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The Nation, March 18, 2020
Who Gets Forgotten in a Pandemic
The only certainty is that rich countries and rich classes will focus on
saving themselves to the exclusion of international solidarity and
medical aid.
By Mike Davis
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. 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 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?
Ayear 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 corona
virus 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 be 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.
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