Setting the Scene for a Public Health Catastrophe
Over the past two years, successive waves of the coronavirus (SARS-CoV-19, “COVID” for short) – the Alpha, Delta, and now, Omicron variants – have revealed grave failings in all the policy fields DeedSpeakOut has regularly featured: Health/healthcare, education, housing, the justice system, and the environment. As we resume coverage of these areas, it may be useful to point to the initial cracks which the pandemic has turned into chasms. We’ll start by setting out the big picture of what happened to public health.
Remember all the way back to late 2019/early 2020, and the stories which began surfacing from Wuhan about a newly-detected respiratory (pneumonia-like) virus? China put Wuhan (pop. 14,000,000) in full lockdown, promptly implemented a massive testing-and-tracing program, and imposed strict quarantine protocols. Westerners were appalled by these images (eerily-empty streets, massive field hospitals), but the Chinese (and Taiwanese, Japanese, Vietnamese, Singaporeans, Malaysians, Australians, New Zealanders, etc.) had more extensive and recent experience of such viruses. They knew the only way to tame them into submission was an all-out “zero COVID” policy, and they had the knowledge, experience, means, and political will to do so.
Remember that Biogen conference in Boston in February 2020 [estimated to have been responsible for some 330,000 cases]? Those two Washington state choir practices in early March? That image of Chicago O’Hare as thousands of Americans rushed home when the U.S. government finally decided to close its air borders [March 15, 2020]? The U.S. dithered, but there’s no time to dither when confronting a new, highly-contagious virus for which neither vaccines nor known therapeutics exist. Every step taken in the U.S. at both federal and state levels came too late.
In consequence of its failure to follow the tried-and-true public health model, the U.S. ended up with one of the highest viral case rates per million, the largest number of hospitalizations, and, inevitably, deaths; even now, in the midst of the Omicron variant, U.S. (pop. 330 million) confirmed cases on Jan. 26, 2022 exceeded 600,000, while those in China (pop. 1.4 billion) were at 57.
The absence of prompt, informed action backed up by long-term preparation for implementing public health’s standard toolkit for dealing with an airborne (via aerosols) virus has now resulted in nearly 900,000 U.S. deaths. The U.S. healthcare system, which is largely privatized and therefore, profit-driven, has been overwhelmed by successive waves of the virus. Once eradication fails, we are at the mercy of the virus itself, forced to await each successive mutation’s unique features (current variant: Omicron = B.1.1. 529, estimated to be about 10 times more contagious than the original strain), hoping that what will eventually emerge as the long-term variant is no more lethal than the common cold. In the meantime, however, new variants emerge. Delta emerged in India; Omicron appears to have emerged in South Africa; an even more contagious sub-variant of Omicron [BA2] has now been identified in Denmark, and appears to have landed in California. It’s not really a race against time; rather, it’s a case of hanging on by a wing and a prayer.
The U.S. doesn’t fund its public health programs sufficiently (less than 3% of total health spending [2020: $4.1tn] goes to public health), which has unavoidable consequences for large-scale health emergencies. The long-term lack of funding results in a chronic dearth of personnel, something all-too-evident during those first months when thousands of county health departments (the first line of defense for ordinary citizens) were unable to coordinate with one another, to articulate in a clear and compelling manner their initial policies (in coordination with state departments of public health), or to implement those policies once they were published.
Chronic underfunding at local, state, and federal levels cannot be overcome in the short term; thus we continued to witness a lack of staffing, coordination, and implementation in the initial rollout of the first vaccines in early 2021. The federal government, unable to deliver a mass vaccination program, contracted with private vendors such as mega-pharmacy chains (CVS, Walgreens) to assist with delivery. County health departments were in many cases compelled to contract out for vaccination appointment software, rather than the federal government rolling out a single platform for the entire country. Time was lost, inefficiencies ensued, federal funding was often spent unwisely or unnecessarily – and private companies profited.
During the first and most critical wave of the pandemic, the dearth of funding for public health in the U.S. meant that we lost both the battle for eradication in 2020 and that on which suppression was staked, viz. vaccines, in 2021. Even today, over a year after vaccines became widely available to at-risk groups (healthcare workers, residents of long-term care facilities, those with comorbidities, the elderly) and more than eight months after they became widely available to the general adult population, only 63.8% of the U.S. population is fully vaccinated – an unimpressive data point which situates the U.S. between San Marino (64%) and Sri Lanka (63.4%). Something went wrong, because the U.S., in contrast for example to Africa (where only 10% of the population is fully vaccinated), had access to abundant supplies of the vaccine from early on once initial production hitches and distribution problems were overcome. Much of what went wrong must be attributed to this absence of federal policy-coordination-oversight, the lack of public health personnel to carry out a fast, mass campaign, and the inevitable involvement of the private sector in vaccine manufacture (and patents), distribution, and delivery. Billions of dollars in corporate profits were earned, but the job didn’t get done. It’s been estimated that +80% of the population needs to be vaccinated given Delta’s R0 (= reproduction number) (5.09, vs. 2.79 for the ancestral strain). The percentage of the population that needs to be vaccinated is even higher for the Omicron variant, given an estimated R0 of 7.0 -14.0. We’re not going to reach the required percentage, ever, given that vaccinations (a) aren’t sterilizing, i.e. their effectiveness begins to wane after 3-4 months and (b) vaccinations are geared at the most recent dominant mutation – they’re always at least one step and several months behind any newly-emerging variant(s).
Why? Countries which succeeded in (nearly) eradicating the virus during the first year – before the emergence of Omicron, which presents a different and much bigger challenge – did so by stringent imposition of NPIs (non-pharmaceutical interventions), namely masking, social distancing, good ventilation (critical for aerosol viruses), and testing-tracing-isolation/quarantines.
There was also a misunderstanding/misrepresentation about the purpose and efficacy of the vaccines themselves; this misrepresentation, however, may have been necessary given the failure to implement first-line NPIs. The vaccines were promoted as offering (nearly) full protection against infection, when in fact their logic is that of the yearly flu shot, which is never referred to as a “vaccine.” The latter term is reserved for diseases such as polio, smallpox, tetanus, whooping cough, measles-mumps-rubella and others for which one shot (or one shot + a booster at a later date) is deemed “sterilizing.” The COVID-19 “vaccine” is not sterilizing and cannot be deemed a definitive solution to the virus. This was known to the developers, the CDC, the WHO, the NIH, the NIAID (of which Anthony Fauci serves as Director), public health personnel, epidemiologists …
In order to gain modest control over the virus once front-line defenses had failed, speed was of the essence – i.e., to vaccinate the largest possible percentage of any given population within the shortest possible timeframe. Speed was necessary to head off mutations of the virus among the unvaccinated and partially-vaccinated – the greater the percentage of the population is at least partially protected, the smaller the chance that new, more lethal and/or more contagious variants will emerge.
The emergence of the Omicron variant (formally identified in South Africa in November 2021) well before the retreat of Delta in many countries proved particularly unlucky; Omicron is more contagious (with a case doubling rate in 2-3 days), has a shorter incubation period (thus making it less likely to be detected in its asymptomatic stage), and, due to the presence of a large number of “spike” mutations, is better able to evade the protection provided by current vaccines, which were developed in response to the ancestral (now essentially extinct) strain of the virus. Two major producers of vaccines for the American market (Pfizer and BioNTech, Moderna) have recently announced that they are entering the trial phase of boosters directed specifically at the Omicron variant, but it will be several months before trials are completed and production ramped up. In the meantime, we must hope that further viable mutations do not occur.
At this point, the virus is out of control in most of the West. Only those countries which continue to enforce strict NPIs have been able to hold it in check. The measures China has taken in preparing for the Olympics are worth considering. For example, China has decided to forego foreign spectators and members of the local general public at events, where stands will be nearly empty starting February 4. Daily testing of contestants, journalists, and support staff is already being carried out; journalists are tested and quarantined for 2 weeks upon arrival; impenetrable “bubbles” have been created for distinct groups (contestants, media, staff); inter-city travel has been severely curtailed; cities where even a handful of cases have been detected have been promptly placed on lockdown.
Why didn’t the U.S. do all the above in the initial phase of the pandemic (say, January – February 2020)? Arguments that such measures would have been “un-American” were disingenuously applied to conceal the fact that the U.S. was objectively unable to do what China, Taiwan, Japan, Vietnam, Australia, and New Zealand – to name a few notable success stories during the first year of the pandemic – did.
The U.S. production economy (apart from the military) has been largely off-shored over the past forty years. During the early days of the pandemic (February – April 2020), the U.S. did not have enough protective (surgical-grade or higher, e.g. N95) masks for its health providers, let alone for the population at large. Most masks, like other disposable medical gear, were being produced in East Asia for the U.S. market. While reshoring was eventually adopted (through a Presidential invocation of the Defense Production Act), the time gap was one of several months – a period during which Americans were successively advised that “masks aren’t really all that necessary,” to “make your own (cloth) masks,” and (later) “don’t wear N95 masks because they’re needed for healthcare personnel.” Masks, of course, are indispensable for protection against an aerosol-borne virus (that the virus was transmitted in this fashion was clear from the first superspreader events in early 2020). Cloth masks are nowhere near as effective as surgical masks or N95s, but they were all the U.S. could muster because the supply chain from East Asia had been interrupted, firstly because China (and other East / Southeast Asian countries) needed all their production for domestic use, and secondly because the supply chain itself was cut off with the closing of ports / interruptions in shipping.
The dominant economic approach governing the production of both durable and disposable goods over the past four+ decades is referred to “just in time” production – delivery – dissemination. Producers (the majority of whom are offshore) keep production to a minimum to avoid maintaining excessive inventory; local (onshore) distributors do the same – orders are deliberately kept low to minimize costs and maximize short-term private profits.
The “just-in-time” production philosophy fails in a pandemic, when response time is counted in days, not months. A public health emergency calls for excess production and inventories, available at the emergency’s onset.
Such shortages occurred not only with masks; other crucial disposables required in the earliest stages of the pandemic such as additional PPE (personal protective equipment) for healthcare providers/hospitals, ventilators, and testing materials and supplies (test tubes, reagents) just weren’t available, or were in such short supply that they couldn’t be used on the scale required. Inevitably, supplies went to the wealthy and better-organized (states / healthcare providers / individuals); other states/counties/communities went without – and the virus spread.
Two years later, we still haven’t got masks right, and politicians are issuing orders against their mandated use in schools, of all places – just at the moment we’ve learned that Omicron is especially contagious among school-age children, and that approximately 10% of children (20% of adults) will suffer “long Covid” for some indeterminate period. The newly-installed Governor of Virginia, keen to give parents more “say” in their children’s education, has issued an executive order giving parents the right to decide whether their children wear masks (the cheapest, simplest, and most effective single means of protection against an aerosol virus) at school.
Next up: we’ll consider how neoliberalism / financial capitalism / techno-feudalism contributed to the crisis of healthcare personnel, including hospital nurses and long-term care facility staff. And then we’ll move on to multi-national pharmaceutical companies, pandemic health/care profiteering, and vaccine apartheid.
In the meantime, stay well, mask up, maintain social distancing, test often (if you can), and if you must go to indoor venues, make sure they are adequately ventilated. The vaccine, especially when accompanied by a booster (3rd shot) is remarkably effective in preventing hospitalization and death, but it doesn’t halt breakthrough cases.