Covid before cancer. Or maybe not.

The Northern Ireland Health minister was interviewed on the BBC here.  After first saying that he didn’t want anyone in the health service to be put in a position of making ethical decisions to deny essential medical treatment the interviewer told him that the Chief Executive of the Belfast Health Service Trust has said that they are already being made, and are life and death decisions.  Does Swann deny this or say he will investigate?  No.  He immediately and without hesitation attempts to justify something he said he didn’t want to happen, as if it hadn’t been happening.

He says that these decisions have to be made – “the ethical decision is could we turn a Covid patient away?  The answer is no.”  For other patients, “sorry your operation, your scope your diagnosis is going to have to be put off.”

When it is put to him that what he is saying is that a Covid patient won’t be turned away but that the result of this is that a cancer patient may die his answer is “yes, that’s as black and white as it is.”

So how is this ‘black and white’?  There has been no medical assessment provided that this blanket prioritisation is justified, in fact it is presented as if its justification is self-evident, an obvious ethical decision.  Except it’s not obvious and it is without justification, in both senses of that term – it has not been justified and any attempt to justify it would be wrong.

Swann says that we ‘cannot turn a Covid patient away’ but we already know that while over 50,000 people in the UK and over 3,000 in Ireland have died with Covid it is not at all clear how many of these have died of Covid.  So how can this particular disease be prioritised?

More people die of cancer than Covid-19.  There are around 165,000 deaths from cancer in the UK – that’s every year.  In 2018 over 4,000 people died of cancer in Northern Ireland.  In the Irish state over 9,000 die every year.

It cannot be because of the severity of the disease: cancer kills cancer patients because of their condition, while for most sufferers of Covid the disease is so mild they may not even know that they have had it.   If someone with Covid has a serious underlying condition making them vulnerable to death compared to a relatively healthy person with the same disease, what is it that makes the difference between survival and death?  Covid may be the proximate cause of death but Covid may not be the underlying condition without which death would not occur. If this is not considered an important distinction then presumably the health service and whole swathes of the economy will close down during the next flu season. A report from the Health Information Quality and Quality Authority shows that not all ‘Covid deaths’ should really be counted as such (see below).*

There is little that can be done to avoid many cancers; even those who don’t smoke, eat healthily and exercise fall prey to it.  Hospital treatment is necessary but can sometimes require less serious intervention if caught earlier, although this is precisely what is being deprioritised. Those most vulnerable to Covid on the other hand can take many of the measures we have all become accustomed to including social distancing etc.  The most vulnerable received shielding letters informing them of their vulnerability and measures they might want to take to limit exposure to infection.  Swann and his chief medical advisor have decided that these letters aren’t necessary this time but provided no real explanation why.  What has changed from the first lockdown?

Why is the protection of those most likely to suffer fatalities from Covid not the major focus of protection, support and prevention from these political leaders and bureaucrats?  Is it not really that, what both measures have in common – prioritisation of Covid patients within hospital and lack of focus on those most vulnerable – and what is being protected, as they have made clear repeatedly, is the NHS?   Protected from doing a job they know it will fail? And by their association, responsibility and accountability for it, protection of themselves?

The NHS in the North of Ireland is the worst in the UK.  There are, for example, more than 2,500 nursing vacancies.  As I have said before, Covid-19 may overwhelm the resources of the health service but is in itself not overwhelming.  It is only so because the NHS is already in crisis, and what we are asked to do is also to accept that we must collude in covering up this permanent crisis, including through regular speeches telling us how difficult it has been for the staff.

This message is all the more powerful, and successful, because it is largely true – many health service staff have been under enormous strain but this should not be an alibi for failure of the bureaucracy that is the NHS as an organisation.  As I have said before, the demand to protect the NHS, when it is supposed to be there to protect us, is an admission that this responsibility of the NHS will not be met.

The unjustified blanket prioritisation of Covid patients in hospital and the failure to issue shielding letters to the vulnerable are political decisions and have been successful because of a political campaign to justify lockdowns.  This has involved not only politicians but also senior health figures, who have given legitimacy to their decisions.  One such figure has been Gabriel Scally who has regularly intervened to argue that policies in the North and the South should be the same, as if two wrongs make a right.  He has stated that ‘the figures speak for themselves’ when it is well know that they don’t, and has stated that over 50,000 have died of the disease without recognition that dying with it is not the same as dying of it.  That such basic errors are repeated by a respected public health doctor illustrates the scope of the group think that has developed.

So egregious was the Health minister’s statement that the Department of Health put out a tweet entitled ‘Myth Buster’ with ‘myth number 1′ being “are Covid-19 patients being prioritised over other patients?” To which the answer was “No, they are not.  Patients are treated according to clinical priority.” Swann pitched in with “it is untrue and offensive for anyone to accuse frontline staff of prioritising one condition over another.”

Since it was Swann who said that prioritising was ‘black and white’ perhaps it is himself he is referring to as being offensive.  So who is right – the Department or the minister, and which version of the minister?

It would be difficult to deny that senior health staff would not be so stupid to as to admit such crass medical practice but easy to understand how Stormont politicians could grandstand with this level of idiocy and ineptitude.

The real problem is not that some politician has instructed hospital doctors to relegate individual cancer patients in order to prioritise Covid patients but that this is what has and will continue to happen by political decisions on allocation of resources that constrain individual medical assessments.  These individual decisions rely on higher level decisions on allocation of staff, wards and beds to deal with Covid that in the first wave witnessed empty Covid beds in the Nightingale hospital while other treatments were stopped.

Lockdown is a political decision involving an analysis not only of the disease but the potential impact of the response.  It is not a question of medical expertise determining the correct approach, even if one were naïve enough to believe that the medical profession is a paragon of virtue and wisdom.  The advocates of lockdown refer regularly to the number of cases, hospitalisation cases, numbers in ICU and deaths but rarely to the costs incurred by lockdown.  To do so would invite a critical debate they are ill prepared to have.  Swann’s mistake was to take soundbites to their logical conclusion and blurt it out.  It denotes the logic of the current approach but too crudely expresses its effects.

It is tempting to see in Swann’s first statement the chaos and breakdown of the functioning of the Stormont Executive that because of its reaction to the pandemic was seen for a while as an example of the political arrangements working.  No one is pretending they’re working now. However, the real political weakness lies not in the political primitiveness of Stormont but that such crass political interventions elicit no popular opposition. Unfortunately on this score looking for the left to offer one would be a complete waste of time, as we shall look at in the next post.

* HIQA: ‘The officially reported COVID-19 deaths may overestimate the true burden of excess mortality specifically caused by COVID-19. This may be due to the likely inclusion within official COVID-19 figures of people who were known to be infected with SARS-CoV-2 (coronavirus) at the time of death who were at or close to end-of–life independently of COVID-19 or whose cause of death may have been predominantly due to other factors.’

https://www.hiqa.ie/sites/default/files/2020-07/Analysis-of-excess-all-cause-mortality-in-Ireland-during-the-COVID-19-epidemic_0.pdf

 

 

5 thoughts on “Covid before cancer. Or maybe not.

  1. I have been reading a batch of studies about the Ideas of Friedrich Engels. One of the essays was called Engels philosophy of science’, begins ‘Neither Marx nor Engels wrote what we would call a philosophy of science. If we want to construct one, we must be anachronistic, since the philosophy of science is of very recent invention’. One debating point in the philosophy of science concerns the criteria that allows for a division between science and not science, Plato called this not science mere opinion, the early enlightenment called it mere prejudice.

    In the nineteenth century of Marx and Engels the division came to be spoken about in terms of science versus bourgeois ideology. In the twentieth Karl Popper proposed a theory that was strict enough to put Marxism on the ideological side of the barrier. However Popper’s own theory came up for a closer scrutiny and initiated the philosophy of science culture war. I wrote an article for socialist democracy saying that there is no generally recognised criteria for separating science and ideology that is ‘philosophically established’, all of the special sciences have escaped the control of philosophy and now operate their own criteria for what distinguishes ‘their science’ from pseudo-science. I used the example of Stephen Hawking who from time to time issued complaining letters about philosophers meddling in physics ie trying to tell them if their theories were up to scratch. For one thing these philosophers did not not understand the maths involved in physics.

    I pointed out in my SD essay that when Marx spoke about ideology he did not think about it in the epistemological fashion as above, an ideology was a collection of ideas that furthered the material interest of one class over another class, it did not matter that much if the ideas were true or false, Marx spent more time showing that the economic ideas of the classical economists were supportive of a social class, the bourgeoisie than he did demonstrating or proving that the economic ideas were incorrect or false. The outcome was that some scientific propositions can be both true and ideological in the same instance, in short science and ideology very often come bound together with no clear or evident demarcation line to separate. This may not be a satisfactory state of affairs, a few academic Marxists, especially Althusser thought of it as a messy outcome, he was famous for bringing some of the tools of the French school philosophy of science to the books of Marx to separate the supposed scientific parts from the ideological parts, he even divided the books of Marx into the scientific works, the later works from the ideological works, the earlier works. The lesson for the here and the now is that it is unwise to speak about ‘the science’ and the government now ‘listening to the science’ this is hardly more than crude propaganda.

    As I read the story of the pandemic, President Trump is acting in the spirit of bourgeois ideology more consistently than PM Arden of New Zealand is, way back in Marx I expected all capitalist States to put the saving of the profits of corporations before the saving of the lives of workers, they have followed the logic but not consistently, there has been much talk of finding the right balance between profits and health, and there had been some swinging back and forth. The lockdown only became a factor when workers began acting spontaneously, walking out of workplaces, even in ultra-conservative northern Ireland workers began leaving the meat plants in droves without the support of the union officials. These escalating walk outs, then subsided due to the first lockdown are now rising to a new fever pitch not yet seen before, I was reading the world socialist website this morning and was struck by the shear ordinance of militant work place rebellions around the globe. In short the State lockdowns were the method chosen by the intellectual planners of the bourgeoisie to prevent workers from escalating their collective opposition to their preferred corona virus policy of profit before health. With some bourgeois States, the USA the President of the State has been more reckless than others and the most astute bourgeois planners in that country are now desperate to get rid of him. It is notable how many American billionaire oppose Trump. The end or purpose of State controlled lockdowns is to head off escalating workers rebellions, maybe the workers taking the organisation of work places out of the hands of the owners and managers. For the bourgeoisie a temporary lockdown is the lesser evil so long as it dampens down the workers militancy. The bourgeoisie would like to run fast with a herd immunity strategy, it is the most rational and effective way from their ideological point of view, from a socialists point of view it would be the worst strategy to follow, socialists would be end up telling the most militant workers that their fears about the harms of the corona virus were irrational and unwarranted, that they should take the advice of the minority of herd immunity scientists who are more ‘rational’ than the majority of scientists who oppose herd immunity. This would be the way of political suicide for socialists.

    The point about working class people mostly ignoring the lockdown is an indication that they know the lockdown is not there for their benefit, never have I heard so many expressions of annoyance that the bosses get to stay at home while they have to go to work in unsafe conditions, never have I heard so many complaints from working class people about how the furlough scheme is managed by the bosses in a fraudulent manner. I know this from my own family circle, they have never been political, but all have been in conflict with their own bosses over work safety, half of them currently have covid symptoms, and they know why, their boss did not give a crap about them. In the building firm my brother in law currently works for anyone who wore a mask in work was mocked by the senior manager for doing so, the top manager proclaimed himself an ardent Trump supporter, two weeks ago he went on a drinking bout with two managers that had over came from England, contracted the virus and spread the infection to everyone else, including the wives and girlfriends of the workforce, one of them being my younger sister, such are the experiences that are moulding the consciousness of the working class, they may not call the corona virus lockdown by its proper name ie ‘a bourgeois lockdown’ but they intuitively understand its class bias.

  2. excellent new article on the so called Stormont Lockdown policy. The DUP in particular have made sure that the Lockdown in the north of Ireland is no more than a sop to the bourgeois media to give the appearance of holding back the pandemic. This conforms to my own personal experience over time that the lockdown in the North is largely is non existent if you happen to live and work in a working class community. Maybe the middle class experience of the pandemic is different as many belonging to the salaried class have been asked/permitted to work from home.

    • see latest article on the socialist democracy web site about the mishandling of the pandemic. The good thing about the article is that there is no need editorial for heavy opinion, the facts speak for themselves. ‘Stormont takes reckless turn over pandemic’

      • I’ve read the article and there isn’t anything new in it in terms of determining the correct response to Covid-19. It assumes the correctness of lockdowns in order to argue for their imposition and like much of the left makes no attempt to determine the costs associated with them, or who will pay the cost. It simply asserts what it needs to demonstrate. It also makes no attempt to determine the validity of any of the measures such as closing retail or personal services such as hairdressing. The idea that another few weeks here or there or repeating the example of the South will be effective ignores the failure of the much longer and stricter lockdown earlier in the year. The lockdowns have failed across Europe and the prescription of zero-Covid with all the costs it entails would be disastrous. I have addressed these issues in previous posts and in Facebook discussions with advocates of this position.

        As your earlier comment made clear in many, although not all areas, the lockdown is being ignored. I have noted before that people report their support for the policy but apply it as it suits them. The pro-lockdown left have the problem of how they can change this without willy-nilly falling behind coercive policies by the state. They also have the problem of explaining to many people why they should suffer such disruption and all the other costs involved when they are under very little risk from the effects of suffering infection.

        Herd immunity is not ‘pseudo-science’ and opposing blanket lockdown is not ‘the right-wing position on the pandemic’. If lockdown is the left position there are a very large number of exceedingly strange left Governments. As you point out yourself, your estate must be full of right-wing libertarians!

        These lockdowns have not brought control of the virus which erupts as soon as they are eased and they cannot be justified simply because they are ‘short-term’ – they have been and will be imposed off and on for nearly a year. Test and trace will not be a solution when the pandemic is so widespread, so many are asymptomatic and the testing regime is so weak and the testing itself so inaccurate.

  3. I have always had problems reconciling my own limited experience with the pandemic and the media narrative based on a theory about a supposed lockdown. If you look up the dictionary definition of lockdown it refers to prison populations and their guards. A lockdown follows on from a prison riot, this is what the dictionary says and it includes confining unruly prisoners to cells 24/7 without exercise or family visits.

    The term lockdown does not capture what has been taking place. It lacks any class nuance. In my part of the world, a working class council estate, there have been few signs of a real lockdown, I spoke to my postman this morning and he said he hadn’t missed a day at work yet, the same is the case for many local working class people, early on tagged by the media narrative as the essential workers, I am thinking of lorry drivers, bus drivers, delivery drivers, shop workers. To be honest even those that in theory who are thought to be at home like hairdressers and bar workers are still carrying on regardless During the first wave of supposed lockdown many a pub in my vicinity was still serving the regulars. I got my haircut twice during the supposed lockdown by a barber who came to the house . I went to a baptism that broke the rules and an after event celebration of about 100 people that was technically unlawful. During the first phase of the lockdown the teenagers and children in my vicinity were gathering on the streets and behaving as normal. There was almost zero effort by the police ie The State to make these people adhere to the so called government rules.
    I have not met anyone who has been reprimanded by the police for flouting the rules . My sister in law told me an amusing anecdote the other day, she works in one of those mini supermarkets that sells hot food. She said that building workers come into buy stuff everyday and never ever put on a face mask as you are supposed to do, one day recently she served a long line of building workers not sporting masks, in the middle of the waiting line were two police officers, they were the only people waiting actually wearing face masks, they refrained from asking the building workers to put on masks. She said it was typical of ‘the pathetic police’ force.

    When I look at news reports, I do see journalists speaking in the midst of city centres that do seem to be really closed down but is this just the appearance of how things are? I have been to my local shop every morning to get the paper and have never been asked to do anything like wash my hands or put on a face mask. Is my own experience of the near None Existent Lockdown unique to my own council estate, I don’t know, my experience is of course parochial. I suspect that big swathes of the working class have just carried on as before the Lockdown and merely offering an appearance of token compliance.

    As far as I can tell most of the vocal opposition to the Lockdown as been libertarian in philosophy,
    Trump supporters, free enterprise websites and think tanks, libertarian judges like Lord Sumption, Peter Hitchens, the entire rostrum of talk radio presenters, ( talk radio is owned by Murdoch and managed by Brookes) there are many more I could mention. The libertarian credo has found traction with some small business owners and trade bodies but not with the working class. As far as I can tell the majority of working class people have been prepared to go along with the lockdown measures and announcements in theory and then not really abide by the rules in practice. I call it a lazy mans sort of socialism of the disobedient, the only route around the pandemic..

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