Lessons from Coronavirus

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 (4^th 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.