On March 16, Professor Neil Ferguson and his colleagues from Imperial College London published a study on the spread of the COVID-19 virus. It is credited with changing the direction of the Johnson and Trump responses — but should workers accept all its conclusions?
Franz Neuhold, Sozialistische LinksPartei (ISA in Austria)
Many capitalist governments throughout the world are, at least for now, looking at the measures that China and South Korea used to combat the virus as a guideline. Of course, China’s dictatorial regime was forced to do a U-turn to take dramatic measures, after first ignoring the disease and losing time, and thus sacrificing lives unnecessarily. As a consequence, it bears responsibility for spreading the disease, which then developed into a pandemic. Capitalist governments, in a panic, are now prepared to grasp any straw, including strict measures and undemocratic actions to fight the pandemic.
Asian countries such as China and South Korea were at the forefront of the battle against the SARS virus in 2002–3, and then the somewhat milder swine flu of 2009. Both of these epidemics demonstrated the dangers and challenges that could be expected with new outbreaks. As a consequence, the COVID-19 crisis was not completely unexpected, nor is it intrinsically apocalyptic, although of course, it still contains some unseen acute challenges. An analysis of the warnings given by the German Federal Robert Koch Institute can be found here.
However, during the critical first weeks of the COVID-19 crisis, the reactionary politics and plain arrogant short-sightedness of the transatlantic axis between Donald Trump and Boris Johnson led to a fatal mismanagement of the epidemic in both countries. A turning point in the approach of Trump and mini-Trump came with the completion of a scientific coup, with the publication in mid-March of research led by Professor Neil Ferguson of Imperial College London.
The key conclusion of this research was that unless proper action was taken there would be 510,000 fatalities in Britain and 2,2 million in the US and that, therefore, a strategy of draconian restrictions was needed urgently, which could last for many months, until an effective vaccine is available.
Johnson’s 180° U-turn
The Imperial College study sent shock waves throughout the world, particularly because it raised the scenario that measures could be needed for up to two years, and also because it warned of the possible rebound of the pandemic once restrictions were eased, requiring a repeat of the clamp-down. However, the results of the study are interpreted, its predictions point to an imminent major collapse of national health systems. The urgent message delivered by this study seems to have tipped the balance, pushing Trump and Johnson, at least temporarily, to change course, although even Johnson’s 180° U-turn to implement the lock-down still will not solve all the accumulated problems.
It may be that the desire to pressurize the government to change course may have pushed the scientists and medical experts to produce their study so rapidly. Given the urgent circumstances, it might not have been possible to complete a full evaluation of the modeling methods and their potential weaknesses. For this reason, as the authors themselves point out, it is possible that some of the numbers presented are too high, or that the model used does not provide a completely correct image of current real-world-processes. Nevertheless, it is explicitly clear that there has been no manipulation of the study’s results and the general claims that are made, despite any error margins and potential flaws seem valid.
But the study also opens a door to an evaluation of the approach of governments, especially in South Korea and flowing from that, to allow us, as revolutionary socialists, to decide which measures of mitigation, suppression and the program that revolutionary socialists we should support.
To do so, we should have a sober approach to the use of information, in particular epidemiological statistics. Key statistics when measuring COVID-19’s effect are the Case Fatality Rate (CFR or lethality) and the Infection fatality rate (IFR), which are closely related. The difference lies in CFR being the ratio of deaths divided by all clinical (symptomatic) cases while the IFR does include all asymptomatic ones and therefore all infected cases.
According to the Imperial College report the estimation for the expected IFR is 0,9% with 95% confidence and an interval, 0,4–1,4%, which concurs more or less with the majority of experts, who think that general lethality (CFR) will likely be between 0,5 and 0,9%. This means that less than 1% of those infected and ill respectively, not just tested positive, will die. But at this stage of the pandemic, it is difficult to make a precise calculation, as it is dependent on many factors including social, political and cultural ones.
A reason for many deaths in Italy is the lack of breathing equipment and trained staff. Lethality is often exaggerated in public debate by confusing the number infected with the number who are tested, or even tested positive, which when testing is limited will give a very high figure. But, comments Dr. Christian Drosten, a leading virologist from Berlin’s Charité hospital about reports of very high CFR numbers: “Oh no, those [cases of] 3 or 4% are special situations with an already overburdened health system and due to the unavailability of testing.” It is noteworthy that he singles out these two factors, an ‘overburdened systems’ and the ‘unavailability of testing’. Conversely, this explains why in Germany, where testing is much more widespread, the apparent proportion of deaths is lower.
In many countries a generally higher CFR/IFR is and will be a result of the age pyramid, the over-aged structure of society. This must not — of course — distract from the irresponsibility of neoliberal cuts and capitalist mis-management and the horrific situation faced by health-workers in many countries who, due to the lack of resources are having to tell the elderly that they cannot be treated.
“Flattening the curve”
It is in this context that the Imperial College study should be viewed. In recognizing that the study is an important work in arguing for the need to “flatten the curve” to avoid a massive overload of the hospitals and many dead, one of the first critical reviews by Chen Shen et al. published on March 17 raised some issues. Firstly, Shen criticized the use of the SIR model by Ferguson, which is “not well suited for incorporating real world conditions at fine or large scale.”
More significantly, however, Shen argues that Ferguson had not chosen the correct parameters, and left some key parameters out of the study. In particular, Ferguson did not model the results of door-to-door monitoring and testing, and contact tracing as used in South Korea. The study investigated just the following actions: Case isolation in the home; Voluntary home quarantine; Social distancing of the elderly; Social distancing of all and the closure of Schools and universities.
By missing out door to door testing and contact tracing, the Imperial college study therefore leads to an extension of the timescale of the crisis. The key parameter here is the base reproduction rate R0, in effect the average number of secondary infections caused by one infected person. For the effective early suppression of a disease R0 should be kept below 1. If this was done, it would not just be a case of “flattening the curve” but of stopping the spread of the disease in the first place. To do this, very early reaction to the first appearance of the disease is required, combined with widespread testing and tracing. This brings into the equation questions of huge political and social importance, which have been mishandled firstly by the Chinese government, which initially tried to hide the outbreak, and almost every other government since that delayed taking action.
The Imperial College study goes further to argue that: “While experience in China and now South Korea show that suppression is possible in the short term, it remains to be seen whether it is possible long-term, and whether the social and economic costs of the interventions adopted thus far can be reduced.” It follows from this that the battle with the virus will be a long term challenge, not even taking into account the state of the world economy and its trajectory, or how the population, particularly the working-class behavior reacts. The battle could last from 18 months to two years time, until a new vaccine has been developed and been proved effective.
The study continues: “The measures used to achieve suppression might also evolve over time. As case numbers fall, it becomes more feasible to adopt intensive testing, contact tracing and quarantine measures akin to the strategies being employed in South Korea today. Technology — such as mobile phone apps that track an individual’s interactions with other people in society — might allow such a policy to be more effective and scalable if the associated privacy concerns can be overcome.” “Social distancing” it says may “need to be in force for the majority of the 2 years of the simulation, but that the proportion of time these measures are in force is reduced for more effective interventions and for lower values of R0.”
So, whether there is a rebound of the disease will depend on how effective the measures are to bring down R0, the base reproduction rate of the virus, which again is influenced by actions such as case isolation (following testing), the control of clusters and potentially other more rigid measures like limitations on movement.
Is a lock-down needed?
Shen et al. in their response having pointed out some flaws in the modeling method and parameters using by Imperial College then challenge another conclusion, saying: “Their conclusions that there will be resurgent outbreaks are wrong. After a few weeks of lock-down almost all infectious people are identified and their contacts are isolated prior to symptoms and cannot infect others.”
In the case of South Korea, there wasn’t even a lock-down in the classic sense of the word, just a general call for social distancing. An article on sciencemag.org deals with this and other questions.
The article argues: “South Korea has emerged as a sign of hope and a model to emulate. The country of 50 million appears to have greatly slowed its epidemic; it reported only 74 new cases today, down from 909 at its peak on February 29. And it has done so without locking down entire cities or taking some of the other authoritarian measures that helped China bring its epidemic under control… Behind its success so far has been the most expansive and well-organized testing program in the world, combined with extensive efforts to isolate infected people and trace and quarantine their contacts. South Korea has tested more than 270,000 people, which amounts to more than 5,200 tests per million inhabitants . . . The United States has so far carried out 74 tests per 1 million inhabitants, data from the U.S. Centers for Disease Control and Prevention show”.
“South Korea’s experience shows that diagnostic capacity at scale is key to epidemic control,” says Raina MacIntyre, an emerging infectious disease scholar at the University of New South Wales, Sydney. “Contact tracing is also very influential in epidemic control, as is case isolation,” she says. Shen et al. concur. The conclusion they propose is a refinement of measures over time “with improved tracing, testing, and other protocols” echoing those experiences of South Korea.
Nevertheless, the Sciencemag article warns: “Even after driving case numbers down, South Korea is braced for a resurgence.” A special challenge is to deal with clusters, such as that created by the activities of the Shincheonji Church of Jesus which first set off the epidemic in South Korea. Dealing with the first cluster tied up resources, which could have been used in other areas. “We have not looked hard in other parts of Korea,” says Oh Myoung-Don of Seoul National University. So there is the potential for the start of further clusters, and therefore a new spread of the disease. As long as they are tackled early, these clusters, as Shen et al. explain: “can be stopped by contact tracing, which is enhanced by the availability of testing”. The Imperial College study also ignores this possibility, it simply assumes exponential growth of infections as restrictions are lifted, although this would require a significant number of new cases.
The huge task of the real-time mapping of new clusters that could lead to the re-emergence of the disease, a rebound, can best be addressed by assuring the broad involvement of the population and democratic control of the process. Mass participation in this way, combined with the necessary widespread testing and tracing, would also benefit society, by strengthening the feelings of solidarity, removing the feeling of isolation and help to combat the strengthening of both authoritarian and far-right tendencies. Such an approach clearly demands the active involvement of workers in an organized way by developing a collective plan to deal with the pandemic, cutting across the zig-zags of the capitalist governments with their forced lock-downs, lack of resources and authoritarian measures. It would be of even further benefit by increasing the confidence of the working class, to resist further austerity plans of the ruling class and demonstrating that it alone is capable of running society.
Conclusions that can be drawn with some confidence from the above studies
- Currently, there is no scientific data whatsoever to support total lock-down measures;
- Reducing physical contacts with people you have no regular contact with and those who are in special danger, is likely to be very beneficial;
- Early and widespread testing, tracing and quarantine based on clear evidence is effective;
- The insistence of employers that non-essential work continues is very harmful. The development of wildcat strikes is an indication that the working class has the most responsible approach, and provides optimism for future independent and mass working class activities;
- Any attempts to introduce authoritarian measures must be opposed, they have a negative effective by reducing the chance of a conscious, collective approach to tackle a crisis that could last for some months.
- Massive investment to rebuild the health services and especially care for the elderly is needed. All privatization plans should be stopped and reversed without delay. Health care should be free, and fully state financed.
- A plan for permanent funding and wage-rises, with the recruitment of new staff to allow reductions in the working week for all who work in jobs where there is exposure to such viruses; developed by all people working with trade unions having control over working conditions;
- The full wages and incomes of all workers, self-employed and unemployed to be guaranteed for the during the crisis, with those companies unable to do this to be taken into public ownership.
Political change is needed
Unfortunately, many trade unions and even left leaders have approached this crisis as if it is a national crisis requiring a unified approach with capitalist governments. But it is clear, even from the approach of South Korea that a completely different approach to health care is needed.
In 1918, after the Russian revolution, the new Soviet state adopted a revolutionary approach to health care. While most health systems provided assistance just to those who could pay, the Soviet system offered free healthcare to all. Just as importantly, the new Soviet healthcare system introduced an important new strategy — whilst most health systems concentrated on the treatment of chronic illnesses and accidents, the Soviets put huge resources into the prevention of contagious diseases, using the widespread participation of the population in ensuring public health with universal treatment and vaccinations, an approach that meant that life-expectancy in the Soviet Union grew quickly to catch up with that in the advanced capitalist countries.
Working-class movements around the globe now urgently need to develop a new approach to healthcare, with well-developed plans and proper financing to ensure that there are adequate staff and resources to deal with such crises. There should be no compromise with private health businesses or those who seek to make huge profits out of our welfare. Never before has it been clearer of the need to overthrow capitalism and its state machines if we want to have a chance of a viable future.