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Friday, March 27, 2020

The six horsemen of the Apocalypse

The COVID-19 exposes the underlying weaknesses of the system. When the economic meltdown hit Europe in 2008, the European Union responded by instituting painful austerity measures that targeted things like health care. Over the past 10 years Italy has cut some 37 billion euros from its health system. The infrastructure that could have dealt with a health crisis like Covid-19 was hollowed out, so that when the disease hit, there simply weren’t enough troops or resources to resist it. What happened was that hospitals eliminated surplus beds and surplus personnel. Hospitals were under-staffed with massive nurse shortages. During this pandemic more important than doctors are nurses. Nursing could ease the strain of a patient, keep a patient hydrated, calm, provide the best nutrition, and cool the intense fevers. Nurses gave victims the best possible chance to survive.

Italy has the oldest population in Europe, and one of the oldest in the world. It did not get that way be accident. Right-wing parties have long targeted immigrants, even though the immigrant population—a little over 600,000—is not large by international standards. Immigrants as a “threat to European values” has been the rallying cry for the right in France, Germany, Hungry, Poland, Greece, Spain, the Netherlands and Britain as well.

Italy has the fourth largest economy in the European Union, and in terms of health care, it is certainly in a better place than the US. Per capita, Italy has more hospital beds—so-called “surge capacity”—more doctors and more ventilators. Italians have a longer life expectancy than Americans, not to mention British, French, Germans, Swedes and Finns. The virus has had an especially fatal impact on northern Italy, the country’s richest region.

Resistance to immigration plays a major role in “graying” the population. Italy has one of the lowest birthrates in the world, topped only by Japan. The demographic effects of this are “an apocalypse” according to former Italian Health Minister Beatrice Lorenzin. “In five years, we have lost more than 66,000 births [per year]” equal to the population of the city of Siena. “If we link this to this increasingly old and chronically ill people, we have a picture of a moribund country.”

Resistance to immigration plays a major role in “graying” the population. Italy has one of the lowest birthrates in the world, topped only by Japan. The demographic effects of this are “an apocalypse” according to former Italian Health Minister Beatrice Lorenzin. “In five years, we have lost more than 66,000 births [per year]” equal to the population of the city of Siena. “If we link this to this increasingly old and chronically ill people, we have a picture of a moribund country.”

According to the World Health Organization, the ideal birth-death replacement ratio in advanced countries is 2.1. Italy’s is 1.32., which means not only an older population, but also fewer working age people to pay the taxes that fund the social infrastructure, including health care. The EU-wide replacement ratio is a tepid 1.58, with only France and Ireland approaching—but not reaching—2.1. While the US replacement ratio is higher than the EU’s, it still falls under 2.

Some 60 percent of Italians are over 40, and 23 percent are over 65. It is demographics like these that make Covid-19 so lethal. From age 10 to 39, the virus has a death rate of 0.2 percent, more deadly than influenza, but not overly so. But starting at age 40, the death rate starts to rise, reaching 8 percent for adults age 70 to 79, and then jumping to 14.8 percent over 80. The average age of coronavirus deaths in Italy is 81.

Spain also has a bleeding population, particularly in small towns, some 1500 of which have been abandoned. Spain has weathered a decade and a half of austerity, which damaged the country’s health care infrastructure. After Italy, Spain is the European country hardest hit by Covid-19.

As populations age, immigrants become a necessity. Not only are new-comers needed to fill in the work needs of economies, broadening the tax base that pays for infrastructure, but, too, old people need cared for.

If Germany does not increase the number of migrants it takes, the population will decline from 81 million to 67 million by 2060, reducing the workforce to 54 percent of the population, not enough to keep up with current levels of social spending. The Berlin Institute for Population and Development estimates that Germany will need 500,000 immigrants a year for the next 35 years to keep pensions and social services at current levels.

To the Bible’s four horsemen of the Apocalypse we can add two more - profits and austerity.
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