I do not claim any epidemiological
expertise, but simply as a locked down observer, I have begun to draw these
lessons from the current crisis. My intention is not to criticize the many
scientists and others who have had to make extraordinarily difficult decisions
in an appalling crisis. These are simply observations of things that the crisis
has brought into sharp relief.
1.
United Kingdom:
· The Conservative Party, in
office since 2010, contains a powerful faction that favours a radical reduction
of the size and activities of government at national, and especially local
levels. In my own borough, Windsor and Maidenhead, the council has ceased to
run almost all services directly, instead outsourcing them to private sector
providers or arms-length companies. Austerity created the perfect environment
to achieve that goal. This ideology ignores a simple fact: in a crisis only the
state can take the actions necessary to protect the population. This was true
in 2008 and is especially true in 2020. Austerity has deliberately weakened the
ability of the state to respond.
· There is a simple truth in
British politics: since the 1980s the funding of the National Health Service is
reduced or severely squeezed, at least in real terms if not in nominal terms,
when a Conservative government is in power. Labour governments tend to increase
spending in both real and nominal terms. We have had more years of Conservative
governments than of Labour governments. The net result is that the UK’s health
spending per capita is low compared to many European countries.
· All governments of all
parties have ignored the need for a robustly-funded and adult social care
system, integrated with the NHS, to support the elderly and infirm, and younger
adults with care needs. Policy has distinguished between health care and social
care, which results in the care sector being organizationally separate from the
NHS. The result has been that the NHS has far too many elderly people in
hospitals than in care settings. Whether in health or non-health settings, care
is quite simply care and the two should be integrated and properly funded. This
had further weakened the NHS when the pandemic occurred.
· Our political class became
preoccupied for more than three years with Brexit. Our politicians paid
attention to little else. Pandemic preparedness received no attention at senior
levels.
· The current government was
elected because it promised one thing: “Get Brexit Done”. Mr Johnson
appointed to his government only politicians who would subscribe to his
version of Brexit. They were required to chant, in response to “What are we gonna
do?”, “Get Brexit done”, like children at a pantomime. They were also told that
their careers, and keeping their cabinet positions, depended on demonstrating
the utmost zeal in achieving this one goal. While the disease began to spread
in the UK, the warning signs were not noticed as quickly as they might have
been because all attention was on Brexit.
· The Prime minister’s
political brand is a breezy optimism. Telling hard truths (indeed, when it
suits him, telling truths at all) does not fit the brand image. As a
consequence, it took time for the grim reality of the pandemic to be heard loud
and clear at the most senior level of government. Popular events attended by
large crowds were allowed to continue as the disease spread. In the first weeks
of the disease’s spread he left his ministers to take charge of the response. The
Prime Minister boasted of shaking hands with health workers, just days before
ordering the lock down. His focus was on other matters.
· Our government ministers
continue to behave as if they are campaigning for office or to retain office,
rather than leading an emergency response. Too much time is spent in
self-justification, telling us that they are “working 24/7” or “night and day”,
rather than explain how a problem is to be addressed. One of the most
pressing needs has been the lack of sufficient protective equipment for medical
and care staff. The Health Secretary took time out from coordinating the
response to the virus to be filmed with his shirtsleeves rolled up (a sign of
“working night and day”) with soldiers loading boxes of equipment on to a
lorry. Faced with a lack of testing, The Health Secretary announced a target of
100,000 tests per day by 30 April. This led to a focus on expanding test
capacity, and regular announcements that ever larger cohorts could now apply
for tests, rather than on the logistics of directing the increased capacity to test
at those who most needed tests. To his credit, the testing capacity expanded
substantially, although the target was reached by counting both completed tests
and tests sent but not completed. However, by no means all those who most need
the tests are receiving them.
· The crisis highlighted
sharply how many of our fellow citizens’ lives are marred by inequality and
insecurity. Now many more of us understand what it means to wait five weeks for
the first universal credit payment. We know that statutory sick pay is a very
modest £95.85 per week, lower than many other European countries. We have
learned that some who find themselves ineligible for financial relief from the
government suddenly have no income at all. The use of food banks has increased enormously
above the already high levels. In short, many of our compatriots have come to
learn just how harsh has been the treatment of the unemployed, the disabled,
workers on zero hours contracts, refugees, asylum seekers. After 2010 the
Conservative government justified austerity by distinguishing between strivers
and shirkers, between those who left early for work in the morning while their
neighbours slept on behind drawn curtains, living on benefits. Now we all
discover how easy it is to become “a shirker”. And now the government calls on
a social solidarity that for years it undermined in order to maintain itself in
power.
· There is also inequality
in terms of rates of infection and deaths: the poorest are more likely to be
infected and are dying in disproportionate numbers. This is not just a public
health issue. The cause is social inequality and poverty, both a direct result,
knowingly caused, of austerity.
2.
Mexico:
· There is a curious
parallel between the administration of president Andrés Manuel López Obrador
(AMLO) and the government of Prime Minister Johnson. The Mexican equivalent of
“Get Brexit Done” is the 4T (4th Transition), an AMLO concept
derived from his reading of Mexican history. The 4T promises to end corruption,
to combat criminal violence by creating employment through social programmes and
large infrastructure projects, and the creation of a new National Guard. A vote
for AMLO was a heartfelt vote for an optimism that corruption and organized
crime could be abolished, or at least contained. Like Mr. Johnson’s Brexit,
AMLO’s 4T depends on maintaining that optimism, even when the facts suggest it
might be misplaced. The coronavirus certainly does not fit the 4T narrative.
· With majorities in the
Congress and Senate, and control of the governorships of many states, AMLO
wields almost unquestioned power and insists on unquestioning loyalty to the
4T, just as Mr Johnson insisted on absolute loyalty to “Get Brexit Done”. Critics
are dismissed as corrupt, conservative neoliberals.
· In terms of state
finances, AMLO’s doctrine is “republican austerity”: no additional government
borrowing, the reduction of the salaries of government employees, the
elimination of many government jobs. In short, what in the UK we term
“austerity”. The Johnson government has responded
to the coronavirus lock down by abandoning austerity in favour of a “do
whatever it takes” huge fiscal stimulus. AMLO has pledged to do whatever it
takes not to increase spending to levels that require an increase in
debt. Many Mexicans in their nation’s equivalent of lock down need social
support even more than poor Britons. They will receive very little indeed.
·
So intense is AMLO’s faith in the 4T that he was reluctant to believe
that the coronavirus could be a threat to it and to his nation. He told the people
that he is protected by amulets, he continued to holds mass political
gatherings. On 5 April, he told Mexicans that “the culture of our people … has
always saved us” from natural disasters, epidemics, tyranny and “from
corruption, which has been the most tragic and dreadful of Mexico’s diseases
and calamities”. He also assured his people that Mexico has the lowest
infection and death rate, as a ratio of population, in the world, with the
exception of India.
· In the UK Mr Johnson
extols our inalienable right to go to the pub (reluctantly suspended). AMLO has
assured Mexicans that very soon they will be able to gather in public spaces once
again to exchange abrazos (hugs). At the moment, Mexicans need food
rather than abrazos.
· AMLO tends to dismiss
anything that contradicts or is not compatible with the doctrines of the 4T. He
offers no state help to those left unemployed by stay at home orders. Rather,
he urges employers to do the moral thing and continue to pay inactive workers’
salaries from their reserves. Many Mexican businesses are small enterprises
with no reserves.
· Before the coronavirus
crisis, AMLO had expanded access to the public health system, without
increasing funding, which was in any case inadequate. There had also been acute
shortages of medicines. AMLO seems to trust that the system will cope. It may
not. In early April, Mexico had one critical care bed per 19,640 Mexicans. AMLO
announced plans to increase beds to 7,824, or one bed per 16,130 people. The UK’s
equivalent figure before the recent increases in beds was 1 bed per 11,305. In
the UK’s more robust NHS this was considered inadequate. Mexcio’s expanded
provision may not be enough.
· The structure of Mexico’s
economy makes effective stay at home policies and social distancing very difficult
to implement. A large proportion of the population makes an extremely
precarious living in the “informal” sector. This includes selling goods on the
street, street food stalls, cleaning windscreens at traffic lights, entertainment
(juggling, fire-breathing and other tricks) at intersections. These people work
to earn each day’s food. They will not eat if they stay at home or keep a
social distance.
3.
USA:
· One of Mr Trump’s appeals
to his supporters was a promise to “drain the swamp”. This spoke to a profound
distrust of the federal government. The president has been entirely consistent
in insisting that federal agencies endorse his views and in demeaning or
dismissing those who do not. For example, there are many federal agencies that carry
out research related to climate change, but they are forbidden to use the term.
As far as preparedness for a pandemic has been concerned, the Trump
administration has reduced the funding and capacities of the Centers for
Disease Control, the key federal agency that, as its name states, controls
disease outbreaks.
· Mr Trump’s winning formula
is to convince his supporters that a variety of dangerous enemies is out to do
them harm, for example Mexican immigrants, Muslims, irresponsible Democrats,
and that Donald Trump alone can protect them and Make America Great Again. Like
Mr Johnson, therefore, his brand depends on optimism and convincing his
followers that he can deliver a wonderful future for them. Bad health or
economic news are bad for Mr Trump. At the start of the outbreak, therefore, he
was keen to dismiss the disease as no worse than the flu. Like Mr Johnson and
AMLO, his attention was distracted from the pandemic.
· America does not have an
NHS. The healthcare system is fragmented, and national coordination of
provision in a crisis is therefore much more difficult. Responsibility for
public health, including contact tracing, tends to be devolved to a very local
level, often to county officials. Some counties are tiny and provide very
limited public services. Therefore, the public health response is very variable
and difficult to coordinate.
· There has been confusion
and disagreement as to whether responsibility for testing and other aspects of
the response to the disease are federal or state responsibilities. Mr Trump has
made contradictory pronouncements in this respect. He has also demonized
certain Democrat state governors in the states he needs to win in the November
election. This has not been consistent with leading a national effort to
address the pandemic.
· Employment protections and
welfare provision are, by European standards very low. Employment is typically
“at will”. Staff can be dismissed summarily with little or no compensation.
Union protections are limited. Most healthcare is provided by employers: the
unemployed get no health care insurance. Provision of welfare is similarly
limited. Lock down and social distancing are, therefore, create great hardship
for many people. Where the British government targeted funding at keeping workers
employed, even if inactive, the US stimulus package has been directed mostly at
supporting companies, not their workers. Companies have been given no incentive
to keep inactive workers in employment. Unemployment has therefore increased by
million every week.