<nettime> Mike Davis on COVID-19: The monster is finally at the door

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By Mike Davis

Links, International Journal of Socialist Renewal
http://links.org.au/mike-davis-covid-19-monster-finally-at-the-door

March 12, 2020 — COVID-19 is finally the monster at the door.
Researchers are working night and day to characterize the outbreak but
they are faced with three huge challenges.

First the continuing shortage or unavailability of test kits has
vanquished all hope of containment. Moreover it is preventing accurate
estimates of key parameters such as reproduction rate, size of
infected population and number of benign infections. The result is a
chaos of numbers.

There is, however, more reliable data on the virus’s impact on
certain groups in a few countries. It is very scary. Italy and
Britain, for example, are reporting a much higher death rate among
those over 65. The ‘corona flu’ that Trump waves off is an
unprecedented danger to geriatric populations, with a potential death
toll in the millions.

Second, like annual influenzas, this virus is mutating as it courses
through populations with different age compositions and acquired
immunities. The variety that Americans are most likely to get is
already slightly different from that of the original outbreak in
Wuhan. Further mutation could be trivial or could alter the current
distribution of virulence which ascends with age, with babies
and small children showing scant risk of serious infection while
octogenarians face mortal danger from viral pneumonia.

Third, even if the virus remains stable and little mutated, its impact
on under-65 age cohorts can differ radically in poor countries and
amongst high poverty groups. Consider the global experience of the
Spanish flu in 1918-19 which is estimated to have killed 1 to 2 per
cent of humanity. In contrast to the corona virus, it was most deadly
to young adults and this has often been explained as a result of their
relatively stronger immune systems which overreacted to infection
by unleashing deadly ‘cytokine storms’ against lung cells. The
original H1N1 notoriously found a favored niche in army camps and
battlefield trenches where it scythed down young soldiers down by the
tens of thousands. The collapse of the great German spring offensive
of 1918, and thus the outcome of the war, has been attributed to the
fact that the Allies, in contrast to their enemy, could replenish
their sick armies with newly arrived American troops.

It is rarely appreciated, however, that fully 60 per cent of global
mortality occurred in western India where grain exports to Britain
and brutal requisitioning practices coincided with a major drought.
Resultant food shortages drove millions of poor people to the
edge of starvation. They became victims of a sinister synergy
between malnutrition, which suppressed their immune response to
infection, and rampant bacterial and viral pneumonia. In another case,
British-occupied Iran, several years of drought, cholera, and food
shortages, followed by a widespread malaria outbreak, preconditioned
the death of an estimated fifth of the population.

This history – especially the unknown consequences of interactions
with malnutrition and existing infections - should warn us that
COVID-19 might take a different and more deadly path in the slums
of Africa and South Asia. The danger to the global poor has been
almost totally ignored by journalists and Western governments. The
only published piece that I’ve seen claims that because the urban
population of West Africa is the world’s youngest, the pandemic
should have only a mild impact. In light of the 1918 experience,
this is a foolish extrapolation. No one knows what will happen over
the coming weeks in Lagos, Nairobi, Karachi, or Kolkata. The only
certainty is that rich countries and rich classes will focus on saving
themselves to the exclusion of international solidarity and medical
aid. Walls not vaccines: could there be a more evil template for the
future?

***

A year from now we may look back in admiration at China’s success in
containing the pandemic but in horror at the USA’s failure. (I’m
making the heroic assumption that China’s declaration of rapidly
declining transmission is more or less accurate.) The inability of our
institutions to keep Pandora’s Box closed, of course, is hardly a
surprise. Since 2000 we’ve repeatedly seen breakdowns in frontline
healthcare.

The 2018 flu season, for instance, overwhelmed hospitals across
the country, exposing the shocking shortage of hospital beds after
twenty years of profit-driven cutbacks of in-patient capacity (the
industry’s version of just-in-time inventory management). Private
and charity hospital closures and nursing shortages, likewise enforced
by market logic, have devastated health services in poorer communities
and rural areas, transferring the burden to underfunded public
hospitals and VA facilities. ER conditions in such institutions are
already unable to cope with seasonal infections, so how will they cope
with an imminent overload of critical cases?

We are in the early stages of a medical Katrina. Despite years of
warnings about avian flu and other pandemics, inventories of basic
emergency equipment such as respirators aren’t sufficient to deal
with the expected flood of critical cases. Militant nurses unions in
California and other states are making sure that we all understand the
grave dangers created by inadequate stockpiles of essential protective
supplies like N95 face masks. Even more vulnerable because invisible
are the hundreds of thousands of low-wage and overworked homecare
workers and nursing home staff.

The nursing home and assisted care industry which warehouses 2.5
million elderly Americans – most of them on Medicare - has long been
a national scandal. According to the New York Times, an incredible
380,000 nursing home patients die every year from facilities’
neglect of basic infection control procedures. Many homes –
particularly in Southern states - find it cheaper to pay fines for
sanitary violations than to hire additional staff and provide them
with proper training. Now, as the Seattle example warns, dozens,
perhaps hundreds more nursing homes will become coronavirus hotspots
and their minimum-wage employees will rationally choose to protect
their own families by staying home. In such a case the system could
collapse and we shouldn’t expect the National Guard to empty
bedpans.

The outbreak has instantly exposed the stark class divide in
healthcare: those with good health plans who can also work or teach
from home are comfortably isolated provided they follow prudent
safeguards. Public employees and other groups of unionized workers
with decent coverage will have to make difficult choices between
income and protection. Meanwhile millions of low wage service workers,
farm employees, uncovered contingent workers, the unemployed and the
homeless will be thrown to the wolves. Even if Washington ultimately
resolves the testing fiasco and provides adequate numbers of kits,
the uninsured will still have to pay doctors or hospitals for
administrating the tests. Overall family medical bills will soar at
the same time that millions of workers are losing their jobs and their
employer-provided insurance. Could there possibly be a stronger, more
urgent case in favor of Medicare for All?

***

But universal coverage is only a first step. It’s disappointing,
to say the least, that in the primary debates neither Sanders or
Warren has highlighted Big Pharma’s abdication of the research and
development of new antibiotics and antivirals. Of the 18 largest
pharmaceutical companies, 15 have totally abandoned the field. Heart
medicines, addictive tranquilizers and treatments for male impotence
are profit leaders, not the defenses against hospital infections,
emergent diseases and traditional tropical killers. A universal
vaccine for influenza – that is to say, a vaccine that targets the
immutable parts of the virus’s surface proteins – has been a
possibility for decades but never a profitable priority.

As the antibiotic revolution is rolled back, old diseases will
reappear alongside novel infections and hospitals will become
charnel houses. Even Trump can opportunistically rail against absurd
prescription costs, but we need a bolder vision that looks to break up
the drug monopolies and provide for the public production of lifeline
medicines. (This used to be the case: during World War Two, the Army
enlisted Jonas Salk and other researchers to develop the first flu
vaccine.) As I wrote fifteen years ago in my book The Monster at Our
Door – The Global Threat of Avian Flu:

Access to lifeline medicines, including vaccines, antibiotics, and
antivirals, should be a human right, universally available at no cost.
If markets can’t provide incentives to cheaply produce such drugs,
then governments and non-profits should take responsibility for their
manufacture and distribution. The survival of the poor must at all
times be accounted a higher priority than the profits of Big Pharma.

The current pandemic expands the argument: capitalist globalization
now appears to be biologically unsustainable in the absence of a truly
international public health infrastructure. But such an infrastructure
will never exist until peoples’ movements break the power of Big
Pharma and for-profit healthcare.



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