Covid-19 and us: The monster arrives

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By Mike Davis*

Capitalist globalization now appears to be biologically unsustainable in the absence of a truly international public health infrastructure.

Coronavirus is like an old movie that we've been watching over and over since The Top Areas (1994) by Richard Preston introduced us to the terminator demon, born in a mysterious bat cave in Central Africa, this demon known as Ebola. It was the first in a succession of new diseases that broke out in the 'virgin field' (this is the proper term) of immune systems unexplored by humanity. Soon after Ebola came bird flu, transmitted to humans in 1997, and SARS, which emerged at the end of 2002. Both originated in Guangdong, the industrial center of the world.

Hollywood, of course, has conspicuously embraced these outbreaks and produced a wide range of films to excite and frighten audiences. (Contagion, by Steven Soderbergh, released in 2011, stands out for its accurate science and lugubrious anticipation of the current chaos.) In addition to these movies (and series), and countless dark novels, hundreds of prominent books and thousands of scientific articles have responded to every outbreak. , many emphasizing the dire state of global preparedness to detect and respond to such new diseases.

1.

Thus, the Coronavirus passes through the gateway like a known monster. Tracing its genome line (much like its well-studied sister SARS) was straightforward enough, even if some vital information remains missing. Researchers who are working day and night to characterize the virus have faced three enormous challenges. First, the continuing shortage of test kits, especially in the United States and Africa, has made it difficult to accurately assess key parameters such as the reproduction rate, the size of the infected population, and the number of asymptomatic infected people.

The result has been chaotic numbers. Second, like the Influenza flu annual, the virus (of Covid-19) is changing, as it affects populations with different age groups and health conditions. The range of Americans most likely to acquire the disease is already subtly different from the population hit by the initial outbreak in Wuhan. The mutation that is to come may be benign, or it may change the current distribution of virulence, which for the time being more severely affects people over 50 years of age. Either way, Donald Trump's corona flu is at the very least a mortal danger to a quarter of Americans who are in old age, have a weak immune system or suffer from chronic respiratory problems.

Third, while the virus remains stable and little changed, its impact on younger population groups can differ radically in poor countries and among people in extreme poverty. Consider the overall experience of Spanish flu in 1918-1919. It is estimated that it killed 1% to 2% of humanity. In the United States and Western Europe, the H1N1 original in 1918 was deadlier for young adults. This has generally been linked to the relatively strong immune system of young adults of those years, which reacted to the infection by attacking lung cells, leading to viral pneumonia and septic shock. More recently, however, some epidemiologists have theorized that older adults may have been protected by memory of 'immunity' from outbreaks that appeared in the 1890s.

A Spanish flu found a favorable space in the battlefields and trenches, claiming the lives of tens of thousands of young soldiers. This became an important factor in the battle of empires. The collapse of the great German offensive in the spring of 1918 and the outcome of the war have been attributed to the fact that the Allies, in contrast to their enemies, were able to recover their ailing armies with the arrival of new American troops.

But Spanish flu in poor countries it looked different. It is rarely addressed that nearly 60% of global mortality, perhaps 20 million deaths, occurred in Punjabi, Bombay and other parts of West India, where grain exports to Britain and the practice of brutal demands coincided with a major drought. . This led to food shortages, when millions of poor people went hungry.

They became victims of a sinister synergy between the flu and poor nutrition, which suppressed their immune systems against infections and produced runaway bacteria as well as viruses, both of which lead to pneumonia. In a similar episode, in the British occupation of Iran, as a result of many years of drought, cholera and food shortages, there was a widespread outbreak of malaria, causing the death of an estimated fifth of the population.

This story – above all the unknown consequences of the relationship with malnutrition and already existing infections – serves to alert us that the Covid-19 may take a different and deadlier path in the dense, unhealthy slums of Africa and South Asia. With cases looming in Lagos, Kigali, Addis Ababa and Kin Shasa, no one knows (and won't know for a long time given the lack of testing) how Covid-19 it can articulate with local health and disease conditions. As Africa's population is the youngest in the world, with the elderly group comprising just 3% of the population – as opposed to Italy's 23% – the pandemic is said to have only a moderate impact.

In light of the 1918 experience, this is a baseless exaggeration. It also makes no sense to assert that the pandemic, like a seasonal flu, will pass with the summer heat. The most likely scenario, as Science warned on March 15, Africa is a ticking time bomb. In addition to malnutrition, the stimulus for viral exploitation is the huge number of people with compromised immune systems due to HIV/AIDS, which has killed 36 million Africans in the last generation. Researchers estimate that there are currently 24 million cases of AIDS, and at least 3 million suffering from tuberculosis, the so-called 'white plague'. Some of Africa's 350 million people are chronically malnourished, and the number of young children whose growth has been stunted by hunger has increased by the millions since the 2000s.

Social distancing in large slums like Kibera in Kenya or Khayelitsha in South Africa is obviously impossible, while more than half of Africans lack access to clean water and basic sanitation. What's more, five of the six nations with the worst health care in the world are in Africa, including the most populous country, Nigeria. Kenya, a country known for exporting nurses and doctors, has exactly 130 ICU beds and 200 certified ICU nurses to handle the arrival of the Covid-19.

2.

A year from now, we may look with admiration at China's success in containing the pandemic – and with horror at the failure of the United States. (assuming heroically that China's statement of the rapid decline in transmission is more or less accurate) the ineffectiveness of US institutions in keeping Pandora's box closed is hardly a surprise. Since the 2000s we have seen recurrent outbreaks at the forefront of the healthcare system. In both 2009 and 2018, for example, seasonal flu overwhelmed hospitals across the country, exposing the drastic shortage of hospital beds, after years of cuts in resources directed to the health area.

The crisis goes back to the period of the corporate offensive that brought Ronald Reagan to power and converted leading Democrats into neoliberal mouthpieces. According to the Association of American Hospitals, the number of hospital beds declined by an extraordinary 39% between 1981 and 1999. The objective of this reduction was to increase profits from hospitalizations by raising the hospital census (the number of occupied beds). But the goal of managing 90% of the occupancy meant that hospitals no longer had the capacity to absorb the flow of patients in cases of medical and epidemic emergencies.

In the new century, emergency medicine in the United States remains in the private sector, neglected by the shareholders' imperative to increase their profits and short-term dividends, and also neglected in the public sector by fiscal austerity, suffering reductions in prevention budgets. As a result, there are only 45.000 ICU beds available to handle the expected overload of critical coronavirus cases. South Korea has more than three times the number of available beds per 1000 inhabitants than the United States. According to an investigation by the USA Today, only eight states will have enough hospital beds to treat the 1 million Americans over age 60 who could be infected with Covid-19.

At the same time, Republicans have spurned all efforts to rebuild the safety nets torn apart by budget cuts in the 2008 recession. of Black Monday 25 years ago. In the last decade, the budget of the CDC (Center for Disease Control) fell by 10% in real terms. Since Trump's inauguration, fiscal deficits have been exacerbated. O New York Timesrecently reported that 21% of local health departments had reduced budgets for the 2017 fiscal year.

Trump also closed the White House Office for Pandemics, a committee established by Obama after the Ebola outbreak to ensure a swift and well-coordinated national response to new epidemics, and three months before the outbreak he (Trump) ended the Prevention Project (from the government), an early control system and an external assistance program created after the avian flu in 2005. Science, the prevention project had discovered more than 1000 viruses from viral families with the presence of zoonoses, including viruses linked to recent outbreaks and others of continuing concern for public health. This total includes 160 types of coronavirus identified in bats and other animals.

We are therefore in the early stages of a medical Katrina. Having diminished investment in medical emergency prevention while all the experts were talking and recommending further capacity expansion, the United States is now short of basic supplies as well as public health workers and emergency beds. Basic stocks for regional and national healthcare have been maintained at levels far below those indicated by epidemiological models.

Thus, the collapse of testing kits coincides with a critical shortage of basic protective equipment for healthcare workers. Advocates in the field of nursing, our current national conscience, are warning us of the grave dangers created by inadequate stockpiles of protective supplies such as N95 masks. They also point out that hospitals have become hotbeds for antibiotic-resistant bacteria such as It's hard, which may be the major secondary cause of death in crowded hospital wards.

3.

The outbreak has exposed the stark class divide in health care that Our Revolution – the base of Bernie Sanders' campaign group for the 2016 election has proposed – is imposing on the national agenda. Those with good health plans who can also work from home will be protected, assuming they follow the necessary recommendations to avoid contamination. Civil servants and other union workers with decent health insurance will have to make difficult choices between their income and their health. Nevertheless, millions of low-wage service workers, farm workers, the unemployed and the homeless will be left to fend for themselves.

As we all know, universal health care in any meaningful sense requires public provision for paid leave. Some of the 45% of the US workforce has been disenfranchised – and therefore forced to transmit the epidemic. Likewise, 14 Republican-ruled states have refused to pass laws for the provision of Affordable care that expands the Medicaid for poor workers. That's because one in four Texans lacks medical care and is only entitled to emergency county hospitals to seek treatment.

With Sanders at the forefront in his traditional responsible leadership, Democrats have successfully pressured the White House and the Republican-majority Congress to consent to paid leave as an emergency measure. But, as Sanders immediately pointed out, the legislature's compromise opens nebulous loopholes, which can be rescinded as soon as the pandemic allows. However, it is important to lead this initiative to take the fight to another level – the continuation of universal paid leave for the entire workforce. The Trump administration is in a panic, worried about the possibility of an electoral defeat, so it starts to grant some sensitive measures, such as the government control over the production of essential medical supplies. Indeed, new opportunities arise to demand public health demands in the coming months.

The mortal contradictions of private health in times of a pandemic become more visible in the millionaire industry of homes for the elderly, which is home to 2,5 million Americans, mostly at Medicare. It is a highly competitive capitalized sector that pays low wages, lacks professionals and cuts costs illegally. Ten thousand die every year from simple negligence of basic infection control procedures and the failure of state governments to establish administrative oversight, which amounts to manslaughter. Because in many of these homes – particularly in the Southern states – it is cheaper to pay fines for health violations than to hire qualified staff and provide them with specific training.

It is not surprising that the first epicenter of community transmission in the United States was the Life Care Center, a nursing home in the Seattle suburb of Kirkland. I spoke with Jim Straub, an old friend and union coordinator for senior housing workers in Seattle, who characterized the nursing home structures “as one of the worst in terms of technical staff and the broader system of senior care in Washington as the most underfunded in the country – an island of austere suffering in a sea of ​​tech money”.

Furthermore, he points out that public health secretaries are ignoring the crucial factor that explains the rapid transmission of the disease (the Covid-19) Of the Life Care Center for another ten nursing homes: 'workers from these homes in a booming US residential rental market often work more than one job, and most often also in nursing homes. Authorities have failed to discover the names and locations of these second jobs and thus have lost all control over the spread of the disease. Covid-19.

No one is proposing compensation for exposed workers to stay at home. Across the country, dozens, probably hundreds, of most nursing homes will become hotbeds for the coronavirus. Many employees will eventually choose hunger programs under such conditions and refuse to work. If it arrives in this condition, the system could collapse and we should not expect the National Guard to do the work of these servers.

4.

The pandemic exposes the need for universal coverage and paid leave at every step of its deadly advance. As Biden weakens Trump, progressives must unite – as Bernie proposes – to win the Democratic Health Care for All Convention. This will be the articulation strategy between Sanders and Warren, as delegates to the Milwaukee's Fiserv Forum in mid-July. Yet we have an equally important role to play on the streets, starting with the fight against evictions, layoffs and employers refusing to pay workers who are on leave. (Fear of contagion? Getting within six paces of the nearest protester will make for the most powerful image on TV.)

The first step consists of universal coverage and associated demands. It is disappointing that, in the primary debates, neither Sanders nor Warren addressed the purpose of the Big Pharma in abdicating the great laboratories in research and development of new antibiotics and antivirals. Of the 18 largest pharmaceutical companies, 15 have completely abandoned this field. Heart drugs, anxiety and depression drugs, and treatments and remedies for male impotence are more profitable than defending against nosocomial infections, emergent illnesses, and traditional tropical diseases. A vaccine for Influenza — that is, a vaccine that targets the unchanging parts of the virus's surface proteins — has been a possibility for decades, but never profitable enough to be a priority.

As the antibiotic revolution recedes, old diseases will resurface alongside new infections, and hospitals will become catacombs. Even if Trump can take advantage of the situation, opposing the cost of medicines, to combat this scenario it will be necessary to have a program that breaks with the monopoly of the pharmaceutical industries and that makes possible the public production of essential medicines for life. (This already happened at another time during World War II, when the US military called in Jonas Salk and other researchers to develop the first flu vaccine.)

As I wrote 15 years ago in The Monster at Our Door: “Access to essential medicines for life, including vaccines, antibiotics and antivirals, must be a human right, universally available, free of charge. If markets cannot provide incentives to produce low-cost such medicines (medicines, vaccines, treatments), then governments and not-for-profit entities must take responsibility for their production and distribution […] The survival of the poorest must at all times be considered a higher priority than the profits of the big pharmaceutical industries”.

The current pandemic expands the argument: capitalist globalization now appears to be biologically unsustainable in the absence of a truly international public health infrastructure. But such an infrastructure will never exist until social movements break the power of big pharma and health care as a profit.

This calls for an independent socialist plan for human survival that goes beyond a New Deal updated. Since the days of Occupy, socialists have put the fight against inequality of income and wealth on the front page: it is certainly a great achievement. But now we need to take the next step and claim social ownership and the democratization of economic power, with healthcare and the pharmaceutical industry as immediate demands.

The left must also make an honest assessment of our moral and political weakness. As much as I welcome the evolution to the left of a new generation and the return of the word socialism in political discourse, there is a disturbing element of national solipsism in the progressive movement in the United States that is commensurate with the new nationalism. We tend to talk about the specifically American working class and our radical history (perhaps forgetting that Debs was an internationalist at heart), which ends up bringing us closer to the rhetoric that puts the United States first in everything.

To tackle the pandemic, then, socialists must emphasize the urgency of international solidarity wherever possible. Concretely, we need to stir up our progressive friends and their political leaders to demand a massive expansion in the production of test kits, supply of protective equipment and vital medicines, and that they be distributed freely and free of charge to poor countries. It is up to us to ensure that medical care for all becomes both a foreign and domestic policy.

*Mike Davis is Professor Emeritus of University of California. Author, among other books, of ecology of fear (Record).

Translation: Ronaldo Tadeu de Souza

Originally published on New Left Review #122 (https://newleftreview.org/issues/II122/articles/mike-davis-in-a-plague-year)

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