The pandemic: where we're at, as of 23 May 2020

Submitted by martin on 25 May, 2020 - 12:44 Author: Martin Thomas
SARS-Cov-2

Daily death tolls have been going down in Britain since 22 April and worldwide (for now, anyway) since 16 April.

Although death figures are unreliable, a country reporting a declining trend almost certainly really has one: definitions and reporting tend to widen rather than narrow.

We don't know whether the current rise of the pandemic in South America will reach levels similar to those suffered in Europe between early-mid March and mid-April, or whether Africa will see something like South America, or whether there will be a "second wave" in Europe.

Britain’s daily death rate remains about twice Italy’s and Spain’s, and markedly higher than France’s. Its rate of new cases is declining only slowly. That is partly because of increased testing: still, its rate is around four times the rates for Italy and Spain, which have tested more, or France, which has tested less.

The Tories’ back-to-work drive is producing only a slow dribble. Tube and rail report only a small uptick so far. 65% of construction sites were shut at the peak of the lockdown, but most had restarted even before 10 May. Scottish construction sites are reopening from 21 May, but slowly. Manufacturing ran at 58% of capacity during the lockdown. Some sites have restarted since 10 May, but usually with low levels of production and staffing.

We look set for an out-of-work drive as much as a back-to-work one. The scaling-down of the furlough scheme, companies’ adjustments to accumulating evidence of much lower demand long-term in some sectors, and a start on creditors chasing debts, have produced and will continue to produce waves of job cuts. Officially there are now 5.8% claiming out-of-work benefits. NIESR estimates 10% jobless soon. Similar 10% estimates have been made for other countries much less hard hit by the virus in human terms than Britain.

Our demands for isolation pay, requisitioning to supply PPE, a reduced working week with no loss of pay, and more, will become more, not less, vital, as back-to-work creeps forward.

Unions have often remained active at workplace level via Zoom and similar even when many workers are working from home or furloughed. Union membership has risen. We should build on those strengths, and fight for “no going back” on many of the social concessions made by the panicked Tories in March.

However, there have been practically no strikes, as distinct from incidental stoppages or refusals of particular unsafe work tasks. Important large-scale disputes have been “furloughed” or effectively abandoned (Royal Mail, universities, Tower Hamlets). At national level unions have mostly been uncombative even over backing members using health and safety legislation, such as Section 44 of the 1996 Employment Rights Act, to refuse unsafe work.

The coming job cuts will hit relatively well-unionised areas (aviation, metalworking, local government) as well as weakly-unionised ones like cafés and pubs. The fact that most workers are not in their workplaces makes it difficult for them to discuss in a collective and continuous way, and difficult for union activists to contact others than those they already had personal contact info for.

Boris Johnson’s approval rating, after rising steeply in the earlier stages of the pandemic, has dropped in the last month from 36% to 34%, and we can reasonably guess it will drop further. But Keir Starmer has been able to move Labour to the right faster than looked at all plausible, and with little effective protest from the “broad” Labour left.

Following the debacles of outsourcing the NHS stockpile to Movianto, NHS logistics to Unipart, and virus testing to Deloitte and others, the government is now outsourcing tracking-and-tracing to Serco, who are advertising for 12-week jobs on minimum wage or little more, and offering a single (reportedly poor-quality) day of training.

The outsourcing of vital public responsibilities to private contractors is a recipe for the job being done by insecure and poorly-paid labour, with profit for the contractor ranking above public good, and for additional layers of buck-passing and bureaucratic fumbling.

David King’s “Independent SAGE” group has proposed that track-and-trace should be organised locality by locality, giving resources to local public health operations to revive them after Tory cuts so they lead the work. That makes sense, although track-and-trace is not a magic bullet, and certainly not with the UK’s current high levels of active cases.

Expanded testing is an essential part of track-and-trace. However, the government’s increased figures for total tests done do not necessarily mean any great progress. Testing is not a magic bullet, either. No large country has done more than test about 6% of the population over time, i.e. only a minute fraction each week. The tests are of limited and unknown accuracy (which is why countries have 14-day quarantine rules for entrants, rather than just testing them).

We have said we are for quarantines (which of course will greatly restrict entry) but not for border closures (of the type of Australia and NZ, which have banned non-citizens, and China, which has barred even many citizens from returning).

Lockdown “rollbacks” started on 11 March in China, and 7 April in Europe (the Czech Republic). There have been “blips” and renewed local lockdowns along the way, but broadly (so far, anyway) all the “rollbacks” have “worked” in the sense that previous general declining trends of virus deaths have continued.

The main exception is Iran, which managed its “lockdown” and “rollback” about as badly as it could have done: there, it’s unclear. Mexico, Indonesia, Brazil, India, and Russia are all now easing lockdowns before having got clear declining trends of infection. It is hard to be optimistic there.

Covid-19 is spreading rapidly in Brazil, Peru, and other South American countries, though not as rapidly as it spread in Europe in mid and late March.

So far the toll in Africa is much lower than in Europe, even in the hardest-hit countries there (Algeria, Egypt, South Africa). Algeria now has a clear declining trend.

After the pandemic?

Some people have talked about the Covid-19 emergency lasting for two years. More realistically, it will last forever (at least on the scale of our lifetimes), but with varying degrees of moving from “emergency” to “new normal”.

That holds even if the current downward trend of deaths continues with only small new spikes; even if a vaccine is developed (it won’t be 100%, and anyway 29% in New York, 20% in Switzerland, 9% in the UK, say they would refuse to be vaccinated); and even if a treatment is developed (very unlikely to be anything like 100%).

Obviously the adjustment will be easier if the downward trend continues (or mostly continues); if a vaccine is developed and distributed; if immunity after infection lasts longer; if it turns out that a higher rather than lower percentage have had the virus with few symptoms and recovered.

New Zealand talks of ridding its islands of the virus completely. But will it keep its borders closed forever? And most countries aren’t islands distant from other islands.

In broad terms, we will revert towards the norm of human history since the rise of agriculture, that is, of infectious diseases being a constant and major background threat.

It will not be a complete reversion: we know more about how to control infectious diseases now. We can reasonably hope that the experience of lockdown-rollbacks, the experience of Sweden, and improved medical knowledge and tracking-and-tracing, will guide us to social measures which allow social and political life and yet bring R0 down enough to get herd immunity at least for a while. We don’t know which measures, or when.

The norm is not lost in the mists of time. In richer countries, death has come to be mostly a matter of heart disease, cancer, and similar, rather than infectious diseases, but even in Britain the 2017-18 seasonal flu caused 50,000 excess deaths.

In his book The Rules of Contagion, Adam Kucharski notes that: “in the time it’s taken you to read this book [about six hours] around 300 people will have died of malaria. There will have been over 500 deaths from HIV/ AIDS, and about 80 from measles”. (There about about 1000 deaths world-wide per six hours currently from Covid-19). We will probably have to operate more like our comrades do in countries where malaria, tuberculosis, and measles are still major killers.

Our comrades in the past did not claim to be infectious-disease specialists, but they campaigned:

• against poverty, which makes the worse-off much more vulnerable to infectious diseases

• for spacious and airy housing for all

• for public-health systems, and National Health Services (of which the first was introduced by the Bolsheviks in 1920)

• for good care for the elderly, and care work to be secure and well-paid.

We are not and should not pretend to be experts on the best other measures to mitigate the Covid-19 risk (to which we cannot give even rough numbers) in the medium term.

We agree with the assessment that a rushed lockdown easing now is reckless and wrong. But we should be clear, in the medium term, however, that it does not follow from the fact that conspiracy-theory right-wingers have led anti-lockdown protests that the more left-wing you are, the more locked-down you want society to be, and for longer.

Some left-wingers have argued against even carefully social-distanced protests. We should dissent, and defend the right to picket and protest safely.

We should also be wary on “work-from-home” as a “new normal”. Some employers, having learned during the lockdown how to control and monitor from-home workers, are already promoting it as their “new normal” to save on office space and costs. More will.

Some workers, who have commodious homes but for example, for health reasons, find commuter travel and crowded offices difficult, will obviously welcome this. Others may welcome it in the short term because they are scared of commuting or keen to save on fares and travel-time – and then find, later on, when they want to return to the workplace, or when they want new jobs, that only work-from-home jobs are available. Unions should insist on conditions about work-from-home.

A very big expansion of work-from-home will atomise the workforce, depriving workers of the ability to get to know their workmates and seek everyday solidarity with them against management impositions, let alone to unionise or organise industrial action with picket lines. It will also shut out from jobs people whose homes are too crowded, too under-resourced, or too insecure to be bases to “work from”.

We don’t know

One epidemiologist puts it neatly: “All models are wrong”. Their value is not that they are right, but they may be able to tease out unexpected implications of different assumptions. Another epidemiologist, Caroline Buckee, quotes Virginia Woolf: “truth is only to be had by laying together many varieties of error”.

Epidemiology allows almost no scope for standard scientific experiments, with control groups, double-blind, and all the rest of it. Some tens of thousands of scientific research papers, of varying quality, have been published on the virus and the pandemic. They contradict each other profusely. No-one has read them all.

We can’t escape that limitation by saying that we will follow “the left-wing epidemiologists”, since socialist or Marxist ideas do not give you magic powers in sifting specialist scientific argument, and in any case few epidemiologists are vocal left-wingers.

The Tories’ talk of “following the science” is self-serving rubbish, since there is no single voice of science. We should argue for open and informed scientific debate, which in other countries at least takes place more than in Britain.

A few things to be aware of

The chasing after R numbers much featured in the media recently is chasing a will-o-the-wisp. R is a ratio of one number which we can only guess to another number which we can only guess.

Most of the serious attempts at calculating R work backwards from death data (as the most reliable), and through social data, to find what value of R will best “predict” the actual death rates. There are three current efforts to do that in Britain, one from the MRC team at Imperial College, and two from different teams at the LSHTM. They give different results.

“Day-to-day” figures for R are worthless. Even halfway useful figures can only be got by studying trends. For example, the MRC Imperial team (whose leader, Neil Ferguson, is hostile to the Swedish epidemiologists’ policy) for a long time assessed R in Sweden as 1.8. The predictions got more and more out of kilter with the daily data. Then they revised to R=0.8. Good for them, for openly correcting themselves. But that wasn’t something that could be done on one day’s data.

The “two metre” rule is only guesswork. Outlier cases have been reported of the virus being transmitted by coughs and sneezes over 8 metres. The WHO says 1 metre, and so do France and China. Taiwan says 1.5 metres indoors and 1 metre outdoors. Germany, Belgium, and the Netherlands say 1.5 metres. The Swedish public health authorities say they don’t know, but recommend 1.5 to 2 metres. The USA and Italy say 2 metres.

As noted above, we know that the RT-PCR tests for the virus are inaccurate, but no-one knows how inaccurate, except that it is fairly certain that the tests return a "false negative" in the first few days after infection.

“Case fatality rates” (the percentage of confirmed Covid-19 cases who die) vary hugely from country to country, from 16% in Belgium through 14% in Italy and the UK down to 6% in China (which is however an average of a much higher rate in Wuhan and a much lower rate outside), 6% in the USA, 4.5% in Germany, a 3% average for “low income countries”, and 0.6% in Iceland and Saudi Arabia. Different extents of testing, which change the fraction of Covid-19 cases “confirmed” and different ways of counting death rates, explain a little of that, but only a little. For the rest, we don’t know.

One thing we do know fairly surely is that children get severe Covid-19 much less than adults do. The strong balance of evidence so far is also that children transmit the virus less. Sweden, which has kept schools (up to age 16) open throughout, has a lower rate of infection among teachers than among most other groups of workers (though it has done badly in its elderly-care homes, for reasons of casualised labour with poor workers’ rights and so on, not of school policy).

The Tories are still wrong to start reopening on 1 June, because overall Covid-19 rates in Britain are still high, and schools, especially British schools, are exceptionally crowded workplaces.

We don’t know why the “rollbacks” have generally “worked”, and we don’t know whether that will last. We don’t know whether a “second wave” of the virus will come later this year.

We don’t know why it has hit poorer countries and refugee camps much less than we feared, but must argue for aid and other social provision to help the response if that changes.

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