2020 Vision, 14 May, 16:00

When my love died fifteen weeks ago, I emailed a question to the thoracic specialist at St Thomas’s who had helped him to manage a chronic condition, sarcoidosis, and, after his emergency admission to the hospital in January, advised its excellent critical care team. Everyone worked so hard to save Andy. Might they have succeeded if I’d called the ambulance days earlier? The specialist replied with kindness: we can never be sure.

Maybe so. In my bones I know the answer. Over the new year break and into the first weeks of this benighted decade, I observed changes in Andy now associated with those hit hardest by Covid-19: low oxygen, lethargy, diminished appetite. He assumed that the cold weather had exacerbated his sarcoidosis and insisted he would fare better at home than on a ward. There was a sweet abstraction to him in those days, however intently he focused on finishing his new album or finalising 2020 tour dates for his band. Already he was drifting away. If I’d acted swiftly, listened to my instincts, perhaps I might have tethered him to this plane for at least awhile longer.

If there is any blame, it is mine alone—although the past two weeks unexpectedly re-opened this question. The cause listed on Andy’s death certificate is not Covid-19, but “(a) multi-organ failure, (b) pneumonia”. His band had returned from China in late November. This information prompted St Thomas’s to ask him if he'd travelled to Wuhan. Health authorities in the region had flagged up a new disease on December 31st; Chinese authorities revealed on Jan 7th the pathogen to be a novel coronavirus. Andy thought it unlikely he had come into contact with it: Gang of Four’s tour had taken the band only to Beijing, Shanghai and Guangzhou. Later, as images and descriptions of Covid fatalities appeared to me not as news bulletins but agonising memories, I assumed the timing of Andy’s death to be a cruel coincidence. The timelines couldn’t be reconciled with official information on the spread of the disease, in China or to Europe.

Then, on May 5th, a story broke. Researchers in France confirmed that they had found evidence of the virus in samples taken from Amirouche Hammar, a patient hospitalised north of Paris in December. Views on the time Covid-19 takes to incubate had also shifted; a man in Wuhan entered lockdown in apparent good health, exhibiting symptoms only after 27 days. I emailed Andy’s specialist again. “Do you think,” I wrote, “that there’s a possibility that Andy was an early victim of Covid-19? I cannot shake that suspicion.”

His answer winded me. “Your question is one that I asked myself more than six weeks ago,” he replied. “It seemed to me at the time of Andy’s illness that we had not fully understood why he deteriorated as he did. Once we learned more about Covid-19, I thought there was a real possibility that Andy had been infected by SARS-COV-2. I discussed this with colleagues in early March—I thought we should explore this further once we had the tools to answer the question such as reliable antibody tests. I did not want to contact you until and if I had a definite answer.”

Andy in ICU, his last selfie

He wasn’t sure whether it would be possible for the hospital to locate in its laboratories any of the samples taken from Andy. In the meantime, he asked me to collate any information that might hint at a coronavirus cluster or trail around Andy and the band. I interrogated not only his beloved band members and crew, but the many friends and family who had seen Andy after his return from China, whether in his music studio, over dinners, chatting with him in the ICU or stroking his lovely hands when he could no longer speak. What could they tell me about their health in the period between Andy’s return to the UK and immediately after his death?

The band reported no symptoms, but alerted me to an incident that seemed pregnant with meaning. Their tour manager—26 and generally in robust health—had joined up with another band after China for a series of UK gigs. On December 2nd, in Leeds, his companions found him in his hotel room in respiratory distress so severe that the first hospital that admitted him quickly transferred him to the better-equipped “Jimmy’s”, St James’s, Europe’s largest teaching hospital. He remained under its care for eight days. His GP has told him she believes he had coronavirus.

My sister Lise and I developed acute conjunctivitis in late January—this is now recognised as a symptom of Covid-19. A friend who brought food and comfort during the long days and nights in ICU later developed the fever, cough and breathlessness originally identified as the three key markers of the virus. Another friend coughed continuously from early February. The UK government issued advice in March that anyone with a fever or “new cough” should self-isolate. Hers did not qualify as new, so she continued to work and socialise. Her husband later noticed chilblains on his feet and legs; members of their close circle came down with fevers and coughs. There are other such stories from our friendship group.

In March, I launched an online initiative #HowCanIHelp, connecting people self-isolating or shielding with volunteers to bring food and medicine. I now looked back on that time and wondered: had I been not a helper but a carrier of the virus? I ran errands myself, bringing food and medicine to some of those who got in touch, strangers and people known to me including a friend whose most likely source of infection, if Andy had coronavirus, would have been me. He took me to dinner just after Andy died.

The personal implications were profound. My mother gently raised the one I had tried hardest to ignore. My stepfather John died on December 22nd. He had been hospitalised with two incurable conditions: COPD and blood cancer. However his death came faster than anticipated, as we made arrangements for home care so he could spend a last Christmas with us. His cause of death is recorded as “hospital-acquired pneumonia”.

But it was, above all else, the public health implications that drove me to keep pushing for answers. If Andy and his tour manager had contracted Covid-19 on tour in China, this would suggest the virus was already circulating outside Wuhan well before the Chinese authorities so much as admitted to its existence. The official submission by China to the World Health Organisation dates the first case of the disease to December 8th; unconfirmed reports suggest the authorities were aware of a new virus at least 20 days before that. Clinicians who tried to raise the alarm, including Li Wenliang, an opthamologist from Wuhan, attracted not praise but retribution from the state. Li later received an apology, but died from Covid-19 just days after Andy.

Thoughts and possibilities whirled. The case of France’s Hammar, who had not travelled abroad for four months before he became ill, shows that Covid-19 already made footfall in Europe in December. This means the reproduction rates of the virus may be lower and the numbers of asymptomatic carriers significantly higher than current modelling accepts. How many hundreds of thousands of Covid-19 deaths might have been prevented by greater transparency and quicker and better public health responses, and not just in China but elsewhere?

Each day brings fresh and staggering numbers of fatalities. The tally of “excess deaths” over and above average death rates for the UK now tops 50,000. The lockdown in the UK, late and raggedy, lacked the accompanying programme of mass testing and tracking essential to protecting life or bringing us safely back out of lockdown. It is good news that Public Health England has approved serology tests to determine whether people have recovered from Covid-19 infections. It is unfortunate that muddled messaging may encourage those who test positive to think this means they no longer need to protect themselves or others against spreading the disease.

On Wednesday, as people struggled with the new brainteasers presented to them by the government—how to go back to work without using public transport; how to protect themselves if neither the state nor employers do so—the specialist emailed me again. A liquid sample taken from Andy’s lung showed negative for the virus. This is not, the specialist explained, a definitive answer. By the time of Andy’s admission into hospital, he had been ill for weeks. The virus could have already left his body, but triggered immune complications. The specialist wonders if it might be possible to locate and screen samples from the tour manager and to test Andy's sample for antibodies. All of us lucky enough to have spent time with Andy during his last weeks of life stand ready to take the new serology tests too.

We may never find out whether Covid-19 killed Andy, yet I will always know, in indelible detail, how he died. I will always know, intimately, how Covid-19 kills, the suffering it causes and the unbearable stillness that follows. I will always know this: that we must do what it takes—whatever it takes—to prevent such deaths.

Andy's signature double glasses (better, he swore, than bifocals), in the studio and in ICU

All words and images ©Catherine Mayer 2020