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What are we planning for?

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The UK government has published plans for responding to the threatened COVID-19 pandemic which ministers say could affect between 50 and 80 percent of the population, and could result in 20 percent of the workforce being off sick at the same time.

As with all of these things, we begin with the two most important questions:

  • Why this?
  • Why now?

The answer to the second question is that cases of COVID-19 crossed a tipping point over the weekend.  Although the number of confirmed cases had been trickling up, all were either people who had recently travelled to an affected area or who had had direct contact with such a person.  Indeed, most of Britain’s confirmed cases at the start of the week had been on a skiing holiday with a single carrier.  What changed on the weekend was that someone who had neither been to a hot spot nor been in contact with someone who had was found to have the disease.  A second case of this kind was reported late on Sunday.

Why this matters is that it means that containment has failed.  The virus is now spreading faster than the authorities can track down and test those who might have been infected.  This appears – although at this stage there is a dearth of peer-reviewed studies – to be an unpleasant feature of this particular virus; it has a long asymptomatic stage (possibly as long as 21 days in some cases) during which it can be passed on by people who do not even realise they are infected.  This would also explain the very short – 3 to 5 day – doubling time in the number of reported cases.  That is, on Friday there were just 20 confirmed cases in the UK; by Monday this had risen to 40.  If it continues at that rate, we could be at 80 by Friday, 160 by Monday, 320 a week Friday and 640 by the following Monday.  If WHO data on the proportion of people who require specialist respirator support is correct, that would be more than enough to fill NHS England’s 28 specialist beds.

According to the UK government plan released to the public, the state response will go through four – probably overlapping – stages:

  • Contain: detect early cases, follow up close contacts, and prevent the disease taking hold in this country for as long as is reasonably possible
  • Delay: slow the spread in this country, if it does take hold, lowering the peak impact and pushing it away from the winter season
  • Research: better understand the virus and the actions that will lessen its effect on the UK population; innovate responses including diagnostics, drugs and vaccines; use the evidence to inform the development of the most effective models of care
  • Mitigate: provide the best care possible for people who become ill, support hospitals to maintain essential services and ensure ongoing support for people ill in the community to minimise the overall impact of the disease on society, public services and on the economy.

The emergence of entirely indigenous cases over the weekend means that containment has failed.  The virus is already spreading among a much wider population than just those with known links to affected regions outside the UK.

This does not mean that containment attempts will cease.  Testing and isolating people is as much a part of the delay phase as the containment phase.  Nevertheless, there is no longer any point in wheeling out ministers and health experts to tell the wider public that they have nothing to worry about.  COVID-19 is not “just like flu,” as earlier messaging implied.  The rate of spread – the so-called R0 – is at best 2.5 (i.e., each affected person infects another 2.5 people) and is probably much higher.  The death rate – 2.5% (outside the Wuhan region of China) is ten times higher than seasonal flu (although may be comparable to the 1918-19 “Spanish flu”).

The government’s aim at this point is to try to bring the R0 down as close as possible to 1; which partially answers the first question.  The government paper indicates – but doesn’t fully spell out – the potential need to – metaphorically – go medieval and lock the castle gates.  Whether a western government can go as far as the Chines Communist Party has done in locking towns and cities down is doubtful.  But the fact that the government is talking about new emergency legislation suggest that they intend doing a lot more than politely asking us to wash our hands and stay home if we feel sick.  We need to read between the lines when they explain that:

“Our experts are considering what other actions will be most effective in slowing the spread of the virus in the UK, as more information about it emerges. Some of these will have social costs where the benefit of doing them to Delay the peak will need to be considered against the social impact. The best possible scientific advice and other experts will inform any decision on what will be most effective.”

We can certainly expect large gatherings such as sports fixtures and music events being cancelled.  The government has also indicated possible restrictions on the use of public transport – which suggests a considerable degree of coercive control of people’s movement.

A lot is being pinned on the possibility – it is no more at this stage – that delaying the spread of the disease for another 4 to 8 weeks will allow warmed weather to stop the spread as it does with seasonal flu.  Given that most of the confirmed cases are in the northern hemisphere this may happen.  However, similar viruses – notably MERS – had no problem spreading in hot weather, so we cannot bank on it.

This is why much higher potential impact figures have now been approved.  When the Minister says that 50 to 80 percent of us could be infected, that is between 33,250,000 and 53,200,000 of us.  And if we can expect similar rates of hospitalisation to the rest of the world, that means between 4,987,500 and 7,980,000 requiring hospital treatment.  For what it’s worth, according to the King’s Fund, NHS England has just 142,000 beds (NHS Wales has just 10,857).  Remember that almost all of those beds are permanently occupied with people who are sick with all of the other conditions that routinely require hospital care.  As Adam Wren at Medium explains:

“The main risk of the coronavirus outbreak isn’t that you’re going to get sick and die, it’s that so many people are going to get sick so quickly that our healthcare services and infrastructure are going to be completely overwhelmed…

“If the present data about the virus is correct, even at conservative estimates we are going to have hundreds of thousands of people needing hospitalisation and intensive care. The strain that this will place on the healthcare system cannot be overstated. We are not prepared to deal with a pandemic.”

Which brings us to the question in the title of this post – what are we (or rather they) planning for?

In fact the UK government paper actually tells us; albeit on page 19 where it is likely to go unnoticed by journalists who usually merely reprint the accompanying press release:

“… if transmission of the virus becomes established in the UK population, the nature and scale of the response will change. The chief focus will be to provide essential services, helping those most at risk to access the right treatment.”

There are two clauses in that second sentence which need to be treated separately.  “The chief focus will be to provide essential services…” is the primary purpose of all emergency planning, which developed out of preparations for the impact of nuclear war in the aftermath of the Second World War.  The aim was not – as many believed – to ensure “survival,” but “survivability.”  The two terms were used interchangeably by journalists during the Cold War.  But survivability refers to the survival of the command and control mechanisms of the state in the aftermath of a nuclear strike.  That is, after the Soviet Union had unloaded its nuclear arsenal on us, somewhere in a deep bunker or a submarine would be someone with the means to give the order to retaliate.  In the years since the Cold War, survivability has morphed into maintaining the command and control structures of the state in the face of any form of disaster or threat.  And so the primary purpose of government efforts to mitigate the spread of COVID-19 will be to protect the state and maintain essential infrastructure and economic activity. 

Which is why, of course, saving the people is diluted to “helping those most at risk…” Given the tiny number of beds relative to the likely spread of the disease, this inevitably means triage – the Napoleonic military approach which divided wounded soldiers into three groups:

  • Those with minor injuries that could be easily patched up
  • Those with more serious wounds who would recover with treatment, and
  • Those with wounds so serious that they were likely to die anyway.

The second group were the only ones who received medical treatment.  The first would be given dressings and left to deal with their own injuries; the last group would be put somewhere out of sight while they awaited the imminent arrival of the grim reaper.

Exactly what we can look forward to in a pandemic depends on two broad factors.  The first concerns the disease itself.  If it continues to spread as rapidly as it has thus far – and especially if the onset of spring fails to slow it – then there is simply no way in which the NHS – even if the government is able to return retired medical staff to active duty – can hope to hospitalise everyone who needs care.  The second concerns the availability of resources – especially human resources – both to deal with the direct medical impact of the virus, and with the socio-economic fall out as large numbers of people get sick.

In this, we can only hope that the government has more detailed plans than the paper which is being circulated for public consumption.  Because our Achilles’ Heel in this is that neoliberal economic system that we have created over the last four decades leaves us particularly vulnerable to second order failures of which a shortage of hospital beds is just one.  Put simply, the policies introduced to allow the economy to continue growing after the energy and economic crises of the 1970s traded resilience for complexity.  As David Korowicz explains:

“Our ability to sustain our basic needs anywhere, now depends upon system integration everywhere.  That means no infrastructure, society or country can be fully resilient as the conditions that maintain function are dispersed beyond visibility or control…

“Because society depends upon multiple interacting networks, within cities and across the globe, there are many routes to cascading disruption. This is an example of non-linearity- a relatively small number of directly impacted people or functions can still cause the failure of a whole system. The speed of our societal processes, from Just-in-Time logistics to financial transactions means that shocks can rapidly cascade. We can think of society as an ecosystem, with keystone species providing the structural anchors through which society functions. Such keystones include critical infrastructure (the grid, telecommunications, water and sanitation etc.); the financial system; societal cohesion; supply chains, and environmental inputs (food, oil, water etc.). These are also interdependent with each other, if you remove any one of them, the others will topple. This allows us to see other paths toward systemic failure.”

It is highly doubtful that the British government can replicate the Chinese state and lock down entire regions while building a new 1,000-bed hospital in a week; it usually takes the best part of a decade for the British to conduct the obligatory planning inquiry.  In any case, medical shortages are just one weak link in the many “services” that government is responsible for providing.  If, as they say, 20 percent of the workforce is going to be off sick at the same time, there is a serious threat to our entire critical infrastructure.  The BBC has an interview with a woman from Singapore who has recovered from COVID-19 describing the experience of the disease.  Even a milder version may leave people debilitated for several days; and in any case, they will be discouraged – possibly with legal sanctions – from returning to work until they have fully recovered.  What this means is that – more or less randomly – 6,500,000 or so of the normally active UK workforce will be incapacitated.  That includes, for example, the people who operate your local nuclear power station, railway signals staff, national grid operators, water and sewage system engineers, telecommunications workers, air traffic controllers, port pilots and a host of other specialists for whom there is no replacement down at the local Job Centre.

Even sickness among relatively routine workforces may prove seriously disruptive.  What happens to local food supplies if supermarket workers become sick or regional depots have to shut down?  How might we access information in the event that data centres and media newsrooms are forced to close?

There are practical concerns here too.  Accessing food could be a serious issue for the tens of thousands of people who rely on foodbanks.  The foodbanks themselves depend upon donations by supermarkets and supermarket shoppers.  But neither is likely to be well disposed to donating food in the event that national food supplies are disrupted as a result of the virus.  Money is also an issue for the millions at the base of the income ladder.  The government has now confirmed that someone who isolated themselves to prevent the spread of the virus will qualify as being sick for the purposes of Statutory Sick Pay.  However, since this is just £94.25 per week compared to the £328.40 minimum wage, millions of the lowest paid workers will have a strong incentive to continue to work while sick; at least until their condition deteriorates or unless the state uses force to prevent them working.  And even sick pay may not be available if bank data centres go down and electronic transfers cannot be made.

The planning paper issued to the public today is less a comprehensive plan than a PR paper designed to prepare the population for state powers being deployed if and when the spread of COVID-19 grows to the point that it threatens the running of the state and critical infrastructure.  While it makes some reassuring noises about maintaining healthcare services, it also indicates the introduction of triage both to people falling ill and to service delivery.  It also contains the not-so-veiled threat of police and special courts to enforce quarantines and rationing that the public would be unlikely to accept in normal times.

In the end, however, the true threat comes not from the COVID-19 virus or from the potentially draconian state response to its spread.  The true threat is from the highly vulnerable global economy that we have collectively chosen to build in response to energy, environmental and economic crises that have been growing worse for the past 50 years; crises that can no longer be remedied…

As you made it to the end…

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