What we have learnt about the limits of science

Thiago Carvalho in The FT

Some years ago, on New Year’s Day, my wife and I noticed that our son, not yet two months old, was struggling to breathe — a belaboured, wheezing effort was all he could manage — and we decided to face the holiday emergency room crush. After assessing his blood oxygen levels, the pediatrician said: “Pack a bag, you will be here all week. He will get worse. Then he will get better.”  

Our son had contracted something called respiratory syncytial virus, and it was replicating in his lungs. In a scenario similar to Covid-19, most healthy adults infected with RSV will experience a mild cold, or no symptoms at all. However, some unfortunate infants who contract RSV may suffer a devastating pulmonary infection. For those kids, there are no drugs available that can reliably stop, or even slow down RSV’s relentless replication in the lungs. 

Instead, according to Mustafa Khokha, a pediatric critical care professor at Yale University, doctors first give oxygen and then if the child does not improve, there follows a series of progressively more aggressive procedures. “That’s all supportive therapy for the body to recover, as opposed to treatment against the virus itself,” says Khokha. Outstanding supportive care was what our son received, and the week unfolded exactly as his pediatrician predicted. (It was still the worst week of my life.)

For all the progress we have seen in 2020, a patient brought to the emergency room with severe Covid-19 will essentially receive the same kind of supportive care our son did — treatment to help the body endure a viral assault, but not effectively targeting the virus itself. The main difference will be the uncertain outcome — there will be no comforting, near-certain “he will get better” from the attending physician. 

Contrast that story with a different one. On a Tuesday morning in early December, in the English city of Coventry, Margaret Keenan, just a few days shy of her 91st birthday, became the first person in the world to receive the BioNTech/Pfizer Covid-19 vaccine outside of a clinical trial. The pace of progress was astonishing. It was less than a year since, in the closing moments of 2019, Chinese health authorities alerted the World Health Organization to an outbreak of a pneumonia of unknown cause in Hubei province.  

The Covid-19 pandemic has given us an accelerated tutorial on the promise and the limits of science. With vaccines, testing, epidemiological surveillance, we know where we are going, and we have a good idea how to get there. These are essentially challenges of technological development, reliant now on adequate resources and personnel and tweaking of regulatory frameworks. For other scientific challenges, though, there may be no gas pedal to step on — these include the prickly problems of arresting acute viral infection, or understanding how the virus and the host interact to produce disease. Science, as Nobel Prize-winning immunologist Peter Medawar put it, is the art of the soluble. 

In March, when, incredibly, the first human vaccine trials for Covid-19 were kicking off in Seattle, the WHO launched an ambitious clinical trial to try to identify existing pharmaceuticals that could show some benefit against Sars-Cov-2. In October, the WHO declared that all four arms of its Solidarity trial had essentially failed. The search for effective antiviral drugs has not lacked resources or researchers, but in contrast to the vaccine victories, it has yet to produce a single clear success story. The concentrated efforts of many of the world’s most capable scientists, relying on ample public support and private investment, are sometimes not enough to crack a problem. 

Perhaps nothing exemplifies this more clearly than what followed Richard Nixon’s signing of the National Cancer Act on December 23 1971. The act was cautiously phrased, but January’s State of the Union address declared an all-out war on cancer: “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease.” The war on cancer would funnel almost $1.6bn to cancer labs over the next three years, and fuel expectations that a cure for the disease would be found before the end of the decade. Curing cancer remains, of course, an elusive target. In 2016, then vice-president Joe Biden presented the report of his own Cancer Moonshot task force. 

The success of the Apollo program planted the Moonshot analogy in the science policy lexicon. Some grand challenges in biology could properly be considered “moonshots”. The Human Genome Project was one example. Like the race to the Moon, it had a clear finish line: to produce a draft with the precise sequence of genetic letters in the 23 pairs of human chromosomes. This was, like the propulsion problems solved by Nasa en route to the Moon, a matter of developing and perfecting technology — technology that later would allow us to have a genetic portrait of the cause of Covid-19 in under two weeks.  

The cancer context was rather different. In the countdown to the war on cancer, Sol Spiegelman, the director of Columbia University’s Institute of Cancer Research, quipped that “an all-out effort at this time [to find a cure for cancer] would be like trying to land a man on the Moon without knowing Newton’s laws of gravity.” And so it proved. 

We now know quite a lot about how the body resists viral infections, certainly much more than we knew about the biology of cancer in 1971. Over 60 years ago, at London’s National Institute for Medical Research, Alick Isaacs and Jean Lindemann exposed fragments of chicken egg membranes to heat-inactivated influenza A virus. In a matter of hours, the liquid from these cultures acquired the capacity to interfere with the growth of not only influenza A, but other, unrelated viruses, as well. Isaacs and Lindemann named their factor interferon. Interferons are fleet-footed messengers produced and released by cells almost immediately upon viral infection. These molecules warn other host cells to ready themselves to resist a viral onslaught. 

Viruses rely on hijacking the normal cellular machinery to make more copies of themselves and interferons interfere with almost all stages of the process: from making it more difficult for the virus to enter cells, to slowing down the cellular protein factories required to make the viral capsule, to reducing the export of newly made viral particles. Interferons are now part of our pharmaceutical armoury for diseases as diverse as multiple sclerosis and cancer, as well as hepatitis C and other chronic viral infections. 

Multiple interferon-based strategies have been tried in the pandemic, from intravenous administration to nebulising the molecule so that the patient inhales an antiviral mist directly into the lungs. The results have been inconclusive. “A lot of it has to do with the timing,” says Yale immunologist Akiko Iwasaki, “the only stage that recombinant interferon might be effective is pre-exposure or early post-exposure, and it’s really hard to catch it for this virus, because everyone is pretty much asymptomatic at that time.”  

This year’s scramble for effective antiviral drugs led to a revival of other failed approaches. In 2016, a team of researchers from the United States Army Medical Research Institute of Infectious Diseases in Frederick, Maryland, and the biotech company Gilead Sciences reported that the molecule GS-5734 protected Rhesus monkeys from being infected with the Ebola virus. GS-5734, or as it is more familiarly known now, remdesivir unfortunately failed in clinical trials. This was a bona fide antiviral, backed up by demonstrations that the drug efficiently blocked an enzyme used by viruses to copy their genome. Ebola was already remdesivir’s third dead-end: Gilead had previously tested GS-5734 against hepatitis C and RSV, and the results were disappointing. 

 In late April, National Institute of Allergy and Infectious Diseases director Anthony Fauci, a member of the White House coronavirus task force, proclaimed that the US remdesivir trials had established “a new standard of care” for Covid-19 patients. As has happened repeatedly during the Covid-19 crisis, the data backing this claim not been made public, nor had it, at the time, been peer-reviewed. 

Fauci explained that the drug had no significant effect on mortality, but claimed that remdesivir reduced hospitalisation times by about 30 per cent. It was the first piece of good news in a spring marked by global lockdowns. Unfortunately, results from a large-scale trial run by the WHO released in the autumn failed to support even the limited claims of the US study (Gilead has challenged the study’s design), and the WHO currently advises against giving remdesivir to Covid-19 patients.  

For those who do not naturally control Sars-Cov-2 infection, or who have not been vaccinated, the failure to repurpose or create effective antiviral agents leaves supportive care. We are only beginning to understand the interplay of this new virus and human hosts. It is also a protean affliction, as sex, age, and pre-existing conditions all affect outcomes. The single clearest way to reduce mortality remains the dexamethasone treatment for patients requiring supplemental oxygen initially reported in the UK Recovery trial. It is not a direct attack on the virus, but a way to ameliorate the effects of infection and the immune response to it on the human body. Dexamethasone is, in a very real sense, supportive care. 

So what have we learned about the limits of science? First, we were reminded that spectacular successes are built on a foundation of decades of basic research. Even the novel, first-in-class vaccines are at the end of a long road. It was slow-going to get to warp speed. We learned that there are no shortcuts to deciphering how a new virus makes us sick (and kills us) and that there is no ignoring the importance of human diversity for cracking this code. Diabetes, obesity, hypertension — we are still finding our way through a comorbidity labyrinth. Most of all, we have learned an old lesson again: science is the art of the soluble. No amount of resources and personnel, no Manhattan Project, can ensure that science will solve a problem in the absence of a well-stocked toolbox and a solid, painstakingly built theoretical framework. 

South Korea recorded its first Covid-19 case on January 20. Eleven days later, Spain confirmed its first infection: a German tourist in the Canary Islands. Spain and South Korea have similar populations of about 50m people. As of publication of this piece, South Korea has had 879 deaths, while Spain reports over 50,000. The west missed its moment. Efficient testing, tracing and containment of Covid-19 was a soluble technological and organisational problem. Here too, we can hear echoes of the war on cancer. The biggest single reduction in cancer mortality did not come from a miracle drug. It was the drop in lung cancer deaths, due to what we could call the war on tobacco. Perhaps Dr Spiegelman might concede that even if we don’t have a law of gravity, we do have a first law of medicine: always start with prevention. 

Covid-19 has pushed science to its limits and, in some cases, sharply outlined its borders. This century’s first pandemic finds humanity, with its transport hubs and supply chains, more vulnerable to a new pathogen. But virology, immunology, critical care medicine and epidemiology, to name a few, have progressed immeasurably since 1918. Unfortunately, in a public health emergency, the best science must be used to inform the best policies. In the seasonal spirit of charity, let us say that that has not always been the case in our pandemic year. 

A coronavirus vaccine could split America

In the battle between public science and anti-vaxxer sentiment, science is heavily outgunned writes Edward Luce in The FT

It is late October and Donald Trump has a surprise for you. Unlike the traditional pre-election shock — involving war or imminent terrorist attack — this revelation is about hope rather than fear. The “China virus” has been defeated thanks to the ingenuity of America’s president. The US has developed a vaccine that will be available to all citizens by the end of the year. Get online and book your jab.  

It is possible Mr Trump could sway a critical slice of voters with such a declaration. The bigger danger is that he would deepen America’s mistrust of science. A recent poll found that only half of Americans definitely plan to take a coronavirus vaccine. Other polls said that between a quarter and a third of the nation would never get inoculated. 

Whatever the true number, anti-vaccine campaigners are having a great pandemic — as indeed is Covid-19. At least three-quarters of the population would need to be vaccinated to reach herd immunity. 

Infectious diseases thrive on mistrust. It is hard to imagine a better Petri dish than today’s America. Some of the country’s “vaccine hesitancy” is well grounded. Regulators are under tremendous pressure to let big pharma shorten clinical trials. That could lead to mistakes. 

Vaccine nationalism is not just about rich governments pre-ordering as many vials as they can. It is also about winning unimaginably large bragging rights in the race to save the world. Cutting immunological corners could be dangerous to public health. 

Such caution accounts for many of those who would hesitate to be injected. The rest are captured by conspiracy theories. In the battle between public science and anti-vaxxer sentiment, science is heavily outgunned. It faces a rainbow coalition of metastasising folk suspicions on both the left and the right. Public health messages are little match for the memology of social media opponents. 

It is that mix of technological savvy and intellectual derangement that drives today’s politics. Mr Trump did not invent postmodern quackery — though he has endorsed some life-threatening remedies. The irony is that he could fall victim to the mistrust he has stoked.  

Should an effective vaccine loom into view before the US goes to the polls in 95 days, Mr Trump would not be the ideal person to inform the country. The story is as old as cry wolf. Having endorsed the use of disinfectants and hydroxychloroquine, Mr Trump has forfeited any credibility. Validation should come from Anthony Fauci, America’s top infectious-diseases expert, whose trust ratings are almost double those of the president he serves. 

Even then, however, the challenge would only just be starting. There is no cause to doubt the world-beating potential of US scientific research. There are good reasons to suspect the medical establishment’s ability to win over public opinion. 

The modern anti-vaxxer movement began on the left. It is still going strong. It follows the “my body is my temple” philosophy. Corporate science cannot be trusted to put healthy things into our bodies. The tendency for modern parents to award themselves overnight Wikipedia degrees in specialist fields is also to blame. 

Not all of this mistrust is madcap. African Americans have good reason to distrust public health following the postwar Tuskegee experiments in which hundreds were infected with syphilis and left to fester without penicillin. Polls show that more blacks than whites would refuse a coronavirus vaccine. Given their higher likelihood of exposure, such mistrust has tragic potential. 

But rightwing anti-vaxxers have greater momentum. America’s 19th century anti-vaccination movements drew equally from religious paranoia that vaccines were the work of the devil and a more general fear that liberty was under threat. Both strains have resurfaced in QAnon, the virtual cult that believes America is run by a satanic deep state that abuses children. 

It would be hard to invent a more unhinged account of how the world works. Yet Mr Trump has retweeted QAnon-friendly accounts more than 90 times since the pandemic began. Among QAnon’s other theories is that Covid-19 is a Dr Fauci-led hoax to sink Mr Trump’s chances of being re-elected. Science cannot emulate such imaginative forms of storytelling. 

All of which poses a migraine for the silent majority that would happily take the vaccine shots. Their lives are threatened both by a pandemic and by an infodemic. It is a bizarre feature of our times that the first looks easier to solve than the second. 

Does Modern Medicine have a Platypus Problem?

By Girish Menon

“Early zoologists classified as mammals those that suckle their young and as reptiles those that lay eggs. Then a duck-billed platypus was discovered in Australia laying eggs like a perfect reptile and then, when they hatched, suckling the infant like a perfect mammal.
The discovery created quite a sensation. What an enigma! it was exclaimed.

What a mystery! What a marvel of nature! When the first stuffed specimens reached England from Australia around the end of the eighteenth century they were thought to be fakes made by sticking together bits of different animals. Even today you still see occasional articles in nature magazines asking ‘Why does this paradox of nature exist?’.

The answer is: it doesn’t. The Platypus isn’t doing anything paradoxical at all. It isn’t having any problems. Platypuses have been laying eggs and suckling their young for millions of years before there were any zoologists to come along and declare it illegal. The real mystery, the real enigma, is how mature, objective, trained scientific observers can blame their own goof on a poor innocent platypus.” Robert Pirsig in Zen and the Art of Motorcycle Maintenance

I wondered if this is the attitude of modern medicine towards primary care physician Dr. Stella Emmanuel for her recommendation of Hydroxychloroquine as a panacea for the Covid-19 virus.

I discussed Dr. Emmanuel's prescription with more than one practitioner of modern medicine and they were all unanimous in their condemnation of Dr. Emmanuel’s self publicity approach of making a film with many white coated authority figures in the background. 'She could have presented her data for scrutiny' and 'her claims will not qualify as level 2 evidence' were some of their verdicts.

Hydroxychloroquine, unfortunately, has become a highly political drug which has divided opinion on liberal v conservative lines. ‘Big Pharma’ has also been accused of trying to destroy a cheap solution to the raging Corona virus problem.

In the UK, modern medicine’s success in combating Covid-19 has resulted in over 50,000 deaths and delayed treatment of all other life threatening ailments. Decision making has been a series of flip-flops and U turns and is best illustrated by Telegraph’s Blowe





I wondered if some of the decisions by modern medicine on the lockdown and thereafter have the same amount of evidence required of Dr. Emmanuel and her panacea?

I am willing to take a sceptical approach to Dr Emmanuel as well as to the science based responses of the Boris Johnson government.

But, I also wondered if modern science and medicine ever consider that they too may suffer from the platypus problem?

Richard Wolff - Sports and Capitalism

A 'Mild Attack' of Corona could be Dangerously Misleading

Otherwise healthy people who thought they recovered from coronavirus are reporting persistent and strange symptoms - including strokes writes Adrienne Matei in The Guardian 

 

‘It’s important to keep in mind how little we truly know about this vastly complicated disease.’ Photograph: Yara Nardi/Reuters


Conventional wisdom suggests that when a sickness is mild, it’s not too much to worry about. But if you’re taking comfort in World Health Organization reports that over 80% of global Covid-19 cases are mild or asymptomatic, think again. As virologists race to understand the biomechanics of Sars-CoV-2, one thing is becoming increasingly clear: even “mild” cases can be more complicated, dangerous and harder to shake than many first thought.

Throughout the pandemic, a notion has persevered that people who have “mild” cases of Covid-19 and do not require an ICU stay or the use of a ventilator are spared from serious health repercussions. Just last week, Mike Pence, the US vice-president, claimed it’s “a good thing” that nearly half of the new Covid-19 cases surging in 16 states are young Americans, who are at less risk of becoming severely ill than their older counterparts. This kind of rhetoric would lead you to believe that the ordeal of “mildly infected” patients ends within two weeks of becoming ill, at which point they recover and everything goes back to normal.

While that may be the case for some people who get Covid-19, emerging medical research as well as anecdotal evidence from recovery support groups suggest that many survivors of “mild” Covid-19 are not so lucky. They experience lasting side-effects, and doctors are still trying to understand the ramifications.

Some of these side effects can be fatal. According to Dr Christopher Kellner, a professor of neurosurgery at Mount Sinai hospital in New York, “mild” cases of Covid-19 in which the patient was not hospitalized for the virus have been linked to blood clotting and severe strokes in people as young as 30. In May, Keller told Healthline that Mount Sinai had implemented a plan to give anticoagulant drugs to people with Covid-19 to prevent the strokes they were seeing in “younger patients with no or mild symptoms”.

Doctors now know that Covid-19 not only affects the lungs and blood, but kidneys, liver and brain – the latter potentially resulting in chronic fatigue and depression, among other symptoms. Although the virus is not yet old enough for long-term effects on those organs to be well understood, they may manifest regardless of whether a patient ever required hospitalization, hindering their recovery process.

Another troubling phenomenon now coming into focus is that of “long-haul” Covid-19 sufferers – people whose experience of the illness has lasted months. For a Dutch report published earlier this month (an excerpt is translated here) researchers surveyed 1,622 Covid-19 patients with an average age of 53, who reported a number of enduring symptoms, including intense fatigue (88%) persistent shortness of breath (75%) and chest pressure (45%). Ninety-one per cent of the patients weren’t hospitalized, suggesting they suffered these side-effects despite their cases of Covid-19 qualifying as “mild”. While 85% of the surveyed patients considered themselves generally healthy before having Covid-19, only 6% still did so one month or more after getting the virus.

After being diagnosed with Covid-19, 26-year-old Fiona Lowenstein experienced a long, difficult and nonlinear recovery first-hand. Lowenstein became sick on 17 March, and was briefly hospitalized for fever, cough and shortness of breath. Doctors advised she return to the hospital if those symptoms worsened – but something else happened instead. “I experienced this whole slew of new symptoms: sinus pain, sore throat, really severe gastrointestinal issues,” she told me. “I was having diarrhea every time I ate. I lost a lot of weight, which made me weak, a lot of fatigue, headaches, loss of sense of smell …”

By the time she felt mostly better, it was mid-May, although some of her symptoms still routinely re-emerge, she says.

“It’s almost like a blow to your ego to be in your 20s and healthy and active, and get hit with this thing and think you’re going to get better and you’re going to be OK. And then have it really not pan out that way,” says Lowenstein.

Unable to find information about what she was experiencing, and wondering if more people were going through a similarly prolonged recovery, Lowenstein created The Body Politic Slack-channel support group, a forum that now counts more than 5,600 members – most of whom were not hospitalized for their illness, yet have been feeling sick for months after their initial flu-like respiratory symptoms subsided. According to an internal survey within the group, members – the vast majority of whom are under 50 – have experienced symptoms including facial paralysis, seizures, hearing and vision loss, headaches, memory loss, diarrhea, serious weight loss and more.

“To me, and I think most people, the definition of ‘mild’, passed down from the WHO and other authorities, meant any case that didn’t require hospitalization at all, that anyone who wasn’t hospitalized was just going to have a small cold and could take care of it at home,” Hannah Davis, the author of a patient-led survey of Body Politic members, told me. “From my point of view, this has been a really harmful narrative and absolutely has misinformed the public. It both prohibits people from taking relevant information into account when deciding their personal risk levels, and it prevents the long-haulers from getting the help they need.”

At this stage, when medical professionals and the public alike are learning about Covid-19 as the pandemic unfolds, it’s important to keep in mind how little we truly know about this vastly complicated disease – and to listen to the experiences of survivors, especially those whose recoveries have been neither quick nor straightforward.

It may be reassuring to describe the majority of Covid-19 cases as “mild” – but perhaps that term isn’t as accurate as we hoped.

The everyone economy: how to make capitalism work for all

After four decades of rising inequality, the Covid crisis is a chance to change the rules writes Martin Sandbu in The FT


A few weeks into the lockdown, when UK Covid-19 deaths were hitting a thousand a day, I crossed my London street to check on a neighbour. Around 50, she does not fall into a vulnerable category, but she works at a supermarket checkout and has been more exposed to contagion than most. And we had not seen her for a while, which was unusual. 

As it turned out, our neighbour was fine. With a pavement between us, we chatted about how she was not allowed to wear a face mask and gloves at the till. Then she said: “But I have to go to work, otherwise people won’t be able to buy their food, will they?” It was not a complaint, but an expression of pride in her new-found status of essential worker. 

That pride reflected the public appreciation suddenly afforded a group that had previously been treated with neglect. The pandemic and the lockdown brought home how we literally depend for our lives not just on doctors and nurses but also on the humbler jobs of cleaners and care workers, shelf-stackers and bus drivers, delivery couriers and cashiers. The weekly clap for carers, which in March became a national ritual in many European countries, embodied this new recognition. 

Pondering this fleeting moment of moral reordering, I could not help noticing how starkly it clashed with the underlying economic reality. In many rich countries, decades of economic polarisation have left people like my neighbour not just underpaid, but having to accept short-term contracts, erratic shift patterns and unpredictable earnings. This “precariat” faces debilitating insecurity, which lockdown has made worse. As the gilets jaunes protests in France illustrated, many people see the economy as a system to which they do not belong, rigged to benefit others. 

How did it come to this? How did much of the work we count as essential become ill-rewarded and precarious? And what has economic polarisation done to the way our societies and politics function? These are questions that Covid-19 forces us to confront. 

They were becoming hard to ignore long before this crisis. As an economic commentator for the FT, I have spent years trying to understand the causes of economic polarisation in the western world, its effects and what policies might reverse it. Like many others, I have worried that when our societies divide economically, they also fall apart culturally and politically. 

But the pandemic makes these questions more urgent, and adds a new one: will Covid-19 remake society? Is this tragedy also a once-in-a-lifetime opportunity to rebuild better economies? 

It is tempting to think we could be at a 1945-style moment, a year remembered as ushering in a new era. As Branko Milanovic, the economist known for his work on global inequality, writes, it is “utterly wrong to believe that history does not matter and that the social and political changes wrought by the pandemic can be ignored”. The political forces it has set in motion, he suggests, “will fundamentally affect how economies behave in the future”. 

The pandemic also highlights forces that were already at work. Donald Trump, the architects of Brexit and populist movements across Europe all advanced by appealing to groups that felt forgotten by elites and saw the economic system as rigged against them. They have, in effect, been promising to restore the post-1945 era and bring about the sort of moral reordering we glimpsed in the lockdown. 

There is a “rhetoric of how the golden days were better”, says political scientist Catherine De Vries. It is obvious why such nostalgia resonates. By happy accident as well as by policy design, the postwar industrial economy of the west was particularly well-suited for most people to share in economic growth. The three decades the French call les trente glorieuses produced a remarkable convergence in income and wealth levels between rich and poor, between workers of different educational levels, between countryside and city. 

I have a lot of sympathy with this nostalgia, having grown up in Norway in the 1970s and 1980s — a time and place that arguably came as close as any modern society to the ideal of an economy with a place for everyone. Few have ever had lower economic inequality or a shorter social distance between top and bottom, and managed to combine it with high productivity and strong growth. 

When I was living in New York in the 2000s, one mundane activity struck me as embodying the economic difference between the US and Norway: having your car cleaned. On entering a New York car wash, you would be set upon by a group of workers — often immigrants — who proceeded to clean your car by hand. In my childhood in Norway, your choice was between an automated car wash or doing the job yourself. 

It was the difference between an economic model employing low-productivity, low-wage labour and one where wage equality made it commercially necessary to automate to make labour more productive. It was, too, the difference between the precariat and what I think of as an economy of belonging. 

Since the late 1970s, every western economy, albeit some much more than others, has experienced widening economic fractures that have also polarised societies politically and culturally. We moved from an economy of belonging to an economy divided between the successful and the left behind. (Et in Arcadia Ego: the manual car wash has had a renaissance in Norway too, courtesy of underpaid immigrants.) 

This end of economic belonging coincided with the peak in industrial employment across what used to be known as the industrialised world. It is a widespread misunderstanding that the shift from industrial to knowledge-intensive economy involved manufacturing vanishing, or being whisked off to China and other low-cost countries. In fact, most rich economies produce about as much stuff today as they ever have. 

What changed was that factories no longer absorbed the same workforce. Growing productivity through automation and better know-how meant ever fewer hands were needed on assembly lines. New jobs were created in services but many of these were less productive, less well paid and less secure than the ones they replaced, as well as geographically distant from them. (This also meant growth rates slowed down, since manufacturing made up a shrinking share of employment even as its own productivity kept growing.) 

Job-altering technological transformation did not stop with factory work. Roughnecks and dockhands gave way to automated rigs and container cranes. Computing put an end to many clerical jobs. The internet has upended in-person retail. Too often, those who rely on such jobs have had to accept worsening conditions to remain employed. 

These changes are not, on the whole, the fault of globalisation, that scapegoat of the populist insurgency, but of technology-driven changes combined with policies that have reinforced the underlying forces of divergence. For example, western countries shifted tax burdens away from capital and high-wage incomes even as income and wealth inequality rose. Unions, which played a part in reducing income inequality, have declined almost everywhere. 

All this undermined the promise that the postwar economy had largely delivered on: that everyone could expect a secure place in the national economy. In many countries, median wages fell behind labour productivity after tracking it closely for decades. Income inequality and wealth inequality both started rising from around 1980. New jobs were not all created equal: manual and routine work lost out to knowledge work, as pay and job security increasingly depended on workers’ educational background and on where they lived. 

The last effect — regional inequality — is perhaps the most corrosive for our politics. The economic geographer Andrés Rodríguez-Pose calls the support for anti-system populists in peripheral areas “the revenge of the places that don’t matter”. Highly paid jobs and capital (but also low-paid service jobs to serve high earners) have been concentrating in the big metropolitan areas, capital cities above all, while peripheral regions have been drained of capital investment and good job prospects. 

The blow from the pandemic, in other words, landed on economies already made brittle by deep fractures. And not only that; it is making those fractures worse. 

Lockdown causes more pain for those already suffering from low pay and job insecurity, because it preponderantly affects manual jobs that require physical presence. In the UK, one-third of the lowest-paid quintile have lost work, against 15 per cent of the top quintile, according to the Resolution Foundation. In the US, African-Americans have suffered income losses at higher rates than other groups. 

Covid-19’s most important political legacy could be that these pre-existing fractures can no longer be ignored. The moment of moral clarity triggered by the pandemic opens a political opportunity to “rebuild better” so as to make the economy work for everyone, including my neighbour and others like her. 

Acute crises have helped reorient societies in the past. But David Edgerton, the British historian, cautions that 1945 may be the wrong reference. The postwar consensus on the welfare state was less radical than sometimes believed, he says — it was the continuation of a wartime consensus in which “Labour buys into a conservative agenda”. There is also no equivalent to the postwar confrontation with the Soviet Union today, Trump’s talk of a “Chinese virus” notwithstanding. According to Edgerton, “1933 is a better analogue.” Like then, the question today is: “How do you get economies going again?” 

The Great Depression was indeed an economic disaster so great that returning to the status quo ante was politically impossible. It produced radicalism unlike any seen today (yet): in the US, Franklin Roosevelt’s hyperactive New Deal reforms; in Scandinavia, groundbreaking compromises between capital and labour; and in continental Europe, fascism. Could the economic consequences of Covid-19 spur similarly radical change, and if so, how to turn it into a force for good? 

Even before the pandemic, I frequently argued that a Roosevelt-style “centrist radicalism” was necessary to stave off a much greater — and potentially much nastier — disruption, of which signs could already be seen in the rise of authoritarian populism. What would this look like today? It would not give up on globalisation. Instead, to close the economic fractures we have allowed to open in the past 40 years, I think such a programme would need to achieve five goals. 

First, it would jettison business models based on using low-productivity (and therefore low-paid) labour, and harness automation rather than resisting it. That means allowing low-productivity jobs to be competed out of existence by higher-productivity ones. Scandinavia has long shown how this can be done: high wages at the bottom of the distribution encourage employers to automate and boost productivity, while high skill levels and active labour-market policies help workers change jobs frequently and adapt to technological developments. 

Second, the programme would aim to shift more labour-market risk from employees to employers and the welfare system. That means lower tolerance for erratic earnings that make it harder for people to plan, retrain and seek new and better work. And it means avoiding aggressive means-testing of benefits, which, when combined with tax, leaves many lower-middle earners facing effective marginal income-tax rates of around 80 per cent or more. 

Together, these two principles point in the direction of higher minimum wages, a universal basic income (or its less budget-heavy equivalent, a negative income tax), generous government funding for education and labour-market mobility, and strict enforcement of labour standards. 

Third, we can reform taxes to counteract economic divergence instead of intensifying it. That means lowering taxes that penalise hiring. To pay for this, as well as for a negative income tax and policies supporting a well-working labour market, other taxes have to go up. The best candidates are a net wealth tax — which, unlike other capital taxes, favours those who put their capital to the most productive use — and removing the gaping loopholes in multinational taxation, as well as increasing tax revenue from carbon emissions, in line with the climate challenge. A particularly promising proposal is the “carbon tax and dividend”, where revenue from higher emissions taxes would be paid out as a universal basic income. Calculations show that such a policy can leave poorer households significantly better off, even after fuel-price increases are taken into account. 

Fourth, macroeconomic and financial sector policy can be reformed in favour of the left behind. That means sustaining a “high-pressure economy” to keep job creation high, in the knowledge that those on the margins of the job market are fired first in a recession and hired last in a recovery. Governments and central banks must stimulate demand strongly for a long time after the lockdowns end, with debts restructured so they do not hold back investment. 

Fifth, and most challenging, we can work to reverse the divergence between the centre and the periphery. The previous four elements would help with this. But greater policy efforts are needed to give regions, where possible, a critical mass of knowledge jobs so they can connect with the leading economic activity in national centres. 

These are big changes. But, as Milanovic argues, one consequence of the pandemic we can predict with some confidence is a “tendency toward [a] greater state role in many countries”. Some politicians are embracing this with gusto, at least rhetorically: this week, Boris Johnson and his colleagues cast themselves as latter-day Roosevelts, and explicitly compared their levelling-up agenda to FDR’s New Deal. 

Governments everywhere have already gone to extraordinary lengths both to halt the pandemic and to offset the economic consequences of the lockdown. After this experience, as French president Emmanuel Macron has asked in the context of climate change, will publics accept claims that large-scale policy shifts are too hard to achieve? 

Having become accidental radicals, centrist parties may well be tempted to keep making more ambitious offers to voters. “When people are unhappy they go for more extreme choices,” says De Vries. Behind populists’ success, she adds, was “the story of how mainstream parties had become Tweedledee and Tweedledum”, lacking any ideology. Centrist parties “could reinvent themselves by taking clearer positions”. 

With the pandemic causing widespread economic damage to already polarised societies, continued radical policy action cannot be in doubt. What we are going to find out is for what — and for whom — that radicalism will be used.

60 is the new 80 thanks to Corona

 Patti Waldmeir in The FT

“Better be safe than sorry.” I have never believed that. 

I have lived my first 65 years often turning a blind eye to risk. I lived in China for eight years, enduring some of the worst industrial pollution on earth, despite having asthma. I risked damaging the lungs of my then small children by raising them in a place where their school often locked them in air-purified classrooms to protect them from the smog. 

Before that, I lived for 20 years in Africa, refusing to boil water in areas where it needed boiling, eating bushmeat at roadside stalls — not to mention the escapades that I got up to as a young woman in the pre-Aids era. 

But now, as I peer over the precipice into life as a senior citizen, coronavirus has finally introduced me to the concept of risk. Part of it is the whole “60 is the new 80” paradigm that the pandemic has forced on us — but most of it is that, whether I like it or not, I fit squarely in the category of “at risk” for severe illness or death if I catch Covid-19. 

I have diabetes, asthma and am finishing my 65th year. I don’t live in a nursing home, a jail, a monastery or a convent (as does one close friend with Covid-19), but according to the US Centers for Disease Control and Prevention (CDC), I still qualify as high risk because of my underlying conditions and age. 

So what do I — and people like me, I am far from alone — do now that the world is reopening without us? I’ve got some big decisions to make in the next few days. My youngest child is moving back to our flat outside Chicago after a month living elsewhere: does one of us need to be locked in the bedroom? Do I have to eat on the balcony for two weeks? 

There is no shortage of people, not least President Donald Trump, telling me that all this is simple: vulnerable people should just stay home. But what if they live with other people? What if those people have jobs? And what about our dogs? Our two old mutts are overdue for a rabies shot because the vet was only seeing emergencies. Is it safe for me to take them in now? Can my kids go to the dentist, and then come home to live at close quarters with me? 

I asked several medical experts these questions, and they all offered versions of “we haven’t got a clue”. Robert Gabbay, incoming chief scientific and medical officer of the American Diabetes Association, was the most helpful: “Individuals with diabetes are all in the higher-risk category but even within that category, those who are older and with co-morbidities are at more risk — and control of blood glucose seems to matter. 

“You are probably somewhere in the middle” of the high-risk category, he decided. My diabetes is well controlled and I don’t have many other illnesses. “But your age is a factor,” he added. Up to now, I’ve thought I was in the “60 is the new 40 crowd”: now I know there is no such crowd. 

The head of the Illinois Department of Public Health underlined this at the weekend when she gave her personal list of Covid dos and don’ts, including don’t visit a parent who is over 65 with pre-existing conditions for at least a year, or until there is a cure. Dr Ngozi Ezike also said she would not attend a wedding or a dinner party for a year and would avoid indoor restaurants for three months to a year — despite the fact that Chicago’s indoor restaurants reopen on Friday. 

I turned to the CDC, which initially said it would issue new guidance for “at risk” people last week, but didn’t. This would be the same CDC that I trusted when it said not to wear a mask — though 1.3 billion people in China were masking up. Today China, which is 100 times larger by population than my home state of Illinois, has less than three-quarters as many total pandemic deaths. (Yes, I know China has been accused of undercounting cases, but so has the US.) Masks aren’t the only reason; but they are enough of a reason to erode my trust in what the CDC thinks I should do now. 

It doesn’t help that the CDC website lists “moderate to severe asthma” as one of the primary risk factors for poor coronavirus outcomes — while the American Academy of Allergy Asthma and Immunology says “there are no published data to support this determination”, adding that there is “no evidence” that those with asthma are more at risk. Who’s right? 

I need to know: this weekend is the one-year anniversary of the death of my eldest sibling. I’ve chosen not to make the trip to visit his grave in Michigan. Next month, I turn 65, and I want to spend that day with my 89-year-old father: should we rent a camper van, so we don’t infect his household? I thought about a porta potty for the journey, since public toilets are apparently a coronavirus hotspot. When I started searching for “female urination devices” online, I knew it was time to ditch this new “better safe than sorry” persona I’ve assumed under lockdown. 

Maybe it’s time to remind myself of a fact that I once knew: that life is a risky business, and there is only so much I can do about that. I’ll die when it’s my time — probably not a day before or after, coronavirus or no coronavirus.

How Socialists would respond to Covid-19

We often accuse the right of distorting science. But the left changed the coronavirus narrative overnight

Racism is a health crisis. But poverty is too – yet progressives blithely accepted the costs of throwing millions of people like George Floyd out of work writes Thomas Chatterton Williams in The Guardian


 

‘Less than two weeks ago, the enlightened position was to exercise extreme caution. Many of us went further, taking to social media to shame others for insufficient social distancing.’ Photograph: Devon Ravine/AP


When I reflect back on the extraordinary year of 2020 – from, I hope, some safer, saner vantage – one of the two defining images in my mind will be the surreal figure of the Grim Reaper stalking the blazing Florida shoreline, scythe in hand, warning the sunbathing masses of imminent death and granting interviews to reporters. The other will be a prostrate George Floyd, whose excruciating Memorial Day execution sparked a global protest movement against racism and police violence.

Less than two weeks after Floyd’s killing, the American death toll from the novel coronavirus has surpassed 100,000. Rates of infection, domestically and worldwide, are rising. But one of the few things it seems possible to say without qualification is that the country has indeed reopened. For 13 days straight, in cities across the nation, tens of thousands of men and women have massed in tight-knit proximity, with and without personal protective equipment, often clashing with armed forces, chanting, singing and inevitably increasing the chances of the spread of contagion.

Scenes of outright pandemonium unfold daily. Anyone claiming to have a precise understanding of what is happening, and what the likely risks and consequences may be, should be regarded with the utmost skepticism. We are all living in a techno-dystopian fantasy, the internet-connected portals we rely on rendering the world in all its granular detail and absurdity like Borges’s Aleph. Yet we know very little about what it is we are watching.

I open my laptop and glimpse a rider on horseback galloping through the Chicago streets like Ras the Destroyer in Ralph Ellison’s Invisible Man; I scroll down further and find myself in Los Angeles, as the professional basketball star JR Smith pummels a scrawny anarchist who smashed his car window. I keep going and encounter a mixed group of business owners in Van Nuys risking their lives to defend their businesses from rampaging looters; the black community members trying to help them are swiftly rounded up by police officers who mistake them for the criminals. In Buffalo, a 75-year-old white man approaches a police phalanx and is immediately thrown to the pavement; blood spills from his ear as the police continue to march over him. Looming behind all of this chaos is a reality-TV president giddily tweeting exhortations to mass murder, only venturing out of his bunker to teargas peaceful protesters and stage propaganda pictures.


George Floyd wasn’t merely killed for being black – he was also killed for being poor

But this virus – for which we may never even find a vaccine – knows and respects none of this socio-political context. Its killing trajectory isn’t rational, emotional, or ethical – only mathematical. And just as two plus two is four, when a flood comes, low-lying areas get hit the hardest. Relatively poor, densely clustered populations with underlying conditions suffer disproportionately in any environment in which Covid-19 flourishes. Since the virus made landfall in the US, it has killed at least 20,000 black Americans.

After two and a half months of death, confinement, and unemployment figures dwarfing even the Great Depression, we have now entered the stage of competing urgencies where there are zero perfect options. Police brutality is a different if metaphorical epidemic in an America slouching toward authoritarianism. Catalyzed by the spectacle of Floyd’s reprehensible death, it is clear that the emergency in Minneapolis passes my own and many peoples’ threshold for justifying the risk of contagion.

But poverty is also a public health crisis. George Floyd wasn’t merely killed for being black – he was also killed for being poor. He died over a counterfeit banknote. Poverty destroys Americans every day by means of confrontations with the law, disease, pollution, violence and despair. Yet even as the coronavirus lockdown threw 40 million Americans out of work – including Floyd himself – many progressives accepted this calamity, sometimes with stunning blitheness, as the necessary cost of guarding against Covid-19.

The new, “correct” narrative about public health – that one kind of crisis has superseded the other – grows shakier as it spans out from Minnesota, across America to as far as London, Amsterdam and Paris – cities that have in recent days seen extraordinary manifestations of public solidarity against both American and local racism, with protesters in the many thousands flooding public spaces.

Consider France, where I live. The country has only just begun reopening after two solid months of one of the world’s severest national quarantines, and in the face of the world’s fifth-highest coronavirus body count. As recently as 11 May, it was mandatory here to carry a fully executed state-administered permission slip on one’s person in order to legally exercise or go shopping. The country has only just begun to flatten the curve of deaths – nearly 30,000 and counting – which have brought its economy to a standstill. Yet even here, in the time it takes to upload a black square to your Instagram profile, those of us who move in progressive circles now find ourselves under significant moral pressure to understand that social distancing is an issue of merely secondary importance.

This feels like gaslighting. Less than two weeks ago, the enlightened position in both Europe and America was to exercise nothing less than extreme caution. Many of us went much further, taking to social media to castigate others for insufficient social distancing or neglecting to wear masks or daring to believe they could maintain some semblance of a normal life during coronavirus. At the end of April, when the state of Georgia moved to end its lockdown, the Atlantic ran an article with the headline “Georgia’s Experiment in Human Sacrifice”. Two weeks ago we shamed people for being in the street; today we shame them for not being in the street.

As a result of lockdowns and quarantines, many millions of people around the world have lost their jobs, depleted their savings, missed funerals of loved ones, postponed cancer screenings and generally put their lives on hold for the indefinite future. They accepted these sacrifices as awful but necessary when confronted by an otherwise unstoppable virus. Was this or wasn’t this all an exercise in futility?

“The risks of congregating during a global pandemic shouldn’t keep people from protesting racism,” NPR suddenly tells us, citing a letter signed by dozens of American public health and disease experts. “White supremacy is a lethal public health issue that predates and contributes to Covid-19,” the letter said. One epidemiologist has gone even further, arguing that the public health risks of not protesting for an end to systemic racism “greatly exceed the harms of the virus”.

The climate-change-denying right is often ridiculed, correctly, for politicizing science. Yet the way the public health narrative around coronavirus has reversed itself overnight seems an awful lot like … politicizing science.

What are we to make of such whiplash-inducing messaging? Merely pointing out the inconsistency in such a polarized landscape feels like an act of heresy. But “‘Your gatherings are a threat, mine aren’t,’ is fundamentally illogical, no matter who says it or for what reason,” as the author of The Death of Expertise, Tom Nichols, put it. “We’ve been told for months to stay as isolated as humanely possible,” Suzy Khimm, an NBC reporter covering Covid-19, noted, but “some of the same public officials and epidemiologists are [now] saying it’s OK to go to mass gatherings – but only certain ones.”

Public health experts – as well as many mainstream commentators, plenty of whom in the beginning of the pandemic were already incoherent about the importance of face masks and stay-at-home orders – have hemorrhaged credibility and authority. This is not merely a short-term problem; it will constitute a crisis of trust going forward, when it may be all the more urgent to convince skeptical masses to submit to an unproven vaccine or to another round of crushing stay-at-home orders. Will anyone still listen?

Seventy years ago Camus showed us that the human condition itself amounts to a plague-like emergency – we are only ever managing our losses, striving for dignity in the process. Risk and safety are relative notions and never strictly objective. However, there is one inconvenient truth that cannot be disputed: more black Americans have been killed by three months of coronavirus than the number who have been killed by cops and vigilantes since the turn of the millennium. We may or may not be willing to accept that brutal calculus, but we are obligated, at the very least, to be honest.

Scientific or Pseudo Knowledge? How Lancet's reputation was destroyed

The now retracted paper halted hydroxychloroquine trials. Studies like this determine how people live or die tomorrow writes James Heathers in The Guardian

 

‘At its best, peer review is a slow and careful evaluation of new research by appropriate experts. ... At its worst, it is merely window dressing that gives the unwarranted appearance of authority’. Photograph: George Frey/AFP/Getty Images


The Lancet is one of the oldest and most respected medical journals in the world. Recently, they published an article on Covid patients receiving hydroxychloroquine with a dire conclusion: the drug increases heartbeat irregularities and decreases hospital survival rates. This result was treated as authoritative, and major drug trials were immediately halted – because why treat anyone with an unsafe drug?

Now, that Lancet study has been retracted, withdrawn from the literature entirely, at the request of three of its authors who “can no longer vouch for the veracity of the primary data sources”. Given the seriousness of the topic and the consequences of the paper, this is one of the most consequential retractions in modern history.

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It is natural to ask how this is possible. How did a paper of such consequence get discarded like a used tissue by some of its authors only days after publication? If the authors don’t trust it now, how did it get published in the first place?

The answer is quite simple. It happened because peer review, the formal process of reviewing scientific work before it is accepted for publication, is not designed to detect anomalous data. It makes no difference if the anomalies are due to inaccuracies, miscalculations, or outright fraud. This is not what peer review is for. While it is the internationally recognised badge of “settled science”, its value is far more complicated.

At its best, peer review is a slow and careful evaluation of new research by appropriate experts. It involves multiple rounds of revision that removes errors, strengthens analyses, and noticeably improves manuscripts.

At its worst, it is merely window dressing that gives the unwarranted appearance of authority, a cursory process which confers no real value, enforces orthodoxy, and overlooks both obvious analytical problems and outright fraud entirely.

Regardless of how any individual paper is reviewed – and the experience is usually somewhere between the above extremes – the sad truth is peer review in its entirety is struggling, and retractions like this drag its flaws into an incredibly bright spotlight.

The ballistics of this problem are well known. To start with, peer review is entirely unrewarded. The internal currency of science consists entirely of producing new papers, which form the cornerstone of your scientific reputation. There is no emphasis on reviewing the work of others. If you spend several days in a continuous back-and-forth technical exchange with authors, trying to improve their manuscript, adding new analyses, shoring up conclusions, no one will ever know your name. Neither are you paid. Peer review originally fitted under an amorphous idea of academic “service” – the tasks that scientists were supposed to perform as members of their community. This is a nice idea, but is almost invariably maintained by researchers with excellent job security. Some senior scientists are notorious for peer reviewing manuscripts rarely or even never – because it interferes with the task of producing more of their own research.

However, even if reliable volunteers for peer review can be found, it is increasingly clear that it is insufficient. The vast majority of peer-reviewed articles are never checked for any form of analytical consistency, nor can they be – journals do not require manuscripts to have accompanying data or analytical code and often will not help you obtain them from authors if you wish to see them. Authors usually have zero formal, moral, or legal requirements to share the data and analytical methods behind their experiments. Finally, if you locate a problem in a published paper and bring it to either of these parties, often the median response is no response at all – silence.

This is usually not because authors or editors are negligent or uncaring. Usually, it is because they are trying to keep up with the component difficulties of keeping their scientific careers and journals respectively afloat. Unfortunately, those goals are directly in opposition – authors publishing as much as possible means back-breaking amounts of submissions for journals. Increasingly time-poor researchers, busy with their own publications, often decline invitations to review. Subsequently, peer review is then cursory or non-analytical.

And even still, we often muddle through. Until we encounter extraordinary circumstances.





Peer review during a pandemic faces a brutal dilemma – the moral importance of releasing important information with planetary consequences quickly, versus the scientific importance of evaluating the presented work fully – while trying to recruit scientists, already busier than usual due to their disrupted lives, to review work for free. And, after this process is complete, publications face immediate scrutiny by a much larger group of engaged scientific readers than usual, who treat publications which affect the health of every living human being with the scrutiny they deserve.

The consequences are extreme. The consequences for any of us, on discovering a persistent cough and respiratory difficulties, are directly determined by this research. Papers like today’s retraction determine how people live or die tomorrow. They affect what drugs are recommended, what treatments are available, and how we get them sooner.

The immediate solution to this problem of extreme opacity, which allows flawed papers to hide in plain sight, has been advocated for years: require more transparency, mandate more scrutiny. Prioritise publishing papers which present data and analytical code alongside a manuscript. Re-analyse papers for their accuracy before publication, instead of just assessing their potential importance. Engage expert statistical reviewers where necessary, pay them if you must. Be immediately responsive to criticism, and enforce this same standard on authors. The alternative is more retractions, more missteps, more wasted time, more loss of public trust … and more death.

Hysteresis means we will have scars after Covid-19

Tim Harford in The Financial Times 

In the middle of a crisis, it is not always easy to work out what has changed forever, and what will soon fade into history. Has the coronavirus pandemic ushered in the end of the office, the end of the city, the end of air travel, the end of retail and the end of theatre? Or has it merely ruined a lovely spring? 

Stretch a rubber band, and you can expect it to snap back when released. Stretch a sheet of plastic wrapping and it will stay stretched. In economics, we borrow the term “hysteresis” to refer to systems that, like the plastic wrap, do not automatically return to the status quo. 

The effects can be grim. A recession can leave scars that last, even once growth resumes. Good businesses disappear; people who lose jobs can then lose skills, contacts and confidence. But it is surprising how often, for better or worse, things snap back to normal, like the rubber band. 

The murderous destruction of the World Trade Center in 2001, for example, had a lasting impact on airport security screening, but Manhattan is widely regarded to have bounced back quickly. There was a fear, at the time, that people would shun dense cities and tall buildings, but little evidence that they really did. 

What, then, will the virus change permanently? Start with the most obvious impact: the people who have died will not be coming back. Most were elderly but not necessarily at death’s door, and some were young. More than one study has estimated that, on average, victims of Covid-19 could have expected to live for more than a decade. 

But some of the economic damage will also be irreversible. The safest prediction is that activities which were already marginal will struggle to return. 

After the devastating Kobe earthquake in Japan in 1995, economic recovery was impressive but partial. For a cluster of businesses making plastic shoes, already under pressure from Chinese competition, the earthquake turned a slow decline into an abrupt one. 

Ask, “If we were starting from scratch, would we do it like this again?” If the answer is No, do not expect a post-coronavirus rebound. Drab high streets are in trouble. 

But there is not necessarily a correlation between the hardest blow and the most lingering bruise. 

Consider live music: it is devastated right now — it is hard to conceive of a packed concert hall or dance floor any time soon. 

Yet live music is much loved and hard to replace. When Covid-19 has been tamed — whether by a vaccine, better treatments or familiarity breeding indifference — the demand will be back. Musicians and music businesses will have suffered hardship, but many of the venues will be untouched. The live experience has survived decades of competition from vinyl to Spotify. It will return. 

Air travel is another example. We’ve had phone calls for a very long time, and they have always been much easier than getting on an aeroplane. They can replace face-to-face meetings, but they can also spark demand for further meetings. Alas for the planet, much of the travel that felt indispensable before the pandemic will feel indispensable again. 

And for all the costs and indignities of a modern aeroplane, tourism depends on travel. It is hard to imagine people submitting to a swab test in order to go to the cinema, but if that becomes part of the rigmarole of flying, many people will comply. 

No, the lingering changes may be more subtle. Richard Baldwin, author of The Globotics Upheaval, argues that the world has just run a massive set of experiments in telecommuting. Some have been failures, but the landscape of possibilities has changed. 

If people can successfully work from home in the suburbs, how long before companies decide they can work from low-wage economies in another timezone? 

The crisis will also spur automation. Robots do not catch coronavirus and are unlikely to spread it; the pandemic will not conjure robot barbers from thin air, but it has pushed companies into automating where they can. Once automated, those jobs will not be coming back. 

Some changes will be welcome — a shock can jolt us out of a rut. I hope that we will strive to retain the pleasures of quiet streets, clean air and communities looking out for each other. 

But there will be scars that last, especially for the young. People who graduate during a recession are at a measurable disadvantage relative to those who are slightly older or younger. The harm is larger for those in disadvantaged groups, such as racial minorities, and it persists for many years. 

And children can suffer long-term harm when they miss school. Those who lack computers, books, quiet space and parents with the time and confidence to help them study are most vulnerable. Good-quality schooling is supposed to last a lifetime; its absence may be felt for a lifetime, too. 

This crisis will not last for decades, but some of its effects will.

Genetics is not why more BAME people die of coronavirus: structural racism is

Yes, more people of black, Latin and south Asian origin are dying, but there is no genetic ‘susceptibility’ behind it writes Winston Morgan in The Guardian 

 

A TfL worker sprays antiviral solution inside a tube train. Photograph: Kirsty O’Connor/PA


From the start of the coronavirus pandemic, there has been an attempt to use science to explain the disproportionate impact of Covid-19 on different groups through the prism of race. Data from the UK and the US suggests that people categorised as black, Hispanic (Latino) and south Asian are more likely to die from the disease.

The way this issue is often discussed, but also the response of some scientists, would suggest that there might be some biological reason for the higher death rates based on genetic differences between these groups and their white counterparts. But the reality is there is no evidence that the genes used to divide people into races are linked to how our immune system responds to viral infections.

There are certain genetic mutations that can be found among specific ethnic groups that can play a role in the body’s immune response. But because of the loose definition of race (primarily based on genes for skin colour) and recent population movements, these should be seen as unreliable indicators when it comes to susceptibility to viral infections. 

Indeed, race is a social construct with no scientific basis. However, there are clear links between people’s racial groups, their socioeconomic status, what happens to them once they are infected, and the outcome of their infection. And focusing on the idea of a genetic link merely serves to distract from this.

You only have to look at how the statistics are gathered to understand how these issues are confused. Data from the UK’s Office for National Statistics that has been used to highlight the disparate death rates separates Indians from Pakistanis and Bangladeshis, and yet groups together all Africans (including black Caribbeans). This makes no sense in terms of race, ethnicity or genetics.

The data shows that those males categorised as black are more than 4.6 times more likely to die than their white counterparts from the virus. They are followed by Pakistanis/Bangladeshis (just over four times more likely to die), and then Chinese and Indians (just over 2.5 times).

Most genome-wide association studies group all south Asians. Yet, at least in the UK, Covid-19 can apparently separate Indians and Pakistanis, suggesting genetics have little to do with it. The categories used to collect government data for the pandemic are far more suited to social outcomes such as employment or education.

This problem arises even with a recent analysis that purportedly shows people from ethnic minorities are no more likely to die, once you take into account the effects of other illnesses and deprivation. The main analysis only compares whites to everybody else, masking the data for specific groups, while the headline of the newspaper article about the study refers only to black people.

Meanwhile, in the US the groups most disproportionately affected are African Americans and Hispanics/Latinos. All these groups come from very different population groups. We’ve also seen high death rates in Brazil, China and Italy, all of which have very different populations using the classical definition of race.

The idea that Covid-19 discriminates along traditional racial lines is created by these statistics and fails to adequately portray what’s really going on. These kinds of assumptions ignore the fact that there is as much genetic variation within racialised groups as there is between the whole human population.
There are some medical conditions with a higher prevalence in some racialised groups, such as sickle cell anaemia, and differences in how some groups respond to certain drugs. But these are traits linked to single genes and all transcend the traditional definitions of race. Such “monogenic” traits affect a very small subset of many populations, such as some southern Europeans and south Asians who also have a predisposition to sickle cell anaemia.

Death from Covid-19 is also linked to pre-existing conditions that appear in higher levels in black and south Asian groups, such as diabetes. The argument that this may provide a genetic underpinning is only partly supported by the limited evidence that links genetics to diabetes.

However, the ONS figures confirm that genes predisposing people to diabetes cannot be the same as those that predispose to Covid-19. Otherwise, Indians would be affected as much as Pakistanis and Bangladeshis, who belong to the same genome-wide association group.

Any genetic differences that may predispose you to diabetes are heavily influenced by environmental factors. There isn’t a “diabetes gene” linking the varying groups that are affected by Covid-19. But the prevalence of these so-called “lifestyle” diseases in racialised groups is strongly linked to social factors.

Another target that has come in for speculation is vitamin D deficiency. People with darker skin who do not get enough exposure to direct sunlight may produce less vitamin D, which is essential for many bodily functions, including the immune system. In terms of a link to susceptibility to Covid-19, this has not been proven. But very little work on this has been done and the pandemic should prompt more research on the medical consequences of vitamin D deficiency generally.

Other evidence suggests higher death rates from Covid-19 including among racialised groups might be linked to higher levels of a cell surface receptor molecule known as ACE2. But this can result from taking drugs for diabetes and hypertension, which takes us back to the point about the social causes of such diseases.

In the absence of any genetic link between racial groups and susceptibility to the virus, we are left with the reality, which seems more difficult to accept: that these groups are suffering more from how our societies are organised. There is no clear evidence that higher levels of conditions such as type-2 diabetes, cardiovascular disease and weakened immune systems in disadvantaged communities are because of inherent genetic predispositions.

But there is evidence they are the result of structural racism. All these underlying problems can be directly connected to the food and exercise you have access to, the level of education, employment, housing, healthcare, economic and political power within these communities.

The evidence suggests that this coronavirus does not discriminate, but highlights existing discriminations. The continued prevalence of ideas about race today – despite the lack of any scientific basis – shows how these ideas can mutate to provide justification for the power structures that have ordered our society since the 18th century.

Returning to work in the coronavirus crisis: what are your rights?

Hilary Osborne in The Guardian 

 

Some people may be concerned about returning to work during the coronavirus crisis. Photograph: Matthew Horwood/Getty Images


As the lockdown restrictions begin to be eased across the UK, more workers are being asked to return to the workplace.

The government has said that employees should only be asked to go back if they cannot do their job from home, so if you can, your employer should not be asking you to travel in to work.

If you do need to go to your workplace, your employer is obliged to make sure you will be safe there. Employment lawyer Matt Gingell says: “Employers have a general duty to ensure, as far as reasonably practicable, the health, safety and welfare of all of their employees.”

Here’s a guide to your rights if your employer wants you back in the workplace.

How much notice should I be given that I have to return?

“If employees are unable to work from home, employers can ask employees to return to work and, technically, no notice is required,” says Gingell.

Solicitor and consumer law expert Gary Rycroft says there is no notice period written into law “but giving at least 48 hours’ notice should allow either side to have discussions and air any concerns or even official ‘grievances’”.

The advisory group Acas says employers need to check if there are any arrangements in place with unions or similar about notice. It advises: “Employees and workers should be ready to return to work at short notice, but employers should be flexible where possible.”

So while your employer could ask you to return straight away, a good employer would understand if there were things you needed to put in place first, and give you chance to do so.

What if I was furloughed?

When you were furloughed your employer should have outlined what would happen when it wanted you to go back to work, and this may have a clause saying that you have to return as soon as you are asked.

“The termination of the furlough agreement and when an employee will be expected to return to work will depend on the provisions of the agreement,” says Gingell. Again, though, even if there is no notice period, a good employer should realise that you may need some time to prepare.

If you have been furloughed under the government’s job retention scheme, your employer can’t ask you to go in and do ad hoc days, or work part-time. They would need to take you off furlough and renegotiate your contract with you.

Can they ask me to go back in part-time?

Not, currently, if you have been furloughed and they are using the government scheme to pay you. It only allows companies to furlough people for all of their normal hours, and bans them from asking you to do any work while you are off.

But if your company has not claimed government money to cover your wages, it can ask you to resume work part-time. Make sure you understand the terms of the request – your employer cannot adjust your contract without your permission, so if it is asking you to change your hours you should get advice.

Can they ask me to take a pay cut?

“The law here is the same as it would be if an employer made the same request in the normal course of an employee’s employment. Reducing hours and/or pay are deemed to be such fundamental changes to an employee’s terms and conditions that the employee concerned should be consulted and then agree in writing,” says Rycroft.

He points out that for some employers “this may be the only economically viable option”, and the alternative, if people refuse, could be redundancies. To make more than 20 people redundant there will need to be collective consultation.

What if I am in a vulnerable group or live with someone who is?

No special rules have been put in place to protect people in these groups who are asked to go into work but some already exist – if you are disabled or pregnant, for example, your employer has extra obligations.

Rycroft says some employees may be able to argue that it will be discriminatory to force them to attend work outside the home. “It is all a question of degrees, in terms of how the employer can show that they have listened to legitimate concerns and made reasonable adjustments,” he says.

If you are pregnant your employer is obliged to make sure you can do your job safely. This can mean allowing you to do your job from home, or giving you a new role which can be done remotely. If your employer refuses either of these options, and you do not feel safe going into work you should take advice. Employmentsolicitor.com says that you could be able to argue for a medical suspension on full pay, which will allow you to stay at home.

Living with someone who is vulnerable or especially at risk is not necessarily a reason an employee can refuse to return to work, says Rycroft. “However, you can, as an employee raise a grievance and ask to be listened to and hopefully a compromise may be agreed, such as unpaid leave or using up annual holiday. But if an employer can show that a workplace is safe, the employer may insist on an employee attending.”
What if I have childcare to worry about?

Legally, you can take time off to look after any dependants – these could be children, or older relatives. This time is typically unpaid. If you are currently furloughed and your employer does not have enough work for everyone to go back full-time, they may agree to leave you on furlough so you can continue to earn 80% of your normal pay.

What information should they give me in advance?

Rycroft says there is no law saying that employers should provide information before you return, but the government guidance to employers recommends that they do. He says this information – written or verbal – should cover how they are making your workplace safe in light of the pandemic. So you should be told what is happening to ensure social distancing and hygiene. “This will allow employees to understand how their health and safety at work is being addressed.

Can I refuse to go back?

Yes, if you believe there is a real danger to going to work. “If an employee refuses to return to the workplace due to the employee reasonably believing imminent and serious danger and is then dismissed for that reason the employee could, depending on the circumstances, have a claim for unfair dismissal,” Gingell says.

“The requirement that the employee has to believe that there is imminent and serious danger, does limit the right.”

Otherwise, you cannot refuse. “If someone refuses to attend work without a valid reason, it could result in disciplinary action,” says Acas. But you may be able to make other arrangements with your employer – perhaps you can use holiday or take unpaid leave, or if you have concerns about something like travelling at peak time, they may be willing to accommodate different shifts. Your employer does not have to agree to this, but it is worth asking.

What if I am worried when I see my workplace?

Rycroft says that under section 100 of the Employment Rights Act 1996 employees may leave a place of work where there is an imminent health and safety danger. So if, for example, you return to find social distancing is impossible, you could argue that this is a reason to leave your workplace.

But in the first instance you should try to resolve the issue with your boss. Gingell says: “Employers ought to to listen to the concerns of individuals and be sympathetic and understanding.”

If you do not get anywhere with this, you should take advice. If you are in a union, it should have a helpline you can call if there is no rep to speak to on site. Acas is another port of call, as is Citizens Advice.

“If the employer has breached the implied obligation to provide a safe working environment and/or trust and confidence an employee could, again, depending on the circumstances, resign swiftly as a result and claim constructive unfair dismissal,” says Gingell. But he says you should get advice before taking this action.

“Another option for employees to consider is contactIng the Health and Safety Executive, which enforces health and safety legislation,” he says.