Monday, April 06, 2020

America's Hospitals In Crisis

Three Rivers, a small hospital, in a remote area of Washington state near the border with Canada had exactly nine days left before it would run out of money to pay its staff and be forced to close. That same day, its CEO learned the hospital likely had its first coronavirus patient. The hospital serves about 15,000 people scattered over 2,500 sq miles (about 6,400 sq km), according to hospital CEO Scott Graham. Its surrounding towns are tiny: one or two grocery stores, one gas station. “We think of it as more frontier than rural,” Graham said. Three Rivers hospital had scraped by for years with a smaller-than-optimal staff and careful economizing, he said. Then, Washington became the first state with a confirmed case of coronavirus, and a confirmed coronavirus death. 
Amid the coronavirus pandemic, rural hospitals play a critical role. As urban hospitals brace for a wave of seriously ill coronavirus patients, Three Rivers has been planning to use its beds to take in the overflow of other patients from those larger hospitals, helping the state hospital system as a whole stay afloat, Graham said. While Three Rivers could provide about one or two patients with ventilators, Graham said, it does not have a formal ICU, or staff trained to work with ICU patients. But it will help take in and stabilize more seriously ill coronavirus patients before sending them to a larger hospital, with more advanced equipment, about an hour away. It can only do any of these things if its own doors stay open.
On 20 March, the state’s hospital association wrote governor Jay Inslee, warning that five rural hospitals, including Three Rivers, were “facing imminent closure”.
The coronavirus pandemic has put a strain even on the wealthier parts of America’s vast, fragmented healthcare system: there are not enough beds, not enough ventilators, not enough protective equipment. But in rural communities, the stakes are different: not whether there will be enough beds at the local hospital, but whether the local hospital will be able to stay open at all. Losing a hospital is a serious blow to rural communities, whose residents are disproportionately older, and often struggle with existing health conditions.

Rural hospitals in the United States have been operating paycheck to paycheck for years, never making enough money to save up for an emergency. George Pink, the deputy director of North Carolina Rural Health Research program at the University of North Carolina at Chapel Hill.
“If a hospital misses payroll once, that can be the death knell,” Pink said. “You’re telling the community and the vendors and the staff that you’re on the ropes.”
 Now, the pandemic is threatening the survival of many rural hospitals, which would leave communities particularly vulnerable to the impact of the virus with fewer hospital beds and fewer options. At least three rural hospitals have already announced abrupt closures in recent weeks, including one in Wellington, Kansas, and two in West Virginia, leaving local residents and healthcare providers scrambling to make new plans for the pandemic. At least 128 rural hospitals have shut down in the past decade alone.

Washing their Hands

Around two-fifths of the USA rely on water utilities which have not suspended the policy of shutoffs for non-payment, despite public health warnings that good hygiene – specifically frequent hand washing – is crucial to preventing spread of the highly contagious virus.

That means millions of Americans risk losing running water if they fall behind with bill payments in coming months, as mass lay-offs triggered by the coronavirus pandemic force families to make impossible compromises on paying household expenses. Despite the evolving economic and health crises, less than 60% of the population have so far been protected from water shutoffs. And just 11% of these utilities have explicitly pledged to reconnect households currently without running water due to unpaid bills.

“This is an emergency and the priority is to stop the spread so this is a no brainer, everyone must have access to water…” said congresswoman Brenda Lawrence.“Access to water has not been a priority in this country because it’s been a poor person’s issue ... now it’s a national concern and we have to transform our mindset.”

With close to 10 millon people filing for unemployment benefits during the second half of March and an unprecedented spike in demand for emergency aid at food banks.  Almost 28 million people could lose their jobs by May, according to forecasting firm Oxford Economics. One in two American adults have either no emergency savings or not enough to cover three months of living expenses.

As unemployment reaches record highs, millions of Americans are going to have to choose between paying for food, rent and bills… water is not something people should have to trade-off,” said Mary Grant, director of water at  Food and Water Watch (FWW). “It’s a package of related factors – institutional racism, environmental injustice, and poverty – which means communities most vulnerable to Covid-19 are the same communities most vulnerable to water shutoffs,” said Grant.

The Queen's Speech

Is the US a Developed Nation?

The United States of America is a developed economy, we are told. 

Inequality scores are higher in America than they are in Mali and Yemen.

In the US  the richest 5% of people own two-thirds of the national wealth.

There are 2.9 hospital beds for every 1,000 people in the United States. That’s fewer than Turkmenistan (7.4 beds per 1,000), Mongolia (7.0), Argentina (5.0) and Libya (3.7). 

In fact, the US ranks 69th out of 182 countries analyzed by the World Health Organization.

The United States has 2.6 doctors per 1,000 people, placing it behind Trinidad & Tobago (2.7), and Russia (4.0 doctors per 1,000)

Life expectancies at birth are lower in the US than they are in Chile or China. 

The US has a higher maternal mortality rate than Iran or Saudi Arabia.

And the US ranks 81st in the world in terms of women’s political representation. So, you’ve got a better chance of making it into office as a woman if you live in Vietnam, or Albania. 

Sub-Saharan Africa is most comparable to America - 24% of seats in the region’s parliaments are held by women, the same figure as in the US.

In the United States, 83% of students graduate high school. That figure is higher in Belarus, Ukraine, Kazakhstan, Barbados, Armenia, Bosnia and Herzegovina as well as Montenegro. None of those countries are considered “developed economies” by the United Nations.

So why is the US considered as a developed economy when statistics  clearly suggest otherwise?

Its the poor that pay

The low-paid, young people and women are likely to be the hardest hit by the coronavirus shutdown of businesses including restaurants, hotels, pubs, retailers and transport services.

Low earners are seven times as likely as high earners to work in a business sector that has shut down, according to the Institute for Fiscal Studies. The body’s analysis found a third of the bottom 10% of earners worked in the worst-hit sectors, against one in 20 (5%) of those in the top 10%.
Workers aged under 25 are about two and a half times as likely to work in a sector forced to suspend trade. Companies closed under the government’s social distancing measures employed nearly a third (30%) of all employees under 25, not including full-time students who also have a job. This compares with just one in eight (13%) of workers aged 25 and over.
Women were about one-third more likely than men to work in a sector that has been shut down, as they make up the bulk of retail and hospitality workers. One in six female employees worked for businesses hit by the lockdown, compared with one in seven of their male counterparts.
Tim Roache, the general secretary of the GMB union, said: “This outbreak has shone a light on those left with more month than money. It’s confirmed the damage done by the proliferation of zero-hours agency work and bogus self-employment during the past decade. There can be no return to business as usual after this crisis.”

It Is Time For Righteous Anger

Capitalist apologists have peddled the idea that the economic system rewards the good and punishes the bad. Their ideology is suppose to incentivize desirable behaviour — i.e., thrift, hard work and keep people from laziness or imprudent spending. Social welfare is deemed problematic because, it rewards those who’ve made bad choices. what the capitalist apologists fails to understand is this: The reason that people are poor is that they have no money. That’s it. The apologists justified capitalism in which competition means accepting inequality and suffering in the name of improving efficiency for all. We accepted the price of that some face poverty, hunger, and homelessness, and we were okay with the myth that it’s natural and better for everyone (or else caused by the moral failings of those who suffer).

Believing that myth caused millions of deaths worldwide and now we face the prospect of many more. However, this time around it just might be you, your family, your neighbor or your co-worker who pays the price. Our only hope is pulling together to help one another through shared sacrifice and collective action.

Capitalism is a system designed to take the wealth that everyday working people create and hand it to an ever smaller, privileged few. And to hide that state of affairs they strategy of scape-goating by racism, and xenophobia, deliberately attempting to divide us to distract from this reality. No matter what we look like, or where we come from, most of us work hard for our families. But today, certain politicians divide us from each other based on our color, our background, or what’s in our wallets, hoping we’ll look the other way while they hand kickbacks to their corporations.
What socialists need to do is insist that life and health cannot be for sale. If a large number of people have to die in order for the economy to work, the economy doesn’t work. And it never has. No matter what we look like, where we live or what’s in our wallets, getting sick reminds us that at our core we’re all just human. But for too long, we’ve let a powerful few divide us to fill their own pockets by making life and health a product for sale.

The Global Supply Chain Breaks

Farmers cannot get their produce to consumers because of lockdowns that aim to stop the spread of coronavirus.  They can either feed their crops to animals or let them spoil.  The problem is getting plentiful supplies food to the people who need it - many of whom have suddenly lost their income. 

FAO’s  Abdolreza Abbassian, a senior economist at the United Nations Food and Agriculture Organization said. “You don’t have labor, you don’t have trucks to move the food, you don’t have money to buy the food.”

Across the globe, millions of laborers cannot get to the fields for harvesting and planting. There are too few truckers to keep goods moving. Air freight capacity for fresh produce has plummeted as planes are grounded. And there is a shortage of food containers for shipping because of a drop in voyages from China.  Exporters are grappling with a shortage of refrigerated containers to supply goods, as voyages of container ships from China to the West Coast are down by a quarter due to reduced demand because of lockdowns.  Port congestion is slowing shipments.

Hotels and restaurants that normally buy local farm produce are closed.

In India, as in many parts of the world, restrictions on population movement are wreaking havoc on farming and food supply chains and raising concern of more widespread shortages and price spikes to come. 
“Who is going to fill the grain bags and bring the produce to market, and transport it to mills?” asked Jadish Lal, a merchant in Punjab’s Khanna grain market, the country’s largest.

In America, a lack of Mexican migrant laborers to pick the harvest means growers face the prospect of rotting crops. Similar shortages of workers in Europe mean vegetable farms are missing the window to plant. Spain has a shortage of migrant workers from countries such as Morocco who cannot travel. In Italy, about 200,000 seasonal workers will be needed in the next two months. In France, Agriculture Minister Didier Guillaume has issued a rallying cry to what he called France’s “shadow army” of newly laid off workers to replace the usual migrant workers on the farms. 
“If the call is not heard, the production will remain in the fields, and the entire sector will be damaged,” said Christiane Lambert, head of France’s largest farm union, FNSEA. 

In Brazil - the world’s top exporter of soybeans, coffee, and sugar - farm lobby CNA said the industry faces a range of problems, including challenges hiring truck drivers to haul crops and a shortage of spare parts for farm equipment. In Argentina, the world’s top exporter of soymeal, exports have been delayed as the government ramps up inspections of incoming cargo ships. 

  A sharp decline in air traffic has cut deeply into capacity to move fresh produce long distances. In Canada, imports of speciality Indian vegetables such as onions, okra, and eggplant have dropped by as much as 80% in the past two weeks as air cargo space was reduced.

Clay Castelino, president of Ontario-based Orbit Brokers,  figured the sharp decline meant the food had simply gone to waste: “With perishable food, once it’s gone, it’s gone,” he said. 

Andres Ocampo,  a fruit importer, relied on commercial flights to shift papayas and other produce from Brazil.  He says volumes of the company’s imports from Brazil have dropped by 80%.
African nations - where many people spend more than half of their income on food - are among the most vulnerable to disruptions in staple food supplies. Africa is the fastest-growing consumer of rice, accounting for 35% of global imports and 30% of wheat imports. Sub-Saharan Africa alone is the third-largest rice consuming region, yet holds the smallest grain inventories - relative to demand - of all regions, because of tight government budgets and limited storage.

The Class Reality of COVID-19

2008 Great Recession should have been a wake-up call but it wasn't. Casino capitalism resurfaced very quickly.

It is suggested that there will be an increased concentration of capital due to the COVID-19 pandemic as those who have weathered the storm, pick up the wrecked businesses in take-overs and mergers at rock-bottom prices and capture the vacant markets that bankrupt companies have provided the “Big Boys” room to expand at low cost. 
This news report reinforces what I posted earlier that the pandemic offers opportunities for some capitalists to profit from:

“…assets in Latin America, Europe, the Middle East and Asia were cheap following the recent heavy falls in global stock markets….”
But unlike 2008, we now know who the essential key workers are that keeps society running. It ain’t those in the stock-exchange but those stocking the shelves in the supermarket. We have discovered the frailty of the capitalist supply chain and the weaknesses of globalisation. 

We have also re-discovered our sense of community and cooperation. Social solidarity and mutual aid has sprung up everywhere. Despite social distancing, we have grown so much closer, understanding the bonds we share with one another.
These must be the lessons workers should all be learning and it is what we must be explaining in our politics. 

Of course, it is okay for the Queen safely ensconced behind the thick walls of Windsor Castle, to bring back the Blitz Spirit and that is the desperate message of the politicians are presenting to us - even the Prince and Prime Minister were equally victims of the pandemic

The virus does not discriminate,” suggested Michael Gove after both Boris Johnson and the health secretary, Matt Hancock, were struck down by Covid-19. But capitalism does

But they suffered only the health aspects not the economic meltdown of livelihoods being taken away and the empty fridges and larders, even some of the “well-to-do” have now suffered.

We can see this in the way that the low paid both disproportionately have to continue to work and are more likely to be laid off. It is the rich having access to coronavirus tests denied to even most NHS workers.

That is the stark inequality fact they cannot disguise any longer but it will be the focus of their future class camouflage, trying to hide it from us. They may well succeed if it is not challenged. 

In the developing world “social distancing” means something very different than it does to Europeans or Americans. It is less about the physical space between people than the social space between the rich and poor that means only the privileged can maintain any kind of social isolation.

 In the Johannesburg township of Alexandra, somewhere between 180,000 and 750,000 people live in an estimated 20,000 shacks. Through it runs South Africa’s most polluted river, the Jukskei, whose water has tested positive for cholera and has run black from sewage. Makoko is often called Lagos’s “floating slum” because a third of the shacks are built on stilts over a fetid lagoon. No one is sure how many people live there, but it could be up to 300,000. Dharavi, in Mumbai, is the word’s largest slum. Like Makoko and Alexandra, it nestles next to fabulously rich areas, but the million people estimated to live there are crowded into less than a square mile of land that was once a garbage dump.

 What can social distancing mean In such neighbourhoods? 

Extended families often live in one- or two-room shacks. The houses may be scrubbed and well kept but many don’t have lavatories, electricity or running water. Communal latrines and water points are often shared by thousands. Diseases from diarrhoea to typhoid stalked such neighbourhoods well before coronavirus. The idea of protecting oneself from coronavirus must seem as miraculous as clean water.

Last week, tens of thousands of Indian workers, suddenly deprived of the possibility of pay, and with most public transport having been shut down, decided to walk back to their home villages, often hundreds of miles away, in the greatest mass exodus since partition. Four out of five Indians work in the informal sector. Almost 140 million, more than a quarter of India’s working population, are migrants from elsewhere in the country. Yet their needs had barely figured in the thinking of policymakers, who seemed shocked by the actions of the workers. India’s great exodus shows that “migration” is not, as we imagine in the west, merely external migration, but internal migration, too. Internal migrants, whether in India, Nigeria or South Africa, are often treated as poorly as external ones and often for the same reason – they are not seen as “one of us” and so denied basic rights and dignities. In one  incident, hundreds of migrants in the northern Indian state of Uttar Pradesh, were hosed down by officials with chemicals usually used to sanitise buses. They might as well have been vermin, not just metaphorically but physically, too.

Trump reportedly offers billions of dollars to a German company to create a vaccine to be used exclusively for Americans, when Germany blocks the export of medical equipment to Italy, when Britain, unlike Portugal, refuses to extend to asylum seekers the right to access benefits and healthcare during the coronavirus crisis, each does so in the name of protecting a particular community or nation. It’s a nationalism and class that excludes many groups, from Muslims to the poor.

 In Dharavi and Alexandra and Makoko, and many similar places, it will not simply be coronavirus but also the willingness of the rich, both in poor countries and in wealthier nations, to ignore gross inequalities that will kill. Capitalist society, both nationally and globally, are structured in ways that ensure that some face far more risk than others

All this should make us think harder about what we mean by “community”. In Britain, the pandemic has led to a flowering of social-mindedness and community solidarity. We have an opportunity, and it has been long time in coming, to directly relate the benefits of socialism to the realities that working people are experiencing right now.

 People are feeling the pain of capitalism but are also discovering what unites us as human beings, the relationships of family, friends, neighbours and co-workers. Some may not like the terminology and reject its use - but our class identity has been getting expressed more and more.

Socialists are looking for the silver lining in this crisis.

adapted from here