Another lockdown – Why?

There are no easy solutions or answers.  So said Doctor Michael McBride, Northern Ireland’s Chief Medical Officer, when announcing the return to lockdown.  There were hard and difficult choices, all with bad outcomes, but what was good for health was also good for the economy, poverty does kill people.

Just before this the Health Minister, Robin Swann, announced that the new restrictions were required in order to protect the NHS.  We could not turn away Covid patients he said – ‘who would suggest such a thing’ – suggesting instead that other patients be turned away, without being so dramatic is saying so of course.  McBride said that we needed to ‘help protect the non-Covid health service’, not long after one hundred planned operations in the Belfast Trust had been cancelled.

The announcement involved a presentation that included graphs of new cases, number of tests and numbers of hospital in-patients, but no graph on the number of deaths.  The Northern Ireland Statistics Research Agency latest weekly report recorded that in the week ending 9 October the total number of deaths in Northern Ireland was 348, of which 89 were due to respiratory causes.  The number of deaths where COVID-19 was mentioned on the death certificate, whether or not COVID-19 was the primary underlying cause of death, was reported as 11, which was just over 3 % of all deaths during the period.

To those who thought Covid was exaggerated Doctor McBride said that they needed to ‘wake up’ to the number of cases, number of in-patients and number of deaths.

Two questions were then asked repeatedly by the journalists invited to speak at the presentation.  What was the evidence that the new measures were required and what happens if it doesn’t work?

The question on evidence wasn’t answered; one journalist was referred to the minutes of the UK experts group SAGE and to unspecified peer reviewed articles.  No one asked whether the members of the Executive were limited to this, or were offered this as an answer if they had asked the question. ‘It worked before’ was one further response to the question.

To the second question – what happens if it doesn’t work? – the answer was that the public must follow the guidelines, so implicitly it’s your fault if it doesn’t.  Only near the end of the press conference did the Chief Scientific Advisor Ian Young state that people’s behaviour would have to change after the end of lockdown.  Elsewhere it was reported in one newspaper that the document informing the decision on a new lockdown had stated that further interventions will be required “early in 2021 at the latest.”

It would also seem that relaxation of restrictions at Christmas with the “likelihood of increased population mixing” in the run up to it is a significant consideration. (No, I don’t understand the rationale behind this either.)

The document apparently reports concern that Covid hospital admissions will rise to 450 to 600 at the peak; while the average number of NHS Acute services beds available in Northern Ireland was reported as 3,891 for 2019/20 and 3,882 in the previous year.  The average number of occupied beds was identical in both years at 3,239.  The forecast peak of Covid-19 patients of 600 would therefore occupy a forecasted maximum of 18.5% of the average number of occupied beds at the peak or 15.4% of available beds, before any plans for temporary expansion.

This includes all Acute beds and it would appear that the document has the aim of having a total of no more than 20% of general medical beds, around 320, being occupied by Covid patients.  Of course, it is more complicated than this and lots of uncertainty surrounds the ability to create additional capacity, and especially how much will actually be needed.  There is no explanation reported on the inconsistency between a target of 320 beds and expectation of up to 600 being required.

Given the lack of transparency, avoidance of answering questions, finger-pointing and general arrogant condescension of the Health Minister and experts it is no surprise they didn’t provide the level of information provided in a short newspaper article.  Non-sequiturs, plain contradiction and pontification are regarded as the currency that is required to get the population to do as it’s told.  And the population in the main accepts the argument, such as it is, and gets on with generally keeping to the rules except when it doesn’t suit them.

The latest Department of Health figures for 16 October show 3,711 beds available, 180 less than the average last year, with 211 taken up by Covid patients and 615 unoccupied.  The figures also show that of 104 ICU beds available 26 are taken up by Covid patients with 21 unoccupied.  No doubt the number of beds occupied will increase as it always does in the winter with the onset of influenza infections.

The effect of winter pressures is already being felt in Care Homes with 301 respiratory outbreaks being reported and 72 being classified as Covid related, with a further 10 suspected to be Covid.  Around three quarters of ICU and Care home outbreaks are therefore not Covid related.  The increased pressure on beds will also most likely reflect the same pattern.  If the NHS is overwhelmed by Covid it will not be because Covid in itself is overwhelming.

The figures for the growth of Covid outbreaks in Care Homes is a cause for concern while ‘protect the NHS’ may again be interpreted as a need to get elderly patients out of hospital  and into Care homes in order to free up beds – regardless of testing beforehand.  It was remarkable that in the press conference the appalling death toll in Care Homes was not referenced or any pledge made to protect their residents.

If the Health Minister and his experts therefore have an argument justifying their approach, it is not that Coivid-19 is an especially lethal threat but that the health service cannot cope with the additional work.  So the focus becomes one of reducing the work on non-Covid patients by creating Nightingale Hospitals that use existing facilities and existing staff and involve relatively little activity, while the capacity of the rest of the Service is massively reduced. The overall efficiency of the NHS therefore plummets just when it needs to increase.  And this is called ‘success’, and we are all asked to applaud it.

Rather than address this issue as the primary problem, which might raise the question how we got into this position, we have instead the enormous task of shutting the rest of society down (in so far as this is possible).  While those most vulnerable are, or can be, identified the message is given that everyone is more or less threatened, when this is not the case.  And because it’s not the case the population more and more ignores the rules when it suits, which allows the politicians and bureaucrats to sermonise and talk nonsense, such as the head of the British Medical Association in Northern Ireland telling us that “success leads to complacency, complacency leads to failure.”  You might think that if a successful strategy leads to failure you’ve got the wrong strategy.

The approach of the politicians and health service bureaucracy has the comfortable effect (for them) of making the population the problem, requiring that it accept the shutting down of much of its normal everyday activity.  Much of the services provided by the NHS is also cut because the NHS is already, how shall we put it, not up to the job.  The politicians and bureaucracy responsible for this situation then demand of the population that it support and approve of this, garnering its sympathy because many of the staff who work in the NHS are now exhausted.

Which, brings us once again to the question of what is the right strategy.  While the North once gain goes into a level of lockdown the Southern Government is discussing going to Level 5, the most severe level of restrictions in its five-level menu.  The prospect now looms of repeated expensive lockdowns that lead only to a higher number of cases when they end.

In ‘The Irish Times’ someone took out a full-page advertisement opposing the current approach and supporting the Barrington Declaration.  This has led to objections and claims by some that they will no longer buy the paper.  The facts quoted in the advert are nevertheless true: that current life expectancy in Ireland is 81.5, the median age of death from Covid-19 is 83, a total of 20 people under 44 have died from Covid-19, and the record of Covid-19 deaths is one that includes those who died with Covid and not from it.

Controversy around the declaration has involved arguments that have little to do with what the Declaration says or what its argument is, but concentrate on the dubious political character of some of its supporters, its supposed nefarious objective of mass murder and criticism of what it does not say, as opposed to what it does.  A number of letters to ‘The Irish Times’ illustrate this.

It is claimed that the facts quoted are intended to mean that the deaths of older people are of less significance, although the point of the declaration is to make protection of the vulnerable the priority, while it has been the current strategy adopted that has demonstratively failed in this regard.

This fact is also construed to imply that these older people lived longer than they should have expected.  In any case it is life-expectancy at 83 that matters, not at birth, which is six years for men and eight for women.  But the first claim is without support from what the advertisement says and the second fact, while absolutely true, would require more information to demonstrate that at age 83 Covid-19 reduces the remaining life span of six or eight years from everyone who dies from it.

Another line of criticism is that sheltering will not work when there is widespread community transmission.  But we have widespread community transmission now after lockdown and there is no reason why measures that are supposed to socially isolate everyone cannot be strengthened for those most at risk.  From some on the left especially, the argument is simultaneously put that lockdowns should be more restrictive and would not work for a targeted minority.

The new lockdown in the North is an admission that the previous one failed.  That there is the expectation of another one of some sort later is further evidence.  That the population is treated as too ignorant to discuss these issues is a repeat on a massive scale of ‘trust me I’m a doctor.’  The modern notion of an ‘expert patient’ is gone.

If the failure of the current policy is unrecognised it is hard to have any confidence that the costs of the lockdown in future deaths will be acknowledged and accounted for.  The only thing that will save the current policy from ignominy is if its central claim is untrue – that we face a massive death toll if some sort of society-wide lockdown is not the major plank of State policy.

Arguments over fighting Covid

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The advice from the health experts of the National Public Health Emergency Team (NPHET) was that it was necessary to move from level 2/3 to level 5 because this was the “only opportunity” to get Covid-19 “back under control”. But when this was rejected by the government and Leo Varadkar went on TV to cut the Chief Medical Officer (CMO) off at the knees, he damned not only the CMO and his advice but also the strategy of his Government.

Not only could it no longer be claimed that government strategy was the product of expert advice, but it raised the obvious question why total lockdown was previously implemented.  If it was necessary in March there was no reason it wasn’t necessary now.  Where is the improvement in the test and trace system and health service capacity over the summer that might have been presented as some sort of explanation for a more relaxed policy now?

All the questions raised in my previous post could be asked again, including how the different levels of intervention make any sense when, for example, the criteria that are supposed to prompt intervention are the same for levels 2 to 4.  In the previous post the question was where was level 2 and a half, or 3 and a bit, applied to Dublin?  Now it is – what are all these levels for in the first place?

There are of course real concerns, such as the reported “sustained increase” in cases among the elderly with seven new outbreaks in nursing homes in the previous week, especially when we recall that over half the deaths have come from these facilities.  But this too raises a question – if lockdown didn’t prevent these deaths then, what would lead us to believe it would do so now?  After all, we have been told that to protect the vulnerable we have to have complete lockdown but it didn’t work before – why not?

And if the NPHET is the while knight alternative to the Government – where have the warnings been about the preparedness of the health service and the vulnerability of the old and special measures proposed to protect them?

The Government has made a mess of communications again and again, but where has the NPHET highlighted that over 95 percent of deaths have been of people with an underlying condition, or that  such people accounted for 87.8 percent of those admitted to Intensive Care Units, as were 67.8 per cent of those hospitalised?  Would it be because this would also highlight the question of why the whole of society, in so far as it is even possible, should be locked down again?

Instead we have a lower level of restrictions, although still based on the same assumption that everyone must be isolated in order to also protect the vulnerable.  To present a show of real intent thousands of Garda, at hundreds of road blocks, have attempted to prevent the whole population from moving outside their county (as if these were epidemiologically significant boundaries) in order to deliberately gum up traffic, when such movement is entirely legal.

Apparently Varadkar had some tough questions for CMO Tony Holohan, like what was the metric for success and how long would the lockdown last?  There has even been speculation of following the widely trailed policy supposedly to be implemented in the North – a ‘circuit breaker’, i.e. a relatively short lockdown to bring the virus ‘back under control’.  But this can’t explain why a shorter repeat of the last lockdown will not result in the same increase in the virus when it ends.

Unless, of course, as I noted in the last post, the spread of Covid is much greater than reported, in which case the rationale for lockdown is even more undermined.

Varadkar also apparently said to the Chief Medical Officer that Ireland needed a plan in case this one didn’t work and a plan for re-opening if it does, and a plan for communications as well.  A bit rich coming from Varadkar you might think, since if we work our way backwards on this list, the Government screws up communications each time it attempts to communicate; a plan for re-opening should already be in place since we have already had a re-opening; and we should also have a plan from the Government if lockdown doesn’t work since we have had a lockdown and it didn’t work.

Which neatly brings us to the need for an alternative.  As in the previous post, we can briefly review what has been proposed by some of the left, by People before Profit (PbP), which has beefed up its press statements and explained a little more about its zero-Covid policy.   This it seems “does not mean we reach absolute zero in terms of cases. It means crushing the virus to the point where we can test, trace and isolate every single case that arises, stopping the spread of the virus.”

But if up to 30% of positive cases show up as negative then it is impossible to “test, trace and isolate every single case.”  Never mind the prior problem that, as The Guardian newspaper reports, “researchers at UCL said 86.1% of infected people picked up by the Office for National Statistics Covid-19 survey between April and June had none of the main symptoms of the illness, namely a cough, or a fever, or a loss of taste or smell the day they had the test.  Three quarters who tested positive had no notable symptoms at all.”

The proposals by PbP support level 5 lockdown and include expansion of testing and tracing and health services; increased workplace inspections and more money spent on teachers with the potential for closure of schools “until the virus is crushed.”  Inexplicably, there is no specific mention of those most at risk.  Nothing is said about how long this lockdown would have to last and what the financial cost would be.  Nothing, in other words, about the deaths and illness caused by prolonged isolation, a health service diverted from its day job or the long-term effects of a prolonged lockdown.

There is also nothing on the level of State coercion that would be required to impose a more severe lockdown with an indefinite timescale.  People before Profit is kidding itself if it believes that this would not be required.

It calls for a harmonised response across the island but the problem isn’t harmonisation, it’s that both jurisdictions are making the same mistakes. To little public response the Health Minister in the North reported that there was, after all, to be no announcement on plans for the NHS to return to normal operation – how and when it will return to delivering all the health and social care that consume more lives but are not now so politically prominent.  There was a time when Sinn Fein complained of political policing, but now it is in office we have the previously undreamed problem of political health care.  

The Guardian has another article ‘Why herd immunity strategy is regarded as fringe viewpoint’ that criticises a strategy focused on protecting the most vulnerable, those at most risk.  Unfortunately it ignores the failure of the current strategy in Britain, which is due not simply to Tory mendacity and incompetence.

The alternative is damned for being outside the ‘scientific mainstream’ and having extreme right-wing supporters, neither of which proves anything more than these bald facts.  It quotes one professor who ‘is among many scientists who are sceptical that the most vulnerable in society can be adequately identified and protected.  “It is a very bad idea,” he said. “We saw that even with intensive lockdowns in place, there was a huge excess death toll, with the elderly bearing the brunt of that.” In the UK, about a quarter of the population would be classed as vulnerable to Covid-19.”

This is stated almost as if 25% is too great a number to protect.  So let’s go for 100%?    They can’t be adequately identified and protected?  So why can’t the health service and social services be mobilised to identify them from its records and then put in place measures to support and protect them?  Why would it be a problem, for example, to identify everyone in elderly person’s homes?  Or receiving treatment for those underlying conditions that make them vulnerable?  Even the first measure might have made a major contribution to protecting half of people who died but were supposedly being protected by measures aimed at everyone else.

And let’s not forget that primary among that to be protected was the health service itself.  As I’ve pointed out before – isn’t it supposed to protect us?

Another biostatistician is quoted as saying that actually this strategy of protecting the vulnerable was tried – “Shielding of the vulnerable was part of the UK policy since the start of lockdown.” Except of course, this was never true, not in Britain and not in Ireland either, as the irresponsible transfer of the elderly out of hospital and into homes with their lack of PPE testing and adequate staffing amply demonstrated.  To claim otherwise is to admit the existing strategy had to entail these deaths – not something you will hear or read very often.

“What troubles many scientists is that with coronavirus no one knows how protected people are after contracting the virus, how long that protection lasts, and exactly what proportion of society needs to be immune to quell a pandemic.”  All good questions, none of which provide support for the existing strategy or damn the alternative; or address the fact that the relatively young and those without the relevant underlying conditions have little to worry about.  These concerns apply equally to a vaccine, but no one will advance them as objections to vaccination.

“It is impossible to fully identify who is vulnerable and it is not possible to fully protect them.”  But is it harder to protect them than to fully protect everyone?

‘Another concern many scientists raise is the impact on the young and healthy. While the risk of death is low in people under 40, infection can still expose them to long-term complications that healthcare could be left dealing with for decades . . . “Quite large numbers of younger people are already becoming infected at present, whether or not they are being encouraged, and there are consequences to those infections.”

There do indeed seem to be some consequences for some younger people but transparency on this, how many there are and what the effects are, is not readily available. But it is not possible to put this into perspective with a strategy that is based on treating the whole population as if it was under the same threat.  Identifying exactly who is at risk and of what is not what the current approach is about, and scare stories and sensationalist reporting are instead the order of the day.

If socialism is about building a counter-power within capitalism that fights for its replacement this must include the development of the organisation and consciousness of the working class, starting with its labour movement.  This organisation must include scientific bodies and scientific consciousness. We don’t have working class scientific organisations – bodies consisting of scientific professionals belonging to or sympathetic to the labour movement or socialism – but the Covid-19 pandemic is one more lesson that we cannot afford to accept that the state, in its welfare guise or not, will provide the protection or support we need.

Beyond the arguments over the failure of almost all capitalist states to protect its most vulnerable, and the strategies that would most successfully address this need, lies this longer term task that the labour movement and socialists must accept and seek to address now and after the pandemic is over.