Author: Michael Safi
Affiliated organization: The Guardian
Type of publication: Article
Date of publication: 1st May 2020
People keep saying it: everything has changed.
As the days spent in our homes blur together and become indistinguishable, outside in the world huge shifts in consciousness are happening.
Just as it was unimaginable that things could go back to normal after the 9/11 terrorist attacks in the US, so it is that policy, investments and our collective imaginations over the coming years will be overshadowed by a virus that took fewer than 100 days to shut the world down.
It is too soon to say what that will look like. Each day brings shocks and possibilities, illuminates a little more of our new reality. Epidemiologists will study the past five months for decades; historians even longer.
But already we can see the rough contours forming. We are learning what works against Covid-19. And, surveying the wreckage of the third coronavirus to become an epidemic this century along with two animal influenzas and several waves of Ebola lessons are emerging about the kinds of societies that will be required to withstand the future outbreaks that scientists tell us are inevitable, and increasing.
We must move fast
China announced the discovery of a “pneumonia of unknown origin” on the afternoon of 31 December. The announcement barely registered in a world preparing to celebrate the end of the decade.
But that same day in Taiwan, the government in Taipei ordered any planes arriving from Wuhan to remain on the tarmac so airport staff could inspect the health of all those onboard.
China resisted implementing country-wide health screenings or taking temperature readings in Hubei province, where Wuhan is located, for the next fortnight, even as doctors in the city were reporting floods of patients struggling to breathe, and as leaders in Beijing became aware they were confronting “the most severe challenge” since Sars.
In the meantime, Taiwan’s Centers for Disease Control was monitoring arrivals from Wuhan, quarantining any person with a fever or cough and urging its citizens to avoid any unnecessary travel to Hubei.
A study released in March underlined the importance of acting fast. Had China implemented widespread testing, a cordon sanitaire around Hubei and other measures a week earlier, it would have reduced China’s caseload by 66%, the researchers argued. Acting three weeks earlier would have cut cases by 95%.
The lesson for governments was underlined by Michael Ryan, a surgeon and the executive director of the World Health Organization’s health emergencies programme, in a press conference in March. “Be fast. Have no regrets. You must be the first mover. The virus will always get you if you don’t move quickly,” he said. “If you need to be right before you move, you will never win … Speed trumps perfection.”
We know what works to contain it …
Months into this epidemic, even basic information about the coronavirus is still unclear. How infectious is it? How deadly? Leaders make life-and-death decisions based on best guesses. “We are flying the plane as it’s being built,” says Ashley Arabasadi.
Yet the basic principles for containing a disease, developed and refined with reference to hundreds of previous epidemics, have held true for Covid-19.
The countries that have implemented early and extensive testing, such as South Korea and Iceland, have been able to keep their societies relatively open, without loosing the virus into their populations.
Singapore kept a lid on its initial wave by diligently retracing the steps of people who tested positive for Covid-19. Those they came into sustained contact with were often put in home isolation, with harsh penalties for breaking it. The sick were quarantined in hospitals, even if their symptoms were mild.
When containing cases is no longer possible, early evidence from Europe shows that physical distancing measures, implemented early, “flatten the curve” and reduce the overall size of a country’s outbreak.
… the hard part is implementing it
In 2014, as Ebola was spreading in west Africa, Rebecca Katz remembers hearing frustrations from some of the countries helping to fund the response.
“As this outbreak has demonstrated, you can have the best labs in the world, the best notification systems and software, but if you don’t have the appropriate governance of when to use these powers … they don’t function,” Phelan says
“They would be asking things like: ‘How dare Sierra Leone not close schools during an Ebola outbreak?’” says the director of the Center for Global Health Science and Security at Georgetown University Medical Center. “For a long time it’s been easy for donor countries to cast judgment on recipient countries for their behaviour in disease transmission.”
The coronavirus outbreak has made clear that it is a universal problem: even countries that know what works, and have the capacity to act, still hesitate.
Some with strong liberal traditions, such as Britain, balked initially at the prospect of drastically curbing civil rights. Italian industry groups are reported to have strongly resisted the idea of shutting down Lombardy, one of the engines of the country’s economy. Developing countries such as Pakistan have had to balance slowing the spread of the disease with the disastrous consequences of closing the farms and construction sites where the poorest work.
There were blind spots in the way countries prepared. A global index released in October concluded the US was more ready than anywhere else to fight a pandemic. But the scorecard, based on WHO methodology, focused more on technical capacity than government processes.
“As this outbreak has demonstrated, you can have the best labs in the world, the best notification systems and software, but if you don’t have the appropriate governance of when to use these powers … they don’t function,” Phelan says.
Civil liberties face their greatest test in a generation
Digital surveillance tools that might have been closely scrutinised in normal times have been urgently rolled out over recent weeks. More than 40 countries have implemented some form of surveillance or censorship in the name of fighting the coronavirus, according to one estimate.
These tools have created a world that might have appeared dystopian a few months ago. In Hong Kong and Bahrain, people in quarantine are being issued with electronic bracelets that track their movements. Drones equipped with cameras hover over some Indian neighbourhoods warning residents they are being watched. Israel has revealed it has secretly been amassing people’s phone data and is tapping that database to find potential coronavirus cases.
Human rights advocates acknowledge we are living through an emergency, but worry governments will use fears of future outbreaks to justify keeping many of these tools in place – whether or not they help.
“The potential for abuse is high,” the UN warned in a report last week. “What is justified during an emergency now may become normalised once the crisis has passed.”
Public trust is a government’s most valuable asset. The next months will strain it
There is no precedent for half the world’s population living under some kind of lockdown. It might just be the single largest collective act undertaken by humanity.
Its successful execution requires extraordinary public trust in their governments, says Lars Trägårdh, a Swedish historian who studies trust in institutions over time. “If you trust the government is working for your good, and you trust other citizens to follow the rules, you have huge advantages for collective action,” he says.
But restrictions implemented in low-trust societies could engender a backlash.
Over the next months, governments are going to allow people to resume their lives amid the worst economic conditions since the Great Depression. Should new waves of the virus be detected, states may again ask their citizens to return home.
Leaders who deny science are a liability
Many leaders have enjoyed what may be a temporary surge in popularity as frightened citizens rally around them in a crisis. Two notable exceptions have been the US president, Donald Trump, and his Brazilian counterpart, Jair Bolsonaro, whose ratings have declined sharply.
Both men, rightwing populists who frame their presidencies as revolts against the elites, including scientific authorities, have been highly skilled at influencing the media environment. But the coronavirus is a unique test. It spreads and kills regardless of how it is being framed online or in the media. It emphasises the importance of experts. Success depends on rallying the country together.
Rather than rewarding bravado, the moment appears to favour leaders who can be honest about the uncertainty inherent in fighting a virus.
Those overseeing some of the more successful responses, such as Germany’s Angela Merkel or Jacinda Ardern of New Zealand, have been praised for their ability to project empathy and communicate complex ideas.
Self-sufficiency matters again …
Governments will not soon forget the desperate global scramble for personal protective equipment and medical supplies they have engaged in these past months. Nor the sight of doctors and nurses forced to guard against infection using bin bags and homemade masks.
Several countries have already restricted the exporting of some pharmaceuticals and more than a dozen have imposed bans on selling some food abroad. The UN has warned that if quarantines persist, food supply chains in some places might start to be disrupted from this month.
The message is being received. EU countries are emphasising the importance of increasing the “strategic autonomy” of the bloc and ensuring it produces its own essential goods.
Australia is one of several countries said to be re-examining the exposure of food, fuel and medical supplies in particular to global supply chains, the fragility of which have been exposed.
… but the world cannot beat the virus without cooperating
The coronavirus got lucky: it emerged at a low point for global cooperation. Countries recognised after Sars that sharing information, coordinating responses and pooling resources such as protective gear, medicine and tests was vital. A set of international regulations that came into force in 2007 laid the groundwork for this cooperation.
The lack of cooperation has weakened the world’s response, public health experts argue. A global stimulus package might have put a floor under the economic catastrophe unfolding in many countries. Coordinated shutdowns and reopenings would have slowed the spread of the virus and could speed up the recovery.
We might have avoided chaos in the global market for medical and protective equipment, with reports of the US waving wads of cash to re-divert planeloads of masks bound for France, and Israel running clandestine spy operations to source testing kits.
Austerity and inequality make us less resilient
No economy could withstand the shock of a large slice of the workforce suddenly ordered home. But the virus has irradiated weaknesses that have made the outbreak deadlier, and will make its aftermath hurt more.
The problems with tying health insurance to employment in the US have become even more obvious: the 26 million Americans who have filed for benefits over the past month did not just lose their jobs, many also lost their medical coverage.
Britain has the NHS, but a decade of austerity had weakened the system and left the country in demonstrably worse health when the virus struck.
Viruses can see the people who are usually invisible to policymakers and the public. The conditions in which they work and live are everyone’s problem
The rise of precarious gig-economy jobs and zero-hours contracts has created a mass of workers without access to sick and paid leave, incentivising some to keep working when the entire community needs them to stay home. Insecure work and barriers to healthcare disproportionately burden people from ethnic minorities and poor people: both are dying from Covid-19 at a higher rate in the US and Britain.
The poor and migrants cannot be invisible
Singapore’s response has been lauded as a model. Its government moved fast, utilising technology, exemplary public communication and the traditional tools of outbreak control to corral its first wave of cases to about 200.
Then last week, it announced it had discovered thousands of new infections, almost all of them among migrant workers living in dormitories on industrial estates on the outskirts of the sleek city-state. Rights groups say little attention was paid to the more than 1 million migrant workers, even as restrictions on crowding and movement were rolled out.
Viruses can see the people who are usually invisible to policymakers and the public. The conditions in which they work and live are everyone’s problem.
The same is true of the residents of Dharavi, a Mumbai slum where almost 1 million people are crammed together within sight of the skyscrapers and penthouses apartments of some of the wealthiest people in Asia. More than 200 cases have been discovered so far. City authorities acknowledge it will be virtually impossible to halt the spread of the disease among these communities.
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