Nurses and other medics: the new revolutionary vanguard?

Forces for change

What will be the long-term consequences of the current crisis? Mark Kosman looks at the possibilities

The Conservative government’s handling of the coronavirus disaster has been chaotic from the start. Meanwhile, criticism from opposition parties has been half-hearted at best. Consequently, health professionals and scientists have had to lead the way in holding the government to account and one of the more effective critics has been the editor of The Lancet, Dr Richard Horton.

As early as January 20, Horton warned: “It must now surely be time to declare a Public Health Emergency of International Concern.” And by January 31, he was already talking about “draconian measures that limit population mobility”.1

On March 10, Horton was calling for the “urgent implementation of social distancing and closure policies”.2 And a week later, he was denouncing the Johnson government’s plan to foster what one of its top science advisors, Graham Medley, called “a nice big epidemic” in the hope of creating so-called ‘herd immunity’. Horton retorted: “Any numerate school student could make the calculation. With a mortality of 1% among 60% of a population of some 66 million people, the UK could expect almost 400,000 deaths.”3

Then on March 26, Horton spoke out on BBC television:

We knew in the last week of January that this was coming. The message from China was absolutely clear that a new virus with pandemic potential was hitting cities ... We knew that 11 weeks ago and then we wasted February when we could have acted.4

Remarkably, it was only on March 29 that the national health service coronavirus director, Keith Willett, responded to Horton, suggesting that his criticisms were unfair, because the NHS had “declared a level four - the highest - national emergency on January 30”.5

Although at first glance this seems like a credible argument, when you look into it, it turns out to be no argument at all. What you find is that, although this NHS emergency may have been declared internally on January 30, it was not announced publicly until March 3. And surely a “national emergency”, which frontline NHS staff presumably knew nothing about, can have done little to prepare the health service for the coming challenges?

Brave Sir Lawrence

With no-one in government willing or able to come up with a better response, the brave individual who stepped forward was none other than Tony Blair’s former foreign policy advisor, Sir Lawrence Freedman. On April 1, the New Statesman published an article by Freedman entitled: ‘The real reason the UK government pursued “herd immunity” - and why it was abandoned’.

Here, Freedman described the dilemmas facing the government’s scientific advisors during the crucial weeks in March, when policy shifted from allowing the development of ‘herd immunity’ to calling for a lockdown. Freedman’s narrative is informative, but it cannot explain why Boris Johnson’s advisors failed to make any preparations for a situation in which this new virus might act differently from their mathematical models.

This over-reliance on mathematical modelling has been widely criticised. For example, in an editorial in the British Medical Journal on March 30, Allyson Pollock complained that expertise in disease control and public health was being ‘sidelined’ in favour of abstract modelling.6 A former director in the World Health Organisation, Anthony Costello, has made similar complaints, warning that “the basic public health approach is playing second fiddle to mathematical modelling”.7

Freedman’s narrative has several other limitations. It cannot, for instance, explain the government’s refusal to follow WHO’s 2005 advice to prepare for mass testing. Graham Medley recently admitted that “mass public testing has never been our strategy for any pandemic”, while even suggesting that the government simply “didn’t want to invest millions of pounds into something that is about preparedness”.8

Freedman’s narrative does nothing to explain why, having supposedly dropped its ‘herd immunity’ strategy, the government then took more than a week to impose a lockdown - a week that surely cost thousands of lives. Freedman is also silent about the present chaos engulfing the NHS, and he says nothing about the systematic running down of NHS provision - under both Labour and Tory governments - that is the appalling background to this whole tragedy.

Although it is well known that, since 2000, the number of hospital beds has fallen by almost a third, the ruthless process by which this sort of ‘reform’ was imposed on the NHS is less well known. It has been memorably described by one senior treasury official in this way: “The money squeeze in the service was akin to financial ‘water-boarding’: they wanted to make hospitals feel like they were drowning, so that they would actually respond by raising efficiency.”9

Freedman’s over-emphasis on strategic planning - rather than on medical opinion and the realities in hospitals - must have something to do with the fact that he is an emeritus professor of war studies at King’s College, and it is striking that he chooses to emphasise the point that the government’s focus on ‘herd immunity’ was due to its belief that “the more the first wave leaves a large proportion of the population with a natural immunity, the better placed we are to cope with a [second wave]”.

Now, it does not take much imagination to picture strategists in No10 calculating that if the British population built up ‘herd immunity’ in the first wave of the coronavirus epidemic - when China and others did not - then the UK would have a significant economic advantage in the second wave. While other countries would have to go into another widespread lockdown during this second wave, further damaging their economies, Britain could maintain its economic activities with far less disruption.

There is, however, no need to believe in such an overt conspiracy to reach an approximate understanding of what occurred. And after decades of justifying every cutback and every policy on the grounds that the economy must come first, it is hardly surprising that the first instinct of our political leaders was to resist a lockdown at almost any cost.

In a speech given on February 3, Boris Johnson revealed that his main concern at the time was that the “coronavirus will trigger a panic and a desire for market segregation that go beyond what is medically rational, to the point of doing real and unnecessary economic damage”.10

This initial fear about the effect of the virus on capitalist globalisation was then soon replaced by a more urgent concern to ‘protect the economy and, if some pensioners die, too bad’. These chilling words have been attributed to Johnson’s top advisor, Dominic Cummings. But, even if Cummings never used this precise phrase, we all know where our rulers’ priorities lie. As one senior civil servant said about the coronavirus measures, “Is it worth the economic disruption? If you look at the treasury valuation of a life, probably not.”11

Whether a product of conspiracy or instinct, the government’s strategy has now spectacularly failed. The economic historian, Adam Tooze, has this to say about the future of the west:

[If] we take the best possible estimate of say 100,000 [US] deaths, and if we assume that the Chinese have underestimated their deaths by a factor of 10 (say they’re engaging in an extraordinary propaganda cover-up), then the stark implication of that is that, per capita, there would be 12 times more victims in the United States than in China - and America’s leading allies in western Europe are not going to do very much better by that metric …

[Those facts] will speak very loudly in the aftermath of this crisis … [From now on, politics] will be overlaid by this shattering failure of public health policy that we are beginning to see unfold in the west.12

This “shattering failure” will only be exacerbated by Donald Trump’s instinctive capitalist revulsion at any idea of a lockdown - any idea that “we’re actually paying people not to work”. As he said at the end of March, “That’s not for us!”13

Trump seems determined that a return to work is “going to happen pretty quickly”.14 On April 4 he stated: “We don’t want to be doing this for months and months and months … We’re paying people not to go to work. How about that? … We have to get back to work.”15

As a leftwing liberal, Adam Tooze has little to say about the prospects for class struggle in the present crisis. However, the Marxist commentator, Richard Wolff, does have this to say about what might happen if - in his determination to “get them back fast”16 - Trump calls on US workers to return to work before it is safe to do so:

If you have this kind of disconnect between what the ruler thinks needs to be done and what a growing mass of people … see as unbearable, outrageous and literally a threat to their health and safety, you have the condition for a system breaking down …

Millions of workers are going to likely have to decide in the weeks ahead whether they will heed the demands of the rulers to go back to work and live with the risks of a disease that can kill you or tell the ruling class we will no longer work with you ... If large numbers of people are told to go to work ... and they don’t do it, that’s a general strike, whether you call it that or not.17

Meanwhile, here in the UK, Graham Medley, is again advocating the ‘herd immunity’ strategy, so people can “catch the virus in the least deadly way possible”.18 So, it is certainly possible that British workers may find themselves facing the same dilemma raised by Richard Wolff: to obey or not obey their rulers.

Wolff’s “general strike” may be little more than wishful thinking. But there have already been a number of strikes over health and safety across the US.19 And we do need to remember that in the past few weeks the political and economic landscape has been completely transformed across the western world.

Struggle continues

In order to maintain society during months of lockdown, western governments have been compelled to underwrite much of the supposedly ‘private’ capitalist system with massive state intervention. This has already gone so far that analysts from the Macquarie Group - the world’s biggest manager of infrastructure - are now warning that the “effective nationalisation of capital, universal income guarantees and deep changes in work practice” are leading to a situation in which “Conventional capitalism is dying, or at least mutating into something that will be closer to a version of communism.”20

This “version of communism” has nothing in common with the moneyless, stateless vision that inspires genuine Marxists. It will, rather, be one in which the state enables companies such as Google and Amazon to monopolise the market - and our lives - as never before. But, now that the state is being seen to be directly responsible for the capitalist system - including everyone’s income and security - workers may start to make demands on it on a scale not seen since the social upheavals of the 1970s. As The Economist says,

The novel notion that the government needs to preserve firms, jobs and workers’ incomes at practically any cost may endure ... The policy will formally end once the pandemic has passed, but political pressure for similar support schemes - from the nationalisation of tottering firms to the provision of a universal basic income - may well be higher the next time a sharp downturn comes along. If politicians are able to preserve jobs and incomes during this crisis, many people will see little reason why they should not try again in the next one ... radical change is looming.21

The Financial Times makes a similar argument: “Radical reforms will need to be put on the table ... Policies until recently considered eccentric, such as basic income and wealth taxes, will have to be in the mix.”22

Unfortunately, the ruling class is likely to throw nationalism, repression and war into this “mix” in the hope of preventing any tendencies towards a genuine socialist transformation. And the capitalist state - no matter how ‘progressive’ - will never be the basis for such a transformation. However, the social forces which might lead us in that direction are now becoming clearer.

It was the US historian, Mike Davis, who back in 2005 predicted the present disaster in his book, The monster at our door. In a recent interview, Davis says:

Nurses are the social conscience of this country ... We have to broaden the definition of who are frontline medical workers, because it also includes nursing home staff, janitors, people who pick up garbage. It includes the Amazon warehouse workers without protection.

These people are not only our heroes and heroines right now, but have become an immensely powerful working class force for change. As socialists, we need to recognise their historical agency, expressing our solidarity in every way we can.23

Elsewhere, Davis observes that nurses - 90% of whom are women – “really are becoming the vanguard of the proletariat”.24

Inspiring words, indeed! But humanity will need more than words to get us through years of epidemics and economic crisis - years which will be especially devastating in the global south. On the other hand, inspiring words do have their place, so let me conclude with these from a recent activist’s report from Italy:

From the Dalmine steel mills of Bergamo to those of Brescia, from the Fiat-Chrysler plants of Pomigliano in Naples to the Ilva steel plant in Genoa, from the Electrolux factory of Susegana in Treviso to many small and medium-sized companies in Veneto and Emilia Romagna, from the Amazon warehouses in the provinces of Piacenza and Rieti, to the poultry and meat-processing companies in the Po Valley, there were thousands of striking workers who came out into the squares and streets, strictly at a safe distance of one metre apart from one another …

The struggle was so widespread that the government … issued a decree on March 17 with economic measures, including blocking layoffs, providing unemployment benefits [and] economic support of €600 for the month of March for self-employed workers ...

The struggle continues, even in the time of the coronavirus …25

  1. . https://twitter.com/richardhorton1/status/1223264064719216640?lang=en.↩︎

  2. . www.ft.com/content/c43b9c3e-6470-11ea-a6cd-df28cc3c6a68.↩︎

  3. . The Guardian March 25.↩︎

  4. . https://reaction.life/coronavirus-prophet-richard-horton-is-at-it-again.↩︎

  5. . www.belfasttelegraph.co.uk/news/uk/nhs-bosses-could-have-prevented-chaos-and-panic-lancet-editor-says-39083294.html.↩︎

  6. . A Pollock, ‘Covid-19: why is the UK government ignoring WHO’s advice?’ BMJ March 30.↩︎

  7. . S Boseley, ‘Coronavirus: health experts fear epidemic will “let rip” through UK’ The Guardian March 15.↩︎

  8. . ‘Exclusive: the systematic failures in the government’s pandemic strategy laid bare’ The Daily Telegraph April 2.↩︎

  9. . C Cook, ‘The NHS at capacity’: https://members.tortoisemedia.com/2020/03/30/chris-cook-coronavirus-nhs-at-capacity/content.html.↩︎

  10. . P Mason, ‘How his “Brexit” project explains Johnson’s dithering on Covid-19’ Social Europe April 6.↩︎

  11. . S Mair, ‘How will the coronavirus change the world?’: www.bbc.com/future/article/20200331-covid-19-how-will-the-coronavirus-change-the-world.↩︎

  12. . ‘Adam Tooze: world after the coronavirus crisis’: www.bloombergquint.com/in-the-news/adam-tooze-world-after-the-coronavirus-crisis.↩︎

  13. . www.rev.com/blog/transcripts/donald-trump-coronavirus-task-force-briefing-transcript-march-29-trump-extends-task-force-guidelines-to-april-30.↩︎

  14. . www.rev.com/blog/transcripts/donald-trump-coronavirus-task-force-press-conference-transcript-march-26-plans-to-classify-counties-by-covid-19-risk.↩︎

  15. . www.rev.com/blog/transcripts/donald-trump-coronavirus-task-force-transcript-april-4.↩︎

  16. . ‘Trump denies “massive recession” even as his top economic adviser warns of “terrible” economic numbers’ ABC News April 3.↩︎

  17. . ‘Covid-19 and the scourge of capitalism - dialogue between Cooperation Jackson and Richard Wolff’: www.youtube.com/watch?v=zYMsqNBMNfM.↩︎

  18. . ‘Boris Johnson’s coronavirus adviser calls for a way out of lockdown - Britain may still need to adopt herd immunity’ The Times April 4.↩︎

  19. . D La Botz, ‘The coronavirus strikes and their significance, so far’ New Politics March 31.↩︎

  20. . ‘Conventional capitalism is dying’ The Australian March 19.↩︎

  21. . ‘Rich countries try radical economic policies to counter covid-19’ The Economist March 26.↩︎

  22. . ‘Virus lays bare the frailty of the social contract’ Financial Times March 3.↩︎

  23. . ‘Mike Davis on the politics of coronavirus’: www.youtube.com/watch?v=SWkSOnlOfwA.↩︎

  24. . Jacobin podcast: ‘Dig: Mike Davis on coronavirus politics’: Jacobin podcast: www.stitcher.com/podcast/jacobin-radio-from-jacobin-magazine/jacobin-radio/e/68183239.↩︎

  25. . L Tartaglia, ‘Dispatch from Italy: class struggle in the time of coronavirus’ Labor Notes March 20.