Goodbye Covid-19?

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

‘Lockdowns . . . a failure of public health policy.’

Coronavirus: 133 patients in intensive care as pressure on hospitals builds

When University College Dublin virologist Dr Gerald Barry was interviewed by ‘The Irish Times’ and asked ­– why have we so many cases when we’re so highly boosted? – he said ‘Even asking the question points to the root of our problem in Ireland and in many parts of the world, we are using a tool that isn’t designed to stop infections and then wondering why it didn’t stop infections.’

‘I would strongly advocate for a complete reassessment of everything we have done to this point, identify everything else that could be done that would help, knock off everything that isn’t feasible or is unaffordable and do everything else.’

So we have failed? – ‘The problem with a “do more” strategy is that some countries that have demonstrably done less to curb the spread of infection, such as England, seem to be doing better overall.’

Just such a reassessment was recently reported in ‘The Guardian’ from Professor Mark Woolhouse, ‘one of the country’s leading epidemiologists’, who has written a forthcoming book, ‘The Year the World Went Mad: A Scientific Memoir’.  Lockdown, he says, ‘was a lazy solution to a novel coronavirus epidemic, as well as a hugely damaging one”.

The day Britain went mad is reported as when ‘the No 10 briefing in March 2020, cabinet minister Michael Gove warned the virus did not discriminate. “Everyone is at risk,” he announced.’  To which Woodhouse responds: “I am afraid Gove’s statement was simply not true. In fact, this is a very discriminatory virus. Some people are much more at risk from it than others. People over 75 are an astonishing 10,000 times more at risk than those who are under 15.”

 “We did serious harm to our children and young adults who were robbed of their education, jobs and normal existence, as well as suffering damage to their future prospects, while they were left to inherit a record-breaking mountain of public debt.  All this to protect the NHS from a disease that is a far, far greater threat to the elderly, frail and infirm than to the young and healthy.”

“We were mesmerised by the once-in-a-century scale of the emergency and succeeded only in making a crisis even worse. In short, we panicked. This was an epidemic crying out for a precision public health approach and it got the opposite.”

That Covid-19 is a disease that discriminates is a point made often on this blog and by others, which should have signaled that a blanket approach wasn’t warranted.  A recent paper analysing this has recently been published, which shows the disparity in effect by age, despite the difficulties in measurement. 

It records that in ‘Twenty-five seroprevalence surveys representing 14 countries were included . . . the median IFR [Infection Fatality Rate] in community-dwelling elderly and elderly overall was 2.9% (range 0.2%-6.9%) and 4.9% (range 0.2%-16.8%) . . . IFR was higher with larger proportions of people >85 years. Younger age strata had low IFR values (median 0.0013%, 0.0088%, 0.021%, 0.042%, 0.14%, and 0.65%, at 0-19, 20-29, 30-39, 40-49, 50-59, and 60-69 years . . .’

These IFRs have been calculated using data from 2020 and are therefore before widespread vaccination, at least in richer countries and before the less virulent Omicron variant.  We can therefore expect these numbers to have fallen not only due to vaccination but also better hospital treatment as lessons began to be learned about ventilation etc.  The paper notes that ‘absolute risk values still have substantial uncertainty’ and mentions the low number of elderly in the studies examined by the paper, but which might also reflect uncertainty about the total number of infections and number of deaths actually caused by Covid as opposed to deaths of people with Covid.

The link here to IFRs for various diseases shows that for the younger age groups Covid-19 is far down the list.  According to the European Centre for Disease Prevention and Control here Influenza (over all ages) appears more severe than Covid-19 for those aged below 30 although this also depends on the virus, host issues, and other factors.

The paper also notes that ‘besides age, comorbidities and lower functional status markedly affects COVID-19 death risk. Particularly elderly nursing home residents accounted for 30-70% of COVID-19 deaths in high-income countries in the first wave, despite comprising <1% of the population. IFR in nursing home residents has been estimated to be as high as 25%.’

Professor Woolhouse argues in ‘The Guardian‘ article that:

‘the country should have put far more effort into protecting the vulnerable. Well over 30,000 people died of Covid-19 in Britain’s care homes. On average, each home got an extra £250,000 from the government to protect against the virus . . .  “Much more should have been spent on providing protection for care homes,”

He ‘castigates the government for offering nothing more than a letter telling those shielding elderly parents and other vulnerable individuals in their own homes to take precautions,’ something this bloggers’ wife found particularly galling as medical personalities and politicians congratulated themselves and were congratulated by others for efforts on her and others’ behalf which consisted of nothing much more than a letter.

As ‘The Guardian’ goes on in reporting Woodhouse’s views ­– ‘The nation could have spent several thousand pounds per household on provision of routine testing and in helping to implement Covid-safe measures for those shielding others and that would still have amounted to a small fraction of the £300bn we eventually spent on our pandemic response, he argues. Indeed, Woolhouse is particularly disdainful of the neglect of “shielders”, such as care home workers and informal carers. “These people stood between the vulnerable and the virus but, for most of 2020, they got minimal recognition and received no help.”

The British Government, according to Woodhouse, thus “lacked a convincing plan for adequately protecting the more vulnerable members of society, the elderly and those who are immuno-compromised.”  

“Lockdowns aren’t a public health policy. They signify a failure of public health policy.”

Back to part 1

Forward to part 3

Hello Omicron

Omicron puts scientists on red alert

Back in December the Deputy First Minister warned that Omicron will hit Northern Ireland “like a ton of bricks”.  “Once again we find ourselves dealing with what potentially is going to be the worst time through the whole of the pandemic,” she added. ‘We are continuing to work around the clock with public health officials to understand the impact because there are things that we currently know, but there are also things that we do not know.’ 

The Chief Medical Officer for Northern Ireland said that he was ‘more concerned than at any previous point in the pandemic’. The Chief Scientific Advisor said that it was inevitable that cases would double every couple of days.

In Dublin the Health Minister said that ‘the reality is the situation is very stark.’  Asked about the comment of the English Chief Medical Officer, Chris Whitty, that hospitalisations will be as bad if not worse  than last winter, he said ‘we could well see that, yes.’  Leo Varadkar warned that the situation was ‘beyond our worst feras’

Mike Ryan of the World Health Organisation has said that Omicron will ‘fill the hospitals up, we will fill the ICUs up.’ Similar warnings were made by politicians and health authorities across the world.

A month later the tone has changed. The Ministry for Health in Northern Ireland has admitted Omicron has not been the threat anticipated, now acknowledged in the South as well.  Learning to live with Covid has been accorded greater weight alongside recognition that lockdowns cannot continue forever. There are now more prominent questions about exactly what the threat from Covid-19 is, and just how many in hospital have been admitted with Covid or for something else but just happen to also be infected.  

At the end of last week it was reported that 44 per cent of those in hospital In the Irish State were diagnosed with Covid only after being admitted, some of whom will not have been admitted due to its effects. While nearly 1,000 Covid related patients are in hospital with the infection almost 500 patients are awaiting discharge from hospital but have nowhere to go, filling beds and potentially posing a risk of further infection.

The need for adequate social services is a longer story than ‘War and Peace’ and as unfinished as most people’s efforts at ‘Ulysses’.  The health service bureaucracy complains that services are under threat from Covid but the real problem is its own failings, in capacity and organisation.  In the South there was much dismay at news that five times more senior managers were recruited in the second quarter of last year than medical staff.

These senior managers complain about staff absences due to Covid but many of these staff are not actually sick but following the isolation rules recommended by them.  And this is not the only part of their lockdown strategy which is worse than useless and is falling apart.  Useless, because testing results take so long when people are most infectious in the first few days.  Useless because many people have been unable to get tests when they want, Useless because to be effective tests would have to be carried out continuously in a way that cannot be performed.  At €200 per PCR test it is an expensive waste.  Falling apart because testing cannot meet demand so it is not even a reliable indicator of extent of infection. It has been estimated that between 300,000 and 500,000 infections went unrecorded last week, up to about 10 per cent of the population. In what possible way could testing act as any sort of measure of control? 

The argument between the National Public Health Emergency Team (NPHET) and Government about whether hospitality should close at 5pm or 8pm now looks laughably pointless, while widespread use of derogations calls into question the whole policy as does reduced periods required in isolation.  At the end of the first week in January there were fewer people in ICU than before Christmas. What is happening is that lots of people are now getting natural immunity.

Even in December it was still clear that infection was primarily an issue for elderly people and especially those unvaccinated.  In mid-December it was reported that 68 per cent of deaths related to Covid in the previous week were among those with an underlying condition and two-thirds were among those aged 65 or older.  This age group accounted for 50 per cent of hospitalisations while the unvaccinated accounted for 45 per cent of patients in ICU.  The unvaccinated were more likely to be in hospital and had a higher death rate. The majority in ICU over the last month have had the Delta and not Omicron variant.

When warnings were first made about the new Omicron variant it was stated by the CMO in England, Chris Whitty, that ‘there are several things we don’t know [about Omicron] but all things that we do know are bad’, which wasn’t true.  The administration in the North and Government in the South took their cue from these warnings.

When the Taoiseach Micheál Martin warned that the projections by NPHET were ‘sobering’, one journalist noted that ‘nobody pointed out that NPHET’s projections have frequently been almost drunkenly inaccurate.’  He admitted that this might not matter given the large numbers involved but this brings us back to Whitty’s remark about all the things known about Omicron were bad.

It was widely argued that the danger of hospitalisation, requirement for ICU, and death – let’s call each of these ‘ Z’ – were all a function of cases, let us call this ‘X’.  The severity of the Omicron variant was known from South Africa to be significantly milder but when the sheer number of cases was taken into account a milder variant with a lower severity – let’s call this level of severity ‘Y’, meant that a much bigger X multiplied by a lower Y still meant a very large Z, i.e. large number of hospitalisations etc.  All making perfect sense in algebraic terms but pretty meaningless in real terms.

If the severity of infection was lower there could be no assumption that a higher number of infections with a mild disease would be a calamity rather than a lot of people suffering a mild infection; but as we see, Whitty and those following simply assumed that a higher number of cases would almost inevitably bring a higher number of hospitalisations, requirement for ICU, and deaths.

Given the much increased transmissibility of Omicron and large numbers forecast it is hardly justified to believe that any general lockdown was going to work, an inadequate testing regime would be relevant, and that a strategy bases on protecting everyone could possibly work.  A policy of focused protection of those known to be most vulnerable is the only one to make sense but hostility to this, in the form of the ‘Great Barrington Declaration’, has been widespread for a long time and defaulting to it would have opened up those responsible for the existing approach to questions.

The reason not to do so, as at the start of the pandemic, was the claim that with so much uncertainty about the new virus the precautionary principle was required: assume the worst and prepare for it while perhaps hoping for the best.  Unfortunately, this explanation doesn’t convince.

If it must be assumed millions would be infected then it should have been obvious that generalised lockdown could not work, even more obvious now with Omicron.  The precautionary principle would require that an optimistic view of its efficacy could not be assumed.  The precautionary principle would also mandate a serious analysis of the prospective harm caused by generalised lockdown and I’ve yet to see any.

Relevant also is the fact that right from the start of the pandemic it was not a question of complete uncertainty – some things were known and should have been acted upon but were effectively ignored.  This was that the real threat to the population was highly correlated with age, with the more elderly suffering a risk multiple times greater than of younger people, which would point to a focused strategy of protection.

Instead of precaution, the real reason was the assumption that the health system could not cope with a sudden increase in cases but, since these were overwhelmingly those at risk, this too was no answer to those advancing the argument of an alternative approach.

Forward to part 2

Covid and the failure of the NHS

Thirty-six years ago I had an interview for a temporary clerical officer job in the local hospital.  One question was – ‘Who is the most important person in the health service?’

Thinking on my feet as I sat in the interview I answered – ‘the patient.’

Which is the right answer.

Although this doesn’t appear to be the case today.

While I was recruited to possibly the very lowest rank in the health service all those years ago, those today at the very top appear to have a different view.

Last week the Minister for Health at Stormont, Robin Swann, issued a public consultation on whether new staff recruited to the health service and social services should be compulsorily vaccinated.  The Minister both in the consultation and in interviews more or less ruled out vaccination of all staff, considering it relevant, or perhaps only possible, for new and agency staff.

It should be remembered that the Minister and Executive ensured that all health service staff, including office staff with no contact with patients, were offered vaccination last year before patients described as extremely clinically vulnerable – those with suppressed immune systems for example. 

When some of these patients were sent the draft of a letter proposing that they ensure all visitors to their homes take a Covid test, the project disappeared when it was returned with a question whether this would also include the visit of district nurses.

The public consultation launched last week mentions that “Trade unions, employees and employers will have a key role in this consultation, but the views of the general public will also be very important.” It also mentioned relatives, and failed to mention patients.

This week the Minister announced he wanted the introduction of a mandatory Covid-19 passport scheme and this has been agreed by all the parties except the DUP.  So, while the Minister wants anyone going into a restaurant or pub to demonstrate that they are vaccinated, or not otherwise a risk, he thinks it’s acceptable for nursing staff dealing with the care of vulnerable patients to be excused this requirement.

Part of the reason for the recent increase in Covid is obviously the partially seasonal nature of the virus. In the case of Northern Ireland however it is also due to the relatively lower numbers vaccinated than Scotland, England and Wales, despite having had a head start on them.  It currently has a higher number totally unvaccinated and a lower number fully vaccinated with a booster shot.

Not only has this probably led to increased severity of infection – requiring hospitalisation – but also increased the sickness level of health service staff (up to 20% among nurses).  Media reports following Freedom of Information requests indicate potentially lower vaccination rates among nursing and social services staff than among the rest of the population.

The trade union UNISON has opposed mandatory vaccination of nurses and called for a voluntary approach of persuasion.  The union might appear to be on more solid ground if it did not make the stupid point of asking why health service staff should be singled out.  Management might also strengthen its position if it were to at least mention the needs of patients, that their views should be canvassed, and that protocols were in place to ensure that the most vulnerable patients were not unnecessarily exposed to unvaccinated staff.  Both might have more of a point if they had followed through on their argument and were to point to a rigorous campaign to get staff to voluntarily vaccinate.

Unfortunately, as argued before, the needs of the NHS bureaucracy have been put before the needs of the people it is supposed to serve; summed up in the mantra that we must ‘protect the NHS.’  Politicians wave the possibility of the closure of Emergency departments; of the health service “about to topple over” if immediate action is not taken; and warnings by senior medical staff that “this phase of the pandemic is now the toughest”.

Just like the Tories in Britain, they point to the crisis they helped create in order to point away from their own culpability.  Instead, it becomes an alibi that implicates those subject to a collapsing service who are blamed for not following guidance and advice.

They congratulate the staff on their heroism in order to absolve themselves while making their heroism a continuing requirement of their work; wrap themselves around the NHS brand in order to avoid and deflect away from their role in its failure, and threaten future collapse as a move to pre-emptively protect . . . themselves.

This partially explains Swann’s particular penchant for lavishing praise on NHS staff with ‘proof’ of seriousness by repeated announcements of additional funding.  When advertising the gruelling pressure on doctors and nurses dealing with the pandemic, he presents himself as a vicarious fellow sufferer.  Identification of the NHS with himself reaches a pinnacle when he says that “I don’t have enough nurses, I don’t have enough doctors.”

Additional funding, as he acknowledges himself, cannot conjure up and deploy staff out of nowhere; its announcement is instead more usefully deployed as a response to internal requests for action by medical staff raising concern at where services are heading.  Additional funding cannot immediately increase capacity, especially if it is non-recurring and limited to a one-off injection, but unfortunately long-term planning has not been a strong feature of the NHS.

So, we are now enjoined to accept renewed restrictions involving Covid-19 passports in order that the NHS not be overwhelmed.  Unfortunately, it is abundantly clear that the NHS has already been overwhelmed.  While pointing to the crisis and away from themselves we are supposed to listen to the words of politicians and not recall their responsibility and years of inaction.

Years of unprecedented underfunding of the NHS are now presented as a historic problem that attaches to no one in particular today.  We are simply reminded that the task now, our task, is to ‘protect the NHS’ in an unprecedented pandemic.

Many socialists get very defensive about criticism of the NHS, as if it were some sort of socialist enterprise in the midst of capitalism.  The reasons for this are numerous, including that it is free at the point of delivery, is not run for a profit and is owned by the state.

Except that it is not free, and is funded by a regressive taxation system; many private companies make a lot of money out of it; it is owned and managed by a capitalist state, and having worked in it for 22 years I can confirm that there is nothing democratic about the way it is managed.  Like all state ownership, it is bureaucratic and unaccountable, as repeated scandals exposed within it testify.

It is not therefore simply a question of underfunding, and to uncritically defend it because the only alternative is conceived as privatisation is a mistake.  Socialism involves different ownership of the productive forces, including those that protect and improve our health, and this democratic workers’ ownership is not a question of a name on a title deed but of how productive forces are organised and developed.  

Workers are not ignorant or indifferent to the bureaucratic failings of the NHS because they are the ones who use it, while some better off workers, middle classes, and definitely the richest all use private health care to one degree or another.

It is argued that the pandemic is unprecedented but the longer restrictions continue the more circumstances can no longer bear the description of exceptional.  The lower rate of vaccination might go some way to explaining the greater effect of increased incidence of Covid than in other countries, while the later roll-out of booster vaccinations than in other countries might similarly explain renewed restrictions.  Nevertheless, it is the declared necessity of protecting the health system that is employed as justification for the new restrictions announced this week.

We have been informed repeatedly about the pressure which health service staff have been put under, and our reliance on them has been reason enough for most people to accept restrictions.  That this pressure has been harsh is real enough but this in itself does not permit the demands of the politicians and bureaucrats to go without challenge.

There have been enough first- and second-hand reports that not all NHS staff have been under similar pressure to ask why this organisation cannot more effectively and efficiently deal with Covid and the other demands placed upon it. Some of the reasons we have mentioned above ­– that the NHS is a bureaucracy in which individual talent and commitment can only have individual effects.

That the NHS is failing is shown by some of the latest statistics from the Northern Ireland health service which show that between the years 2019/20 and 2020/21 total admissions to hospitals fell by 30%; average occupied beds fell by 17.9% and total theatre cases fell from 110,605 to 59,762, a fall of 46%, and 50% on the previous year’s figure.

What these figures show is that it was not simply a question of capacity but the capability to use that capacity and the inability to use it efficiently.  A factor in this will no doubt be increased sickness of staff, but the higher rate of unvaccinated staff contributed to this. Other factors will be the inability to institute infection control without reducing capacity with the creation of much-hyped ‘Nightingale Hospitals’ illustrating the problem.

The results of this failure can be seen in increased waiting times; for example in the 112,915 patients waiting to go to hospital at 30 June 2021, up from 97,243 at 30 June 2020, and 88,203 at the same time in 2019; an increase of 28% over the two years. This is an example of only the most obvious and measurable outcome, which most damaging effect is in the impact on health.

The British government has successfully protected itself by using the NHS as a shield because its popularity has facilitated this, which in turn is partially because the only alternative to it is perceived as privatisation, which is widely unpopular.  Much of the Left, with its state-centred view of socialism and greater predilection for knowing what it is against rather than what it is for, has put itself in no position but to follow the government, with the add-on of demanding more money.

When the London Olympics opened nearly ten years ago, it was noted that the NHS was part of the show, a tribute to its place in the national psyche.  What it wasn’t was a tribute to socialism, no more than was the presence in the show of James Bond and the Queen.  

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

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?

Covid, Brexit, Protest, and the Left too

A couple of months ago in a Facebook discussion with a supporter of Zero Covid I argued that if he really did believe that Covid-19 represented the threat to humanity that he appeared to claim he should demand (albeit critically) more coercive restrictions on democratic rights from the State.  Nothing, after all, is more important than life.

He disagreed, insisting that socialists can never support restrictions on democratic rights by the capitalist state.

Unfortunately the proponents of Zero-Covid supported all the previous restrictions and if they are to be consistent then these new restrictions must also be an unfortunate necessity.  All the rest of the Zero-Covid demands have been made to the state and who else is going to implement them?  Again, it was they who have been hysterical in their claims that capitalism was engaged in what amounts to mass murder.

Of course, Covid-19 did not and does not represent the existential threat claimed and much of the left is wrong about this.  Their position becomes more and more untenable as people appreciate the personal threat to themselves, they tire of lockdown restrictions and more people, especially the vulnerable, get vaccinated.  Were it to become clear that Covid-19 is endemic and therefore requires regular vaccination, as with the flu, their policy would become obviously stupid.

So it should only be embarrassing that they now condemn the rough tactics adopted by the Metropolitan police when it broke up the protest of the murder of Sarah Everard.  To be consistent they should have defended the policy of the police while salving their conscience by condemning the roughness of its implementation.

Of course, the Tories have taken advantage of the widespread acceptance of restrictions of social interaction by proposing to introduce new laws that go a long way to criminalising protest altogether, as should have been feared from the start.  I recently posted another comment on Facebook pointing this out and suggesting that those who didn’t see this coming should avoid politics and find something else to do.

Meanwhile, the Labour Party is to engage in ‘parliamentary warfare’ over NHS pay while forgetting that austerity would be worse had the Tories implemented the greater lockdown restrictions demanded by Labour.  The cost would have been even greater had the Zero-Covid policy of some on the left been adopted; a policy that is the product of an opportunist attempt to attack the Tories but like all opportunism is incapable of taking a longer-term view.

It is no defence of this policy to declare that you also have a policy against austerity; one which makes heroic assumptions about the capacity of the working class to resist it.  Opportunism here is accompanied by ultra-left perspectives that envisages the capitalist class paying hundreds of millions of pounds for furlough payments, loans and grants to business and the shortage of tax receipts from workers etc.

Again, the Tories will claim the legitimacy of the bill to be paid and the left will again be exposed as it argued a policy that would have needlessly cost more. The policy of Zero-Covid simultaneously relies on the repressive apparatus of the state to work, while positing that this state can be defeated in the implementation of austerity that the policy requires.

We will leave aside any stupid notion that the combination of pandemic and austerity will somehow galvanise the working class to revolution; although these conceptions are precisely how much of the left envisages socialist revolution coming about – capitalist crisis producing a mass political consciousness that their political conceptions and interventions are incapable of envisaging coming about in any other way.

Despite their serial corruption and incompetence in most of their response to the pandemic the Tories are ahead in the polls.  Their bedrock support has relied, and continues to rely, upon their support for Brexit.  The pandemic has been used to hide the damage done by it and the Labour Party has been too afraid and too stupid to lead a political attack on it.

The Guardian columnist Polly Toynbee can write that “Labour will plug away, exposing myriad flaws in the dreadful trade deal” but this is meaningless if you don’t oppose it.  It looks hypocritical, since Labour supported the deal, and it looks like the dishonesty typical of politicians given Starmer’s avoidance of even mentioning the word, refusal to seek renegotiation of the deal, and previous policy of pushing the Tories to ‘get Brexit done‘.

But once again, while Labour fails, much of the left is actually worse, having supported Brexit from the start and campaigned for it in the referendum.  The damage to working class living standards and the austerity it will entail is on them.  They too, just like the Tories, are relying on Covid and the Tory press to hide Brexit’s damaging effects and just like Boris Johnson they will – child-like – deny any responsibility.

Two alternative narratives have developed – the fault is with Brexit or the fault is with the big bad EU.  The left that thought it could move on will be cut in two by these scissors but there is little chance that it will fess up and admit a mistake.  As a rule the left does not admit mistakes and certainly not ones as big as this, especially as they cannot consign it to history.

A few years ago a comrade on the left from the Official Republican tradition said to me, while we were watching the May Day parade in Belfast, that so much of the left was rotten that it basically had to die away before a new generation of socialists could make progress. He may even have included his own tradition in that, and in my view this should certainly be the case, but it isn’t as simple as that.  The corruption of Marxism perpetrated by the nationalist and statist left both in Ireland and Britain will not be easily cleansed.

In the meantime, you can hardly blame the British working class if it ignores much of the left, it is quite right to do so.

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

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?

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’

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.

Back to part 2

Vaccine nationalism

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.