Ian Welsh

The horizon is not so far as we can see, but as far as we can imagine

Category: health care Page 9 of 35

How We’re Making Sure Covid Goes Chronic

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On May 30, 2021

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So, you may all recall, for much of the first eight months or so of the pandemic, people would natter on about how “viruses always become less deadly.” I never bought that.

You may have noticed that Covid variants are not less deadly, but more deadly.

I was wondering about this the other day, and got my answer, courtesy of a specialist in mass murder.

In a vacuum, sure, viruses evolve towards a situation where they reproduce more, which tends toward lower lethatlity and more chronic infection. What they want, like most lifeforms, is more offspring. But this isn’t a vacuum, they’re evolving against public health measures

The first big breakout variant, the UK strain, was specifically adapted against masks. It was much more contagious, so minor mask lapses were more easily exploited. It spread more evenly, relying less on super-spreader events, and was more infectious to children, who mask poorly.

The next big breakout was the South African strain, which was part of the family of Covid strains that contain a mutation colorfully labeled “Eek” which evades antibodies, especially from natural infection or weaker vaccines, because that was/is becoming a bigger impediment than masks.

Now that MRNA vaccines are becoming the tool of choice, if the virus is allowed to continue to circulate in a partially vaccinated western population, it is only a matter of time before that becomes the biggest impediment to Covid’s success, and viruses are selected for resistance to it.

I feel a little silly not realizing this myself, as it’s Natural Selection 101.

What this means is that half-assing a workable measure only allows the virus to adapt to defeat it. If you don’t mask/shutdown/quarantine/track-and-trace properly, if vaccines aren’t quickly spread to virtually everyone, Covid adapts.

By leaving large chunks of the population effectively un-protected, we have ensured Covid’s continued evolution into forms optimized against our half-assed measures. This means everyone has to be protected and quickly, and that includes people in other countries. Just protecting your own population is not enough — especially if you half-ass it and don’t insist on compliance.

This suggests a rather bleak future for us v.s. Covid: A chronic, but still fairly deadly, disease which also gives some people long-Covid, i.e., impairment long after the initial infection.

This will allow pharma to sell booster shots every year. Pfizer wants to sell them for $150 a shot. Small and medium businesses will continue to shut and large businesses will continue to expand their market share since they can use the internet and delivery to cut around retail distribution. Those retail businesses which pretty much have to remain will continue to put workers at risk, and the same will be true of production and distribution centers, where low-paid workers must come together in large groups.

Countries which wish to opt-out of this future will have to go to hard borders with mandatory quarantines (jail sentence for skippers; track-and-trace and quick shutdowns against any break-outs). Although the main transmission vector is airborne, such countries will probably want both robots to offload freight, and then temporarily isolate shipped goods (especially anything coming in by air.)

I do hope this is all wrong and that vaccines can get Covid under control by main force, but I fear my desire for a decent future is overcoming my analytical sense when I wish for such.

In some ways, Covid has been a perfect test of humanity, which most of the “West” has failed abysmally, and we’ll discuss that more in a future article.

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CDC Decides to Just Not Count All Covid Cases

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On May 25, 2021

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If you’re vaccinated, you can still get Covid, but… (courtesy of my favorite Dalek.)

Now, the Center for Disease Control and Prevention has stopped investigating breakthrough infections among fully vaccinated people unless they become so sick that they are hospitalized or die.

Now, this may seem reasonable, but people with breakthrough Covid can give it to other people, and they can get Long Covid from it.

And, yeah, you can still die.

Earlier this year, the agency was monitoring all cases. Through the end of April, when some 101 million Americans had been vaccinated, the CDC had received 10,262 reports of breakthrough infections from 46 states and territories, a number that was very likely “a substantial undercount,” according to a CDC report issued on Tuesday….(my emphasis)

Some 995 people were known to have been hospitalized, and 160 had died, though not always because of Covid-19, the new study said. The median age of those who died was 82.

So, we’re not going to count cases unless they wind up in the hospital, but the people with Covid are still infectious and can still die (looks like about a 1.5 percent chance, based on the numbers above).

This, along with the decision to stop recommending masks for people who are fully vaccinated (which, yeah, people who don’t believe in vaccination will lie about) smacks of “the pandemic is all but over, nothing to see here.”

“If we don’t measure it, it doesn’t exist!”

Neither the CDC, nor the WHO have covered themselves in glory during this pandemic. In fact, they have burned credibility like it’s ten cent oil, and they want to set the world on fire. They said masks didn’t help, then they changed their minds. They resisted evidence that the virus was airborne vigorously, and as a result, didn’t emphasize proper ventilation. They were wrong about schools, where, yes, children and teachers do get infected and pass it on.

What should have be a disease we stomped into the ground is now likely to become chronic (also because of refusal to share vaccine manufacturing information), which will, it must be admitted, earn Pharma tens of billions of dollars every year, so I guess that’s a win. And who really needed old people, or people who are immune-compromised? Think of all the saved money on pensions and healthcare for people who are mostly worth more dead than alive to governments and corporations. (Especially since the kids of old people can spend their money. It doesn’t require mom or dad or grandpa or grandma to be alive.)

Back in the Bush era, a joke I liked was: “Stupid or evil?”

“Why not both?”

It sure is fun to be ruled by incompetent psychopaths.

Over in Britain, the government is now trying to deny that they started off with a herd immunity strategy: “Let almost everyone get it and who cares if grandma dies?” But anyone with a memory span of more than year remembers that they did.

Psychopaths. The rich get richer if Covid isn’t stopped. The richest people in the world have seen massive increases in their wealth and income because of Covid. Life is fucking marvelous and Covid has been a blessing.

Understand this in your bones. The people making decisions not only don’t care if you die, if you dying will make them richer or more powerful, they’ll go with the decision path that leads to you or your mum or your best friend dying or winding up homeless. You are nothing to them, you’re meat. A prey animal.

Welcome to late-stage capitalism.

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Neoliberalism in India and Covid Deaths

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On May 18, 2021

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I’ve had my eye on India ever since I found out that calories per capita had dropped in India over the last 30 years.

That’s not what happens when things are going well, unless a huge number of people have moved to sedentary jobs, which they had not.

Neoliberalism is about production and supply trains. They’re very complicated, and the parts for a finished good may be made in a dozen countries and shipped to a plant which does the final assembly. The IP holder often skims ten to 30 percent profit off of this.

Most countries currently industrialized didn not industrialize under neoliberalism. They ran protectionist trade policies and exported their way to mature economies. That was generally allowed because they were a military ally or satrapy. Japan was first Britain’s ally, then for the US. Taiwan and South Korea were American satrapies, etc.

China used a hybrid model. They got themselves into the supply chains by offering high profits to Westerners, generally through simple wage arbitrage (“our workers cost less”). They put heavy pressure on people who took those profits to give them their technological secrets (IP) in exchange. And for much of the early period, they also ran a protectionist policy, keeping their currency low against the US dollar. They turned neoliberalization into mercantalism, and because less than five countries have EVER industrialized under any system but mercantalism, they succeeded.

They were able to do this because they made it very worth the while for greedy Western elites to ship jobs to them; they made a lot of Western elites rich. They knew exactly the deal they were offering.

India was socialist for a long time. They felt it didn’t work, so they decided to try neoliberalism.

But, they ran into the fact that it made more sense to offshore to China, and they didn’t do neoliberalism smart — they didn’t control their currency properly or find another way to turn neoliberalism into mercantalism. China kept large parts of their economy state-controlled, and used those companies actively. Yes, state-controlled companies were less efficient, but they gave the State power, and they provided ways of spreading welfare to people that the private companies weren’t taking care of. Not immiserating too many people meant making sure that Chinese citizens saw the new industrial and trade policies as good for them.

India, on the other hand, got in mostly on service jobs. “We speak English, so we can do service center stuff,” and a fair bit of IT outsourcing and offshoring.

But they neoliberalized as if they were already a first world nation; they sold off public enterprise and gutted state control over the economy as if there were a huge surplus created by decades of good growth which could be cannibalized to create a rich class.

India did create a small new middle class and rich, yes, but they did so without creating widespread prosperity.

Because of the way human psychology works (we have a strategy, it has not worked, we must do it harder because we are always right until we are overthrown), when the old elites couldn’t really make this work, a toxic mix of neoliberalism and Hindu Nativism took control of the country, with the face of Modi.

Modi’s a right-wing nationalist, verging-on-fascist (some would take out the word “verging”). But he’s also a neoliberal’s neoliberal. Practically, his first act was to de-monitize: removing large bills from circulation and forcing poor people to use electronic money. This was sold as crushing corruption, but what it did was make sure that the government and financial elites could grab more money from more transactions, while crushing the informal economy most Indians live in.

Recently, he’s passed a law which allows farms to be bought more easily. And so they will be (farmers, not being idiots, have opposed this law).

So Modi’s run the same play you can see in right-wing parties around the world: He’s offered nativism and feel-good, right-wing identity politics (Hindus are the best, Muslims are scum, get rid of them, no Hindu girl should marry a Muslim, etc.), and then run policies which will, over time, hurt the poor and create more rich.

But these general policies were running long before Modi.

One of those policies that has now been brought to light by Covid is that the public health care sector was gutted under neoliberal governments, so that private healthcare could make more money. So now, when it’s needed, there isn’t enough public (or private) care around.

This is how neoliberalism works: It looks for a public good and then it gets rid of it. This can be a regulation which, if removed, allows profit (making it hard to buy farms means they can’t be bought up and turned into large cash farms; cutting pollution rules means someone makes more money, etc.) or it can be by making public services shitty, or selling them off to the private sector, or other variations.

Again, in a developed country with a large prosperity cushion like the US, France, or Canada, you can do this for a while, and it doesn’t look so bad.

If, on the other hand, you do this to a country which had never hit developed status in the first place, well, people eat less calories, and when a pandemic happens, hospitals turns away patients in droves.

Neoliberalism doesn’t work when trying develop or industrialize countries, unless you game it so it turns into protectionist trade. China did that, India didn’t, and Indians are now paying the price.

Neoliberalism is designed to create rich elites while crushing ordinary people. In India’s case, it also created a small middle class (because that’s rich, really, in India, as anyone who’s spent much time there knows. Middle class means you have servants, for example. It’s not middle class like in The US or Europe.)

Neoliberalism is not designed to help anyone but the rich, except temporarily. Some asset holders will win (say, if you owned a house in 1980 in the US and didn’t sell until retirement, then moved somewhere cheap.)

But no other groups win for any length of time, because neoliberalism is the policy of looting, of pumping asset prices and of crushing wages. That’s the policy regime. It does what it’s meant to: It creates a rich class and, for a while, it keeps enough people supporting it who won’t win the end (unless they die soon enough) by giving them large, unearned asset price increases that are much greater than inflation.

India needs a new strategy. The overwhelming of its medical infrastructure is exactly the result of the neoliberal policies it has followed for decades. Modi is only the latest and worst, not the first.

I wish the Indians well. They have a very challenging few decades ahead of them, perhaps the most challenging of any non-African large country in the world. I hope they get their act together, ASAP, or a lot more Indians than Covid is killing will die, and die ugly, as climate change, ecological collapse, and water shortages hit.

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Biden Defies Pharma Plan to Never Wipe Out Covid So They Can Profit Forever

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On May 10, 2021

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So, this is a good thing. As is often the case with monopoly-related issues, the best explanation comes from Matt Stoller, and let’s start with why Pfizer and Moderna don’t want this to happen.

On an investor call last month, the CEO of Pfizer, Frank D’Amelio, discussed what would happen to revenue from his vaccine product as the Covid pandemic ends, what he called the “durability of the franchise.” He told analysts not to worry. People in rich countries will need annual booster shots, and that is where Pfizer will make real money.

For these annual treatments, Pfizer will be able to charge much more than it does now. The current price for a covid vaccine, D’Amelio noted, is $19.50 per dose. He told analysts of his hope that Pfizer could get to a more “normal” price, “$150, $175 per dose,” instead of what he called “pandemic pricing.”

This is to say, that if Covid is not defeated, then Pfizer and Moderna can charge everyone who can afford it $150/year (and maybe twice a year) for the rest of history.

Nice money, if you can get it, and based on simple pharma economics, which I’ve long pointed out, that selling a palliative which patients have to keep buying is a lot more profitable than selling a cure. Pharma doesn’t want cures: They want you on their pills or shots for the rest of your life.

Fortunately, as Stoller points out, Pharma’s out-gunned this time:

  1. No other industry wants more Covid shutdowns, so they’re up against every other economically powerful lobby
  2. The US diplomatic and military centers are livid that China and Russia are getting credit for sending vaccines that aren’t as good, while the US looks like the bad guy. So the generals are arguing for breaking the patents.

Because it comes up every time I write about this, let us note that Moderna’s former director of Chemistry said that with help, “a modern factory should be able to get vaccine production going in, at most, three to four months.”

Let us assume that the number is double that, and remember that many countries aren’t expecting to be able to start mass vaccination until 2023. Let us remember that if we had just broken the patents six or seven months ago, the first ones from new factories would be starting up now.

mRNA is a moderately difficult technology. There are real supply chain issues. There are also huge countries, technologically advanced enough, who have every incentive to move heaven and earth to solve those issues if they know how.

Anyway, Biden is doing the right thing here, presuming this doesn’t turn into a “make promises then drag the process out” situation.

We’re gong to discuss IP more, because it’s at the heart of the way that modern supply chains mostly return more profits to rich people in the Western world, which is at the heart of why the US and China are hustling towards the next Cold War.

The Chinese are real neoliberals who believe in supply chain fragmentation. They just think they should be ones reaping the profits at the center, not the West.

Meanwhile, let’s hope that mRNA is released, and Covid ends. I don’t know about  you, but I’m damn sick of seeing people die who didn’t need to.

 

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The Catastrophic Covid Crisis in India

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On April 23, 2021

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I follow a fair bit of Indian media, as a lot of it is English language, and the last few days in India have unveiled a Covid situation far worse than the stats suggested. People are scrambling for oxygen in particular, with patients in hospitals dying because of its lack. There isn’t enough medicine and bodies of Covid victims are being burned in vast numbers.

At the start of the Covid crisis, I figured that India, with its vast population, inadequate health infrastructure, corruption and idiotic leadership in the form of Modi would be a fiasco. It seemed like it wasn’t so bad, and I couldn’t figure out why, but decided that since I haven’t been  there in decades there was a factor I was missing.

Turns out the main factor was probably under-counting Covid cases.

Meanwhile, where I live in Ontario, Canada, the situation is also dire, though not as bad as in India, with ICUs in the largest metropolitan center so full, they’ve had to move patients in large numbers out.

Worse, the Premier had non-ICU Covid patients moved to long-term care homes — exactly the move that New York governor Cuomo made that caused New York’s LTC disaster and which amounted to him committing mass manslaughter, for which he should go to prison.

Again, Ontario is a place where, at the start of the pandemic, I figured it would be a catastrophe because Doug Ford, the Premier, is a noted incompetent who’s also probably a sociopath or psychopath. In his youth, he was a drug dealer who allegedly enjoyed beating people  up.

But Covid seemed to be going better than I expected, until it wasn’t.

It turns out that bad leadership (Cuomo is also a psychopathic incompetent) is a good predictor for who did catastrophically bad with Covid.

In India, Modi is the fool who demonitized India, getting rid of large bills in an effort to crush corruption, but instead massively damaging the informal cash economy which most Indians live in. Any idiot knew that India, of all countries in the world, was one of the least candidates to move hard towards more e-cash, but Modi is an idiot’s idiot, enamoured both with right-wing Hindutva religious ideology and with neoliberalism, because Indian socialism didn’t work well, so the solution is obviously to do the opposite form of stupdity.

I don’t really have a moral here, except the obvious: that leadership does matter, and that one’s initial impression of competence is usually right. Modi’s incompetent. Cuomo’s incompetent. Trump was incompetent. Ford is incompetent. All of them are also malign: They don’t care about what happens to other people. Ford famously stole money from his brother’s widow, so he isn’t even in the Biden class of at least being good to his own family.

Probably, electing evil, incompetent people is a bad idea, and we should do less of it.

If I wind up dead from Covid, feel free to blame Ford, with a sidecar of blame for Canadian Prime Minister Justin Trudeau, who has refused to treat Canada as a country and take charge of Covid efforts in provinces, where the Premiers are incompetent.

As for India, the Indians have my deepest sympathies, and if you don’t care about them, remember that India has the world’s largest vaccine industry, and those vaccines will not be leaving India until Covid is under control there, which means catastrophe in India will hurt many countries, allow even more variants to be created, and kill a hell of a lot more people, far from India.

Turns out that electing an evil moron like Modi effects countries far from India, just as electing Trump, Obama, or Bush effected countries far from the US. Leaders of powerful countries, and India is powerful, matter beyond their borders.

Good luck to everyone led by shitty leaders, Indian, Canadian, and other. In the future, let us remember that mean assholes are usually also incompetent, and to stop electing them.

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Only Zero Covid Worked and Everyone Knows It

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On April 6, 2021

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Vietnam has a population of 96 million and 34 Covid Deaths.

America has a population of 328 million and 550,000 Covid Deaths.

 

Australia has a population of 25 million, and 909 deaths.

The UK has a population of 67 million people and 127,000 deaths.

 

South Korea has a population of 52 million, and 1,752 deaths.

Germany has a population of 83 million, and 77,136 deaths.

 

Now here’s the thing, this has been known for at least six to eight months.

You shut down everything except actual essential services until cases are essentially at zero. You track and trace. You quarantine travelers. Any outbreaks afterwards, you shut down the area, HARD.

You can avoid mass lockdowns ONLY if you track and trace furiously at the start, with immediate traveler quarantine, and local quarantines as necessary, along with a mask mandate and other such policies. (See, Taiwan.) Never let Covid get out of control, and no widespread lockdown is necessary.

This works.

Taiwan, population 23 million, 10 deaths

New Zealand, population 5 million, 26 deaths.

Sweden, population 10 million, 13.5K deaths.

So, any government which had the capacity to do this and did not, after the first wave proved it worked, essentially chose to kill a huge number of people who didn’t need to die. Mass negligent homicide, at best.

It also turns out, to the surprise of no one with two brain cells, that Zero Covid produces better economic results than reopening repeatedly and allowing multiple waves.

What Zero Covid doesn’t do, however, is make the rich much, much richer while everyone else suffers. US billionaires increased their wealth 44 percent; 1.3 trillion, over the course of the pandemic until March.

That is SWEET. Forty-Four percent in about a year. Holy shit. This last year has to be one of the best times ever to the filthy rich.

Each US Covid death was worth $4,268 to America’s billionaires.

Is it any wonder that Covid was allowed to reign largely unchecked?

What a great time to be a billionaire! And it isn’t even over yet!

Edit: Article corrected to include the strategy which works with no or limited lockdowns.

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Offshoring Critical Industries Is So Harmful It Should Be Treason (Covid Edition)

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On March 25, 2021

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I was impressed how fast the UK and the US were vaccinating their population. How were they doing it, after they had been so incompetent during the rest of the pandemic?

Simple enough. Restrictions on vaccine exports.

Meanwhile:

India delays big exports of AstraZeneca shot, including to COVAX, as infections surge

And then there’s this:

(Spare me the self-serving arguments that breaking the patents wouldn’t have helped because it takes too much time to ramp up production. However long it takes, the sooner  your open up the IP, the faster it happens.)

And we could make it happen faster:

But the global capacity for producing vaccines is about a third of what is needed, says Ellen t’Hoen, an expert in medicines policy and intellectual property law.

….

To make a vaccine you not only need to have the right to produce the actual substance they are composed of (which is protected by patents), you also need to have the knowledge about how to make them because the technology can be complex.

The WHO does not have the authority to sidestep patents – but it is trying to bring countries together to find a way to bolster vaccine supplies.

The discussions include using provisions in international law to get around patents and helping countries to have the technical ability to make them.

Rich countries use IP law to keep poor countries poor, and to kill and impoverish their citizens to make even larger profits.

And, of course, if you’re stupid enough to believe neoliberal bullshit about how your countries will be OK and don’t take steps even though you have manufacturing capacity, (Europe), well, your citizens die. The EU is now restricting imports to the UK. I wonder how many Europeans will die because of not having those 10 million doses?

“I mention specifically the U.K.,” said EU Commission Vice-President Valdis Dombrovskis. Since the end of January, “some 10 million doses have been exported from the EU to the U.K. and zero doses have been exported from U.K. to the EU.”

OK. I have said this for years and years but I’m going to say it again now that it is being illustrated brutally: if you can’t make it yourself, you can’t be sure you’ll have it when you need it, since countries that can make it will tend to prioritize themselves.

You must make and grow everything essential to your country domestically if you can. Any international laws that forbid you from doing so are illegitimate. They may exist; they are not Just. This doesn’t mean completely breaking patent law (though it needs to be much less draconian and a lot less long), it does mean, at the least, writing in mandatory licensing provisions at reasonable prices.

A lot of people are going to die who didn’t need to because neoliberal “free trade” orthodoxy said you didn’t need to be able to both design and make vaccines in your own country: the “market” would supply you.

Eventually.

This isn’t just about behaviour now. It is about behaviour that has been encoded into law and trade practice over decades.

Don’t offshore anything that matters. If your citizens have to pay 5% or 10% more, slap on tariffs.

To not do so, if you think the welfare of your citizens is your duty, is treason.

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The Simplest Explanation For Not Breaking Covid Vaccine Patents

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On February 15, 2021

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The faster we get everyone immunized, throughout the world, the more likely we can stop Covid from going chronic, becoming the new flu (but more deadly, unless/until it mutates to become less fatal, which the untried models say it should.)

However, if Covid is cured, well, you can’t make money off Covid any more, can you?

Chronic Covid, mutating constantly, means more and more vaccines, and more and more and more money for vaccine makers.

Ghastly, and I know that many readers are probably, “that’s absurd”, but consider, does it have both explanatory and predictive power?

Does, “Covid makes the rich, richer so they want it to keep going” have explanatory and predictive power?

Qui Bono? Who benefits? Since the people who run our societies profit from Covid, why would they actually want it over (remember, billionaires have become vastly richer.)

I, too, dislike living in a society where this explanation has stronger predictive power than “our leaders don’t want us to die in large numbers, and become poverty-struck, just so they can get richer,” but that statement, well, look at it closely. If that was true, how would our rulers behave? Not just during Covid, but at other times?

Yeah.

I mean, I’ve been saying this sort of thing for a while, because it’s obviously true, but I’m embarrassed it took me so long to realize it applied to vaccine creators as well, especially since Pharma has a well-known bias towards medicines that are palliatives, not cures. Someone who needs your medicine again and again is much better than someone who needs it only once.

Gotta admire the pure predator instinct in our rulers. They’re the wolves, we’re the sheep and God, do they love mutton.

It’s them or us, and so far, it’s us.

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