Tag Archives: Covid-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Back to part 3

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Back to part 2

Vaccine nationalism

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Forward to part 3

Back to part 1

A year of Covid-19 (1) – following ‘the science’

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On 20 April last year the lead story in ‘The Irish Times’ was a report of research led by an Irish scientist that there may have to be repeated waves of Covid-19 epidemics until enough of the population is infected to provide herd immunity.  At best there would be three more infection cycles before 60 per cent was infected, enough for immunity.

It reported intense debate on the subject, with World Health Organisation epidemiologists warning that there was no proof yet that having the infection would confer immunity for a significant period of time.  Later, when it was apparent that immunity did occur, the response was that the level of antibodies recorded in previously infected cases declined more or less rapidly so that immunity would also decline.  This however did not take account of the body’s reduced need for higher levels and its newly acquired capacity to ramp up again if required; it also did not take account of the role of T-cells in fighting infection.

The point however, is that herd immunity was not dismissed as beyond the pale and was not considered a euphemism for mass murder.  In fact, as the link to the debate below records, herd immunity is not so much a strategy as an outcome, the inevitable outcome of defeating the pandemic.  That it has been understood as anything else illustrates the impairment of critical thought that has accompanied the physical restrictions introduced by lockdown.

Throughout the pandemic, governments in Ireland, Britain and elsewhere have been keen to demand that people follow ‘the science’ (as they put it), backed up by certain scientists or doctors, usually on the state payroll, who have given authority to government policy even when it is sometimes reported that they don’t agree with it.

The appeal to authority, the idea that there is one ‘science’ with one rational direction available to policy makers, the unwillingness to debate, and repeated charges of lack of transparency; all these are very far from any scientific approach.  The debate here on what the correct approach should be is an example of what has not been presented to populations.  The effects of this have been many and not always acknowledged.

I recently had a disagreement on Facebook with a supporter of a ‘Zero-Covid’ strategy, who refused to accept our differences were political, claiming that there was a psychological issue involved with my approach (along with some other remarks I have committed to amnesia).  The alternative that I argued, of focused protection of the vulnerable and opposition to generalised lockdown, was not received as a legitimate one to be considered, but simply one to be condemned and damned as so mistaken as to be the product of some psychological imperfection.

What was remarkable was that the principal issue facing the world was argued as something above, beyond or otherwise disassociated from politics.  Marxists, and this guy is one of long standing, are supposed to base their ideas on the reality that science, morality and all aspects of human behaviour are permeated with politics.  Science has its political aspects and the actions of the Government and state obviously does, especially when they involve drastic restrictions on human activity.

So, to regard Covid-19 as a non-political issue is absurd.  That such an argument could arise on social media is not at all surprising since everything under the sun appears on it.  In this case however the response is not uncommon, and is a mirror reflection of the approach taken by almost all Governments, which is to deny legitimacy to any questioning of their policies.  We can see this clearly for example in the pathetic ‘opposition’ of Keir Starmer, whose only point of disagreement is that the lockdown policy of the Government has been implemented incompetently and incompletely.

The policy of inducing fear into the population is ably assisted by a willing media seeking the simple and the sensational, through stressing the lethal nature of the virus; repetition of statistics on cases, hospitalisation numbers and patients in intensive care; the numbers with ‘long-Covid’; the prominence given to sufferers among the young, and of course the rising number of deaths.

This goes along with a determined policy of down-playing the specificity of those most under threat, and claims that the virus is either out of control or will utterly swamp the health service.  The fear generated has enough truth behind it to get acceptance of actions that would in normal times have generated heated opposition; including cancelled urgent cancer operations and a policy of isolation of individuals that admits that increased domestic abuse and enormous deterioration in mental health will follow.  The cumulative effect in generating fear is to dampen and discourage further the exercise of people’s critical faculties.

Instead of opposing all this, much of the left has echoed it and amplified it, as my minor Facebook argument illustrated.  This Left demands stricter and longer lockdowns and ‘zero-Covid’, i.e. no cases and no deaths from Covid.  To state that there is an alternative approach to generalised lockdown, and admit that some deaths will almost certainly result, is to damn oneself out of one’s own mouth.  How dare you advocate a policy that accepts any deaths!

We will, for the moment, leave aside the obvious truth that the current lockdown policy has abysmally failed to prevent avoidable deaths, and that the ‘Zero-Covid’ policy has yet to indicate what injury and deaths would flow from its implementation.  It has failed to admit that it would have to be enforced; that the state would have to do the enforcing and that it would have to apply much enhanced powers of coercion to attempt to achieve it.  An additional result would be to limit further the space for open debate on different approaches and alternative futures following the pandemic.

The policy of the Left has not been to encourage scientific debate but to back one element of the consensus view that lockdowns are the answer.  The problem here is that there has been far from a free debate on what the best approach to dealing with Covid-19 is and not, as the left would have it, a refusal to follow through on what is so obviously the right, or rather only, one.

These two articles, here and here, show that there is no single and unequivocal scientific approach that supports lockdown.  Rather, there is an intensely political debate within the scientific community that has suffered from, but resisted, restrictions on discussion.  The result of the attempt to impose a single approach has been the development of what has been called ‘groupthink’, censorship and self-censorship and something of a climate of fear, in which critical thought is seen as criticism of the scientific establishment, which might be damaging to the careers of those who engage in it.

The inevitable uncertainties generated by a new viral infection requires engagement with the issues that the political establishment does not believe the population can handle, something the media reinforces with its superficial treatment of every issue.  The mechanisms and apparatus that circumscribes political argument has been easily employed to narrow debate on the right approach to dealing with the pandemic.  The idea that the issues around it are non-political is, to repeat, ludicrous.

This political debate has been grossly distorted by an anti-scientific assault by the far-right, typified by the often-imbecilic antics of Donald Trump, with his alternative denial of the virus, its importance, his success in dealing with it, and his recommendation about drinking bleach.  The mass base of scientific ignorance he mobilised in the US has been reflected everywhere to a greater or lesser extent.  The effect on rational criticism of the prevalent lockdown approach has been to prejudice reception of it and create a barrier to its discussion.  Sections of the left have joined in, unwittingly contributing to the anti-scientific shut-down of rational debate.  As with so many issues, the opposition to lockdown by sections of the right, whether of the crazed anti-vaxxers or libertarian conservatives, has been the cue for some on the left to take an opposing view.

We are over a year into the pandemic, about a year since it hit Europe, and there is no excuse for lack of debate on how to deal with it. Only episodically has one taken place in Ireland and like everywhere else, any alternative to lockdown has been subject to condemnation. It has had its own share of far-right sceptics that have made the task of challenging the lockdown consensus harder; but the fact is that the policy of lockdown has failed, and the experience of the last year has proved it, which is what we will review in the next post.

Forward to part 2

The Left and Covid crisis

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The policy of lockdowns has been approved by many on the left, with the additional argument that they have not been strict enough.  Some appear to believe that pandemic induced crises necessarily open up opportunities for revolutionary crises.  These are considered opportunities to mobilise the working class to resist attacks on its social position and turn it towards socialism.  Crises then become both the necessary and sufficient condition for political revolution.  What these sufficient and necessary conditions might actually be is not considered.  That question has been answered and is no longer a question.

Previous crises have not entailed socialist revolution, but rather than investigate why this is, the approach has been to lament the weakness of the revolutionary left and the treacherousness of existing working class leaders.  Crises therefore are expected to do much of the heavy lifting of working-class political consciousness, allied to an unexplained rise to prominence of revolutionary organisations.  Rather than see such crises as occasions of potential radicalisation which must be based on prior conditions giving rise to class consciousness, this consciousness is assumed to arise from crises itself and the spontaneous activity generated.  This latter activity is then fed by Left economic and political demands that further radicalises it.

This process however requires prior development of the working class, including organisation and consciousness which already disposes the working class to defend itself through ‘spontaneous’ mobilisation that rests on some prior socialist consciousness.  We know that a lack of such consciousness has not been overcome by crisis in itself because of previous decades of defeats of working-class struggle; from a sober assessment of current working-class consciousness and passivity, and from appreciation that the last real revolutionary period rested on this prior development of socialist organisation.  Of course, many struggles in this period were betrayed by reformist and Stalinist leaderships but these betrayals had precisely the effect of setting the working-class back decades.  It’s why continuing opposition to these political trends in the working-class movement is a continuing imperative.  But it is wrong to simply repeat the explanations of previous defeats that happened decades ago as applicable now to much later generations.

In demanding a more stringent lockdown the purveyors of this general view rally behind the most lurid and sensational predictions of the effects and deaths that will be caused by Covid. The pandemic itself has become a ruling class conspiracy – “as far as the ruling elite is concerned, if the old and infirm die and allow for further cuts to pensions and health care, that is to be regarded as a positive good.”  As has been pointed out: across the world capitalist governments have spent fortunes in response to the pandemic.  If their objective has been to save money they have failed abysmally. In Ireland and UK the state has borrowed billions and seen their debt mushroom as a result.

If their favoured policy of total lockdown requires emulation of the approach of China, Australia and New Zealand etc., as some have claimed, then why are these countries not also in on the conspiracy?

This left appears oblivious to the cost of lockdown in terms of deaths, illness and social and economic loss; and sliding over who suffers these costs: from the lost jobs, education, domestic violence and damage to menial health.  It may point to the massive and wasted expenditures on testing and tracing systems that don’t work, and from failed and corrupt contract awards for PPE etc., but what has facilitated this?

They don’t stop to consider how their approach supports the politicians and state bureaucrats who cancel cancer and other life-saving treatments in order to protect their politicised health choices, and a health system that is failing and for which these politicians and bureaucrats bear responsibility.  Instead, their demand for lockdown puts the onus on the population to accept the most restrictive forms of social control and denial of civil rights, opposition to which is another one of their conspicuous silences.

Instead they oppose the opening of schools, though children are not at significant risk and infections in schools are low (see here and here and here).   One organisation dismisses schools as a “child-minding service’ employed to force parents into work, oblivious to this being a service that many parents are very glad of. It complains of trillions going to corporations but ignores that this is a product of lockdown; or do they believe that the state would give money to furloughed workers and not corporations?  What would happen if they didn’t, would all these corporations survive?

This organisation proposes committees that “would provide the means to organize a Europe-wide general strike to compel the closure of schools and nonessential production and allow workers to shelter at home.”  A stay away from work in order to get paid to stay away from work!  Since when did the capitalist class pay for an indefinite general strike? And how would one be organised with the mass of workers at home and socially distancing?  How would any revolutionary potential of a general strike be realised, i.e. acknowledging that society cannot simply close down but must continue to run, raising the question of who runs the economy – who rules?  How would this be possible unless major sections of the working class were actually at work?

“Massive resources must be invested to provide a high standard of living to everyone throughout the pandemic, including the resources required to maintain online learning for students.”  But how could anything be invested if the workers required to deliver the investment are to stay at home?  Or is this yet another essential section of the working class that must work – like so many the total-lockdown supporters refuse to acknowledge.

“The claim that there is “no money” for such measures is a patent lie. Trillions of euros have been handed to the banks and corporations in bailouts since the beginning of the pandemic. The resources exist, but they are monopolized by a corporate and financial oligarchy.”  The utterly un-Marxist idea is again advanced that money can equal “resources” and that pieces of paper are of use without human labour to deliver the real goods and services for which they are exchanged.  And anyway, isn’t the monopolisation of productive resources by a separate class not called capitalism?

Indeed it is, which once again demonstrates that every intervention by the ultra-left telescopes into demanding the overthrow of capitalism.

“The fortunes of the rich must be expropriated and the major corporations transformed into public utilities, democratically controlled by the working class as part of the socialist reorganization of economic life on the basis of social need, not private profit.”  But how are “the major corporations” to be put under the control of the workers unless they are actually at work?

As we know, Covid-19 is a specific threat that must be defended against.  When advocates of total lockdown call young people having a party ‘granny killers’ they acknowledge this reality.  Yet the pretence is still made that everyone is equally threatened at least to such degree that no strategy must distinguish between those who are old and/or otherwise vulnerable and those who are relatively young and healthy.  Students must go home, schools must close and young people socialising is an existential threat.

What this does is weaken the protection of those most at risk because it calls into question any restrictions.  If there really was no significant differential impact then many thousands of young people would have died. They haven’t.  Many working class people, as I have noted in previous posts, and here in a previous comment by a reader, are ignoring the rules when it suits.  The left advocates of complete lockdown are really now following Bertolt Brecht when he said – should this left not just elect a new people?

Most people however do register the greater threat to older and vulnerable people but rather than this being informed, encouraged and organised it has more or less been ignored by the authorities when it comes to organisation of the response.  Tightening restrictions affects everyone, and in some ways young people more, and undifferentiated relaxation exposes older people more because it cannot be admitted that they should still be shielded or socially distanced; just in case everyone decides that is the way it should stay, that this is the correct approach that should now be implemented and those in charge have got it wrong.

This approach has failed in Ireland, Britain and across Europe and further afield.  Part of the left doubles down and says the lockdown is not tough enough, without weighing up the cost or admitting that total lockdown has never actually been implemented because it can’t.  You cannot close down society, which relies on the continuous labour of millions of workers.  Admission that ‘essential’ work must continue never admits the enormous extent of what this entails given the development of the forces of production and division of labour involved.

A blanket threat in many ways protects the authorities from blame for failure because Covid-19 becomes an all-embracing indiscriminate threat that is difficult to defend against because of this character.  It allows them to introduce harsh social restrictions and coercive powers that for most people are totally unnecessary, and which some on the left who, were they consistent, should support because (1) they should endorse a fair claim to be necessary and (2) totally warranted given the assumed threat.  What could be more important that saving lives?

The longer the pandemic lasts the more incredible become the demands for total lockdown and ‘zero-Covid’.  The failure of existing restrictions has been too great to inspire notions that just more of the same will be both successful and at an acceptable cost.  Given the attacks stored up for the future, there will be plenty of time to reflect on the lessons.

Covid before cancer. Or maybe not.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Covid-19 – the random killer?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Another lockdown – Why?

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There are no easy solutions or answers.  So said Doctor Michael McBride, Northern Ireland’s Chief Medical Officer, when announcing the return to lockdown.  There were hard and difficult choices, all with bad outcomes, but what was good for health was also good for the economy, poverty does kill people.

Just before this the Health Minister, Robin Swann, announced that the new restrictions were required in order to protect the NHS.  We could not turn away Covid patients he said – ‘who would suggest such a thing’ – suggesting instead that other patients be turned away, without being so dramatic is saying so of course.  McBride said that we needed to ‘help protect the non-Covid health service’, not long after one hundred planned operations in the Belfast Trust had been cancelled.

The announcement involved a presentation that included graphs of new cases, number of tests and numbers of hospital in-patients, but no graph on the number of deaths.  The Northern Ireland Statistics Research Agency latest weekly report recorded that in the week ending 9 October the total number of deaths in Northern Ireland was 348, of which 89 were due to respiratory causes.  The number of deaths where COVID-19 was mentioned on the death certificate, whether or not COVID-19 was the primary underlying cause of death, was reported as 11, which was just over 3 % of all deaths during the period.

To those who thought Covid was exaggerated Doctor McBride said that they needed to ‘wake up’ to the number of cases, number of in-patients and number of deaths.

Two questions were then asked repeatedly by the journalists invited to speak at the presentation.  What was the evidence that the new measures were required and what happens if it doesn’t work?

The question on evidence wasn’t answered; one journalist was referred to the minutes of the UK experts group SAGE and to unspecified peer reviewed articles.  No one asked whether the members of the Executive were limited to this, or were offered this as an answer if they had asked the question. ‘It worked before’ was one further response to the question.

To the second question – what happens if it doesn’t work? – the answer was that the public must follow the guidelines, so implicitly it’s your fault if it doesn’t.  Only near the end of the press conference did the Chief Scientific Advisor Ian Young state that people’s behaviour would have to change after the end of lockdown.  Elsewhere it was reported in one newspaper that the document informing the decision on a new lockdown had stated that further interventions will be required “early in 2021 at the latest.”

It would also seem that relaxation of restrictions at Christmas with the “likelihood of increased population mixing” in the run up to it is a significant consideration. (No, I don’t understand the rationale behind this either.)

The document apparently reports concern that Covid hospital admissions will rise to 450 to 600 at the peak; while the average number of NHS Acute services beds available in Northern Ireland was reported as 3,891 for 2019/20 and 3,882 in the previous year.  The average number of occupied beds was identical in both years at 3,239.  The forecast peak of Covid-19 patients of 600 would therefore occupy a forecasted maximum of 18.5% of the average number of occupied beds at the peak or 15.4% of available beds, before any plans for temporary expansion.

This includes all Acute beds and it would appear that the document has the aim of having a total of no more than 20% of general medical beds, around 320, being occupied by Covid patients.  Of course, it is more complicated than this and lots of uncertainty surrounds the ability to create additional capacity, and especially how much will actually be needed.  There is no explanation reported on the inconsistency between a target of 320 beds and expectation of up to 600 being required.

Given the lack of transparency, avoidance of answering questions, finger-pointing and general arrogant condescension of the Health Minister and experts it is no surprise they didn’t provide the level of information provided in a short newspaper article.  Non-sequiturs, plain contradiction and pontification are regarded as the currency that is required to get the population to do as it’s told.  And the population in the main accepts the argument, such as it is, and gets on with generally keeping to the rules except when it doesn’t suit them.

The latest Department of Health figures for 16 October show 3,711 beds available, 180 less than the average last year, with 211 taken up by Covid patients and 615 unoccupied.  The figures also show that of 104 ICU beds available 26 are taken up by Covid patients with 21 unoccupied.  No doubt the number of beds occupied will increase as it always does in the winter with the onset of influenza infections.

The effect of winter pressures is already being felt in Care Homes with 301 respiratory outbreaks being reported and 72 being classified as Covid related, with a further 10 suspected to be Covid.  Around three quarters of ICU and Care home outbreaks are therefore not Covid related.  The increased pressure on beds will also most likely reflect the same pattern.  If the NHS is overwhelmed by Covid it will not be because Covid in itself is overwhelming.

The figures for the growth of Covid outbreaks in Care Homes is a cause for concern while ‘protect the NHS’ may again be interpreted as a need to get elderly patients out of hospital  and into Care homes in order to free up beds – regardless of testing beforehand.  It was remarkable that in the press conference the appalling death toll in Care Homes was not referenced or any pledge made to protect their residents.

If the Health Minister and his experts therefore have an argument justifying their approach, it is not that Coivid-19 is an especially lethal threat but that the health service cannot cope with the additional work.  So the focus becomes one of reducing the work on non-Covid patients by creating Nightingale Hospitals that use existing facilities and existing staff and involve relatively little activity, while the capacity of the rest of the Service is massively reduced. The overall efficiency of the NHS therefore plummets just when it needs to increase.  And this is called ‘success’, and we are all asked to applaud it.

Rather than address this issue as the primary problem, which might raise the question how we got into this position, we have instead the enormous task of shutting the rest of society down (in so far as this is possible).  While those most vulnerable are, or can be, identified the message is given that everyone is more or less threatened, when this is not the case.  And because it’s not the case the population more and more ignores the rules when it suits, which allows the politicians and bureaucrats to sermonise and talk nonsense, such as the head of the British Medical Association in Northern Ireland telling us that “success leads to complacency, complacency leads to failure.”  You might think that if a successful strategy leads to failure you’ve got the wrong strategy.

The approach of the politicians and health service bureaucracy has the comfortable effect (for them) of making the population the problem, requiring that it accept the shutting down of much of its normal everyday activity.  Much of the services provided by the NHS is also cut because the NHS is already, how shall we put it, not up to the job.  The politicians and bureaucracy responsible for this situation then demand of the population that it support and approve of this, garnering its sympathy because many of the staff who work in the NHS are now exhausted.

Which, brings us once again to the question of what is the right strategy.  While the North once gain goes into a level of lockdown the Southern Government is discussing going to Level 5, the most severe level of restrictions in its five-level menu.  The prospect now looms of repeated expensive lockdowns that lead only to a higher number of cases when they end.

In ‘The Irish Times’ someone took out a full-page advertisement opposing the current approach and supporting the Barrington Declaration.  This has led to objections and claims by some that they will no longer buy the paper.  The facts quoted in the advert are nevertheless true: that current life expectancy in Ireland is 81.5, the median age of death from Covid-19 is 83, a total of 20 people under 44 have died from Covid-19, and the record of Covid-19 deaths is one that includes those who died with Covid and not from it.

Controversy around the declaration has involved arguments that have little to do with what the Declaration says or what its argument is, but concentrate on the dubious political character of some of its supporters, its supposed nefarious objective of mass murder and criticism of what it does not say, as opposed to what it does.  A number of letters to ‘The Irish Times’ illustrate this.

It is claimed that the facts quoted are intended to mean that the deaths of older people are of less significance, although the point of the declaration is to make protection of the vulnerable the priority, while it has been the current strategy adopted that has demonstratively failed in this regard.

This fact is also construed to imply that these older people lived longer than they should have expected.  In any case it is life-expectancy at 83 that matters, not at birth, which is six years for men and eight for women.  But the first claim is without support from what the advertisement says and the second fact, while absolutely true, would require more information to demonstrate that at age 83 Covid-19 reduces the remaining life span of six or eight years from everyone who dies from it.

Another line of criticism is that sheltering will not work when there is widespread community transmission.  But we have widespread community transmission now after lockdown and there is no reason why measures that are supposed to socially isolate everyone cannot be strengthened for those most at risk.  From some on the left especially, the argument is simultaneously put that lockdowns should be more restrictive and would not work for a targeted minority.

The new lockdown in the North is an admission that the previous one failed.  That there is the expectation of another one of some sort later is further evidence.  That the population is treated as too ignorant to discuss these issues is a repeat on a massive scale of ‘trust me I’m a doctor.’  The modern notion of an ‘expert patient’ is gone.

If the failure of the current policy is unrecognised it is hard to have any confidence that the costs of the lockdown in future deaths will be acknowledged and accounted for.  The only thing that will save the current policy from ignominy is if its central claim is untrue – that we face a massive death toll if some sort of society-wide lockdown is not the major plank of State policy.

Arguments over fighting Covid

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

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

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

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

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

Instead we have a lower level of restrictions, although still based on the same assumption that everyone must be isolated in order to also protect the vulnerable.  To present a show of real intent thousands of Garda, at hundreds of road blocks, have attempted to prevent the whole population from moving outside their county (as if these were epidemiologically significant boundaries) in order to deliberately gum up traffic, when such movement is entirely legal.

Apparently Varadkar had some tough questions for CMO Tony Holohan, like what was the metric for success and how long would the lockdown last?  There has even been speculation of following the widely trailed policy supposedly to be implemented in the North – a ‘circuit breaker’, i.e. a relatively short lockdown to bring the virus ‘back under control’.  But this can’t explain why a shorter repeat of the last lockdown will not result in the same increase in the virus when it ends.

Unless, of course, as I noted in the last post, the spread of Covid is much greater than reported, in which case the rationale for lockdown is even more undermined.

Varadkar also apparently said to the Chief Medical Officer that Ireland needed a plan in case this one didn’t work and a plan for re-opening if it does, and a plan for communications as well.  A bit rich coming from Varadkar you might think, since if we work our way backwards on this list, the Government screws up communications each time it attempts to communicate; a plan for re-opening should already be in place since we have already had a re-opening; and we should also have a plan from the Government if lockdown doesn’t work since we have had a lockdown and it didn’t work.

Which neatly brings us to the need for an alternative.  As in the previous post, we can briefly review what has been proposed by some of the left, by People before Profit (PbP), which has beefed up its press statements and explained a little more about its zero-Covid policy.   This it seems “does not mean we reach absolute zero in terms of cases. It means crushing the virus to the point where we can test, trace and isolate every single case that arises, stopping the spread of the virus.”

But if up to 30% of positive cases show up as negative then it is impossible to “test, trace and isolate every single case.”  Never mind the prior problem that, as The Guardian newspaper reports, “researchers at UCL said 86.1% of infected people picked up by the Office for National Statistics Covid-19 survey between April and June had none of the main symptoms of the illness, namely a cough, or a fever, or a loss of taste or smell the day they had the test.  Three quarters who tested positive had no notable symptoms at all.”

The proposals by PbP support level 5 lockdown and include expansion of testing and tracing and health services; increased workplace inspections and more money spent on teachers with the potential for closure of schools “until the virus is crushed.”  Inexplicably, there is no specific mention of those most at risk.  Nothing is said about how long this lockdown would have to last and what the financial cost would be.  Nothing, in other words, about the deaths and illness caused by prolonged isolation, a health service diverted from its day job or the long-term effects of a prolonged lockdown.

There is also nothing on the level of State coercion that would be required to impose a more severe lockdown with an indefinite timescale.  People before Profit is kidding itself if it believes that this would not be required.

It calls for a harmonised response across the island but the problem isn’t harmonisation, it’s that both jurisdictions are making the same mistakes. To little public response the Health Minister in the North reported that there was, after all, to be no announcement on plans for the NHS to return to normal operation – how and when it will return to delivering all the health and social care that consume more lives but are not now so politically prominent.  There was a time when Sinn Fein complained of political policing, but now it is in office we have the previously undreamed problem of political health care.  

The Guardian has another article ‘Why herd immunity strategy is regarded as fringe viewpoint’ that criticises a strategy focused on protecting the most vulnerable, those at most risk.  Unfortunately it ignores the failure of the current strategy in Britain, which is due not simply to Tory mendacity and incompetence.

The alternative is damned for being outside the ‘scientific mainstream’ and having extreme right-wing supporters, neither of which proves anything more than these bald facts.  It quotes one professor who ‘is among many scientists who are sceptical that the most vulnerable in society can be adequately identified and protected.  “It is a very bad idea,” he said. “We saw that even with intensive lockdowns in place, there was a huge excess death toll, with the elderly bearing the brunt of that.” In the UK, about a quarter of the population would be classed as vulnerable to Covid-19.”

This is stated almost as if 25% is too great a number to protect.  So let’s go for 100%?    They can’t be adequately identified and protected?  So why can’t the health service and social services be mobilised to identify them from its records and then put in place measures to support and protect them?  Why would it be a problem, for example, to identify everyone in elderly person’s homes?  Or receiving treatment for those underlying conditions that make them vulnerable?  Even the first measure might have made a major contribution to protecting half of people who died but were supposedly being protected by measures aimed at everyone else.

And let’s not forget that primary among that to be protected was the health service itself.  As I’ve pointed out before – isn’t it supposed to protect us?

Another biostatistician is quoted as saying that actually this strategy of protecting the vulnerable was tried – “Shielding of the vulnerable was part of the UK policy since the start of lockdown.” Except of course, this was never true, not in Britain and not in Ireland either, as the irresponsible transfer of the elderly out of hospital and into homes with their lack of PPE testing and adequate staffing amply demonstrated.  To claim otherwise is to admit the existing strategy had to entail these deaths – not something you will hear or read very often.

“What troubles many scientists is that with coronavirus no one knows how protected people are after contracting the virus, how long that protection lasts, and exactly what proportion of society needs to be immune to quell a pandemic.”  All good questions, none of which provide support for the existing strategy or damn the alternative; or address the fact that the relatively young and those without the relevant underlying conditions have little to worry about.  These concerns apply equally to a vaccine, but no one will advance them as objections to vaccination.

“It is impossible to fully identify who is vulnerable and it is not possible to fully protect them.”  But is it harder to protect them than to fully protect everyone?

‘Another concern many scientists raise is the impact on the young and healthy. While the risk of death is low in people under 40, infection can still expose them to long-term complications that healthcare could be left dealing with for decades . . . “Quite large numbers of younger people are already becoming infected at present, whether or not they are being encouraged, and there are consequences to those infections.”

There do indeed seem to be some consequences for some younger people but transparency on this, how many there are and what the effects are, is not readily available. But it is not possible to put this into perspective with a strategy that is based on treating the whole population as if it was under the same threat.  Identifying exactly who is at risk and of what is not what the current approach is about, and scare stories and sensationalist reporting are instead the order of the day.

If socialism is about building a counter-power within capitalism that fights for its replacement this must include the development of the organisation and consciousness of the working class, starting with its labour movement.  This organisation must include scientific bodies and scientific consciousness. We don’t have working class scientific organisations – bodies consisting of scientific professionals belonging to or sympathetic to the labour movement or socialism – but the Covid-19 pandemic is one more lesson that we cannot afford to accept that the state, in its welfare guise or not, will provide the protection or support we need.

Beyond the arguments over the failure of almost all capitalist states to protect its most vulnerable, and the strategies that would most successfully address this need, lies this longer term task that the labour movement and socialists must accept and seek to address now and after the pandemic is over.