The coronavirus crisis is more severe in Italy than anywhere else in Europe. This shows the chronic failures of the government – whose response so far has been totally inadequate, and which is attempting to shunt the economic burden of the emergency onto working people.
The spread of the new coronavirus in Italy is intensifying. On 10 March, the number of infected patients was 10,149 and the number of dead 631. The mortality rate is thus 6 percent, even higher than in the Chinese province of Hubei, where the pandemic started. This situation marks the failure of the containment measures deployed by the government in the last few weeks.
The attempt to create a national war spirit, in which we all have to get behind the government to fight a fatal, mysterious enemy, lest we betray the martyrs on the frontlines, is a way of hiding the real responsibilities behind this situation, as well as the class character of and confusion created by the measures adopted to manage it.
We are convinced that preventive measures should be applied and that even more radical measures should be undertaken, like stopping non-essential activities, as well as strengthening healthcare infrastructure. But in order to do so, we must combat this rhetoric of national unity and expose the real essence of this crisis.
Concrete responsibilities, not an inevitable catastrophe
The ongoing health emergency has mercilessly exposed the effects of 30 years of cuts to the national healthcare system. Today, the strategies deployed to contain the epidemic aim to avoid the “collapse of the healthcare system”. This situation was not inevitable, however, and has not been caused by an all-powerful enemy, but by the fact that the healthcare system was already forced to operate at the limit of its capacity. Anyone who is aware of the waiting time for a routine check-up, for a visit to the doctor, for an elective surgery; anyone who has been to pronto soccorso (emergency department) knows that hospital beds placed in corridors and chronic understaffing have been the reality for a long time, long before the arrival of the coronavirus.
Government spending on healthcare has been decreasing for years and has now been pushed down to 6.5 percent of GDP. Below this threshold, the World Health Organisation says that a state is incapable of guaranteeing the right to basic healthcare. Indeed, official data shows that, for 11 million Italians, this right is not a reality.
From 2009 to 2017, 5.2 percent of healthcare staff was cut: 46,500 fewer workers.
In the last 10 years, 70,000 beds were lost. In acute medical units, crucial in the current epidemic, bed availability per 100,000 inhabitants in 1980 was 922: today it’s 262.
In intensive care units (ICUs), there are 5,090 beds for a population of 60 million (data from the Ministry of Health 2017), which is to say 8.92 beds per 100,000 inhabitants. On average, 50 percent of these beds are occupied, with much higher peaks. They have 667 pulmonary ventilator machines. Already, in past years, head physicians of ICUs have reported that the mildest flu outbreak causes the units to fill up. On 10 March, there were 877 people hospitalised in ICUs just due to coronavirus, with units in Lombardia already saturated and requests to transfer patients to other regions… and the peak hasn’t been reached yet. When it is, it will have even worse consequences.
The effect of these cuts in a context like the current one were not just predictable, but had explicitly been evaluated. A study from Johns Hopkins University assigned Italy a Global Health Security Index of 56/100 and a “rapid pandemic response and mitigation” capacity of 47.5/100.
Today, these numbers translate into human lives. The Italian Society for Anaesthesia, Analgesia, Reanimation and Intensive Care published some “Clinical ethics recommendations for intensive care admissions and their suspension” in which, faced with the shortage of equipment for intensive care, it recommends to choose whom to give pulmonary ventilation based on the probability of survival and, secondly, based on an estimation of how many years of life can be saved. The document defines this scenario as essentially within the scope of “catastrophe medicine”. Also, the decision to suspend the majority of GP appointments and surgeries, in order to concentrate staff and have more beds for intensive care, will in turn have a human cost (delayed diagnoses, medical cases left unchecked, etc.) which will be hard to measure, because it will get lost in the sea of general data, away from the spotlight of the coronavirus death toll. Those who can afford it will turn towards private healthcare for these services.
Private healthcare, which makes stellar profits under normal circumstances, will make even more from this emergency, while public healthcare bears the brunt of the crisis. The fact that some private facilities are making million-euro campaigns with the help of small-time musicians is enough to make one nauseated. Subpar rapper Fedez and his wife started a crowdfunding campaign for the San Raffaele hospital, which is one of the biggest private hospitals in Italy.
The coronavirus is certainly an extraordinary event, but not an unpredictable one. It is the fifth aggressive virus of the last 17 years, an eventuality that the healthcare system ought to be ready to respond to. It shouldn’t be in the realm of catastrophe medicine, but normal planning. The catastrophe has been generated by economic and political choices made in the name of austerity and guaranteeing private profit, in a sector where human lives are directly at stake. This catastrophe is called capitalism, and those who approved these measures and made profits off the privatisation of healthcare are directly responsible for the preventable deaths of these past weeks.
The government is hiding behind the enormous efforts of healthcare workers, but isn’t doing anything to change the way the system is managed. The healthcare workers’ collective bargaining agreement still hasn’t been renewed. The plan to hire 20,000 workers that was flaunted and approved three weeks after the beginning of the crisis doesn’t provide for stable jobs but only “autonomous contracting work, including coordinated and continued cooperation, of a duration not exceeding six months” or “fixed-term individual assignments”, which at the most will give one priority status for future hiring. Even more scandalous is the fact that the decree did not include the proposal to integrate 5,000 resident doctors.
The management of the crisis
With the decrees of 8 and 9 March, the Conte government wanted to give the impression of being decisive and determined. The truth, however, is that the issuing of these decrees certified the failure of the measures adopted in the entire preceding period, characterised by a lack of planning and prevention, by an approximative management always taken by surprise by events, and by the contradictory nature of the decrees.
In fact, what has been lacking is preventive action and rapid identification of the first epidemic focuses. For a virus with an asymptomatic incubation period of several days, this would have been decisive in keeping it from spreading.
In South Korea, a country that developed a similar number of cases to Italy, but where the contagion curve is already going down, tests were already being carried out before there was a “patient zero”. By now, 200,000 tests have been carried out (in Italy the number is around 60,000), to the tune of 20,000 a day. Special stations were set up where people could be tested without having to leave their cars, thermal cameras were used to screen body temperature, and apps were created to map the movements of people at risk. This allowed the government to adopt more targeted measures to isolate the people who tested positive and those at risk from the rest of the population, thus avoiding the spread of the virus. Simply isolating the population, like Italy is doing, has its own merits – but mostly as a last resort. It has also had the effect of facilitating the spread of the virus between people who are in the same quarantine area – be it territorial or domestic.
In China, this type of action was missing initially, and actually the regime tried to deny the existence of the epidemic, which led to its spreading widely. This was then dealt with by quarantining the entire Hubei province and suspending all activity, but above all by mobilising an impressive amount of healthcare resources: building new hospitals, public hospitalisation centres with divisions based on the seriousness of symptoms, blanket testing, supplying equipment and means of prevention on a mass scale, and an influx of healthcare workers from all of China. These resources are what stopped the spreading of the virus, not a “spirit of discipline”, which is what the Italian authorities are brandishing today in order to place the blame on the masses, painting Italians as undisciplined layabouts.
In Italy, neither the Korean nor the Chinese example was followed. The search for the phantom patient zero has taken on the tone of a detective story, rather than a systematic and thorough control operation. Aside from the creation of red zones, the first decrees were contradictory: schools were closed, but bars could stay open until 6pm. No, actually they could stay open until late but people should maintain a safe distance from one another… but in the meantime people can keep going to work. These decrees went so far as to envisage having football games where supporters from one region would be allowed into the stadium, whereas those from the neighbouring region wouldn’t, as if the spread of the virus would follow the completely insane regional division of the healthcare system.
Bulletins were given out to hospitals, instructing them how to manage the emergency, telling staff about the precise norms to be respected. Except they realised two days later that the equipment necessary to enforce these norms was largely missing, and medical staff were forced to work without adequate protection. Today, 12 percent of infected patients are medical staff, which is leading to a further shortage of resources. There was a campaign against those who didn’t follow the hygiene guidelines, painting them as wilful transmitters of disease, but workers weren’t given basic hygienic instruments (gloves for supermarket cashiers, to give one example). There are thousands of reports of this kind coming in from workplaces.
The Holy Grail of private property
The Conte government, even in all its decisiveness, will always hesitate before threatening the holy grail of private property. People’s lives need to be disciplined, services closed without providing alternatives or safeguards for those suffering the consequences (like with the closure of schools and kindergartens) but private economy must keep making profits. They have even gone so far as to call on workers not to strike, in a paradox that perfectly encompasses the class nature of the measures adopted, and determines their effectiveness.
The video #Milanononsiferma (“Milan doesn’t stop”) commissioned by the mayor Sala was a lyrical exhibition of voluntarism and productivism, with claims like “we work at unthinkable rhythms every day”: an ode to exploitation. Also on 10 March, the Sole24Ore, the newspaper of big business, displayed the headline “Factories open in Lombardy. Production continues with caution.” Exactly what cautionary measures were being referred to was not made known. At STMicroelectronics in Agrate, where there were two cases, the only shift that was suspended was the one that the two sick workers were scheduled for, letting the rest of production go ahead. We are receiving reports from factories, where there have been cases of the virus, of the workers themselves having to bring their own face masks from home. The bosses are terrified of the economic impact of this crisis and the last thing they care about is safeguarding the workers’ health.
It is the workers themselves that in this moment are mobilising to demand measures that will guarantee their health security, or even that they be allowed to self-isolate. There was a spontaneous strike at the Fiat plant in Pomigliano, a work-to-rule at Leonardo (an aerospace company), a waste collectors’ strike in Acerra, putting pressure on the workers’ representatives; as well as many using their time off and spontaneous absences in many workplaces. It is possible that Confindustria (the employers’ federation) could reluctantly shut down activities, at least in some areas of the country.
Closing down non-essential activities to guarantee workers’ health and safety is now a necessary measure. However, the economic cost of this should not be placed on the workers’ shoulders. The government has told workers to use up their days off and leaves of absence: this must be rejected, because it makes the workers pay for the emergency, and not everyone has access to those measures. Wages for the days of closure must continue to be paid normally, just as a guaranteed wage must be given to those who have no security because they are self-isolating. A fund to safeguard self-employed workers and those small businesses that will be brought to their knees by these closures must also be created.
The trade union movement should be leading this fight. Instead, the trade union leaders have deserted the struggle for the sanitary and economic defence of the workers, completely capitulating to the rhetoric of national unity and sacrifice, limiting themselves to making tutorials explaining how to apply the government decrees or, at best, explaining in technical terms how workers can ask for some social security cushions to be applied.
Faced with an emergency situation, emergency measures are needed. The safeguarding of public health should be the number one priority and all available resources should be deployed in a coordinated and planned manner. We need:
- A special, long-term plan to hire healthcare workers to deal with the system’s needs. This includes getting rid of the admissions caps in universities’ Medicine Faculties.
- A plan to increase the number of beds and ICUs, starting with a return to the historical maximum levels. Blocking all plans to reduce healthcare infrastructure.
- Abolishing all plans towards regionalisation and marketisation of the national healthcare system.
- Immediate requisitioning of private healthcare facilities without compensation, to be used in order to manage the crisis. Following this, expropriation of the private structures, to be integrated into the national healthcare system with full employment guarantees for staff.
- Requisitioning of strategic companies that produce sanitary equipment and materials, in order to guarantee large-scale production of medical equipment, intensive care equipment and personal safety products like face masks, to be given out for free.
- Stopping non-essential work activities that endanger workers’ health, with potential conversion of machinery to meet the needs created by the healthcare crisis.
- Full wages for the workers of closed companies. Guaranteed wages for the non-safeguarded workers who have self-isolated.
- Workers’ control of production in activities that must stay open, on the basis of the RSU (unitary trade union representation) and RLS (workers’ representatives for safety).
The cost of these measures must be covered not by increasing public debt and making workers foot the bill, as is currently being proposed, but by cancelling public debt repayment.
Essential measures like the ones listed above enter into conflict with the operations of the system we live in, where the means of production are concentrated in the hands of a few capitalists, where production and services are dominated by the profit motive instead of collective well-being… in an uncoordinated way, at that. It is enough to note that solving the epidemic crisis in one country would not guarantee that it wouldn’t return if it was still active in other countries. What is necessary is a planned international operation, but under capitalism this emergency risks becoming just another variable in the protectionist war. In Italy, it seems it is difficult to coordinate even on a regional scale.
According to the rules of this system, the economic consequences of this pandemic will translate into renewed austerity policies, which will paradoxically lead to a further weakening of healthcare. Right now, there is an initial shock factor created by the coronavirus emergency, but the essence of the system we live under is being harshly exposed to the eyes of everyone in society.
Once the emergency has been dealt with, the bosses won’t wait long to demand compensation for the damages they endured. A conflict will erupt to divide public funding amongst themselves (contributing to the public debt), and gruelling sacrifices will be demanded in every workplace in order to recover lost production. After the war against the virus, we will be asked to participate in the war to restart the economy, and the cannon fodder will once more be the working class. But the rhetoric of national unity is already full of contradictions and it won’t be long before it explodes into a million pieces.
When it does, we will present the bill to those who are making profits from this crisis – and they will pay a high price!
Read the original in Italian Sinistra classe rivoluzione |