Tag: Social Distancing

  • Covid-19: A Flawed Consensus

    Covid is a nightmare from which we are still trying to awake. But whether the unprecedented response represents a singularity, or the beginning of an era of authoritarian capitalism, is unclear.

    Many of us remain incapable of distinguishing a reliable version of reality from lonely projections. Thankfully, telling insights arrive in a new publication: The Covid Consensus: The Global Assault on Democracy and the Poor – A Critique from the Left. Authors Toby Green (a professor of African history and culture) and Thomas Fazi (a writer and journalist) navigate a path through the scientific thickets, to reveal the socio-economic and cultural factors that shaped the pandemic response.

    The temporary elevation of public health officials in many countries to positions of almost unfettered power led the Mozambique writer Pedrito Cambrao to observe that ‘the secular West has essentially turned science into a religion and scientists and healthcare workers into a priestly caste that cannot be challenged. (p.346)’

    Media, new and old, brought unrelenting focus to a single challenge, while only rarely surveying accumulating evidence of collateral damage. As in Albert Camus’s great novel, The Plague: ‘Rats died in the street; men in their homes. And newspapers are concerned only with the street.’[i]

    Additionally, as I propose in this review, a “left-brained” positivism appears to have informed the Covid Consensus that Green and Fazi define.

    Positivism is a philosophical system recognizing only that which can be scientifically verified, or which is capable of logical or mathematical proof, but this can lead to a narrowing of perspective. Thus, long-standing challenges yielded to a singular metric, the waxing and waning of “the virus” – as defined by the PCR test, a dubious diagnostic tool that accounts for exaggerated mortality statistics.

    Positivism is identified with the nineteenth century philosopher Auguste Comte (d.1857), whose conclusions, according to Albert Camus, ‘are curiously like those finally accepted by scientific socialism.’

    Comte conceived of a hierarchical society that looks similar to what we witnessed over the course of the Covid Consensus:

    [S]cientists would be priests, two thousand bankers and technicians ruling over a Europe of one hundred and twenty million inhabitants where private life would be absolutely identified with public life, where absolute obedience ‘of action, of thought, and of feeling’ would be given to the high priests who reign over everything.[ii]

    In our time, technocratic rule relied on an underlying hysteria founded on a generally irrational fear of premature death, whipped up by social media in particular.

    Only once this dissipated – arguably when wide availability of rapid antigen tests revealed the widespread prevalence of basically harmless infections – was normality restored. As in Camus’s novel The Plague: ‘Once the faintest stirring of hope became possible, the dominion of the plague was ended.’[iii]

    Questioning Authority

    The paucity of left-wing lockdown critiques, ignoring the plight of Global South, where more than one hundred million people fell below the poverty line (p.286), despite the minimal impact of the virus itself, demonstrates an intellectual impoverishment in a broad-based movement that achieved extraordinary progress during the twentieth century, by questioning established authority in terms or wealth, gender and race.

    In contrast, the veteran Greek socialist Panagiotis Sotiris observed that what went missing during the pandemic was an understanding that ‘science and technology are not neutral’.

    All too many who identify as left-wing, Green and Fazi argue failed to recognise, ‘something much more profound than a straightforward conflict between left and right’, but instead,

    a struggle at the heart of capitalism between the traditional press and business interests it has always represented (hotels, restaurants, high street shops) and the new corporate giants which did not require such promotion. (p.19)

    A sympathetic explanation might trace broad left-wing approval for what were ineffectual lockdowns to the accompanying state largesse. Below the surface, however, a huge transfer of wealth occurred to billionaire owners of giant corporations. Thus, the ten richest men in the world doubled their fortunes during the pandemic, while supports to workers proved transient, and were based on unsustainable quantitative easing, which has, predictably, given way to inflation.

    Through effective control over online content, including outright censorship, and regulatory capture – including of the WHO – the corporate giants successfully narrowed the Overton Window of acceptable discourse. Dissenters from a dominant narrative were stigmatised as far-right, libertarian or conspiracy theorists.

    Importantly, statements of President Donald Trump were weaponised by architects of the Consensus. Green and Fazi contend that it was ‘no longer possible for left-leaning progressives to question ‘the science’ since that is what Trump had done. (p.78)’

    Beyond Conspiracy Theories

    Various conspiracy theories purport to explain the decisions of governments to quarantine almost half of humanity for almost two years to inhibit (rather than eliminate) a virus with a median infection fatality rate of c. 0.27% (the figure for Spanish Influenza in 1918-19 was > 2.5%) that posed a vanishingly low risk of death to anyone under the age of seventy, prior to the arrival of vaccines that were not designed to save lives.

    The Covid Consensus addresses a more interesting question however, namely: why did Western populations overwhelmingly consent to unprecedented infringements on civil liberties, culminating in the population-wide, medical coercion of vaccine mandates and passports?

    Indeed, leading experts seem to have been surprised at the power they wielded. Thus, after the British government adopted Chinese lockdown policy, Professer Neil Ferguson observed: ‘It’s a communist, one-party state, we said. We couldn’t get away with it in Europe, we thought. And then Italy did it. And we realised we could.’

    It should also be noted that any idea of locking down healthy people was contrary to best practice in global health prior to 2020. An article from 2014 on the history of quarantine, ‘Gold, fire and gallows: quarantine in history by Médecins Sans Frontières’s Duncan Mclean found:

    There is limited and far from definitive research on quarantine effectiveness and far too many other factors at play that are difficult to ascertain from the historical record. Yet while present understanding about the pathology and transmission of hostile pathogens is far advanced on centuries past, there are some basic conclusions that can be made. For example, it is fairly certain that isolating a healthy population alongside an unhealthy population risks causing more harm than good, especially when access to food, water and medical care is taken into account. For quarantine to be successful, it requires perfect compliance and transmission without symptoms.

    Moreover, notwithstanding the dubious achievement of temporarily excluding Covid-19 from certain countries through a Zero Covid policy, the idea that a highly infectious respiratory pathogen causing a low level of morbidity (a U.K. study from October, 2020 found 76.5% of a random sample who tested positive reported no symptoms and 86.1% reported none specific to COVID-19) could have been eliminated was never a serious proposition.

    The lockdown-to-vaccine strategy was also predicated on a misplaced article of faith, which is that vaccines – what Boris Johnson referred to as “the scientific cavalry” – would essentially eliminate Covid-19, or at least the transmission of the virus. The progressive – or “left-wing” – argument to take vaccines for the sake of others never stood up to serious scrutiny from the outset; but mainstream media had suspended critical assessment as part of what was immediately likened to a war-time effort.

    Despite failing to achieve what most people assumed it would, i.e. block transmission, which its inventor claimed it could achieve, seemingly pre-planned measures were rolled out, while serious harms largely went unreported in a mainstream media dangerously reliant on ‘philanthro-capitalism.

    Social Distancing

    According to the authors of the Covid Consensus the pandemic ‘provided a radical continuity of many trends which had been latent in global society.’ They point to a steady growth over many years in social inequality, ‘the power of computing, information wars, and the shift towards increasingly authoritarian forms of capitalism across the world had all been growing.(p.2)’ Arguing:

    we should perhaps consider the troubling hypothesis that the Chinese and Western regimes, far from representing two opposites may actually have come to embody two different types of authoritarianism, conflictual but symbiotic at the same time – as the striking convergent responses to the pandemic would seem to suggest. (p.398)

    Notwithstanding the similarities Green and Fazi point to, the approaches of East and West did diverge in one significant respect: China’s early adoption of a highly authoritarian Zero Covid policy ensured life continued for most of the time “as normal”, whereas Western governments promoted a more consensual social distancing approach that relied on an unprecedented propaganda campaign.

    The disturbing effects of social distancing might be viewed as the apotheosis of neo-liberalism. The virus seems to have provided a welcome pretext for the wealthy to remove themselves from the hoi polloi.

    Covid-19 also laid bare the widespread out-sourcing of manufacturing to lower wage economies (such as China). Lockdowns demonstrated that many workers in the West were no longer in productive employment, and instead engaged in what the late David Graeber called ‘bullshit jobs’, often as part of swollen bureaucracies.

    Thus, Green and Fazi identify the lockdown response as ‘a symptom of the ever-increasing removal of people in wealthier societies from economic production. (p.2)’ For many Western consumers concern for ‘the implications of lost harvests, ruptured supply chains, and abandoned industrial plant machines was not as real as the threat of a new virus to this group of disproportionately influential people. (p.3)’

    An important cultural facet the authors refer to is a crippling fear of death. Over many decades Western governments have cleansed ‘the dead from daily life’ (p.11). This contrasts with the far more obvious folk rituals and religious practices attending a person passing away in the Global South.

    A collective inability to reconcile ourselves to death best explains the panic generated by coverage of events in Lombardy, Italy in February, 2020: as ‘the shadow loomed of death re-entering the normal spaces of society people sought to seal themselves away from something which terrified them. (p.11)’

    Ferguson’s candid testimony suggests it is highly unlikely that anyone in power anticipated the propaganda value of “the scenes in Italy”. Indeed, many governments displayed little appetite for lockdowns initially. Most quickly rolled over, however in the face of an enduring hysteria; even after initial mortality projections of 0.9% (used by Ferguson in his infamous paper) had been show to be seriously inflated.

    A fear of premature death is most obvious explanation for why peopled consented to unprecedented infringements on their civil liberties.

    Left-brained?

    Another cultural factor the authors point to is ‘the undermining of social science and humanities degrees by governments … in favour of STEM subjects’. They contend that ‘these subjects were routinely ignored in the shaping of major policy decisions by both government and the media. (p.14)’

    This educational trend, I would argue, reflects a longer term tendency in advanced industrialised societies (now including China) to perceive the world disproportionately through the left hemisphere of the brain, which has yielded a distinctive version of reality.

    In an extraordinary work, The Master and His Emissary: The Divided Brain and the Making of the Western World (2009), Iain McGilchrist charts the ascendancy of left-brained thinking over that emanating from the right. He stresses that both are involved in most mental processes, but that each nonetheless retains discrete functions.

    McGilchrist argues that since antiquity we find an ‘increasingly mechanistic, fragmented, decontextualised world, marked by unwarranted optimism mixed with paranoia and a feeling of emptiness.’[iv] This sounds suspiciously like the prevailing state of mind under lockdown.

    McGilchrist also averts to the totalitarian regimes of the twentieth century, arguing the real horror of the Concentration Camps lay in ‘the detachment with which the detailed plans of the extermination camps were developed, often relying on expertise of engineers, physicians and psychiatrists that makes the Holocaust so chilling.’[v]

    It is inappropriate to compare those who promoted lockdowns to the architects of the Final Solution, or the Gulags for that matter. Indeed, many lockdown agitators were probably motivated by a misplaced altruism. The architecture of lockdowns, however, also required a detachment from the far-reaching consequences of shuttering societies and undermining community life.

    Lockdowns and vaccine roll-outs depended on (“left-brained”) technical approaches – relying on engineers, physicians and psychiatrists for disease modelling, track and trace and “psy-ops”. In an era of positivism, the role of governments essentially narrowed to curbing the spread of Covid-19. This obscured “big picture” determinants of health and well-being such as social connection, as well as causing almost incalculable educational loss by closing schools for up to two years in some countries.

    An acknowledged tendency to mislead the public over the course of the pandemic may also be traced to the left hemisphere; as McGilchrist puts it: ‘The left hemisphere is the equivalent of the person who, when asked for directions, prefers to make something up rather than admitting to not knowing the way.’

    Thus, more proportionate policies, such as those followed in Sweden, were sadly lacking in the response. The consequences of a detachment from other determinants of health and well-being seem to be reflected in the troubling excess death statistics we are now witnessing.

    A Singularity?

    The belated repeal of emergency powers in most countries indicates that we have not entered a prolonged period of government led by public health officials. Indeed, conversely, there are strong arguments for greater emphasis on health initiatives to contend with other, more profound, challenges such as the obesity pandemic.

    However, the overnight shift from blanket coverage of the virus to the War in Ukraine suggests we may have entered an era of ‘permanent crisis.’ This, according to Green and Fazi, ‘means being stuck in a perpetual present where all energies are focused on the fight against the enemy of the moment. (p.397)’

    As with the response to Covid-19, the populations of Europe and America are presented with a single prescription – here a total victory for Ukraine – seemingly at all cost. This is, arguably, indicative of an ascendant “left-brained” positivism, which narrows or simplifies the range of possibilities to the “enemy of the moment”.

    Moreover, our dependence on compromised technology accelerated under lockdown. This increases a susceptibility to propaganda, although freedom of association blunts the insidious power of the smart phone device.

    Also, fear of Putin and Russia has not awakened a similar hysteria to that generated by Covid-19, although the plight of Ukrainians has certainly been used to garner sympathy for the war effort. A major difference, is that many, though certainly not all, on the left in Europe are questioning a dominant narrative; alert to the fingerprints of the military industrial complex; in contrast to the Covid response – where the role of Big Pharma was generally overlooked.

    Importantly, the power structures of the Covid Consensus remain intact. There is a serious dearth of critical media and investigative reporting into the ties of the Biden administration to the world’s largest asset manager, Blackrock, which along with Vanguard and State Street manages a combined total of over twenty trillion dollars.

    My concern is not simply that the billionaire class is enriching itself through proximity to power. It is also with the dominance of a “left-brained” caste of mind reigning ascendant in both the West and the East.

    Perhaps Bobby Kennedy Jr’s bid for the Democratic nomination will bring greater attention to the influence of the corporate money men in power. An outspoken critic of the pharmaceutical industry and the military industrial complex over many years, Kennedy might previously have been easily dismissed as an “anti-vaxxer”, but that term may have lost its valency in the wake of Covid.

    Unless, or until, there is a thorough evaluation of what has occurred during Covid-19, the possibility of a renewed assault on basic liberties at the behest of the billionaire class remains. Green and Fazi’s Covid Consensus represents an important first draft of history, which should inform that inquiry.

    Feature Image: A classroom with socially distanced desks.

    [i] Albert Camus, The Plague, (1947), p.18

    [ii] Albert Camus, The Rebel, Translated by Anthony Bower, Penguin, London, (2013), p.145

    [iii] Albert Camus, The Plague, (1947), p.272

    [iv] Iain McGilchrist, The Master and his Emissary (2009), p.3

    [v] Iain McGilchrist, The Master and his Emissary (2009), p.165-66

  • Covid-19: Questioning the Three Mantras

    The three mantra for this pandemic in Ireland are: wash your hands; socially distance; and wear a mask. Stated repetitively with suitable gravitas the guidelines have been internalised by most of the population. Fears around the spread of the ‘deadly’ virus are even driving people to police one another. The valley of the squinting windows is alive and well.

    But what are the inherent costs to these three injunctions? And why shouldn’t we keep measures in place when this pandemic abates, as has recently been argued?

    Throughout this pandemic we have witnessed very little meaningful scientific debate in Ireland. Irish experts are drawn from a small circle of academics, some with vested interests, supporting the government’s highly successful publicity campaign. In other countries, in contrast, there are heated public debates between scientists as to whether to adopt a dominant approach of blanket policies, or one of shielding elderly populations.

    But in Ireland Nobel laureates and professors from prestigious universities around the world are routinely dismissed with smart quips by gullible journalists. But let us examine the three mantras in a dispassionate way that acknowledges each of their adverse impacts.

    Wash Your Hands

    The first injunction to ‘wash your hands’ is sound advice, which unless you are living on another planet you will be aware of by now. Do we always follow this injunction? Probably not. Are we all dying of ghastly flesh eating infections or coughing up great globules of blood stained mucus? No we are not. Why? Because very few of the billions of micro-organisms with which we share our bodies are actually pathogenic.

    We have existed as a species for approximately a quarter of a million years, and as part of the great evolutionary flow of life for over four and half billion years. In that time adaptation to adversity has been the rule; hence homo sapiens is now thriving, sadly often to the detriment of the rest of the natural world.

    In the advanced economies at least, most of us are now almost invincible until old age. Thus, over the past two hundred years improved nutrition, housing and sanitation have brought life expectancy up to almost eighty years in many countries.

    Medical science, including antibiotics and vaccines, has contributed to this longevity, but not to the extent some of us doctors would have you believe. The authors of The Changing Body: Health, Nutrition and Human Development in the Western World since 1700 (Floud et al., Cambridge, 2011) state:

    it would be easy to exaggerate the importance of scientific medicine when one considers that much of the decline in the mortality associated with infectious diseases predated the introduction of effective medical measures to deal with it

    So yes washing your hands regularly is a good idea. Soap and water should be the principle means, not the bactericidal or viricidal gels we now find on entering every shop or building, some of which are to be avoided – especially the 52 sanitation products the Department of Education has told schools to refrain from using.

    Our skin harbours myriad micro-organisms – that form a part of the human microbiome – all vying for space to live, raise a family and grow old peacefully in a quiet stable neighbourhood. They generally live harmoniously with us in what is referred to as a state of homeostatic balance.

    What happens when we kill off all the good micro-organisms, repeatedly, just in case there is a bad micro-organism on our skin? First, these agents damage our skin’s protective oil barrier, and kill micro-organisms with which we live symbiotically, contributing to our health and wellbeing.

    These ‘good’ bacteria and other microorganisms are easily replaced by ones that are resistant to the effects of the gels, and who can then run amok when given the chance.

    Prior to this pandemic, excessive hygiene measures against infections has given rise to the hygiene hypothesis, according to which ‘the decreasing incidence of infections in western countries and more recently in developing countries is at the origin of the increasing incidence of both autoimmune and allergic diseases.’ So let us be on our guard against excessive hygiene.

    “Social” Distancing

    Hannah Arendt in 1933.

    The second part of the mantra and perhaps the most dystopian is the injunction to distance ourselves socially. It recalls Hannah Arendt’s warning in The Origins of Totalitarianism (1951) that ‘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.’

    This “safe” distance is anywhere from the depth of the average grave – two metres – to imprisoning ourselves in our homes and limiting the number of fellow humans we allow to enter that space, which is no one from another household under current ‘Level 5’ Irish regulations; or previously an arbitrary number such as six, a figure no doubt chosen after repeatedly employing the reading of the runes technique.

    Not seeing anyone at all would be ideal, but the illuminati could not depend on the imbecilic general public abiding by their lofty standards, or reverting to having sex online to limit the spread of the virus, and so some meagre concessions have been made to human frailty, with the advent of support bubbles.

    Yet social isolation is a potential pathway to madness and a lonely death. We are social creatures and in solitary confinement few can flourish. A Screen New Deal is a recipe for Surveillance Capitalism, and enrichment of the billionaire class. Human touch brings emotional balance and better health.

    A person may be technically alive but is he or she really living without conversing directly with others, dancing, or otherwise demonstrating his love and empathy? We are not avatars in a complex, visually stunning computer game. We are connected physical beings. Those connections extend back into the past, embrace the present, and reach forward into an unknown future.

    It is impossible to tell whether the shocking spate of domestic homicides and suicides that occurred in the last week of October in Ireland, just as stricter measures were introduced, are the product of isolation, but the UN has described the worldwide increase in domestic abuse as a ‘shadow pandemic’ alongside Covid-19.

    Irish incidents include a murder-suicide in Cork involving a father and two sons; the apparent murder of a mother and her two children in Dublin; and the death by suicide of a Dublin nurse along with the death of her young baby through asphyxiation.

    Moving forward, we just have no idea what effect the injunction to “socially” distance – and the attendant loss of touch will have on us – a very tactile people.

    Recall that in shaking hands we make character judgements based on grip and duration; we embrace and kiss those we love with warmth and energy, and those we like with fleeting touching cheeks; we cup the faces of babies and ruffle the hair of cute children – especially if they possess more than us.

    We are now ordered to stop doing all of that, but for how long? Is there any evidence to suggest ‘the virus’ passes from one healthy person to another when we hug? Hasn’t common sense always dictated that we avoid hugging when we are under the weather?

    In this precarious age, however, it is necessary to assume we are guilty of being ‘asymptomatic’ into what seems like an interminable future, and either hug with extreme caution, or not at all. I fear these tactile behaviours will disappear altogether given Covid-19 is very unlikely to vanish.

    Mandatory Masks

    The third and final of the government’s mantras is perhaps the most pernicious: the mandating of masks. It has infantilised the population and turned people into part-time police officers.

    We’ve heard Irish and other experts overturn forty years of science, allowing celebrity doctors to demonstrate to the Irish public, with a cheeky Charlie smile, that masks will prevent contagions. In fact, the only masks that offer real protection are N95 masks or similar respirators. The popular cloth masks are of little more than symbolic value in preventing contagion.

    Instructively, in Norway, which has had among the lowest incidence of Covid-19 in Europe, but where case numbers have increased in recent weeks, the latest national measures do not include a requirement to wear masks in public, although this option is left open to municipal authorities in the event of high infection levels.

    Yet in Ireland journalists and ‘social influencers’ have accepted as self-evident that masks are a form of panacea; failing to recongise that approach is not backed by experimental data, and is in fact the lowest form of evidence.

    Now armed with the received wisdom – mumbling ‘I follow the science’ – righteous members of the public are on the lookout for slackers, and woe betide anyone not wearing a mask when shopping or travelling on public transport; it has reached a point of such absurdity that some even wear them while alone in their cars.

    But you might ask: what is the cost apart from mild to medium, or even extreme, discomfort, depending on how long it has to be worn? And as most of us don’t have to wear them other than when we enter shops then what of it?

    Masks hide our faces so that we have difficulty recognising and communicating with each other. Indeed, our brains have evolved to recognise faces. We see faces in clouds, bushes and cracked tiling, a phenomena called pareidolia. I have yet to hear of such an occurrence where the face is obscured by a mask.

    Pareidolia

    Our face has a remarkable forty-two muscles and is the site from which we deliver most of our body language. Ask a mother of a new born to stare at her child without changing her facial expression for more than a few moments and the baby will become distressed and cry. This is how hardwired our need is to read faces.

    Facial coverings – called surgical masks for good reason – are useful in clinical settings to prevent bacteria, hair, skin cells and mucus from falling into open wounds, but hardly when worn by unruly schoolchildren in class. The best reason to wear one now is simply to make people comfortable who believe they confer protection.

    Asians, have worn masks for various cultural and environmental reasons, including non-medical ones, for decades. In Japan people who feel ‘under the weather’ wear them to be polite.

    But there is no reliable scientific evidence to support widespread use, as Professor Carl Heneghan of Oxford University pointed out to the Dáil Committee on Covid-19 Response. There have only been three registered trials on the use of masks in the community: one in Denmark, one in Guinea Bissau and one in India – but none have reported outcomes so far.

    Now let us for a moment indulge in that age old technique of the thought experiment. Viruses are measured in nanometres. If we looked at the material from which most of these facial coverings are made under an electron microscope we would see more holes than material.

    A virus leaving your mouth, journeying out into the big bad world, is like a football passing through your front door. The football could hit the door frame and bounce back, but this is unlikely. The pseudo-scientific argument is that the virus travels first class in a large globule of spit and this globule gets jammed in the doorway, “proving” the efficacy of masks.

    Ahh, but wait a minute, mask are often worn for hours by kids and cashiers in shops, so what about all the other graduating viruses and their globular carriages? I doubt they are all just clinging for dear life on to the mask for fear of upsetting the Irish expert.

    Instead the globule eventually evaporates, after all it is mostly water vapour, the front of the mask dries and the viruses, being virtually weightless, just waft off on their merciless way.

    Other Approaches

    Now when I hear the mantra ‘wash your hands, social distance and wear a mask,’ I consider: are we running the risk of undermining our society to preserve some cherished scientific authority? We are supposed to be entering the second wave of a pandemic, yet while hospitals in countries such as Italy are under severe pressure – as was the case last February – few Europeans countries are now showing excess deaths. Yet the doomsday models that were wildly inaccurate last time around are being revisited.

    Excess mortality in Europe source since 2017: https://www.euromomo.eu/graphs-and-maps/#excess-mortality

    Shouldn’t our health authorities, especially in Ireland – which has had among the most stringent measures in the world throughout the pandemic – also be conscious of maintaining our humanity, and recognising the huge value – in terms of our health and wellbeing – of being able to gather, kiss, hug, talk, sing and laugh with abandon, without fear of breaking the law? We especially need to explain to our children that the world they currently live through is not going in a normal phase.

    In preventing infections with a respiratory disease such as Covid-19, we might look back on what the great American polymath and Founding Father Benjamin Franklin once observed:

    From many years’ observations on myself and others, I am persuaded we are on a wrong scent in supposing moist or cold air, the cause of that disorder we call a cold. Some unknown quality in the air may perhaps produce colds, as in the influenza, but generally, I apprehend they are the effect of too full living in proportion to our exercise.

    Franklin observed  a connection between succumbing to an infectious disease and poor dietary choices (“too full living”) and a lack of physical exercise that contributes to obesity, which we know significantly increases the likelihood of death from Covid-19.

    He also had the following to say on the benefits of being outside into the fresh air:

    I hope that after, having discovered the benefit of fresh and cool air applied to the sick, people will begin to suspect that possibly it may do no harm to the well. I have long been satisfied from observation, that besides the general colds now termed influenza (which may possibly spread by contagion, as well as by a particular quality of the air), people often catch cold from one another when shut up together in close rooms, coaches, et cetera, and when sitting near and conversing so as to breathe in each other’s transpiration, the disorder being in a certain state.

    During this pandemic, and moving forward, we should thus be addressing a pre-existing obesity pandemic that is being exacerbated by some of the current restrictions on sports especially. Franklin also seemed to have recognised the importance of adequate ventilation in buildings.

    Image (c) Daniele Idini

    Thus addressing the underlying conditions exacerbating the Covid-19 pandemic may prove to be the optimum response, as the editor of The Lancet Richard Horton has argued:

    we must confront the fact that we are taking a far too narrow approach to managing this outbreak of a new coronavirus. We have viewed the cause of this crisis as an infectious disease. All of our interventions have focused on cutting lines of viral transmission, thereby controlling the spread of the pathogen. The “science” that has guided governments has been driven mostly by epidemic modellers and infectious disease specialists, who understandably frame the present health emergency in centuries-old terms of plague. But what we have learned so far tells us that the story of COVID-19 is not so simple. Two categories of disease are interacting within specific populations—infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an array of non-communicable diseases (NCDs). These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies. The aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. COVID-19 is not a pandemic. It is a syndemic. The syndemic nature of the threat we face means that a more nuanced approach is needed if we are to protect the health of our communities.

  • 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.

    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 19th, 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 3rd, 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 12th, 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 15th, 2020 https://blogs.sciencemag.org/pipeline/

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

    [vii] ‘Yuval Noah Harari: the world after coronavirus’ March 20th, 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 2nd, 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 17th, 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 4th, 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 13th, 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 28th, 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 14th, 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 9th, 2020,  https://time.com/5817412/sweden-coronavirus/

    [xix] Untitled, ‘Revealed: The state of Sweden’s housing shortage’, The Local, May 14th, 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 18th, 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 12th, 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 23rd, 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 1st, 2020, Time Magazine, https://time.com/5813711/coronavirus-underlying-conditions/

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

    [xxvi] Frank Armstrong, ‘The Unbearable Heaviness of Human Beings’, October 7th, 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 13th, 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 3rd, 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 27th, 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 7th, 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 26th, 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 1st, 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 21st, 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 29th, 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 7th, 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 7th, 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 7th, 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/