Positions for a solidarity-based fight against the Covid-19 pandemic & its consequences
A contribution by break isolation, Munich
The deadly failure of capitalized health systems
In April 2020 in the middle of the first Covid-19 wave, we published 12 concrete measures for a solidarity-based fight against the Sars-CoV-2 pandemic in the founding call of our initiative break isolation. At a demonstration in front of the Bavarian Ministry of the Interior on May 11, 2020, we loudly demanded that the government immediately implement these measures. Until today, most of the points of this catalog of measures have not been realized or not consistently implemented by the politicians and crisis staffs. Due to these failures and wrong decisions, tens of thousands of people died in the Covid-19 wave between November 2020 and March 2021 in Germany alone.
Between the 4th and 5th wave of the Covid 19 pandemic in 2021/22, we have now used the experience of the last two years to discuss and reflect again on the social development and formulate positions on how to combat the pandemic as comprehensively as possible. With our text, we would like to strengthen the necessary discussion, especially in the social movements, about what consequences should be drawn globally from the lethal failure of capitalized health systems in this pandemic, how pandemics could be fought successfully in the future in solidarity, and what would have to change fundamentally for this to happen.
A Orientation towards those at risk
1.) For a successful and socially just fight against pandemics, as experience has shown for over 100 years, transparent and appreciative communication is a very important prerequisite. This requires educating all people, for example, about preventive hygiene and protective measures to prevent infection and the spread of a virus on an equal footing. In contrast, fear and scaremongering or repressive measures as well as ignoring inconvenient findings and facts are counterproductive. Especially publicity show effects of self-centered and election campaigning politicians are dangerous, because their decisions only aim at a short-term success for their own person or party. Or, to put it another way, effective and socially just pandemic response would have required a high degree of responsibility on the part of governments and crisis teams for the people affected, as well as differentiated, positive, supportive and solidarity-based communication. Instead, undifferentiated threat scenarios were often disseminated, in which all people were equally panicked, while at the same time those most affected were left alone without protection.
2.) To combat a pandemic, rapid, well thought-out, targeted and sustainable measures and hygiene concepts are required, as well as low-threshold offers: e.g. the implementation of nationwide prevention measures such as supplying the population with masks, disinfectants and tests. These measures must be geared first and foremost to the vital interests of the people and groups in society most affected by and at risk of a pandemic. This requires the responsible decision-makers to have extensive social, epidemiological and medical knowledge and at the same time a concrete understanding of the situation.
3.) Only effective early warning systems and consistent protection and prevention measures could have prevented the global and diffuse spread of the new pathogen within a short time window. With a few exceptions, such as Taiwan, this failed in most countries: because there were no professional early warning systems and/or because the dangers were initially ignored, concealed or incorrectly assessed by governments and crisis teams, and measures were thus taken far too late. In addition, there was a lack of appropriate resources and structures. It proved to be particularly fatal that the crisis teams in Germany ignored for months the already existing scientific knowledge that the SARS-CoV-2 virus spreads predominantly without symptoms, i.e. a large number of infected people develop no, mild or diffuse symptoms, therefore do not go to the doctor and continue to spread the virus undetected. In this case in particular, effective protection of people at risk requires the immediate implementation of consistent hygiene rules (mouth-nose protective masks, especially for staff, disinfection, taking temperature) as well as the immediate establishment of area-wide and daily testing structures in hospitals and especially also in senior citizens’ and nursing homes in order to prevent the virus from entering inpatient facilities.
4.) Effective control of a pandemic such as Covid-19 would therefore have required the immediate provision of protective masks (where necessary and possible with FFP2 or FFP3 masks) to all people, with priority given to all people in inpatient facilities such as hospitals, seniors and care facilities, facilities and reception centers for asylum seekers and refugees, facilities for people with handicaps, psychiatric wards, and correctional facilities, as well as in prisons. This did not happen for months because, first of all, the decision makers and their advisors massively doubted the protection of masks in public and, moreover, there were no supplies of masks and disinfectants.
5.) In a pandemic, the most vulnerable groups of people always have the right to the greatest possible social solidarity and effective assistance and support. They need special protection and care, but not social exclusion and isolation for months. A corresponding prioritization would have made personal and at the same time the safest possible contacts possible for residents of inpatient facilities, if a consistent and binding application of protective measures for the affected persons, their caregivers and relatives as well as the nursing staff and their relatives had been implemented immediately. The following simple but consistent and comprehensive measures would have saved the lives of tens of thousands of people in Germany alone in the first and especially in the second and third waves: regular daily Covid 19 testing of caregivers, service staff and visitors, temperature measurement, hand hygiene, wearing of protective masks (where possible FFP2 or FFP3 masks) and later a mandatory vaccination priority for all these groups of people.
6.) A pandemic must not suspend existential human rights: Even in times of Covid-19, the will of patients and relatives as well as living wills must remain valid and respected. In concrete terms, this means that appropriate protective measures must be taken to ensure that sick people can be visited and dying people can be accompanied with dignity in the presence of their loved ones. The fact that this was not possible in probably tens of thousands of cases and is still not guaranteed today, but is often dependent on the individual decisions and solutions of committed employees and facilities, is one of the most unforgivable mistakes made by those responsible. Instead of creating the necessary personnel and material capacities immediately, visiting rights are temporarily suspended, denied or arbitrarily restricted in hospitals and inpatient facilities to this day.
7.) Measures in a pandemic, such as lockdowns, should always be reflected upon and weighed by decision-makers with regard to their negative consequences instead of simply ignoring them: For example, the increase in excess mortality due to delayed or omitted medical care for other diseases, as well as the collapse of supply chains and, as a result, the massive increase in hunger and poverty in the world.
B Communalization of measures and global approach
8.) Necessary for a successful and solidarity-based fight against the pandemic are communal, public and resident-based structures of free health care and services of general interest, which can implement meaningful measures promptly and effectively. Such structures have been massively thinned out or completely dismantled in recent decades. They have been destroyed across the board and permanently in the course of the privatization and profit orientation of the health care systems. The stockpiling of hygiene and protective materials has also been massively dismantled. This situation should have been changed immediately with a major effort.
9.) The practical implementation of protective measures and the education of the population require low-threshold public health structures close to homes and workplaces, as well as adequately trained personnel with language skills: Only in this way can effective protection concepts be implemented quickly and, above all, initially for those groups of people who are most at risk from a pandemic. In the absence of these basic prerequisites, neither contact tracing of infected persons nor support for inpatient facilities in the immediate implementation of testing concepts worked in Germany, among other things.
10.) Successful pandemic control requires broad social acceptance of the measures. Transparent communication and credible information about the meaning of the protective measures, as well as addressing the specific situation and people’s concerns, are essential for this. This is particularly evident in the success or failure of vaccination campaigns: concepts that rely on target-group-specific education close to home (e.g., health advisors with language skills) and low-threshold services (e.g., vaccination buses or health centers in residential neighborhoods) achieve high vaccination rates (see, among others, the successes in Bremen, Portugal, Cuba, etc.). This includes target-group-specific education of the population.
Promises that are not fulfilled and threats, on the other hand, have disastrous effects: They lead to strong uncertainty, massive loss of trust, ignorance, fatalism and irrational defense mechanisms. In this context, it is particularly negligent when politicians initially categorically rule out compulsory vaccination and later try to enforce it by law.
11.) It is nonsensical to try to raise the vaccination rate in Germany from 75 to 80 to 85% by force, when only a fraction of the people in the global South are vaccinated. This vaccination imperialism only prolongs the pandemic senselessly (Delta from India, Omikron from South Africa). Instead of metropolitan compulsory vaccination, there should be a global vaccination campaign with approximately equal quotas in all regions of the world, as well as a release of vaccination patents.
If there were an option in this country to choose a traditional vaccine, a bridge would be built for the skeptics who distrust the new bio- and genetically engineered vaccines. It is estimated that these skeptics account for one-third of all vaccine opponents.
Moreover, it is still unclear whether the somewhat weaker dead vaccines remain effective even longer than the GM products that focus only on the spike protein.
12.) A pandemic can only be tackled effectively, sustainably and comprehensively on a global and community-wide basis. Any form of national and private-sector competition for power, influence and profits acts like a fire accelerator in pandemics and is fatal for very many people. This is particularly evident in the prevailing vaccine competition between geopolitical power blocs, state alliances and individual countries: Instead of publishing scientifically sound, independent expert opinions on all available vaccines globally and distributing vaccines effectively and equitably, the development of vaccines and medicines has been politicized and economized for state and private sector interests since the beginning.
C The common good instead of profits: stopping marketization
13.) In a pandemic, all knowledge and findings about the virus, its spread, the disease, possible protective measures, the conduct of studies, and the research and development of vaccines and medicines should be made available and shared globally and communally with maximum transparency and as a common good. This means, for example, organizing the development and production for all protective and medical devices, masks, disinfectants, and ventilators, as well as vaccines and medicines, as tasks for society as a whole and transnationally equitable, and not leaving them to the chance of private sector interests. Sufficient stocks of the necessary products must be acquired, stored and regularly renewed in real terms. They must therefore not only be “in place” in pandemic plans, because the neoliberal concept of just-in-time production of vital health goods will – as has been shown – always lag behind, especially in a pandemic, especially if the supply chains collapse.
14.) Effective pandemic response requires an immediate price and speculative freeze on all needed protective and medical products: i.e., especially masks, disinfectants, tests, vaccines, and medicines, as well as all raw materials, supplies, and products needed to produce them. In addition, in such a crisis, production capacities for masks, hygiene products and PCR and rapid tests, for example, must be created immediately. In contrast to some countries that immediately decided to seize stocks and build up sufficient production capacities, nothing of the sort happened in Germany.
15.) Profit maximization with vaccines and medicines and their (world-)market distribution by pharmaceutical companies have deadly effects in a pandemic: Research and production of vaccines and medicines against Covid-19 should therefore be organized in social hands for an effective fight against the pandemic and be accessible to all people worldwide. Profits at the expense of people’s health or illness must no longer be allowed in the future. Instead, it would make sense to immediately repeal vaccination patents and medicines. Because in a pandemic, patents on vaccines and drugs guarantee secure profits for the pharmaceutical industry, but they kill millions of people: capitalism kills pandemically!
The experience of the AIDS pandemic had already shown that many millions of people worldwide had to die only because the prices of life-saving drugs were unaffordable for most of those affected and often still are today. It took years of global struggle by social movements against the pharmaceutical industry to at least lower the prices of HIV drugs.
D Labor, exploitation & necessary consequences
16.) After the neo-liberal clear-cutting of the last decades, the municipal health care including a maximum care close to the place of residence with sufficient capacities of intensive care beds should have been massively expanded immediately with the beginning of the pandemic. The opposite has happened: the number of nursing staff has actually decreased further over the duration of the pandemic, as has the number of intensive care beds. However, instead of admitting the mistakes of the past and finally taking action, politicians are intensifying the rhetoric of threatening everyone with triage debates, while the work situation for medical staff continues to deteriorate.
17.) It has long been shown that one-time crisis bonuses for nursing staff and health care workers do not improve professional practices and situations! Better pay is an important factor and the welcome development in the premium segment of university hospitals should be generalized across the board to geriatric care. However, it must be ensured that better pay is not saved again by further work intensification.
A fundamental upgrading of the health care professions requires good staffing levels that equalize stressful situations at all times of the day and night; for example, two people must always be available for physically heavy tasks in order to prevent long-term musculoskeletal damage among nursing staff. Shift schedules that are geared to the needs of employees must become the rule. In practice, necessary rest breaks within and even between shifts are often omitted. The prevailing system of flat rates per case and degrees of care does not do justice to either those being treated or those being treated individually (they only serve the returns of listed file companies and owners of the privatized health care system and should be abolished). This is illustrated by the example of hygiene measures, which are of crucial importance for patients even in non-pandemic times: They require time that is neither provided for in the billing nor in the shift schedule. The sick are then perceived as a burden and hygiene measures are neglected due to lack of time and manpower. The result is a blazingly dangerous situation: multi-resistant germs are now one of the most common causes of death worldwide.
A 30-hour work week is also desirable in the health professions, as it would necessitate the need to reorganize working conditions and the entire health care system.
18.) For the past 25 years, a massive transfer of highly qualified professionals has been taking place very particularly from the poorest countries of the EU and Europe to Germany; since 2012 also increasingly from civil war countries such as Syria and Iraq. Between 2007 and 2017, the number of physicians who completed their training in other countries increased by almost 29,000 in the Federal Republic. At the end of 2019, they make up more than 13% of working physicians (total number in 2019: 402,119) – and most of them have migrated from countries with poorer economic, social or political prospects, fled or been directly poached. Without them, nothing would work in the German healthcare system. In addition, the training to become a medical doctor in Germany costs more than 30,000 € of taxpayers’ money, but the countries of origin of these doctors have not been reimbursed a single cent for the training costs! This further exacerbates international inequality and injustice.
The doctors are also missing every day in the care of sick people in their countries of origin and this also aggravates the pandemic extremely. Furthermore, it is striking that these doctors mainly support the German hospital system. There, they made up over 20% of the medical staff in 2019.
On the failure of the deregulated health care system and the systematic transfer of labor to Germany, see also our article “Systematic labor transfer”.
19.) The roughly same picture emerges in nursing: While domestically trained professionals often secure pay-scale jobs – for understandable reasons – the proportion of workers poached from abroad increases the worse the working conditions and remuneration turn out to be. Roughly outlined, there is the disparity between hospital and geriatric care on the one hand and the question of the profit orientation of the facility on the other. In the area of “24-hour care” by a single person in the home – with the exception of relatives – the workforce is almost exclusively recruited or “mediated” from (Eastern) European countries: In the rarest cases, they are covered by social insurance and, moreover, have hardly any contractual security.
The pandemic has generally worsened the work situation in the health care professions: hygiene measures take time, colleagues fall ill, have to go into quarantine or reduce their working hours. For employees from abroad, however, there were additional imponderables: At times, travel to one’s own family was completely prevented, and a country could also end up on the list of particularly endangered regions upon return. And the crowded coach as the common means of transport is an additional risk of infection in times of pandemic. To date, there is a lack of assured travel options for all nursing staff to their families in their countries of origin from Covid-19 emergency aid funds.
20.) We call for government funding compensation for all health costs resulting from the Covid 19 pandemic:
This includes all costs incurred by nursing facilities due to price speculation and cost explosion for protective masks alone. These must be funded from Covid aid.
In principle, the additional costs for adequate salaries for nursing workers must be borne by society in the future and not be passed on further at the expense of those affected and their relatives. Otherwise, there is a risk of further impoverishment of large sections of the population.
E Solidarity instead of exclusion: break isolation!
21.) Pupils and young people are still among the losers of the pandemic: First, schools were simply closed. The demands for sufficient air filters and ventilation possibilities in classrooms to conduct face-to-face lessons have not been implemented until today. The immediate guarantee of digital school lessons for children in institutions for refugees, but also for socially disadvantaged children and young people through support staff and sufficient PC workstations were simply forgotten and are still not guaranteed today.
22.) Until today, the central reception facilities and camps for asylum seekers and refugees in Germany and at the EU external borders have not been dissolved, as demanded in many cases, and decentralized accommodation including vaccination offers and medical care has not been guaranteed. Those affected were deliberately exposed to an immense risk of infection, even though hotel capacities were empty. Not infrequently, entire facilities were placed under curfews and additional degrading barriers were drawn.
23.) The experience of the pandemic has shown that social projects for the homeless, as well as information centers and safe havens for victims of sexualized and domestic violence, were forgotten by the crisis staffs. They, too, should definitely have remained open and needed rapid provision of protective equipment and financial resources. Their capacities must be expanded under sanitary conditions, because otherwise the victims will not only be left unprotected to face the pandemic, but their lives will also be neglected to protect them from the dangers they face in everyday life.
F Redistribution, municipalization and deprivatization
24.) Federal German burden sharing in the pandemic currently means: large corporations are “saved” from tax revenues, no matter how climate-damaging they may be. Employees subject to social security contributions are being fobbed off with short-time workers’ benefits and kept quiet, while the unemployment insurance reserves that they themselves have financed are being plundered. Hundreds of thousands of small tradespeople and the self-employed are impoverished. They now belong to the group of precarious people, for whom traditionally no one is interested.
Silent and little-noticed winners of the crisis are the real estate corporations and rent sharks. At the end of the day, they did not have to give up a single month’s rent, and billions in economic aid continued to flow indirectly into their pockets! It is profoundly lacking in solidarity when some are impoverished by the pandemic through no fault of their own and others do not have to contribute to overcoming the crisis.
25.) We demand a decent basic income for all instead of bureaucratic aid packages and Hartz-IV (i. e. german social welfare).
26.) Health and care are human rights that we should again organize jointly and communally in a society based on solidarity. For this we need an immediate deprivatization of clinic and home operators into non-profit and communal hands. The health care system, as well as facilities for senior citizens and nursing homes, must not be allowed to continue to degenerate into the profit objects of large investment funds and stock corporations.
Summary: What must follow from the failure to combat the pandemic?
It was already evident in the first wave that, in addition to the elderly and the chronically ill, those who were particularly at risk were those who lived in completely cramped living conditions and had to ensure their survival under precarious working conditions. For them, there was no lockdown: instead, unsafe conditions when traveling to work, at work, and afterwards, a high-risk daily routine, confined to far too cramped apartments and neighborhoods that are particularly affected by the spread of the virus and thus high infection and mortality rates.
As the break isolation initiative has already demanded in April 2020, a nationwide binding protection and testing strategy for nursing homes, clinics and inpatient facilities (i.e. no isolation of residents!) as well as for those affected by precarious living and working conditions could have prevented very many deaths.
The Corona crisis shows dramatically: health, water, air, food, soil and education must not be privatized for the purpose of profit maximization for a few. We need the development of solidary and social communal health, education and social structures in decentralized self-administration.
The Corona crisis shows the total failure of global capitalism: the pandemic exacerbates inequality and injustice worldwide in an extreme way. This makes it necessary to fight for the human right to health care and a good and healthy life for all people worldwide with initiatives and solidary struggles of social movements.
Note: In the debate about the positions of the #zerocovid campaign or in the positions of Giorgio Agamben, it unfortunately also becomes apparent that even in the left many positions and assumptions that were previously considered common have been lost and the understanding about them must be conducted anew. In our article “Why #zerocovid is an aberration” we try a first analysis and Karl Heinz Roth has analyzed the end-time versions of Agamben in his article “Giorgio Agamben’s Visions of the End Time”.