Underfunded and under threat

‘At least 29 US states have passed laws, enacted other initiatives, or succeeded in lawsuits that permanently weaken state and local government authority to protect public health, and similar efforts are pending in multiple other states. The analysis was published by Kaiser Health News and the Associated Press as part of their ongoing series “Underfunded and Under Threat,” which examines how US public health systems were unprepared to confront the COVID-19 pandemic and face ongoing politicization, funding cuts, and other hindrances. Legislators in at least 16 states have limited public health authorities’ ability to issue mask mandates or quarantines or isolation orders, and in some cases, legislatures gave themselves that authority or shifted it to other elected officials. In at least 17 states, lawmakers passed legislation banning SARS-CoV-2 vaccine mandates or passports or facilitated opt-out options. And in at least 14 states, new laws, executive orders, or court rulings ban or limit mask mandates. 

‘Proponents of the new measures argue that they are a necessary check on executive powers, particularly for appointed officials, and give lawmakers a voice in public health emergencies. Public health officials and experts have expressed frustration with these efforts and warned that the consequences of these actions will extend far beyond the current pandemic. These new limits could also impact public health officials’ ability to prevent and contain future outbreaks for any number of communicable diseases. At least 303 state and local public health department leaders have resigned, retired, or been fired during the pandemic, according to the analysis.’ Johns Hopkins Center for Health Security e-newsletter 

• Public health officials face wave of threats, pressure amid coronavirus response (June 12, 2020). Read here
• Pandemic backlash jeopardises public health powers, leaders (Dec 15, 2020). Read here
• Hollowed-out public health system faces more cuts amid virus (July 1, 2020). Read here
• Politics slows flow of US pandemic relief funds to public health agencies (August 17, 2020). Read here

Read here (KHN & AP, as at Sept 17, 2021)  

Prioritising profits reversed health progress

‘Instead of a health system striving to provide universal healthcare, a fragmented, profit-driven market ‘non-system’ has emerged. The 1980s’ neo-liberal counter-revolution against the historic 1978 Alma-Ata Declaration is responsible.’

This story is well argued and contains several relevant and informative links under the following subheadings:

• Alma-Ata a big step forward
• Primary healthcare
• Lalonde Report turning point
• Neo-liberal ascendance
• Healthcare financing key
• Philanthropy rules

Read here (IPS News, Aug 24, 2021)

Beware the fifth wave of Covid-19 — Amar-Singh HSS

‘On 8th May 2021 I wrote about how to “Avoid a Covid-19 Disaster in Malaysia”. This crisis has washed over us and the toll in deaths and loss of livelihood has been and continues to be significant. I am now writing about the impending, massive fifth wave. This wave may be so big as to make the current one look pale in contrast. In a sense we have, in the fourth wave, experienced what Italy did last year. Now the fear is that we may experience what India, Peru and some other countries in South America are experiencing.

‘Some of our leaders seem to live in denial of the reality; one even saying that the pandemic in Malaysia is under control. Others have set a value of '4000 cases' as a benchmark to use, but in the face of a high positivity and limited testing this is fraught with problems. A good look at the data and trends suggest that the worst may be yet to come.’

Read here (The Malay Mail, June 25, 2021)

The Nightingale alternative: Cast out fear in favour of love

‘According to Miss Nightingale: “True nursing ignores infection, except to prevent it. Cleanliness and fresh air from open windows, with unremitting attention to the patient, are the only defence a true nurse either asks or needs. Wise and humane management of the patient is the best safeguard against infection.”

‘Tell that to those who decided that old people already suffering from life-threatening complaints should be shut away for months on end, deprived of free movement in the open air and of the contact they crave with those they love!

‘And what would a woman who remarked, “How very little can be done under the spirit of fear!” have thought of the deliberate incitement of terror which has been the hallmark of public policy in the UK for the past eleven months?

‘What would her opinion have been of a government that splashes out apparently unlimited sums of public money on fear-inducing propaganda, with the aim of increasing “the perceived level of personal threat…using hard-hitting emotional messaging”?

‘A Nightingale approach to Covid, and to all infections, would allow us to cast out fear in favour of love, resolving the present conflict between concern for public health and the moral imperatives which should always take precedence over panicked speculation.

‘It would, however, be exceedingly inconvenient for those currently seizing the chance to impose their anti-human agendas on humanity, under cover of a pandemic.’

Read here (OffGuardian, Mar 7, 2021) 

Fighting the medical monopoly: Mobilising for Zero-Covid and decommodified healthcare

‘As I have discussed in an article on Interferon 2b and Cuba’s other treatments for COVID-19, decommodified universal healthcare is the alternative to monopoly-driven healthcare ravaging countries around the globe. Not for profit production and delivery of all health related goods responding to general and specific human needs of the majority of any given country is the only means to assure quality health for all, in pandemic as well as non-pandemic times.

‘More concretely, decommodified universal healthcare is ecologically sound, public sector production of everything from food to psychological support, medicines to medical technology, and medical care. Rather than results based management and other corporate models adopted by most state owned enterprises globally in the past four decades, such public production would be designed and managed democratically by citizens, health professionals, scientists, and the range of other workers involved.

‘Taxation of corporations and rich individuals would be the primary means of financing decommodified universal healthcare. Due to the social importance of health related goods, and high employment potential given the extent of need in most countries around the globe, decommodified universal healthcare would constitute a significant segment of needs based, ecologically sound, nationally focused economies.’

Read here (The Bullet, Mar 4, 2021)

Covid-19: Social murder, they wrote — elected, unaccountable, and unrepentant

‘After two million deaths, we must have redress for mishandling the pandemic... Murder is an emotive word. In law, it requires premeditation. Death must be deemed to be unlawful. How could “murder” apply to failures of a pandemic response? Perhaps it can’t, and never will, but it is worth considering. When politicians and experts say that they are willing to allow tens of thousands of premature deaths for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life? If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-covid excess deaths? When politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling because to act goes against their political strategy or ideology, is that lawful? Is inaction, action?1 How big an omission is not acting immediately after the World Health Organization declared a public health emergency of international concern on 30 January 2020?

‘At the very least, covid-19 might be classified as “social murder,” as recently explained by two professors of criminology. The philosopher Friedrich Engels coined the phrase when describing the political and social power held by the ruling elite over the working classes in 19th century England. His argument was that the conditions created by privileged classes inevitably led to premature and “unnatural” death among the poorest classes. In The Road to Wigan Pier, George Orwell echoed these themes in describing the life and living conditions of working class people in England’s industrial north. Today, “social murder” may describe the lack of political attention to social determinants and inequities that exacerbate the pandemic. Michael Marmot argues that as we emerge from covid-19 we must build back fairer...

Getting redress

‘Where then should citizens turn for accountability, if they don’t find it in their leaders and feel unsupported by experts and the media? The law remains one form of redress, and indeed some legal avenues, including criminal negligence and misconduct in public office, are being explored, although proving any such claims will be difficult and drawn out. But the notion of murder, at least “social murder,” is hard to shake emotionally, and strengthens with every denial of responsibility and every refusal to be held accountable or to change course.

‘That leaves three options. The first is to push for a public inquiry, as The BMJ and others argued for in the summer of 2020—a rapid, forward looking review rather than an exercise in apportioning blame that will identify lessons and save lives. The second is to vote out elected leaders and governments that avoid accountability and remain unrepentant. The US showed that a political reckoning is possible, and perhaps a legal one can follow, although research suggests that mishandling a pandemic may not lose votes.21 The third is for mechanisms of global governance, such as the International Criminal Court, to be broadened to cover state failings in pandemics...

‘The “social murder” of populations is more than a relic of a bygone age. It is very real today, exposed and magnified by covid-19. It cannot be ignored or spun away. Politicians must be held to account by legal and electoral means, indeed by any national and international constitutional means necessary. State failures that led us to two million deaths are “actions” and “inactions” that should shame us all.’

Read here (British Medical Journal, Feb 4, 2021)

The Biden-Harris plan to beat Covid-19

‘The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. President Biden believes that the federal government must act swiftly and aggressively to help protect and support our families, small businesses, first responders, and caregivers essential to help us face this challenge, those who are most vulnerable to health and economic impacts, and our broader communities – not to blame others or bail out corporations.

The Biden-Harris administration will always:

• Listen to science
• Ensure public health decisions are informed by public health professionals
• Promote trust, transparency, common purpose, and accountability in our government

President Biden and Vice President Harris have a seven-point plan to beat COVID-19:

1. Ensure all Americans have access to regular, reliable, and free testing.
2. Fix personal protective equipment (PPE) problems for good.
3. Provide clear, consistent, evidence-based guidance for how communities should navigate the pandemic – and the resources for schools, small businesses, and families to make it through.
4. Plan for the effective, equitable distribution of treatments and vaccines — because development isn’t enough if they aren’t effectively distributed.
5. Protect older Americans and others at high risk.
6. Rebuild and expand defenses to predict, prevent, and mitigate pandemic threats, including those coming from China.
7. Implement mask mandates nationwide by working with governors and mayors and by asking the American people to do what they do best: step up in a time of crisis.

Read here (White House, Jan 20, 2021) 

Where is Malaysia headed with Covid-19? Dr Amar-Singh HSS

‘For Malaysia to have a hopeful 2021 where Covid-19 is concerned we need the following changes in outlook and behaviour.

• Transparency is crucial: ‘If we want to move forward then there must be transparency. We must not learn about things first from whispers on social media and cries for help on Twitter or Facebook. We must learn it first from the authorities, no matter how unpalatable the situation...’
• Stop blame shifting and take responsibility: ‘Stop putting the entire blame on the public for the failure to control the pandemic. It is time to stop fining and arresting the average citizen for SOP violations. The failure of some elected representatives in government to maintain effective SOPs and the lack of penalty for them is a major thorn in the side of the public...‘
• We need many voices: ‘We need many people with ideas to speak up. We need many divergent views to be aired and discussed. We need an ongoing national dialogue to chart the best way forward...’ 
• More support is required: ‘The amount of resources and support we have put into dealing with this pandemic is still limited. We need to ramp up our support and initiatives. We urgently need to absorb all the health manpower that is available (before we lose them to our neighbours)...’

Read here (The Malay Mail, Jan 1, 2021)

Relaxing Covid rules at Christmas will cost lives: Rare joint statement by two major UK medical journals

‘The British government came under intense pressure on Tuesday to revise its plan to relax COVID-19 restrictions for five days around Christmas, with two influential medical journals making a rare joint appeal for the policy to be scrapped... In what was only their second joint editorial in more than 100 years, the British Medical Journal and the Health Service Journal said the government should be tightening the rules rather than allowing three households to mix over five days. “We believe the government is about to blunder into another major error that will cost many lives,” the editorial said.’

Read here (Reuters, Dec 15, 2020)

The governance of Covid-19: Anthropogenic risk, evolutionary learning, and the future of the social state

‘We consider the implications of the Covid-19 crisis for the theory and practice of governance. We define ‘governance’ as the process through which, in the case of a given entity or polity, resources are allocated, decisions made and policies implemented, with a view to ensuring the effectiveness of its operations in the face of risks in its environment. Core to this, we argue, is the organisation of knowledge through public institutions, including the legal system. Covid-19 poses a particular type of ‘Anthropogenic’ risk, which arises when organised human activity triggers feedback effects from the natural environment. As such it requires the concerted mobilisation of knowledge and a directed response from governments and international agencies. 

‘In this context, neoliberal theories and practices, which emphasise the self-adjusting properties of systems of governance in response to external shocks, are going to be put to the test. In states’ varied responses to Covid-19 to date, it is already possible to observe some trends. One of them is the widespread mischaracterisation of the measures taken to address the epidemic at the point of its emergence in the Chinese city of Wuhan in January and February 2020. 

‘Public health measures of this kind, rather than constituting a ‘state of exception’ in which legality is set aside, are informed by practices which originated in the welfare or social states of industrialised countries, and which were successful in achieving a ‘mortality revolution’ in the course of the nineteenth and twentieth centuries. Relearning this history would seem to be essential for the future control of pandemics and other Anthropogenic risks.’

Read here (NCBI, Dec 4, 2020)

Pandemic, ‘Great Reset’ and resistance

‘The Covid pandemic is a turning point, an opportunity to change. The reset we need now is not the creation of a ‘post-human, post-nature’ world defined by unregulated corporate-led growth of artificial intelligence and biotechnology. We need to balance digitalization and commoditization with an ecological reset, a way of living that respects the environment, promotes agroecology, bioregionalism and local communities. We need to raise our consciousness and understanding of humanity as a species in nature, our connectedness to each other and the rest of planetary life.’

Read here (IPS News, Dec 1, 2020)

Movement control orders are not the way to defeat Covid-19: Academy of Professors Malaysia (APM)

Here are their suggestions in seven parts:

1. Red Zones with more than 40 new daily cases should continue to be under EMCO, but the rest of the country should return to RMCO. Perhaps these acronyms could best be replaced with number codes in order to avoid the misconceptions.
2. The continued detection of localised outbreaks (clusters) should continue. However, since the Covid-19 infection survival rate is 99.9 per cent for healthy people under 70, to achieve an optimal balance between health, social wellbeing, and the economy, the emphasis should be on "focused protection" and "targeted approach" for those at risk while allowing the less vulnerable to work and go to school. (a) Young and healthy adults and children above the age of 12 should be allowed to go back to school and work. (b) People with co-morbidities regardless of age and the elderly should stay at home. (c) People who go to work and school should be taught how to clean themselves and how to approach vulnerable family members when they return home. These measures should be taught on media, at the workplace and at school.
3. As advocated earlier, people should be taught and continually reminded about carrying out the responsibility of protecting themselves against Covid-19 by practicing the 3W and 3C as the daily norms. The public should also be educated on the level of risk of getting an infection from activities so as to avoid the activities that are high risk, for example avoiding bars, indoor close contact, meetings and parties, eating in crowded indoor restaurants, etc. Activities outside, with physical distancing, is generally low risk and since we need the sun to produce Vitamin D, exercising outside should be encouraged.
4. That the SOPs need to be well defined, complete and accurate to avoid confusion. For instance, the misunderstanding on the usage of masks during fuelling at petrol stations, and the restriction of travelling together and eating at a table in restaurants, while the group may be from the same household, hence sharing the same living environment and air. Such restrictions may further increase the risk of depression, lethargy, and family discord of being cooped up for too long.
5. That nutritional education on the right food would assist the development of a stronger immune system. Get nutritionists and dieticians on board in the media to tell people what to eat, how to prepare and cook and when to eat is as important as showing people how to exercise in the mornings.
6. The creation of platforms for people with mental health issues to reach out to either at the university, healthcare, organisational or even individual level and if possible make it free so that anyone can get help when needed.
7. That the message of keeping the vulnerable and high risk groups safe should be constantly reaffirmed and resonated to the public via media and to communities. It is important to make sure that people above 70 and anyone who has chronic diseases do not get infected.

Read here (New Straits Times, Nov 14, 2020)

The Chinese model against Covid-19: A total war of the people, for the people, by the people

‘Wang Hui, an intellectual leader of the so-called New Left movement, offers an interesting alternative explanation [on China's Covid response]... Wang, by the way, is quite well-known among China specialists in the West. Harvard University Press is scheduled to publish an English edition of his multivolume The Rise of Modern Chinese Thought.

‘...he argued that Beijing utilised the old Maoist-Leninist models of the people’s war and total war, to mobilise the entire nation – horizontally across the medical and scientific professions, and up and down the ranks from the top Chinese leadership to humblest local neighbourhood units. Everything was put on hold, even the all-important economy, while the nation’s resources were devoted to a single task.’

Read here (South China Morning Post, Nov 13, 2020) 

Memo for President Biden: Five steps to getting more from science

‘The list of needed actions is long, but here we highlight five that the Biden administration should take swiftly. We call not for a return to business as usual but for fundamental, sometimes counter-intuitive changes that will strengthen the use of science in US policy and by the research community more broadly... (1) Let an oft-overlooked White House office [Office of Science and Technology Policy] lead the pandemic response. (2) Make advisory processes more independent. (3) Expedite scientific-integrity legislation.  (4) Give public universities tough love and lots of support. (5) Refocus science funding.

Read here (Nature, Nov 8, 2020)

Polls reform panel hails govt review of electoral process for Covid-19 era

‘The Electoral Reform Committee (ERC) today welcomed the government's willingness to review create laws concerning elections during the pandemic. Its chairman Tan Sri Abdul Rashid Abdul Rahman said it is high time a comprehensive review be conducted on existing laws for the electoral process, whether it is for by-elections or for a general election. “This is especially to determine if elections can be suspended in times of crises, including those related to health, public disorder, natural disaster, or in situations which threaten national security,” he said in a statement.’

Read here (Malay Mail, Nov 3, 2020)

Trump team just announced its surrender to the pandemic: Jeffrey Sachs

‘The Trump administration has announced its unconditional surrender to the Covid-19 pandemic. "We are not going to control the pandemic. We are going to control the fact that we get vaccines, therapeutics and other mitigation areas," White House chief of staff Mark Meadows told CNN's Jake Tapper on "State of the Union" on Sunday. Donald Trump has surrendered without ever joining the battle. I have no doubt he will be remembered as the greatest presidential failure in American history...

‘Trump surrounded himself with fools and knaves who echoed his false belief that the choice was Covid versus the economy. This includes three types of advisers who led Trump to his likely imminent political demise and to our nation's mass suffering... The first group were the evangelical preachers who were more interested in packing their pews than in saving their parishioners who caught the disease in their megachurches... The second group was the Murdoch media empire with the "thought leadership" ― if one can call it that ― of the Wall Street Journal editorial board, and the nihilism of Fox News... The third group was those who would stand up and oppose the overwhelming scientific consensus on NPI's, thereby bolstering Trump in his conviction to do nothing.’

Read here (CNN, Oct 26, 2020) 

Vietnam is fighting Covid without pitting economic growth against public health

‘The motto for the first phase was that if we stay alive, the question of wealth and the economy can come later. Ordinary people did suffer, such as the gig economy workers: whenever I order a Grabcar (a south-east Asian version of Uber) these days, the vehicle that arrives is always newer and more expensive that what I’m used to; as a driver explained, those who used to pick me up in their cheaper cars have had to sell them to stay afloat, leaving only those with deeper pockets left in the market.

‘But now the government has shifted its anti-Covid strategy towards the economy. The tactics for the second wave are more sophisticated. Contact tracing is still prompt and aggressive but lockdown and isolation are more selective; international flights have been opened for foreign workers, such as engineers from South Korea’s LG, who are needed to keep the economy functioning.’

Read here (The Guardian, Oct 20, 2020)

Covid-19 has exposed the catastrophic impact of privatising vital services

‘The Covid-19 pandemic has exposed the catastrophic fallout of decades of global privatisation and market competition. When the pandemic hit, we saw hospitals being overwhelmed, caregivers forced to work with virtually no protective equipment, nursing homes turned into morgues, long queues to access tests, and schools struggling to connect with children confined to their homes. People were being urged to stay at home when many had no decent roof over their heads, no access to water and sanitation, and no social protection. 

‘For many years, vital public goods and services have been steadily outsourced to private companies. This has often resulted in inefficiency, corruption, dwindling quality, increasing costs and subsequent household debt, further marginalising poorer people and undermining the social value of basic needs like housing and water. We need a radical change in direction.’

Read here (The Guardian, Oct 19, 2020)

‘No longer groping in the dark’: NCID doctors share how Covid-19 is being treated in Singapore

‘So far, 28 people have died of COVID-19 in Singapore - one of the lowest mortality rates in the world. In the US, where there have been about 8 million cases, more than 200,000 people have died. As of Saturday (Oct 17), 37 COVID-19 patients remain hospitalised in Singapore, with none in intensive care. More than 99 per cent of those infected have been discharged, while there are 41 in community care facilities.

‘But it wasn't always like this. Three National Centre for Infectious Diseases (NCID) consultants told CNA how treatment of the novel coronavirus has evolved here and how NCID has kept the number of critical cases low.’

Read here (Channel News Asia, Oct 18, 2020)

China got better. We got sicker. Thanks, Trump

‘Public health expert Dr. David Katz argued in a New York Times op-ed and in an interview with me back in March that we needed a national plan that balanced saving the most lives and the most livelihoods at the same time. If we just focused on saving every life, we would create millions of deaths of despair from lost jobs, savings and businesses. If we just focused on saving every job, we would cruelly condemn to death fellow Americans who deserved no such fate.

‘Katz argued for a strategy of “total harm minimization” that would have protected the elderly and most vulnerable, while gradually feeding back into the work force the young and healthy most likely to experience the coronavirus either asymptomatically or mildly — and let them keep the economy humming and build up some natural herd immunity as we awaited a vaccine.

‘Unfortunately, we could never have a sane, sober discussion about such a strategy. From the right, said Katz, we got “contemptuous disdain” for doing even the simplest things, like wearing a mask and social distancing. The left was much more responsible, he added, but not immune from treating any discussion of economic trade-offs in a pandemic as immoral and “treating any policy allowing for any death as an act of sociopathy.”

Read here (New York Times via Salt Lake Tribune, Oct 15, 2020)