The Covid-19 pandemic has revealed startling failures of leadership across much of the Western world but could the increasingly harmful strategies abopted by various Western nations be redirected to achieve a sustainable response?
It is perhaps time to accept that the proverbial horse has bolted, with the near certainty that tens of thousands having been infected across the Republic of Ireland, and many millions thought to having been infected across the United Kingdom.
The frayed British Labour party has been arguing that Boris Johnson’s administration acted rather slowly with the introduction of lockdown restrictions, with many in Europe warning of dire consequences for a matter of weeks. The Republic responded more quickly to Covid-19, thus managing to keep within a quite normative death rate within Europe, although a lower population density may have also assisted.
However, obvious failures across Europe and much of the Western have occurred as indicated by a comparison of international per capita death rates. Although it should be noted that such data snapshots are complicated by varying methods of counting the dead, trends with regard to food consumption, the benefit of longevity, and issues of population density – i.e. these issues have varying degrees of outright responsibility involving political leadership that are complicated by longstanding cultural trends – substantial blame should still be directed at the political classes.
It has been a mistake for governments to rely solely or almost entirely upon health departments and scientific advisors. The error is based upon a false and simplistic dichotomy so often endorsed in the media, which contrasts economic concerns with the risks to life posed by Covid-19. All one needs to consider is the rate of death due to other forms of illness which has been starkly referenced with comparisons of “excess” mortality rates usually attributable to Covid-19. If the disease is here to stay, then where exactly is the money going to come from to deal with its effects? Taoiseach Leo Varadkar stated that the response can be funded as long as cheap credit is available but what happens when investors take fright, when increasing debt becomes unsustainable, as with the 2007-2013 economic crisis?
Will the world rally together to underwrite all such debt? After all, won’t many countries face the same struggles and an economic recovery will benefit all nations? Such a solution is quite possible but prior evidence of disunity within the EU, where quite a number of member states faced stark economic challenges, make the assumption questionable, where, for example, Ireland was thrown under a bus by our friends in Europe, with the ECB imposing higher rates of interest than the IMF, and had to resort to years of debt restructuring to bring an end to the crisis. Today, many nations also face legacy debt, and will likely face deep political instability in the fallout of the Covid-19 crisis which will undermine long-term confidence that debt can be serviced.
The contention is of course that an immense economic crisis will occur – well in fact it has already enveloped the world – and is of an intensity never before seen, which will likely more than negate the life-saving benefits of a long-term lockdown, especially for the least well-off when austerity bites hard and severe taxation hurts desperately needed economic growth. Many in Ireland, for example, have been increasingly turning toward the hard-left for its range of rather simplistic solutions to difficult problems. Will we hear renewed calls for multiplying Ireland’s much envied corporation tax rate and may similar calls come from abroad
There is much talk of a gradual easing of restrictions as a sort of panacea, a reward if we are very good and somehow manage to stay two metres apart on our rather narrow pavements, but apparently “we are not there yet” but at what point we will be deemed to have arrived at our rather mysterious destination is yet to be determined. What is clear however is that the promised “easing” will further push the West into a profound recession for many years to come, even if the prospect of an extremely harmful half-speed economy, imposed for as long as it takes for a vaccine to be developed and produced, only lasts for one year.
The failure of the political classes occurred most keenly by affording undue faith to the transparency of China and the United Nations World Health Organisation, while ignoring the warnings issued by Taiwan, a nation not recognised by the International Community. The UN has long been known to be politically partisan, and to show undue deference for autocratic and tyrannical regimes, in part due to endemic structural failures that have allowed the (Cold War pro-Soviet) Non-Alligned Movement’s voting bloc to control the General Assembly. The West looked away and continued to support the UN as it has thrashed Israel and the United States for decades, largely ignored episodes of war, genocide and various forms of oppression when politically expedient, whilst going through ever increasing levels of politicisation with the involvement of progressive NGOs that target Western values, immigration policies etc. Despite obvious malfiesance, US President Donald Trump was reviled on the international stage for castigating the WHO for whitewashing the gravity of Covid-19 and for discouraging the suspension of international travel.
Numerous Western nations, including the UK and Ireland, have still avoided closing their borders, despite openly expressing concerns about the movement of seasonal farm workers. Western nations have been eagerly abopting the WHO’s “test, test, test” mass contact tracing strategy, issued on March 16th, as a means to emerge from a pandemic, the existence of which they had previously denied. However, with infection and death rates rapidly multiplying across Europe, the horse had already bolted the stable – what a shame the WHO chose not to issue such good advice six weeks earlier! Contact tracing still remains a major talking point despite high continuing rates of infection, indicating that such an endeavour has become a near impossibility to impose in a comprehensive and thorough manner with such a large number of permutations for each of the very many infected individuals – a near-universal uptake is a necessity for such schemes to work, given the extremely high levels of contagion that make the virus so destructive and so very difficult to contain.
Turning away from strategic failure
Another grave failure was the emulation of China’s lockdown of Wuhan, an important but relatively small territory within China. What might have been practical and expedient for the Chinese leadership was not emulated in Taiwan, which imposed strict immigration controls on migration but maintained a relative degree of normalcy.
The Covid-19 disease poses a largely minor non-lethal risk of illness in general populations, not least due to studies which indicate a very high rate of infection, with the exception of certain groups where its danger increases by a substantial multiple because effective therapeutic solutions have yet to be developed or have yet to come into mainstream usage. Mortality rates multiply with age, especially amongst those of 70+, and those with certain medical conditions, while those of 50 or below and in reasonable health face limited risk. To incapacitate the principal income generating group within any given society is something of an own-goal because that group faces the least risk to health and the greatest capacity to fund the proverbial war against Covid-19.
There are also ample indicators that long-term lockdowns are impractical because populations will simply run out of patience due to the considerable and unprecedented impositions involved. More and more have been venturing out in recent weeks, and improving weather will increase cabin fever yet further. Besides a worsening of mood, a generalised lockdown also has the capacity to cause a large number of potentially profound life-changing harms (within the broad and related areas of mental health, physical/nutritional health to the social/familial and educational), not to mention the potential for unnecessary criminalisation, especially in the long-term. The prospect should be deeply worrying given the damage to mental health caused during the last recession. Quite how a devastated economy could manage the very real social impact of such harms is anyone’s guess.
Political leaders need to acknowledge that the present circumstances are wholly unacceptable from both a moral and an economic perspective, and that any societal solution should take these quite obvious if rather unique challenges into account instead of continuing to apply a generalised lockdown strategy. Now more than ever a bit of imagination is needed. The proposed solution below attempts to address some of these concerns while maximising safety.
The fight against Covid-19 has been described as a war. Nations that faced an existential threat have usually restructured many areas within their respective societies to maximise their capacity to fight and survive extreme hardship. With a major health crisis it therefore follows that a profound restructuring of health systems is necessary to better deal with the imminent causes of Covid-19, while allowing economies to urgently return to substantive normalcy, in order to survive the consequences of a long-term medical emergency – the latter is non-optional for the long-term health and broader well-being of any given society/people/nation.
A triple-layered strategy is proposed that emulates the recently loosened Swedish model for the general populace, while offering a more sharply focused form of assistance for those at substantive risk, and especially for those at a particularly grave risk of mortality.
The UK’s National Health Service contacted 1.5 million people in March, which the organisation deemed to be at a particularly grave risk, due to serious illness and/or medical procedures, to commend self-isolation. The figure corresponds to approximately 1/45th within a population of approximately 67 million. It is proposed that structures be put in place to closely assist such groupings at gravest risk from Covid-19, which would fully take into account their accommodation needs.
Many health authorities, including the Health Service Executive, have stated that 80% of those infected with Covid-19 will only have mild illness, 14% will experience significant illness, and 6% will become critically ill due to advanced age and/or certain medical conditions. It has become easier to identify those at serious risk as greater knowledge of the impact of Covid-19 emerges. (Many of those infected with Covid-19 (estimates vary but large percentiles are indicated) but remain asymptomatic are not addressed here).
With a virus that most are expected to get, 6% would of course represent a very sizeable cohort. However, with a greater predictive capacity, and the expectation that many families will be able to safely assist vulnerable members (perhaps with training), the provision of direct assistance and some housing infrastructure, to allow for effective self-isolation may be a practical solution that allows a greater level of protection for those most vulnerable to Covid-19.
Within this cohort, the most vulnerable, namely the very elderly and infirm and those suffering from serious illness, may need greater assistance with self-isolation, with provision for medical needs, and as well as sustenance and other essential needs including maintenance and repair work. This assistance may require the availability of housing for vulnerable people where necessary, albeit of a quality considerably higher than the poor standards of hygiene offered in care homes where issues of poor health care, and infection-transmission with insufficient isolation between patients, were outstanding matters of concern long before a perfect storm hit with the Covid-19 outbreak. In certain circumstances, the transfer of working families into more suitable accommodation may be required (such as vacant hotels), where one or more family members are vulnerable but unable to isolate to a satisfactory standard.
This solution would of course represent a major endeavour but an acceptable one in these remarkable times because it would be far less challenging than a long-term lockdown/half-speed economy. The strain on the health sector would likely be substantial due to a diverging systematic approach with mainstream and targeted healthcare but there would likely be less strain on critical emergency services where the crisis is most acutely experienced. An easing on emergency departments, and hospitals more generally, would allow a further improvement in services for other critical illnesses thus further suppressing mortality rates. The perception of a more functional health service would also follow and so will likely reduce the unwillingness of patients to visit hospitals out of fear.
A greater degree of testing for Covid-19 is beneficial but targeted use is more effective especially in an environment where a widespread outbreak has already occurred. Contact tracing may have become largely impractical where tens of thousands are likely carrying and have carried the Coronavirus in Ireland, while testing has shown that at least 4.2 million have carried the virus in the UK. Such an approach would be especially inefficient in an environment where greater rates of contagion would occur with the kind of easing here proposed.
Randomised general testing should occur to evaluate rates of infection and recovery in different regions and cities, to better evaluate health needs, allow for an informed further easing of restrictions, or to impose regional travel restriction where substantive escalation occurs. However, greater focus should be upon testing within health care. Extremely high rates of testing should be mandatory for all health professionals and carers (especially those interacting physically with long-term elderly patients), as well as those individuals at greatest risk. Health professionals working with greater numbers of particularly vulnerable groups should also be offered restricted accommodation.
As part of a long-term strategy to address the current crisis and ease pressure in critical areas, strong inducements should be provided for retraining that focuses on workers found in sectors that will be particularly affected during a long-term recession, such as those previously working in the areas of hospitality and catering. An enlarged workforce may in turn allow the upskilling of carers to more safely assist those groups most vulnerable to Covid-19, and may also have some economic benefit in the immediate aftermath of the crisis.
Rob Harris occasionally contributes articles to several websites on contentious political issues (not to be confused with the popular English novelist (1957-) of the same name). He lives in Dublin.