Part of the problem is that the Left has turned the NHS into a fetish.
“The basic source of left orthodoxy is not hard to trace, It lies in the widespread over-romanticised attachment to the NHS on the left, which derives from a belief that the 'principles of 1948', under which it was set up, form the basis for a socialist health care service.”
(Left Orthodoxy and the Politics of Health, in Capital & Class 11, Summer 1980)
But, of course they don't. The NHS was established to meet the needs of capital not labour. As Carpenter says, the Left seemed to have more difficulty understanding this with the NHS than it did even with other elements of the welfare state, such as education. Most of the Left could understand that education is geared to the needs of capital; it concentrates on the kind of education and training required by capital to provide the kinds of workers in demand at the particular time. In truth, large sections of the Left have lost even this understanding. The kind of statism that dogged the Left for a century, based upon the ideas of Lassalle and the Fabians, and promoted by Left social democrats and Stalinists, but which had begun to weaken in the 1960's and 70's, has grown ever stronger since the 1980's, and for much the same reason that Carpenter identifies here. The Left lost the ability to think critically. It became obsessed with fighting immediate battles over cuts, austerity, privatisation, job losses and so on, and did so simply on the basis of placing a minus sign wherever their enemies placed a plus sign. The obvious manifestation of that was to defend existing state capitalist institutions, to defend the existing capitalist state itself, including, as can be seen today, defending institutions like the BBC, which acts as the propaganda organ of the capitalist state. It completely failed to present, as an alternative, any independent working-class analysis or solution.
“Let us take for granted that the NHS is different. Nevertheless, if we accept the 'socialist' character of the NHS at face value, it leads to the acceptance of a particular kind of socialism, obscures the way in which the NHS serves fundamentally conservative purposes. It has led socialists in this country to think of health services as the 'natural' means of tackling the ill-health effects of capitalism, and it has on the whole led them to accept the medical mandate to define health and ill-health even when criticising aspects of doctor's practice.”
(ibid)
As Carpenter says, any Left critique of the NHS has amounted only to a criticism of its failure to live up to the socialist principles of 1948, not to question whether those principles were themselves socialist in any case. The more the NHS came under attack from, particularly, Tory governments, though the Labour government of the 1970's inflicted cuts on the NHS too, the more the critique has become not of the NHS itself, as a state capitalist institution, but merely of the failure of Tory governments to provide adequate financing of it.
“In capitalism... health and ill-health are both made to serve the needs of capital accumulation.”
(ibid)
Capitalism sought healthy workers to facilitate capital accumulation, but in so far as capital made workers ill, resulted in accidents and so on, a section of capital profited from this too via the provision of drugs, surgical treatment, the provision of devices and so on. The NHS fulfils a useful ideological role in presenting a fiction that everyone is provided with free healthcare on an equal basis, and on the basis of need. But, it never has. Its not free, but paid for out of the wages fund, as healthcare is a component of the value of labour-power. Workers buy it collectively from their wages in the form of an insurance payment, or tax.
In the process, by enabling healthcare to be undertaken on massive Fordist lines, they also reduced the cost of healthcare for the bourgeoisie too, who benefit from the production of new drugs and so on at much reduced costs, because of economies of scale. Every survey also shows that the provision of healthcare is neither provided equally across the country nor on demand. There is greater provision in more affluent areas, and many of the workers who require treatment for their particular complaints do not get it. The current decisions to deny treatment to many workers, for cancer or many other life-threatening conditions, in preference to providing treatment for COVID patients, is a case in point. But, it also assumes that every individual starts from an equal position of health, whereas it is always the case that the bourgeoisie, or even just the more affluent, tend to start with better health than do workers.
“Of course, in reality, working class people have sickness problems which the NHS does not deal with at source, or even adequately after the event...”
(ibid)
As Carpenter says, illness is a “profoundly decollectivising experience”. In many ways, its a bit like the way people turn to God when they suffer bereavement, or some other tragedy, because such events always appear as individual, personal events, and lead to a desire for some form of succour, for events that are outside our own individual control. Its no wonder that, in all those decayed urban areas, a similar attachment to the capitalist state, as benefactor, provider of doles and even minimum security, and a paternalistic, more or less feudal, relation of dependency is created from it. Its no wonder that its in those areas that this semi-feudal relationship of dependency to the capitalist nation state manifests itself in the form of a nationalistic desire to keep its bounty for the preserve of the natives, and deny it to foreigners, and leads to reactionary ideas such as Brexit.
Left orthodoxy,
“... helps to foster 'the NHS illusion' that the problem of ill-health in our society can be largely dealt with by more and 'better' health services, the 'better' meaning to a considerable extent 'whatever doctors decide'.”
(ibid)
And, this feeds directly into the mechanisms of the medical-industrial complex, because individual doctors are under tremendous pressure from those medical-industrial companies to prescribe the latest drug etc.; they are under pressure to conform with the orthodoxy within the medical-industrial complex itself, which has been obvious in relation to responses to COVID, and to the demonisation of any medial scientists or practitioners, such as those that have signed the Great Barrington Declaration, who dared to point out that the Emperor had no clothes on, when it came to the claims about the existential threat posed by the virus, or the requirements for lockdowns as a means of responding to it.
The proponents of lockdown have tried to use the old Stalinist tactic of the amalgam to defame those scientists that have signed the Great Barrington Declaration, and who argue for focused protection of the elderly and vulnerable, not by dealing with their arguments, but by talking about the libertarian ideals of some of its backers. Yet, no one points to the actual medical-industrial complex that channels millions of pounds into universities like those listed in the FT article cited above, such as Imperial, Cambridge, and UCL, in research grants that, in turn, results in the development of very expensive drugs that produce billions of pounds of revenue for those drug companies, paid for by the capitalist state, out of the NHS budget!
As described above, the current test and trace scheme is useless. It would be useless even if the tests were reliable, and the computer systems to identify contacts, and to trace them worked perfectly. In Germany, which has as close as can be considered to such a system, it has seen the same surge recently in infections that have been seen in Britain, France, Spain and Italy. But, the tests are not reliable. Around 30% of positive infections are missed by the tests, whilst a significant number of false positive tests have been shown up by the fact that people on holiday who had the virus weeks ago, are still showing up as positive, because the tests cannot distinguish between the DNA of dead viruses and those of live viruses.
But, it is useless anyway, because around 90% of the population who have the virus are not tested. They are asymptomatic or not ill enough to seek testing. So, the vast majority of people who are infected are walking the streets infecting others anyway. Testing and tracing would require testing everyone every day, even if the tests were reliable. It is simply a diversion and means of giving a false impression. Yet, the focus put on testing and tracing alongside the idiotic lockdowns has pumped £12 billion directly into the pockets of the tech companies, and consultants responsible for developing the app, on top of that it has pumped billions more into those drug companies that produce the test kits, and those that analyse the tests. The only tests that make sense are those that identify existing immunity, but it is those tests that no priority is being given to.
All of the emphasis is on expensive medical solutions, be it testing, hospital treatment, or the production of a vaccine or other drugs to deal with the symptoms of the virus. All of that channels money into the medical-industrial complex on a vast scale, pumping up the profits of the drug companies and other medical services providers, swelling the personal empires of the health bureaucracies in the department of Health and NHS. Yet, a sensible approach would instead start from the perspective of simply isolating that minority of the population actually at risk from the virus. Compared to the billions of pounds already spent, on useless testing systems, the state could have simply told those over 60, or in vulnerable categories to self isolate, and could have financed that at much less cost. But, it would have provided no revenues to the medical-industrial complex, no addition to the profits of those big companies.
The policy of focused protection immediately protects the elderly and vulnerable, who are being culled in their tens of thousands by the current lockdowns, which have not even provided effective protection for the elderly and vulnerable in hospitals and care homes. And, by allowing everyone else to go about their business normally, it means that not only is the economy not destroyed, but these millions of people develop herd immunity safely at no cost. It is this herd immunity at no cost that the medical-industrial complex, of course, is most concerned about, because no cost means no profits for the big drug and medical supplies companies, no bigger empire for the health bureaucrats, and so on. Not to mention no funding for the university epidemiologists that, time and again, have told us that there was going to be some existential threat that, in fact, turns out to be nothing of the kind.
Instead, we have huge sums being pumped into the development of vaccines, with government already ordering tens of millions of them from the drug companies, at a cost of billions of pounds, even without knowing whether they are safe, or will work. In Russia, we have seen that resulting in vaccines being rushed out without proper testing, we have seen vaccine tests stopped in the US and UK, due to the development of illness by trial participants. In order to develop vaccines quickly, genetic modifications are being used, which normally would require extensive testing before any new vaccine was released generally, but governments know they cannot keep populations locked down forever, both because there would be increasing rebellions against it, and because the existing lockdowns are destroying economies, and so they are placing all their eggs in the basket of a vaccine saving their bacon. Even, so the reality is that a vaccine is not going to be ready for at least six months, and it is no wonder that, with all the pressure for it to be rushed out, there are many who will be reluctant to take it for fear of being used as guinea pigs.
We can bet that the first people its tested on will be the old, the vulnerable and the poor. If a successful vaccine is produced that is safe, then, of course, that will be great, but will it be worth all of the death and destruction that lockdown has caused as the necessary consequence of relying on its development, rather than the development of cost-free natural immunity in the intervening period? Once again, we see the consequences of health policy being determined by the interests of the medical-industrial complex rather than the interests of workers and their health.
Why (in your opinion) has test/trace/isolate succeeded pretty much universally in East Asia and the Antipodes, while failing (again pretty much universally) in Europe and the Americas?
ReplyDeleteIs it likely that the explanation is that the eastern countries were facing the original Wuhan virus, while the western countries were facing a much more contagious variant which first appeared in Lombardy, and which never reached the eastern world because those countries had already closed their borders in response to the original virus?
I'm not an epidemiologist or virologist, but my educated guess is that it will be multiple factors, such as:-
ReplyDelete1) They locked down their borders early, and so prevented large numbers of carriers bringing the virus into the country
2) They rolled out widespread testing early, on people coming into the country, so again they were dealing with small numbers of carriers, and so small numbers of people who might need to be traced.
3) The main problem with test and trace is not the efficacy of the tests, or indeed, the efficacy of the tracing mechanisms, but the fact that the virus itself is largely transmitted by people who are asymptomatic, because 90% of infected people ARE asymptomatic. Once you have passed a critical mass of infected people, you are never going to be able to test them frequently enough to identify when they become infected, or then to prevent them spreading it to others.
4) That is also then a problem with countries that rely on open borders, or that have large borders.
5) I suspect that the spread of previous SARS viruses in Asia has created a level of immunity, at least as is expected with some of the proposed vaccines, i.e. not to prevent you being infected, but to mean that you do not suffer badly from the virus, are asymptomatic. Only later study will discover whether, in fact, there are large numbers of people in East Asia who were infected, but who never showed up, because they too were asymptomatic.
6) There is a culture of routinely wearing masks in Asia, so that transmission rates were also reduced, meaning the numbers that had to be identified by test and trace remained small.
7) A study has found that those with a higher proportion of Neanderthal genes are more prone to COVID19. Neanderthals were specific to Northern Europe, so there will be few people in Asia and Africa carrying those genes.
I'm sure there will be other factors. But, the fact remains that the concentration has continued to be on infection rates rather than deaths or serious illness, which is nonsensical. We do not close down economies to prevent millions of people being infected with colds each year, for example. Yet for 90% of people COVID19 is less serious than the common cold!
I think point 5), but also superior metabolic health in their elderly, were the real factors at play. 7) is a very interesting point which I've never heard until now.
ReplyDeleteI don't believe for a second it didn't spread through the whole of populous China - like wildfire. Pretty sure they developed HI very quickly, anyway, for the reasons noted. (Unlike western countries, China has not been in the business of bigging up and broadcasting infection rates and mortalities.)
It's clear this coronavirus is like any other - seasonal. The antipodes entered their summer period recently; we'll see what happens when their winter period again (cf Eastern European countries like Poland/Czech Republic which delayed their infection waves until this season)... and whether the vaccinations they've lined up -presumably to be taken in the interim-, will make a difference.
Boffy,
ReplyDeleteBorder control is of course an enormous factor, although I'm not sure the physical length of borders is a significant factor: Canada has been one of the western world's better performers (perhaps being hit worse by SARS than any other western country had something to with that?) in spite of its huge border with the United States.
Regardless of other policies, no country has succeeded in keeping the virus under control unless all people entering the country from outside are quarantined. This permitted one remarkable success story right in our own backyard (the Isle of Man) but such border quarantine really does have to be airtight: Hong Kong suffered a second wave because they foolishly exempted the crews of ships and aircraft from quarantine (because airlines and shipping companies had said they wouldn't stop at Hong Kong otherwise, and the Hong Kong government felt they couldn't do without their business).
Rhodri Evans has noted that while before Covid the UK typically saw 400,000 entries per day, and never less than 30,000 even during lockdown, there were many days during mid-2020 when not one person entered New Zealand!
Given that Covid suppression can only really work with airtight border quarantine (which usually means keeping all foreigners out, as there's only enough quarantine capacity to deal with returning citizens), I was initially baffled by the fact that Team Zero Covid tends to be mostly Remainers while Team Herd Immunity tends to be mostly Brexiters, but I think I have a better understanding now. Leave voters tend to be strong believers in the superiority of Western civilization (and/or of the English-speaking and/or UK-based subsets of said civilization), while a lot of Remain voters (especially the young and/or ethnic minority ones) suspect that the UK, the Anglosphere and/or Western civilization as a whole is actually inferior, and feel acutely conscious of how Asia is humiliating the West in the Covid death rate statistics.
I'm conflicted incidentally on how my views on Brexit have been affected by Covid: on the one hand it does seem to underline just how futile Brexit is – if it doesn't even permit us to close our borders during a pandemic then what's the point? But on the other hand Covid has hardly painted the EU in a favourable light: indeed it is Western civilization as a whole that has failed.
While the disparity in deaths between Asia and the West may be in part down to better general health in Asia (eg much less obesity) or the cross-immunity to coronaviruses that is posited by many critics of lockdowns, is it not likely that they are also actually better at suppressing it. The key to this success is most likely (as it's the one policy common in Asia but little used in Western countries) that the infected are confined in quarantine facilities (often requisitioned hotels, which with closed borders would otherwise be empty) until a given amount of time (usually 2-3 weeks) has passed, or until they test negative. This policy was followed by all the Asia/Pacific success stories except for Australia (where quarantine was at home, but actually enforced with guards posted outside).
China and Vietnam solved the issue of asymptomatics by quarantining not just those who tested positive and/or showed symptoms, but also their contacts and their contacts' contacts: I can understand however why this would be extremely problematic if attempted in a democracy.
(continued)
(continuing)
ReplyDeleteCentralized quarantine of this type is not alien to the West: it was used in the Middle Ages against leprosy, in 17th-century Ferrera (in Italy) against bubonic plague, as well as in the 19th and early 20th centuries (in the form of sanatoriums) against tuberculosis. It was even used against flu pandemics in 1918, 1929 and 1943 (but not in later cases because by then a vaccine was available). So why wasn't it used against COVID19 – did the West no longer have the moral fibre to do what it needed to do to protect itself?
Quote from the article above:
Put bluntly, had COVID arrived in 1970, before PCR testing existed and when we still had orders of magnitude more quarantine sites and more widespread lived experience of sanatoriums, polio, and other epidemics, there is no question in my mind what would have happened. If the World Health Organization notified America about COVID in January of 1970, there is absolutely no doubt in my mind that President Nixon would have rolled out a centralized mass quarantine program within weeks. Not because he was clever or wise, but simply because that’s what all the public health manuals of the time made clear you simply had to do. The nation would not have locked down: We would never have shown that kind of weakness to the Soviets. Rather, we would have locked down infected people, their close contacts, and any other potential or suspected cases. We would have tackled the problem with the tools we had, and we would have beaten it.
I'm sceptical that your point on Neanderthal descent is significant, as this would mainly be the case for white people, and in most western countries dark-skinned people have proven to be more vulnerable. This suggests that any increased vulnerability from Neanderthal genes must be minor, and outweighed by the factors that make dark-skinned people more vulnerable: either medical ones (more likely to be deficient in vitamin D) or economic ones (more likely to be essential public-facing key workers).
Tomsky,
Yes, I suspect metabolic health (related to obesity, and this world map of obesity shows a stark difference between Asia and Africa on the one hand, and the Western world on the other) was also a factor in the low death rates in the former. Of course this doesn't explain the success of Australia and New Zealand...
Suppose there was a virus that was only dangerous to pigs, but could be contracted by other animals. So, other animals coming in to the country might be asymptomatic carriers, and they could infect other animals in the country. What would be the rational policy course? Would you close the borders to all of these anonymous potential carriers. Would you quarantine all of them, in vast holding pens? Would you lock down all other animals in your own country, even though they were at no risk from this virus? Or, would you simply introduce measures on pig farms to prevent your national pig herd from being decimated?
ReplyDeleteAll of the discussion about infection rates, why some countries have higher infection rates than others, what is the best means of suppressing infections are a complete red-herring. They are irrelevant. We did have the kind of situation you describe about a pandemic prior to PCR testing. It existed with the 1918, 1957 and 1968 Flu Pandemics. As I wrote a while ago, the 1968 Flu Pandemic killed as many people in Britain as COVID - far more globally than COVID, on a population adjusted basis - but, we did not have lockdowns or mass incarceration of the infected!
In fact, we do already have incarceration of those most likely to be seriously ill or die from COVID. In England, more than 30% of deaths are people in Care Homes, in Scotland, more than 40%. No one can seriously say that these deaths are due to an absence of lockdowns, because the people in these homes are not going to the pub or cinema and so on. Yet, it is they, not the younger, healthy people who do go to the pub, cinema, gym and so on, who are dying or becoming seriously ill. So, the question is, how are these people in care homes contracting the virus?
The answer quite clearly is that the virus is being brought into these supposedly safe and secure environments! In some cases, it is being brought into them by residents who have gone to hospital and contracted the virus in hospitals, and who have then been returned disgracefully by the NHS whilst being a carrier of the virus. The NHS has acted like a super spreader of Coronavirus into the vulnerable parts of the UK population. The NHS, of course, is the other main centre of where old and vulnerable people have both contracted and died from the virus alongside care homes. Its a repeat of the MRSA scandal from years ago, but on a larger scale. Yet, of course, hospitals too, like care homes, should be safe and secure places for people, which should be the last place where you should be at risk of contracting the virus. As it is you are more likely to die from coronavirus having contracted it in a hospital or care home than you are if you contracted it in the local pub. Using the government logic we should close down hospitals and care homes, and leave the pubs open!
So, the question is, why is it that we can introduce measures on farms to lock them down and protect animals, for example during Swine Flu or Foot and Mouth, and do it effectively, but we can't lock down hospitals and acre homes effectively to protect the health and lives of their inhabitants?
On Neanderthal genes, the study found its correlation to be about the same as the greater likelihood of people from BAME communities suffering compared to white populations. One does not exclude the other. But, the fact remains neither of these are decisive compared to age.
On Remainers and Leavers and COVID there is no necessary correlation. Why should there be? I can identify why there is a negative correlation, and I've set it out before. Remainers are overwhelmingly anti-Tory, and Leavers pro-Tory, indeed, petty-bourgeois reactionaries. The Remainers, opposition to the Tories is also overwhelmingly opportunist in nature. They looked for an easy opportunist basis on which to attack the Tories, and found it in the same basis as to oppose Trump, i.e. failure to respond to COVID with big measures, and particularly failure to lockdown. They failed to look beyond this quick short-term response, putting a minus sign where Trump/Johnson placed a plus sign.
ReplyDeleteFrom their middle class viewpoint they have an overarching belief in managerialism and the power of the state to solve all problems. From the same perspective they have no view of society based on the workplace and the role of labour in value creation. They think that the state can simply print "money", which is only worthless bits of paper, but do not look at then who is to produce the goods and services that everyone is to buy with this confetti money that will now lead to large scale inflation.
Having chosen that path, when Johnson introduced lockdowns, what were they to do? They couldn't now say, "Oh actually lockdowns are wrong." They could only complain that the lockdowns were not harsh enough, the policing was not authoritarian enough, and so on. The same with test and trace. They can only complain that t & t is being done ineffectively, not that it can never work, even though in Germany and elsewhere, where it was done effectively, it still hasn't worked, and cannot work. Most of the left has been equally abysmal.
On Brexit, it was good to see that 50% of the population see it as being a wrong decision, with the chart showing a sharp upward surge in that sentiment, with only about 39% saying it was the right decision, and that line heading down. But, Labour is again way off base in responding to this trend, again tailing the working-class rather than leading it. (0% of Remainers think they made the right decision, but only 80% of leavers, now believe they voted the right way. Nearly everyone under 50 thinks it was the wrong decision, and its only amongst the elderly that there continued to be strong support for the oncoming disaster they voted for.
Correction 90% of Remainers think they made the right decision not as in the type 0%.
ReplyDeleteI find it striking that the Great Barrington Declaration's critics have attacked it primarily on an ad hominem basis (pointing out how it was sponsored by the libertarian and Koch-funded American Institute for Economic Research) when there are strong arguments for attacking the policy of focused protection that it proposes!
ReplyDeleteNote that while at least half a dozen countries in the Asia/Pacific region (I could name China, South Korea, Taiwan, Vietnam, Thailand, Australia and New Zealand just for starters) have achieved great success by following a suppression policy, no country has succeeded with a focused protection policy. While Florida, Norway, Finland and Germany have all done a reasonable job at protecting their hospitals and care homes, none have followed a pure focused protection policy (Norway at least has a policy of test-and-trace and border quarantine) and all have still suffered far more deaths per capita than the countries of Asia and Australasia.
One problem with the focused protection strategy is determining who exactly is vulnerable: in your imaginary example it is trivial to distinguish pigs from non-pigs, while vulnerability to Covid is a function of age, obesity, vitamin D levels and immune system health amongst other examples. A more serious flaw is that it proposes the places where vulnerable people are found (not just care homes and hospitals, but also individual households containing vulnerable people) be fortified against a sea of virus raging outside: it's not surprising that no-one fully managed to pull it off, especially given that care homes and hospitals need to be staffed. (And you to seem to have too much faith in PPE on that score: perhaps the issue is that full hazmat-type suits are extremely unpleasant to work in?)
Surely trying to block the national borders to keep the virus out is more plausible, especially if you look at the problem in military terms? While castles (which would be the nearest military analogy I could think of to the hospitals and care homes that a focused protection strategy would need to protect) were of course a key feature of medieval European warfare, their function was to house garrisons which would sally out when necessary to dominate the surrounding countryside, and without this capability (which has no real analogue when it comes to fighting a viral infection) an enemy which controlled the countryside could easily besiege them into surrender.
You do make a good point about nosocomial spread, as the care home victims will almost have either been infected in hospital (by staff or directly by Covid patients) or in the care homes themselves (by infected residents returning from hospital, or again by staff). A study suggested that 44% of care home deaths in Washington State would have been avoided if all staff had worked in just one location. The actual quality of the individual care homes was irrelevant, only whether or not the staff worked at multiple locations. Another big factor in Italy's initial spread is that the WHO initially opposed testing of anyone with no connections to China – it was only when Annalisa Malara (a Codogno doctor, later awarded a knighthood) defied this WHO protocol that the Covid outbreak in Lombardy was detected, but by then it was already far too late for places like Bergamo.
(continuing)
I don't think there are good grounds for opposing focused protection. The fact that no government has implemented it, or implemented it effectively is not an argument against the strategy only against the failings of those governments. If the argument is that its not perfect or foolproof that is not an argument either, because no strategy is. Tens of thousands have died as a result of lockdown strategies, for example.
ReplyDeleteYour argument about identification falls into hat category. I challenge your claim that we don't know who the vulnerable are in the same way we can distinguish pigs from non-pigs. We know that the most at risk are the over 85's, followed by the over 80's, the over 75/s, over 70's, over 65's and over 60's. We know who all these people are individually, because that data is available from NI information at the push of a button. Fortunately, the vast majority of those people are retired, so the question of paying sick pay and so on for them to be isolated does not arise. Most will live in households with others of the same category, removing the question about shared households with non-vulnerable categories. Many will be in care homes, or hospitals, particularly in the over 85 group.
This latter group should have been the easiest to identify and protect, but has in fact been the group most exposed to the virus, and contains by far the greatest number of deaths! If nothing else, a policy of focused protection, properly implemented would have saved all those deaths for a start, amounting to probably around 30,000! Already its a more efficacious strategy than lockdown has been.
For the over 60's-65's, many of these will be in work, but as a proportion of the total vulnerable group they represent only a small minority. Having them isolate would require the provision of sick leave on full pay, or at least the equivalent of the furlough payments of 80%. But, providing such payments to this minority would have been far cheaper than the provision of furlough payments to all those workers laid off as part of a blanket lockdown strategy. That is before considering the hundreds of billions cost of lost production arising from lockdown. Again already focused protection is more efficacious.
Some in this group may have younger members of their households, though this is likely to be a small minority. Either, those younger member of the household would have to be provided with separate accommodation, or as with my elder son, he has to abide by the same isolation regime that we do. Again, socialists would demand that the state provided the adequate financial support to enable that to happen. Again it would be far cheaper than lockdown has been, and would not have the long term damaging consequences for the economy and people's lives and livelihoods.
Cont'd
Cont'd
ReplyDeleteSome of those people require care in the home, but this is no different to the question of care in a care home or hospital. It requires those providing the care to have access to proper PPE, it probably requires additional workers to be able to provide the care properly under more difficult conditions, and so on. Again, these additional costs are nothing compared to the costs of lockdown.
Then there are the people in the category of vulnerable due to medical conditions. Again, these are known to the NHS. We get a call each year to tell us to get our flu jab, for example. Contacting them poses no greater problem. If the state in March had contacted all these groups and said, you should isolate to avoid contact with the virus, and then set out how it would facilitate that, tens of thousands of lives would have been saved.
Would it have been perfect, would no one have died, of course not. Some elderly people would ignore the advice and put themselves at risk, and so on. But, the vast majority of the actual deaths could have been avoided. No strategy could be perfect. We get an average 8,000 deaths a year from flu, despite having vaccines, and in a bad year between 15,000-20,000. We could with focused protection have had fewer deaths than that.
On PPE etc. The WHO has been abysmal. It opposed using face masks early on, and that advice was parroted by the scientists in the individual countries. Had face masks been used from the start, thousands of lives could have been saved. Ensuring non-transmission in hospitals and care homes should not have been a great problem, just requiring common sense.
ReplyDeleteIsolation hospitals or wings would have helped, proper use of face masks and so on would have helped, even if they might have been out of their use by data, surely something would have been better than nothing. We know that transmission is by the virus being breathed in, and so just simple face masks to prevent infected staff from breathing it out on to residents/patients would have helped! As I've said before, it has all the hallmarks of a repetition of the MRSA, Stafford Hospital and other scandals, but worse.
As for closing borders valid if you have something like Ebola running riot, but not for something as non-lethal as COVID. The cost-benefit simply does not merit it.
(continued)
ReplyDeleteYou mentioned the 1957 and 1968 flu pandemics, but I suspect that quarantine wasn't used for those because a flu vaccine was already available by then as well as (rudimentary) anti-viral drugs. Quarantine as a disease-fighting tool is only appropriate when no vaccine or effective treatment is available, and when the disease is transmitted by casual human contact. It isn't appropriate for water-borne diseases like cholera, for insect-transmitted diseases like malaria or Zika virus, or for sexually-transmitted diseases like AIDS (where instead condom usage – the equivalent of social distancing/masks – was prescribed and is effective).
In the earliest months of the Covid crisis, the political alignment (at least in the United States) was more-or-less what I'd naturally expect. Trump and his supporters were very eager to shut down travel from China (even though a shutdown of all international travel was what was really required) while the Democrats were condemning this policy as racist. It was only by the end of March that the Trumpist right became anti-suppression (in response to lockdowns by mostly-Democratic state governors) and the left largely embraced lockdowns.
It thus isn't that surprising that the suppression camp was made up mostly of liberals and leftists, while the herd immunity camp was made up mostly of right-wingers, but what I find more surprising is that Western supporters of suppression were so eager to double-down on ineffective suppression policies while ignoring Asian successes. Imposed business closures and stay-at-home orders (the policies which Westerners describe collectively as "lockdown") are far more economically damaging than Sweden's milder measures, but are scarcely more effective at saving lives because a large fraction of the population ("key workers") must go to work and risk infection regardless, and this segment of the population is also inherently more likely to come into contact with vulnerable people, than the young highly-sociable segment who would be the first to be infected in the absence of any suppression policies.
Asians however introduced centralized quarantine, which is both less damaging to the economy than lockdowns, and far more effective at curbing the spread of the virus. They also pretty much universally wear surgical masks, while Westerners were late to start masking at all, and when they did usually went for less-effective cloth masks. Note that Australia did explicitly point out in its public information campaign that surgical masks were considerably more effective than cloth masks.
Is it that Western supporters of Covid suppression are simply too parochial (on a civilizational if not a national level) to learn from Asian examples, or is it that they believe that the successful Asian policies simply wouldn't be tolerated by Westerners? That latter argument may have more force in a country like the United States that is awash with guns (many of whose owners would be sure to take up arms against the government if they got a whiff of "FEMA concentration camps" being in the air), but which would this objection be equally forceful in European countries which have strict gun control?
There was no available vaccine for Hong Kong Flu until after it had largely spread through populations. As with COVID its mortality rate was low, though it was actually higher than for COVID, as is the case with all flu viruses compared to coronaviruses. As a result of the low mortality rate, it was allowed to spread through populations, who then built up a degree of herd immunity to it, prior to the vaccine for it being developed. Despite its low mortality rate, for a flu virus, it killed far more people globally - on a population adjusted basis - than has COVID, and about the same number in Britain and the US as COVID, despite the introduction of a vaccine to prevent infection. Despite this larger degree of mortality, and despite there being no vaccine for it, until the pandemic was nearly over, there were no lockdowns nor incarcerations, or closing of borders.
ReplyDeleteYour account of the events in the US is wrong. Trump from the beginning talked about it all being a hoax, as is his wont. As the number of infections began to rise, he talked about the "China Virus", and stoked conspiracy theories about it being something developed by China to attack the US. He shut down travel from China. But, Trump's approach was never based on herd immunity. He basically wanted to deny the existence of the virus as any widespread phenomena, a requirement of developing herd immunity. When the widespread nature of the virus became undeniable, he switched to claims that it was not serious, without making any distinction in terms of not serious for who!
The opponents of Trump, also failed to make this distinction, simply responding to Trump's implication that its not serious for anyone, with the opposite - its serious for everyone, and so its necessary to lock everything down.
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ReplyDeleteNew Zealand did close its borders, but as with every other country that has done so, or used any suppression strategy, such as lockdowns, or as in Germany, and so on, extensive test and trace, it does not provide immunity to the virus, and so as soon as its relaxed, the virus surges again. I disagree that closing borders does less damage to the economy than lockdowns, because the global economy is based upon such trade.
In Europe, that trade is conducted by millions of vehicles travelling across borders on an hourly basis, and that applies to Britain too. Its not a strategy that is economically viable in Europe, nor in North America. As for quarantining, its only viable if you are talking about relatively small numbers, but in Britain alone there are millions of people who have had the virus, and without mass effective testing its impossible to know who they are, either those that currently are carriers or those that have obtained immunity.
If for whatever reason, large numbers of asymptomatic carriers developed in East Asia, the policy of closing borders and quarantining would collapse overnight.
If quarantine wasn't in fact used for the 1957 or 1968 flu pandemics, then that argues against Lyman Stone's counterfactual (quoted above) in which US President Nixon used a centralized quarantine strategy to successfully suppress Covid-69.
ReplyDeleteIf that is the case, wouldn't that imply that the way in which Covid-19 differs politically from those flu pandemics, could be simply that there were no examples of successful suppression in 1957 or 1968, that could be used to fuel a moral panic? By contrast Asia has suppressed Covid-19 well, using techniques that it originally developed in response to the (much more dangerous) SARS and MERS coronaviruses that had minimal impact on the Western World (except Canada in the case of SARS).
Not that some pandemics have struck in multiple waves even in the absence of suppression, which would mean that hoping for herd immunity is a mug's game. One such example would be the OC43 coronavirus (usually misnamed "Russian flu") of 1889-1892. While OC43 is now just another common cold virus, in the late 19th century (in the immediate wake of its crossing the species barrier from cattle to humans) it was a lot more lethal.
Do you think that European countries never adopted centralized quarantine for in-country infections neither out of ignorance nor out of fear of a violent backlash, but simply because they knew that it would be pointless if they couldn't also maintain airtight quarantines on their borders? And if so, why was effective border quarantine possible in Asia but not in Europe?
One possibility is cultural: Asians believe that it is a given that the state sovereignty implies control of borders, while many Europeans (particularly supporters of the EU) see border controls as inherently morally suspect, even racist. In addition, even those who want stricter controls of immigration (like most Brexit supporters in Britain) still expect to be able to travel between countries (for tourism or business purposes) with minimal interfererence, and during the Edwardian heyday of European imperialism most European countries had no border controls for people at all, only customs controls for goods. And ironically, actual immigrants (who by definition are moving permanently to a new country) are probably the main example of a very small group of travellers who could afford to spend two weeks in quarantine any time they enter a new country.
By contrast East Asian countries tended to have much less interaction with one another, and sometimes went through periods of extreme isolationism when most if not all foreigners were barred: in Japan this was called sakoku while in Korea it was called swaegug – the two words are likely cognates.
Perhaps the issue was the proselytizing Jesus-as-Messiah religions, with Japan's elites initiating sakoku to keep out Spanish and Portuguese missionaries, while pre-Enlightenment Europeans (who unlike the East Asians were already Christians) only excluded adherents of the other Jesus-as-Messiah religion (Islam) which they regarded as the only real threat to continued Christian dominance? Is it a coincidence that the countries of South East Asia where these religions are dominant (Catholic Philippines and Muslim Indonesia) didn't handle Covid-19 quite as well as other countries in their region?
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ReplyDeleteOr was Europe's problem more economic and geographical than cultural? You make a good point about Europe's dependence on truck traffic: while even Schengen countries have closed their borders to tourists, it's unlikely they (especially landlocked countries) could also quarantine every one of tens of thousands of truckers crossing their borders (just look at what a nightmare post-Brexit Kent is expected to be, and that is the result of customs checks lasting hours rather than quarantine lasting two weeks or more), and as I mentioned upthread border quarantines really do have to be airtight in order to work.
There's probably far less truck travel between Asian countries: if we look at China it has has sparsely-populated Mongolia and Siberia to its north, and very nasty mountains along most of its other land borders. Nor would I expect international truck trade using roll-on/roll-off ferries to be common as they are in Europe. While the Channel Tunnel and ferry routes link England to the entire continent of Europe, a Japanese ferry to South Korea would give access only to South Korea (as that country's only land border is sealed) while there will be no ferries between China and Taiwan as those two regimes are officially at war.
Similar considerations would apply to Australia, which of course didn't just shut foreigners out and impose lockdowns but also closed its internal state borders. Australia is a huge sparsely-populated country where the vast majority of the population lives in a few widely scattered cities, almost all of which are coastal. While people and goods travelling between (for example) Paris and Frankfurt would usually travel by road (or perhaps rail), travel between Melbourne and Brisbane would be far more likely to be by air in the case of passengers, or by ship in the case of goods.
With trade between Asia/Pacific countries largely via (unmanned) shipping containers rather than trucks (which must have drivers), and passenger travel will go overwhelmingly by air, dealing with Covid contagion will be far easier than in Europe where road transport is dominant. These modes of transport are far less problematic Covid-wise than road transport (especially road transport in a land with as dense a road network as Europe's!) as air travel is easy to shut down, and ships are easy to quarantine (even the Renaissance-era Venetian Republic could do it!)
Is there any possibility (even though you as a steadfast opponent of Brexit would no doubt be loath to consider it) that the UK, being the island nation that it is, could reconfigure its trade to be less like a European nation and more like an East Asian island nation, and thus be better protected against future pandemics.
I'd recommend reading my Sepember post The 1968 Flu Pandemic v Covid19, where most of the questions you raise are dealt with.
ReplyDeleteI've dealt with question of borders before. Its to do with the nature of Asian economies, as against European and North American economies, the fact that many Asian economies are islands, or peninsula. We really don't know what the situation in China is, but next door, India has seen widespread infections and deaths. It could also be down to questions such as age profile, the amount of movement within countries and so on, that requires in depth, detailed analysis. What we do know is that there is no correlation between lockdowns and either spread of the virus or deaths.
Another factor can be the extent to which climate affects lifestyle. Countries where people spend most of their time outside are less likely to see high infection rates, compared to society's where people spend a lot of time in doors socialising.
Any thoughts on the issue of centralized quarantine in particular, and why it was used in East Asian countries (and in Israel) but not in Europe or the Americas?
ReplyDeleteNot really.
ReplyDeleteWhat lesson then do you think Europe and the Americans can learn from Asia with respect to pandemic preparedness?
ReplyDeleteThat each pandemic is different, and that the conditions in each country, region are different, so there is no single fit solution to them. AS with wars, its best not to base your preparations on fighting the last one, but to have the capacity and flexibility to respond to the realities of the one you are fighting.
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