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

 

 

Covid-19 – the random killer?

In a recent opinion column in ‘The Irish Times’ the writer asserted that the virus ‘has always killed randomly’, proving the old adage that opinions are like arseholes – everyone’s got one.  In fact, of course, Covid-19 doesn’t kill randomly and the fact that it doesn’t should be the starting point for understanding not only its effects but also how it should be dealt with.  And so, in many cases, it has.

For example, in this article in Nature Medicine the writers state in relation to the first wave that ‘in absolute terms, the total mortality toll of the pandemic was overwhelmingly in those aged 65 years and older, who experienced 94% of all excess deaths. In relative terms, older people were also affected more, with mortality in these ages being ~40% higher than it would have been in the absence of the pandemic in Spain and England and Wales and ~30% higher in Belgium, Scotland and Italy. The largest effect on those younger than 65 years was in England and Wales—26% (20–32%) for males and 22% (17–28%) for females—followed by Scotland, Spain, Sweden and Italy.’ 

It goes on to state that ‘the fourth group of countries, which experienced the highest mortality toll, consists of Belgium, Italy, Scotland, Spain and England and Wales’, which confounds the political spin that the Scottish Government did a good job.

‘The spread of infection within and between hospitals and care homes, and between them and the community, is itself an important determinant of infections and deaths in both the vulnerable groups and the general population. Where infection rates were high and care homes were not appropriately safeguarded—namely in Spain, the United Kingdom, Belgium, Italy, France and Sweden—a large number of care home residents died from confirmed or probable COVID-19. The initial seeding through discharge of infected patients to care homes was compounded by lack of testing and protective equipment for staff and residents and, especially in privately run care homes, regular movement of (temporary) staff across facilities.’

In the Irish state 93 per cent of fatalities have had an underlying condition according to the Central Statistics Office, with a median age of 83.  The most common underlying condition of those who died was chronic heart disease but the relevant conditions also included kidney, liver and neurological disease as well as cancer and diabetes.  In the North people aged 75 and over accounted for 78 per cent of Covid-19 related deaths in the year up to the end of October.

Health experts in Ireland, both North and South, and defenders of the lockdown approach more generally, have claimed that the only way to prevent death in these groups is a blanket lockdown that restricts everyone and justified their recent and current restrictions on this basis.  But it hasn’t worked.

In yesterday’s Belfast paper, the ‘Irish News’, it was reported that there were outbreaks of the virus in 146 care homes; in September it was only 20. At the end of last week the newspaper reported that 44 per cent of deaths were accounted for by care home residents.

Yesterdays ‘Irish Times’ reported that a letter from the Irish State’s health regulator to the Department of Health asked why residents at some nursing homes where staff had tested positive had not themselves been tested. “Luckily, to date most centres are reporting that these residents are asymptomatic.  However, we cannot rely on the situation continuing.”  In the month of October, 39 of the 103 deaths were of residents of nursing homes, while some of these homes have made persistent complaints of inadequate support from the health service.

Defenders of universal lockdown argue that you can’t protect the vulnerable without generalised measures, but these measures mean that not only has there not been a focus on, and resources directed to, those most in need but that there can’t be.

Lockdown brings temporary reductions in cases, hospitalisation and deaths that increase when they are inevitably relaxed, which earlier in the year was modified by the warmer weather during the summer.  This has led some to advocate stricter lockdowns and a ‘zero-Covid’ strategy, which sometimes doesn’t actually involve zero cases but only reduction to lower numbers so that test and trace then addresses new cases.  Since the majority of cases are asymptomatic it is never explained how these could be identified, and most of them wouldn’t; which also explains why the common metric to determine the severity of restrictions –  the R number – is a guess.  Given the wide range of estimates of this number right from the start it should have been obvious that imprecise metrics were being employed to justify an imprecise strategy.  It isn’t actually known how many people have had it or what sort of immunity has already been created.

The cost of the lockdowns has been enormous and the financial cost, which will be paid by workers in the near future, has been eye-watering.  The social and health cost has been less easily defined but we know it will also be huge. The Irish Hospital Consultant’s Association has estimated that almost 150,000 fewer people have had cancer screening in the first six months of this year compared to last, a drop of around 60 percent. In the North operations have been cancelled and cancer treatments delayed.  The graphic at the top of this post indicates the possible fatal consequences of such delay and was tweeted by a hospital doctor in Belfast.  Children’s and young people’s education has been badly damaged, domestic abuse is expected to have dramatically increased and children’s safeguarding has been endangered by the closure of schools and restricted access by healthcare professionals.  Mental health is expected to have suffered, something that can only get worse over the winter.

Huge sums of money have been announced and dispersed that previously were denounced as the ravings of a lunatic Jeremy Corbyn and the left of the Labour Party.  The difference however is that while the latter put forward increased spending as investment to deliver more and better jobs, the Tories have spent money to pay people to do nothing, or to pay out to their incompetent and corrupt friends through competition-free contracts.

The Left has long been aware that the best way to get people to do as they are told is to scare them, so the threat of terrorism has been used to spread fear and act as cover for attacks on democratic rights.  These attacks are as nothing compared to the restrictions imposed by general lockdowns.  We are invited to look down on Sweden and its policy of largely voluntary measures to restrict virus circulation and to accept that we aren’t responsible and sensible enough to do likewise – we are both too stupid and too smart.  Too stupid to be trusted and too smart to try.  Alternatives have come to be seen by many as the preserve of the far-right and assorted anti-science nut-jobs who sometimes deny that there is any threat at all.

The Left would normally have been expected to oppose this transparent attempt to scare the population into restrictions on their civil liberties, but instead they have joined in the moral outrage at those who aren’t doing as they are told.  So young people having a rave become ‘granny killers’.  They would normally have been expected to take an approach based on a materialist analysis.  Instead, they have demanded that massive sectors of the economy shut up shop and their workers get paid for doing nothing, workers who are overwhelmingly young and not threatened by the virus.  Pieces of paper or numbers on a computer screen are supposed to be a substitute for the production of real goods and services.  Everything Marx taught about capitalism is dumped in favour of illusions in money and the state.

The alternative of an intervention through which jobs are kept, the economy can continue to function and targeted measures are taken to protect the vulnerable are labelled herd immunity as if these were some sort of swear words.  The language of much of the Left has become dominated by definitions that are uttered as if they were insults.  So, in Scotland, unionism and unionists are by definition reactionary.  But do these words denote reaction by definition?  Would the description ‘rebel’ have denoted a reactionary during the American or Spanish civil war and would socialists therefore have rejected the description ‘unionist’ or ‘loyalist’ in these struggles?

Of course, it may be said that it all depends on the context, which is precisely the point.  The words herd immunity, which denote a real phenomenon, has become a term to dismiss consideration of a different way forward.  Any and all speculation that acquired immunity is inadequate has been published without recognition that these objections apply equally to vaccination. 

So, it has been noted that covid-specific antibodies have declined rapidly in those infected, without recognition that the immune system will have reduced these naturally because they are no longer required but will have developed the capacity to generate them again if required.  The possibility of achieving some sort of herd immunity was dismissed but it has been reported in ‘The Economist’ that in Northern Italy the most badly hit places including Bergamo now enjoy some degree of immunity: ‘Serosurveys show that antibodies there are not only common, but especially so among the old and health-care workers, who need them most.’

Less reported than the possible existence of antibodies and their rapid decline has been the potential of T-cells to provide protection.  This is only partly because they are harder to measure and less studied; they haven’t fitted the narrative.  Except  now they do.

One research project directed at health care workers in England may have found that six months after infection all the patients studied, even those who had mild symptoms, still had detectable levels of T-cells directed against the virus, even if their anti-bodies had disappeared.  This, it is speculated, might be why reinfection cases seem so rare.  It has been found that for some people T-cell response lasted over a decade in patients with the original SARS-COV-1 outbreak from 2002-03.

It is through seeking this type of response that the much-heralded Pfizer and BioNTech vaccine is based, and was reported in ‘The Economist’ before it became a headline in the mass media.

News of a potential vaccine doesn’t make the debate over the correct response irrelevant.  There will be no mass vaccination until well into 2021, as even the Northern Ireland Health Minister has said, even if it goes through all the necessary testing and authorisation, which it hasn’t as yet.  The avoidable cost of lockdown, which governments don’t seem to know how to get out of, is a big added pressure to rush vaccine approval, with all the risks this might involve.

Governments have narrowed down their options and, allied with their favoured expert advice, have given every appearance of the proverbial person who only has a hammer treating every problem as a nail.  Months of potential wasteful lockdown lie ahead and the issue of targeting the vulnerable doesn’t become less important because there appears a means of protection through vaccination.  Maybe then, finally, those pretending that the virus kills ‘randomly’, or that everyone has to be subject to equal treatment, will acknowledge that it doesn’t and they shouldn’t.

 

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

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.

Covid-19 – try again, fail again, but some people would have made it worse

A couple of weeks ago the Irish Government announced a new plan to deal with Covid-19.  It consisted of five levels that were to signal the approach everyone should take to social distancing and the restrictions the Government would impose.  These guidelines and restrictions would follow from the perceived level of threat from the virus.

Immediately however Dublin fell into level two and a half and quickly moved to three and a bit, though the trajectory of the infection had hardly changed.  Far from the new plan setting out discrete levels of intervention and expected behaviour, the expected behaviours and interventions were not consistent with the plan, or the plan was not consistent with the interventions.  Either way the plan immediately became discredited.

But this is the least of the problems with it.

The major problem is the idea that the virus can be locked away in lockdown, then we can ease lockdown and the virus doesn’t return.  No one believes this.  Yet the consistent approach now would be to reintroduce lockdown.  But this isn’t going to happen.  Yet if it’s not going to happen, if it’s not justified now, what justified it in the first place?

One argument was to ‘flatten the curve’.  In other words, reduce the strain on the health system and prepare for an elongated engagement with the virus based on an expected ‘second wave’.  The problem with this is that the health services have less resources immediately available to it than before, with the ending of sequestration of private hospitals, and there has been no satisfactory expansion of the test and trace system over the summer.

We are promised a planned expansion of health services but these cannot be conjured up in weeks or months and there can be no assurance that what we will get is not a reduction in normal critical care to permit less critical, but now more politically important, Covid treatment. The alternative potential outcome is that Covid-19 is not as threatening this time, but this hardly accords with the Government message.

But this isn’t the only problem, because it is becoming clear that a hoax is being perpetrated and it isn’t the crazy one from the deranged far right – that Covid-19 doesn’t exist.  The last week has revealed that, according to Prof Philip Nolan of the National Public Health Emergency Team, public health doctors ‘don’t need to know” where someone got the disease. “We don’t have the time or resources to pursue this academic exercise” he said.  Which rather makes a mockery of the whole plan, based on isolating the virus.  As this blog has said repeatedly – it’s not the virus that is being isolated but the people.

So if knowing where infections spread is not important how do they then know where to limit activity, where to shut up and for how long?  Hundreds of thousands of jobs will be lost on the basis of an guesses and assumptions paraded as expert evidence-based public health practice.

This might be considered the most scandalous admission but it isn’t.  Instead, that award goes to the admission that, as infection rises among the older population, the Health Services Executive chief clinical officer states that it is not possible to keep nursing homes and other congregated older settings completely immune from a virus spreading through the rest of society.  Over half of those who have so far died did so in these settings but the Government can’t promise there won’t be some sort of repeat.

It is well known that younger people have relatively, and absolutely, little to worry from catching the virus unless they have a relevant underlying health problem, yet it appears that they have to be locked-down to protect those really at significant risk.  Everyone has to be controlled to control the risk to those really threatened.  But is it easier to protect everyone from a virus that is widespread or a minority of the vulnerable?  Well, how did the original more restrictive lockdown go?

The Government approach attempts to scare everyone, with some evidence of success, when this is not credible.  And this lack of credibility has infected the population, especially the young, who seem perfectly aware that they are not significantly at risk.  This discredits those public health messages that really are important and it detracts from mobilising the majority to realise the need for them to assist in the protection of the vulnerable.  For the latter, if everyone is threatened and so many are ignoring or resentful at the advice and restrictions being introduced, why should their responses be different?

More and more credible arguments against the current approach are being reported but the longer the mistaken strategy continues the more difficult it is for the Government to change tack, even as the end of the process seems further and further away.  If it did it might have to admit to an enormous series of mistakes we will have to pay for, and for a very long time.  In the meantime, continuation of the current approach leads to inconsistent and contradictory advice and measures that arise because the strategy is mistaken.

The bill for this has been paid for in direct deaths from the virus, from the absence of treatment for other critical conditions, from the effects of social dislocation and isolation and from the massive economic cost that will be paid for in health terms as well as in reduced living standards and life chances. Here, it will be predominantly the young who will be most affected.  The current approach is not one that should divide generations but one that should unite them.  The higher incidence of Covid in poorer areas with greater prevalence of the underlying conditions that entail heightened risk makes it a class issue as well.

All the more reason then to note that the current attitude of the left is a disaster.  Far from seeking to base itself on understanding what is going on, seeking an effective alternative and challenging the draconian restrictions on democratic rights.  Far from highlighting the enormous cost that will be imposed on working people, it has supported the Government, except it wants greater restriction and calling for more money from the Government as if it is going to pay the enormous bill.

Every day, the press and media declare that the Government will pay this wage subsidy or that pandemic unemployment benefit, provide this support to small and large business and that tax exemption.  The left appears either to assume that money will simply be printed so it is considered more or less costless, or no thought is given to it at all.  But of course, the Government will not pay out of its own pocket because the pocket of the Government is the pockets of working people.  The money spent will be borrowed and working people will pay back the debt.  How could this be a surprise – the left is always going on about how unfair the taxation system is but here it is proposing to unnecessarily make the potential burden so much greater.

Some on the left might entertain the idea that printing money will work, but money is a claim on the real resources of society, the resources created by the labour of the working class, and only this labour creates these resources. Once this is understood, as it is supposed to be by Marxists, it is abundantly clear that paying people money for closing the place that they work in, or the business that they own, will not create any additional resources but will create an enormous financial bill that will have to be repaid.

I had a discussion on Facebook with a contributor who argued that since capital created the mess it can pay for it and workers should make sure that it does.  I argued that if all these payments were for our own good we were on weak ground rejecting paying the cost, regardless of who was to blame.  Workers in Ireland have found it hard to fight against their tax burden in the past, with Ireland having a history of such resistance going back to the 1970s.  The burden imposed by the financial crisis wrought by the Celtic Tiger crash doesn’t bode well for further imposition and confidence in successful resistance.  It makes no sense to make this challenge so much greater if we can prevent it.

Were we really able to get capital to pay the enormous bill coming we would either have replaced it, or capitalism would no longer be the exploiter of the working class socialists have always claimed.

Richard Boyd Barrett TD for People Before Profit admits new public health restrictions planned for Dublin were “sadly necessary” given a rapidly rising infection rate but that they “reflect a failing and incoherent strategy.”

“The government’s failure to plan for and resource permanent capacity building in key areas such as test and trace, health and ICU capacity, school infrastructure and teacher numbers is now coming back to bite us all with a vengeance.”

Many of the issues raised in this statement are correct, but they do not amount to a strategy that will work and have all the defects just presented, because essentially it is built upon the same strategy as the Government’s.  It is but a supercharged version of Kier Starmer in Britain, who also supports the Tory Government’s strategy but simply wants it implemented competently.

From the social democrats of Labour to the ‘Marxists’ of People before Profit and others, the left has failed.  Failed on the two biggest issues facing Irish (and British) workers today – Covid-19 and Brexit.  Both have been a disaster for workers and both are now supported by major parts of the left, with the caveat that they support the most stringent version of both – greater restrictions on free movement and a more complete Brexit.

This is a left that is seriously lost; if its programme had actually been followed, including an Irish exit – Irexit – we really would be facing disaster.

The Covid-19 politics of Ireland and Britain

Just over a month ago my wife and I visited my daughter, her boyfriend, and my sister in Glasgow and had dinner in my sister’s house.  Two weeks later this would not have been possible, I would have been breaking the Covid regulations; in fact, my daughter and sister couldn’t have done it together even without us. They could, however, have met together in the pub, which of course doesn’t make much sense, as this Scottish blogger argued.

This week new restrictions were introduced in the North of Ireland, and even more stringent ones in Belfast and a number of other areas, making breaking of the regulations inevitable.  This has led to the targeting of students returning to University and partying in the Holyland area.  As some students have pointed out – we can’t party in numbers in our houses or on the street but we can all go to the Hatfield bar and ‘socially distance’.

When more restrictions were to be introduced by the Government in Dublin it was also stated that it would be looking at opening ‘wet’ pubs (that don’t serve food).  Later it suffered complete derision by asking publicans to keep receipts showing that punters had indeed ordered a panini costing at least €9 when they had bought their pint of Guinness.

This week it unveiled a new strategy that had five levels of restrictions, leaving Dublin to fall into level two and a half!  The Health Minister took sick on the day of the launch and had to isolate, causing the rest of Cabinet to briefly join him.  Since all these rules and regulations are based on assigning individual responsibility for avoiding the virus it wasn’t a good look.

In all these jurisdictions the number six has become a new guideline for people meeting up, the number to be made up – or not made up – of children and belonging to one, two or three households, sometimes differing between indoors and outdoors.  Overall however the differences seem less and less important.

The timing and severity of lockdown has proved no protection as infection rates increase in Dublin, Belfast and Glasgow while various parts of England are subject to greater restrictions every week.  In all places the threats of a second wave reveal the failure of the measures to deal with the first, and in all of them, despite its much-vaunted role, the test and trace systems are not operating as the should.  The readiness of the health services is unclear, but only in so far as the extent of new wave of infection is unclear, otherwise the inadequacies of each health service is perfectly clear.

Such inadequacies were the subject of a column in the Belfast paper ‘The Irish News’, in which was noted the absence of protest at the local NHS having almost closed down.  The lockdown has led to much reduced access and reduced capacity, on top of waiting lists much worse than those in Britain.  It has been justified in terms of keeping Covid out of hospitals and preparing for the second wave but deaths have now arisen in two hospitals – so it isn’t working.  In the South, the number of people screened for cancer was down 60 per cent in the first six months of 2020 compared to the previous year and the already unprecedented waiting lists have increased.

The so-called second wave was to be addressed by much improved test and tracing systems.  Unfortunately, the system in England is reported to be collapsing and the Irish one is nowhere near what was projected as necessary in April.  While still considering itself better than the British, the Irish are testing 1.8 per thousand people while the UK is doing 2.43, and has been achieving this only by using scarce heath care staff to do the testing, meaning they can’t do their day job.  In Scotland pressure on the system has meant results are taking up to ten days to come through with this reported to be threatening the regime for care workers in elderly persons’ homes.

In all countries extra funding for health services have been announced as if this will quickly address the neglect and austerity these services have suffered for years.  The additional funds are a reiteration, on a much greater scale, of repeated funding for new initiatives that are periodically announced but that rely on recruiting health professionals from other parts of the service, which create problems further back.  It’s as if you can deploy thousands of trained medical, nursing and other professional staff in a matter of weeks or months despite taking years to train them and years to put in place new facilities for them to work in.

The announcement of potential fines of £10,000 in England is many things, but an effective public health measure it is not.  It will discourage compliance with the rules and disaffection with the whole public health campaign.  The call for respect for the law, given the exclusion of Dominic Cummings from its requirements and the threat to break international law over the Brexit Withdrawal Agreement, is too obviously hypocritical to be acceptable.  The result will be intensification of blame on the general population for the Government’s failures.

Irish public health officials have warned of an increase in cases in the over-75s, the most vulnerable group and those who have suffered the greatest loss.  The argument advanced is that the whole population must suffer increasingly arbitrary and unenforceable rules to protect its most vulnerable section.  But all this achieves is failure to focus on targeted measures that might work in protecting the vulnerable, through steps to support their social distancing, ensure safe care home environments and safe hospital care when they need it.  It is impossible to square the idea of widespread social distancing to protect the vulnerable with the return of schools, colleges and the necessary return to some sort of normal working by many workers.

One noticeable aspect of the approach of all these administrations has been their failure to protect the old, through their being dumped out of hospital into homes without testing or even after testing positive. None of them has made a genuine attempt to investigate and report the lessons of their failure.  The traditional centralisation of power and secrecy in Britain has not been shattered by devolved administrations but reproduced.  The Scottish and Stormont regimes show exactly the same tendencies to secrecy, centralisation and lack of accountability.  They also show exactly the same instincts to authoritarian measures that substitute for an effective policy that goes beyond nationalist slogans.

Statistics are still paraded as proof of one jurisdiction being more successful than the other although this is fraught with difficulties and assumes that the statistics reflect the impact of respective Government measures: that it is the virus that is being controlled for either better or worse, rather than the virus determining mistaken responses to it, which is more obviously the case.

Lockdowns have been relaxed in each and the virus has flared up again, alongside dire warnings from Governments and their official advisors.  In circumstances where many are asymptomatic the possibility of testing and tracing systems identifying the source of every or most infections and then closing them down, even if efficiently carried out, is unlikely.  Not unless we face complete shutdown, which is not going to happen and which is now both too late and impossible to sustain in any case.

Comparisons drawn are always carefully chosen.  Sweden was the comparator not to be followed, except that at the beginning of September the Irish State recorded 30.6 cases per 100,000 while the Swedes reported only 23.4.

On 19 September the death rate for the four parts of the UK were reported below:

Area Deaths Rate per 100,000 population
England 37,076 65.9
Northern Ireland 575 30.4
Scotland 2,505 45.9
Wales 1,603 50.8

https://coronavirus.data.gov.uk/deaths

It is clear that England has performed worst and Northern Ireland best.  Scotland has done better than England, and my relatives confirmed reports that the SNP Government is getting credit for this.

Scottish nationalists claim that the dire performance of the Tory Government shows that Scottish independence is justified, and sometimes use comparisons to judge the Scottish performance poorly because of membership of the UK.  So, for example, this blog damns membership because Scotland did not match the performance of some Scandinavian countries. Of course, its comparison at that time excluded Sweden.

So not only do the nationalists get to pick their comparators but they get to pick whether being worse means that Scotland should separate from the UK and being better (especially than the English) also means they should separate.  If these statistics were the product of good Governance one must marvel at the so-far hidden wonders of the Stormont regime in Belfast that some believe works best when it doesn’t work at all, which it frequently doesn’t.

The Irish State in turn has been compared favourably to Northern Ireland, both of which recorded their first cases only two days apart.  Crude mortality rates calculated by two economists, one from the North and one from the South, showed a mortality rate at that point in time of 44.5 per 100,000 in the North but only 35.8 in the South.

They recognise however that the majority of deaths, in what they call the first phase of the pandemic, was of the over-65s, 93.5% between March and June in the South and 92.8% in the North.  They noted that a higher proportion of the population in the North is over 65 – 15.8% compared to 13.9% in the South. Adjusting for the age profile in each jurisdiction produces a mortality rate of 35.6 per 100,000 in the North (if it had the South’s population distribution – the rate in the South itself was 35.8), and the mortality rate in the South using the North’s population distribution would be 45 per 100,000 (the actual rate in the North was 44.5).  So in fact not much different at all.

The following graphs show first, the daily new cases, and the following two graphs the cumulative total cases and death rate per million for a number of different countries.

 
 
 

The first graph shows that there are increased numbers of cases in a number of countries giving rise to the concern about a resurgence.  The second graph however puts this into perspective, that growth in the cumulative number of cases is not at all as high as it was initially or in the first 50 to 100 days.

The third shows that the increase in the number of deaths has slowed even more than cases and the lines in the graph have flattened considerably.  The point is not comparison between countries but the common pattern of reduced growth of both cases and especially deaths over the whole period of the pandemic.  The first graph shows that this is the situation while cases have and may continue to increase in a range of countries.

The first of the following two graphs shows that across the world the number of new cases continues to grow but the second that the number of deaths is not following the same trajectory.  A strategy that assumes the opposite will be increasingly exposed and indefensible.

 
 

Despite claims that Covid-19 and state responses to it are not political issues, it is clear that in every country this is not the case.

Dominic Cummings and his Government are determining the strategy in England; the centralising SNP is doing so in Scotland, and the dysfunctional Executive is doing it in the North of Ireland.  The latest strategy out of Dublin makes explicit that the National Public Health Emergency Team has been downgraded and that decisions will be taken by politicians.  The punitive fines being introduced in England are eminently political and make for potentially violent confrontation.  That Keir Starmer supports them shows only that he will contribute to that coming confrontation.  Maybe he will be looking for his old job back.

There is widespread deflation, if not complete surprise, that the incompetent mess that we are passing through has not led to more precipitate decline in Tory support in opinion polls.  The ‘secret’ of course is the solid nationalist and reactionary support behind Brexit that clings to the Tories in order to deliver the promised new Jerusalem.  The more Johnson fails to deliver the more some will cling.

Considerable responsibility for this must be laid at the door of the Labour Party whose previous leader acted as if a good Brexit was possible, but whose new one has collapsed into more or less criticising that the Tory deal has not been implemented.  The idea that Brexit and its effects must be gotten out of the way, and Labour can then compete more effectively with the Tories afterwards, forgets that the effects of Brexit that have already been severe have only started.

At the moment the British press is full of articles that show that the real opposition to Boris Johnson comes not from the clever lawyer and stupid politician opposite but from those behind him.

This view that there is a good, or at least defensible Brexit, is held even by sections of the left who correctly opposed it in the referendum.  Against all the evidence of its toxic character socialists are asked to unite against the specifically Tory Brexit.  But far from the Tory Brexit being as far away as possible from the Brexit supported by the nationalist left’s Lexit, the Johnson version is exactly what they have demanded.  There is no reason for these people to unite against a Tory Brexit with those socialists who supported Remain and there is no reason for the latter to renounce total opposition to Brexit when its every step is a disaster.

The other opposition comes from the nationalists of the SNP, which have always employed English nationalism to strengthen their own and are now successfully hiding their own failures over Covid by pointing to the worse failures down south.  The difference is mainly presentational, with Sturgeon substituting seriousness for bombastic incoherence.  It is noticeable that the growth in support for separation appears not to be based on any confidence that things will be so much better but that it couldn’t be worse.

Scottish nationalism appeared in a ‘Yes’ campaign to offer some positive solution to Scottish workers’ problems even if the experience of the SNP Government provided no grounds for such a view.  The movement for it appeared more progressive than the objective itself, at least to those inside it.  Its renewed support is based on a hope and a prayer that somehow an ‘independent’ capitalist Scotland, by virtue of this alone, will solve problems.

The North of Ireland shows the complete bankruptcy of nationalism.  Just as England has an opposition that wants Government policy implemented (competently), and Scotland has a divided and discredited one, the regime in the North of Ireland can’t afford to have an opposition at all.  In Ireland the governing parties may have to accept that the current opposition is not really an opposition and will have at some point to be trusted.

Governing parties and States have gotten accustomed to exercising control and issuing dire warnings tempered only by the knowledge that a new lockdown is unaffordable and unenforceable without money.  Only the far-right has so far opposed the restrictions on civil liberties while pushing insane conspiracy theories and dangerous health edicts.

The justification for these restrictions reduces with every case that does not result in a death, while deaths of the vulnerable are their responsibility.  A danger is that the right leverages legitimate opposition to repression of civil rights into acceptance or tolerance of other reactionary parts of its programme.  Passivity and acceptance of the state’s increasingly unjustified repressive public health measures facilitates development of this possibility and does nothing to prepare workers for the disaster of a no-deal Brexit or, more likely, a Brexit sealed with a rotten deal.

The shared anti-Covid strategy of these Governments appears increasingly at odds with reality and is generating indifference and resentment.  Socialists need an alternative view of the pandemic rooted in observable fact, one that avoids any support for undemocratic measures or calls for more restrictive lockdown. We also need to renew opposition to Brexit and expose its effects while seeking to draw attention to the bursting of its illusions.  On their own, Covid-19 and Brexit would be a major threat, together the effect is multiplied.  But opposition requires some coherent view of what is happening.

Ireland’s Dominic Cummings moment

Well that didn’t take long.  No sooner had the new restrictions to deal with Covid-19 been introduced but they had been broken, and not just by anyone.

They have been broken by the members of the Oireachtas Golf Society at their dinner in a Co Galway hotel, the first time anyone had heard of it.  Apparently, it’s a collection of TDs, ex-TDs, Senators and ex-Senators, councillors, a former high-profile RTE journalist and the Chief Executive of the Banking and Payments Federation – where would a gathering of the political class be without a representative of the banking fraternity?

Four names stood out, first the Minister for Agriculture Dara Calleary. He who complained loudly, when he originally didn’t get the job, that “I had hoped to lead a department. That’s always been my ambition and I can tell you that it’s still my ambition and it will happen, it will absolutely happen.”  And it absolutely did, for just over five weeks, which was better than his predecessor who lasted less than four. New Fianna Fail may be as scandal-prone as the old one but they’re not as good at getting away with it.

It had taken Calleary one day from approving the new guidelines at the cabinet to breaking the new guidelines, in fact even breaking the old ones, forcing him to resign quickly, along with the leas-chataoirleach of the Senate, Jerry Buttimer.  This could hardly be avoided.  What many people want now is for the other two high-profile names to do the same.

This includes EU Commissioner Phil Hogan, whose approach has been to deny that he did anything wrong, shift the blame onto the organisers of the dinner and the hotel, and avoid an apology, until it seemed absolutely required in order to avoid anything more serious.

The most embarrassing is possibly that of Séamus Woulfe, the former Attorney General who held that post when the rules were being introduced, and is now a Supreme Court judge.  He reprised the same deflection as Hogan by attempting to shift the blame onto the organisers and hotel, but he also added “I ended up in a situation where breaches may have occurred.”  It’s funny how things like that can just sort of happen to you.  We can look forward to that plea of mitigation at the next trial to come before him.

There is no doubt that the rules were broken and a Garda investigation has begun.  The recent change to the regulations limited such gatherings to six people, but since over 80 were present the gathering broke even the previous limit of fifty.

Media reaction has indicated widespread anger from a general public that has generally stuck by the rules quite rigorously.  It exposed those making the rules to the charge that everyone is not all in this together and that there is one rule for the powerful and a different one for everyone else.  The credibility of the new Government has been seriously undermined as have its demands for social distancing.  Very much the same in other words as the actions of Dominic Cummings in Britain.

In fact, it is surprising how little this parallel has been drawn, as if the national self-satisfaction at having performed better than the British could not be allowed to give way to acceptance of being just as bad.

The opposition, including Sinn Fein, has condemned the Government for its hypocrisy and disorganisation, another parallel with the Brits, but given its own embarrassment over the breach of the rules at IRA leader Bobby Storey’s funeral they don’t make very convincing purveyors of unimpeachable conduct themselves.

Mary Lou McDonald has called for the recall of the Dáil as has People before Profit TD Bríd Smith.  This in itself is not wrong, it provides a forum to expose the Government’s hypocrisy, but this is only useful in so far as it has a further purpose, and one beyond seeking a bit of party advantage for electoral purposes.

Without an alternative it is mainly posturing and without anything additional it miseducates workers that only within the Oireachtas can these issues be pursued and settled.  It tells them that the voice of workers is within these walls and the Oireachtas must be left to deal with the Oireachtas Golf Society.

This unfortunately is where we are with the left in the Dáil.  If it has a policy of its own it is that the lockdown must be more restrictive, address questions such as the working conditions in meat processing plants and direct service provision centres that hold asylum seekers, and that we need better testing.  It’s a call to action – directed to the state.  And that’s the problem.

The arguments about the lack of action in meat processing plants and direct service provision centres, and the need for better testing, are all fair enough but the action they say workers themselves should take are follow-ups to the demands on the state and are so generalised as to be ritualistic incantations.  They are a dead letter.  We know this because there is no workers’ action.  The most prominent has been that of the Debenhams’ workers, which is itself at least partially a result of the lockdown the left wants more strictly enforced.

The original justification for electoral participation, that it would support and promote workers action, has disappeared only in the sense that it never appeared in the first place.  The cart has long been in front of the horse which explains, at least to some extent, why the working class movement hasn’t moved forward.

The proposals of the left include mandatory sick pay for all workers, full reinstatement of the €350 a week Pandemic Unemployment Payment, more teachers hired on permanent contracts and private hospitals to be taken under public control.  There is no inkling that you cannot pay workers to do nothing for very long and no warning that all this spending will have to be paid for.

This requirement isn’t a feature of neoliberalism but a fact that socialists acknowledge by putting forward an alternative.  The idea that public ownership, i.e. state ownership, of hospitals is the answer ignores the disastrous performance of the NHS in the UK and its failure to protect the old, who aren’t mentioned in some left analysis, and its responsibility for having exposed them to infection.  The NHS didn’t even properly protect its own staff.

Above all, and specifically, these measures would not “move us towards zero Covid” as claimed.  Not only could they not but it is utopian to believe that the virus can be suppressed and eliminated.  Any attempt to do so would see an endless lockdown until a vaccine was found and even then this might not see final eradication, no more than flu has been eliminated by vaccination.  The attempt to do so would incur costs that would inflict much more damage in economic and health terms than the strategy of the Irish State.

A couple of days ago I noted that the strategy of the state was unravelling and the latest drama is a further example.  It faces its sternest test with the return of schools, which itself calls for enormous levels of cognitive dissonance: support for mass transport and containment of children when a deadly virus requires such stringent controls in the home, at work and elsewhere.  You do not have to be very smart to realise it doesn’t add up.

In other words, the moral outrage of the left, upon which its politics is based, would lead to a worse outcome than that of the current Government.

So, while we all condemn the state elite that dines out on its hypocrisy, the left needs to educate workers to show social solidarity in order to protect the vulnerable, to protect themselves and to prepare for the bill that is mounting up from the lockdown.  Without such an approach the left simply becomes the liberal conscience of the state whispering good advice in its ear, for in reality this is all the grandest and loudest speeches in the Dáil currently amount to.

The Covid-19 strategy in Ireland starts to unravel

 

At the beginning of the week it was reported that the 14-day average of Covid-19 cases per 100,000 in the Irish State had risen to 22.1 compared to 18.6 for the UK and 16.3 for Germany.  The Acting Chief Medical Officer warned this was because people were socialising with each other “recklessly”, the disease was spreading “really widely” among younger people and was likely to spread to older people “unless we change what we are doing, and do something different.”

“We are seeing outbreaks among younger people, but once it gets into nursing homes we would see a much higher mortality.”  Meanwhile ‘senior Government sources’ complained about growing anxiety about “Covid fatigue” among the public.

As a result the Government announced a series of new measures this week, with immediate effect, and promised to provide a new plan for the management of the virus over the next six to nine months.

It was reported at the same time that the 14-day average of Covid-19 cases per 100,000 had increased to 26, up from four earlier in the year.  The Health Minister noted that “we are at tipping point.  Ireland’s rate of growth in new cases over the last two weeks is the fourth highest in Europe.  In the last two months we have gone from a low of 61 cases in one particular week to 533 cases last week.”

The Taoiseach announced that “if the current increase continues, it will be impossible to stop the spread of the virus to our most vulnerable and most compromised”, while The Irish Times reported that ‘there are significant concerns that a big increase in cases is on the way in the coming days.’  All this when it has also been reported that the test and trace system has been slowing down.

To put this in context it should be recognised that the number of deaths has been low:

Date Number of Deaths
19-Aug 2
18-Aug 1
17-Aug 0
16-Aug 0
15-Aug 0
14-Aug 0
13-Aug 0
12-Aug 1
11-Aug 1
10-Aug 0
09-Aug 0
08-Aug 1
07-Aug 4
06-Aug 5
05-Aug 0
04-Aug 0
03-Aug 0
02-Aug 0
01-Aug 0

One commentator in The Irish Times however stated that “the public gets increasingly restive – some resentful of those flouting the lockdown; others fed up of it and wondering why Ireland’s lockdown is one of the most stringent in Europe despite relative success in containing the virus over the summer.”

In truth, the Irish State is in danger of repeating the same mistakes as before, despite its self-congratulation at being better than the British, which is currently no longer the case according to its own quoted metric.

It hadn’t occurred to this newspaper commentator that it was the virus that had contained the population, and it was this that was one of the most stringent in Europe; or that this is why opening up has inevitably resulted, as it has all over the world, in the renewed spread of the virus.

It has happened now, before winter, when it was stated that we faced a potential second wave when the weather turned for the worse.  Yet despite this earlier warning we are now informed that the Government is working on a new strategy when surely the existing one for the second wave is already waiting to be taken off the shelf?

The inevitable spread explains what many see as the anomaly between previous success and the forecast increased transmission, and highlights the many contradictions in the Government’s policy pointed out immediately after the introduction of the new measures.

What strikes one first in looking at them is their meagreness, the main impact of which seems to be to delay the easing that was planned.  The new measures include:

  • All visits to home limited to six people from outside the home and from no more than three households, with outdoor gatherings limited to fifteen people
  • The closing time for restaurants, cafes and pubs (serving food) to be extended by half an hour
  • Sports events to be held behind closed doors
  • Public transport to be avoided and in private transport mask wearing is advised where there are mixed households and
  • The over-70s are asked to exercise individual judgment in their social interaction (which it must really be assumed they have been doing already)

It has been pointed out that while the over-70s are advised to stay at home Masses and other religious services are to continue as before.  While still told that they are allowed to holiday in the State by the Taoiseach, the Acting Chief Medical Officer warns that “at the moment we wouldn’t be recommending that someone would go to a hotel.”

Weddings are still allowed attendance by 50 people, despite public health advice that it be limited to six, while gatherings at home are limited to six.  Even a ‘Government source’ described this as “incoherent.”

The move to close sporting events has been described by a professor of experimental immunology from TCD as “bizarre” given that (some) pubs are open, so that you can watch games on TV in the pub but not outside from the sidelines, adding that public transport was not an area of great transmission. While accepting that there must be some rise in cases he hoped that the new measures represented a more “finessed and tailored” approach than the previous lockdown, which might be like the proverbial lipstick on a pig.  It has been noted that there are no specific measures for meat plants, which have been significant sites of transmission.

The public health advice is clearly stronger than the measures introduced and is warning that a full lockdown may have to be reintroduced, something already rejected in private by the Government.  It is clear that a full lockdown will not work, as has already been proved, and will cause much more significant long term problems than it solves as I have argued in a number of previous posts on the virus.

Unfortunately, while the politicians reject a complete lockdown they also warn that development of the current situation threatens those most at risk – the old and vulnerable – yet there is no focus or strategy on this group, except advice that your actions are at your own risk.  Having tried a complete lockdown the Government has failed put together a more limited strategy to protect those most at risk, calling into question, for anyone who cares to think about it, the previous lockdown and all its costs.  The more it tailors and finesses the less sense it appears to make.

While many people are angry at the measures in place either because they are fed up with them and don’t see the risk to them or the death toll as justification, others are blaming this group for the growth of infections.  Like the strategy of the Tory Government in Britain, including Scotland and also the North of Ireland, the Government’s responsible for the failure to protect those known to be at risk are setting themselves up to blame those they rule.  If people are angry now they should be made aware that the bill is in the post and will not be limited to billions of Euros, but will include the effects of ill health brought on by economic deprivation.

As an alternative it is possible to demand a coherent strategy that focuses on protecting the vulnerable and that avoids the inconsistencies of the existing strategy, which claims justification from public health advice that it cannot and will not implement.

Similar comments could be made in relation to the measures introduced in the North and the promise of more stricter measures that have just been flagged.

Confusion now does not bode well for the future need for a well-grounded resistance to the austerity that is coming, or the blame that will inevitably be seeking a target.  In this respect we should remember the claim after the financial crash that ‘we all got carried away’ as the explanation for the failure of the Celtic Tiger.  Given the buy-in by so many to the Government’s approach blaming it will not be as simple as blaming the bankers, not that that did any good anyway.

The end of Lockdown and mass murder

Boris Johnsons has more or less announced the end of lockdown in his own incoherent way, while some on the left in Britain are claiming the advent of (further?) “mass murder.”

” Workers who do not feel safe returning to their job should continue to be paid by the furlough scheme.”

It must be said that thousands of people, especially the old, have died unnecessarily.  Their deaths could have been prevented by prompt and appropriate Government and State action.  Their deaths are to be laid at the door of both.

The article points out the undoubted incompetence, mendacity and utter shambles of the response to Covid-19, but on the face of it it makes little sense.  Workers are not afraid of mass murder, at least not the ones I work with or those I meet.  They fear, to a greater or lesser extent, catching Covid and being exposed to the risks involved.  Those risks for the majority of the population are small and most people know it.

Those who are vulnerable have a greater fear, of their being lumped in with the greater population on the way out of lockdown in the same way as they were in the way in: that is without proper appreciation of their vulnerability and the necessary measures to protect them.

By exaggerating the threat to the general population the threat to them was underestimated because it failed to adequately distinguish between them.  This lack of differentiation removed the focus on those most at risk, and then the price that they paid, by a Government that couldn’t protect them, so pretended it was going to protect everyone – by declaring instead that it was going to protect the NHS.

A policy of blanket opposition to a return to work does nothing to help.

First, everyone will have to go back to work before any possible second wave because the Government and employers will compel them and because the effects of continuing to pay people for not working will be worse.  The demand for furlough payments might seem revolutionary because it challenges the profitability of the capitalist system but if there is no real possibility of overthrowing capitalism in the next few months (pretty much a given for me) then simply proposing bankrupting the state and multiple businesses is not socialism but a form of nihilism.

Second, most workers are working and drawing a line in the sand over those not doing so, or like me working from home, is really to have missed the fact that the majority of workers have been working away throughout, and we would be facing many more deaths had they not done so.

In my own work, the local union committee is discussing with management how the staff are coping with working from home, and we have successfully argued that consultation on returning to work can wait until this is completed.  This is a reflection of the concerns of staff.  But as I have just said, this is unsustainable and the local union committee is clear that the issue will quickly turn to what terms we return on.  For a socialist the question is – how do we impose some control over that return?  No one, and certainly not me, will be declaring the potential advent of mass murder.

The virus has not inflicted the casualties many predicted.  It is clear most people have relatively little to be concerned about.  The point now is to protect the most vulnerable in a way that was not done before when the lockdown was first implemented.  Saying everyone is facing massive danger doesn’t help this task but detracts from it.  If the danger facing everyone is at this level why have the vulnerable suffered so much more?

Over half the deaths in the North and South of Ireland have been in care homes for older people and the failure to protect them has been repeated in many countries.  In the North of Ireland (and also in relation to services in the South) and in Britain, the NHS stopped doing its day job and became a National Covid Service.  Countless people will die because of this.  Countless, in the sense of very many and countless in the sense that many will not be identified as having died from lack of health services that they might otherwise have received. And this isn’t an issue belonging to the past.

The disastrous performance of health services resulted from their working to a political agenda determined by the Governments in power, whether it be the Tories in Britain, the unelected Fine Gael in the Irish State or the coalition of reactionaries in the North of Ireland.  For them the issue was one of political performance and credibility.  The Tories highjacked the NHS brand, so easily done since they are in charge of it; the Irish administrations did the same with perhaps less outrageous brass neck, and they all did what politicians do and fight a political campaign as well as a public health one.

The Tories showed their utter incompetence while Varadkar’s Fine Gael gained popularity with a combination of nationalism, fear, an overwrought initial threat of the virus that didn’t materialise, subsidies to workers and business; the fact lockdown hasn’t lasted too long, and of course the fact that the Irish State sits between its two greatest cultural and economic influences – Britain and the US – who are widely regarded as having f****d it up.

Now they face two issues.  The backlog of healthcare cases, which in both Irish States is horrendous, as it also is in Britain, and how to approach a second wave. Oh . . .  and how the bill for the lockdown is going to be paid and who is going to pay it.

If what I have heard about Belfast is correct and applies more widely, the health systems are still going to be focused on Covid and how they are going to address the second wave.  The excuses trotted out everywhere for the failure to protect the most vulnerable do not inspire confidence that they will receive the protection and support they need the next time, if there is one.

Promises that cancelled and postponed services will be renewed are not completely reassuring when this is caveated with ‘explanations’ that re-creating these services will not be as quick as shutting them down, and that some services will return at much reduced capacity.

At the start of the lockdown it was argued that what was going on was not social distancing but physical distancing, and that this was a more accurate description.  But that has not really proved to be the case.  One metre or two depends on the expert medical advice you listen to.  The fear and confusion involved with Covid-19 has led to a situation of social distancing in which the State and mass media has imposed a climate of fear that has justified the most draconian restriction of civil and democratic rights, and without the protest it has deserved.

Dependence on the state and its propaganda that (some) socialists have lamented and opposed has grown enormously.  To oppose it has been seen as the preserve of the deranged right, who unfurled the banner of freedom only as outriders for that part of the capitalist class that most exploited it workforce or who otherwise wanted out of the lockdown as quickly as possible.  The left’s penchant for highlighting opposition to the far right kicked in with warnings that this would assist the secret project of less extreme Government leaders getting ready for implementing the same policy.

Only the protests against the state murder of George Floyd in the US, encapsulated in the Black Lives Matter protests, has shattered the instruction that the people must do as they are told.  Social distancing was more or less ignored.  Social isolation, whether in terms of ‘stay at home’ or unemployment, is no basis on which to create a working class movement, a task not suspended by the virus.

The left, or much of it, has saddled itself with a policy of maintaining a lockdown that largely doesn’t exist for many; will not exist for much longer; is unsupportable; that incurs costs workers will face paying or an almighty fight to oppose, and misses the main issue, which is not to extend lockdown but to try to help workers take some form of control over how it is ended, while accepting that it will and it must.

There is of course the alternative to what I have just said; that what I am advocating is a continuation of mass murder and that this is what we are about to face.

‘Protecting’ the NHS

I watched the BBC Panorama programme on the NHS and the Government failure to prepare properly for the Covid-19 pandemic, despite warnings.  It focused on its failure to stock and resupply adequate amounts of appropriate Personal Protection Equipment, and to spin the amount of PPE newly received by, for example, counting a pair of gloves as two items and including cleaning disposables as equipment.

The Tories cannot legitimately complain if they have made the NHS the centre of controversy because it is they who put it to the fore – ‘Protect the NHS’ is the slogan, with ‘success’ of its whole effort defined as the NHS not being overwhelmed by casualties of the virus.  It is important we don’t buy into this.

We are implored to ‘Protect the NHS’ when it is the function of the NHS to be the last line of defence for us.  Instead it has become the last place anyone wants to go.  Having scared everyone by the lockdown, vast numbers of existing and prospective patients have either been told not to attend, had their treatment cancelled or postponed, or have been unable to get diagnoses and tests they badly need.  The NHS isn’t dealing with them – it has been estimated that 18,000 extra deaths from cancer might result, currently around half of those recorded as dying from Coronavirus.

Not only has the NHS moved from defending us to us being exhorted to defend it, but the NHS is actually a threat, including to its own staff, over a hundred of whom have been estimated to have died from the virus.  While appointments and operations are cancelled, and Emergency Department attendances have collapsed, we are invited to acclaim the empty Nightingdale hospitals and empty beds as a success!  We are expected to recognise as successful an NHS that has become the site of infection and the one certain place to avoid unless you have absolutely no choice.

We are to applaud a service that has stopped being a National Health Service and become a National Covid Service following a transparently political agenda.  As I have written before, we are invited to ‘Protect the NHS’ when truthfully what we are invited to protect is the Government that has so denuded the NHS of resources for so long, and made such a mess of the current outbreak, that it simply cannot cope with doing its day job and deal with the virus at the same time.

By making sure that the NHS is able cope we ensure that the cuts and their effects are hidden despite the crisis; but rather than seeing this as a grotesque choice we have been forced to accept we have been invited to greet it as ‘success’, as Johnson so glibly and cynically put it.

And we do this because the NHS is one indivisible saintly entity without a bureaucracy that heads it, or an amoral Government that directs it, that unproblematically reflects the innate compassion of humanity – despite the evidence that doctors, nurses and purchasing managers have all complained that this organisation is failing its own staff never mind those it is there to serve.

The NHS, created to put an end to dependence on charitable provision, has become the biggest charity case in the country.  No doubt many people want to help, but the greatest help is not the individual resources many have had to fall back on but development of critical political consciousness.

We are supposed not to pay attention to the censorship of NHS staff who complain about their lack of protection but invited to applaud every week the protection these people are supposed to give us.  We are simply to accept that cancer patients will not get their treatment because on balance they would then have their immune system too compromised if they became infected, which is only the proper choice if we already accept that they cannot be protected.

We are to ignore that the NHS has taken PPE from elderly care homes while moving infected patients from hospitals into them: ‘Protect the NHS’ does not apparently mean Protecting Social Care.  Their clients’ deaths weren’t even counted in the headline daily total until very recently.

It becomes ‘pragmatic’ to downgrade the level of PPE required by NHS and care staff because the real scientific advice, unencumbered by Tory political pressure, would demand a level of PPE that the NHS cannot provide.   So the ‘objective’ scientific advisors objectively become conspirators in covering up Tory austerity, neglect and incompetence.

This is a surreal world of spin and lies and suppression of facts, fairness and free expression that has worked because of fear and ignorance and lack of accountability, and because we really do rely on the NHS.

The Government has not been held to account by the Labour ‘opposition’, has only begun to face some media criticism recently, and has benefited from the social isolation of social distancing.  This distancing includes distancing from reality, substituted by what Marxists call reification and alienation that amplifies the worst media influences and instincts to defer to authority.  This authority would have us rally round flags standing either side of Government spokesmen who substitute for the primacy of the people clichéd totems of Britishness and itself.  Real solidarity is replaced by calls to the police by snitches reporting neighbours who don’t get out to clap the NHS and its workers.

So, in Belfast we were told that 15,000 people would die but now only 1,500.  We have appointments and procedures cancelled and postponed and over 70 Covid-19 beds created, that last week saw only around half occupied, while a further 200 plus have been set up.  A hotel has been taken over but only one floor is so far used.  Never mind, this may be ready for the next surge in September – October, which will perhaps translate as another Johnsonian ‘success’.  Ring for a service and you can be told that resources are being devoted to the treatment of Covid-19.  Appear in the City Hospital and find yourself inside a ‘clean’ area that unfortunately has just had red signing put up to indicate Covid-19 areas as the green signs disappear.  In some locations work is hectic while in others activity has hardly been lower and there are only the rituals of infection control.  Similar stories could be told across the NHS but it is all socially and politically invisible.

The NHS is a bureaucracy as well as a service, but it has become a saintly institution which it is blasphemous to criticise, and one that the Government has wrapped round itself to shield itself.  In the Orwellian world of 2020 those who have spent ten years weakening it are holding up the banner of its defence against those whom it should serve and have suffered from the years of austerity inflicted on it.  Just as NHS staff have been blamed for PPE shortages so patients are held responsible for its inadequacy.

It is therefore not ‘Our’ NHS.  It doesn’t even belong to those who work in it.  Working people should be asking themselves how all this is the case and what it is we really should be defending.  Socialists should ask themselves just what a genuinely socialist service would look like.  The NHS hasn’t been hijacked, it’s simply following orders