EHFF COVID-19 Bulletin for end of May
Introduction from David Somekh, EHFF Network Director
For our third COVID19 Bulletin we provide another four thought pieces, looking mostly at other aspects of the impact of the pandemic on society, one exception being the follow-up we sought from Dr Tobias Gantner from his ‘Faster than corona’ project. He’s provided us with a transcript of a recent interview with an investigative journalist on the subject. Caroline Costongs of Euro Health Net allowed us to reprint a thought piece of hers on COVID19 and health inequality. We borrowed a piece on the economy and COVID19 written by a senior economist from University College London, Mariana Mazzucato. Finally, I’ve written a short piece about plans for recovery
What COVID-19 is teaching us about inequality and the sustainability of our health systems
COVID-19 is painfully exposing the existing and persisting health inequalities in our societies. This pandemic will have the heaviest impact on the lives of people living in deprivation or facing difficult socio-economic circumstances. EuroHealthNet partners – the public bodies responsible for health – are doing their utmost to protect citizens and contain the outbreak. In the difficult days and months to come, the need to work together will be clear. Protecting health is the responsibility of all. Good health starts in the community. In the long term, we must consider how our health systems are structured, their sustainability, and their ability to protect all in times of crisis.
“EuroHealthNet partners are now preventing the spread of the corona virus to support us all. Now we must join forces with all sectors to make the changes that will protect our work forces, the people at greatest need, and the sustainability of our health systems. We have to be visionary and have to get prepared for the future needs of people, routed in the economic and social changes caused by the virus.” – Dr Gabrijelčič Blenkuš, President of EuroHealthNet and senior advisor at the National Public Health Institute in Slovenia.
Social inequalities and health outcomes from COVID-19
Research has suggested that most fatalities will be among those with underlying illnesses such as high blood pressure, diabetes, and heart or respiratory disease. The more socially and economically disadvantaged a person is, the more likely they are to suffer from these diseases(1). Diseases that are largely preventable. This also applies to risks of mental ill-health, which will be exacerbated by isolation, fear, and insecurity (2). The immediate focus now is on controlling the spread of the disease. Next, we will need to act to address high and rising levels of chronic diseases in our societies and reducing pressure on care services.
“Half the calls to emergency lines are from lonely seniors and half of the deceased had at least three chronic diseases and were largely of a lower social background. The most critical shortage these days is that of professionals in intensive care and infectious disease units. Italy hasn’t yet passed the peak of infection and we have more questions than answers, but there are some lessons we can already learn.” -Giovanni Gorgoni, Director General, Regional Healthcare and Social Affairs Agency of Puglia (AReSS Puglia), Italy
People in poorer socio-economic circumstances can also be more exposed to infection. They may be unable to self-isolate due to insecure labour conditions which do not allow for teleworking or provide statutory sick or care leave. They also live in closer proximity to each other and are more likely to experience overcrowding (3). In both the short and long term, they are more likely to experience unemployment and financial insecurities and are more vulnerable to labour market fluctuations resulting from macroeconomic changes.
Health systems fit for the future
The EuroHealthNet partnership of national and regional public health institutes and authorities has long called for the need to reorient our health systems towards prevention and promotion (4), and providing healthcare professionals with the support and training that they need (5). This transition, and the reduction of chronic diseases and health inequalities, would relieve pressure on secondary health care services, leaving them more able to respond to crises.
“For now, we must all follow instructions and be aware that nobody is protected. After this immediate crisis has passed, we must not forget the hidden inequalities and disadvantages of current health systems which are exposed by epidemics.” – Prof. Dr Hristo Hinkov, Director, Bulgarian National Centre for Public Health and Analyses
COVID-19 lessons tell us yet again to invest in prevention and health promotion, as well as in the wider health workforce, tackling avoidable health inequalities, and boosting health literacy. Solutions to addressing problems in the health system lie beyond it too: it is essential that social protection systems are solid and well-funded. Employment and income support must be provided to cope with additional costs, and consequences of disease and ill health. Investing in these services, means investing in people, in resilience, solidarity and ultimately in the wellbeing of our society and economy.
While the European Commission has earmarked €140 million to support 17 research projects for diagnoses, treatment and vaccine of the disease (6), and €50 million to create a stockpile of medical devices such as ventilators and protective masks to help EU countries, €37 billion (7) will be dedicated to addressing the pandemic, providing a much-needed boost to overburdened healthcare systems and services and businesses. When the first wave of the crisis passes, we need long-term comprehensive strategies and sustained investment, aligned across all sectors including education, housing, food, environment, economic etc. These strategies should boost health promotion and disease prevention, make our health systems sustainable, and support good health for all. Caroline Costongs, Director EuroHealthNet: Mar. 24th
 Courtney L. McNamara, Mirza Balaj, Katie H. Thomson, Terje A. Eikemo, Erling F. Solheim, Clare Bambra, The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health, European Journal of Public Health, Volume 27, Issue suppl_1, 1 February 2017, Pages 22–26, https://doi.org/10.1093/eurpub/ckw222
 WHO, Social Determinants of Mental Health, 2014  https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=2B47C1C22D 562D0C355B71D35DDA0949?sequence=1
 In 2018, 26.2% of the European population with an income below 60 % of median equivalized income lived in overcrowded dwellings. Overcrowding rate by age, sex and poverty status – total population – EU-SILC survey 2018
 EuroHealthNet, The European Semester from a Health Equity Perspective, 2019 https://eurohealthnet.eu/publication/european-semester-2019-health-equity-perspective
 EuroHealthNet, What role for health professionals to address health inequalities, 2019 https://eurohealthnet.eu/media/news-releases/what-role-health-professionals-address-health-inequalities
 COVID-19: Commission steps up research funding and selects https://ec.europa.eu/commission/presscorner/detail/en/ip_20_386
 Corona Response Investment Initiative https://ec.europa.eu/info/sites/info/files/regulation-coronavirus-response-investment-initiative-march-2020_en.pdf
Update on FasterThanCorona
We published some information about Tobias Gantner’s HealthCare Futurists project in our first COVID19 Bulletin on April 10th. Here is an update: Excerpts from Interview between Tobias Gantner of HealthCare Futurists and a Polish journalist based in Berlin, Artur Olesch, Editor-in-Chief, OSOZ. A.O. “How can data help in research on COVID-19?” T.G. “Every single thing we do is based on data and again also produces data. Some of these data we might never get into our hands even though, they exist.
Think about the number of left handed people at any given moment in time on this planet. Indeed, it is a natural number. Albeit it does not make a life changing difference as much as I can tell from my point of view, it would still be interesting to know but the effort to find out this number would outweigh the benefit generated from the knowledge.
We think that some data in some contexts are more important than others and since the world works on data we have come up with the idea that data in Covid-19 might open up a door to get an earlier view on some correlations that years later we will find in lab tests. So what we do is, we ask citizens for altrusitic, i.e. non-recompensed, data donation and have employed an AI algorithm to sort these dirty data and find some patterns in there that provide hints to medical correlations we have either not thought of for want to be tested within our batch of hypotheses that we had generated a priori. Our AI is trying to filter all the noise in the dirty data to push to the core. Whenever we find traces, we would pass results and raw data on to scientific institutions, telling them to double check and possibly then employ targeted lab tests to see if there are correlations or even causal connections between our, what we call them, “computer-generated biomarkers“ and clinical or laboratory findings. It is our hope to produce a set of these computer-generated biomarkers and so be of help in the quest of deciphering the Covid-19 chameleon”.
AO: “The project “Faster Than Corona” aims to gather data to learn more about the virus and “save lives”. What benefits are expected?”
TG: “As claimed, we want to do exactly this: learn more about the virus by cutting through the data and discerning noise from patterns and use the patterns detected though machine learning and advanced mathematical methods in order to save lives. We hope to find out if certain populations are at higher risk to conceive Covid-19 or how super-spreaders, if they exist at all, behave and whether they can be detected from the data at an earlier point in time. Besides these hypotheses that we have set up together with our medical experts, we think it feasible that the algorithm will be able to detect further patterns and from them generate hypotheses by itself. All of these of course we will have to run through labs where we need to see what of our data is reflected in biology. But we hope to accelerate scientific knowledge expansion by setting the target a little narrower and defining a little closer what we might be looking for. Honestly, it is not a lot we know about Covid-19 today and some of the older knowledge seems to be dated already while we find it difficult to put piece by piece together in our quest to approximate truth by data. It is a little bit as if every single person had a little torch and would shine a light on Covid-19. We are trying to turn the light in the room on by synchronizing all the torches. Then we can get the bigger picture and will know more about how to save lives”.
AO: “Are the first conclusions of the study available yet?”
TG: “Yes, we do have some conclusions that we have presented on a congress on data science already. As our mission statement says, those findings do not pertain to medical information or recommendations as to take your medicine. We leave this to those authorised to do this. We have been reporting on the number of users and what they are looking at, where they come from and how we got their attention. It makes us proud that as a completely self-funded project that comprises of a number of leading people in the healthcare systems in Europe we have managed to become the largest data donation platform in COVID-19 on a global scale with donors coming from 81 countries so far.”
AO: “How would you rate the readiness to share data by citizens?”
TG: “I think in general people are open minded to share some data, even medical data. For that they have to understand the overall benefit. Altruism or the idea to contribute to scientific advances can be a good enough reason.
Our main obstacle lies in the over obedient discussion on data security. We thought on the verge of the lockdown, when we first initiated www.fasterthancorona.org that finally the time has come where we could do something new that in normal times would have been devoured by the official collective of change inhibitors and given our agility, we could get by with what we do. For some time, it looked quite promising, but some people still got hung up on the data safety thing, even though it is all clearly formulated on our website. This deprived us of the opportunity to generate some more media attention and thus more data donors. After all, in my view, data security and data privacy at the end of the day are for healthy people. Those in dire need for a cure consider data privacy completely different if it carries the perspective to save their life.
AO: “The current crisis shows that not everyone trusts scientific data. Do you have an idea of how to change it?”
TG: “It is interesting to see what happens in a crisis. Politics and science get into a strange liaison. This has the tendency to confuse a lot of people. We found out in our ‘question of the day’ survey on our website that people tend to trust more, those who are able to explain properly. It does not correlate with academic titles and the trust in social media and politicians in general did not seem to be exactly exuberant. We have from the beginning gone the route of transparency. This means, people can opt out from data donation at any given point in time. We have a very understandable legal disclaimer which does not require a JD and a PhD. We open our data vault to anyone with a valid research question and we cooperatively share our data with trustworthy institutions. It is our clear idea to go from Citizen to Citoyen, to be a movement of citizen scientists who employ a now methodology to be faster than the natural spread of the virus, hence our name.”
Another aspect of the impact of the Pandemic. The economy.
We think that this is a suitably thoughtful article on how the pandemic, as it has on many aspects of our lives, exposed flaws that we have been content to live with, but perhaps shouldn’t continue to do so, as we go forwards.
Capitalism’s Triple Crisis
Mar 30, 2020 Mariana Mazzucato
After the 2008 financial crisis, we learned the hard way what happens when governments flood the economy with unconditional liquidity, rather than laying the foundation for a sustainable and inclusive recovery. Now that an even more severe crisis is underway, we must not repeat the same mistake.
LONDON – Capitalism is facing at least three major crises. A pandemic-induced health crisis has rapidly ignited an economic crisis with yet unknown consequences for financial stability, and all of this is playing out against the backdrop of a climate crisis that cannot be addressed by “business as usual.” Until just two months ago, the news media were full of frightening images of overwhelmed firefighters, not overwhelmed health-care providers.
without directing it toward good investment opportunities. As a result, the money ended up back in a financial sector that was (and remains) unfit for purpose.1
The COVID-19 crisis is exposing still more flaws in our economic structures, not least the increasing precarity of work, owing to the rise of the gig economy and a decades-long deterioration of workers’ bargaining power. Telecommuting simply is not an option for most workers, and although governments are extending some assistance to workers with regular contracts, the self-employed may find themselves left high and dry.
Worse, governments are now extending loans to businesses at a time when private debt is already historically high. In the United States, total household debt just before the current crisis was $14.15 trillion, which is $1.5 trillion higher than it was in 2008 (in nominal terms). And lest we forget, it was high private debt that caused the global financial crisis.
Unfortunately, over the past decade, many countries have pursued austerity, as if public debt were the problem. The result has been to erode the very public-sector institutions that we need to overcome crises like the coronavirus pandemic. Since 2015, the United Kingdom has cut public-health budgets by £1 billion ($1.2 billion), increasing the burden on doctors in training (many of whom have left the National Health Service altogether), and reducing the long-term investments needed to ensure that patients are treated in safe, up-to-date, fully staffed facilities. And in the US – which has never had a properly funded public-health system – the Trump administration has been persistently trying to cut funding and capacity for the Centers for Disease Control and Prevention, among other critical institutions.
On top of these self-inflicted wounds, an overly “financialized” business sector has been siphoning value out of the economy by rewarding shareholders through stock-buyback schemes, rather than shoring up long-run growth by investing in research and development, wages, and worker training. As a result, households have been depleted of financial cushions, making it harder to afford basic goods like housing and education.
For the rest of the article, here’s the link to the original source: (copyright Project Syndicate 2020):
After the apocalypse. The plan to re-boot Europe?
Many commentators great and small (i.e. including ourselves!) have observed that the events surrounding the pandemic, on our health systems, our economies, on the condition of the least privileged in our society and on public trust in respective governments (to name just some of them) ought to lead to a profound re-think of the way that we currently live our lives and the way that we relate to the rest of the world.
On May 13th, Ursula von der Leyen, President of the European Commission, quoting the motto ‘together in adversity’, made a keynote speech to the European Parliament on a proposed ambitious recovery plan for Europe.
She reiterated the three existing priorities, the Green Deal, digitalisation and resilience.
Over and above the previously proposed budget, she described an additional fund, what she called a recovery instrument. This can be expressed as having three pillars, a recovery and resilience tool to strengthen key public investment and reforms and a second pillar to stimulate private investment, especially in the technology areas related to clean energy and the development of 5G and AI but also supporting the pharmaceutical sector. The third pillar is about learning lessons: a new, improved health strategy.
“The recovery instrument will be the ambitious answer Europe needs. An answer that will include new owned resources that we need in our budget – just as the Commission proposed in 2018. An answer that reflects our common values with a mechanism to protect the rule of law. An answer that is built on necessity but is designed for the future. This will strengthen solidarity between nations, between people, but also between generations. Sooner or later our scientists and researchers will develop a vaccine against corona virus. For climate change, however, there is no vaccine. This is why Europe must now invest in a clean future. Our investment in rebuilding comes at a price: rising debt. If it is necessary to increase our debt, which our children will then inherit, then at the very least, we must use that money to invest in their future, by addressing climate change, reducing the impact on climate and not adding to it.
As we come out of the crisis, we must not fall into old habits, we must not hold onto yesterday’s economy as we rebuild. On the contrary, we must boldly use this opportunity to build a modern, clean and healthy economy, which secures the livelihoods of the next generation. The European Union alone cannot heal all the wounds left by the crisis. But we will shoulder our share of the responsibility, by evenly distributing the burden between Member States right now – whilst ensuring that younger generations also reap the rewards of this incredible effort.”
EHFF applauds the spirit of the President’s message, but given the complexities that lie behind the ‘together in adversity’ principle, it is the detail that concerns us. No one doubts that at a time of major turbulence, opportunities for innovation are maximised and some unplanned step-change innovation will inevitably happen. An obvious example is the jump forward in the use of tele-medicine, with a large number of primary care consultations taking place online rather than face to face. It is unlikely that this shift will be reversed. Use of contact-less credit card transactions instead of exchange of money is also especially noticeable, and there will be other examples from different aspectsof daily life. The use of online business meetings to name just one. So there is some basis for people talking about ‘the new normal’.
Yet other signs point in the opposite direction. As anxieties lessen re coronavirus (reality based or otherwise) it seems as if air travel is starting to resume without obvious evidence that anything will change longer term and that within months our skies may be as crowded as ever. The high level gambling of other people’s money reflected in the behaviour of the stock markets has continued apparently unabated for nearly the whole period of the crisis so far. Therefore, if we are to fulfil the laudable aim: “not to fall into old habits, we must not hold onto yesterday’s economy as we rebuild”, how exactly will this be accomplished?
There are signs that the pandemic has succeeded in bringing health back up the list of Commission priorities as its wide-reaching impact has underlined the previous message of ‘health in all policies’ although von der Leyen’s support for greater investment in health policy does predate the pandemic. Similarly, the Green Deal concept was already on the table. What is new then?
For some, the experience of lockdown meant slowing down, smelling cleaner air, hearing less mechanical background noise, a curious sense of ease. Conversely there were families pushed further into poverty, with anxiety about lost income, forced to live in claustrophobic proximity with others without recourse to outside spaces, a kind of hell. While the spirit of community support, as in wartimes, was awakened, history suggests that such good will vanishes relatively soon after the immediate threat subsides. For the latter group particularly, getting back to normal would be an immense relief. It would not only be greedy bankers or promoters of ultra-conservative values that would be very wary of significant change in our prevailing economic model, despite many seeing it as profoundly dysfunctional.
The acid test is to see what alternatives are being proposed and how realistic it would be to gain sufficient support from enough sections of society to have them implemented. Until we see evidence of this, we are left with a set of good intentions we can identify with, but which at present, despite the recent catastrophe, stay firmly in the realm of ideals rather than a genuine action plan for transformational change.