Medical Staff at a Hanoi Hospital. Personal photo from H.P., photocredit forthcoming

In the span of weeks, the Corona virus has gone from an isolated problem “over there” to a global pandemic that is generating carnage on an unimaginable scale. Its reach is extending across countries and increasingly into our communities and homes. By 28 March at least 30,000 people had lost their lives to the virus. The worst is still to come.

Viewed on a global scale, from our screens and in our living rooms, we experience the spread of virus and death in an endless parade of charts and video footage, and news articles, clips, and broadcasts of the more or less confused statements and declarations and denials of public authorities whose job, we are now reminded, it is to keep us safe and promote public good.

In this context, one of the most troubling if ever-present aspects of this new plague is its disorienting effects. Simply put, the scale, scope, and complexity are simply too huge to comprehend from any given angle or standpoint. As individuals and as members of communities, countries, and nations, the challenges before us are indeed overwhelming.

And yet our capacity to deal with these depends on our resilience. We are now, all of us, in a life and death struggle in which our survival and that of our families and communities depends on our ability to direct our behaviors in constructive ways … all this while the sky and our sense of normalcy is falling around us.

New York Times photo

Three aspects of crisis

In these times it is essential if difficult for us to be able to stably navigate, to comprehend what is happening in our countries and in our lives in ways that can contribute to effective responses rather than panicked desperation. To do this, it seems, there is a need to attend to three aspects of our lives.

Most immediately there is the individual and family aspect. In the context of a global plague, the urgency of local action takes on a new meaning. Responsible personal behavior is a requirement for our survival and must be promoted and if necessary enforced to the best of our abilities.

A second and perhaps more challenging aspect is that of community, by which is meant our associations with those in and around our places of work and residence. For decades, we have been observing the loss of the sense and reality of community. Today our survival depends on recovering this sense, of nurturing it and putting it to good use, even if its expressions take on new forms and new modes of social coordination. Part of community is empathy and the ability to act in the public interest. In an age of hyper globalization and soulless anonymity, our wellbeing requires we work to recover our humanity as if our lives and those of our family and neighbors depend on it, because they do.

Perhaps the most daunting but nevertheless essential aspect of the pandemic is its political aspect. As a frontline medical worker in Spain has noted, “This is not only an epidemic of illness, it’s an epidemic of really bad government.” That may very well be the understatement of our times. We need to appreciate why China didn’t do it but why bad governance in China did. We need to recognize that the current global health calamity reflects and is exacerbated by a failure of public governance of historical proportions.

To be specific, the current pandemic began with the profound irresponsibility of China’s authoritarian rulers in tolerating conditions conducive to disease, suppressing information, and effectively if passively promoting its spread for two months, as infected travellers crisscrossed the planet. Across Europe, America, and soon the rest of the world, the crisis is being exacerbated by grossly under-equipped (and often profoundly irresponsible governments). It is ironic but not surprising that the leader of world’s wealthiest, most powerful, and most triumphantly capitalist country has been so lethally inept in his response.

Responsibility to self, community, and humanity

As the magnitude of the crisis increases, we are increasingly presented with the harrowing stories of those on the front lines and of those whose with loved ones whose lives are being swiftly cut short, with little in the way of goodbyes. From witness accounts, our hospitals are seeing intensities of death and disease terrifying to even the most seasoned health professionals. As individuals and members of families, we need to devote ourselves to caring for those we love and those who love us by maximizing our preventive measures one day at a time.

We also need to extend our unnaturally atrophied sense of community as best we can, by finding ways of supporting those who live and work around us with an eye to promoting collective wellbeing. Admittedly this is difficult. But we need to find ways recognizing the vulnerabilities of those around us linked to age, socioeconomics status, and other characteristics. Combing social distancing with community requires creativity. Across countries we are seeing experiments in mutual support, from red paper in windows to indicate support is needed to neighborhood chat groups and various forms of social gathering. While we need social distance, we also need to reach out. “Liking” and trolling won’t do.

Finally, responsible cooperation and (where warranted, non-cooperation) with public authorities is essential. We must always insist public controls remain transparent, not be put to abusive ends, and always promote public health inline with the best public health expertise. Yes, in some places life Columbia, death squads are using the current emergency to target political enemies. But clearly, there is no room for patience with libertarian or fascist-populist no-nothings.

Spreading virus is no one’s right. That includes government, however, and chambers of commerce suggesting lives be sacrificed to profits. Where necessary, informed resistance to public authority may be necessary. The basic standard of evaluating when this is warranted is simple enough: our must behavior must never compromise public health.

Who knows what the world will look like after this storm has passed. Who knows what our communities will look like. And even our families and us. Surely we will need to rebuild our economies and put them to the service of humanity.

In the mean time we need to develop new capacities and resiliencies. Part of this, I suspect, is the ability to link together these different aspects of our collective crisis, to take occasional breaks for emotional health and restoration, and to appreciate the finer things in life which, above all else, are our relations with those we love and, somewhat more hopefully, with the communities and collective efforts of humanity on which our lives now depend. Our future is now.

JL, Leiden

Jonathan D. London is Associate Professor of Political Economy at Leiden University’s Institute for Area Studies, in the Netherlands. His most recent books include Welfare and Inequality in Marketizing East Asia, published in 2018 and the Routledge Handbook of Contemporary Vietnam, forthcoming in 2020. London has more than 20 years of experience living and working in Asia. He was born in Boston and raised in Cambridge Massachusetts. He holds a PhD in sociology from the University of Wisconsin-Madison.

However rich, that none of the “advanced capitalist countries” of the West have the capacity to test and have therefore failed in responding to the pandemic has largely to do with the fact that none of them passed through the SARS or MERS epidemics and therefore failed to develop and adequately arresting vision of future possibilities. In the many years since SARS and MERS, the governments of these countries continuously failed to prioritize the development of an effective testing or emergency preparedness regime.

Unluckily for these countries and for those of us who live in them (and soon, especially, for those in poor countries and those in poor households and vulnerable groups in rich countries), it is not possible to have effective testing and emergency pandemic response regimes in short order or to have treatment materials, medicines, and equipment on a sufficiently large scale.

That health systems in the world have become so thoroughly commercialized and profit-driven has reduced their effectiveness with respect to public health, leading to the current situation that is aptly summarized in conversations long overheard in hospitals in the so-called Third World: “There are not tests we can do because we don’t have them for you. I am sorry but there is no treatment, so I suggest you just go home and wait.”

And one more note…

I just learned this morning that the lovely family directly across our very small street has the virus. We see them every morning and every day of the year through the windows of our houses, which are only meters away from each other. Every so often we wave to each other through our windows. Our small whatsapp group of immediate neighbors is supporting them. My wife just brought them groceries.

Will not be surprised if I/we get it soon. Wait at home, perhaps? Let’s see.

Notes on the Plague (Original Post Here)

COVID -19 is finally the monster at the door. Researchers are working night and day to characterize the outbreak but they are faced with three huge challenges. First the continuing shortage or unavailability of test kits has vanquished all hope of containment. Moreover it

is preventing accurate estimates of key parameters such as reproduction rate, size of infected population and number of benign infections. The result is a chaos of numbers.

There is, however, more reliable data on the virus’s impact on certain groups in a few countries. It is very scary. Italy, for example, reports a staggering 23 per cent death rate among those over 65; in Britain the figure is now 18 per cent. The ‘corona flu’ that Trump waves off is an unprecedented danger to geriatric populations, with a potential death toll in the millions.

Second, like annual influenzas, this virus is mutating as it courses through populations with different age compositions and acquired immunities. The variety that Americans are most likely to get is already slightly different from that of the original outbreak in Wuhan. Further mutation could be trivial or could alter the current distribution of virulence which ascends with age, with babies and small children showing scant risk of serious infection while octogenarians face mortal danger from viral pneumonia.

Third, even if the virus remains stable and little mutated, its impact on under-65 age cohorts can differ radically in poor countries and amongst high poverty groups. Consider the global experience of the Spanish flu in 1918-19 which is estimated to have killed 1 to 2 per cent of humanity. In contrast to the corona virus, it was most deadly to young adults and this has often been explained as a result of their relatively stronger immune systems which overreacted to infection by unleashing deadly ‘cytokine storms’ against lung cells.

The original H1N1 notoriously found a favored niche in army camps and battlefield trenches where it scythed down young soldiers down by the tens of thousands. The collapse of the great German spring offensive of 1918, and thus the outcome of the war, has been attributed to the fact that the Allies, in contrast to their enemy, could replenish their sick armies with newly arrived American troops.

It is rarely appreciated, however, that fully 60 per cent of global mortality occurred in western India where grain exports to Britain and brutal requisitioning practices coincided with a major drought. Resultant food shortages drove millions of poor people to the edge of starvation. They became victims of a sinister synergy between malnutrition, which suppressed their immune response to infection, and rampant bacterial and viral pneumonia. In another case, British-occupied Iran, several years of drought, cholera, and food shortages, followed by a widespread malaria outbreak, preconditioned the death of an estimated fifth of the population.

This history – especially the unknown consequences of interactions with malnutrition and existing infections – should warn us that COVID-19 might take a different and more deadly path in the slums of Africa and South Asia. The danger to the global poor has been almost totally ignored by journalists and Western governments. The only published piece that I’ve seen claims that because the urban population of West Africa is the world’s youngest, the pandemic should have only a mild impact. In light of the 1918 experience, this is a foolish extrapolation. No one knows what will happen over the coming weeks in Lagos, Nairobi, Karachi, or Kolkata. The only certainty is that rich countries and rich classes will focus on saving themselves to the exclusion of international solidarity and medical aid. Walls not vaccines: could there be a more evil template for the future?

*

A year from now we may look back in admiration at China’s success in containing the pandemic but in horror at the USA’s failure. (I’m making the heroic assumption that China’s declaration of rapidly declining transmission is more or less accurate.) The inability of our institutions to keep Pandora’s Box closed, of course, is hardly a surprise. Since 2000 we’ve repeatedly seen breakdowns in frontline healthcare.

The 2018 flu season, for instance, overwhelmed hospitals across the country, exposing the shocking shortage of hospital beds after twenty years of profit-driven cutbacks of in-patient capacity (the industry’s version of just-in-time inventory management). Private and charity hospital closures and nursing shortages, likewise enforced by market logic, have devastated health services in poorer communities and rural areas, transferring the burden to underfunded public hospitals and VA facilities. ER conditions in such institutions are already unable to cope with seasonal infections, so how will they cope with an imminent overload of critical cases?

We are in the early stages of a medical Katrina. Despite years of warnings about avian flu and other pandemics, inventories of basic emergency equipment such as respirators aren’t sufficient to deal with the expected flood of critical cases. Militant nurses unions in California and other states are making sure that we all understand the grave dangers created by inadequate stockpiles of essential protective supplies like N95 face masks. Even more vulnerable because invisible are the hundreds of thousands of low-wage and overworked homecare workers and nursing home staff.

The nursing home and assisted care industry which warehouses 2.5 million elderly Americans – most of them on Medicare – has long been a national scandal. According to the New York Times, an incredible 380,000 nursing home patients die every year from facilities’ neglect of basic infection control procedures.

Many homes – particularly in Southern states – find it cheaper to pay fines for sanitary violations than to hire additional staff and provide them with proper training. Now, as the Seattle example warns, dozens, perhaps hundreds more nursing homes will become coronavirus hotspots and their minimum-wage employees will rationally choose to protect their own families by staying home. In such a case the system could collapse and we shouldn’t expect the National Guard to empty bedpans.

The outbreak has instantly exposed the stark class divide in healthcare: those with good health plans who can also work or teach from home are comfortably isolated provided they follow prudent safeguards. Public employees and other groups of unionized workers with decent coverage will have to make difficult choices between income and protection. Meanwhile millions of low wage service workers, farm employees, uncovered contingent workers, the unemployed and the homeless will be thrown to the wolves. Even if Washington ultimately resolves the testing fiasco and provides adequate numbers of kits, the uninsured will still have to pay doctors or hospitals for administrating the tests. Overall family medical bills will soar at the same time that millions of workers are losing their jobs and their employer-provided insurance. Could there possibly be a stronger, more urgent case in favor of Medicare for All?

But universal coverage is only a first step. It’s disappointing, to say the least, that in the primary debates neither Sanders or Warren has highlighted Big Pharma’s abdication of the research and development of new antibiotics and antivirals. Of the 18 largest pharmaceutical companies, 15 have totally abandoned the field. Heart medicines, addictive tranquilizers and treatments for male impotence are profit leaders, not the defenses against hospital infections, emergent diseases and traditional tropical killers. A universal vaccine for influenza – that is to say, a vaccine that targets the immutable parts of the virus’s surface proteins – has been a possibility for decades but never a profitable priority.

As the antibiotic revolution is rolled back, old diseases will reappear alongside novel infections and hospitals will become charnel houses. Even Trump can opportunistically rail against absurd prescription costs, but we need a bolder vision that looks to break up the drug monopolies and provide for the public production of lifeline medicines. (This used to be the case: during World War Two, the Army enlisted Jonas Salk and other researchers to develop the first flu vaccine.) As I wrote fifteen years ago in my book The Monster at Our Door – The Global Threat of Avian Flu:

Access to lifeline medicines, including vaccines, antibiotics, and antivirals, should be a human right, universally available at no cost. If markets can’t provide incentives to cheaply produce such drugs, then governments and non-profits should take responsibility for their manufacture and distribution. The survival of the poor must at all times be accounted a higher priority than the profits of Big Pharma.

The current pandemic expands the argument: capitalist globalization now appears to biologically unsustainable in the absence of a truly international public health infrastructure. But such an infrastructure will never exist until peoples’ movements break the power of Big Pharma and for-profit healthcare.