. This has turned into a full time job in itself. I had visions of endless hours catching up on all the jobs and chores that built up whilst running a busy dental Practice.
The reality is that while the stack of neglected tasks has diminished somewhat, the more pressing needs of fielding calls and liaising with hospitals, doctors and pharmacies is filling an unbelievable amount of time.
Our front line medical services are doing an unbelievable job under ferocious pressure and with limited resources, God give them the strength to continue.
My own profession are struggling to manage the unfolding situation.
We have been informed that there are Urgent Treatment Centres up and running in Scotland, Wales and Northern Ireland, but we are still awaiting the commissioning of them in England.
There is currently no dental treatment available to patients at present.
NHS England and the Dept. of Health are in the process of setting them up and there are scores of practitioners who are prepared to redeploy as I have done, either in a dental setting or allied medical services.
In the capacity as a triager, all I can offer is what is referred to as the ‘3 A’s’, Advice, Analgesics, Antibiotics.
In the light of this I feel that there is a need to explore what can presently be done.
A perspective on the above approach
The 3 A’s is not an alternative to timely and appropriate dental treatment. However, the closure of the UK dental surgeries was a necessary part of the strategy to contain and ultimately control the spread of the Corona virus. These measures appear to be limiting the spread; but again only time will tell.
Any situation where clients spend time face to face with a service provider, be they medical, dental, hair stylist or beautician is an absolute hotspot for transmission of the disease, and as difficult as this is, we all need to observe the strategy and do our part.
We have tried to limit the use of antibiotics over the past 4 decades, due to the emergence of resistant ‘super bugs’, with the capacity to inactivate the medication and continue to thrive and spread through the population. This has not changed. We must still continue to resist the ‘little magic bullets’ or we will run out of them – either physically or they simply will no longer perform their essential roles.
The maxim must be antibiotics as a very last resort.
Analgesics will reduce inflammation and will raise the pain threshold. This should always be a first step in controlling any form of discomfort, dental or otherwise. If there is any capacity for the body to heal itself, this will aid the process and make life more bearable.
The use of whitening pastes can cause sensitivity. Desensitising pastes will do the reverse by blocking off the tubules in the dentine and creating an impervious layer. Not instantly but will build up with successive applications.
Swelling is a sign that the body's defence systems are being over run and the infection is starting to extend its area of action. This is the sign for the need for advice and an antimicrobial medication.
Swellings in the floor of the mouth, under the jaw or in the neck, which affect either swallowing or breathing constitute a medical emergency, and fall into the province of a doctor, not a dentist.
In the UK call 111.
Lost fillings, crowns, broken teeth
These pose a more difficult problem. There are kits available on line and through some pharmacies, which contain temporary filling materials and cements. However these are difficult to apply, as the tooth needs to be cleaned and perfectly dry for the material to have a chance of sticking. Also a poorly cemented crown may not be in the correct position to eat with, and might dislodge and cause problems being inhaled or swallowed.
Homecare and self-help
We all now have the time and the opportunity to perform excellent dental hygiene.
Please utilise your freed up time to indulge in good and thorough brushing and interdental cleansing.
Good quality fluoride containing pastes will help to remove plaque.
Chlorhexidine is a chemotherapeutic agent, not an antibiotic, which creates a layer on the surface of the tooth and root, which helps prevent the plaque forming bacteria getting an initial attachment, and slowing up plaque formation. Take the time to clean all round each tooth – view it as an island and address each surface.
Once we have dislodged the plaque, the body has a natural process, like tears, to flush way the bacteria and debris – but we need to assist the process.
I sincerely hope that I have not bored or worried you. We need to be self-sufficient now more that ever. I hope that this entry will give you something practical to do. Remember, taking control in any situation is the best way to not be frightened.
My good wishes go to you all, and especially those wonderful people who are manning the front lines for us.
Keep well and take great care in all you do, John.
Words from Wood Lane
Susan Neave, Beverley
Recently one of our neighbours sent round a ‘WhatsApp’ message to say that he would be putting some trays of seedlings together with ‘salad pots’ in his front garden, with an invitation to help ourselves. On the appointed day I wandered down the street and collected a couple of plugs of lettuce and dill seedlings, and took one of the pots to which was attached small bag of seeds – or so I thought. No instructions, so I moistened the compost, sprinkled over a few of the generous quantity of tiny seeds, lightly covered them with more compost and left the pot on the window sill. Nothing happened. Last night I got round to reading last week’s neighbourhood newsletter, and realised that what I’ve actually planted is vermiculite! I obviously missed the accompanying packet of salad seeds. Should have gone to Specsavers .....
Chris Gates, Norfolk UK
Awoke to find total unremitting greyness, a bit of overnight rain and the threat of more to come. Determined to find this useful, if a tad limiting. It’s no surprise my relaxed view of self-isolation is largely to do with the fact I can find endless acceptable, positively welcome distraction outside... confined to barracks I seem to mainly have unwelcome scope, and my laziness is more obvious - but it’s not that troubling. A bit of reportage here is just the ticket, a bulletproof reason to be sat in the garden chair for... well, as long as it takes, or as long as I care to spin it out for.
It’s 9.35 and despite the above I find I’m just a bit tense - and that’s with my trump card, an escape, a visit to the nearby Co-op, already spent. Incidentally it was wholly good. No queue outside, well stocked, in fact only cocoa powder missing (so no chocolate cake then) and straight to a checkout. Having grumbled about them in the past, it seems only fair to give them this credit.
Anyhow, before anything else, and to fully restore my spirits I log in to Captain Tom’s site to get current stats - £21,450,325 from 1,046,541 sponsors - and see there’s now a move to get a hospital named after him as well as the Knighthood.
Also, and in very welcome news beyond the obvious, Engineers somewhere have developed an aluminium ‘sponge’ of unimaginable complexity which I’m going to ask you to imagine: it’s surface area within is such that a lump the size of a cherry tomato can ‘unravel’ to the area of a football pitch. What use is this? I hear you cry. Well, they reckon it can be used to form a high capacity fuel tank for a hydrogen powered car, storage space having been a hindrance. If so, this may save people tripping over charger cables laid across pavements to parked electric cars, which seems to be the metropolitan outlook. Let’s go hydrogen.
Back to reality and from the ‘you couldn’t make it up’ Covid19 almanac: having announced early release of some prisoners to lower the high prison population for fear that the Virus would sweep through a heaving mass of prisoners and their keepers, it’s quickly discovered 6 have been released who shouldn’t have been and, in panic, the Authorities cancel the whole initiative for the moment, thus at the same time irritating a section of Society that really shouldn't be provoked (prisoners) and restoring a diminishing Covid risk to Prison Officers to ‘high’. The six wrongly released very sportingly return to prison - presumably to solitary confinement as they pose an infection risk to everyone else now, if they didn’t before.
While the news from the briefing yesterday is that we’re still ‘many months’ from the likely roll-out of a vaccine, oddly there is now over capacity of testing. As we get to a potential 38,000 per day (remember, that nice Matt Hancock promised a reassuring 100,000 per day by the end of the month) it emerges that only 22,000 have taken up the invitation to get tested. At this rate, Hancock could claim he’s hit his target and never be caught out because 100,000 a day will never turn up for testing.
It’s now 1.30. No, it hasn’t taken me this long to cobble a post together, there’s been a few phone calls and a bit of cooking and a good deal of idle gazing, but I thought I’d finish with a 4 hour Captain Tom update: + £1,316,331 to £22,766,656, + 55,230 sponsors to 1,101,771. An average of £20 or so per head. Amazing.
I think a Knighthood, a Hospital name and a seat at Cabinet.
Tom would sort it.
Then and Now
It seems to be a wet day in Market Rasen, some time in 1941, so I will leave the outdoors to look after itself till the weather clears up. So what is there to do indoors, as well as prowl aimlessly round the house, picking bits of the world up and putting them down again, or get under Evelyn’s feet in the kitchen.
Some eighty years later, I read with a kind of baffled curiosity at the various pieces of advice for surviving lockdown. Well, we haven’t got round to giving virtual dinner-parties yet, we don’t feel an urge to play Monopoly or do jigsaws; Scrabble never had enormous charms for us and I rather doubt whether there is a pack of cards in the house. At the moment we read, read, read and I scribble at my poems, sometimes just, like Oscar, putting a comma in in the morning and taking it out in the afternoon; Margaret gardens, makes cakes and runs the online plague journal. Oh, and we watch the dishy Jeremy Brett being Sherlock Holmes, the part which trapped him and seems to have eaten him alive.
Still, it’s 1941 and there’s a long haul to go to get to now. I’m lying on the horsehair sofa, but the garden is shrouded, not just by rain but by the yellow netting of sticky tape which is stuck to the panes against bomb-blast; there’s also sticky tape hanging from the ceiling to catch flies. So I cross to the table for a happy morning with the German stone Richter bricks my mother had as a child, part of the pleasure being to fit them exactly back again into the pattern which matches the picture on the lid. In eighty years time, there will still be no flaw in the pattern; it will be as complete as in 1912 or so. But the paper Germanic cut-out figures which were supplied with them have turned to dust. Then there is Solitaire. Since I never learn the trick of smartly getting the marbles down to one, this can take hours, with three marbles or five still perched in their holes in mockery. Then I set up a board which ends in arches and little tunnels, each numbered, and roll marbles down to make an imaginary, important score. And the button-box, my case of jewels - or the chipped stopper of a decanter, throwing prisms of rainbow light around my little world. Since my sister is younger, many games are the inventions of unshared solitude. Yes, there are jigsaws, proper wooden jigsaws. My favourites are a Clipper in full sail, titled ‘Off Valparaiso”; or the glamorous ‘Coronation of George V1’.
Most of the games in the house belong to the pre-war years, by which I mean pre 1914-1918. Yes, there are playing cards, but only thought of by me as the building-bricks for paper towers. Meccano has not arrived on my scene, though, with the Children’s Encyclopedia, it will be the great staple of some later years. It seems to be clearing up a bit, so perhaps it’s time to find an outworn tennis ball and keep it up, bounced and caught against the house-wall a hundred times, or else . . . And there’s a scooter, and whip-tops with whips. I do not realise it, but I am an Edwardian child. And since it’s raining again I can float stamps off old letters and happily stick them in my album with little hinges.
So, dear and isolated Reader, I will allow you the jigsaws - so long as the pieces are plywood. Good luck with the German bricks, the tennis ball and the marbles. How can you ever be bored ? And I haven’t mentioned the house’s books yet!)