Tag Archives: Coronavirus

‘The Day the World went Mad’ – a review (3)

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No death from coronavirus is acceptable’ said Nicola Sturgeon in Scotland, while the idiot Health Minister for the North of Ireland stated that the health service could not turn away any Covid-19 patient.  When asked whether this meant that a cancer patient may die, he replied “Yes, that’s as black-and-white as it is.”

Mark Woolhouse describes the first remark, if taken literally, as making it ‘impossible to tackle the novel coronavirus epidemic in a rational manner’.   He goes on: ‘unfortunately, it was taken literally, and not only in Scotland, and that’s a large part of the reason why we ended up in lockdown.’

His argument is therefore that the lockdown policy wasn’t rational because it was impossible to find a balance between costs and benefits.  The Health Minister in the north of Ireland took it a step further and in effect claimed to throw all clinical judgement out the window by making Covid-19 patients a priority no matter what.

What sort of priority? Why a political priority of course!  One so obvious he did a U-turn, but only after the absurdity was too embarrassing.

While statistics were regularly produced on test numbers, infections, the R number and other covid metrics, the health cost of lockdown was ignored by invoking a simplistic health versus ‘the economy’ argument.  The need to protect the NHS, especially exposure of its inadequacies – due in part to Tory policy – covered up both the failure of the Covid policy and the performance of the NHS.  Woolhouse notes that during the first lockdown bed occupancy was 65 per cent between April and June while television news homed in on the small number of hospitals close to 100 per cent capacity.

Woolhouse reviews the harms of lockdown under the headings of health care provision, mental health, education, the economy and societal well-being.  He could have added the political effect of the government and state taking on dictatorial powers, frightening large sections of the population, and determining very basic activities that would never have been thought before to require some right in order to exercise.  These costs are nowhere near being evaluated and quantified even now and were all but ignored during lockdown.

Even the argument of prioritising health over ‘the economy’ had to ignore the health effects of austerity, including that an ‘additional 335,000 deaths were observed across Scotland, England & Wales between 2012 and 2019’, according to research at the University of Glasgow.  Marxists are often accused of wrongly exaggerating the importance of ‘the economy’ to social life but in this case some went further than anyone in claiming its inconsequence.

As we noted in the previous post, the first models assumed a disease with very different incidence from Covid-19, yet a later risk estimation algorithm analysed from the data of over six million people found that ‘the 5% of people predicted to be of greatest risk accounted for a staggering three-quarters of all deaths attributed to Covid-19’. It should therefore have been possible to target protection of the population in the same way the disease discriminated, and Woolhouse makes some suggestions how this could have been done, saving lives and money.

But politicians disagreed, and Michael Gove declared that ‘we are all at risk’ – ‘the virus does not discriminate’, while Health secretary Matt Hancock claimed one localised outbreak was ‘disproportionately’ affecting children.   They followed the views of certain experts who claimed, according to the BBC’s Newsnight programme, that ‘ a substantial number of people still do not feel sufficiently personally threatened . . . the perceived level of personal threat needs to be increased . . .’

The media themselves played their part by ‘regularly reporting rare tragedies involving low-risk individuals as if they were the norm.’  Then, of course, we had some on the left for whom all this was far, far too relaxed, if not a calculated conspiracy to weed out the unproductive members of the working class.

Woolhouse recounts his experience of the second lockdown, in which the failures of the first were largely repeated – ‘the case for a second lockdown in England remains weak to this day.’  On the issue of lockdown at Christmas at the end of 2020 he argued that ‘we could focus not on reducing the number of contacts but on making those contacts safe’, but states that ‘this idea did not gain hold in what became an increasingly hysterical debate.’

He observes that ‘as the second wave raged across mainland Europe, the zero Covid campaign faded away when even its most ardent supporters were forced to admit that zero was not a realistic target.’  Woolhouse, however, is obviously not familiar with all its advocates, for whom the last politically correct stance by the Chinese state has now been surrendered.  One recent article has claimed that China embraces ‘forever Covid’ when what is really happening is that Covid is embracing China as it was always going to do, with the only appropriate response being to prepare for it in the correct way.

The arrival of vaccines is presented by Woolhouse as the cavalry, and the fact that China has failed on this while pouring its energy into repressive lockdowns should be yet another lesson.  Many, however, will let the whole Covid-19-episode retreat into the distance that is known as the past and become ‘history’.

Woolhouse reviews the experience of several other countries, including Taiwan, New Zealand, and Sweden, which was prominently disparaged but which he defends.  He also addresses the experience in Africa, where he has interesting things to say but is less definitive.  He looks at alternatives but is critical of The Great Barrington Declaration, despite its emphasis on protecting the vulnerable, although it is not clear to me that his criticism is not compatible with a version of its general approach.  Of the UK’s science advisory team, he accepts that the following could have played a part in its failures: ‘group-think, unconscious bias, tunnel vision, hubris, discouragement of dissent and lack of diversity . . .’

Though disliking the term ‘lockdown sceptic’, which he thinks makes him sound like a ‘climate change denier’ or ‘flat earther’, he still declares ‘why I’m a lockdown sceptic.’  He describes what happened as ‘following the crowd even while it is stampeding in the wrong direction’ because changing course would mean admitting being wrong in the first place, although he notes that the case to do so was so compelling the World Health Organisation did so.

He lists the thigs he did not expect to happen in the pandemic, including many ignoring elementary principles of epidemiology or scientists abandoning their objectivity, and finally that the world would go mad.

‘But it did.’

concluded

Back to part 2

‘The Year the World went Mad’: a review (2)

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In his book Mark Woolhouse provides the story of the Covid-19 pandemic in Britain and his role as an advisor to the British and Scottish Governments.

His restrained story does not cover all aspects of the pandemic and the Governments’ response, but it is nevertheless pretty damning.  He notes that that Scottish Government didn’t set up its own expert advisory committee and have its first meeting until three days after the first lockdown, ‘by which time the course of the epidemic in Scotland and the UK . . . was pretty much set’. He criticises the World Health Organisation (WHO) for only declaring a pandemic until well into March, so undermining early action in the UK, and by which time he deems it also ‘pretty much irrelevant.’ 

In fact, WHO comes in for other scathing criticism, including for its approval of China’s strict lockdown policy – “China’s bold approach . . . has changed the course of a rapidly escalating and deadly epidemic’ it said at the end of February 2020, even as Covid-19 had already spread to forty-eight countries.  Nearly three years later China’s strict lockdown policy is falling apart and the call by the Director-General of WHO to follow its policy now looks foolish.

The UK had its own problems right from the start, including the assumption in its pre-existing planning that it was going to be fighting an influenza pandemic.  As Woolhouse puts it, the modelling group he sat on ‘had to contend with one challenge right away; it was set up to tackle the wrong disease.’

The difference this made can be seen in the models created to inform decisions on what action to take against the spread of the disease.  More appropriate for an influenza pandemic, the ‘new, bespoke coronavirus models’ included the impact of schools but not of care homes for the elderly.  Covid-19 was a disease massively disproportionately affecting the elderly, with the average age of death in the UK at 78 and 80 for deaths attributed to coronavirus, but having generally only mild effects on children.  The original influenza models also didn’t include lockdown.

Woolhouse says that ‘We’d done our homework, but we’d prepared for the wrong exam’.  He still claims that they ‘were useful tools’ but also that ‘I wouldn’t want decision-making to be over-reliant on models either’.  Unfortunately, he also says that ‘in March 2020 . . . you could easily get the impression that the UK government’s mantra of ‘following the science’ boiled down to following the models.  That’s how it looked and that’s how the media presented it.’

The models were used to produce an R number every week: the average number of cases generated by a single case. ‘The R monster turned out to be quite dangerous . . . The relentless focus on the R number detracted from the usual public health priorities of saving lives and preventing illness.’  This, for him, was part of a wider problem, accusing many scientists of ignoring elementary principles of epidemiology and abandoning objectivity and common sense.

One example, that was employed as an ignorant term of abuse also on the left, was the damning of ‘herd immunity’, and he criticises the editor of the leading medical journal ‘The Lancet’ for continuing ‘to rail against their straw man version of a herd immunity strategy.’

This criticism of the approach of many scientists is measured and unpolemical, and he presents it from an insider perspective in which models create scenarios and not predictions. He nevertheless finds a particular target in the Imperial College report number 9, which generated a worst-case scenario of half a million deaths in the UK by the end of July.  He admits to generating such a scenario himself.  ‘The problem was that these worst-case scenarios weren’t realistic and weren’t intended to be.’  This one however had the very real consequence of making lockdown ‘accepted as a necessity the first time it was proposed.’

The strategic objectives were presented as saving lives and protecting the NHS.  As Woolhouse notes, if this meant ‘trying to minimise deaths due to novel coronavirus while ignoring deaths from other causes, and if social distancing is the intervention of choice, then we don’t need a complex computer model to tell us what to do.’

Boris Johnson’s ‘flattening the curve’ to ‘protect the NHS’ had two problems according to him.  Firstly, flattening infections and hospitalisation reduced peak demand on NHS services but prolonged it, and the NHS couldn’t cope with either. The NHS therefore required more resources and, while it got new hospital facilities, these remained largely unused because it didn’t get the required staff.  Woolhouse claims the UK got what he predicted – ‘yo-yoing between intolerably severe restrictions and unsustainable pressure.’

In my own posts during the pandemic, I argued that protecting the NHS was attractive to politicians because it would also protect them from accountability for their prior policy of running the service down.  Ritual hand-clapping on the street became the substitute, while we are now invited to condemn NHS workers for striking to recover the fall in living standards incurred over the past number of years.  Perhaps these workers would be in a stronger position today if the failures of government had been exposed during the pandemic instead of demanding more of the same policy.

Woolhouse admits to supporting the introduction of the first lockdown despite concerns, because there was no other option on the table, he was unsure of the effect of earlier measures and he was not prepared to take the risk.  The central message of the book however is that lockdown was wrong and there was an alternative.  He argues that there were already marked shifts in people’s mobility before lockdown and that the latter ‘seems to have come late to the party and had surprisingly little effect.’  Imperial College published a counter-factual analysis ignoring this voluntary activity and exaggerating the effect of lockdown.  

Woolhouse notes some problems with its analysis.  Sweden never went into full lockdown but brought the epidemic under control. Imperial then claimed implausibly that its banning of mass gatherings had had the same effect. Other researchers came up with the quite different conclusion that the UK epidemic was already in decline before lockdown took effect.  He doubts that ‘anyone would claim now that the March 23rd lockdown saved anywhere near half a million lives.’

His alternative was to act earlier, but not to introduce the lockdown that was implemented, while lifting restrictions earlier.  ‘Lockdown was never going to solve the novel coronavirus problem, it just deferred it to another day, and it did so at a great cost.  Epidemiologists and modellers knew that it was going to be the case from the outset. It turned out policy-makers did not . . .’

‘Lockdown was conceived by the World Health Organisation and China as a means of eradicating novel coronavirus once and for all from the face of the earth. With hindsight, this plan was doomed from the outset . . . The world was given an intervention that only made sense in the context of eradication as the preferred means to control a disease that was clearly here to stay.’

Many on the left maintained this position – of zero-Covid – long after this was obvious, while the World Health Organisation eventually backed away from the policy.  In October 2020 it stated that ‘we really do appeal to all world leaders: stop using lockdown as your primary control method.’

As Woolhouse puts it – ‘tragically, this appeal came seven months too late and by that time a colossal amount of damage had already been done.’

Back to part 1

Forward to part 3

‘The Year the World went Mad’: a review (1)

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‘The Year the World went Mad; a scientific memoir’, Mark Woolhouse, Sandstone Press, 2022

The working class in Ireland and Britain face dramatic cost of living crises caused by inflation, and in the UK by austerity justified by claims that the public sector deficit has dramatically increased.  The BBC reports that ‘the cost of living is currently rising at its fastest rate in almost 40 years’ and that ‘the UK faces its biggest drop in living standards on record.’  This is ‘largely due to the war in Ukraine and the fallout of the pandemic’ says the BBC.

In Britain the sudden collapse of the pound following the Liz Truss/Kwasi Kwarteng budget was the result of large unfunded tax cuts that the international finance markets would not accept.  One reason they did not accept them was the previous massive expenditure arising from the Covid-19 pandemic.  In Britain and the North of Ireland the cost has been estimated as £376 billion, or 15 per cent of total Government debt and enough to fund over eight and a half years of a deficit that supposedly justifies the current austerity.

The war in Ukraine has resulted in sanctions by the West on Russia, which has in response limited energy supplies to the West.  Sanctions have also disrupted trade and increased many commodity costs, exacerbating the inflationary effect of state expenditure during Covid and the money printed through quantitative easing.  There was always going to be a price to be paid for the money spent as a result of the lockdown policy and sanctions on Russia and it is hardly a surprise that it is being imposed on working people.  What should be a surprise is that the Left should have opposed incurring these costs in the first place but didn’t.

In so far as the war in Ukraine goes, much of the Left has been an echo of Western Governments, which so far have been willing to incur the pain as long as it can be transferred on to rivals and/or dumped on workers.  The voices of the pro-war Left tend to mute when it comes to accepting responsibility for supporting the sanctions policy and consequent assault on working class living standards.

As far as the policy of lockdown during Covid is concerned, the problem would be massively worse had much Left advice to extend and deepen lockdown been accepted.  This book by a member of the British and Scottish Governments’ Covid-19 advisory bodies is a Professor of Epidemiology and a critic of both of their pandemic policies.  He is critical of the lockdown policy of both, of its health, social and economic costs, and insists there was a better way.

If his credentials are supposed to inspire confidence it should of course be remembered that there were many other scientists and medical experts who would disagree with his analysis and conclusions.  Appeals to authority are not going to take you very far.  It is necessary, as always, to think for yourself. His book is worth reviewing because he was an insider in the Governments’ responses and therefore in an advantageous position to recount their decisions and why they were made.  He can also provide background to the pandemic and the response to it but essentially his analysis backs up what was very largely known during lockdown and which led this blog and others to reject the consensus that lockdown was the only correct response.

As to why so much of the Left supported lockdown, this in itself is no pointer to a correct policy; we long ago left the terrain of seeking comfort in majority opinion on this end of the political spectrum.  Stalinism, social democracy and ultra-left sectarians have been making up the majority of it for a long time and even the last grouping almost invariably seeks maximum action by the state as the answer to immediate political and social problems, washed down with a heavy dose of scatological political prognoses based on the supposed radicalisation of the working class through a seemingly permanent capitalist catastrophe.

If capitalism is in permanent crisis then it would seem obviously impossible that the greatest political, social and health disasters are anything other than the immanent outcomes of capitalist economics and the calculated strategies of the representatives of the capitalist class.  This resulted in some on the left demanding even greater lockdowns because the existing ones were either a sham or simply inadequate.  This involved highlighting the potentially worst possible outcomes, repeating the greatest scares and calling for the most drastic actions.

Their recommended policy ignored the level of repression required to enforce their preferred extreme version of lockdown, and ignored the real costs of existing lockdowns and the very impossibility of achieving more restrictive enforcement. It ignored the stupidity of closing down production of goods and services while calling on the state to fund the incomes of workers who produce them so that they could buy the goods and services that they were being paid not to produce.  Anything else was denounced as sacrificing lives for profit, as if under capitalism the goods and services required to produce and reproduce life could be created any other way.

From this perspective the advantage of this book is that it is not in the least concerned with much of the disputation on the left, but may be read as a critique of their proposed approach from which they might at least ask–did we get it wrong?

Forward to part 2

Goodbye Covid-19?

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Common Cold Can Protect Against Infection by COVID-19 Virus

Professor Tim Colbourn of University College London was quoted in the ‘Financial Times’ (on 4 Jan) that it was “entirely reasonable to think that the burden of Covid can be reduced by 95 per cent in 2022, so that it’s no longer a top 10 health problem.  That would be a reasonable goal to end the pandemic.”

The article notes that ‘some experts view Omicron itself as a pointer to future evolution of the Sars-Cov-2 virus, as natural selection favours mutations that pass quickly and efficiently between people who already have some immune protection . . . These conclusions are supported by epidemiological evidence that the risk of severe disease is reduced by half or more with Omicron.’

The Director of the Wellcome Medical foundation, Jeremy Farrar, is quoted as saying that he was reassured at the prospect of Omicron taking over from Delta and that “I’d be more worried if you had different variants circulating at the same time.” 

The article states that ‘another variant of the virus is a certainty and that while individual changes in the genetic code are random the environmental pressures that allow some to thrive are not.  This favours variants that transmit quickly while evading immune response but mutations that make the virus more lethal are unlikely to make it fitter and may even be a handicap.’

Jennifer Rohn, a cell biologist and UCL professor, said that “although you can imagine a deadly new variant emerging that’s more harmful . . . I don’t know how feasible that would be for this virus.  Sars-Cov-2 depends on infecting cells and it may already be close to the limits of its repertoire.”

The article notes that the view that the virus will become milder is ‘a matter of debate among scientists’, but quotes another professor of medicine at the University of East Anglia, Paul Hunter, that he is convinced this is true of coronaviruses.  “Sars-Cov-2 will continue to throw up new variants forever but our cellular immunity will build up protection against severe disease every time we’re infected. In the end we’ll stop worrying about it.”

Jeremy Farrar notes that there is a small risk of an evolutionary jump – “something out of left field that does not come from existing lineages”, the article states that ‘most experts regard it as extremely unlikely. “I’m much more scared of another pandemic caused by a new virus that we don’t yet know about than by some variant of Sars-Cov-2” says Tim Colbourn.

Since much of the left has taken a doomsday view of Covid-19 this is perhaps not good news for their perspectives.  How they can continue to argue for a zero-Covid policy – the article quotes a forecast of 3bn infections world-wide over the next two months – is a terrain I don’t really want to explore.  With perspective not far from the fictitious character Private Frazer of ‘Dad’s Army’, perhaps they will cling to a dialectical understanding of the non-linear revolutionary genetic leap that will confirm their pessimism.

They will not, in addition, be enamoured with the views of the former chairman of the UK’s vaccine taskforce, Dr. Clive Dix, who has said ‘Covid should be treated as an endemic virus similar to flu, and ministers should end mass-vaccination after the booster campaign.’

He effectively repeats the views of Dr. Gerald Barry in Dublin quoted in the previous post in calling ‘for a major rethink of the UK’s Covid strategy, in effect reversing the approach of the past two years and returning to a “new normality”.

“We need to analyse whether we use the current booster campaign to ensure the vulnerable are protected, if this is seen to be necessary,” he said. “Mass population-based vaccination in the UK should now end.”

‘The Guardian’ article goes on to report him saying that ministers should urgently back research into Covid immunity beyond antibodies to include B-cells and T-cells (white blood cells). This could help create vaccines for vulnerable people specific to Covid variants . . .  adding: “We now need to manage disease, not virus spread. So stopping progression to severe disease in vulnerable groups is the future objective.”’

The article quotes Professor Eleanor Riley, professor of immunology and infectious disease at the University of Edinburgh, saying: “Everything depends on whether another variant comes up.  A fourth dose or second booster of the existing vaccine probably isn’t going to achieve very much. The evidence is that immunity against severe disease is much longer lasting. The only justification for doing a second booster for the majority of the population would be if we saw clear evidence of people, five or six months after their booster, ending up in hospital with severe Covid.”

Most people will welcome these views, if only because it’s what they want to hear, as they are tired of lockdown and fed up with the restrictions on their lives.  One danger of pretending everyone has been equally in danger from Covid-19 was always that the vulnerable would be overlooked.  A continuing blanket assertion that we are all still threatened, including children, is worse than useless.

The left’s zero-Covid strategy has nowhere to go, except to expose its exponents as wild catastrophists whose ultra-left politics is exposed once again; supporting longer restrictions for which more and more people can see little justification.  Believing that socialist revolution can only arise out of crisis, they wrongly assume that every crisis requires revolutionary methods.  They do so in pursuit of relevance and sign of their revolutionary purity.  That social crisis has not shown itself conducive to working class politics was the subject of some of the earliest posts on this blog.

A continued forlorn and regressive campaign for zero-Covid will ignore the real issues that are arising, and will have to argue that individual, very basic, freedoms and civil rights should continue to be suppressed by the state.

The issues arising include other costs of lockdown, which will affect working people, and the young especially, for decades.  A left that wants this lockdown extended and deepened has no credibility in responding to these problems.

These costs include financial, health and educational losses.  Calls by the left for the government to pay for workers not to work exhibit all the ignorance often called out by conservatives and reactionaries.  Those workers genuinely at risk or sick must be fully protected but this requires that the rest of the working class actually continues to work.  Real mass lockdown of society is impossible.  Pretending that only ‘essential’ workers should continue to work divides the working class perniciously and reveals levels of ignorance about a division of labour under capitalism that makes the vast majority ‘essential’.

As for asking the government to pay, this reveals incredible confusion at multiple levels – illusions in the capitalist state; illusions in the power of money without workers producing goods and services to buy with this money; the effects of inflation on workers’ living standards in simply handing out money, and the fact that governments don’t pay for anything – they tax or borrow and pay back the latter with the former, unless of course they print money, but then see previous comment.

If any of what this left claimed was true for any length of time, the ‘property question’ which Marx said was key would not be the ‘leading question’ in socialist politics.

More immediately, socialists should support workers being back in the workplace, in order to strengthen their feelings of shared identity, interests, solidarity and organisation.  Concern about health and safety should be dealt with collectively, which is much easier to do if you actually work closely together.

The Health Service has failed – see this earlier post – but to say so is almost to be damned as impugning the staff who work in it, some of whom have made real sacrifices during the pandemic.  Unfortunately, the politicians and bureaucrats who have been responsible for the incapacity of health services to carry out their role have cynically hid behind them, substituting rhetoric about heroes and rituals of hand-clapping for an effective service.

The British left is especially bought into illusions in the NHS, which is a health bureaucracy that was exposed from the start as incapable of protecting even its own staff.  The overwork of many staff is testament to its essential nature as a medical bureaucratic creature of the state, which for socialists is first and foremost a capitalist state with operations, functions and direction determined by the requirements of its class character.

Much of the Irish left wants an Irish NHS, because health care in the South is two tier, in complete ignorance of the fact that the failure of the NHS in the North means that health care there is more and more two tier as well.

Health provision in the pandemic has undergone a real crisis, with services closed down or restricted, waiting lists increased and diagnoses not carried out.  Just like an economic crisis, no crisis goes to waste as far as those in power are concerned.  Simply defending the existing service and believing that more money is the answer is an illusion.

So, to answer the question – Covid-19 will only go away if a zero-Covid policy was possible and was implemented.  It isn’t possible so it isn’t going to happen.  Instead Covid-19 and the mistaken reaction to it will leave in its wake multiple problems.  We need to understand the reason for this mistaken reaction and what the correct approach now is to the current and future evolution of the disease.

Back to part 2

Covid-19 Delta – ‘the biggest hurricane that has ever hit Ireland’

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Ireland on cusp of fourth wave of Covid due to deadly Delta variant, NPHET warns - Irish Mirror Online

The Irish State has reached the milestone of 5,000 deaths associated with Covid-19 at the same time as it controversially announced that there will not be a reopening of indoor hospitality on 5 July as planned.

Two weeks ago a government source had said that “the narrative that our reopening will slow down is not true.’ However that was before the National Public Health Emergency Team (NPHET) presented advice to it that a pessimistic ‘scenario’ forecasted 2,000 deaths over three months, largely due to the new Delta variant of the disease, with advice that only vaccinated people and those who have had Covid should be allowed inside restaurants etc.

Such a measure was denounced as ‘absolutely bananas” by one opposition leader amid accusations that it was unworkable, discriminatory and potentially illegal, never mind the damage to the social bond that arises from everyone making sacrifices together.  Young people, it seemed, who predominantly serve in hospitality but are unvaccinated could serve, but not be served. Sinn Fein denounced the Government while more quietly accepting the decision; in this case talking more softly out of one corner of its mouth than the other. What would you do if faced with this dreaded forecast was the stock response from the governing parties.

While it was noted that NPHET had failed to factor into its assumptions newly allowed vaccination of younger people and there were calls for an independent audit of its modelling, plus claims that the Irish were an outlier in Europe in terms of indoor hospitality, by and large the figures were accepted without real challenge.  The Irish State has had one of the strictest and longest lockdowns in Europe but if many more people are no longer so scared as they were, there is no alternative critical view of State policy beyond making it harder.

There are a number of reasons for this including that the Irish State has done relatively well in relation to deaths:

State support payments to the unemployed and businesses have continued, and political opposition, including from the left, has been in favour of even tighter restrictions.  Such opposition as has declared itself, has been restricted to the far-right, including anti-Vaxxers who are easily dismissed but serve to make any other criticism easier to ignore.

The Irish economy is also set to grow by over 8%, according to the Central Bank, with this growth having less to do with base effects (the previous fall caused by lockdown making future growth easier statistically as well as economically) because the Irish economy has been hit less by Covid-19 despite the lockdown. The disproportionate presence of US multinationals, which includes companies in the pharmaceuticals, medical devices and IT sectors, has seen demand for their products increase.

An opinion poll in June reported that ‘fewer than one third of voters (32 per cent) agree that life should return “to the way it was before Covid” even after most people are vaccinated. Almost two-thirds (65 per cent) say that some precautions should remain in place, such as wearing masks in shops. Older voters remain significantly more cautious on this issue, with 79 per cent favouring continued precautions.’(Irish Times). The greater threat to older people goes a long way to explaining their particular concerns, as does the failure of the state to protect these people in its care or in private homes for which the state still has a responsibility.

That this number of people are so anxious is not a healthy sign, either from a psychological view or politically. A scared population is not one that is likely to be critical of state policy or seek to map out its own alternative. From a socialist viewpoint it is not conducive to independent thought by workers and rather affirms their social subordination.  In this case the attendant denial of very basic civil liberties emphasises it.

Given the current very low level of cases, hospitalisation and deaths, plus the summer season, the dire warning by the Minister of Health, that “the biggest hurricane that has ever hit Ireland is coming’ simply reaffirms all these negative effects of state policy. Although one must assume his remark excludes An Gorta Mór.

The Government’s decision rests heavily on the most pessimistic of four scenarios presented by NPHET:

The presentation by NPHET shows a wide variation between a central scenario of 187,000 cases in three months and 545 deaths, and the pessimistic scenario of 682,000 cases and 2,170 deaths.  Given the prevalence of the Delta variant, plus greater transmissibility by Alpha, it is the increase in social mixing that appears as the cause of the difference, but this is placing a big burden on indoor hospitality to make this the cause of such an increase.  It is the possibility of the pessimistic scenario that is nevertheless given as the reason, although no probability is presented and the message appears to be that no possibility is acceptable.

The Chief Medical Officer has admitted that advice from his Scottish equivalent is that the Delta variant presents less risk of hospitalisation even if it is more transmissible.  It is already well known that the virus is predominantly a threat to life to those who have other underlying health conditions.

The most recent figures published for the period up to 12 December 2020 report that 93.4% of deaths were of those with an underlying condition.  The figures for those who had Covid-19 and also had an underlying condition was 16.9% for those aged 25 – 34, 52.58% for those aged between 65 and 74, and 59.4% of those 75+.

Clearly it is older people who are most at risk and it is mainly older people who are dying.  The proportion of total deaths accounted for by 25 – 34 year-olds at 11 May 2021 was 0.81% while it was 15.5% for those aged 65 – 74, 33.75% for those aged 75 – 84, and 42.39% of those aged 85+.  In other words, 91.64% of deaths were of those aged 65 and over, but being over this age is not sufficient to have a severe risk posed, you also need to have a relevant underlying condition.

NPHET has reported that cases amongst the eldest has fallen and lower than younger age groups, as this heat map shows:

This is due in good part to the vaccination programme prioritising by age but also by considerations of those most vulnerable.  The programme has also prioritised health care staff although this was supposed to be targeted to front line workers.  In the North not so much pretence was made and back-office support workers with no interaction with patients were vaccinated before, for example, immunosuppressed cancer patients.  The mantra of ‘protect the NHS’ reached a logical conclusion when bureaucrats came before extremely vulnerable patients. While the Southern vaccination programme has been beset by some scandal in which relatives of senior executives and others favoured by them have been vaccinated out of priority, the existence of similar in the North has gone unreported.  

In both jurisdictions the unchallenged requirement for vaccination of health care staff arises because both health systems have been incapable of implementing effective infection control.  In part this is because of the large number of Covid patients hospitalised but this in turn has been mainly due to the failure to protect older people, including those in care and nursing homes.  The Irish Government Covid-19 hub reported, as an example, that on Tuesday 11 May over half of hospitalised cases were in the over 65 age group.

In any case, the vaccination programme has gone a long way to protecting those most vulnerable.  Among these the rates of full vaccination are very high – 94% of those aged 80 and over, and 91% of those aged 70 – 79.  Among the 60 – 69 age group 43% are fully vaccinated while 93% have had one dose. Around 68 per cent of all adults have had one dose of the vaccine, while 45 per cent have had full vaccination.  This compares with Scotland where the incidence of infection, and by the Delta variant, has dramatically increased but existing relaxation of restrictions, including on indoor hospitality, have remained.

However, the argument of the government and NPHET is that the vaccination programme has not progressed sufficiently to reduce the risk and that it is younger people who must be increasingly targeted by the vaccination programme.

However, it is openly acknowledged that the dire warnings and continued restrictions are based on uncertainty about the possible number of cases, the number that will be hospitalised and the number of deaths.  NPHET has forecast 2,170 in the next three months in its pessimistic scenario, but this would mean an over 40 per cent increase in the existing death toll in a very short period, one-fifth the time of the preceding pandemic.  This, when the most vulnerable have received some sort of vaccination, so protecting them to a significant extent against both hospitalisation and death, and against a dominant variant we are informed involves less risk of hospitalisation.

There is a final reason to be wary of attempts to frighten the population and potentially introduce discriminatory measures against those who face least risk.  Leo Varadkar has written ‘that Ireland is among a small number of countries that includes in our numbers suspected and probable deaths from Covid even when the patient did not test positive or was not tested at all.’ 

The Northern Ireland Statistics Research Agency has reported that: 

‘There were 1,626 deaths registered up to 31st December 2020 where Covid‐19 was identified as the underlying cause of death (88.8% of the 1,831 Covid‐19 related deaths). For 157 out of these 1,626 deaths (9.7%), there were no pre‐existing conditions.’

‘In Scotland, 6.8% of deaths involving Covid‐19 from March to December 2020 had no pre‐existing conditions. In the same period, the Office for National Statistics found 12.5% and 17.2% of Covid‐19 deaths had no pre‐existing conditions in England and Wales respectively.’ 

‘The Health Protection Surveillance Centre in the Republic of Ireland found that those who died with confirmed Covid‐19 up to 12th December 2020, 93.4% reported an underlying medical condition. The differences in these proportions between countries could be due to differences in the methodology and demographic make‐up of each country.’ 

The definition employed by NISRA is that the ‘underlying cause of death’ is a ‘disease or injury which initiated the train of morbid events leading directly to death’. On its own Covid-19 causes few deaths yet the virus has assumed unprecedented power to freeze social activity and civil liberties.

All the factors that might cause the Irish State to have a better outcome have received little attention, including it having by far the lowest proportion of its population in the EU in the over 65s.  As has been pointed out, 500,000 Irish people left for Britain in the 1950s and a further 300,000 in the 1960s. How many of these died in Britain who might have done so in Ireland?

There is no evidence that identifying those at risk and protecting them has been seriously considered or modelled.  As I have noted in previous posts, the state has in fact failed these people in the guise of protecting everyone.  That other states have also failed similarly has acted as some protection for them.  

The issue isn’t that indoor hospitality has been postponed to whenever, or the unemployment or business failures that will result, or even that it has involved justification through discrimination.  The issue is that it is yet one more example of an ‘abundance of caution’ ignoring the associated abundance of cost.  Where is the modelling of the health and social cost of lockdown?  Where is NPHET’s and the Irish State’s pessimistic ‘scenario’ for it?

People before Profit’s ‘Zero Covid-19’ Strategy

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This week the Dáil debated a motion tabled by opposition parties calling for a ‘zero-covid’ strategy.  It was supported by People before Profit and repeated a number of measures published in their strategy document.  Their approach has been supported by much of the Left in Ireland and in Britain. What can we make of it?

A number of questions are immediately raised that the strategy would have to answer. How long would lockdown have to last to achieve its objective; how much would this cost not only financially but also in the well-known drastic effects of lockdown, and what lives and health would be preserved by the strategy compared to the costs?  Is it demonstrated that the costs will not exceed the benefits?

You will search in vain for answers to any of these questions in the PbP document.

Government strategy is based on a balance of restrictive measures and permission to do certain things that have previously been taken for granted. It is accepted that this involves costs but also benefits that justify the costs, while some costs it refuses to accept.  The financial cost to the state in 2020 is estimated to have been €20 billion and Leo Varadkar has speculated that the final cost may be €50 billion.

The ‘zero-covid’ strategy means the balance is wrong but doesn’t say what the financial cost is of drastically shifting it (or the other non-financial costs e.g. deterioration in mental health, rise in domestic abuse and restriction of basic civil rights etc.).  The People before Profit (PbP) document calls for the ‘closure of all non-essential workplaces’ but doesn’t say what they are: how many more would be closed compared to the current lockdown?  Would the difference be significant?  What work is currently not essential and what would be the impact on the economy and the workers in the closed sectors?

PbP say that profits are being put before health but since we live in a capitalist society production is both for profit and to meet needs.  Socialists object that the former is an obstacle to satisfaction of the latter but they don’t claim that under capitalism needs can be met by closing down production for profit.  Even their organisation’s name seems an unconscious acceptance of this (and you could write a whole post on how incoherent that name is).

PbP says that Governments only care about people working and spending, but working class people care about these things as well, for quite obvious reasons, although this seems to escape those seeking to drastically reduce both.  Socialists of the Marxist variety also don’t believe that pieces of paper, or electronic data in bank computers, are a substitute for the actual production of the goods and services people use and consume.  The pieces of paper that capitalism presents as the universal equivalent of real wealth is useless without the production of that which really embodies the potential satisfaction of needs.

Their demand for economic security as a fundamental requirement of public health is equated with state welfare that has always been a permanent source of insecurity, as well as a more or less inadequate safety net.  Welfare systems are not meant to provide economic security for working class people and it fundamentally miseducates them to say they can.

So, the ‘zero-covid’ strategy doesn’t answer basic problems or objections.  To make big claims requires big arguments and big evidence but even obvious questions are ignored.

A second problem concerns the idea of the strategy itself.  It is called ‘zero-covid’ but appears to accept that you can’t get to a situation of absolutely zero.  Having reduced the number of cases to a low level it still envisages periodic eruptions of cases.  It does not mean ‘eradication’ but repeats that it does mean ‘elimination’, which means that control measures will still be required.  The problem is that for a zero-covid strategy these measures mean punishing lockdowns.

So, the ‘zero-covid’ strategy actually involves severe lockdown of indeterminate duration to reduce cases to very low numbers whereupon lockdown is relaxed, cases will again increase, which will require further lockdowns.  Its advocates think these lockdowns can be achieved by testing, tracking and isolation but widespread asymptomatic infection, incentives not to report, ineradicable errors in testing, more transmissible viral mutations, and drastic quarantine measures to impose isolation all point to something much more sweeping.

It should not be forgotten that cases reduced dramatically during the summer to something close to what I assume ‘zero-covid’ supporters would aim at, but was then replaced by an increasing number of cases giving rise to new lockdowns that the same supporters called to be more drastic.  Rather than the strategy looking like an alternative to repeated lockdowns it looks like a mutant variant of it, following what currently appears to be seasonal eruptions of infection.

The analogy used to describe the strategy provides something of an understanding of what is intended but analogies have a habit of leading to misunderstanding.  The example is put forward of a forest fire that requires maximum effort to put out, while recognising that embers may still remain that require to be put out when they again spark new localised fires.

The analogy fails because while forest fires destroy everything in their path the Covid-19 pandemic does not, and while new local fires can be quickly identified and ring-fenced new outbreaks of covid-19 are often without symptoms and can quickly become far from localised.

This brings us to a third failure of the strategy, which is really incredible but says a lot for its affinity to the current approach and its even worse failure to identify what the danger of the pandemic is.  While noting the importance of targeting Covid hotspots and ensuring the safety of vulnerable groups, it mentions in this category workers in meat plants, those in direct provision and migrant detention centres, and travellers and homeless people.  It fails to say anything at all about the vulnerable most at risk of dying.  Neither does the Dáil motion, which mentions that women are disproportionately bearing the burden of the pandemic.

Nothing is said about the median age of those dying being in their eighties or about over 90 per cent of fatalities having an underlying condition. Nothing is said about the scandalous multiple deaths in residential care homes, where older people should have been made safe.  Nothing about the failure of the state to secure them in its dedicated facilities or of the general failure of health services to protect them.  Nothing about the infection of older people by the heath service either in hospital or through then discharging them into homes.  Instead, infection rates in healthcare staff are put down to lack of money, as if infection control should not be a standing requirement.  The actions of the Health Service Executive has on the contrary demonstrated that this has not been seen as an absolute priority.

To say any of this would undermine the zero-covid approach advocated by PbP, including its reliance on the state and its determined refusal to accept the very limited risks posed to all but the identified vulnerable groups.  To do so might be seen to rob the situation of the sense of extreme crisis so necessary to its attempt to talk up the murderous policy of putting profit before people, and the hope that workers will wake up and smell the coffee.

What we therefore have is a strategy, not unlike the current one, that has ignored the real pandemic that has taken place, and has bought into the idea that it is a threat to everyone equally when patently it is not.  The priority given by the virus in killing people is ignored by a strategy that wants zero cases for everyone, and in doing so has ignored the priority of those whose lives are threatened by it.

The health bureaucracy has moulded its response in its own image to put itself in charge.  The left has moulded its response in the image of its own misguided political conceptions, including the potential benevolence of the capitalist state, despite that state’s obvious failure.  Which brings us to a last major failing of the strategy.

Again and again the state, especially in the form of a national health service, is held up as the answer when a quick look across the border will show that the NHS in the North has failed, has ceased to become a health service and become instead a covid-19 service.  The cost of this in future illness and death has not been a first concern.  Long waiting lists have become even longer while the latter is blamed on the former and previous failure becomes the excuse for its extension.

The PbP strategy is replete with references to the recruitment of new healthcare staff ‘to dramatically increase capacity’.  It wants ‘more public health specialists’ and to ‘recruit extra nurses and doctors’ but there are definite limits to how much can be done quickly.  Really significant increases cannot be created in months but only over years.  As an answer to the pandemic today it is a wish list that can only promise salvation sometime in the future.

It says the problem with the health services is ‘structural’ but then contradicts itself by saying it arises from lack of funding and ‘neoliberal’ management, and further contradicts itself by calling for the ‘nationalisation of private hospitals’, imposing the same structural model that has failed.

Because PbP believes that state ownership is socialist, and they think they’re socialists, then the solution is state ownership when the ‘structural’ problem is precisely this form of ownership and control.  An ownership and control beset by bureaucracy and bedevilled by narrow professional hierarchies and egos.

The problem is not a style of management but that health services are bureaucracies that privilege themselves, with the most powerful within them being best able to do so, including medical consultants who prioritise private work, although this is only one feature of the state capitalist service.  The policy of Governments to portray health service workers as heroes beyond all reproach is resisted by some staff but is pursued in order, not to protect the interests of these staff, but to protect the bureaucrats and politicians who govern the system.  The blinkered approach to the health system leads to mistakes such as the widespread responsibility for infection by hospitals and care homes being either ignored, downplayed or excused.

The absence of answers to key questions posed by the strategy; the inadequate understanding of what it would actually mean in Ireland; the failure to even identify the main threat from the pandemic, and the call for measures that cannot be implemented quickly enough to make the difference its authors say is needed; all this points to an underlying impotent political programme summed up at the end of the strategy document:

“. . . most of all, we will need to clearly articulate a vision for an alternative to the destructive instability of capitalism – in Ireland we can play our part by popularising the call for a Transformative Left Government that would reorganise the economy under democratic control, as part of an ambitious Just Transition. .  .  . A left government supported by people power and workers organised in fighting trade unions can deliver real change . . .”

Capitalism will not be changed by a ‘Left Government’, by a group of politicians seeking to transform society through wielding the power of a state that exists to defend it.  Neither can the economy be ‘reorganised’ top-down by such a Government that will in some way, somehow, then be subject to democratic control.  If anyone in PbP still subscribes to any of the fundamental ideas of Marxism they will know all this is false, and being false it is dishonest to sell such a strategy, which is why it is so threadbare.

It is not in any sense a socialist strategy either at the level of transforming society or in dealing with Covid-19, as ritual references to emulating New Zealand, Australia and Asian countries demonstrates. In what way are any of these socialist?  In what way are they safe from future infection, if it at any point they cease to separate themselves from the rest of the world in a way simply impossible for Ireland?  Australia itself provides evidence that there is no such thing as one big final lockdown that breaks the back of infection.  Numerous mutations in many countries belie the idea that these are necessarily foreign and can be avoided by border controls over any extended period.

The great advantage of the zero-covid strategy is that it presents an ideal outcome that compares brilliantly with any other potential approach; the more so since no cost is admitted and no account taken of any problems arising from, or consequences of, its practical implementation, even were such implementation possible in any relevant timescale.

That is why it is also ideal, unreal and hollow.  Not so much transformative as transcendental.

A year of Covid-19 (4) – a tragedy to be forgiven?

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It’s almost as if someone has been reading these posts on the course of Covid-19 in Ireland.  Fintan O’Toole’s latest column (paywall) in ‘The Irish Times’ also notes some of the mistakes made in its early management and, while he treats the Irish approach as one of ad-libbing and improvisation, he lends a sympathetic ear to the early performance.  To what extent is this justified?

Well, let’s start with the scope afforded by this forgiveness: “when it’s all trial and error, no one should be tried for making an error – even when, as in the case of nursing homes and residential institutions – the flaws were fatal.”  But consider if we change the tense of the sentence – ‘even when . . . the flaws are fatal’.

‘Error’ he goes on to say ‘is moreover built into the structure of science . . . but science isn’t a set of certainties . . . to follow science is to follow evidence and with a new disease the evidence has been constantly evolving.’

Well, yes and no.  The important link between the worst effects of the virus and a person’s underlying conditions has been more and more understood.  On the other hand, as I noted at the end of the previous post – ‘one aspect . . . has appeared stubbornly consistent, the median age of those dying was reported in mid-January to be 82.’  Most recently, of over 1,500 deaths in care homes 369 were in January alone, a five-fold increase from December to January.

The Health Service Executive (HSE) noted on 21 January that the 27th of the month would be the anniversary of the first meeting of the National Public Health Emergency Team (NPHET), the crisis management team for the pandemic.  It was noted in April that no mention of nursing homes had been made in its first 11 meetings, with the HSE claiming that the Health Information and Quality Authority (HIQA) that attended the meetings were supposed to represent the interests of older people.

While boasting of the support given to care homes the HSE officials were at this time unable to provide up-to-date figures of deaths within them or a breakdown between state and private providers.  Neither did they answer as to whether any of the deaths could have been avoided.

Around the same time that NPHET was being set up a number of important academic papers were just being published on the effects of the new disease (here and here), including evidence of the effect of the pandemic in China.  The notable paper from Imperial College in London included further disclosure of the much greater threat to older people posed by the virus.  While the infection fatality rate was 0.002% for children aged 0 – 9, the rate for those 80+ was 9.3%, 4,650 times higher.  While these absolute figures were too high the relative differences remained.

Clearly avoiding infection was many multiples more important for older people than for the very young. Even between the age groups 40 – 49 and 60 – 69 the relative fatality rate was nearly 15 times higher for the latter group.  So protecting the older age groups was vital, which involved isolating them from potential infection.  How could these most vulnerable people be effectively separated?

Fortunately, many of these people were already relatively isolated in social care facilities, while identification of those in the community would be relatively straightforward.  Unfortunately, this relative isolation was not a protection.

While the health regulator was supposed to represent the interests of older people the HSE was there to protect the health of the whole population.  It became apparent however that the facilities they managed, controlled and regulated had become prime sites of infection, all while the NPHET engaged in interminable debate about opening or closing shops, hospitality, schools and workplaces etc.

When it wasn’t about the various levels of lockdown that were never applied at the levels specified, it was about testing and tracing, which didn’t identify where the virus was coming from and was later no longer advised for close contacts of confirmed cases.  So, what had been the point of it?

At the beginning of this year ‘senior sources’ were reporting the exhaustion of their approach, admitting that there was “not much else that can be done”, which didn’t stop the debate of vanishing returns continuing.  Today it revolves around rules for entry from outside the state, which is almost a moot point given the levels of domestic infection.  More honestly, it is being reported that ‘Ministers and senior officials’ view it as ‘more about politics than public health.’

Yet the places where around half of the deaths have occurred – residential homes and hospitals – are spared the outrage they properly deserve.  On 26 January it was reported that the level of infections among staff and patients in health care settings had never been higher.  And three days later the Chief Medical Officer was explaining that there was an “exceptionally elevated” infection rate among those aged over 85; that 55 recent deaths were associated with hospitals and 140 with nursing homes; and that we could “expect a large number of additional deaths in the coming weeks.”  Not much had changed over the year despite the ‘trial and error’ of ‘following the science.’

The state has incurred increased debt of around €20 billion in 2020 through various lockdowns but it is still unable to target resources effectively at the greatest problem: the daily death toll for Tuesday was the highest of the pandemic and the median age is still 80+.

It cannot be that a targeted prevention strategy would cost too much or that resources could not be prioritised – €2 billion would go a long way towards protecting older people never mind €20bn.  If even half the current death toll had been avoided and it was now around 1,750 who had died, would this justify the lockdown of society along with its enormous cost?  Would it not have been possible to identify those with the underlying conditions that make them vulnerable apart from advanced years, accounting for well over 90% of deaths? And would it then not have been possible to recognise the difference between those dying with Covid-19 and those from Covid-19?

But why would new problems be adequately addressed by the Irish health system when forever problems have not? When it turns out that the new problems are really the old ones?  As was pointed out by one TD early on, the Health Regulator – supposed to represent the interests of older people – had already reported that in care homes the compliance rates for risk assessment and infection control had fallen from 27 per cent to 23 per cent between 2017 and 2018.

Repeated problems identified have never been adequately addressed, with the HIQA complaining in November that nursing home residents were picking up the infection in hospitals and then being returned to their homes, while care home staff were being lost to contact tracing teams and agency staff were not being included in testing.

As Prof Sam McConkey, an infectious disease specialist with the Royal College of Surgeons, put it “nursing homes have been chronically under-staffed for several years.  They are going to have to start cherishing their staff as the most important thing they have.”  If staff were paid adequately they wouldn’t have to take second jobs, which might for example go some way to addressing the problem that staff weren’t turning up for testing and some were showing up for work while showing symptoms.

Some care homes were simply too small with too few resources. In some residential facilities for people with disabilities derogations were given to staff to continue working though they were identified as having possible close contact with infection.  They had not been tested and it was not clear when they would.

Yet, repeatedly bizarre statements have been issued by those in charge, including that NPHET was proposing setting up an infection-control team – in mid-December!  As if infection control was not a standard and routine hospital requirement. Or that there were difficulties in approving employment of nurses for care homes from India, Philippines and other countries outside Europe, reported in January, when many problems were the result of shortages of staff.

All this was occurring at the same time as repeated statements were made by the NPHET, which we noted in the previous post, that “there was simply no way of protecting nursing homes or any other institutional setting if we don’t control the spread of this infection in the community.” Then saying that vulnerable groups in care settings were a priority although also saying that it was “not realistic to think we could keep it out of homes.”

Unfortunately, seeking to prevent community infection through a generalised lockdown makes all talk of prioritisation a nonsense.  A general lockdown is precisely not to prioritise, and the actions and non-actions of the state are convincing evidence of this lack of ordering of risk.  To talk then, as O’Toole does, of inevitable mistakes is itself to fall into the error of identifying policy as simply mistakes.   Even in the case of vaccination, the representative body of private nursing homes has complained that just 10 per cent of the initial 77,000 vaccinations administered by mid-January were within nursing homes.

The identification, right from the start, that Covid-19 represented a specific threat should have been met with targeted and focused measures to protect those most vulnerable.  The ramshackle and incoherent attempt to lock everybody up, that cannot be sustained, has diverted attention away from this task.

That diversion continues with a false debate over a ‘Zero-Covid’ strategy, which is simply a variant of the current approach.  Like the existing approach, it targets what measures are required to support closing society instead of what measures are needed to keep it open.  It again ignores experience of just who is threatened and how specific measures might be implemented to protect them.

Both the current approach and its extension into a ‘Zero-Covid’ one can’t tell us how long we would have to be locked up for and how we could be sure that whatever metric of success is decided upon could be achieved on a sustainable basis.  What ‘Zero-Covid’ would gain in reducing deaths associated with Covid-19 would be more than offset by the costs of an intensified and indefinite lockdown, which if the advocates of it had been followed, would have been in place since March. Both ultimately can only be sold to an increasingly weary population by promising something that they can’t deliver: the development of the pandemic has had more to do with the weather than lockdown measures, and the end-point of immunity through vaccination may be illusory if new variants are impervious to the vaccines just developed.

In this case, and it may be the situation anyway, living with Covid-19 will be required and immunity through infection become the outcome, if not the objective.  In any case and in the meantime, the policy should be directed to protection of the most vulnerable.  In relation to the assessment of O’Toole, the prerequisites for forgiveness do not exist.

Back to part 3

A year of Covid-19 (3) – the Irish experience of following ‘the science’

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Following ‘the science’ and its scientists that we looked at in the two previous posts does not look well in hindsight, as a short review of the course of the pandemic in the Irish State demonstrates.  In the early days these were forecasting 20,000 deaths, six times the current figure which is just over 3,300, and an even greater over-estimate than the influential Imperial College paper that forecast a possible 500,000 deaths in the UK.

At the start, what characterised the response, just like Britain, was complacency.  On 4 March the Chief Medical Officer Tony Holohan of the HSE stated that “as things stand” there was no reason why the St Patricks day festival could not go ahead, and he did not believe that it was proportionate to prevent Italian rugby fans from visiting Dublin for a cancelled match.  The attendance of thousands of Irish racegoers at the Cheltenham festival also went ahead.  From the point of view of the generalised lockdown that was later to be implemented this was a catalogue of mistakes.

The State supposedly had a policy of test and trace, in which all cases could be identified and followed up to ensure isolation.  The system and its resources were quickly shown to be inadequate, with it only subsequently being admitted that test and trace did not identify where infections came from.  Prof. Philip Nolan from the National Public Health Emergency Team (NPHET) stated that “we would like to go back and find out where people are getting the virus, but we don’t have the time or resources to pursue this academic exercise”.  In any case, in October researchers from Beaumont reported that up to two out of every three infections could be missed through poor technique when people are being swabbed.

At this early stage the policy on testing was confused: so to be tested before March 12 a person had to be symptomatic or either in close contact with a confirmed case or have travelled from an affected area. Then having one symptom was required, then the list of symptoms changed, and if this threshold was passed the person needed to be in a priority category.

These early mis-steps have led many to see the issue as being one of weak or incomplete implementation of policy rather than the policy being misconceived in the first place.  The record suggests the latter.

The island of Ireland could not isolate itself from the rest of the world so could not avoid importing the infection.  Having imported it, it was always going to be impossible to identify all cases since most were asymptomatic.  Social distancing and isolation of suspected cases was considered to be the equivalent of the mass quarantine implemented elsewhere but was not.  The measures adopted simply slowed the spread of the infection, justified to protect the health service, but with the by-product that doing so gave it time to mutate, as it did.

Much bigger ‘mis-steps’ were made at this time, again flowing not from failure to adequately implement policy but as a result of its conception. On March 6 the representative organisation of private nursing homes, Nursing Homes Ireland, (NHI) banned all visitors to its homes.  Four days later Tony Holohan of the NPHET questioned the closures “before they are really necessary” while the Department of Health only eventually gave approval to the action ten days after NHI had introduced the restrictions.

In early March Holohan was claiming that ‘we had reacted very early and with significant action compared to other countries’, although the performance of these other countries seemed to be held up as some sort of exculpation rather than a pointer to a failing common approach. For the Chief Medical Officer their response “in the first instance had to focus on dealing with community transmission of this virus.  There was simply no way of protecting nursing homes or any other institutional setting if we don’t control the spread of this infection in the community.”

NPHET later claimed that it was not until late March that research pointed to the threat of asymptomatic transmission in care homes although by the end of May Paul Reid, chief executive of the Health Service Executive (HSE), was acknowledging that “there are obvious gaps in clarity and responsibility in the overall governance and oversight of private nursing homes.”

By mid-April Holohan was stating that vulnerable groups in care settings were a priority, but by that time there were 330 outbreaks in residential cares facilities, with concern expressed about under-reporting.  While boasting of the “unprecedented level of support” given to homes the HSE was unable to provide up-to-date figures for deaths.

Not much later Holohan was stating that it was “not realistic to think we could keep it out of homes”, while by the end of April it was reported that 735 people had died in residential community settings.  By early May the mortality rate in nursing homes was three times that among the rest of population, accounting for 61 per cent of deaths (including those in other residential facilities).

By the end of May the Department of Health had been warned by the health regulator of more than 200 “high risk” nursing homes, while receiving “just an acknowledgement” and “no response”.  NHI had quickly raised concerns around PPE and hospital discharges, but by late March 88 per cent of homes had bought either their own PPE or used home-made. Almost half of nursing homes said that they had to wait 10 days for test results to come back, and publication of cases in particular homes was not provided (unlike for hospitals).

By June it was apparent that nursing and other residential facilities were not the only health and social care facilities where infections were occurring.  At the start of the month, it was reported that more than 200 people had contracted coronavirus while in hospital in 102 outbreaks. By the end of August, it was also reported that about 90 per cent of all cases among over-65s were of nursing home residents (between March and end of June), amounting to almost 6,000 cases resulting in 968 deaths (56% of the total at that point).

By the beginning of the following month concern was again being expressed at the rise in cases among older people.  In early October a NPHET letter noted a ‘sustained increase’ in cases, with home residents accounting for more than half of the 1,810 virus-related deaths, but with Holohan again asserting that it was not possible to document all patterns of infection and that measures directed to the whole population were needed.

The Health Information and Quality Authority (HIQA) expressed concern that there was no “consistency of approach” on whether nursing home residents should be tested where staff had tested positive. The HSE chief clinical advisor claimed that older people could not be “siphoned off safely” but the chief inspector of HIQA stated later that “not all centres where staff have tested positive have undertaken a programme of resident testing.”

In November, NPHET priorities, according to Holohan, were protection of the most vulnerable, continued resumption of non-Covid health and social care services and education of children; but by mid-November it was reported that in the week up to Oct 31 there were 56 outbreaks of infection in nursing homes and 33 associated with hospitals.

Lockdown however appeared to be getting some results, even if this was little more than postponement rather than eradication. This was now success, as was the perceived protection of a health system unable to adequately do its own job of protection.

By the beginning of December the Irish state was hailed, especially by itself, as the best performing in Europe measured by the average number of new cases.  Unfortunately, even in success the most significant threat remained, with Holohan expressing concern at the level of infections in nursing homes despite the highest Level 5 lockdown.  Hospitals also remained a problem, and on 13 November it was reported that pre-admission tests for Covid that had been recommended for hospitals were not being practised by all.  Anne O’Connor, the chief operations officer of HSE, stated that guidance had been changed in the previous two weeks.

By December the problem with hospital acquired infection was continuing, with over 200 confirmed cases in the four weeks up to 13 December and more than 400 picking it up in hospital in two weeks in January.  By the new year the Irish State had gone from the being the best in Europe to being the worst in the world in terms of growth in cases.  The State went from 80,000 cases in nine months to doubling this total in three weeks.

Since there had been a partial opening before Christmas this was held up for blame but there remained no evidence that cafes, hairdressers or clothes’ shops were a problem; it was a question of a seasonal infection flourishing in its best environment with any human interaction facilitating spread.

Doing away with the latter altogether was the only logical extension of the existing policy and all the variations on the different social distancing rules were the proverbial number of angels dancing on the head of a pin.  Very few wanted to go there, and those who might would face the difficulty that closing down sites of infection might have to start with hospitals and nursing homes, with 100 outbreaks in the former from July to mid-December and 93 in the latter.  A study in mid-January reported that the rate of infection among hospital staff in Galway and Dublin was six times that of the local community.

Despite the months of restrictions and despite the worst-in-the-world figures there did not appear to be excess deaths.  The prevailing narrative appeared to tell a story that did not add up.  One aspect however appeared stubbornly consistent, the median age of those dying was reported in mid-January to be 82.  This outcome was consistent with the North despite its apparent different path, with people aged 75 and over accounted for 77.7 per cent of ‘coronavirus-related’ deaths and with 91.5 per cent having some pre-existing condition, Dementia and Alzheimer’s disease being the most common.

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Vaccine nationalism

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The decision to attempt to prevent vaccines made in the EU getting to the UK via Northern Ireland led to a flurry of arguments that almost all mirrored the same nationalist impulse of the EU that was being criticised.  This was true of some on the left as much as any other.

Production of vaccines is an international effort and equitable access could only be carried out by agreed international Governmental and regulatory action.  If it is true, as has been claimed, that AstraZeneca had claimed that it would provide vaccines to the EU from its UK operation and promised the UK it would not, then its failure to deliver the number promised to the EU is a neat example of international production suffering from the imperatives of capitalist ownership.

On top of this, it is obvious that the conflict between the EU and UK would not have arisen without Brexit, even if its supporters are trumpeting the cack-handed approach of the European Commission and celebrating the faster advance in vaccination of the UK compared to the EU.  This opportunity for Brexiteers arises because it involves one of the few industries in which Britain is a leading participant.

Prize for top hypocrite in the affair must go to the DUP leader Arlene Foster who expressed outrage at the EU’s decision to invoke Article 16 of the Irish Protocol. This allows either the EU or the UK – in the event that the application of the instrument leads to “serious economic, societal or environmental difficulties that are liable to persist, or to diversion of trade” – unilaterally to take “appropriate safeguard measures”.

This, she condemned as an “incredible act of hostility” that places a “hard border” between Northern Ireland and the Irish Republic.  “By triggering Article 16 in this manner the European Union has once again shown it is prepared to use Northern Ireland when it suits their interests but in the most despicable manner – over the provision of a vaccine which is designed to save lives”.

The impulsive triggering of Article 16, before hastily being withdrawn, shows that the EU is indeed motivated by self-interest, something that no one with even a modicum of sense would entertain the least doubt about for a second.  Socialist opponents of Brexit didn’t oppose the project because there was any illusion in the purity of the motivations of the EU.

However, a unionist complaining about the hardening of the Irish border, that they spend every minute of existence fretting over the permanence of, is too absurd for words. Since a number of leading figures in her party have already been calling for Article 16 to be invoked by the British, the charge of an “incredible act of hostility” is more than a bit rich.

In the North of Ireland, to point such things out is called ‘whataboutery’, and is frowned upon, which means circumlocution is constantly required to call someone a hypocrite and allows those who exercise it most to get away with it most often.  The North of Ireland is getting its vaccine from Britain so no one would be missing out if they weren’t allowed to get it through a supply across the Irish border.

What it shows is that disputes between Britain and the EU have the potential to reverberate inside the North and act as a catalyst for political instability, exactly what the Protocol was to supposed to avoid but reflecting the fact that the political agreement it was to support is unstable. Unionists are reminded, and demoralised by the fact, that for some essential purposes the EU determines economic and social policy and the sovereignty of the British has been diminished; while nationalists have been reminded that the EU is not a cuddly benefactor but has its own interests and that the idea of upending the Protocol they support has just become more conceivable. The latter will at least have been assuaged by the quick change of approach by the EU, promptly enacted following representations by the Irish member state, which will have had some effect.

Some on the left saw the episode as displaying the necessity for big pharma to be nationalised, or put under public ownership, as the misleading euphemism puts it.  In fact, state ownership would have exacerbated rivalry between producers of the vaccine.  Brexit is itself testament to the destructive rivalry that can be introduced to economic and social relationships by state competition.  The pharmaceutical industry is characterised by international research, development and production and it would not help if state ownership overlaid company competition.

The answer to the equitable distribution of vaccines is international cooperation that cannot be assumed to be achieved by capitalist states that might (and just has) rather hindered the international cooperation that is needed.  The socialist answer is to recognise that the separate interest of different companies and states stands in stark contrast to the common interest of workers in the pharma companies and those outside, in every country, most vulnerable to the virus and the catastrophic effects of lockdown.

It is in their joint interest that they, their families, friends and communities are protected, recognising that no single country will have immunity unless they all have it.  This points not to state ownership but the ownership of the workers, in workers’ cooperatives, working together across borders in taking over the current development of vaccines in their own interests.

If socialism is the answer, the answer is the action of workers not capitalist states, although again and again so many parts of the left forget this, if they were ever aware of it in the first place.

 

A year of Covid-19 (2) – following doctor’s orders

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The view that there is a single scientific approach to the Covid-19 pandemic has had a number of consequences.

Firstly, it became simply a scientific question; at most politicians had some discretion to accept or reject the extent of the measures proposed by the scientists and doctors, but no wider political questions were involved despite the dramatic effect on people’s everyday lives, their employment and their freedoms.  Any regard to these was argued to be putting ‘the economy’ before lives and particularly denounced by some on the Left.  The Government could pay for any of the economic consequences and let the science-led effort to control the virus take effect.  Anything else was letting politics interfere and was by definition unjustified.

Secondly, because there was a single science, whatever scientific approach was adopted was the right one, again with only a difference of degree acceptable, so that whoever was appointed the scientific leadership was by definition the single scientific authority.  Others could comment, but as we saw in the links in the last post, the scientists themselves were under pressure to accept that there was a single scientific approach, resulting in censorship and self-censorship of critical views.

One example of this was the criticism of the voluntary approach adopted by Sweden, pointing at certain times to its relatively high death toll, while failing to highlight that this had resulted from the failure to protect the elderly in care homes.  Yet exactly this same failure was held up to excuse the record of the Irish state, which pointed to the failure of other countries to protect its elderly population as some sort of exoneration.  In April the Health Service Executive national clinical advisor was pointing to the failure in Ireland not being unique and that many countries were struggling with outbreaks of infection in homes.

At this stage between 45 and 60 per cent of all Covid-related deaths in the UK, Belgium, France, Spain and Italy had been of residents of nursing homes.  Yet rather than this being a series of warnings, of wake-up calls that something was wrong with the prevailing approach, it was accepted.  The chief medical officer Tony Holohan later stating that it was “not realistic to think we could keep it out of homes”.

In 2017 the Irish State had adopted a management plan to deal with emergencies, which it then ignored when the pandemic threatened.  Instead, it made the top leadership of the Health Service Executive the scientific leadership, which almost immediately appeared to have so much authority devolved to it that it also appeared to have almost total control.

This in itself was pretty extraordinary since the HSE (and the Health Service in the North) was widely regarded as being something of a disaster, while the bureaucrats with medical qualifications that had presided over the failing health systems, along with the various governments, were for that reason considered responsible.

In the North, the extent of the failure was brought home when it was reported that Poles living there travelled home for treatment rather than wait years on a waiting list; and that one GP had disclosed that some of his patients who had fled the war in Syria were in ‘disbelief’ at the state of the North’s health system.  The same one sometimes held up as a model for the two-tier service in the South.

Such was the moral panic induced, the responsibility for the ability of the health services to do its job, to protect the health of the population, instead became the responsibility of the population to ‘protect the health service’.  In this, the situation in Ireland North and South was the same as in Britain, the architects and executive of the failing system made their failure the responsibility of the people they had failed.

Since the health services could not protect the people and had already failed, it was clear from the start that the people would fail to protect the health service. Simple and routine daily activity became the occasion for berating the public that they were letting the health service down, or as the Health Minister in the North put it, was equivalent of going into a hospital and ‘slapping a nurse.’

The blinkered approach that considered there was a single scientific approach, and the domination of this approach by a medical bureaucracy, meant that wider considerations were ignored.  It became a situation I have described before as one in which those with only a hammer perceive every problem as a nail. This was obvious when the strategy adopted became subject to the inadequate resources of the acute health systems North and South.

It is important to recognise the domination of health services by the acute sector, the hospitals, which always downgraded social and community services and public health; the price of which in the pandemic has been paid in lost lives.  It is not as if the problems with this have never been acknowledged.  In the North the necessity of greater emphasis on community services has been repeated in reports as often as it has been disregarded following their publication.  Public Health has always been the Cinderella service, although at least she got to go to the ball; in the health service she would have got to go to the laundry in the outhouse.

The National Public Health Emergency Team (NPHET) married the erroneous view that there was a single scientific approach with the acute services bias common to many health systems.  This common bias helps explain the similar failed approach adopted by so many countries that ironically justified each other’s failure by their own.  Yet the nature of the threat has been obvious from the start.

In the last week of December, it was reported that a majority of the 2,150 deaths in the Irish State were accounted for in nursing homes and that in this, and in infections among hospital staff, it was among the worst in the world.  In the North it was reported that 39.2 per cent of all Covid-19 related deaths in 2020 were of care home residents in hospital.  In effect, the gathering of the vulnerable in enclosed locations became not protection but helpless confinement, and the mechanism to provide treatment the instrument of infection.

The common approach of generalised lockdown was justified by the need to protect an inadequately resourced health service that precluded targeted protection of the vulnerable in homes and outside.  Yet it is admitted in NPHET minutes reported over a week ago that “the majority of the excess hospitalisations, intensive care admissions and deaths would be amongst those aged 60 – 79 Years”.  The policy of precisely targeted measures and resources to protect these people was rejected on the grounds that this would lead to unsupportable demands on the heath service.  Was it not taken into consideration that targeted protection would act to reduce potential demands on the health service?

Despite all this, the authority of the medical leadership has withstood the outcome of the failed approach adopted, in Ireland and in other countries.  Instead, the measure of success is not avoiding failure, but failing better.  That is, not being so bad that the country comes out looking worse than others.  The performance of the Boris Johnson government has therefore been a bit of a get out of jail free card, and the Irish is not the only political leadership on these islands that has relied on nationalism for political protection, not excepting the Johnson government itself.

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