When the Irish government via the HSE (Health Services Executive) introduced a Chronic Disease Management programme into general practice, and offered to pay G.P.s for running with it I thought that at last Irish general practice was moving away from its original reactive model and embracing a NHS-style piece work-approach.
We could now show our paymasters what we had done during the working day, not unlike the majority of ordinary people who work for a living. How very plebeian.
As mentioned, a version of this system already exists in the U.K., having been introduced in 2004, against much resistance from the usual suspects. However, once income rose by 25% within a short period of time, a mouth full of gold seemed to make it impossible for anyone to grumble very loudly.
It didn’t take long before problems became apparent, as G.P.s focused on the work that generated most income, waiting times for appointments increased. The government required large amounts of data, so administration workloads increased; a tension thus arose between the demands of actual general practice and that of the masters they served.
That last point needs a little clarification. In the UK the software most commonly used is EMIS. Once a consultation begins, EMIS makes certain demands of the G.P. on behalf of the Department of Health, which appear on the computer screen. The G.P. is paid based on the responses given to these demands, not on what the patient needs, wants or demands. The poor G.P. is now serving two masters, one of whom values metrics, the other maybe just some empathy. But the former pays the bills. Having worked and trained in the U.K., I soon became aware of the grumblings of family doctors and the frustrations of patients.
We now have a similar system in Ireland. It would be nice to think that this will improve the lives of patients and outcomes, and not just increase the incomes of G.P.s, the pharmaceutical industry and any other entities that benefit from illness in society. In the U.K. the evidence would suggest that the management of chronic diseases was improving pre-2004 with the introduction of national and international guidelines and the use of clinical audits in practice.
No Difference to Mortality
There is some evidence to suggest that the management of specific conditions such as asthma and diabetes did improve after 2004, especially in lower socio-economic areas resulting in less emergency admissions, but there appears to be little or no evidence that it has made any difference to mortality.
Having written that last sentence I’m not sure I fully understand it. I’m assuming that the conditions being paid for improved, as per the metrics. Or did it just look good on paper but not translate into increased longevity for the patient?
I wonder who benefits from gathering metrics, moving them up or down, using them to diagnose and prescribe? I suspect there is a health benefit for those suffering from chronic diseases. They see their G.P. regularly and are told at least twice per year that they ‘could do better’, are given more medications and the promise of a dietitian, physiotherapist, occupational therapist or perhaps the mythical unicorn of the health service, a psychologist.
But what are we really doing with this programme which, since 2022, provides ‘opportunistic case finding’, AKA finding customers for Pharma?
As G.P.s we are incentivised to find and manage illness, not return people to health, we maintain the status quo and consider our roles to be central to the process.
I would argue that we are central because without G.P.s the pharmaceutical industry would experience a profit crushing bottleneck. We therefore accept their ‘educational’ courses and their biomedical model of illness as a unidirectional process. Nowhere do we engage our patients in the fundamentals of health, such as how to breathe, sleep, eat, move and connect with others. Strangely, these crucial determinants are seen as by-the-ways, not fundamentals.
We have a society where the state we call health is detrimental to the wellbeing of the shareholders of the large pharmaceutical companies based here.
Fat Boy Slim
For many the Mediterranean lifestyle consists of a takeaway pizza and imported Spanish beer consumed whilst wedged into a Fat-Boy recliner watching perfectly coiffured people extolling the virtue of the Mediterranean lifestyle.
When watching sports becomes the nations favourite activity; when luxury, ease and relaxation, are lauded ambitions; when a narrow STEM education is promoted over the breath of the arts, is it any wonder that we have become a society of vacuous, soft-shelled and compliant serfs?
Maybe we need a dose of Hobbesian reality, to go with our morning lattes, and make us realise that we won’t be protected from the ‘solitary, poor, nasty, brutish and short’ life by accumulating ‘likes’ ,’followers’ or virtual friends on social media. Alas, we are creating William Blake’s ‘mind forged manacles’, as we shackle ourselves to a beast that cannot be satiated.
In my view the simplistic associations that we are developing between metrics such as blood pressure, cholesterol etc, the remuneration of doctors and alleged health outcomes is a road leading to obsolescence of G.P. practice, as AI (Artificial Intelligence) can do this far more efficiently and quickly than any human, and it won’t take ten years to train it to perform the role.
When we structure a health service around metrics, data and finance we are defining these as our goals. Lip service is paid to actual health. These numbers then become a society’s hallmarks of health.
Systems of Control
It doesn’t take too much of a stretch of the imagination to link all possible systems that use metrics to make decisions about human beings and turn them into systems of control.
The Internet of Things will in theory provide this interconnectedness so that our financial, health, consumer and in some circumstances political data can be knitted into societal straitjackets, for our own good of course.
Yuval Noah Harari has made a career frightening the pants off people on this subject. And Mustafa Suleyman in his book The Coming Wave documents the alarming power the already all-pervasive influence of AI, and what it might be in the future.
For those of us who enjoy chaos and unpredictability this is, to coin the exhausted hackneyed phrase, dystopian but if one is of an authoritarian bent, or just has a deludedly ‘in control’ mindset, this shouts out as an opportunity to create a barcoded Nirvana.
We could control everything from what people eat, what they wear, how far they drive, how much they move, physically, and even who they associate with, using personalised algorithms.
The technology already exists. Ubiquitous facial recognition technology, central bank digital currency, social credit scoring systems, wearable devices that record movement and supermarkets that would allow purchases of the ‘right’ sorts of goods for you if you are the ‘right’ sort of person for that product. This could all be linked to one’s current PPSN (Personal Public Service Number).
What could be simpler. A benevolent government could ‘incentivise’, initially, the consumption of the ‘right’ foodstuffs, consumed in the company of the ‘right’ people, whilst watching the ‘right’ types of programmes followed by the ‘appropriate’ amount of exercise.
Brave New World?
Wouldn’t that be such a healthy world? We could prevent obesity, under-activity, mindless viewing of soaps, loitering, even voting for the wrong candidate!
The preceding description is one of an idealised world, in which those in power have our best interests at heart, but it could have a darker side.
A healthy population would be bad for business and business owns politics through a process euphemistically termed lobbying. There is something malodorous about the funding of the main regulatory bodies in for example the pharmaceutical industry. The FDA in America, EMA in Europe and the TGA in Australia are over 70% funded by the industry they are charged with regulating.
Not only is the fox in charge of the chicken coop but he also has the farmer in his employment. This leaves us chickens stuffed and roasted and, perversely, eternally grateful.
A truly nefarious government influenced by business might even encourage the production of foodstuffs that make us ill, whilst our minds are hijacked by media that have the intellectual value of chewing gum. Meanwhile our bodies convert the ‘food’ into surplus, never to be utilised, into fat.
A few decades of this and we are ready to invite another business into the rest of our shortened existence, the erroneously named, health industry and all it has to offer.
As a species we would only have value as consumers, passed from one corporate entity to the next for, for the seventy or less years that we spend on this Earth, our value measured accurately at each stage by metrics dictated by the needs of the individual corporations.
Thankfully such a scenario is only found in dystopian science fiction.
How are the little ones holding up at home? I wonder how and with what my old mother feeds them?
We toil daily to subsist Forced to migrate to make ends meet
The nation may be great But our lives are miserable
This wicked disease struck us and wrecked our lives
What life is this? What life is this? a wretched life, a pathetic life an abject life, a broken life
Is there a disease worse than poverty? Is there a solace greater than being with one’s family?
Just to be at home in these troubled times would have been enough
At least we would have survived together, on some gravy or gruel
The kids flit and hover in my eyes all the time My wife’s laments chase me ceaselessly
What, what should I do? What am I to do? What to do? What can I do?
No need of buses or trains, O’ saaru Just let me go, master! I will walk my way home
No need of buses or trains, O’ saaru Just let me go, master! I will walk home
How are the little ones holding up at home? I wonder how and with what my old mother feeds them?
How are the little ones holding up at home? I wonder how and with what my old mother feeds them?
Let me go, O’saaru! I will walk my way home! Let me go, master! I will just walk home!
Imagined Communities
Nations, while possessing points of similarity with others, such as a general ‘reverence’ of their external borders, are each a unique and distinct mélange of dominant and disputed histories, cultural groupings, social identities, economic modalities, political structures and legal strictures. Citizens share a set of collective memories and a sense of belongingness with their wider national community – though this can conflict with localised identities particularly in post-colonial states where different ethnic and religious groups were lumped together – despite only ever getting to know a small minority of its members.
These ‘imagined communities’, according to Benedict Anderson, possess a number of characteristics. They imagine themselves as ‘limited’, as each nation sees itself as different from others; ‘sovereign’ as they are free to determine their own destiny; and ‘as a community’ in that no matter how unequal the internal social relations might be, ‘the nation is always conceived as a deep, horizontal comradeship.’[ii]
‘Habitus’ and the State
The French sociologist Pierre Bourdieu uses the term ‘habitus’ to describe how individuals are socialised through the ‘historical and cultural production of individual practices – since contexts, laws, rules and ideologies all speak through individuals who are never entirely aware of what is happening.’ Individuals then reproduce these practices, mediated to varying extents by their own self-interest and interpretation.[iii] This individual concept of habitus can be applied at the level of groups, such as a nation. This ‘collective habitus’ refers to its
shared perspective on the world, relatively common sets of values and shared dispositions to believe and behave in particular ways. The state partially orchestrates this collective habitus by creating the conditions under which certain things come to be viewed as natural and inevitable… and others unthinkable… But perhaps the most effective way that the state creates an orchestrates this collective habitus is by ensuring that is seen by the people it governs as being ‘the voice of the people’, which gives it legitimate authority to rule us, and even to exercise violence against us.[iv]
As individual nations have their own distinctive ‘collective habitus’, the political and social contexts within which governments operate will vary. This will impact upon the respective levels of freedom they have to resort to force or repressive measures in advancing specific policies. What is deemed acceptable by the citizens of different polities will largely depend on the history of repression in their states, the restrictions accepted in the past, the tradition of resistance, public confidence in the authorities, the current levels of political freedom and whether the state and its citizens are faced by some form of existential threat.
An interesting illustration of how the historical experiences and collective habitus of a nation can impact upon how repressive measures are accepted and rejected, can be seen in the reaction of some segments of society and even the political leadership in the U.S. to the lockdown. In several cities, large gatherings of citizens were able to successfully assemble in public to protest lockdowns in defiance of restriction on movement ordinances.
Paul Becker/wikicommons
Moreover, not only did the U.S. President Donald Trump state his support for their actions but he even went so far as to encourage them to ‘liberate Minnesota, Michigan and Virginia’, states which are, not surprisingly, ‘election swing states with Democratic governors.‘[v] In many other nations, such acts of civil disobedience, in contradiction of state ordinances enacted to protect citizens from an infectious disease, would have been heavily clamped down upon by the authorities.
Power, Control and the Use of Force
In his book on Power, John Scott expounds on modern governmental management of a territory and the political management of nations and their citizens.
Modern rulers… see their task as one of government in… shaping, guiding, and directing of the conduct of others by using persuasive processes of signification and legitimation to work through their desires, aspirations, interests, and beliefs… Sovereignty over territory also involves the management of the population to regulating the life processes through which they live, work, and relate to each other. This is what Foucault termed ‘bio-politics’… discipline is a control that is exercised over people through systems of rules that are not simply imposed on them but are instilled in them.”[vi]
Governments can increase their power and control either by direct imposition of repressive measures or through the prohibition of alternative voices and movements, which they wish to suppress. In most instances, a judicious melding of both methods will be applied. The precise mix will depend on the political and social environment together with the historical experiences of the state in question.
However, it is important to remember, as Max Weber emphasises, that while:
Force is certainly not the normal or only means of the state… but force is a means specific to the state… the state is a relation of men dominating men [and generally – one should add – of men dominating women], a relationship supported by means of legitimate (i.e. considered to be legitimate) violence…[vii]
As David Held writes ‘the web of agencies and institutions’ of a state find their ultimate sanction in the claim to the monopoly of coercion, and a political order, is only, in the last instance, vulnerable to crises when this monopoly erodes.[viii]
Covid-19 – Gateway to Repression?
Confronted by an unprecedented and menacing threat, it is normal for people to feel disorientated and even experience levels of panic disproportionate to the threat itself. It is not surprising therefore that the past few months have seen the imposition of unprecedented restrictions in response to Covid-19 by governments around the world. Emergency powers have been used to shut down large sectors of the economy, enforce movement restrictions, screen and isolate potential carriers, and enforce quarantining.
Covid-19’s rapid spread around the world has impacted upon people living in a wide variety of political, economic, social and cultural contexts. These diverse contexts have mediated the repressive policies available to governments – facilitating, refracting or impeding the measures they have attempted to impose – the insecurity and fear caused by the pandemic have undoubtedly facilitated the imposition of repressive measures.
While these measures have generally been implemented in response to scientific guidelines on how to tackle Covid-19, they should be limited to what is required and not used as a means to surreptitiously increase governmental power. Furthermore, as Amnesty International researcher Massimo Moratti warns, while states of emergency are permitted under international human rights law, such restrictive measures should not become a “new normal” and should last no longer than the danger that has necessitated their implementation.[ix]
‘Shock Doctrine’
In her book The Shock Doctrine, Naomi Klein describes how this process mimics the CIA method of ‘coercive interrogation’ which aims at breaking ‘resistant sources’ by creating violent ruptures between prisoners and their ability to make sense of the world around them. Klein argues that this is how shock doctrine works: ‘the original disaster, the coup, the terrorist attack, the market meltdown, the war, the tsunami, the hurricane – puts the entire population into a state of collective shock. Like the terrorised prisoner who gives us the names of comrades and renounces his faith, shocked societies often give up things they would otherwise fiercely protect.’[x]
The advent of Covid-19 has led to a situation where people are confronted by an infectious disease, for which there is no vaccine, and global lockdowns resulting in deep and widespread social and economic disruption. This has provided an opportune environment for governments to increase their power and control as well as advancing interests of their more powerful supporters. Repressive policies and measures can be introduced, as the ‘shock’ caused by the Covid-19 pandemic leaves the public less able to resist. In a world where lockdowns, isolation and quarantining have become the new accepted norm, coordinated, active resistance to repressive and inhibiting policies has become more complicated. As Patrick Cockburn points out:
Autocratic governments everywhere are becoming more autocratic and repressive regimes more repressive. They believe that they can get away with it: frightened peoples are looking to their governments to save them in this time of peril, and do not want to discover that they are ruled by incompetent people determined to serve their own interests and stay in power.
State Repression
While most of the measures imposed to fight Covid-19 have some level of scientific justification, emergency and repressive powers entail an inherent risk of abuse. Moreover, it is clear many governments have used the COVID-19 pandemic to push through laws and other measures that impose disproportionate restrictions on public freedom and civic rights.
Significant international controversy arose with the granting of wide ranging powers to Viktor Orban, the Hungarian PM, and his Fidesz party, which decreed jail terms of up to five years for the intentional dissemination of misinformation that might impede the government’s tackling of Covid-19. While the chilling effect of this legislation was widely criticised, it was the refusal to place any time limits on the powers being abrogated by Orban and his regime that led to the most concern.[xi]
Viktor Orban
Writing in late March, Osama Tanous describes how Covid-19 has been used as an excuse by Israel to further repress Palestinians:
Repression has continued, with the Israeli occupation forces using the excuse of increased police presence to continue raids on some communities, such as the Issawiya neighborhood in East Jerusalem, home demolitions in places like Kafr Qasim village and the destructi‘’on of crops in Bedouin communities in the Naqab desert.[xii]
Despite initially downplaying the threat posed by Covid-19 and the publics’ ‘hysterical’ response to it, the Philippines President Duterte has subsequently implemented an ‘extreme, militarized approach.’ By early April, the Duterte regime had arrested almost as many people for alleged violations of the Covid-19 lockdown and curfews as had been tested for the virus.[xiii]
In Colombia, already heavily besieged rural and indigenous communities have come under even greater threat as a result of the Covid-19 measures enacted to prevent transmission. In the week following imposition of quarantine measures in cities across Colombia in mid-March, three social leaders were murdered. Already one of the most dangerous countries in the world for social activists and community leaders, with 271 activists killed since the conclusion of the early 2017 peace deal between the government and the Revolutionary Armed Forces of Colombia (Farc), the government’s focus on the pandemic has led to activists saying they are now at even greater risk.[xiv]
emergency declarations based on the COVID-19 outbreak should not be used as a basis to target particular groups, minorities, or individuals. It should not function as a cover for repressive action under the guise of protecting health … and should not be used simply to quash dissent.[xv]
Furthermore, as the OSCE Right’s Chief, Ingibjörg Sólrún Gísladóttir emphasised, a state of emergency must be proportionate to its aim, and only remain in place for as long as absolutely necessary.[xvi]
Masked political control means a systematic effort to hide repressive actions by dressing them in the cloak of democratic norms. Governments might justify an internet crackdown by saying it is necessary to suppress hate speech and incitement to violence. They might cast the jailing of dozens of critical journalists as an essential element in the global fight against terror.[xviii]
As Patrick Cockburn explains:
Governments worldwide claim that journalists are impeding their heroic struggle against coronavirus, but their real motive is more often to conceal the inadequacy of those efforts. Political elites everywhere fear that the pandemic will expose their incompetence and corruption, weakening their grip on political power and economic resources.[xix]
Writing in pre-Covid-19 times, Simon used the ‘fear of terrorism’ as an example how a government might justify repressive actions. Today, similar arguments are being used to validate punitive measures to fight the current pandemic and prevent the dissemination of disinformation. In the digital age, people can access and disseminate information more freely and in real time. However, the technology that enables this unprecedented intensity and extensity of communication has allowed states to devise and develop measures to corrupt information flows by manipulating and influencing the content that reaches people, thus facilitating a new form of censorship. While [This] tactic is commonly used in countries rated as having closed or repressed civic space… [it] has also been seen in all corners of the globe as a subtle tool to silence critics.[xx]
The aim here is to control the narrative and if this proves impossible to at least prevent a coherent oppositional one. As White House Chief Strategist, Steve Bannon once said, the story is more important than reality.[xxi] Today, many governments are applying this dictum to their communications on Covid-19.
Twitter-Gate
The circulation of conspiracy theories can also be co-opted by governments as a valid rationale for the curbing of the free flow of information, on the grounds they are misleading and may be used, as in their usage by extreme groups, to stir up animosity and violence against targeted groups. However, once these repressive measures they can be used to increase government control over the general flow of information, thus having a chilling effect on communications and alternative narratives, as well as potentially preventing the development and implementation of genuine civil society initiatives.
An interesting outcome of the struggle to control the flow of information has been that in the U.S., where social media platforms have been caught in the crosshairs of Trump and his administration. Well in advance of Covid-19, governments around the world had been criticising the dissemination of ‘fake news’ and misleading stories being posted and circulated via social media. Incidents such as the burning of phone masts due to false rumours that they were helping to spread Covid-19 and the dissemination of dangerous remedies to fight the virus, the call for social media platforms to monitor content posted has only increased.
In response, social media companies have started to police posts to a greater extent, purportedly to prevent injurious or false content being uploaded. This increased monitoring of posts led Twitter to fact check a post by Trump over a ‘false assertion that mail-in voting leads to widespread voter fraud.’ In a fit of presidential pique, Trump retaliatedby signing an executive order on May 28 that would decrease the protection of social media companies from being sued for content posted on their services.[xxii]
Failing the Vulnerable
The development and implementation of measures to reduce the spread of Covid-19 need to take into account the particular needs of the most vulnerable. Unfortunately, as the UN Special Rapporteur on extreme poverty and human rights, Philip Alston writes, this has not been the case as many countries have blithely ignored the needs of the most vulnerable communities,
The policies of many States reflect a social Darwinism philosophy that prioritises the economic interests of the wealthiest, while doing little for those who are hard at work providing essential services or unable to support themselves… Governments have shut down entire countries without making even minimal efforts to ensure people can get by. Many in poverty live day to day, with no savings or surplus food. And of course, homeless people cannot simply stay home.[xxiii]
Tanay barisha (wikimedia)
During an address to the nation at 8pm on March 24, the Indian Prime Minister Narendra Modi announced that a strict lockdown of 21 days duration would come into force throughout the whole of India at midnight. Every state, district and village were subject to this lockdown.[xxiv] The initial lockdown was to be for three weeks, though it has been extended since, and the people of India were informed they would have to get used to staying at home. Modi warned:
Do not step outside your house. For 21 days, forget what is stepping outside. There is a Lakshman Rekha[xxv] on your doorstep. Even one step outside your house will bring the coronavirus inside your house.[xxvi]
Paulrudd (wikimedia)
Acknowledging that these measures could provoke ‘hard times’ for the poor in India, Modi insisted that draconian lockdown measures were required to prevent the untrammelled diffusion of Covid-19, which ‘spreads like wildfire.’[xxvii] While Modi and the Indian government might argue they had ‘reasonable justification’ for ordering such a harsh lockdown, they could surely have implemented it in a manner which would have relieved the severity of its impact on migrant workers and the impoverished. As Professor of Gender and Development Nitya Rao outlines:
Half of India’s 1.3 billion people are food insecure which means they lack access to sufficient safe and nutritious food. Around 60% of the poorest people from India’s scheduled tribes and scheduled castes, are also anaemic. This means that a total lockdown, while it may help stop the spread of coronavirus, is likely to have a significant impact on food and nutrition. Deprived of the ability to work, threatened by arrest if they ventured forth to secure their rations, the poor of India risked starvation.[xxviii]
The Indian ‘Trail of Tears’
As the lockdown came into force, a serious humanitarian crisis erupted with in excess of an estimated hundred million migrant workers stranded in cities and other locations around India with no work or ability to pay for accommodation.[xxix] Many of these migrants were forced to part with their meagre savings so they and their families could gain places in overcrowded trucks to try and get home. Many more were unable to afford the luxury of transport were forced to make their way home by foot. The traumatic scenes of hordes of migrants of all ages, from babies carried by fatigued parents and siblings to old men and women, struggling along the roads of India in a desperate attempt to return home became a common sight.[xxx]
One of the many heart-breaking stories that have emerged from this modern ‘Trail of Tears’ is that of Jamlo Madkam, a 12-year-old girl. Her parents, Andoram (32) and Sukamati Madkam (30) had eight children. As Jamlo’s mother Skamati recounts, ‘I gave birth to eight children, and of them four died at the age of crawling. And now Jamlo is dead too.’ Jamlo left her home in mid-February for the first time to work at a chilli farm in Telegana with relatives and friends. When the lockdown was instituted, she was left with no choice but to try and make her way home. Tragically, Jamlo passed away on April 18 from exhaustion and lack of food and water. She was only 11 kms from her home in Aded in Bijapur district of Chhattisgarh, having walked more than 100 kms over three days.[xxxi]
Bringing the virus home
Follow-up on the condition and living circumstances of labourers who managed to return to their villages is, at best, minimal. Professor Nitya Rao reports how a local project coordinator witnessed truckloads of migrant families returning from Andhra Pradesh, Chhattisgarh, Karnataka and Kerala to their homes in Koraput district in the week leading up to March 26th. The economic situation of these returnees was extremely precarious as many had not received their payments and had little prospect of any income in the coming months. In addition, they might have brought Covid-19 with them back to their families and communities, with whom they live in cramped quarters.[xxxii]
The lockdown to enforce physical distancing had resulted in the opposite — physical compression on an unthinkable scale. This is true even within India’s towns and cities. The main roads might be empty, but the poor are sealed into cramped quarters in slums and shanties.[xxxiii]
The lack of consideration of the impact of these Covid-19 measures on the more vulnerable members of society is not just on the part of governments. Humra Quraishi writes of the ‘wretched mode of thinking’ on the part of ‘upper-middle class people’ who report that the lockdown is causing them no problems as they can access all they need, blithely ignorant to the suffering of the poor as they themselves ‘have never been exposed to hunger.’[xxxiv]
Of course, India is not the only country that has seen the more vulnerable members of society suffering disproportionately due to repressive measure that that fails to consider or take account of their needs. In Colombia, while the more affluent have isolated themselves in relative comfort during the lockdown, the more vulnerable have experienced severe economic hardship and increased food insecurity. The urban informal sector of small-scale and street vendors comprising the greater part of the Colombian economic system, deprived of adequate support to help them through this period, now face having to choose between letting themselves and their families die of hunger or of Covid-19.[xxxv]
Repression Post Covid-19?
The struggle against the Covid-19 pandemic has provided scientific justification for the imposition of repressive methods including quarantining, isolation and lockdowns. Although their design and implementation have been disputed, there was general agreement that action was required to avoid overwhelming the public health services, often already stretched to their limits due to chronic under-funding. However, there is widespread concern governments might keep repressive and increased surveillance measures in place post Covid-19.
My home country of Israel, for example, declared a state of emergency during its 1948 War of Independence, which justified a range of temporary measures from press censorship and land confiscation to special regulations for making pudding (I kid you not). The War of Independence has long been won, but Israel never declared the emergency over, and has failed to abolish many of the “temporary” measures of 1948 (the emergency pudding decree was mercifully abolished in 2011).”[xxxvi]
Hariri goes on to warn that ‘data-hungry governments’ might try to keep biometric surveillance measures in place on the grounds there might be a second wave of Covid-19. Yuval fears that this could help overcome the resistance of those campaigning for the right to privacy as many might accept this argument given the understandable concern of people in general to place health concerns above those of privacy.[xxxvii]
Google HQ, Dublin.
Since May 5th, the U.K. government has been running a trial of a contact tracing app which has been made available on the Isle of Wight for its residents. The NSHX app chosen by the government however presents a number of ‘practical, legal and ethical questions and concerns that need to be answered.’ Primary amongst the concerns raised is the fact that the NSHX app, uses a centralized model. This means that the data collected by this app will not just be retained on your phone but will also be collected centrally on government servers. This is in contrast to the privacy-protective modelschosen by most other European countries, including Germany, Italy and Ireland.[xxxviii] Although, it should be noted that the Irish app is also facing issues with respect to privacy issues in addition to technical concerns.[xxxix]
Far-Right
Jumping on the Covid-19 fear bandwagon has become a central plank in the platform of the far-right as it capitalises on the elevated levels of social disorientation due to the pandemic. As Barbara Perry director of the Centre of Hate, Bias and Extremism at the University of Ontario Institute of Technology highlights, ‘[T]here’s nothing the far right likes more … than a crisis.’ Increased online right wing activity during Covid-19 comes under three main rubrics: ‘conspiracy theories, anti-immigrant and xenophobic attitudes and accelerationist rhetoric, which is concerned with trying to hasten the collapse of society and a race war that would lead to a “white ethno-state.‘[xl]
A report produced by the London-based Institute of Strategic Dialogue documents how ‘far-right communities have started talking about COVID-19 as an accelerant for a second civil war, also known as boogaloo… From Feb. 1 to March 28, more than 200,000 posts on social media contained the word “boogaloo.” The most popular hashtag within those posts was “#coronachan.’[xli]
Worryingly, Perry warns these narratives are not restricted to the far right anymore, if that was ever truly the case. She notes that ‘[T]here’s a bigger audience for folks for the far right now. So many of us are online… So we’re so vulnerable, I think, to this sort of messaging.‘[xlii]
In a recent article, Thomas Klikauer and Nadine Campbell outlined how the Nazi leader Hermann Goering once observed that ‘the people can always be brought to the bidding of the leaders. That is easy. All you have to do is tell them they are being attacked and denounce the pacifists for lack of patriotism and exposing the country to danger. It works the same way in any country.‘ Klikauer and Campbell then go on to highlight how Neo-Nazis in Germany have adopted a similar approach to that advocated by Goering, by weaving ‘their ideology into the fear of the coronavirus.‘[xliii]
President Donald Trump talks to senior staff Steve Bannon during a swearing in ceremony for senior staff at the White House in Washington, DC January 22, 2017. REUTERS/Carlos Barria
Staying Vigilant
There is a need for the public to rest vigilant to the introduction of repressive and enhanced surveillance methods in this time of Covid-19, both to ensure theses measures are appropriate and fit for purpose, and are rescinded with the passing of the pandemic.
We also need to pay attention to the impacts that repressive measures can have on the most vulnerable in our midst including, inter alia, people on low income with few resources, the homeless, asylum seekers forced to live in direct provision and women at home with abusing partners, and hold our governments to account in this respect. In Australia, experts centrally involved in Australia’s Covid-19 response and the Australasian Society for Infectious Diseases have advocated on behalf of immigration detainees and recommended the relocation of those considered no major security or health risk, to safe accommodation in the community.[xliv]
As the Australian Human Rights Commissioner, Edward Santow, asserts:
We must… speak up for those whose voices are hardest to hear… If combating Covid-19 is a war, we can be proud of why we got into the fight: to preserve life, especially for vulnerable people. Those are the best of our values. We must now ensure those same values guide how we fight.[xlv]
[i] These are the lyrics from a song written by Aadesh Ravi, a Hyderabad composer, about the suffering caused by the lockdown migrations across India. You can see the story behind this song and also listen to it at the following link – Aadesh Ravi, The long march of the locked-down migrants, Rural India online, 16 May 2020, https://ruralindiaonline.org/articles/the-long-march-of-the-locked-down-migrants/
[ii] Benedict Anderson, Imagined Communities, Verso (new edition): London/NY, 2006, pages 6-7
[iii] Jen Webb, Tony Schirato and Geoff Danaher, Understanding Bourdieu, Sage: London/Thousand Oaks/New Delhi, 2002, p. 15
[iv] Jen Webb, Tony Schirato and Geoff Danaher, Understanding Bourdieu, Sage: London/Thousand Oaks/New Delhi, 2002, p. 93
[xvi] OSCE Press Release, Newly declared states of emergency must include a time limit and parliamentary oversight, OSCE human rights head says, OSCE, 30 March 2020, https://www.osce.org/odihr/449311
[xxv] Originally a line drawn by Lakshmana around the residence he shares with his brother Rama and sister-in-law Sita to protect Sita, as recounted in the Ramayana. In modern India, ‘Lakshmana Rekha’ refers to a strict convention or regulation which must be followed.
[xxxi] Purusottam Thakur and Kamlesh Painkra, Jamlo’s last journey along a locked-down road, Rural India Online, 14 May 2020, https://ruralindiaonline.org/articles/jamlos-last-journey-along-a-locked-down-road/
[xliv] Edward Santow-Australia’s human rights commissioner, We must combat Covid-19 but creeping authoritarianism could do more harm than good, The Guardian, 7 April 2020,
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.
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.
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.
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.
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.
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
[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
[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
[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
[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,
[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,
[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
[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/
