Tag: Covid-19

Covid-19: A Simple Moral Calculus

Introduction

There are still many unresolved questions regarding the pathogenesis of this disease and especially the reasons underlying the extremely different clinical course, ranging from asymptomatic forms to severe manifestations, including the Acute Respiratory Distress Syndrome (ARDS). SARS-CoV-2 showed phylogenetic similarities to both SARS-CoV and MERS-CoV viruses, and some of the clinical features are shared between COVID-19 and previously identified beta-coronavirus infections. Available evidence indicate[s] that the so called “cytokine storm” an uncontrolled over-production of soluble markers of inflammation which, in turn, sustain an aberrant systemic inflammatory response, is a major [factor] responsible for the occurrence of ARDS.
Francesca Coperchinia, Luca Chiovatoab, Laura Croceab, Flavia Magriab, Mario Rotondi, ‘The cytokine storm in COVID-19: ‘An overview of the involvement of the chemokine/chemokine-receptor system’ (2020)[i]

For the first time in the post-war history of epidemics, there is a reversal of which countries are most heavily affected by a disease pandemic. By early May, 2020, more than 90% of all reported deaths from coronavirus disease 2019 (COVID-19) have been in the world’s richest countries; if China, Brazil, and Iran are included in this group, then that number rises to 96%.
Richard Cash and Vikram Patel, ‘Has COVID-19 subverted global health?’ (2020)[ii]

The evidence of Hitler’s as well as Stalin’s dictatorship points clearly to the fact that isolation of atomized individuals provides not only the mass basis for totalitarian rule, but is carried through to the top of the whole structure.
Hannah Arendt, The Origins of Totalitarianism (1951).

All this hate and violence [in the world] is being facilitated by a handful of internet companies that amount to the greatest propaganda machine in history.[iii]
Sacha Baron Cohen, speech, (2019)

Comment is free, but facts are sacred.[iv]
John Scott, editor of The Guardian, (1921)

In March, 2020 a simple moral calculus seized Western consciousness. Prompted by grim epidemiological assessments, and distressing accounts from emergency doctors in Northern Italy, a call to #flattenthecurve resounded across social media. The global force of hashtag activism led millions to renounce meeting friends and family in an extraordinary display of solidarity with vulnerable older people.

Twitter, which had previously styled itself ‘the free speech-wing of the free-speech party’^[v], allowing all manner of unmoderated content to appear on controversial subjects such as climate change – as well as hate speech from President Donald Trump – abruptly changed policy on March 16^thsaying it would be:

Broadening our definition of harm to address content that goes directly against guidance from authoritative sources of global and local public health information. Rather than reports, we will enforce this in close coordination with trusted partners, including public health authorities and governments, and continue to use and consult with information from those sources when reviewing content.^[vi]

Problematically, however, there is no canonical response to the global pandemic and significant debate has occurred between authoritative sources, as different governments pursue varied policies, with mixed results. This has created potential for national authorities to impugn or disqualify reasonable criticism by grafting health warnings on accounts at variance with a particular government’s guidance, or wider political objectives.

Twitter has not acted alone, Google has taken unprecedented steps to erase material that violates ‘Community Guidelines’: ‘including content that explicitly disputes the efficacy of global or local health authority recommended guidance on social distancing that may lead others to act against that guidance.’[vii]

Typically, Facebook adopted a laissez faire approach, although users who had read, watched or shared ‘false’ coronavirus content received a pop-up alert urging them to go the World Health Organisation’s website.[viii]

Whatever one’s view on the importance of social distancing, our readers may recall Ronald Dworkin’s pronouncement that ‘free speech is a condition of legitimate government.’ He argues that the universality of speech as a mode of rational discourse and scientific inquiry could act as truth-seeking counterweight to mass hysteria, negating unreason and prejudice.[ix]

Moreover, Stephen Sedley, the great English judge, called freedom of expression ‘the lifeblood of democracy;[x] or as George Orwell put it in the introduction to Animal Farm (1945): ‘If liberty means anything at all, it means the right to tell people what they do not want to hear.’

Accepting Covid-19 represents an extraordinary challenge requiring a concerted response, censorship by Big Data in such a blanket form, including of recognised academic authorities, surely only lends credence to conspiracy theories, fomented by the far-right in particular. Disregard for freedom of expression casts doubt over the integrity of scientific inquiry and inhibits rational debate.

Reappraisal

The English-speaking world was led to believe in early March that Covid-19 had a mortality rate of between 2% and 3% [xi], and that its spread would be exponential, with a reproductive (R) value of 3 (i.e. one person would infect another three), compared to an R value of 1.28 for seasonal influenza.^[xii] Moreover, based on Lombardy’s experience, it seemed the death toll would include hundreds or even thousands of health service workers tending to the sick.

As the weeks passed the assessment of the mortality rate was scaled back to 1.4%,^[xiii] but by then the virus seemed to be moving through Europe like a forest fire at the height of summer. Soon the number of daily mortalities from the disease was dominating news headlines.

Insofar as possible, most reasonable citizens abided by the popular injunction to #staythefuckathome, entrusting governments with emergency powers to guard against errant behaviour.

As time passed, however, we learnt that early projections on the infection fatality rate seem to have been significantly wide of the mark. Lone Simonsen professor of population health sciences at Roskilde University in Denmark recently said she expected a infection fatality rate ‘possibly as low as 0.2% or 0.3%’, while Professor Emeritus at the Karolinska Institute in Stockholm Professor Johan Giesecke has suggested an even lower figure of 0.1%.^[xiv] The U.S. Centre for Disease Control’s best estimate implies a COVID-19 infection fatality rate below 0.3%.^[xv]

Sunetra Gupta, Professor of Theoretical Epidemiology at the University of Oxford has gone lower still estimating an infection fatality rate of between 0.1% and 0.01%.[xvi] She bases this on an assumption the virus has been in circulation far longer than initially assumed, an argument gaining traction, with satellite data suggesting the pandemic hit Wuhan in China a far back as October,[xvii] while France’s ‘first known case’ was in December.[xviii] In truth, however, the infection fatality rate appears to depend hugely on the nature of any society, and not simply its age profile, for reasons to be discussed.

An aggravated perception of danger is also likely to have occurred through media reports juxtaposing confirmed cases, with mortalities. Thus The Guardian reported on May 16^th that, ‘According to the Johns Hopkins University tracker there are 4,531,811 confirmed cases worldwide. The number of people who have lost their lives is 307,001 according to official tolls, but the true number is likely to be much higher.’^[xix]

On a cursory examination, one might assume a infection fatality rate of 6-7%, or “much higher”. Little wonder then that people have been jumping out of the way of one another on footpaths.

This infection fatality rate may well prove to be considerably higher than a seasonal flu mortality rate of 0.04%, but it is instructive that during one such outbreak in 2017-2018 that there were 61,000 influenza-associated deaths in the United States alone.^[xx] Yet these preventable deaths hardly registered on the national consciousness, unlike like the victims of Covid-19.

100,000 people have now died in the U.S. from the coronavirus.

We highlighted 1,000 of them this week — their names and their stories. https://t.co/PILnDapjLI

— The New York Times (@nytimes) May 27, 2020

As Simon Jenkins, one of the few Guardian commentators who has kept the pandemic in perspective put it: ‘When hysteria is rife, we might try some history.’[xxi]

Epidemiological Modelling

Based on a infection fatality rate of 0.9%, in late March an Imperial College team led by Professor Neil Ferguson predicted that unless stern measures were taken there would be half-a-million deaths in the U.K. and over two million in the U.S.:[xxii]

But as early as March Nobel-prize winning bio-physicist Michael Levitt was identifying common sense flaws in prominent epidemiological modelling, saying:

In exponential growth models, you assume that new people can be infected every day, because you keep meeting new people. But, if you consider your own social circle, you basically meet the same people every day …. You can meet new people on public transportation, for example; but even on the bus, after sometime most passengers will either be infected or immune.^[xxiii]

Levitt assumed the R rate would decline once reasonable steps were taken, such as social distancing and removing the possibility of close confinement in pubs, at sporting events and other so-called ‘super-spreader’ events.^[xxiv] In March Levitt told Ferguson that he had over-estimated the potential death toll by ‘10 or 12 times.’[xxv]

Moreover, given only one branch seems to have closed its doors over the course of the outbreak in the U.K.,^[xxvi] it appears early panic about contagions occurring in supermarkets, which is still leading to people disinfecting their shopping, were largely unfounded.^[xxvii]

Mistaking Flu for Coronavirus

Mortalities from novel flu viruses tend to be among individuals under the age of forty. This is because ‘emergent viruses resembled those that had circulated previously within the lifespan of then-living people.’^[xxviii] This means older peoples’ immune systems are generally better equipped with antibodies to fight off such novel infections.

As yet it is still unclear whether exposure to other coronaviruses, including the ‘common cold’, provide greater immunity to Covid-19, although one recent paper does suggest, ‘cross-reactive T cell recognition between circulating “common cold” coronaviruses and SARS-CoV-2.’[xxix]

It remains to be seen whether the death toll from Covid-19 will scale the heights of the ‘Asian’ Flu (H2S2) of 1957, (with a an estimated median R value of 1.65^[xxx]) which led to 1 million deaths around the world, including 80,000 in the United States; or the ‘Hong Kong’ flu (H3N2) of 1968 (with an estimated median R value of 1.80) that was responsible for between 1 million and 4 million^[xxxi]; let alone the Spanish Influenza (H1N1) outbreak of 1918 that carried off an astonishing fifty million people^[xxxii], (with an estimated median R value of 3^[xxxiii]), most of whom were in the prime of their lives.

Hugh Pennington emeritus professor of bacteriology at the University of Aberdeen recently took an optimistic view on the prospect of avoiding a dreaded ‘second wave’ of infections:

The idea of a second wave comes almost entirely from the 1918 Spanish flu pandemic. The first wave occurred in June and July and the second in October and November. The first was mild, the second was lethal. It is yet to be explained why the infections occurred in waves and why the virus faded away after the first and then returned.

‘Flu is very different from Covid-19’ Pennington says, ‘Although both are commonly spread by the respiratory route, and both have infected prime ministers, the more we learn about Covid-19, the less its biology and epidemiology resemble that of flu.’

He further contends, ‘In the absence of controls, flu has an R rate of seven [presumably he means at the height of a pandemic]; Covid-19’s is between two and three [lower seemingly than the earlier assessment]. And far more than with flu, Covid-19 cases have very commonly occurred in clusters.’

Conflation with flu modelling may also be discounting wider “imperviousness” than assumed. UCL Professor Karl Friston famously drew on astrophysics to explain Germany’s low infection rate relative to the U.K.:

it looks as if the low German fatality rate is not due to their superior testing capacity, but rather to the fact that the average German is less likely to get infected and die than the average Brit. Why? There are various possible explanations, but one that looks increasingly likely is that Germany has more immunological “dark matter” – people who are impervious to infection, perhaps because they are geographically isolated or have some kind of natural resistance. This is like dark matter in the universe: we can’t see it, but we know it must be there to account for what we can see.[xxxiv]

The curious case of Japan also indicates that certain societies – or nations – are considerably more impervious than others. As the country in the world with the oldest population in the world, and with heavy urban densities, one would have expected the virus to have had a devastating impact there, yet:

No restrictions were placed on residents’ movements, and businesses from restaurants to hairdressers stayed open. No high-tech apps that tracked people’s movements were deployed. The country doesn’t have a center for disease control. And even as nations were exhorted to “test, test, test,” Japan has tested just 0.2% of its population — one of the lowest rates among developed countries.[xxxv]

Japan’s population of over 125 million experienced less than 1,000 deaths from Covid-19.

Nonetheless, apart from underlying exacerbating factors such as population density and an ageing population – relative to its Irish neighbour at least[xxxvi] – as well as a high obesity rate,[xxxvii] the U.K.’s high death toll can, at least in part, be attributed to Boris Johnson’s government’s ‘sleepwalking’ through the beginning of the crisis,[xxxviii] almost wlilfully ignoring the threat, and putting out highly inappropriate messages, including on shaking hands.

Nevertheless, the suggestion aired on an episode of Channel 4’s Dispatches that 13,000 deaths would have been avoided if a lockdown or stay-at-home order had been introduced at the beginning of March came from a health analyst, George Batchelor, rather than a recognised academic authority, and should be treated with caution.

Revealingly, in Hong Kong where 90% of cases were contact traced, ‘the number of individual secondary cases was significantly higher within social settings such as bars and restaurants compared to family or work exposures.’ In time it may be determined that Boris Johnson’s hesitation in closing pubs was his most costly mistake.[xxxix]

QALY

In Italy, where average life expectancy is approximately eighty-three-years-of-age, the average age of mortality from Covid-19 was approximately eighty years-of-age.^[xl] This figure includes over one hundred health care workers.^[xli] Many of these premature deaths occurred in the clusters that Hugh Pennington refers to – perhaps from heavy ‘viral load’[xlii] encountered in poorly ventilated hospitals and care home facilities.

The overall loss of life years from the Covid-19 pandemic may prove minimal, however, compared to novel flu viruses, which have mainly afflicted the young over the past century.

This is not to diminish the value of any life, but public health interventions are conventionally given a comparative value (QALY – Quality-adjusted Life Year), ‘which is routinely used as a summary measure of health outcome for economic evaluation, which incorporates the impact on both the quantity and quality of life.’ The financial cost of any intervention, including a lockdown or stay-at-home order, must be measured against its impact on both quantity and quality of life.

There are now serious question marks around the efficacy of lockdowns. Using ‘Bayesian’ modelling a team led by Professor Simon Wood in Bristol University supports Michael Levin’s assessment that early epidemiological models were flawed, suggesting that ‘the number of new daily infections in the UK peaked some days before lock down was implemented, although it does not completely rule out a slightly later peak.’^[xliii]

Furthermore, a quasi-experimental study carried out by the University of East Anglia concluded that stay at home orders, or lockdowns were ‘not associated with any independent additional impact.’[xlvi] Another recent study in Nature, however, offers a different assessment, but includes data from China, which may be unreliable, and where the extremity of the measures are incompatible with democratic norms. Lockdown advocates also generally assume a higher infection fatality rate than recent reappraisals.

During lockdown, across Europe and beyond, cases and deaths occured in clusters: within enclosed spaces such as care homes,[xliv] hospitals and meat packing plants,[xlv] but also households. Hashtag activism informed the public in most Western countries about the pandemic, who were refraining from unnecessary social encounters, and travel, already.

This may be why the Norwegian Institute for Public Health has recently called for the government to avoid such a far-reaching measure if the country is hit by a second wave.^[xlvii] Norwegian Prime Minister Erna Solberg also bravely admitted before a national television audience: ‘I probably took many of the decisions out of fear.’[xlviii]

The adverse consequences of lockdowns – including a spike in domestic violence[xlix], its effect on children[l] and unprecedented economic impacts, especially on SMEs and casual workers, also cannot be discounted.

Worst of all has been the effect of draconian lockdowns on developing countries, such as India. Vikram Patel and Richard Cash (both of Harvard University) wrote in The Lancet:

we suggest that countries must let people get on with their lives—to work, earn money, and put food on the table. Let shop keepers open and sell their wares and provide services. Let construction workers return to building sites. Allow farmers to harvest their crops and to transport them to be sold on the open market. Allow health workers to do their daily work as before, with sensible precautions such as use of gloves and masks to minimise the risk of exposure to the virus. And allow the average citizen to travel freely with restrictions only applied to clusters where lockdowns are necessary. Livelihoods are an imperative for saving lives. Some will say such an approach, which runs the risk of spreading disease, implies that the lives of poor people are not as valuable as those in wealthy countries. Nothing could be further from the truth. The policies of widespread lockdowns and a focus on high-technology health care might unintentionally lead to even more sickness and death, disproportionately affecting the poor.

These arguments also apply in wealthier societies, as many among the poor do not have the privilege of being able to work from home, and may participate in the black economy. Government supports are generally inadequate and do not last indefinitely.

The preceding points are not a definitive argument in favour of Sweden’s policies during the pandemic, faults in which have been acknowledged by its chief architect Anders Tegnell. But it is important for policy makers to recognise the cost of lockdowns, especially for extended periods. Also, importantly, handing discretionary powers to police forces in such circumstances establishes a dangerous precedent.

Fatalism

In solitude we have been consumed by a story that feeds into pressing contemporary dilemmas, including on the role of scientific expertise. This can be situated within a long-standing division in Western culture between rationality and intuition, evident during World War II in the conflict between Communism and Fascism.

As Martin Glover put it:

Stalin, as a version of the Enlightenment idea of redesigning society on a rational basis, shared the catastrophic implications of carrying out such a project without moral or human restraints. Nazism was against the universalism of Kant and other Enlightenment thinkers. It was tribal: not rights of man, but the German right to lebensraum … Stalinism shows what can happen when Enlightenment ideas are applied wrongly, Nazism shows what can happen when unenlightened ideas are applied rightly.[liii]

A form of this has spilled into the so-called Culture Wars, including identity politics, that have raged in particular since the 1990s, culminating in Brexit and President Trump, but it is also perhaps evident at a psychological level within most of our personalities. Importantly, excesses of rationality can be as destructive as Fascism, as we saw under the guise of Communism.

Responses to the pandemic have also been conditioned by prior faith in, or suspicion of, the Western medical system – including from so-called anti-vaxxers – with Populist right-wing politicians dismissing concerns about a bad flu,[liv] and offering to take it on the chin.[lv] In contrast, some on the left seem to have viewed the crisis as an opportunity to enlarge the role of the State, leading to countervailing scientific authorities to be dismissed on ideological grounds.

There may also have been a tendency, evident in The Guardian, The New York Times and elsewhere, to heighten outrage against the administrations of Donald Trump in the U.S. and Boris Johnson in the U.K. by front-loading mortality statistics.

Another explanation for the extreme response of individuals who consented to prolonged periods of self-isolation – including those of an age profile suggesting they had little to worry about themselves – is an evident fatalism haunting a globally dominant capitalist system. As David Graeber put it:

Capitalism is a system that enshrines the gambler as an essential part of its operation, in a way that no other has, yet at the same time, capitalism seems to be uniquely incapable of conceiving of its own eternity. Could these two facts be linked?^[lvi]

An understandable fatalism in the face of climate change and mass extinctions, perhaps spilled into reactions to this pandemic, with self-isolation a form of repentance.

Moreover, the idea of plague as representing divine retribution may operate at an unconscious level. Apart from Biblical episodes such as that visited on Egypt, it is found in ancient epics such as Homer’s Iliad. Thus, when King Agamemnon makes a war prize of Chryseis the daughter of Chryses a priest of Apollo, the sun god takes revenge by unleashing poison-tipped arrows against the Greek army, many of whom succumb to plague.

More recently, films, such as Outbreak (1995) starring and Dustin Hoffman, and novels such as Jose Saramago’s Blindness (1997), have played on these fears.

What was Covid-19 but God or Gaia punishing us for our consumerist sins?

Guardian Angle

The so-called hashtag activism that prompted civil society to take preventive measures against Covid-19, and which led to many governments to adopt draconian suppression policies, including lockdowns, has been led in the U.K. and Ireland in particular by The Guardian newspaper

The free digital site with an estimated 42 million monthly visitors[lvii] devoted unrelenting rolling coverage to Covid-19, emphasising the simple moral calculus with a banner across its home page. This has been to the almost complete exclusion of all other content for the months of March, April and May.

The Guardian’s loss of proportion, and nuance, has been particularly damaging as it is the most trusted newspaper brand in the U.K., including, importantly, among readers aged 18 to 29.[lviii] This may be traced to its position as a global news provider of free content dependent on maintaining an enormous click rate to derive a profit.

In a recent memoir the former editor Alan Rusbridger describes how: ‘Only by going for reach could you make up for … the ‘frightening disparity’ between the yields in traditional and online media.’[lix]

He reveals that by mid-2018:

The Guardian was reaching 150 million browsers each month and a billion page views per month. There was no talk of paywalls: even so, reader revenues had overtaken advertising. And digital revenues – at £109 million – had, for the first time, overtaken the £107.5 million of print revenues. The paper was confidently talking of hitting break-even in 2018/19.[lx]

The difficulty is that once you have reached such a high threshold, and have taken on hundreds of staff, you have to keep that readership transfixed.

The Guardian’s increasingly monopolistic position has come at the expense of journalistic diversity, as smaller publishers cannot compete with its reach. Moreover the perceived reliability of its reporting creates a difficulty for competitors wishing to mount a pay wall without significant marketing investment. In such a squeezed field alternatives are increasingly the preserve of billionaires, such as Rupert Murdoch, the Barclay Brothers, Mike Bloomberg and Jeff Bezos. This is having a corrosive effect on democracy, as many of these publications are ideologically tainted, and support vested interests.

Underling all this, the number of American journalists fell from 60,000 in 1992 to 40,000 in 2009,[lxi] This pattern has been seen all around the world as revenues diminish and workloads increase. In the U.K. Cardiff University researchers recently conducted an analysis of 2,000 U.K. news stories. They discovered the average Fleet Street journalist was filing three times as much as in 1985. Or, to put it another way, journalists now have only one-third of the time they used to have to do their jobs.[lxii]

This results in what Nick Davies has described as ‘churnalism’, whereby most journalists are passive processors of ‘unchecked, second-hand material, much of it contrived by PR to serve a political or commercial interest.’[lxiii]

Hyperbolic Coverage

An exhaustive assessment of Guardian coverage is beyond the scope of this article, but two examples of their unsatisfactory reporting throughout this crisis should hopefully suffice.

On Friday, May 15^th an article ran under the headline: ‘Dying to go out to eat? Here’s how viruses like Covid-19 spread in a restaurant’.[lxiv] It referred to a video experiment simulating ‘how quickly germs can be spread across a variety of surfaces in environments such as restaurant buffets and cruise ships.’

To begin with, one guest of 10 at a restaurant buffet is shown with the substance on his hands meant as a stand-in for the coronavirus. Over the course of a typical dining period, the rest of the guests behave in predictable fashion, selecting utensils from serving stations, enjoying their food, checking their phones and so on.

At the end of the experiment the black light is turned on and the substance is revealed to be smeared everywhere: plates, foodstuff, utensils and even all over some of the guests’ faces.

A few paragraphs into the article, however, a second experiment demonstrates the positive effect of improved hygiene techniques, after ‘the “infected” person and the other diners take the simple precaution of washing their hands, and utensils and other implements are cleaned or replaced.

The first difficulty with the study itself is that it is conducted in a canteen-style restaurant – a worst case scenario where cutlery and plates are exposed to many hands. But the most obvious problem is that the headline feeds into a narrative of fear and paranoia, to the detriment of anyone struggling to keep a restaurant afloat.

Another headline from May 26^th paints a lurid picture: ‘Global report: ‘disaster’ looms for millions of children as WHO warns of second peak’.[lxv] Yet it soon apparent that the “disastrous” consequences for children, who are more likely to die after being struck by lightening than from a dose of Covid-19 and barely register as mortalities from the virus,[lxvi] is from increased vulnerability to forced labour and underage marriage. The “second peak” warned of by the WHO in the headline is a non-sequitur that has nothing to do with any elevated danger to children,

Choice of headline is crucial as many browsers simply scan news sites. A 2010 Pew analysis found that the average visitor spent only 3 minutes 4 seconds per session on the typical news site. That compared with a 2005 survey showing about half of U.S. newspaper readers spent more than thirty minutes reading a daily paper.[lxvii]

What has gone wrong?

Clay Shirky writes in Here Comes Everybody (2008):

When we change the way we communicate, we change society. The tools that a society uses to create and maintain itself are as central to human life as a hive is to a bee … The hive is a social device, a piece of bee information technology that provides a platform, literally, for the communication and co-ordination that keep the colony viable. Individual bees can’t be understood separately from the colony or from their shared, co-created environment. So it is with human networks.

He asserts that the ‘Web didn’t introduce a new competitor into the old eco-system, as USA Today had done. The Web created a new ecosystem.’[lxviii]

The Guardian embraced a form of ‘collaboration media’, which companies and politicians rapidly learned to respect, and fear. Former editor Alan Rusbridger recognised that ‘social media would disrupt conventional politics and transform the speed at which it happened.’ He acknowledges, however, that, ‘It was, obviously, not necessarily good at complexity – though it could link to the complexity. It could be frustratingly reductive. It didn’t patiently and painstakingly report, in the way a good new organisation still did. It was to some extent parasitical.’[lxix]

Rusbridger also quotes former Sunday Times editor Harold Evans to the effect that ‘an investigation only really began to count once the readers and even the journalists were bored with it.’[lxx] But in an all-consuming demand for clicks, and in the frenzied political era of Trump and Brexit, balance has been lost. Lacking detached and independent journalism we have walked into a prolonged social experiment that will take considerable unravelling.

A New Hashtag

On May 25^th, 2020, George Perry Floyd, a 46-year-old black man was killed when a white Minneapolis police officer kneeled on his neck during an arrest for passing a counterfeit $20 bill. His death brought a wave of demonstrations in major U.S. cities that have spread to other countries, with many protestors donning masks as protection against the virus.

The hashtag generation has discovered another noble cause in #blacklivesmatter – to be clear #flattenthecurve was certainly well motivated – but let us hope balance and nuance is not lost, and that a deadening conformity does not ensue in debates over race, poverty and the ambit of the state.

The extraordinary scenes witnessed around the world could also be interpreted as a proxy for societies throwing off the heavy knee of lockdowns, containing a basic human impulse to interact with one another, honouring the exuberant Dionysian element in our nature that had been contained by Apollonian rationality.

Fyodor Dostoyevsky’s unnamed narrator from Notes from the Underground (1864) seems to envisage the poles of this division. First, he describes the archetypal rationalist that ‘scientifically’ predicts all outcomes in society:

All human actions will then of course be calculated, mathematically, like logarithm tables up to 108,000, and recorded in a calendar; or even better, well-intentioned publications will then appear, like the present-day encyclopaedic dictionaries, in which everything will be so precisely calculated and recorded that there will no longer be deliberate acts or adventures in the world.

But he suggests this would create a reaction:

I, for example, wouldn’t be at all surprised if, in the midst of all this reasonableness that is to come, suddenly and quite unaccountably some gentleman with an ignoble, or rather a reactionary and mocking physiognomy were to appear and, arms akimbo, say to us all: “Now, gentlemen, what about giving all this reasonableness a good kick with the sole purpose of sending all those logarithms to hell for a while so we can live for a while in accordance with our own stupid will![lxxi]

Thus an excess of rationality may create conditions for profound irrationality, or even absurdity in the case of the utilitarian philosopher Jeremy Bentham’s felicitous calculus.

What Next?

We still have to address the public health crisis of a pandemic, requiring substantial reforms in healthcare, architecture and spatial design to contend with a disease that should not be treated as a flu pandemic.

Once unsustainable lockdowns ease, Western societies with susceptible populations must adapt to life with the virus. A policy of elimination is unrealistic and even cruel, unless we essentially exclude entrants from the outside world, as in New Zealand, or become a police state like China.

Like a thief in the night, Covid-19 discovered weaknesses in the wealthiest countries in the world that also happen to be among the most unequal. Most obviously it found its way to older individuals, many weakened by increasingly poor diets and sedentarism that is behind a pernicious obesity pandemic.

It has already been argued that life expectancy is declining in the United States,[lxxii] after two centuries during which it climbed steadily. Our lives, and diets, are simply unsustainable, and perhaps Covid-19 is nature’s (God or Gaia’s?) way of telling us so. The question is whether we are prepared to adopt the environmental approaches to lower the risk of further zoonotic episodes that lead to viruses.

On a more basic level we need to retrofit buildings – embracing the idea of a healthy home[lxxiii] or workplace that diminishes viral load – and redesign transport systems to prevent contagions. As a priority we require hospital design for better infection control as ‘Building ventilation, whether natural or mechanical serves to dilute droplets nuclei in the air and is the single most important engineering control in the prevention of transmission of airborne infections.’[lxxiv]

Yet surely we cannot lose the joy of social interaction, or turn romance into an online transaction controlled by algorithms. Great gatherings of people are still the lifeblood of politics, the arts and sport. For these to become historical curiosities, outlawed indefinitely as “super-spreader” events, would be lamentable.

We have to shake the trauma off somehow, or dance it off perhaps. Above all children cannot be confounded by the fear of their parents and other adults, and have natural inclinations to play frustrated indefinitely. Let us restore the friendly hug or kiss in time. We have to accept a measure of death in exchange for the expression of lives we all value. Society cannot be broken by social distancing.

Another vital lessons from this pandemic is that we require greater freedom of expression and media diversity. It is unacceptable for unaccountable corporate bodies such as Twitter, Google and Facebook to control narratives indefinitely. In truth, people may have to get used to paying for journalism once again, or at least acknowledge that without payment you are (mostly) getting clickbait.

In writing ‘the first draft of history’ on Covid-19, The Guardian may be excused for making errors, but nor should the publication be viewed as a neutral conduit of facts either, unmotivated by profit, and without a seat at the highest tables of power. As Rusbridger reveals in response to the Edward Snowden and Julian Assange accounts: ‘I once remarked to a senior intelligence figure that the British and American governments, instead of condemning our role, should go down on their knees in thanks that we were there as such a careful filter.’[lxxv]

All Images © Daniele Idini

[i] Francesca Coperchinia, Luca Chiovatoab, Laura Croceab, Flavia Magriab, Mario Rotondi, ‘The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system’ (2020)https://www.sciencedirect.com/science/article/pii/S1359610120300927

[ii] Richard Cash and Vikram Patel, ‘Has COVID-19 subverted global health?’ May 5^th, 2020, The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31089-8/fulltext

[iii] Untitled, ‘’Greatest propaganda machine in history’: Sacha Baron Cohen slams Facebook, other social media companies’, NBC November 22^nd, 2020, https://www.nbcnews.com/tech/social-media/greatest-propaganda-machine-history-sacha-baron-cohen-slams-facebook-other-n1089471

[iv] Simon Rogers, ‘Data journalism in action: what is Facts are Sacred about?’ April 4th, 2013, https://www.theguardian.com/news/datablog/2013/apr/04/data-journalism-facts-are-sacred

[v] Josh Halliday, ‘Twitter’s Tony Wang: ‘We are the free speech wing of the free speech party’’ March 22^nd, 2012, https://www.theguardian.com/media/2012/mar/22/twitter-tony-wang-free-speech

[vi] Vijaya Gadde and Matt Derella, ‘An update on our continuity strategy during COVID-19’, https://blog.twitter.com/en_us/topics/company/2020/An-update-on-our-continuity-strategy-during-COVID-19.html

[vii] Jon Levine, ‘YouTube censors epidemiologist Knut Wittkowski for opposing lockdown’, New York Post, May 16^th, 2020, https://nypost.com/2020/05/16/youtube-censors-epidemiologist-knut-wittkowski-for-opposing-lockdown/

[viii] Untitled, ‘Coronavirus: Facebook alters virus action after damning misinformation report’, BBC, April 3^rd, 2020, https://www.bbc.com/news/technology-52309094

[ix] Ronald Dworkin ‘The Right to Ridicule’, March 23^rd, 2006, The New York Review of Books, https://www.nybooks.com/articles/2006/03/23/the-right-to-ridicule/, accessed 26/4/19.

[x] Stephen Sedley, Law and the Whirligig of Time, London, Hart Publishing, 2018.

[xi] Sharon Begey, ‘Lower death rate estimates for coronavirus, especially for non-elderly, provide glimmer of hope’, March 16^th, Stat, https://www.statnews.com/2020/03/16/lower-coronavirus-death-rate-estimates/

[xii] Matthew Biggerstaff, Simon Cauchemez, Carrie Reed, Manoj Gambhir & Lyn Finelli, ‘Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature’ BMC Infectious Diseases, September, 2014, https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-480

[xiii] Ibid, Sharon Begley, Ihttps://www.statnews.com/2020/03/16/lower-coronavirus-death-rate-estimates/

[xiv] Justin Fox, ‘The Coronavirus is worse than the flu, bro’ Bloomberg, April 24^th, 2020 https://www.bloomberg.com/opinion/articles/2020-04-24/is-coronavirus-worse-than-the-flu-blood-studies-say-yes-by-far

[xv] Jacob Sullum, ‘The CDC’s New ‘Best Estimate’ Implies a COVID-19 Infection Fatality Rate Below 0.3%’, Reason, 24^th of May, 2020, https://reason.com/2020/05/24/the-cdcs-new-best-estimate-implies-a-covid-19-infection-fatality-rate-below-0-3/

[xvi] Freddie Sayers, ‘ Sunetra Gupta: Covid-19 is on the way out’ Unherd, May 21^st, 2020, https://unherd.com/2020/05/oxford-doubles-down-sunetra-gupta-interview/

[xvii] Kaitlyn Folmer and Josh Margolin, ‘Satellite data suggests coronavirus may have hit China earlier: Researchers’, ABC News, June 8^th, 2020, https://abcnews.go.com/International/satellite-data-suggests-coronavirus-hit-china-earlier-researchers/story?id=71123270

[xviii] Untitled, ‘Coronavirus: France’s first known case ‘was in December’, BBC, May 5^th, 2020, https://www.bbc.com/news/world-europe-52526554

[xix] Guardian staff and agencies, ‘Global report: US House passes $3tn stimulus as experts track Covid-19-linked syndrome’, The Guardian, May 16^th, 2020, https://www.theguardian.com/world/2020/may/16/global-report-democrats-push-for-3tn-stimulus-as-experts-track-covid-linked-syndrome?fbclid=IwAR1tpHpfNr_3zdSY68Yw6BUpUfAM6S56Dke8VANSk21Fhx2OQZO9pRDzFug

[xx] Center for Disease Control, ‘Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season’, https://www.cdc.gov/flu/about/burden/2017-2018.htm

[xxi] Simon Jenkins, ‘Why I’m taking the coronavirus hype with a pinch of salt’, The Guardian, March 6^th, 2020, https://www.theguardian.com/commentisfree/2020/mar/06/coronavirus-hype-crisis-predictions-sars-swine-flu-panics

[xxii] David Adam, ‘Special report: The simulations driving the world’s response to COVID-19’, Nature, April 3^rd, 2020, https://www.nature.com/articles/d41586-020-01003-6

[xxiii] Graig Graziosi, ‘Coronavirus: Nobel Prize winner predicts US will get through crisis sooner than expected’, The Independent, March 24^th, 2020, https://www.independent.co.uk/news/world/americas/coronavirus-michael-levitt-china-italy-a9422986.html

[xxiv] Richard A. Stein, ‘Super-spreaders in infectious diseases’, International Journal of Infectious Diseases, April, 2011, https://www.sciencedirect.com/science/article/pii/S1201971211000245

[xxv] Tom Morgan, ‘ Lockdown saved no lives and may have cost them, Nobel Prize winner believes’, 23^rd of May, 2020, https://www.telegraph.co.uk/news/2020/05/23/lockdown-saved-no-lives-may-have-cost-nobel-prize-winner-believes/

[xxvi] Amelia Winn, ‘Lidl becomes first supermarket chain to CLOSE a UK store after staff catch coronavirus – but shoppers are told doors will reopen on Monday’, Daily Mail, May 3^rd, 2020, https://www.dailymail.co.uk/news/article-8281995/Lidl-supermarket-chain-CLOSE-UK-store-staff-catch-coronavirus.html

[xxvii] Emily Holden, ‘Do you need to wash your groceries? And other advice for shopping safely’, The Guardian, April 2^nd, 2020, https://www.theguardian.com/world/2020/apr/02/do-you-need-to-wash-your-groceries-and-other-advice-for-shopping-safely

[xxviii] Tom Reichert, Gerardo Chowell & Jonathan A McCullers, ‘The age distribution of mortality due to influenza: pandemic and peri-pandemic’ BMC Medicine, December 12^th, 2012, https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-10-162

[xxix] Alba Grifoni, Daniela Weiskopf, Sydney I. Ramirez, Davey M. Smith, Shane Crotty, Alessandro Sette, Cell, ‘Targets of T Cell Responses to SARS-CoV-2 Coronavirus in Humans with COVID-19 Disease and Unexposed Individuals’ May 14^th, 2020, https://www.cell.com/cell/fulltext/S0092-8674(20)30610-3

[xxx] Matthew Biggerstaff, Simon Cauchemez, Carrie Reed, Manoj Gambhir, and Lyn Finelli, ‘Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature’, BMC Infectious Diseases, September 4^th, 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4169819/

[xxxi] Mark Honigsbaum, ‘Revisiting the 1957 and 1968 influenza pandemics‘,The Lancet, May 25^th, 2020, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31201-0/fulltext

[xxxii] Center for Disease Control, ‘1918 Pandemic (H1N1 virus)’ https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html

[xxxiii] Emilia Vynnycky, Amy Trindall, Punam Mangtani, ‘Estimates of the reproduction numbers of Spanish influenza using morbidity data’, International Journal of Epidemiology, May 17th, 2007, https://academic.oup.com/ije/article/36/4/881/667165

[xxxiv] Laura Spinney, ‘Covid-19 expert Karl Friston: ‘Germany may have more immunological “dark matter”’’ The Guardian, May 31^st, 2020, https://www.theguardian.com/world/2020/may/31/covid-19-expert-karl-friston-germany-may-have-more-immunological-dark-matter

[xxxv] Lisa Dua and Grace Huang, ‘Did Japan Just Beat the Virus Without Lockdowns or Mass Testing?’ Bloomberg, May 22^nd, 2020, https://www.bloomberg.com/news/articles/2020-05-22/did-japan-just-beat-the-virus-without-lockdowns-or-mass-testing

[xxxvi] Nicola Davis and Rory Carrol, ‘ Experts divided over comparison of UK and Ireland’s coronavirus records’, The Guardian, April 13^th, 2020, https://www.theguardian.com/world/2020/apr/13/experts-divided-comparison-uk-ireland-coronavirus-record

[xxxvii] Untitled, ‘ Obesity crisis: The UK’s weight problem in seven charts’, Sky News, August 20^th, 2019, https://news.sky.com/story/seven-charts-on-the-uks-obesity-problem-11583981

[xxxviii] Jonathan Calvert, George Arbuthnott and Jonathan Leake, ‘Coronavirus: 38 days when Britain sleepwalked into disaster’, The Sunday Times, April 19^th, 2020, https://www.thetimes.co.uk/article/coronavirus-38-days-when-britain-sleepwalked-into-disaster-hq3b9tlgh

[xxxix] Untitled, ‘Coronavirus: Prime Minister Boris Johnson orders pubs, restaurants and gyms to close across the UK’ March 21^st, 2020, Sky News, https://www.skysports.com/more-sports/other-sports/news/12040/11961096/coronavirus-prime-minister-boris-johnson-orders-pubs-restaurants-and-gyms-to-close-across-the-uk

[xl] ‘Coronavirus (COVID-19) deaths in Italy as of June 3, 2020, by age group’, Statista, https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/

[xli] Untitled, ‘Italy says number of doctors killed by coronavirus passes 100’ France24, April 9^th 2020, https://www.france24.com/en/20200409-italy-says-number-of-doctors-killed-by-coronavirus-passes-100

[xlii] Marta Gaglia and Seema Lakdawala, ‘What we do and do not know about COVID-19’s infectious dose and viral load’, The Conversation, April 14^th, 2020, https://theconversation.com/what-we-do-and-do-not-know-about-covid-19s-infectious-dose-and-viral-load-135991

[xliii] Simon Wood et al, ‘UK Covid-19 infection peak may have fallen before lockdown, new analysis shows’, May 7^th, Bristol University, May 7^th, 2020, https://www.bristol.ac.uk/maths/news/2020/peak-lockdown.html?fbclid=IwAR2g2Mr0IudkXCnQo8leIdVBueq-fdkLNGk9lQjPYrrrO7GW2jfMT19Hg1Q

[xliv] Observer Reporters, ‘Across the world, figures reveal horrific toll of care home deaths’, The Guardian, May 16^th, 2020, https://www.theguardian.com/world/2020/may/16/across-the-world-figures-reveal-horrific-covid-19-toll-of-care-home-deaths

[xlv] Megan Molteni, ‘Why Meatpacking Plants Have Become Covid-19 Hot Spots’, Wired, May 7^th, 2020, https://www.wired.com/story/why-meatpacking-plants-have-become-covid-19-hot-spots/

[xlvi] Press Release, ‘New study reveals blueprint for getting out of Covid-19 lockdown’, May 6th, 2020, University of East Anglia https://www.uea.ac.uk/about/-/new-study-reveals-blueprint-for-getting-out-of-covid-19-lockdown

[xlvii] Untitled, ‘Norway could have controlled infection without lockdown’, The Local, May 22^nd, 2020, https://www.thelocal.no/20200522/norway-could-have-controlled-infection-without-lockdown-health-chief?fbclid=IwAR1jJTUpQLXLgONVqWmLJHQ2-rd-FG7794lONTsaquGaw0DJmhIUEOqWLwk

[xlviii] Richard Orange, ‘Coronavirus: Norway wonders if it should have been more like Sweden’, The Telegraph, May 30^th, 2020, https://www.telegraph.co.uk/news/2020/05/30/coronavirus-norway-wonders-should-have-like-sweden/

[xlix] Emma Graham-Harrison, Angela Giuffrida in Rome, Helena Smith in Athens and Liz Ford, ‘Lockdowns around the world bring rise in domestic violence’, The Guardian, March 28^th, 2020, https://www.theguardian.com/society/2020/mar/28/lockdowns-world-rise-domestic-violence

[l] United Nations Sustainable Development Group, ‘Policy Brief: The Impact of COVID-19 on children’ April, 2020, https://unsdg.un.org/resources/policy-brief-impact-covid-19-children?fbclid=IwAR35l8582cnFgE_sWLurILYXeGWyg_PYSo8BApmmsarSwa_8_FQGzafxoI0

[li] Johan Giesecke ‘The invisible pandemic’, The Lancet, May 5^th, 2020, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31035-7/fulltext

[lii] Jon Henley, ‘We should have done more, admits architect of Sweden’s Covid-19 strategy’, June 3^rd, 2020, The Guardian, https://www.theguardian.com/world/2020/jun/03/architect-of-sweden-coronavirus-strategy-admits-too-many-died-anders-tegnell

[liii] Jonathan Glover, A Moral History of the Twentieth Century, Pimlico, London, 1999, p.394

[liv] Oliver Milman, ‘Seven of Donald Trump’s most misleading coronavirus claims’, The Guardian, March 30^th, 2020, https://www.theguardian.com/us-news/2020/mar/28/trump-coronavirus-misleading-claims

[lv] Michelle Cottle, ‘Boris Johnson Should Have Taken His Own Medicine’, New York Times, March 27^th, 2020, https://www.nytimes.com/2020/03/27/opinion/boris-johnson-coronavirus.html

[lvi] David Graeber, Debt – The First 5,000 Years, Melville, London, 2011, p.357

[lvii] ‘Top 15 Most Popular News Websites | February 2020’, http://www.ebizmba.com/articles/news-websites

[lviii] Jim Waterson, ‘Guardian named UK’s most trusted newspaper‘ The Guardian, October 31^st, 2018, https://www.theguardian.com/media/2018/oct/31/guardian-rated-most-trusted-newspaper-brand-in-uk-study

[lix] Alan Rusbridger, The Remaking of Journalism and Why it Matters Now, Canongate, Edinburgh, 2018, p.145

[lx] Ibid, p.348

[lxi] Ibid, p.163

[lxii] Ibid, p.181

[lxiii] Ibid p.181

[lxiv] Luke O’Neill, ‘Dying to go out to eat? Here’s how viruses like Covid-19 spread in a restaurant’, The Guardian, May 15^th, 2020, https://www.theguardian.com/world/2020/may/15/how-coronavirus-spreads-in-restaurant-video

[lxv] Guardian Staff and Agencies, ‘Global report: ‘disaster’ looms for millions of children as WHO warns of second peak’, The Guardian, May 26^th, 2020, https://www.theguardian.com/world/2020/may/26/global-report-disaster-looms-for-millions-of-children-as-who-warns-of-second-peak

[lxvi] Statista, ‘Coronavirus (COVID-19) deaths in Italy as of June 3, 2020, by age group’ https://www.statista.com/statistics/1105061/coronavirus-deaths-by-region-in-italy/

[lxvii] Rusbridger, Ibid, p.275

[lxviii] Quoted in Rusbridger, Ibid, p.135

[lxix] Ibidp.143

[lxx] Ibid, p.161

[lxxi] Fyodor Dostoyevsky, Notes From the Underground, Alma Books, London, p.23-24

[lxxii] S. Jay Olshansky, Ph.D., Douglas J. Passaro, M.D., Ronald C. Hershow, M.D., Jennifer Layden, M.P.H., Bruce A. Carnes, Ph.D., Jacob Brody, M.D., Leonard Hayflick, Ph.D., Robert N. Butler, M.D., David B. Allison, Ph.D., and David S. Ludwig, M.D., Ph.D. ‘ A Potential Decline in Life Expectancy in the United States in the 21st Century’, The New England Journal of Medicine, March 17^th, 2005, https://www.nejm.org/doi/full/10.1056/NEJMsr043743

[lxxiii] Kate Hamblet, ‘How to Design a Healthy Home ~ An Architect’s Blueprint’, HealthyGreenSavvy, January 5^th, 2019, https://www.healthygreensavvy.com/healthy-home/

[lxxiv] Fatimah Lateef, ‘Hospital design for better infection control’, Journal of Emergencies, Shock and Trauma, 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776365/

[lxxv] Ibid, Rusbridger, p.250

June 10, 2020
Reflections on Covid-19

Déjà Vu

As Covid-19 sweeps through Ireland, I can’t help experiencing a feeling of déjà vu. In early 2015, I was based in Guinea as part of the international response to the Ebola epidemic ravaging west Africa. I was responsible for reporting on the progress of the epidemic as well as the measures being applied to halt its further progression. An important element of my work was in helping define the potential recovery needs of the country and articulating a vision as to how the international agency I was working for could contribute in helping Guinea transition from the ongoing short-term emergency humanitarian focus to a middle-long term recovery and development operational approach.

Conakry in the Time of Ebola

Prior to travelling to Guinea, I had read everything I could find both about Ebola and the situation on the ground. Similar to Covid-19, Ebola is a virus and is also believed to originate from bats. However, it is far more virulent, can result in serious haemorrhaging with severe internal and external bleeding and has a far higher death rate.[i] The first Ebola case in west Africa occurred in late December 2013 in Guinea. A 2 year-old boy in the village of Melandiou, close to the Guinean border with Liberia and Sierra Leone feel ill with a mysterious disease, later identified as Ebola and died a couple of days later.[ii] His grandmother, pregnant mother and three year old sister died shortly after.[iii] Ebola was on the march.

In the latter half of 2014 and early 2015, the media was full of apocalyptic descriptions and assessments of the impacts of Ebola on Guinea, as well as its neighbours Liberia and Sierra Leone, and the danger of its spreading further afield. However, the situation on the ground in Conakry which greeted me upon my arrival, was not at all what I had expected. If I had not been aware of the virulence and mortality rate of those who contracted Ebola, I could easily have been convinced that its threat had been seriously over-hyped.

While hand sanitisers were omnipresent and my temperature was taken each time upon arrival at the office, as well as when visiting other organisations, there appeared to be little restriction on the movement of people in Conakry. There was an abundance of economic activity as people moved freely through the streets and the colourful markets heavied with custom. Street food vendors displayed and sold their succulent delicacies to eager passers-by. Aspiring footballers practised their skills on the open roads, briefly making way for passing traffic, while others jogged through the streets. One bridge I passed, several times a day, had a perpetual presence of primarily young men performing their workouts and practising stretches from early in the morning until late evening. A sofa conveniently placed at the end of the street, where our office was located, had been drafted into service as a temporary meeting place for an ever-changing guard of young males.

Conakry in the time of Ebola. (c) Justin Frewen

The absence of constraints on physical proximity was particularly evident during the finals of the African football Cup, for which Guinea had qualified after a long absence. In the days leading up to the tournament, a tangible thrill of expectation hung in the air as pockets of people congressed in the streets and cafes to assess their country’s chances. The day of the tournament launch, a pair of enormous speakers were placed in the street behind our office. From 8 AM onwards, music blasted through the neighbourhood. From my vantage point on the second floor, I could see boys and girls dancing in their gardens and passers-by congregating to animatedly discuss the imminent tournament kick-off. A middle-aged woman walked down the street laden with two substantial shopping bags. As she neared the source of the pulsating beat, a broad smile flickered across her pleasant features as she swayed to the rhythm without missing a stride. Some 20 metres later, she resumed her erstwhile gait and homeward struggle with her sagging shopping bags.

International Women’s Day, Conakry,, Guinea, Justin Frewen.

Coronavirus Lockdowns

In contrast, the current coronavirus pandemic has led to lockdowns of varying intensities around the world. As early as 24 March, the Guardian newspaper highlighted how some 20% of the world’s population was under lockdown imposed as a result of Covid-19.^[iv] The past month, if anything, has seen a radical increase in the imposition of such measures and the consequent reduction of social and economic activities to prevent the onward transmission of this virus. This contrasts sharply with the general situation in Guinea during the Ebola crisis. Although strict quarantine was imposed on those who contracted Ebola and in spite of the lurid accounts of Ebola’s impact upon the people of Guinea, Liberia and Sierra Leone, there was paradoxically far less overt evidence of its threat in daily, public life.

The primary reason for this difference lies in the transmissibility of the respective viruses that lead to Ebola and Covid-19. As outlined by ‘Médecins sans frontières’ (MSF – Doctors Without Borders), who were instrumental in rallying international awareness and required resources to tackle Ebola, “(H)uman to human transmission occurs through contact with bodily fluids of an infected person or through surfaces contaminated with these fluids.”[v] Covid-19, like other common human coronaviruses, transmits from an infected person a) in water droplets through the air, as a result of coughing or sneezing; b) close personal contact such as shaking hands; and c) touching one’s face (eyes, nose, mouth) after touching an object / surface before washing one’s hands.[vi]

It is therefore clear the potential onward transmission of Covid-19 is far greater than for Ebola, as it does not require direct physical contact with the carrier of the virus. Fortunately, it appears that it cannot be transmitted through the air directly which would greatly increase its range and ease of transmission.[vii] This fact has led to a far greater restriction on social and economic life due to Covid-19’s enhanced transmissibility that was the case with Ebola.

Virus Mobility

Ebola’s infection spread was relatively localised. Despite the occurrence of a few cases outside the epicentre of west Africa (Guinea, Sierra Leone and Liberia), such as in Scotland and North America predominantly via the return of health workers, the virus was effectively contained. Approximately 11,000 people succumbed to the illness and while each of these fatalities was a tragedy for the victims and their loved ones, this figure obviously pales in significance to the rapidly increasing daily totals of Covid-19. As I write today, on 24 April, the recorded deaths are fast approaching 200,000. These figures, however, are undoubtedly a significant underestimation of the actual number of people who have succumbed directly to this coronavirus, not to mention those who may have succumbed to secondary infections due to enfeebled immune systems. In the UK, for example, the daily figures of deaths released to the public do not include those that have occurred in nursing homes or other residential settings.[viii]

One of the major issues confronting health personnel combating Ebola in Guinea was the mobility of people in this region as there was widescale migration by people particularly in the rural areas to obtain income for their families. This situation was aggravated by the porous frontiers between neighbouring countries as people would often traverse national borders in search of work and food or even simply to visit their extended family. Borders in Africa have frequently been subject of fierce contestation and the manner in which they were imposed during colonialism has been one of its most enduring, negative legacies. They have both divided members of ethnic groups, as in the case of the nomadic Tuareg of North Africa, and also forced members of diverse cultural and religious groups into a single polity, such as the Sudan or Nigeria.

In tackling Ebola, it became clear that the presence of these different national jurisdictions, divided by arbitrary and highly porous borders, such as those that existed between Guinea, Sierra Leone and Liberia greatly complicated the tracing of potential contacts of Ebola victims. Frequently, there would be no accurate records of who had crossed from one country to its neighbour. During the Ebola epidemic this resulted in severe delays in tracing potential contacts of Ebola victims, with the potential that these contacts could inadvertently become the source of waves of new infections as they moved from one place to the next.

While Ebola was spread in west Africa predominantly through the movement of local people in rural areas trying to augment their meagre incomes, the worldwide dissemination of Covid-19 has been by the more relatively globally affluent. The massive growth in air travel has greatly increased the ease by which viruses can move from one part of the globe to another via their human hosts. When the Spanish Flu, so named because the flu was first widely reported on there, global movement was far slower and it therefore took the virus far longer to journey from one region to another. Today, we can get to virtually anywhere in the world in under 36 hours. This makes it far more difficult to control the onward progression of viruses such as Covid-19 and to effectively localise their impact, as was the case with Ebola.[ix] It should be noted that this risk had been noted as an issue of concern prior to the current pandemic.[x]

‘The massive growth in air travel has greatly increased the ease by which viruses can move’

Fear and ‘loathing’

A frequent occurrence in serious epidemics and pandemics is the parallel transmission of fear which can radiate through impacted communities, even amongst those not yet exposed to the pathogen. A particularly tragic episode during the Ebola crisis occurred in September 2014 in the southern Guinea village of Wome when a team of eight health workers and journalists were murdered. The villagers were terrified that this deputation, which had been sent to help there and fearing they were there to spread the disease, attacked them violently with clubs and machetes.

Although unique in terms of loss of life, the tragedy at Wome was not an isolated event. The Red Cross reported that its teams were attacked an average of 10 times per month over a year by frightened members of the local population.[xi] While there was a degree of understanding amongst member of the international community in Guinea as to the apprehension of local people confronted by outsiders, particularly those decked out in full hazmat suits, there was also disbelief that this could result in such aggression. Outside Guinea, people generally express incredulity at what transpired at Wome. How could people be so ill informed or be in such a state of fear that they would murder those sent to provide assistance. This would surely never happen in ‘developed countries’.

However, if there is one thing we have learnt from Covid-19, it is that the people of Wome were in no way exceptional in falling victim to the plague of fake rumours, conspiracy theories or the negative treatment of health personnel.

Over the Easter weekend in England, numerous phone masts were set on fire amid claims they were spreading the coronavirus. In the early hours of April 14 in Huddersfield, dozens of people had to be evacuated from their homes as a nearby phone mast was set ablaze.[xii] Similar fires were also reported earlier in April at masts in Birmingham, Liverpool and Melling in Merseyside. A video was shared on Facebook and YouTube, allegedly documenting a fire in Aigburth while claiming a link between Covid-19 and mobile technology.[xiii]

One such attack also impacted directly upon the victims of coronavirus when, in Birmingham, a phone mast serving the NHS Nightingale Hospital was targeted by arsonists.[xiv] Mobile masts have also been set alight in Ireland with the latest incident occurring in Cork on the night of 22 April.[xv] Rumours linking Covid-19 and 5G technology have been spread by social media sites such as Facebook, YouTube and WhatsApp, leading to questions as to whether greater control should be exercised over these media to which their providers have responded by deleting what they categorise as false or harmful content related to the virus.[xvi] Intriguingly, there have been reports that social media has also been used in some places to name and shame people breaking social movement restrictions in their communities.[xvii]

There has been deserved widespread praise for those on the frontline of the fight against Covid-19, including nightly clapping by the general public to display their support of health workers. Starting in Italy and Spain, this tribute has spread to many countries around the world. Despite these public accolades, health professionals have been abused in public on account of their engagement in tackling coronavirus. While these incidents have not resulted in fatalities, as in Guinea, they have been extremely disturbing. In early April, Howard Catton, CEO of the International Council of Nurses, revealed his organisation had received reports from around the world of abuse and harassment related to their work in fighting Covid-19. According to Catton, nurses were seen as potential carriers of the virus and thus a threat to the communities in which they lived.[xviii] In England, nurses have been abused in public and accused of being disease spreaders.[xix] Heath personnel have even been forced to quit their accommodation by landlords afraid they may contract the virus from them. In one such instance, Joseph Alsousou, a surgeon based in Oxford was asked to leave his rented accommodation as soon as possible.[xx]

Health Care workers.

From Ebola to Covid-19: Has the WHO Failed Again?

The WHO came under severe criticism for its handling of the Ebola epidemic. The international president of Médicins Sans Frontieres (MSF), Joanne Liu, appeared before the UN Security Council in September 2014 to inform the members directly as to how Ebola was impacting upon west Africa. She revealed that MSF was effectively engaged in building “crematoria instead of hospitals”. The same month Liu demanded that UN members deploy civilian and military resources to tackle this emergency.[xxi]

Following the successful containment of the Ebola outbreak, the WHO apologised for its failure to respond in time and promised to undertake the necessary reforms to avoid a similar situation in the future. However, less than five years later, the WHO is once again under attack for its alleged slowness to respond to the outbreak of Covid-19 and its delay in communicating the gravity of this outbreak to the world at large. To punish the WHO the U.S. President Donald Trump has announced he will withhold the U.S. contribution of US$400 million to the WHO.^[xxii] Although some commentators have pointed out that in fact the figure of $400 million is an overestimation given that the U.S. is already as much as $200 million behind in its pledged contributions,^[xxiii] this has the potential to seriously disrupt WHO operations at this critical moment.

In effect, while there are understandable concerns that the WHO could have reacted more promptly and effectively to the outbreak of Covid-19, this is not the time to engage in such an analysis. As its Director-General has stated the WHO’s performance in tackling this pandemic will be reviewed both by member states and independent bodies to identify failures in the organisation’s performance.[xxiv] The ongoing underfunding of the WHO together with the organizations endemic internal problems, which predated this crisis, will hopefully feature in this review.[xxv]

WHO Headquarters in Geneva, Switzerland.

Clear Communication

As illustrated in contexts as diverse as New Zealand and Kerala, successfully tackling Covid-19 requires a communications strategy that provides clear guidelines and recommendations, supported by transparent explanations as to the approach adopted through easily accessible media platforms. In Kerala, the state government provided detailed media briefings on a daily basis outlining the necessary actions to tackle the virus, the importance of contact tracing, the need for quarantining and training for healthcare and hospital personal while also seeking the support and cooperation of the general public in surveillance and containment.[xxvi] These daily briefings proved highly popular and earned widespread public respect for the manner in which decisions and their rationale were explained. Updates on government actions to tackle the virus, relayed through the Chief Minister’s social media accounts, also proved highly popular. The effectiveness and accessibility of these communication measures resulted in a statewide awareness of Covid-19 and the necessity for close cooperation and mutual support between the health service and public to reduce transmissibility and avoid clinical case overload.[xxvii]

In addition to providing Covid-19 related information through standard media channels, the NZ Prime Minister, Jacinda Ardern, has communicated directly with the public, making herself available to the media and holding daily public press conferences, led by New Zealand’s director-general of health, Dr Ashley Bloomfield. Together they have displayed “a reliable, measured and authoritative face for New Zealand’s Covid-19 response”. [xxviii] Of particular value has been the clarity of Jacinda Ardern’s communication on the virus.[xxix] Her leadership style has been assessed by one commentator as “one of empathy in a crisis that tempts people to fend for themselves. Her messages are clear, consistent, and somehow simultaneously sobering and soothing. And her approach isn’t just resonating with her people on an emotional level. It is also working remarkably well.”[xxx]

Jacinda Ardern, New Zealand’s Prime Minister.

Uncharted Territory?

One of the primary excuses offered for the difficulty in responding to Covid-19, has been that it is unprecedented and there is no reliable roadmap to guide us. However, while the current situation whereby so many countries have implemented lockdowns of varying levels of severity, closing down large sectors of their economies, is unique, it would be false to argue that we had no warning of the possibility of such an event.

The first two decades of this millennium has been witness to several new epidemics, that could potentially have had a similar, if not far worse, outcome than Covid-19. Two of these were also coronaviruses, namely Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). In 2002, SARS originated in Hong Kong, resulting in 8,098 reported cases and 774 deaths, a mortality rate of just under 10%.[xxxi] Middle East Respiratory Syndrome (MERS) was first identified in Saudi Arabia in 2012 and spread to several countries. By the end of November 2019 some 34.4% of patients infected by MERS-Cov had died (858 of 2,494 laboratory confirmed cases).^[xxxii] In 2014, Ebola first struck west Africa. Although mainly contained to Guinea, Liberia and Sierra Leone, there were a number of cases in other countries. In 2018, another outbreak of Ebola occurred in the Democratic Republic of Congo (DRC), the 10th in 40 years. As of 19 April 2020, there had been 3,316 confirmed cases, resulting in 2,277 deaths or a mortality rate of almost 69%.[xxxiii]

Many warnings have also been given by experts that a significant threat of a pandemic existed.[xxxiv] There has been at the very least an awareness that the threat of a pandemic which could result in significant fatalities and international disruption existed. Several countries had undertaken simulations that pointed out where major risks lay in terms of their readiness to counter such a threat. The US alone has held several of these exercises since the turn of the century, which had pointed out severe deficiencies in its preparedness.[xxxv]

Kerala – a model to tackle Covid-19?

The southern Indian state of Kerala which has been widely praised for its response to Covid-19. Its success would appear to be based upon two major elements. The first was the speed with which the state reacted to its outbreak in Wuhan. The health minister, K. K. Shailaja, alarmed by news of the virus in China and aware many students from Kerala were studying in Wuhan, organised a high-level meeting to discuss the situation on January 25th. The following day a control room was established to coordinate the department’s work. Eighteen committees were established and held daily meetings to evaluate actions undertaken and host daily conferences where Shailaja briefed on the actions her department was undertaking. The slogan “Break the Chain” has been given to the approach adopted in Kerala where open quote contact tracing” is implemented. This involves tracing all who have potentially been in contact with the infected person, similar to that approach which was critical in tackling Ebola.

By March 19, Kerala had 25 people who had tested positive and 31,173 people under surveillance, of which 273 were isolated in hospitals with the rest quarantining at home. These high numbers were mainly due to the high influx of travellers, including people from Kerala returning home. On March 18 and 19 alone, 7,861 and 6,103 people respectively were put under surveillance. The resources required, both in terms of management and coordination as well as the active input of all sectors of society, leads to the second reason why Kerala has proved so successful to date in its struggle against Covid-19.

The second critical element in Kerala’s approach is the existence of a strongly supported and well-funded public health sector, which forms a strong health shield against epidemics and other threats, even in a state which would be relatively poor compared with Europe and the U.S. This has been greatly supported by the active participation of a strong grassroots section of the state’s public which has combined with the health service to fight Covid-19.^[xxxvi]

When one contrasts the resolute measures, large scale mobilisation and effective containment of Covid-19 by a state such as Kerala or a nation like Vietnam – a country of over 96 million people, which despite sharing a border with China had only 268 cases and no fatalities as of 24 April – one cannot but be impressed at their performance. By the same token, one has to question how these relatively resource poor polities have been able to handle this crisis so much better, at least up to now, than the affluent nations in Europe and the U.S..

The Indian state of Kerala has been widely praised for its response.

What Lies Ahead?

While it is difficult, at this stage, to estimate with any certainty the actual mortality rate of this coronavirus, it is certainly far less lethal than Ebola. Although Covid-19 discriminates greatly against the elderly in our society, its mortality rate is probably inferior to 1% and is likely to be less than this. However, whether we will ever be able to effectively assess the actual number of Covid-19 cases and related deaths is itself a moot point given the wildly varying rates of testing for the virus in different countries, the differing methods for compiling statistics related to deaths and the fact that almost certainly many deaths that occur as a result of this virus will never be acknowledged.

Moreover, there is still much we do not know about this coronavirus. For example, do those who contract and survive Covid-19 gain immunity and, if so, would this be short or long-term? In South Korea, people who appeared to have recovered have later tested positive again for the virus, though preliminary Indications are that rather than being reinfected, the virus has been reactivated.[xxxvii] Similarly in China, patients who had apparently recovered from the virus are still registering as positive without displaying any symptoms. One 50-year-old man was still testing positive some two months after he first acquired Covid-19.[xxxviii] Given the complexities of and uncertainties related to Covid-19, the current phase consisting of lockdowns and other physical isolation measures may yet prove the easier part of our struggle to return to normality.

If the virus can remain dormant in our system with the possibility of being reactivated and/or being transmitted onwards, the struggle to eradicate Covid-19 becomes infinitely more complex. Either coronavirus victims who continue to test positive, despite not displaying any symptoms, might require extended periods of isolation until they are no longer considered potential vectors of onward transmission or there is an approved vaccine in place. The earliest estimate for such a vaccine, despite acceleration of the testing process worldwide, is mid-2021. However, we need to remember there are still no vaccines for the four coronaviruses, including SARS and MERS, that currently circulate amongst humans.[xxxix]

Certainly, the spread of Covid-19 has been far more extensive than Ebola. However, its transmission rate is only one of the issues facing us today. Just as certain underlying health conditions – cardiovascular disease, cancer, diabetes, high blood pressure – can severely aggravate the impact of coronavirus, this coronavirus could have widespread knock-on effects even more deleterious than its health impact. Covid-19 could become an underlying condition, which will lead to serious economic and social disruption as a result of measures applied to counter its spread. We have even been warned that we could face a worse depression that that which provoked by the Wall Street crash of 1929.[xl]

A further significant area of concern is that of food supply. Although supermarket shelves in the global North, despite earlier panic buying, have been kept sufficiently stocked for our immediate needs, this may not last. Should this pandemic continue for an extended period of time, food supply chains will almost certainly be weakened, if not effectively broken. Food chains are complex structures, composed of intricate, interlinked and interrelated elements – agricultural producers and inputs, large brokerage agencies, shipping and land transport companies and distribution nodes, which are all subject to potential disruption. According to the Food and Agricultural Organization (FAO), reported shipping industry slowdowns due to foreclosures and logistic blockages could soon start to disrupt this chain.[xli] The consequences for the Global South could be catastrophic with potentially hundreds of millions threatened by food insecurity.[xlii]

In short, when and how will the global economy recover? As an article on the McKinsey site bluntly puts it, “(T)he pandemic’s economic challenges are unprecedented.”[xliii]

[i] World Health Organization (WHO), Ebola virus disease, WHO, accessed 24 April 2020, https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease

[ii] WHO, Ground zero in Guinea: the Ebola outbreak smoulders – undetected – for more than 3 months, WHO, accessed 24 April 2020, https://www.who.int/csr/disease/ebola/ebola-6-months/guinea/en/

[iii] Dr. Jonathan D. Quick, The End of Epidemics: The Looming Threat to Humanity and How to Stop it, Scribe Publications, Brunswick (Victoria) Australia / London U.K., p. 27

[iv] Davidson, Helen, Around 20% of global population under coronavirus lockdown, Guardian, 24 March 2020, https://www.theguardian.com/world/2020/mar/24/nearly-20-of-global-population-under-coronavirus-lockdown

[v] MSF, Ebola and Marburg: Quick Facts, MSF, accessed 23 April 2020, https://www.msf.org/ebola c

[vi] Centers for Disease Control and Prevention (CDC), Common Human Coronaviruses, CDC, accessed 23 April 2020, https://www.cdc.gov/coronavirus/general-information.html

[vii] World Health Organization (WHO), Q & A on coronaviruses (Covid-19), WHO, accessed 23 April 2020, https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

[viii] Chris Giles, UK coronavirus deaths more than double official figure, according to FT study, Financial Times, 22 April 2020, https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa6ab; Niamh McIntyre & Pamela Duncan, Care homes and coronavirus: why we don’t know the true UK death toll: Government figures only tell part of the story as they only cover hospital deaths, 14 April 2020, https://www.theguardian.com/world/2020/apr/14/care-homes-coronavirus-why-we-dont-know-true-uk-death-toll

[ix] Geoffrey Holland, COVID-19, and Pandemics on a Crowded Planet – A MAHB Dialogue with Infectious Disease Expert, Arthur Reingold, Millennium Alliance for Humanity and the Biosphere (MAHB), 12 March 2020, https://mahb.stanford.edu/blog/covid-19-and-pandemics-on-a-crowded-planet-a-mahb-dialogue-with-infectious-disease-expert-arthur-reingold/

[x] Aidan Findlater & Isaac I. Bogoch, Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel, Trends in Parasitology (Vol 34, Issue 9), September 2018, https://www.cell.com/trends/parasitology/fulltext/S1471-4922(18)30142-9, pp 772-783

[xi] Dr. Jonathan D. Quick, ibid, p. 150

[xii] BBC Coronavirus Pandemic News, Huddersfield phone mast fire ‘put residents at risk’, BBC, 14 April 2020, https://www.bbc.com/news/uk-england-leeds-52279341

[xiii] BBC Coronavirus Pandemic News, Mast fire probe amid 5G coronavirus claims, BBC, 4 April 2020, https://www.bbc.com/news/uk-england-52164358

[xiv] Mark Sweney and Jim Waterson, Arsonists attack phone mast serving NHS Nightingale hospital, Guardian, 14 April 2020, https://www.theguardian.com/technology/2020/apr/14/arsonists-attack-phone-mast-serving-nhs-nightingale-hospital

[xv] Adrian Weckler, Mobile mast near Cork Apple headquarters set ablaze in suspected 5G arson attack, 23 April, https://www.independent.ie/irish-news/mobile-mast-near-cork-apple-headquarters-set-ablaze-in-suspected-5g-arson-attack-39151454.html

[xvi] BBC Technology News, YouTube bans ‘medically unsubstantiated’ content, BBC, 22 April 2020, https://www.bbc.com/news/technology-52388586

[xvii] Alice Yan, Chinese web vigilantes name and shame people for breaking coronavirus quarantine, South China Morning Post, 20 March 2020, https://www.msn.com/en-sg/news/other/chinese-web-vigilantes-name-and-shame-people-for-breaking-coronavirus-quarantine/ar-BB11tD2i

[xviii] Stephanie Nebehay, Nurses must be protected from abuse during coronavirus pandemic: WHO, nursing groups, Reuters, 6 April 2020, https://in.news.yahoo.com/nurses-must-protected-abuse-during-220640671.html

[xix] Rebecca Gilroy, Nurses of coronavirus frontline facing ‘abhorrent’ abuse from public, Nursing Times, 20 March 2020, https://www.nursingtimes.net/news/coronavirus/nurses-fighting-coronavirus-facing-abhorrent-abuse-from-public-20-03-2020/

[xx] BBC Oxford, Coronavirus: Doctor ‘kicked out’ by Headington landlady, BBC website, 25 March 2020,https://www.bbc.com/news/uk-england-oxfordshire-52032909

[xxi] Dr. Jonathan D. Quick, ibid, p. 170

[xxii] David Smith, Trump halts World Health Organization funding over coronavirus ‘failure’, The Guardian, 15 April 2020, https://www.theguardian.com/world/2020/apr/14/coronavirus-trump-halts-funding-to-world-health-organization

[xxiii] Binoy Kampark, The WHO, Trump And The Coronavirus Wars, Oriental Review, 18 April 2020, https://orientalreview.org/2020/04/18/the-who-trump-and-the-coronavirus-wars/

[xxiv] WHO, Rolling updates on coronavirus disease (Covid-19), WHO, accessed 24 April 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

[xxv] Linton Besser, World Health Organization division tackling coronavirus underfunded and facing internal corruption allegations, audits reveal, Australian Broadcasting Corporation, 16 February 2020, https://www.abc.net.au/news/2020-02-17/coronavirus-who-underfunded-internal-corruption-allegations/11970382

[xxvi] R. Krishnakumar, Kerala model, The Hindu (Frontline series), 10 April 2020, https://frontline.thehin, du.com/cover-story/article31130309.ece

[xxvii] R. Krishnakumar, ibid

[xxviii] Bryce Edwards, Ardern has shone in the coronavirus crisis but a recession could still doom her re-election chances, The Guardian, 18 March 2020, https://www.theguardian.com/world/2020/mar/19/ardern-has-shone-in-the-coronavirus-crisis-but-a-recession-could-still-doom-her-re-election-chances

[xxix] Sam Clench, Clarity is the quality that makes Jacinda Ardern so effective in a crisis, new.com.au, 27 March 2020, https://www.news.com.au/lifestyle/health/health-problems/coronavirus-clarity-is-the-quality-that-makes-jacinda-ardern-so-effective-in-a-crisis/news-story/efbb0fcc2f80f12e83719c4f2428f5b5

[xxx] Uri Friedman, New Zealand’s Prime Minister may be the most effective leader on the planet, The Atlantic, 19 April 2020, https://www.theatlantic.com/politics/archive/2020/04/jacinda-ardern-new-zealand-leadership-coronavirus/610237/

[xxxi] NHS, SARS (Severe Acute Respiratory Syndrome, NHS, accessed 24 April 2020, https://www.nhs.uk/conditions/SARS/

[xxxii] WHO, Middle East respiratory syndrome coronavirus (MERS-CoV), https://www.who.int/emergencies/mers-cov/en/

[xxxiii] MSF, Ebola Crisis Update, MSF, 23 April 2020, https://www.msf.org/drc-ebola-outbreak-crisis-update

[xxxiv] Dr. Jonathan D. Quick, ibid

[xxxv] Nicola Twilley, The Terrifying Lessons of a Pandemic Simulation, The New Yorker, 1 June 2018, https://www.newyorker.com/science/elements/the-terrifying-lessons-of-a-pandemic-simulation

[xxxvi] Times of India Editorial, Kerala Shows The Way: Decades of investment in public health is helping the state control Covid-19 The Times of India, 16 April 2020, https://timesofindia.indiatimes.com/blogs/toi-editorials/kerala-shows-the-way-decades-of-investment-in-public-health-is-helping-the-state-control-covid-19/; M.K. Bhadrakumar, Kerala’s Covid Story is Hard to Replicate, NewsClick.in, 20 April 2020, https://www.newsclick.in/Kerala-Covid-Story-is-Hard-to-Replicate

[xxxvii] Yaron Steinbuch, More covered patients in South Korea are testing positive again, New York Post, https://nypost.com/2020/04/10/recovered-coronavirus-patients-in-south-korea-testing-positive-again/, 10 April 2020

[xxxviii] Brenda Goh, Recovered, almost: China’s early patients unable to shed coronavirus, Japan Times, https://www.japantimes.co.jp/news/2020/04/22/asia-pacific/china-early-patients-coronavirus/#.XqA9aW5FxPY, 22 April 2020

[xxxix] James Gallagher, Coronavirus vaccine: When will we have one?, BBC, 23 April 2020, https://www.bbc.com/news/health-51665497

[xl] Geoff Zochodne & Victor Ferreira, How bad could the coronavirus crisis get for the economy? Some point to the great depression, Financial Post, 20 March 2020, https://business.financialpost.com/news/economy/coronavirus-crisis-new-great-depression

[xli] Maximo Torero Cullen, Covid-19 and the risk to food supply chains: How to respond?, FAO, 29 March 2020, www.fao.org/3/ca8388en/CA8388EN.pdf

[xlii] Fiona Harvey, Coronavirus crisis could double number of people suffering acute hunger – UN, The Guardian, 21 April2020, https://www.theguardian.com/world/2020/apr/21/global-hunger-could-be-next-big-impact-of-coronavirus-pandemic

[xliii] Matt Craven, Mihir Mysore Shubham Singhal and Matt Wilson, Covid-19, Briefing note, April 13, 2020: our latest perspectives on the coronavirus pandemic, McKinsey, 13 April 2020, https://www.mckinsey.com/business-functions/risk/our-insights/covid-19-implications-for-business

April 29, 2020
John Gray: the UK’s Leading Public Intellectual

Like errant flames from the dying embers of a once great fire, there is much fakery to be found emanating from a previously proud tradition of public intellectualism in the U.K., and elsewhere. The English philosopher John Gray (1948-) is at least not one of the self-help gurus, such as Jordan Peterson, that have gained public attention and earned ample remuneration in the process.

We do not find in Gray’s work the resigned intellectual play-acting evident in many books randomly grappling with our universe, and which provide the kind of quotable flourishes that play well at north London dinner parties. He is the doyenne and most garlanded of U.K. intellectuals today and so demands engagement.

Gray is no worshiper at the alter of the Enlightenment or the humanist tradition. He does not believe it provides us with the coping mechanisms for our current challenges. Ultimately, he has little faith in the ability of civilization, or rationality, to overcome the barbarism of a liberal experiment riveted by self-contradiction.

In short, he sees, both historically and now, the extent to which human irrationality governs actions. Thus he is decidedly anti-utopian, an empiricist and pragmatist. He holds out little hope for the realisation of lofty objectives, such as we find among technological evangelists or Bible-belt Christians. This is a theme he explores in some detail in his book Black Mass [2007].

In fact, all forms of demonist eschatology, chiliasm or end of day’s nonsense is parsed thoroughly in the text, from religious fundamentalism to neo-conservativism, to Marxism and Nazism. Quite correctly he identifies Tony Blair as a neo-conservative.

Thin Veneer

One suspects Gray would endorse Lon Fuller’s remark in a different context about legality and civility providing a thin veneer of civilization if the underlying culture is barbaric. This covering is growing thinner by the day I would argue.

And yet – although he may beg to differ – he displays a residual fractured humanism, and embraces certain conservative values. In effect, he is a Tory of the old school, with modest liberal leanings; the sort of person who, although he writes for the New Statesman, would equally happily associate with Tory grandees. His Disraeli-esque conservatism is one I would share some common ground with.

He has thus embarked on a voyage of passage from an earlier more doctrinaire, Thatcherite conservatism. He no longer venerates a laissez faire approach to the economy, and seems to have recognised that that approach went seriously awry. He is a fellow-traveller in a way with Jonathan Sumption, who has also arrived at a modified conservatism on his own intellectual pilgrimage.

Rather than seismic shifts – in that very British way – Gray argues that change should arrive incrementally, with allowance for the exercise of individual responsibility.

He also argues for a bridge between conservatism and the green or environmental agenda. He expresses a desire to create a Burkean ‘community of souls’, preserving that which is good and noble. But this seems a forlorn hope given how the Antarctica icebergs are on the brink of collapse, and international accords are torn apart with a pandemic upon us.

Covid-19

In a recent article for The New Statesman John Gray argued that the Covid-19 pandemic is a turning point in history, which will bring lasting changes to human behaviour. This will see online interaction rather than face-to-face communication becoming the norm, and a Hobbesian state becoming ever more intrusive, and with people increasingly accepting of this.[i]

In his view the populace will submit to the imposition of increased control, permitting a gradual and imperceptible erosion of civil liberties.

In effect we may be seeing the arrival of a new society of unfreedom, and the arrival of a technological serfdom evident in China, where Bentham’s Panopticon is writ large. But also in Western countries we are seeing surveillance from private and public bodies covering all of society.

China: technological serfdom. Image: Dmytro Sidashev / Alamy Stock Photo

One advantage, however, of the ‘Great Pause, of quarantine, as he points out, is that it could lead to a recalibration of ideas and fresh thinking. In silence new thinking may occur. But in order for this to happen we must escape from the distraction of what Frank Armstrong describes as the ‘Doomsday Machines’: the smart phones that prevent us from realising our true selves.

As Fernando Pessoa put it: ‘only by methodically, obsessively cultivating our abilities to dream, analyse and attract can we prevent our personality from dissolving into nothing or identical to all the others.’ It is certainly time for reflection but the path that lies ahead is shrouded in uncertainty.’[ii]

Gaia Hypothesis

John Gray is a convert to James Lovelock’s Gaia Hypothesis that the Earth is a self-regulating organism which maintains the conditions for life on the planet. It is a word he invokes regularly, and without exclusively focusing on humans.

Indeed, Gray appears to have a uniformly negative view of human nature and human beings. In his seminal text Straw Dogs (2004) we are depicted as rapacious, destructive and transhumanist. I suspect he is even more of this view now. Yet he clings on to a belief in decency and the exercise of personal responsibility, and liberally urges for peaceful co-existence to prevail.

As a Green Conservative and an opponent of neo-liberalism, he cautions against what Greta Thunberg described as the fairy tale of growth-without-end, and recognises how this is destroying the planet, and making human lives impossible. The pursuit of profit for its own sake of profit has led human activities to spiral out of control.

Our planet on the brink. Image (c) Daniele Idini.

Malthusian

While I warm to his Gaian sympathies, there are more disturbing aspects to his ideas that I take issue with. He appears to venerate a Malthusian liquidation or winnowing of the human population in the aforementioned New Statesman article. If there are too many of us I wonder does he regard himself as expendable and surplus to requirements?

In fairness it is ultimately a point about human progress having to be off set against scarcity. Yet it is easy to be sanguine – or even blasé – about meltdown when you sit atop the academic food chain. Stoical acceptance of human absurdity is not what is needed right now. It is a time for action after reflection.

Gray may have glimpsed the gorgon’s head of the dangers we confront, but seems to shrink from urging the radical responses required. I suspect donnish privilege has softened the attack and brought a modus vivendi with these circumstances. After all, his own life has been a success by most measures, so he can at least take refuge in haughty disapproval, or at least he could prior to the Corona-pocalypse.

But of course, in the interests of fairness, his prescience should be noted in pointing out that dwindling planetary resources, and wealth inequalities, are undermining what we cherish, and accelerating Malthusian dynamics.

Any invocation of Thomas Malthus (1766-1834) nonetheless reminds me of Jonathan Swift’s indispensable ‘A Modest Proposal’ (1729). Swift responds to the genesis of the ideas that Malthus would go on to articulate with withering satire, expressed with deadpan seriousness: he promotes the consumption of babies as a way of solving the problem of over-population.

Gray walks the same Swiftian line – though without quite the panache – in an essay on torture in which he mocks liberal values. Tongue-firmly-planted-in-cheek, he argues torture potentially promotes human rights:

Self-evidently, there can be no right to attack basic human rights. therefore, once the proper legal procedures are in place, torturing terrorists cannot violate their rights. in fact in a truly liberal society, terrorists have an inalienable right to be tortured.[iii]

Religious Fundamentalism

I share Gray’s contempt for religious fundamentalism. He does not display the dogmatic atheism or extremism of Richard Dawkins or Christopher Hitchens, but allows for Christian worship in a tolerant way, and merely warns against barbarism, and end-of-day’s eschatological chiliasm.

Yet the solution in his new book of jettisoning both the sweet poetry of Genesis and secular humanism engenders in Seven Types of Atheism (2018) a rather denatured Arcadian spirituality, which is neither flesh nor fowl or even a guide to a more meaningful existence for the varied lives he believes we should lead.

It’s almost an intellectual Flake commercial, which tastes like religion never tasted before; although it should be acknowledged that he is resolutely anti-consumerist, and critical of the manufacture of insatiable desires. At one level he is arguing for makeshift true grit or graft to cope with unbounded irrationality. We must, he suggests, develop new patterns of living to cope with the new disorders and challenges we face.

Intellectual flake commercial.

He says anyone can live in a variety of ways, and I suppose we all do need to slow down and embrace both distraction and silence. But I believe the finality of total silence is always to be resisted – ‘Rage, rage against the dying of the light…’

The Good Life

There are many ways, Gray contends, of living well. Differing types of the good life, but he is insufficiently specific as to what these are.

With the changing world of work, and a lack of employment prospects for many, one suspects he has an overly optimistic understanding that whatever fulfils someone is what they ought to be doing, which is all well and good, but that doesn’t necessarily put supper on the table. I fear most of us will have to find different survival strategies to cope with our disposability in a world that cares for us less and less.

John Gray is reliably sceptical of junk science that is now crashing into us in ceaseless waves, most recently with Donald Trump’s proposal to inject disinfectant to prevent Covid-19.

Donald Trump throws out the idea of injecting disinfectant to kill the coronavirus during the White House press briefing https://t.co/U6rH0PwJkR pic.twitter.com/KDWlanFCRE

— Bloomberg (@business) April 24, 2020

Phrenology.

A useful example Gray has provided is in the recrudescence of phrenology, where criminal patterns of future behaviour are derived from skull sizes, which feeds into racial stereotypes. Our criminal justice system, in allowing bad character admissions, has dangerous preludes of pre-crime and conviction by demonization.

It will take a brave leader, of men or opinion, in future to insist on civilized values. John Gray has intimated, and I agree, they will not matter.

In his esteem for silence to avoid distraction and enhance contemplation Gray comes across like the effete aristocrat in Turgenev’s Father and Sons, as the Bolsheviks steadily take control. But at least The New Statesman provide him with a platform, and the books continue to sell to a dwindling educated public.

Featured Image: Joseph Wright’s An Experiment on a Bird in the Air Pump, 1768, National Gallery, London.

[i] John Gray, ‘Why this crisis is a turning point in history’, New Statesman, April 1^st, 2020, https://www.newstatesman.com/international/2020/04/why-crisis-turning-point-history

[ii] Fernando Pessoa, The Book of Disquiet, translated from the Portuguese by Margaret Jull Costa, The Serpent’s Tail, London, 2017, p.107

[iii] John Gray, Gray’s Anatomy: Selected Writings, Penguin, London, p.222

April 24, 2020
Underlying Conditions Exacerbate Covid-19 Pandemic

Pressing Pause

In the grip of serious illness anyone but an obtuse contrarian seeks medical assistance. As the coronavirus Covid-19 pandemic sweeps across the globe, doctors are performing heroics, often at grave risks to their own health. Enhanced screening, testing and emergency treatment facilities, along with developing a vaccine, are now paramount considerations; but we cannot ignore our underlying fragilities.

Exclusive focus on the Holy Grail of an elusive cure disregards how the virus is exploiting poverty in wealthy countries, flawed public health policies and destructive environmental practices. At least we may still soften the blow of this outbreak, and reduce the harm and incidence of future episodes. With all changed – changed utterly – returning to business-as-usual is inconceivable.

Despite what we hear from the Trump administration,[i] there are no specific medicines available to prevent or treat the new coronavirus Covid-19.[ii] The best estimate is that a year-and-a-half is the minimum time required to develop a reliable vaccine, which would actually set a record.[iii] Remarkably, a British-Italian partnership claims it will have one ready as soon as this September, but the challenge of manufacturing, distributing and mass-immunization – including the thorny issue of consent – on an unprecedented global scale, remain.[iv] The options are comprehensively laid out by medicinal chemist Derek Lowe.[v]

The dangers posed by this outbreak, and future ones that nature will throw at us, require a thorough reappraisal of public health priorities. Medical systems in advanced Western countries – especially those dominated by the private sector – tend to prioritise treatment of the symptoms of the main non-contagious diseases. We ‘live’ with cancer and heart disease as opposed to addressing multifarious lifestyle causes, which the virus is now preying on.

As Boris Johnson’s predicament underlines, anyone is susceptible to Covid-19, but chances of exposure – without recklessly ignoring medical advice – are often determined by social class, which intersects with lower life expectancy already.

"I was at a hospital the other night where I think there were actually a few coronavirus patients and I shook hands with everyone."

Boris Johnson says he has not refused to shake hands with people during the #COVID19 outbreak.

More on this story here: https://t.co/6N1ZLNKpvT pic.twitter.com/yV1qkQkDkh

— Sky News (@SkyNews) March 3, 2020

In responding to the pandemic any nation is likely to be only as strong as its weakest links. The co-existence of extremes of poverty and wealth in societies such as the United Kingdom and U.S. poses particular dangers.

We must awaken to the environmental origins of viral diseases. What Julio Vincent Gambuto[vi] has described as this ‘Great Pause’ should bring a more harmonious relationship with nature, and other animals, as we negotiate with this and even greater environmental dangers.

Finally, as Yuval Noah Harari cogently argued:

When choosing between alternatives, we should ask ourselves not only how to overcome the immediate threat, but also what kind of world we will inhabit once the storm passes. Yes, the storm will pass, humankind will survive, most of us will still be alive — but we will inhabit a different world.[vii]

In confronting this pandemic we face a choice between top-down, authoritarian control – seen vividly in China – where basic liberties have been all-but extinguished. The alternative is a state that trusts in the collective education and responsibility of citizens – civil society – a rather extreme experiment in which is unfolding in Sweden.

There may indeed be periods when a state-imposed lockdown is justified to avert a calamity – as in Italy at the height of its surge – but we must remain vigilant to the seepage of emergency powers into ordinary usage when this crisis lifts and only countenance measures that are proportionate to risk.

Already, authoritarian regimes, such as Viktor Orban’s in Hungary,[viii] are undermining democratic institutions. Alas, the ‘Fourth Estate’ of journalism has been greatly diminished by job losses in the age of the Internet and reliance on commercial advertising, which has opened the door to regressive but digitally-savvy far-right Populism.[ix]

Social Gradient

“Nickelsville” homeless encampment, Seattle, Joe Mabel (wikicommons).

At this stage much of our knowledge of Covid-19 is provisional, but early research from the WHO in China found 78%-85% of contagions occurred in clusters within family groups.[x] Armed with knowledge of how the disease spreads and sufficient resources, affluent families around the world are taking care of elders and other vulnerable people.

However, as Charles M. Blow put it: ‘Social Distancing is a Privilege’. He reported on how incidences are highly intersected with race (which aligns with poverty in the United States), citing surveys from Milwaukee and Chicago where victims were 81 and 70 per cent African-American respectively.[xi]

Myriad factors link poverty to the contagion including: the number of residents per household; the space afforded to each occupant; the extent of inter-generational co-habitation; exposure to pollution; besides other health indicators, such as obesity. Particularly vulnerable categories include individuals squeezed into homeless shelters, or those living in crowded facilities accommodating refugees and asylum seekers; also older generations inadequately protected in residential care homes across Europe.[xii]

Notably, countries that bore the brunt of austerity policies since the Financial Crash from 2007 such as Italy, Spain, and the U.K. are now experiencing higher mortalities tolls than others, such as Germany or Denmark, where living standards were maintained.

Sweden

Swedish Social Democratic Party in Vasaparken, Stockholm in 2013, Image: Frankie Fouganthin (wikicommons)

Unlike almost every other European country the Swedish government did not mandate the closure of schools, pubs and restaurants. As the pandemic raged this seems to have been flawed, but it is worth exploring why a true catastrophe has not unfolded, as we’ve seen in Italy, Spain, France, the U.S. and the U.K.. Indeed the trajectory of new cases appears to be flattening as we enter mid-April.[xiii]

Sweden’s mortality count per capita (which is equivalent to Ireland’s whose government has generally been lauded for its response[xiv]) is four times higher than that in neighbouring Norway’s and twice Denmark’s,[xv] both of which swiftly closed their borders, schools, pubs and other businesses, and imposed lockdowns. But the divergence may, in part, be explained by recent under-investment in healthcare. The country had the second lowest number of critical beds in Europe after Portugal prior to the crisis, with only 5 beds for every 100,000 inhabitants.[xvi] Moreover, we are yet to measure the health benefits of avoiding draconian measures.

Cultural factors such as the absence of kissing and hugging as conventional greetings and sparse habitation are relevant, but it appears that Sweden’s mostly uninterrupted social democratic history throughout the twentieth century,[xvii] including free university education, insulates its population from the worst ravages.

Notably, 40% of Swedish households are single-person residences,[xviii] and, although the largest cities of Stockholm and Gothenburg have experienced a recent housing crisis with scarce supply and high prices,[xix] recent concerted action by the Social Democrat-Green coalition government has alleviated this, providing subsidies to builders and tweaking capital gains tax for house sellers to encourage turnover.[xx]

In contrast, English-speaking countries such as the United States and Britain (predicted to experience the worst outbreak in Europe[xxi]) have avoided intervention in the housing market, except at the very bottom of the social scale. But the ensuing ‘Financialization of Daily Life’[xxii] has been accompanied by the stripping away of welfare entitlements, bringing widespread homelessness and reliance on food banks. The current pandemic has been aggravated by political leaders so wedded to commercial priorities they seemed prepared to sacrifice the sick and the old.[xxiii]

Obesity

Image: Tibor Végh (wikicommons)

The damage wrought by free market ideologies may run deeper in terms of human health if we accept a link with another global pandemic: obesity. This condition is strongly associated with many of the pre-existing health problems that place a person at greater risk of death from Covid-19 infections, including hypertension and diabetes.[xxiv]

The onset of the obesity pandemic, now afflicting nearly two billion people around the globe,[xxv] has been linked to numerous developments, including the invention of high fructose corn syrup in 1967, as well as over-reliance on the motor car. But the arrival of Margaret Thatcher and Ronald Reagan into power in the 1980s is a generally overlooked factor.

As Avner Offer asserted: ‘Among affluent societies, the highest prevalence of obesity is to be found in countries most strongly committed to market-liberal policy norms.’ He argues: ‘if stress generates obesity, then welfare states protect against stress, and are likely to have lower states of obesity.’

He says: ‘it is appropriate to think of the rise of obesity as an eruption, and to look for another eruption to explain it’. He identifies this as the emergence of the New Right in the 1970s, and the market-liberal regimes that carried out economic and social programmes in the main English-speaking countries, and elsewhere.

With regard to the U.K., where obesity rates have almost tripled since 1979 when Margaret Thatcher came to power, he claims obesogenic conditions were already in place by the 1970s: car-use and television-watching were well established, and food was already cheap and plentiful; but that Thatcherism acted as a catalyst.

Heightened stress levels especially fuelled by employment uncertainties affect dietary choices: ‘Physiologically, stress leads individuals to prefer fatty and sweet foods, and frequently to consume more calories, exacerbating weight gain, especially in the form of risky abdominal fat.’[xxvi]

The link between insecurity, stress and obesity is supported by the ‘social gradient’ of obesity’: it is most prevalent among those at the bottom of the social scale, stressed out and living in crowded accommodation in so-called ‘food desserts’, lacking access to nutritious foodstuffs.

Public v Private Health

It is a misconception that increasing health expenditure in any Western society, above a certain level, will lead to a rise in life expectancy. In fact, there are rapidly diminishing returns on investment. Moreover, many treatments arrive with significant health warnings, and leave many of us susceptible to Covid-19.

Primary care, especially maternity services, paediatrics (including selective use of antibiotics and vaccination), and emergency treatment facilities, certainly minimises premature deaths. But countries in thrall to privatised healthcare tend to focus spending on medications, and other costly treatments, as opposed to preventive strategies. Thus the United States, which spends almost 18% of its GDP on healthcare (the highest level per capita in the world)[xxvii], has among the lowest life expectancies among advanced countries.[xxviii]

Rather than addressing the environmental and lifestyle triggers of the diseases of cancer and heart disease that are the leading causes of mortality (and morbidity), the United States supports a vast pharmaceutical industry that thrives off ill-health, just as its Military Industrial Complex profits from perpetual warfare.

Shockingly, in the United States a John Hopkins team calculated in 2016 that 250,000 deaths were caused by medical errors each year, making iatrogenic illness the third leading cause of death.[xxix]

All of this coheres with the 1971 Tudor Hart Inverse Care Law,[xxx] stating:

The availability of good medical care tends to vary inversely with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. The market distribution of medical care is a primitive and historically outdated social form, and any return to it would further exaggerate the maldistribution of medical resources.

In other words, efficiency declines as expenditure increases, and the more privatised the health market the worse the outcomes.

Cancer and Heart Disease

Disconcertingly, Siddhartha Mukherjee characterises the history of cancer research as, ‘intensely competitive’, and featuring, ‘a grim, nearly athletic, determination.’[xxxi] Patient welfare, as opposed to survival, is often not to the fore, as experts compete for the next breakthrough in extending life, or finding an ever-elusive cure.

Apart from successfully discouraging smoking, we see insufficient focus and investment by national governments on preventive strategies, particularly in terms of nutrition, which often threaten vested interests. Confronting a virus that can often prove fatal for those on prolonged treatment courses should shift priorities.

Notably warnings ought to be provided when we purchase red and processed meat, which according to the WHO are ‘possible’ and ‘probable’ carcinogens respectively.[xxxii]

These foodstuffs, along with saturated animals fats and refined sugars, are also linked to heart disease, the other big killer in Western societies. The Harvard School of Public Health recommend a Mediterranean diet including: ‘high intake of olive oil, nuts, vegetables, fruits, and cereals; moderate intake of fish and poultry; low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.’[xxxiii]

Urban planning should also inculcate more daily exercise by encouraging cycling and walking as opposed to motor car dominance. At least Covid-19 gives us a vision of how tranquil cities can be if motor cars are restricted.

Antibiotic Overuse

Another longstanding issue related to this pandemic is persistent overuse of antibiotics in most Western countries, as Covid-19 patients in hospitals are now at great risk of succumbing to infection by bacterial opportunists.[xxxiv]

Indirectly also, the welfare of a person’s microbiome, the collective term for the bacteria with which we enjoy a symbiotic relationship, is critical to overall health. Fundamental to the understanding of our complex relationship with the bacteria with which we coexist is the concept of amphibiosis: ‘the condition in which two life-forms create relationships that are either symbiotic or parasitic, depending on the context.’

Over the last seventy years we have progressively weakening this crucial organ, upsetting our cohabitants. Martin Blaser links bacterial impoverishment to the onset of a host of modern plagues including obesity, diabetes, heart-burn and GORD, asthma, a host of allergies, IBS and even autism.

According to Blaser the main source of the microbiome’s decline has been the invention in 1942 and subsequent over-use of antibiotics, which he likens to the development of the atom bomb. Apart from generally weakening our immune system, over-use in humans and in animal agriculture has given rise to superbugs such as MRSA that already kill thousands each year.

Antibiotics have saved millions of lives, and many surgical procedures are too dangerous to consider without them. However, over-use by doctors and dentists has surged in most Western countries to the extent that often the average twenty year old has taken almost twenty courses. Indeed, a 2016 study found that over 30% of antibiotics prescribed in the U.S. are unnecessary.[xxxv]

Generally, the fault does not lie with individual doctors. Besides patients demanding medication, they reflexively prescribe for sore throats to avoid occasionally fatal rheumatic fever, which typically occurs two or three weeks after an untreated strep infection and can be fatal. These infections are mainly viral and do not respond to antibiotics, but problematically a sore throat may already have been colonised by a strain of bacteria that is not causing the disease.

Today most bacterial infections are treated with broad-spectrum antibiotics. Martin Blaser asserts that: ‘Until doctors can readily distinguish viral from bacterial throat infections, they will always follow the safer course.’ He continues: ‘It is not profitable for companies to go to the trouble and enormous expense of developing new antibiotics.’[xxxvi]

Targeted antibiotics are only applicable in a small number of cases, and make little sense where companies are concerned with the bottom line, as opposed to the overall health of the patient, and society. A genuinely public healthcare system dictating research priorities would surely address this problem, and help confront Covid-19 and other respiratory diseases.

Another problem lies with the use of antibiotics in animal agriculture. Just as in humans, untreatable bacterial infections are emerging in farm animals and these are passing the species barrier into human populations. Often farmers utilise antibiotics not to treat disease but in order for these animals to grow more quickly. The practice of using sub-therapeutic doses is now banned in the EU but the law is difficult to enforce.

Blaser also connects over-use to the obesity pandemic as antibiotics also cause weight gain in humans. This is borne out by studies showing obese individuals to have far less of a range of bacterial strains compared to individuals of normal weight. An NHS study the Avon Longitudinal Study of Parents and Children showed that children who received antibiotics in the first six months of life were likely to have a higher body mass index.[xxxvii]

Air Quality

As in most crises, there is a silver lining to the Covid-19 pandemic as we witness huge improvements in air quality all across the world.

In 2008, the European Environment Agency warned that air pollution causes almost 500,000 premature deaths in Europe every year, with most of the twenty-eight EU states failing to meet air quality targets.

In 2015, about 422,000 people died prematurely in European countries from exposure to harmful levels of fine particle matter (PM2.5). These particles are too small to see or smell but cause or aggravate heart disease, asthma and lung cancer.

The report also attributed 79,000 premature deaths to the toxic gas nitrogen dioxide (NO2) – related to vehicles and central boilers. Ground-level ozone (O3) is also killing an estimated 17,700 people, prematurely, across European nations.

The main sources of air pollution are: fuel-consuming forms of transport; energy production and distribution; commercial and institutional buildings, and homes; industry agriculture, and waste management.[xxxviii]

Air pollution has been linked to elevated mortalities in hot spots such as New York and Lombardy, where the Alps are visible from Milan as never before.[xxxix] This Great Pause allows us to reflect on the necessity of much of what we produce in our economies.

Spillover

Concentrated animal feeding operation (CAFO), Unionville, Missouri, United States, owned by Smithfield Foods.

In 1994 Laurie Garrett warned the world:

While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes’ court. They are our predators and they will be victorious if we, homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities.[xl]

The origins of most of the contagious diseases we confront lie in our relationship with other animals. As David Quames puts it: ‘ecological disturbance causes disease to emerge. Shake a tree, and things fall out.’ He warned that human activities are causing the disintegration of ‘natural ecosystems at a cataclysmic rate.’[xli]

Correctly, a huge amount of attention has been focused on China’s so-called wet markets of captured or dead wildlife, as the probable location of a zoonotic incident that engendered the novel virus (involving bats and the rare pangolin as a reservoir host).

Previously, a southern Chinese appetite for wild animals was conflated with a period of sustained economic growth in the 1990s, and termed ’the Era of Wild Flavor.’ Businessmen would reportedly gather at one of the province’s many ‘Wild Flavor’ restaurants to feast on a great variety of animals, some of which were reputed to make consumers fan rong or ‘prosperous.’[xlii]

David Quames describes the scene at the markets:

The catfish the crabs, and eels churned slowly in aerated tanks. The bullfrogs huddled darkly in scrums. It was grim to be reminded how we doom animals with our appetite for flesh, but this place seemed no more odd or morbid than a meat market anywhere.[xliii]

He goes on to warn that the risks are not limited to exotic meat markets, and that factory and livestock farms around the world present dangers: ‘It’s almost impossible to screen your pigs, cows, chicken, ducks, sheep, and goats for a virus of any sort until you have identified that virus (or at least a close relative), and we have only begun trying. He adds: ‘tomorrow’s virus pandemic may be no more than a “blip on the productivity output” of some livestock industry today.’[xliv]

Cow fields are not a timeless and harmless rural idyll: ‘A trillion pounds of cows, fattening in feedlots and grazing on landscapes that formerly supported wild herbivores, are just another form of human impact. They are a proxy for our appetites and we are hungry.’[xlv]

Perhaps it is no coincidence that carnivorous is an anagram of coronavirus.

Little State, Big Government

Fictitious map from George Orwell’s novel 1984.

The finger must come off the pause button soon. Whether we develop a vaccine or not, we cannot indefinitely endure life as contestants on a dystopian game show. For many of us restraints on natural inclinations – including so-called ‘social distancing’ – have been traumatic. Extended lockdowns will be impossible to enforce without a descent into a barbarity of petty betrayals and transhumance; while the Chinese approach of tracking movements through smart phones – adopted in other countries too[xlvi] – is deeply sinister.

As in Sweden, civil society can adjust behavioural norms to resist this virus and others to follow, and ensure governments respond meaningfully to even more pressing challenges, such as climate change and the Sixth Extinction. We may have to accept health passports at border checkpoints for a time, but within countries, we should expect freedom to roam, interact and trade.

At this juncture we need a Little State, which does not impinge on basic liberties and privacy, but a Big Government – as in Sweden too – working to ensure conditions for human flourishing including: healthy nourishment, clean air and water, a roof over one’s head, as well as education and basic healthcare.

Anyone resistant to government intervention might consider John Rawls’s justification of a redistribution of wealth by allusion to a hypothetical rational agent, ‘situated behind a veil of ignorance.’[xlvii] This fictional character cannot know the situation he will be born into, and must decide the kind of society he would favour. If the family you are born into is a lottery, any rational person surely favours an equitable distribution of wealth.

At least we confront the prospect of another financial meltdown with an enhanced awareness of the financial clout of governments in a period of crisis. The public purse is deeper than has been acknowledged. Governments control the distribution and value ascribed to money, a measurement tool for the exchange of goods and services.

In terms of public health we can reduce the use of antibiotics and other unnecessary drugs; promote exercise and combat sedentarism; curb pollution; and highlight the danger of over-consumption of unhealthy foodstuffs.

It would be tragic if this pandemic led to the demonization and eradication of animals that could harbour suspect viruses, as opposed to leading to the permanent closure of the wet markets and hopefully factory farming too. Quite apart from the morality of this, we are dealing with highly complex ecosystems. Any measure could have unintended, dire consequences.

As the U.N.’s Sustainability Goals[xlviii] reminds us, biodiversity is essential for human flourishing. The limits of natural capital must be taken into account if economic activity is to remain sustainable, which is especially important for feeding populations. The pandemic highlights crucial interdependencies, and the catastrophic consequences of another outbreak means that the burden to adapt is shared by us all.

[i] David Smith, ‘Trump sows confusion with claim coronavirus drug will be ready soon’, The Guardian, March 19^th, 2020, https://www.theguardian.com/us-news/2020/mar/19/coronavirus-drug-trump-confusion-malaria-treatment-readiness

[ii] WHO, ‘Coronavirus disease (COVID-19) advice for the public: Myth busters’ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters

[iii] Megan Molteni, ‘Everything You Need to Know About Coronavirus Vaccines’, Wired, April 3^rd, 2020, https://www.wired.com/story/everything-you-need-to-know-about-coronavirus-vaccines/

[iv] Untitled, ‘Coronavirus: Vaccine could be ready as early as September, according to scientist’ Sky News, April 12^th, 2020, https://news.sky.com/story/coronavirus-vaccine-could-be-ready-as-early-as-september-according-to-scientist-11971804

[v] Derek Lowe, ‘Coronavirus Vaccine Prospects’ In the Pipeline, April 15^th, 2020 https://blogs.sciencemag.org/pipeline/

[vi] Julio Vincent Gambuto, ‘Prepare for the Ultimate Gaslighting*’, Medium April 10^th, 2020, https://forge.medium.com/prepare-for-the-ultimate-gaslighting-6a8ce3f0a0e0

[vii] ‘Yuval Noah Harari: the world after coronavirus’ March 20^th, 2020 https://www.ft.com/content/19d90308-6858-11ea-a3c9-1fe6fedcca75?fbclid=IwAR2am6cP4xQoG17fnKTsCeJdteQJRNwE_D6YkUkkZL25gD7AQN4CW8AOFck

[viii] Yasmen Serhan, ‘The EU Watches as Hungary Kills Democracy’, April 2^nd, 2020, The Atlantic, https://www.theatlantic.com/international/archive/2020/04/europe-hungary-viktor-orban-coronavirus-covid19-democracy/609313/

[ix] Frank Armstrong, ‘Democracy in Decay: Steve Bannon & Jordan Peterson’, January 17^th, 2020, Cassandra Voices, https://cassandravoices.com/current-affairs/global/democracy-in-decay-steve-bannon-and-jordan-peterson/

[x] WHO, ‘Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)’, February, 2020, https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

[xi] Charles M. Blow, ‘Social Distancing Is a Privilege’, New York Times, April 4^th, 2020 https://www.nytimes.com/2020/04/05/opinion/coronavirus-social-distancing.html

[xii] Robert Booth, ‘Half of coronavirus deaths happen in care homes, data from EU suggests’, The Guardian, April 13^th, 2020, https://www.theguardian.com/world/2020/apr/13/half-of-coronavirus-deaths-happen-in-care-homes-data-from-eu-suggests

[xiii] Worldometer, ‘Sweden’, https://www.worldometers.info/coronavirus/country/sweden/

[xiv] Frank Armstrong, ‘Ireland’s Response to the Coronavirus’, Cassandra Voices, March 28^th, 2020, https://cassandravoices.com/current-affairs/irelands-response-to-the-coronavirus-pandemic/

[xv] Niclas Rolander, ‘Swedish Virus Deaths top 1000 fueling criticism over strategy’ Bloomberg, April 14^th, 2020 https://www.bloomberg.com/news/articles/2020-04-14/swedish-virus-deaths-top-1-000-fueling-criticism-over-strategy

[xvi] A. Rhodes, P. Ferdinande, H. Flaatten, B. Guidet, P. G. Metnitz & R. P. Moreno, ‘The variability of critical care bed numbers in Europe’, Intensive Care Medicine volume 38, pages1647–1653(2012), https://link.springer.com/article/10.1007/s00134-012-2627-8

[xvii] Untitled, ‘Before Sweden Was Social-Democratic, An interview with Erik Bengtsson’, Jacobin Magazine, September, 2019, https://www.jacobinmag.com/2019/09/sweden-social-democracy-erik-bengtsson

[xviii] Melissa Godin, ‘Sweden’s Relaxed Approach to the Coronavirus Could Already Be Backfiring’, Time Magazine, April 9^th, 2020, https://time.com/5817412/sweden-coronavirus/

[xix] Untitled, ‘Revealed: The state of Sweden’s housing shortage’, The Local, May 14^th, 2019, https://www.thelocal.se/20190514/revealed-the-state-of-swedens-housing-shortage

[xx] Simon Johnson, ‘Sweden grapples with housing market reform as risks mount’, Reuters, December 18^th, 2019, https://www.reuters.com/article/sweden-economy-housing/sweden-grapples-with-housing-market-reform-as-risks-mount-idUSL8N28L43A

[xxi] Rowena Mason, ‘UK could have Europe’s worst coronavirus death rate, says adviser’, April 12^th, 2020, The Guardian, https://www.theguardian.com/world/2020/apr/12/uk-could-have-europes-worst-coronavirus-death-rate-says-pandemic-expert

[xxii] Randy Martin, Financialization of Daily Life, http://tupress.temple.edu/book/3182

[xxiii] Chris Smyth, ‘No 10 denies Dominic Cummings would have let elderly die’, March 23^rd, 2020, The Times, https://www.thetimes.co.uk/article/no-10-denies-dominic-cummings-would-have-let-elderly-die-qsl760jr9

[xxiv] Jeffrey Kluger, ‘The True Impact of Underlying Health Conditions on Coronavirus Severity’, April 1^st, 2020, Time Magazine, https://time.com/5813711/coronavirus-underlying-conditions/

[xxv] WHO, ‘Obesity and overweight’ March 3^rd, 2020, https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

[xxvi] Frank Armstrong, ‘The Unbearable Heaviness of Human Beings’, October 7^th, 2020, The London Magazine, https://www.thelondonmagazine.org/article/the-unbearable-heaviness-of-human-beings-2/

[xxvii] Irene Papanicolas, Liana R. Woskie, and Ashish Jha ‘Health Care Spending in the United States and Other High-Income Countries’, Commonwealth Fund, March 13^th, 2018,

https://www.commonwealthfund.org/publications/journal-article/2018/mar/health-care-spending-united-states-and-other-high-income

[xxviii] OECD.stat https://stats.oecd.org/index.aspx?queryid=30114

[xxix] Vanessa McMains, ‘Johns Hopkins study suggests medical errors are third-leading cause of death in U.S.’, John Hopkins University, May 3^rd, 2016, https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-cause-of-death/

[xxx] Julian Tudor Hart, ‘The Inverse Care Law’, The Lancet, February 27^th, 1971, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(71)92410-X/fulltext

[xxxi] Frank Armstrong, ‘Cancer – A Distorted Version of Our Normal Selves’ Cassandra Voices, September 7^th, 2019, https://cassandravoices.com/uncategorized/cancer-a-distorted-version-of-our-normal-selves/

[xxxii] Untitled, ‘Q&A on the carcinogenicity of the consumption of red meat and processed meat’, WHO October 26^th, 2015 https://www.who.int/news-room/q-a-detail/q-a-on-the-carcinogenicity-of-the-consumption-of-red-meat-and-processed-meat

[xxxiii] ‘Preventing Heart Disease’, The Nutrition Source, Harvard School of Public Health, https://www.hsph.harvard.edu/nutritionsource/disease-prevention/cardiovascular-disease/preventing-cvd/

[xxxiv] Claas Kirchhelle, Adam Roberts, Andrew C. Singer, ‘Antibiotic Resistance Could Lead to More COVID-19 Deaths’, Scientific American, April 1^st, 2020, 2020https://blogs.scientificamerican.com/observations/antibiotic-resistance-could-lead-to-more-covid-19-deaths/

[xxxv] Center for Disease Control and Protection, ‘CDC: 1 in 3 antibiotic prescriptions unnecessary’ https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html

[xxxvi] Martin Blaser, Missing Microbe: How Killing Bacteria Creates Modern Plagues, One World, London 2014 pp.64-78.

[xxxvii] L. Trasande, J Blustein, M Liu, E Corwin, LM Cox, and MJ Blaser, ‘Infant antibiotic exposures and early-life body mass’ August 21^st, 2012,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3798029/

[xxxviii] Untitled, ‘Air pollution: Half a million early deaths in Europe despite progress’, BBC, October 29^th, 2018, https://www.bbc.com/news/world-europe-46017339

[xxxix] Damian Carrington, ‘Air pollution linked to far higher Covid-19 death rates, study finds’ April 7^th, 2020, The Guardian, https://www.theguardian.com/environment/2020/apr/07/air-pollution-linked-to-far-higher-covid-19-death-rates-study-finds?fbclid=IwAR0HF2B0LT8aNLWigzRzEhui_w1_gfndwFPP2Xfe4nvu0r2ujY78Hy56RXM

[xl] Richard Horton, ‘Coronavirus is the greatest global science policy failure in a generation’, April 7^th, 2019 https://www.theguardian.com/commentisfree/2020/apr/09/deadly-virus-britain-failed-prepare-mers-sars-ebola-coronavirus

[xli] David Quames, Spillover: Animal Infections and the Next Human Pandemic, Bodley Head, London, 2012, p.23

[xlii] Cheryl Miller, ‘The Red Plague’, The New Atlantis, Winter, 2007, https://www.thenewatlantis.com/publications/the-red-plague

[xliii] Quames, p.197

[xliv] Quames, p.322

[xlv] Quames, p.497

[xlvi] Zac Doffman, ‘COVID-19 Phone Location Tracking: Yes, It’s Happening Now—Here’s What You Should Know’, Forbes, April 7^th, 2020 https://www.forbes.com/sites/zakdoffman/2020/03/27/covid-19-phone-location-tracking-its-moving-fast-this-is-whats-happening-now/#1b7e565e11d3

[xlvii] Stanford Encyclopaedia of Philosophy, https://plato.stanford.edu/entries/original-position/

[xlviii] UN Sustainability Goals, https://www.un.org/sustainabledevelopment/biodiversity/

April 16, 2020
Barcelona Under Lockdown

It all happened too fast, so quickly that we didn’t have time to fully understand. The night before we were sipping beer and eating tapas and waiting for spring to come in the warm evening breeze; the following day we were on the sofa consulting the Netflix schedule for the umpteenth time, without finding an entirely satisfactory choice.

That feeling is like after an unexpected accident, with a supernatural aftertaste. It is as if a divine finger had pushed a gigantic ‘STOP’ button, and our swirling swarm on planet Earth had been suspended; crystallized in a drop of time. One after another, the places where we went to disfrutar de la vida, ‘to enjoy life’, closed their shutters, leaving us confused and lost.

For some it was a trauma to be compelled to cook for themselves. Staying indoors in a city that has unbridled sociability as one of its calling cards is difficult, but Barcelona is still trying to maintain its atmosphere despite the lockdown.

Normally in the evenings the lights of buildings are turned off, with people outside. Lately I discovered that the building opposite my own is actually inhabited.

Yesterday I went out to dispose of the trash and do the occasional shopping we are allowed to do. As I left the door from the balconies above I heard a ripple of applause: for a moment I was moved, it seemed to me that I had become the hero in a dystopian film.

I know they weren’t applauding me, it was just a manifestation of unity in this battle, fought with heavy doses of TV series, bored yawning, punctuated by scared, masked bellboys who bring stuff up to your home. I understood these people: even applauding strangers helps fill the empty minutes.

At least to help us stop missing our previous lives, the weather has decided to remain cold, even if the cold of Barcelona is far from the perennial grey nightmare overhead in Dublin, under which I lived for eight years.

Occupying one’s time is difficult, with the bars all closed there is no possibility of drinking red vermouth with friends. I live in Barceloneta, a neighbourhood that is a peninsula kissed by the sea.

Out on the street, the police remind you to stay at home, speaking calmly into megaphones. Someone brings out their dog to take a piss. The most important road, Carrer de la Maquinista, is empty. The most famous restaurant, ‘La Bombeta’, is closed. The buzz of people’s voices is replaced by the singing of birds, unexpected protagonists in neighborhood life, the vida de barrio that we miss so much.

Flags of Catalonia are still draped from the balconies, moved by a gentle wind. At this time, these people should be my enemies on the football field, as my team, Napoli was set to face Barcelona in the UEFA Champions League round of sixteen, but looking at their worried and tired eyes, so similar to my own, I never felt so close to them. There will be time for confrontation, on the field. Now is the time to be close, very close. If not with our bodies, then in our hearts.

We all wonder when we will be able to walk back to the Paseo Joan de Borbò, stopping at one of the many bars to talk about stuffed bombas; or who is the greater footballer between Diego Maradona and Lionel Messi; or to watch that black-eyed chica that turns the cabeza and makes the corazon skip a beat, every time she passes by.

Such a simple thing, like shopping, has become an experience reminiscent of hours spent gaming; at times I feel I am becoming the protagonist of any chapter in the Fallout saga. The neighbourhood is deserted, everything is closed and dark. The only lights on Plaza de la Barceloneta are those emanating from the church of Sant Miquel.

In the supermarket people are afraid even to smile at you. They are not worried about touching you or being too close, they are simply afraid to recognize in you the fragility of the human condition that unites us all. Breathing inside a mask is for me, with my glasses, embarrassing: with each breath the lenses mist up, giving my vision of the surroundings a dreamlike quality.

In the meantime people are dying, the daily bulletins are becoming increasingly distressing; there is a great deal of concern, and prayers, for the situation in Madrid, but more than miracles the patients need respirators and medical personnel. Here in Barcelona, too, cuts to the health budget are being felt.

People have stopped applauding and there is silence around me, so dense and spooky that it is frightening. More than the infection, and what can happen to any of us if we are hospitalized alongside people fighting for their lives.

We are used to fight for our place in the world, but are we prepared to fight for a lifesaving hospital bed? Now we don’t want to think about it. On the sofas where we spend our days we try to feel secure. Less weak.

In the meanwhile, I’m out. I allow myself five minutes to smoke a cigarette sitting on a bench. But my mind is not free. I just cannot relax. My only thought is about how to get home and carefully spread the antibacterial soap between my hands. A little anguish peeps out: what if I caught the virus on this excursion? I already know that for the next two weeks this thought will haunt me.

But I’m not the only one: here we are, stuck between the duty to stay at home and the desire to go out. In the middle of two fires, or, as De Lucia would say, entre dos aguas. But Barcelona no se rinde – ‘Barcelona won’t give up’. It plays the rumba and waits patiently. The day when we will be allowed to leave our thirty-five-square-metre apartments is inching closer.

When I get back home, I close the door behind me. The sofa seems to look at me worriedly: “Where have you been?”, he seems to ask me. Everything is so unreal that I don’t know how to answer.

April 3, 2020
Diary of a Pandemic Doctor Part 2

No one will want to read this, as this is about death.

As we sit, quarantined in our homes, scrolling through the news of the pandemic, death seems to stand, ever present, in the corner of the sitting room. Our everyday behaviour is now invested with the knowledge of his presence. The actions we take, staying home, keeping two metres from one another, have a direct, logical relationship to the struggles of people gasping on ventilators in intensive care units.

It is alien for us to have death at such close proximity. We have in the last decades managed to block it out, hide it away, to think that if we throw all our resources at it we might prevent it.

But of course death is as natural to life as birth.

Most of the time doctors battle against the humdrum vagaries of life: the sore throats, broken arms and anxieties; but now and then we are called upon to joust with death, and sometimes during this battle we have to lay down our arms and allow death take its prize.

Some of my patients have begun dying from Covid-19. They have been unwell for a few days with fevers, chills, and muscle pain. Most get better after a week, but some suddenly develop hypoxemia, a low level of oxygen in their blood, and a few hours later are on a ventilator, mechanically deflating and inflating their lungs.

If they develop the cytokine storm, a sudden rush of inflammatory cells entering the lungs, the immune system aberrantly attempting to combat the virus, they often die. Death walks the intensive care unit, taking every second patient.

Just before the pandemic started I made several house calls to an elderly couple. They lived in an airy, high-stucco-ceilinged apartment, full of the accretions of a long life: family pictures hung on the walls, showing adult children, grandchildren; a straw parasol from a tropical holiday in the corner; coloured crystal glasses on the fireplace.

In an overheated bedroom the elderly man lay on the bed, his limbs cachexic, his skin mottled with liver spots. His chest heaved unnaturally with the effort of breathing. The pump of his heart was failing, so his lungs filled with fluid.

I had sent him to hospital twice, where they had tapped his lungs, but the respiratory physician called me on his final discharge to say that they would not take him again. I had tried, with diuretic tablets, to clear his lungs, so he could breathe more comfortably. But now even these were failing. It was time to lay down arms and give comfort, rather than fight.

I took his wife and son aside in the darkened corridor and told them that I would be removing most of his medication, giving just the necessary to make him comfortable. His wife begged me to send him to hospital, saying that she had arranged things so the whole family would be home for Christmas to spend it with him.

I tried, as best I could, to explain that now was the time to recognise that he would soon die, to gather the family quickly, to make him comfortable, and to spend that time with him. After a long discussion they became reconciled to the situation, took their places either side of the bed, holding the old man’s hands in theirs.

The home nurse injected an infusion of morphine to relieve his distress, and I left to the sound of the quietening of his ragged breathing and his wife’s sobs.

By recognising what death is we recognise what life is. That is maybe why this feels like such a moment of quickening. Death has come knocking at our doors and we are forced to open and acknowledge him. The door will close again, but the collective memory will remain, and when the pandemic is over this may help us to invest life with more meaning.

Read the first installment of Dairy of a Pandemic Doctor here.

April 1, 2020
No Comment: A view of Sligo Town amid the Covid-19 Pandemic

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

Fellipe Lopes/Cassandra Voices

March 29, 2020
Ireland’s Response to the Coronavirus Pandemic

The total number of deaths attributed to the Coronavirus in Ireland had reached 22 by March 27^th, from 2,121 confirmed cases. However, with 14 of those occurring over the previous two day it suggests that number could rise steeply. Indeed, Taoiseach Leo Varadkar has warned that intensive care units may be at capacity ‘within a few days.’ Historically underfunded and mismanaged, the system of public healthcare in Ireland is at full stretch.

Entrance of the Mater Hospital in Dublin on the North Circular rd. on 27 March 2020. Daniele Idini/Cassandra Voices

Nonetheless, a concerted promotion of social distancing and enhanced hygiene, instigated in particular by civil society and the medical profession, and eventually led by an initially hesitant government, offers hope that the trajectory in the rise of the curve of new cases will flatten. This will bring vital breathing space to implement a detailed national action plan.

The provisional success of containment measures came in the wake of doomsday scenarios being painted in the national media. On March 8^th The Sunday Business Post led with a headline quoting a senior health official to the effect that 1.9 million – out of a total population under five million – were likely to catch the virus over a concentrated three-week burst. Collective minds were also focused by the harrowing accounts arriving, especially through social media, from Italy, leading to hording of foodstuffs.

Daniele Idini/Cassanda Voices

But air travel continued unabated to and from countries such as Spain and Italy, from where the first cases were traced from February 29^th. At least the annual Six Nations rugby fixture against Italy, scheduled for March 7^th in Dublin was cancelled. Nevertheless, ignoring the looming threat, as many as twenty thousand Irish horse racing fans travelled to and from the annual Cheltenham Festival in the U.K., between March 10^th and 13^th.

Flight Zurich-Dublin, 19 March 2020. Davide Beschi/Cassandra Voices

Importantly, the government announced the closure of schools and universities from March 13^th, calming mounting fears and, after a rising volume of complaints on social media, elected to call off the annual St Patrick’s Day parades. This followed the decision of organisers in the small towns of Cobh, Middleton and Youghal to cancel.

Pubs were not shut down until March 15^th, however, by which time concerned citizens were uploading videos of crowded venues onto broadsheet.ie.

O’Connell Bridge, 27 March 2020. Daniele Idini/Cassandra Voices

On March 19^th the Dáil passed emergency legislation containing financial measures assisting those affected, and permitting the Gardaí to close down mass gatherings and, potentially, to order people to stay in their homes; as well as providing for the detention of a person on foot of a medical recommendation.

On the evening of St. Patrick’s Day, Taoiseach Varadkar, a trained doctor, solemnly addressed the nation. The competence he projected provided reassurance, even to his critics, that the State would henceforth deploy all means necessary to confront the contagion.

An initial two-week lockdown, permitting walks within 2km of a person’s home, was finally announced on March 27^th. It remains to be seen whether this delay in taking this course of action will prove costly. More draconian measures, however, bring their own health risks.

Montjoy Square, 27 March 2020. Daniele Idini/Cassandra Voices

A long-running housing crisis has seen Dublin becoming the third most expensive city to rent in Europe behind Paris and Geneva. This means almost 50% of young adults aged between 25 and 29 now live with their parents. Also, many immigrants, in particular, live in cramped conditions in large groups in the capital. These factors could accelerate the spread of the disease.

One revealing development has been a massive increase in the availability of properties to rent on the Dublin market, especially near the city centre. This suggests these had been reserved for short-term, Airbnb lets, and that the authorities have not been enforcing regulations prohibiting short-term rents in pressure zones.

As of March 24^th, Ireland’s testing figures compared favourably with other European countries. The rate of 1,350 tests per million lagged behind Austria and Germany, but was ahead of the U.K. and France. Senior health officials are following WHO guidelines, rather than trialling risky hypotheses, like the flawed ‘herd immunity’ idea, initially floated in the U.K., and elsewhere.

The pandemic has hit Ireland during a period of political instability after a February general election yielded an indecisive result, with Leo Varadkar’s government no longer commanding a Dáil majority. Notwithstanding the challenge of installing a new cabinet under emergency conditions, it sets a dangerous precedent for a caretaker government to be in power for a prolonged period.

The pandemic appears to have increased the prospect of a united Ireland, especially given the U.K.’s mishandling of the pandemic. The Northern Ireland Power-Sharing Executive, containing politicians from both the Unionist and Nationalist communities, has already agreed to heightened cooperation with the Republic.

Ireland suffers from a legacy of poor planning decisions, with sprawling developments and one-off rural housing commonplace, leading to reliance on motor cars. In the peculiar circumstances of a pandemic, however, this may prove advantageous as communal apartment blocks and crowded public transport seems to have exacerbated transmissions elsewhere.

Henry Street, Dublin. 23 March 2020. Daniele Idini/Cassandra Voices

Located on an island, albeit one with a portion under the United Kingdom, and having a comparatively young and well educated population, Ireland can control its borders easier than most. A best case scenario sees the virus being excluded in a matter of months.

It is unclear, however, whether this can be achieved without curbing liberties to a point where national cohesion dissipates. There is also a danger that reliance on food imports, exposed as a weak point in Brexit negotiations, could drive up the cost of many staples, and even exacerbate long-term health inequalities.

President Michael D. Higgins, who is almost eighty years of age, wrote a poem called ‘Take Care’ to reassure his people in a period of dread uncertainty. A portion reads:

Belief
requires
that you hold steady.
Bend, if you will,
with the wind.
The tree is your teacher,
roots at once
more firm
from experience

March 28, 2020
Diary of a Pandemic Doctor Part 1

Tonight I walked to the sea in the dark. The city streets were empty except for a tomcat clawing at a wooden lamp post. It turned and padded off as it heard my steps, its shoulders rolling, leonine.

When I came to the shore the air was still, the city’s lights amber diffusions in the ocean’s surface stretching out towards the islands marshalled in the bay. As I sat there I thought of personal crises I’d been through, small things now, that made it seem to me that the world for days or weeks creaked and turned askew. And then I thought of this moment, and this external threat, when the world really is altering before us.

The sea’s surface had the sheen of glass – a dead calm. I imagined the water suddenly retreating, the shingle of the ocean’s floor hushing as it was revealed, fish flopping where they lay, the water gathering itself into a giant wave, a dark curtain throwing the skyscrapers of the city into shadow, its angry upper lip broiling with white foam.

Over nine hundred dead in Italy today. Five of them doctors and nurses. 9% of those infected are medical personnel.

What do we do in the face of this wave? Give in to hopelessness?

Someone posted a photo of my graduating class from medical school in Ireland the other day. Young faces then, kids – Asian, Indian, American, Canadian, Australian, Irish, Norwegian. I think of them seeded through the world, now senior doctors, readying themselves for what is to come.

Over 24,000 retired doctors and nurses in my own, small home country of Ireland took themselves out of retirement this week, and said they were ready to throw themselves into the fray; many are people who are of an age that they have a high risk of dying from the virus if they get infected.

With that kind of bravery around we can’t give in to hopelessness. So we build a wall, use ourselves as bricks, and we repel the fucker as best we can.

Before leaving I crouch at the sea’s edge and hold my fist under the water until it’s so cold it hurts. It’s time for all of us to get to work.

March 24, 2020