Corona Virus

The end of globalisation

Entering and Leaving forbidden: The italian City of Codogno, southeast of Milan. (Photo: Google Maps)
Isolation, sealing and surveillance can’t stop a virus. Listening to experiences in Public Health could. By Dr. Andreas Wulf

The promise of borderless globalisation, which was initially an economic project, is also reflected in the seemingly borderless tourism options open to the wealthy part of the world. Or were open, it must be said. Globalisation is now increasingly taking on the threatening face of comprehensive enclosure and sealing-off in Europe, as has already been the case in Asia over the past two months. Whereas two weeks ago it was the luxury cruise ships that were turned away from the Asian port cities as if they had the bubonic plague on board, it is now hitting a large holiday hotel on the Canary Islands, which has been transformed into a temporary prison for 1,000 guests.

And as always, China is one step ahead of the world: with new apps, the authorities in Hangzhou collect health and movement data of their citizens and the algorithms determine their mobility: green means free passage at roadblocks, yellow means 7 days quarantine, red 14 days. This is monitored by the estimated 500 million surveillance cameras that exist in the People's Republic. But also, in old analogue fashion, by the local party committees, which are used throughout the country for these measures.

The Virus is always a step ahead

The German Minister of Health is still reassuring that there is (currently) only a low risk in Germany, all known infected persons are under surveillance and treatment. But he too is showing the instruments of the infection protection law as a precaution, should a similar case of spreading as in Italy occur: Not only would the beloved weekly Bundesliga games be cancelled, but the imposition of quarantine over entire cities would be just as possible in Germany as in its southern European neighbor. But everything should be done with a sense of proportion and proportionality, of course.

Although, the case of the hotel in Tenerife makes clear that the virus is always one step ahead. Especially due to the incubation period of up to 14 days, during which the infected persons are still healthy, such spread in the mobile world cannot be stopped. The hope of containment in China, or at least in the Asian countries, can hardly be sustained with the arrival of the epidemic in Iran and Italy, where the chains of infection can no longer be clearly traced.

Panic at outbreaks, neglect inbetween epidemics

The scope and speed of modern mobility has increased to such an extent that these attempts were perhaps doomed to failure from the outset - compared to 2003, when another coronavirus, SARS, appeared, more than twice as many tourists are now travelling globally, and urbanisation has also increased enormously in the last 20 years, and with it the possibilities for spreading newly emerging infections.

"You cannot wall in a virus," says Larry Gostin, Professor of Global Health Law at Georgetown University in Washington. And he sees the greatest drama in the typical sequence of panic reactions during acute outbreaks and complacency in the periods between epidemics: A striking indication of this is the typical Trump style announcement by the US government that it will now immediately invest USD 1 billion in the vaccine and drug research of COVID 19, and the EU will release EUR 230 million to support the affected countries in Europe. While at the same time, the WHO's Emergency Epidemic Fund, which was set up in 2015 after the Ebola crisis and is supposed to always be filled with USD 100 million for such emergencies, almost never reached this target due to the stingy contributions of Member States over the last 5 years.

Action is only taken when the economy is threatened

Although much is said and written about building and supporting "resilient health systems" and developing cooperation in individual projects, such as the German Robert Koch Institute with Nigeria in recent years, a truly strong long-term and global investment in the prevention and care capacities of countries outside the OECD zone would look different.

In fact, the world's response to this as well as the previous global epidemics of SARS, MERS, H1N1 shows beyond doubt: only when a disease threatens the very foundations of global economic flows and also affects people in the first and business class of the "world community", then enormous resources can be found that are never available for the world's chronic hunger sufferers, the poor diabetics, the mentally ill and cancer patients.

Human Rights take a back seat

Even more worrying, however, seems the willingness of the "world community" to forget all attention to the otherwise so praised "human rights approach" in health policy in case of disasters: a massive imprisonment of millions of people arouses more admiration for the "strength" of the Chinese authorities than asking the right questions about the proportionality of the means and the problematic side effects of such an authoritarian policy. The WHO does not mention human rights in its strategic goals of responding to the corona epidemic, even Amnesty International and Human Rights Watch remain timid, as South African AIDS and human rights activist and long-time medico partner Mark Heywood recently wrote. Hardly mentioned was also the suppression of the first reports of new types of infections by the Chinese authorities since the beginning of December 2019.  The tragic death of doctor Li Wenliang, who was forced to declare his warnings of a new SARS-like pneumonia irresponsible "fake news" became a symbol of this repressive policy.

In fact, fake news and panic can only be countered by an open, self-critical attitude of authorities, press and public, who also spread the well-known but still important message of the limited danger of COVID-19 and instead of painting pictures of an medieval plague giving a realistic assessment of the actual dangers, to which appropriate reactions can then be made.

Capitalize on experience!

In the case of the COVID-19 epidemic, it would be urgently time to heed the experience of the annual flu outbreaks: everything depends on the capacities of a health care system in which such seasonal workloads are also factored in while in reality our hospitals are forced to generate as much  revenue as possible with overworked and poorly paid staff in the name of competition.

When sick people have to lie in the corridors, public outrage is great. Instead of panic, however, the only thing that will help here is a systematic shift towards a genuine nursing staff key that also includes capacities for such additional peak loads. As much as the German Health Minister Jens Spahn may currently praise the German health system, the current staffing limits proposed by his ministry are far from adequate.  Pressure from outside and below is still needed here - such health movements have already sprung up at many hospitals in Germany in recent years. March 8th would be a new opportunity to do so, when on International Women's Day also health and care workers are on the streets in many cities. And on 17 June, when the health ministers meet in Berlin for their annual meeting.


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