Category Archives: Covid-19

Arguments over fighting Covid

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

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

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

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

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

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.

The Covid-19 politics of Ireland and Britain

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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:

AreaDeathsRate per 100,000 population
England37,07665.9
Northern Ireland57530.4
Scotland2,50545.9
Wales1,60350.8

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.

‘Protecting’ the NHS

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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

The Irish and British responses to Coronavirus – different or just equally bad?

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The British Government’s approach to the Coronavirus has been the subject of much, almost smug, criticism on this side of the Irish Sea.  In the North nationalists, and not only they, have called for an all-island approach and rejection of the British strategy of ‘herd immunity’.  Every British failure has been criticised and the response of the Irish Government lauded.

This was boosted enormously by the speech of acting Taoiseach Leo Varadkar, standing between the Tricolour and flag of the European Union, in bright contrast to the performance of Boris Johnson, sandwiched between two union flags.  The serious and statesmanlike approach of Varadkar was taken as so much more apposite than the unpredictable and sometimes incoherent ramblings of the Tory leader.  The two countries were adopting very different approaches and there was no doubt which was the better, even if Varadkar did a Churchill by saying ‘never will so many ask so much of so few’.

However, when all is said and done there is more than a little bollocks to such a view.   There are certainly more similarities than differences, starting with the flag waving as the cover for a host of failures.

Ostensibly, the Irish approach is to avoid exposure of the population and to reprise the South Korean model of testing, contact tracing and then appropriate isolation.  It has also taken more extreme measures to lockdown the population, for example by limiting outside exercise to within 2 kilometres of the home, and appearing to close down its economic activity even more drastically than the British.

The perception that this is a more responsible and sensible approach is one reason it has received popular support, although the same forces of compliance and deference apply in Ireland as much as in Britain.  Rallying round together in face of the enemy is a natural response even if it is conflated with rallying round a political leadership that has done nothing to deserve it.  And that is the most obvious similarity between the two countries.

But not only that.  The NHS has been subject to at least a decade of underfunding and misleadership that has led it to be woefully unprepared for any crisis, never mind this one. The current Fine Gael administration is the most openly right-wing and pro-free market of all the parties, which caused it to be decisively rejected at the last general election, not least because even in an economic boom the Irish health services are seen as a mess.

In February it was reported that 677,344 cases were on the waiting list with over 12,000 left on trolleys in January, the second worst month on record.  2019 was the worst year ever for hospital overcrowding as 118,367 patients were left without beds during the year.  This level of overcrowding showed that the Irish health system had insufficient capacity before the crisis and is utterly unprepared to deal with much greater demands now.  The ‘Irish Times’ reported on the front page of its 9 April edition that ‘emergency care doctors have expressed concern that the peak of the most critically ill coronavirus patients has yet to hit hospitals as existing intensive care units approach full capacity.’

As for the expected surge, the chief executive of Nursing Home Ireland has said that ‘nursing homes are effectively dealing with the surge that the hospitals were expecting.’  This has led to ‘clusters’ of the virus appearing in 137 nursing homes and other residential facilities, up from 4 on 21 March.  It is primarily the old who are dying, with the last reported median age of fatalities being 81.  The Irish State is proving no more capable of protecting its older citizens than the British.

The Irish health system is so bad the NHS is held up as an examplar, mainly because of the gross inequality in Ireland arising from health insurance that gives you greater access than public patients.

While, just like Britain, the policy is to protect the service, both states are near the bottom of hospital beds and ICU beds per capita.  The Government has hatched a deal to use private hospitals for public patients but this has led to protests from consultants that their private patients will not receive necessary treatment.

In both jurisdictions the Government has promised levels of testing that they have completely failed to deliver, which is possibly even more egregious in the case of Ireland given its so-called strategy. Johnson and his Government have gone from promising 250,000 tests a day, to promises of 100,000 by the end of the month (made at the start of it), while on 8 April Public Health England was reporting a testing capacity of 14,000.

In Ireland the Minister of Health promised 15,000 tests per day on March 19, while two weeks later the total was 1,500.  Almost a week after that, Dr Jack Lambert from the Mater Hospital in Dublin was asking ‘how can you talk about flattening the curve where you’re testing such small numbers of people and people are queuing up to get testing?’

In nursing homes some tests have taken 10 days or more for results to come through.  There are also reports of delays in tracing people having contact with those testing positive, making a total nonsense of the supposed strategy. Never mind, the Irish Minister of Health has promised action by the end of the month as well.

Shortages of Personal Protection Equipment exist in Ireland just as they exist in Britain, exposing health and care workers to the virus and onward transmission to the patients, clients and residents they care for.  Again, the chief executive of Nursing Home Ireland has said that nursing homes are suffering severe shortages, with just 51 receiving enough, and then only for three days normal usage, while 63 others are still waiting for a delivery.  Promises made by the Minister of Health to the sector have not been delivered.  Not that hospitals have all they need, St Vincent’s in Dublin has warned that it is facing ‘considerable difficulty’ in sourcing masks, and that the ‘ongoing availability of masks cannot be guaranteed’.

In Britain there are numerous reports of threats to NHS staff who go to the media to explain the consequences of Government failure.  Weekly clapping on behalf of NHS workers is evidence of widespread support for the service, but the silencing of NHS workers demonstrates that the NHS is not ‘our’ NHS; it is owned, run and controlled by the same state that has so abysmally failed to protect its own workers.  Were the NHS really an example of socialism we would not have its workers afraid to speak out – they would own, run, and control it and be able to speak openly.

In their place we have daily press conferences, where questions routinely don’t get answered, including by the experts, while data is misleading – the figures of those infected are next to worthless and the total number dying isn’t even accurate.  But at least in Britain they have daily press conferences where questions are asked, and there is a pretence at answering; the Irish Government has distinguished itself by its even greater secrecy, opposition to accountability or examination of its policies.  Instead, as everywhere else, moral commands induce moral outrage as a substitute for critical engagement.

Even that voice of the restrained and sober middle class, ‘The Irish Times’, has editorialised on the difficulty of obtaining information, e.g. on waiting times for test samples, on the backlog of tests, the state’s stock of protective equipment, the real-time state of ICUs, and how the virus is interacting with other conditions.  It has noted the ‘discomfort with scrutiny’ and Ministers’ requests that questions be sent in advance.

This follows the Executive’s attempt to shut down debate in the Dail, which was rejected.  This, from a Government without a mandate, that has shut down large parts of the economy sending unemployment rocketing; instituted strict limits on free movement, and introduced draconian measures that give the Garda the power to arrest you for refusing to obey instructions or to give your name and address.

We are informed that the decisive intervention that ensured the Garda got such powers was the Garda itself, through the Commissioner Drew Harris, ex of the Royal Ulster Constabulary and Police Service of Northern Ireland, recalling for me that the date of birth question was always the one that refusal to answer might lead you to being lifted by the RUC.

We can see that the Irish State has done nothing to warrant either the praise or trust it has received.  Yet it cannot hide forever from the inadequacies of the health system for which it is responsible. It will also not be able to make good its promise that the cost of shutting down the economy and temporarily supporting incomes  will not lead to austerity further down the line.  This is simply a lie.

At the same time as coronavirus has consumed attention, the politicians and media have been obsessing over the formation of a new Government, with the prospect of a coalition between the two reactionary civil war parties, ruled out so categorically, now looking more likely.  The complaint of both is that no other Party wants to join them, such is the distrust.  Except for Sinn Fein, which says a lot about all three.

However, rather than the problem being lack of a Government, the problem is lack of an opposition.  The trade union movement is disarmed because of state subsidies for those affected by unemployment although this is unsustainable and will not be sustained.  The left is in thrall to massive state intervention, which it talks and acts as if is some sort of socialism, when it is not.  The authoritarian measures are opposed but not vehemently because these have not yet become unpopular.  Not for the first time the potential to present an alternative is lost, because no alternative is presented.

Coronavirus – ‘we simply don’t know’

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In my previous post I said that the initial disorientation caused by the eruption of SARs-CoV-2 was ‘evaporating’, but I got that wrong. I had hoped that what was happening was a recovery from an initial shock so that some rational inquiry would emerge among the general population.  This hasn’t happened, at least not as far as I can see.

In part this is due to the mass media, which has a story and are going to run with it; I’m reminded of that great film starring Kirk Douglas – ‘Ace in the Hole‘.  It also reflects the disintegration of the socialist and labour movement that there are no scientific organisations, milieu or debate that could focus and inform debate on what approach is in the interests of the mass of working people.  Instead we have dependence on the state which breeds deference and subservience instead of critical thought.  The illusions that arise are all the greater for their being based on real dependence.  I’d hoped that the healthy dislike and skepticism of Boris Johnson among many would lead people to be more critical, although there is still plenty of time for this.

I have stayed away from BBC News and current affairs, with the exception of the web site, for years and especially after seeing some of the coverage of Jeremy Corbyn, but I tuned in this past week to watch the Prime Minister broadcast announcing increased restrictions and the half hour ‘analysis’ afterwards.  If this is reflective of the rest of the coverage then I have missed nothing.  BBC journalists often complain about the ‘Westminster bubble’ but it is they who are the prime culprits in inflating it; when they are not talking about political personalities they are essentially talking about themselves.  I also watched one of the daily press conferences, and this was much more revealing.

None of the questions asked were answered and the two experts demonstrated that they were more skilful in not answering the question than Johnson.  What answers were given provided plenty of grounds for skepticism.  We were informed that ‘the science is coming from a low base’ and when asked whether it was true that perhaps half the population had the virus, as suggested by a study from Oxford University, the answer was ‘we simply don’t know.’

The Chief Medical Officer stated that it was ‘going to be a close run thing’ whether the health service could cope while another advisor Prof. Neil Ferguson expressed confidence that NHS capacity won’t be breached.  Johnson has got by by with promises that testing, protection equipment, and ventilators etc.will all be coming soon while also claiming that everything is going to plan.  The machinery of Government has ignored offers of ventilators while giving contracts to Brexit-supporting friends who don’t make them, just like it earlier gave shipping contracts to companies without ships.

It absents itself from cooperating with the EU, giving us all a taste of things to come, while lying about why it did it, the taste of things just past.  The only thing more personally aggravating is the silence from the British Labour Party, which is only interrupted by craven agreement with Tory policy and calls for ‘more’; which reminds me of another film – ‘Oliver Twist’.

At the end of February, the Government’s Rasputin – Dominic Cummings – is reported  to have outlined the government’s strategy as “herd immunity, protect the economy, and if that means some pensioners die, too bad.”  It is supposed to have resulted in that strategy being revised on foot of a report from Imperial College London.  This report considers that there are two possible strategies: mitigation and suppression, outlining evidence that the Government strategy was mistaken and that ‘suppression’ of the virus was the only way to avoid a ‘likely result’ of ‘hundreds of thousands of deaths’.

It describes as its main conclusion “that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over.”  The Government strategy therefore appears compromised because the health service can’t cope.  This is why the ‘strong and stable’ mantra of the latest Tory Prime Minister includes the dictum ‘protect the NHS’, which actually means protect the political fortunes of the Tory Government that fought the demands of junior doctors, cut nurses pay and inflicted a decade of unprecedented austerity on the NHS.

The difference between the two approaches is to move the R number, the average number of secondary cases which each antecedent case generates, to below 1, thus reducing the number affected over time.  It argues that only a strategy of suppression can do this.  The study recognises that the main challenge to this is that it has to be maintained indefinitely, until a vaccine becomes available; but it also suggests that there should be periodic relaxations of restrictions when infection numbers reduce and their reimposition when they increase again.

It may be doubted if such fine tuning is possible given lack of data on the extent of infection, the potentially misleading character of the data available as a true indicator of infection rates, and the risk that people will not find it easy or reasonable to open and shut down their lives at instruction from the Government.  The study itself notes that:

‘Once interventions are relaxed . . .  infections begin to rise, resulting in a predicted peak epidemic later in the year. The more successful a strategy is at temporary suppression, the larger the later epidemic is predicted to be in the absence of vaccination, due to lesser build-up of herd immunity.’

 

So what the report doesn’t do, as we can see, is condemn in principle the idea of ‘herd immunity’; in fact it notes that such an approach has been taken before,’by the world more generally in the 1957, 1968 and 2009 influenza pandemics’.

The report also doesn’t factor into its ‘suppression’ strategy the ‘enormous social and economic costs which may themselves have significant impact on health and well-being in the short and longer-term.’  It does assume that on recovery from infection individuals are immune to re-infection in the short term.

The significant assumption on which the study rests is an infection fatality rate (IFR) of 0.9%, based on an estimate of the experience in China. (It should be noted that the paper referenced in the Imperial College study states that ‘we obtain an overall IFR estimate for China of 0.66% (0.39%-1.33%), again with an increasing profile with age.’  That is, the application of the estimate of the IFR for the GB population derived from the estimate for China results in a figure over a third higher.)

The study then estimates the impact of the virus in age cohorts based on this figure and taking account of its increasing severity with age (for much more analysis of the full table see Boffy’s blog here):

Age group (years) Infection Fatality Ratio %
0 to 9           0.002
10 to 19           0.006
20 to 29.           0.03
30 to 39           0.08
40 to 49           0.15
50 to 59           0.6
60 to 69           2.2
70 to 79           5.1
80+           9.3

What this shows is that it is only for those aged 60 and above that the virus contains a significant risk.  As noted, the figures above rest on estimates for China and there has been criticism that decisions are being taken without reliable data. Others have pointed out that many cases of the virus have not been detected, because carriers have been asymptomatic or their symptoms were too mild to report:

‘Research published last week by Jeffrey Shaman of Columbia University in New York and his colleagues analysed the course of the epidemic in 375 Chinese cities between 10 January, when the epidemic took off, and 23 January, when containment measures such as travel restrictions were imposed.  The study concluded that 86 per cent of cases were “undocumented” – that is, asymptomatic or had only very mild symptoms (Science, doi.org/ggn6c2).’

The Imperial College report quotes unidentified cases as 40 to 50 per cent of infections, based on the experience of China and those returning on repatriation flights.

This would mean that the Infection Fatality Rate in the table above would be too high since deaths recorded would be a smaller proportion of those infected, many of whom were ‘undocumented’. This does not nullify the seriousness of the threat to those in older age groups, or to those with a suppressed immune system, or who rely on the immune system for effective treatment, such as targeted cancer drugs.  It means that this is where the real problem lies.

It is also recognised that all deaths of patients with the virus have not died because of it, just as it is well known that all men with prostate cancer will not die of it.  The Government advisor mentioned above noted that one half to two thirds of those dying might have died anyway.

So it is not just that the health service was, and still is, unprepared for a pandemic, which the Government knew, but that the various arrangements that are required to protect the most vulnerable are still not in place.  Lots of initiatives have come from outside Government, which can barely coordinate its own actions, and many of the grand schemes announced by it are like its promises on testing and equipment, they remain promises.  The second category of people who may suffer is therefore health service staff themselves if, as seems possible, they become exposed too much to the virus without adequate protection.

It is therefore clear that the strategy of suppression may go the way of the previous strategy of mitigation.  The Imperial College report states that its preferred strategy involving social distancing, home quarantine, case isolation at home and closure of schools should be in place for five months, not the 12 weeks spouted by Johnson.  It envisages maintenance of such policies for perhaps 18 months until a vaccine is discovered.  This raises the question whether the shift of NHS resources to treatment of the virus for such a long time would have implications for the treatment of other patients.

The report also states that ‘suppression policies are best triggered early in the epidemic’, and ‘for suppression, early action is important’, while the British and Irish Governments cannot be accused of acting quickly, and it also admits to ‘very large uncertainties around transmission of the virus.’

In accepting the difficulties of long term suppression policies it states that ‘social distancing of high-risk groups is predicted to be particularly effective at reducing severe outcomes given the strong evidence of an increased risk with age.’

The report ends by noting that ‘we emphasise that is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time. How populations and societies will respond remains unclear.’

What should be clear is that the promises of the Government have a sell by date and a use by date; promises of delivery of tests and equipment and the mobilisation of additional staff and hundreds of thousands of volunteers will require that these are organised effectively.  If they are not then this will become a political challenge to the Tory Government that no amount of self-isolation will shield them from.

 

Fighting Coronavirus

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An initial effect of Coronavirus in Ireland and Britain was one of disorientation, with uncertainty as to its impact and in particular its effect on those considered most vulnerable.  This is now evaporating.

The response of the British Government was a plan with four stages.

The first has passed and clearly failed.  It was called containment and was to involve trying to catch cases early and trace all contacts to avoid the spread of the infection.

The disease has spread and despite self-praise that the tracing system has been very effective there are an estimated 10,000 cases and no one knows who they are.  The disease has not been contained.

The second stage is called delay.  According to Sky News ‘this means the government will ramp up efforts to delay the spread of the illness’.  This however has only involved a recommendation that anyone with coronavirus symptoms, such as a continuous cough or high temperature, must stay at home for seven days, which appears not long enough to isolate the disease, and is anyway only a recommendation. School trips abroad should be stopped, while people over 70 with serious medical conditions should not go on cruises, which implies the problem is a foreign one that might be imported, and we are way past any such idea.

The second phase has therefore involved no actual measures so that the delay stage merely involves delaying a decision and a delay in doing anything.

This has been ignored by sporting and other bodies who have cancelled events, calling into question the Government’s strategy.  The Government, including Arlene Foster here in the North of Ireland, is hiding political decisions behind the advice of its experts.  Unfortunately, these experts are political appointments, and while Johnson gained credibility by their presence at his first press conference, their credibility will sink faster than his if they follow his agenda.  In Northern Ireland it was appropriate that the long-awaited report on the Renewable Heat Incentive scandal has just been published, reminding everyone of the lengths of stupidity that civil servants will go to in servicing their political masters.

The policies arising from the scientific advice that the British Government claims to be working from obviously conflict with that given in other countries, including the Irish State.  True to the traditions of the British state, this advice is a secret.  What we know is that Johnson appears sanguine that ‘many families will lose loved ones before their time’, and the mass media has played its role in preventing a tsunami of anger that this remark should have evoked.

On Thursday evening Radio 4 had an expert – ‘Chris’ – who continually referred to someone called ‘Boris’ as the font of all authority, as he defended the Governments’ strategy, and the interviewer gave the Government the deference it has so much enjoyed.  Social distancing measures were opposed because they could not be fully effective, but without the least recognition that less than perfect effectiveness in no argument in favour of no attempt at any effective action at all.  The strategy is clearly to allow the majority of the population to get infected in order for it to develop its own immunity and spare the health services from a task that it cannot cope with.

Delaying social distancing measures is supposed to delay the hit on the health service and flatten the impact on it; although it would appear to make more sense that the quick introduction of such steps would be much more likely to achieve this, while it also seems clear that no amount of realistically conceivable flattening will save it.

The third Phase of the British Government’s plan is called research and has been described as follows – ‘if delaying the spread fails, the government will intensify its focus on finding out more about how the virus spreads and how those who are infected can be treated most effectively.  The government has put £40m into finding a vaccine for the virus, which is undergoing clinical testing and is likely still several months off.’

So only if the delay fails will the Government focus on finding out more about how the virus spreads and how those infected can be treated most effectively???  It is impossible to take this seriously, or rather, impossible to take the plan as a serious attempt to achieve what it purports to be its objective.

The final Phase is mitigate, which, according to Sky News again,‘implies this is essentially the worst-case scenario . . . during this phase the pressures on services and wider society may start to become significant and clearly noticeable. At this stage, the virus would be considered widespread.’

However, it is clear by now that whatever impact the Coronavirus has, it will be lessened, or ‘mitigated’, less by anything the Government does than by what people do themselves, including health service staff doing their jobs.  It is beyond doubt that they are not well prepared.

Nothing in the strategy is capable of explaining how health systems will be able to deal with the massive increase in cases involving those in vulnerable groups such as the elderly and those with suppressed immune systems.  Acute facilities will be unable to cope and Governments have long starved social care systems of funds even before the last decade of austerity.

Promises of additional money now are of limited use without concrete plans to quickly requisition buildings or begin to increase production of necessary medical supplies and equipment. And these will also require additional staff, who even now should be brought forward for training in some of the basic tasks that will be required, freeing up qualified medical and nursing staff to carry out more complex tasks.

Self-isolation can only work if many of those isolating are not totally isolated.  An efficient state would be identifying this need and the means of ensuring that these people receive the minimum help in terms of food and monitoring so that they are able to maintain their self-isolation.

To pose such tasks is to expose the weakness of the current health system and illuminate the truth that far from there being no such thing as society, as Thatcher and her acolytes would have it, we are all individuals who are nothing without it.  And the nature of that society determines how we survive and thrive as individuals.  A society that defers to a state that is essentially unaccountable and governed by a moronic narcissist like Trump, or sociopathic liar like Johnson, is not one that can respond adequately to the current threat.

A struggle is therefore required to fight this disease and protect our most vulnerable fellow workers and citizens.  Relying solely on the state, a top-down bureaucratic monster that now has monsters at its top, is not an option.  A campaign to demand an adequate response to the crisis from the state is therefore only one option.

I work in an office, for the state, and it took the local union committee to raise the question of dealing with the virus and its implications for vulnerable staff and their families before local management took even minimal action.  They were, and still are, waiting for orders from above, as everyone working for the state often does, at which point we are back in Renewable Heat Incentive-land.

In general, the union movement has failed to act as a movement (as has the British Labour Party), revealing the extent to which it is a purely sectional organisation and not a class movement; more and more a series of organisations hollowed out of active participants and dominated by bureaucrats.

Acting as a social mobilisation to protect the most vulnerable and isolated would make it appear relevant to many in the working class, to whom its current relevance is not that much.  In Ireland the high level of membership at least gives it the potential to play such a role, although no one can have much confidence that it will do so.

Instead community organisations, including the GAA in Ireland, could play a major role in identifying the most vulnerable and offering them support and assistance.

A pervasive social disease requires a wide social response that only organisations within and for the working class can hope to provide adequately.  This is the perspective that socialists should offer and advance.

In the meantime it is to be hoped that the Governments that have left their populations exposed without adequate protection pay a political price; that Johnson for example is reminded how his breezy cynicism promised that the county is “extremely well prepared” when it obviously is not.

While over half the country has bitterly opposed him as an inveterate liar, and most of the rest have regarded him similarly, the latter have at the same time also agreed with him and so supported him.  With Brexit this might have been easier to do as xenophobia could be employed to ‘fight’ the EU and the imagined hordes of foreigners and immigrants.  But Johnson’s lies will be no use against viral infection and neither will xenophobia and prejudice..

The virus will be with us for some time, if it ever disappears completely at all.  It will more and more become a political issue, as it should. While we all familiarise ourselves with viral infections and epidemiology, and seek to protect ourselves and those vulnerable that we love, we should not forget what our politics means in all circumstances.  The class struggle between oppressed and oppressor is sometimes open and sometimes hidden, but it always exists.