by Ravi Bali
From Containment to Delay
We are in the second month of the public lockdown in the UK to deal with the COVID-19 pandemic. The government’s strategy was initially focused on containment, until it was clear that the infection was already rampant. The aim then switched to slowing the eventual spread through a general isolation and social distancing strategy. It became clear that containment, through a testing and contact-tracing procedure, expecting that those who had contracted the virus could be kept from spreading it at all, was unworkable. This is because those who have contracted the virus often do not show symptoms for several days, the whole time being infectious and unknowingly spreading the virus.
Perhaps unsurprisingly, London, the most densely populated city in the country and a world hub for travellers, was where the virus initially spread most rapidly. It has since spread across the country and with very variable effects on those who catch it. In the absence of widespread reliable testing, the variability by which this coronavirus affects people makes it more difficult to track how it is spreading. Some people can catch it with barely any symptoms, while others require hospitalisation and even intensive care, such as happened with UK Prime Minister Boris Johnson.
Johnson had boasted of going to UK hospitals and shaking hands with those who had contracted the virus. Johnson was brazenly advocating a “herd immunity” strategy, but all this amounted to was allowing the virus to spread and assuming that once enough people had gotten it, we would be immune to it. While this might eventually achieve herd immunity, it would be at a great human cost.
Nor is this the way “a herd immunity strategy” is used by medical professionals in diseases for which they have already developed a vaccine. A vaccine is usually a weakened form of the disease, in which the virus is injected into a patient’s bloodstream to trigger an antibodies response without giving them the full-blown disease. The ignorance of Johnson around this approached Trumpist levels. This was a strategy of inaction rather than a controlled response. Due to the lateness of the government response, we came to see what happens when the full-blown disease is spreading rapidly: a lot of people got very sick and many died unnecessarily, before a mitigation strategy was put in place. Perhaps we should be grateful for the small mercy that we don’t have our leaders advocating injecting people with disinfectants to clear out the virus!
Structural Barriers to an Effective Strategy
Many criticisms of the government’s strategy suggest its incompetence or deliberate neglect, but there are deeper systemic issues that influence what is going on. In 2016 there was a pandemic drill, named exercise Cygnus, in which UK’s critical systems were tested for their preparedness in case of a respiratory-impacting infection. The results pointed to many shortcomings, which were evidently not addressed by subsequent government actions.
It was a time of austerity, and finding money for what was then only a hypothetically imagined scenario, albeit based on clear evidence of continually emerging new viral threats, was not treated as a priority. It was the kind of short-termism that marks all governments when they have to invest in something that may or may not be used down the road. Consider, for instance, testing kits. They have a limited shelf life and by the time an outbreak occurs, these medical tests may no longer be suitable. The test kits need periodic renewal, without which they aren’t much use when a pandemic arrives. To just cross your fingers and hope it doesn’t happen is a political decision that would be very difficult for any government not to consider seriously. The health service for decades has not being funded for many things that are immediately needed, never mind things to build capacity for contingency measures.
This is the reality of life under capitalism. It does not mean we have to accept it. It does not have to be as blatantly irrational as the now fateful 2016 decision of Donald Trump to scrap the funding for the US Pandemic Response Team. In the UK, medicine is often thought of as a public good, but the pandemic exposes the limits of this. When you operate within a capitalist system, the supply chain and intellectual property issues involved hamper the delivery of healthcare based on need. When the pandemic was already in full swing, UK Health Secretary Matt Hancock, in a Department of Health and Social Care briefing published on April 4, 2020, revealed that:
The challenge is the global shortage of materials needed to run the end-to-end testing process at full capacity, particularly the reagents that help to ensure high levels of sensitivity and specificity for these tests, the swabs with which they have been validated, and the challenge of matching specific materials to the different machines available. Most of these high-tech testing platforms are ‘closed,’ which means that these materials can only be supplied by the same manufacturer as the machine. We are therefore dependent on global manufacturers to very rapidly increase the quantity of their specific reagents and kits. We are working in partnership with them to increase supply of these proprietary reagents, maximising the UK’s global allocation, and creating a sustainable supply of these components, including setting up local manufacturing bases here in the UK. Where possible, we are ‘opening up’ the closed platforms to make use of alternate suppliers of suitable reagents.
Even the UK’s much-vaunted National Health Service (NHS), supposedly free at the point of need, is still operating within a profit-seeking supply chain. The companies in that chain jealously guard their intellectual property, even in the middle of this public emergency. Companies design their testing machines to only work with patented consumables that only they are licenced to produce, to guarantee they are the only supplier. Like most state activity in a capitalist society, the NHS only ever modifies, in secondary ways, the profit-maximisation principle that governs the business of health care.
The frontline nurses, doctors and broader support staff of the NHS are dedicated professionals committed to saving lives and safeguarding health, but everything they are supplied with is produced according to capitalist criteria. The pharmaceutical companies, those who make different types of medical equipment, and the suppliers of medical consumables are all profit-seeking enterprises. We should not lose sight of the fact that the values that govern the operation of a capitalist economy will not always be presented to us as such. That same report treated the slowness to respond to COVID-19 as though it were a question of purely technical capacity. That technical capacity is not organised according to rational and socially beneficial criteria; those are just a necessary precondition for the real goal of profit making.
People in lockdown isolation seem to have had more time to conjecture on social media about the nature of the COVID-19 pandemic and the various government responses to it. A significant misconception, even during normal times, is that the state is an instrument to be used by whatever government for whatever purpose. In a time of crisis, such as war or depression, when normal business routines are disrupted, the state seems to start behaving differently, in an effort either to maintain or restore the conditions for profitability.
Looking After Older People is Not Seen as a Priority
The change is not always a conscious conspiracy to keep business running (sometimes it is), and when a corporate conspiracy is established, it has often become the subject of Hollywood movies. More often, guaranteeing capitalist expansion is the end product of a seemingly random cascade of pressures on the government to act in certain ways. In the UK, it became clear that a very high proportion of coronavirus deaths (as high as one in four in parts of the country) were occurring in care homes for the elderly and sick, rather than in hospitals. Yet the government insisted on offering tests for only the first five residents in any given home who displayed symptoms. In the public outcry that followed the announcement of this policy, the government relented and offered the test to all care-home residents.
It is not that the initial government restriction was consciously choosing for old people to die. It just wasn’t a top priority to spend large amounts on elderly people who will no longer be a productive part of the economy. It is not being overly cynical of politicians to say that, when there are a myriad of different demands for spending emergency funds, the ones that they will experience as the most urgent are those that are seen as most essential to maintain the whole system of production.
It is the same reason that the chancellor will not now guarantee the continuation of the “triple lock” state pension, which was introduced in 2010 to prevent retirees from being left behind after there had been just a 75p increase in the state pension. It was decided to link state pensions to any one of three metrics: the rate of inflation, the change in average earnings, or 2.5 percent, whichever was the highest. There is an implied contract between the state and workers that we pay taxes during our working life to be in turn looked after in our old age. In reality, pensions are not stored as a deposit to be drawn on in retirement, but are paid for out of the value created by the presently working population.
The dramatic economic slowdown precipitated by the COVID-19 pandemic has made the government very nervous. The natural voting base for the ruling Conservative Party tends to be heavily weighted towards older people, so the “triple lock” pension is an incentive for pensioners to remain loyal to the Tories. Pensioners, through the “triple lock”, have done rather well relative to active workers, many of whom have only very recently started to see their real wages and salaries recover from the 2008 economic crash. It is the elderly population who are more seriously affected by the COVID-19 virus and have consequently required more healthcare spending during this emergency. If workers experience a post-COVID squeeze on their living standards, then justifying the “triple lock” on pensions might, this time, prove difficult to sell politically.
The anxiety over the post-pandemic recovery is due to the need to catch up with lost production to create value, not only to cover for pensions, but also the massive jump in payments to the unemployed and to those who have been furloughed. It is why the government asked for every care-home resident, at the same time, to voluntarily sign agreements that if they contracted the virus they would not go into hospital. While it was the choice of the care-home resident to sign, it is well known that elderly people often feel guilty about being a burden.
The resourcing of health care is not simply about meeting human need. There is always an underlying calculation of what is necessary for overall capitalist production. Anything superfluous to spending on direct production needs, such as on pensioners, is usually a result of historic struggles by workers to improve their conditions of life.
There is, unsurprisingly, lots of apocalyptic forecasting of what the pandemic might mean for different societies across the world. If there is a fear that the health services in the industrialised nations of Europe and North America might be overwhelmed by the rapid spread of the virus, how much worse might it be for developing countries with more basic health care systems and fragile food chains?
COVID-19 Testing and the Lockdown on the Economy
Since COVID-19 emerged through mutation as a distinct strain within the coronavirus family of viruses which allowed the spread through human to human transmission, it has already undergone a minor mutation. There is now an “L” sub-strain as well as the original “S” strain of the virus. The genetic chain is similar enough in both types of COVID-19 that it is expected they will be susceptible to a common treatment once one is developed.
A greater potential problem arises if the virus has the tendency to rapidly mutate. Then, like the influenza bug, each year when the disease returns in a modified form, it will have changed sufficiently so that the antibodies we have produced from the previous infection do not recognise it as the same strain. This means even those who have caught the earlier strain will not have full immunity and so can catch this new version of the disease all over again. And since COVID-19’s lethality rate is, according to some estimates, already around five times higher than that of flu, this could be devastating. We will need to commit far more resources to health care, if what we experience presently were to become the new normal.
The social distancing strategy and lockdown recommended by the government and now enforced by the police and the staff at food shops, has received much criticism from many quarters. Once the containment strategy was seen as unworkable, the strategy became about slowing the spread of this coronavirus, sometimes referred to as “flattening the curve”. This is about recognising that we can only delay the spread of the virus, as represented on a graph, so that the peak of new infections is postponed and spread out. That way our medical capacity is better able to cope. This is to avoid the hospital system from being overwhelmed by too many people contracting the virus at once.
The social isolation part of the strategy is asking all but essential workers to stay in their homes. Exceptions to this are shopping for food or medicine, delivering essentials to those in total isolation due to suspected infection, and going outside to exercise once a day. Some people are starting to bristle at these restrictions, recognising the damage that closing down large parts of the economy will cause to the broader well-being of the country. The question that arises is what level of a precautionary approach should be adopted and how long is it appropriate for it to continue?
It is already clear that there has been some overreach by police in enforcing the new rules. People hanging out in local parks have been moved on when they are clearly observing social distancing protocols, and others have been fined for socially permitted exceptions. The aim of keeping a minimum distance of two meters from anybody who is not part of the same household in order to help prevent the airborne transmission of the virus through water droplets is, however, a rational requirement. Some non-emergency work places have continued to operate, if they have proved able to maintain that minimum social distance between their workers. However, most workplaces outside those in the food supply chain, social care, or medicine have closed as a precautionary measure.
The harm caused by the shuttering of large parts of the economy is not inconsiderable. The scheduled and critical medical treatments that have had to be side-lined in order to deal with the coronavirus outbreak, though much reported in the media here, are just the tip of the problem. Some have commented on the class dimension of the lockdown. Working from home is a possibility if you are a laptop creative, less so if you are a bricklayer or an electrician. While being largely confined to home is stifling for anyone, if you are on a low income and living in cramped conditions with children constantly around, it becomes a special kind of hell that will certainly impact on mental health, if not physical health too.
So, is the lockdown justified? Well, the probability of this virus, which is already more lethal for humans than most, mutating into something even more dangerous increases the more people become infected. One way this can happen is through recombination. This is when the virus infects someone who is already carrying a different type of virus and a recombination (or reassortment) occurs in which they swap some of their genetic material with each other.
Then we have new type of virus, sharing characteristics from the originals but being different to either. If through a process of natural selection, of being well adapted to its host environment, then this new virus can thrive as a new strain. The threat posed to us by the new virus will be determined by a range of factors. It can be relatively more benign or even more lethal depending on how it reacts with our bodies. Most viruses over time, through natural selection, will become less lethal. If a virus is too lethal and kills off its host too quickly, it will itself die out before being passed on. The most successful viruses are those that adapt to their host well without causing too much harm to the body they inhabit, while being resilient enough to not be killed off by an immune response.
While much is still unknown about COVID-19, the latest information from China suggests that it presents as completely or largely asymptomatic in 80% of cases. From an evolutionary perspective that is quite a well-adapted virus that can go undetected in the vast majority of human hosts it infects. For the unlucky 20% of those infected, it has serious consequences. If that 20% of the population were all to come down with the virus in short succession, the NHS would be overwhelmed and many more people would die than if the spread was slowed by the measures that are now being taken.
Establishing who has had the virus using the antibody test is frustratingly limited because it takes about five weeks after infection for the body to produce a sufficient quantity of antibodies into the bloodstream to be detectable by current tests. Even then, the 95% accuracy being touted for the COVID-19 antibody test is a conventional one assumed in biological sciences rather than a measured one. The two aspects of this are its sensitivity and its specificity. In the case of COVID-19, the 95% sensitivity is the presumed chance of correctly identifying the presence of infection (true positive rate), and the specificity is the presumed chance of correctly saying someone has no presence of the virus (true negative rate). A 95% confidence in the result of a test, whether positive or negative, is not sufficient to give any individual the all clear. What widespread testing, even of a limited accuracy, will give you is an improved picture of the overall levels of infection, even if not being able to say if any particular individual is clear or not. The more antibody testing, particularly as the infection total rises, the more accurately the tests can be made through checking them with other forms of testing that are more accurate, but not presently scalable because of the technology involved.
The Unhelpful Accusation of Authoritarianism
The closing down of large parts of the economy and the lockdown are being treated by certain “critical voices” as authoritarianism, and deemed to be worse than the damage done by the virus. The longer this goes on, the more questions that will need to be raised. For the moment, however, we have to take it on faith that the government is doing what is necessary for slowing the pandemic. This virus, while largely harmless to most of us, but very serious and even deadly to a considerable minority of us, has to be anticipated in its worst impact. Until we work out how to deal with the virus through effective medical intervention, some restriction on movement will been needed. The longer the current restrictions continue, the more likely they will be flouted by people becoming complacent about the need for the lockdown or being pressured to return to work, but none of that invalidates the need for restrictions now.
The infection rate (Ro) is the number of new people an infected person will spread the disease to. In the UK, before the lockdown, each person infected was infecting between 2.5 and 3 other people; since the isolation and social distancing measures, the Ro has dropped well below 1 (to around 0.67). This represents a declining rate of new infections.
As uncomfortable as this disruption to our lives caused by the lockdown is, we cannot shrug our shoulders at something that is clearly more lethal than most of the viruses that we regularly encounter. The number of people who die from this virus relative to those who only become very ill but recover from it, will be much worse if the hospital system cannot cope. This for now justifies the lockdown and later the gradual unlocking of parts of society, as those infected and needing hospital care will have a better chance of survival if there is availability of beds, equipment, medicine, and relevant health professionals.
The government was slow in increasing the capacity to roll out the testing for COVID-19. This would be a central part of any informed strategy for dealing with the pandemic. This, while taking place on the watch of a Conservative government, is deeper and more systemic than political failure. Not disrupting the economy would very likely have been the response of whoever was in charge of the government. This is confirmed by the reluctance of the opposition parties to make a political issue of the government’s failure to have acted quicker.
The lack of debate on how this crisis was handled is in stark contrast to the US, where Trump has been attacked for his complacency and misinformation in the face of the pandemic. The short-termism and adapting to the profit-seeking behaviour of business is how every government is pressured to behave under capitalism. The government here seems to have operated on a business-as-usual footing, until the scientific evidence pushed them to act more decisively. Then it behaved perhaps as responsibly as it could, in its state of unpreparedness. There was the predictable partisan covering up of both parties’ complicity in allowing for the situation to arise. The lack of debate on strategy is because none of the political class can indicate how they would have dealt with the situation differently on the basis of the evidence as it emerged.
Any discussion of dealing with this pandemic should not be conducted purely on technical/medical capacity grounds, nor on narrowly party-political ones. We must also consider the form of social organisation we are forced to endure under capitalism.
I think when dealing with a deadly new virus that has devastated another part of the world, you do deal with it as a worst-case scenario and take the earliest possible intervention so that the problem does not grow. It is precisely when a precautionary approach is appropriate, because the alternative is to be less prepared than you might otherwise be. Does that have opportunity costs, in terms of resources and manpower being devoted to something that may or may not happen? Yes, it does, but that is the real world. To anticipate a potential threat that scientists have been warning of as looming, is what a rationally organised society would do.