Initial (State) Response to Covid-19

Abstract

The Chapter 2, entitled “Initial (State) Response to Covid-19” of the book titled “Covid-19 and Capitalism - Success and Failure of the Legal Methods for Dealing with a Pandemic”, aims to explain how a number of Western countries and jurisdictions, particularly the European Union, have responded to the outbreak of the Covid-19 pandemic. Methodologically, this second chapter aims to interpret this governmental response in light of the characteristics of the neoliberal policies that these Western countries have been pursuing for a number of decades already, drawing in part on various previous work by the author himself (referenced throughout the chapter). In addition, to elaborate on the factual background of the events that have taken place at a frightening pace since the end of 2019, it has throughout this chapter been necessary to rely, to a substantial extent, on the findings of the specialized press, as well as professional journals (medical and others). The author himself has not conducted any such own factual research but has, on the contrary, relied on the research findings by said journalists and other academics, to which reference has been made under explicit acknowledgment that these have in many cases been the original authors of the relevant, thus cited, statements and information. The overall purpose of this chapter is to point out how Western-world neoliberal policies that have been pursued for decades already have eroded the resilience and responsiveness of Western countries to a virus-induced pandemic. In that sense, the chapter reads like a blueprint of failed neoliberal policies to guard the safety and health of its citizens. As a result, the Covid-19 pandemic is not only the result of a successful virus, but at least equally, if not more so, of failed neoliberal government policies.

2.1 The Neoliberal State as the Socio-Economic Background Against Which Covid-19 Hit the World

2.1.1 Neoliberal Diminishment of the Welfare State Model vs the Ideal Neoliberal State Model

By the time Covid-19 hit the Western world—especially the European and North American continents—their societal organisation had, after four decades of applying various theories of economic neoliberalism,¹ been unilaterally, albeit with some cultural differences between countries, reshaped according to the dictates of said neoliberal ideology.²

The fundamental public policy approach of neoliberal ideology is that markets should never be controlled or governed by states, but rather the opposite, that states are merely a means to help free markets function as efficiently, harmoniously and profitably as possible.³ From the 1980s onwards, the theories of economic neoliberalism translated into a policy approach⁴ according to which the main, if not the only, objective of a state is to make the free market function as freely, and therefore as optimally, as possible to serve the objectives of the financial and business world.⁵ Moreover, this approach also gradually started determining the policy of international institutions, such as the International Monetary Fund, the World Bank and the World Trade Organisation. The latter has also been indicated as the “Washington consensus”. (Cf. furthermore Sect. 3.4.1.)

As phrased by Brown, to achieve this overall goal, states need to do the following⁶:

• (1) A (neoliberal) state must (always) respond to the needs of the market, be it through its monetary, fiscal and labour policy, its immigration policy, the way it treats criminals, the organisation of social welfare and/or the provision of public services, such as public education and healthcare. Neoliberal rationality hereby indexes the success or failure of the state in terms of its ability to support and foster the free market and it, moreover, even links the legitimacy of the state to this continued success (of failure).

• (2) A state can only be enveloped and driven by the rationality of the market. This characteristic of a neoliberal state is not simply a question of mere profitability, but rather of a generalised and continuous calculation of costs and returns which has been turned into the measure of all state objectives and practices (which, in the EU, has led to the so-called ESA 95 standards and which, in a more recent past, explains the adherence to austerity). The political discourse on all these issues is framed in entrepreneurial terms: A state should not only be concerned with making markets as free as possible, but should also force itself to start thinking and behave as a (free) market player in the exercise of all its functions, including education, social care, law and its enforcement, safety…

• (3) The health and growth of the economy becomes the (only) basis of state legitimacy, both because the state is held responsible for the health of the economy, but also because of the economic rationality to which state practices have themselves become subject. The slogan “It’s the economy, stupid” has hereby become the sole guiding principle of state legitimacy and the sole basis for all state actions, from constitutional adjudication and campaign finance reform, to welfare and education policy, to foreign policy, including war and the organisation of homeland security.

Anything that hinders the state’s ability to make the economy prosper and grow is, by definition, considered harmful, and the state, therefore, has a sacred duty to eliminate these elements.⁷

In this context, the proponents of economic neoliberalism launched an unprecedented attack on the welfare state model from the 1980s onwards, which to a large extent has continued to this day (cf., for example, the EU’s neoliberal austerity in the aftermath of the severe financial crisis in 2008).⁸

Among the key measures used by neoliberal governments in their efforts to transform former welfare states into neoliberal free market states are⁹:

• The implementation of the neoliberal doctrine of “consumerism” (which essentially amounts to stimulating consumer spending, and thus the demand side of the economy, even more than is already the case in the capitalist logic of “consumption for consumption’s sake”).

• A total focus on production and full employment—the idea being that every member of society should be continuously, and for as long as possible, at work to keep the free-market machine running. Not surprising, ensuring full employment has been indicated as one of the two guiding principles of the mandate given to the US Federal Reserve by the US Congress (which we shall explore further in Sect. 3.3.1).

• An unprecedented stimulation of all types of (consumer) credit mechanisms (obviously to help stimulate consumption itself).¹⁰

• Extensive deregulation of many economic sectors, such as the financial sector and the energy sector.

• Increased military spending (and even warfare).

• Tax reforms mainly benefiting the rich in society (especially (large) companies and their underlying capital providers, as well as their CEOs and other executives).

• The systematic dismantling of social protection systems, including access to healthcare and public education.

• The systematic dismantling of public institutions, alongside the privatisation of all kinds of public sectors and/or public services (e.g., the energy sector, transport sector, the education sector...).

• The adoption of the doctrine of “monetarism” (which has attributed to all strata of society a frantic recourse to credit financing).

• Breaking the influence of trade unions.

• …

According to Lohmann, this all went hand in hand with an increasing privatisation and commercialisation of public services, and by extension of the state and its resulting functions itself, which has primarily been aimed at redistributing wealth upwards to the benefit of profit-hungry capital (i.e. the rich) or at improving the basic conditions for capital accumulation.¹¹ This is due to the fact that previous public services have more and more been turned into market services by which the providers enrich themselves to the detriment of society, with the (new) private service providers charging increasing fees and even making claims of getting subsidized out of public financial means. As we shall explore further in more detail, a noticeable example of this evolution has been characterising the sector of the nursing homes for the elderly (cf. Chap. 6.).

According to Lohmann, this has, obviously, involved a “rollback” of a wide variety of social and public services, such as health, education and welfare. Still according to Lohmann, this has been possible thanks to various types of environmental, financial and social regulation, along with a “roll-out” of new heterogeneous state and inter-state mechanisms and regulations. These range from (international) trade treaties, public-private partnerships, governance based on a cost-benefit analysis, new property rights regimes (especially in the field of intellectual property), licensing of new activities, laws facilitating offshore tax havens and secretive jurisdictions, a relaxation of capital reserve requirements and, to cite one more dramatic example in recent history, “the allocation of huge shares of public treasuries to the ‘rescue’ of private financial institutions”.¹²

This also went hand in hand with an increased political dominance of and economic dependency on the financial sector (also known as the “financialization” of the global economy).¹³ This “financialization” has not only channelled more wealth from the poor to the rich (to the extent that former social services have been turned into market services only to be acquired against the payment of a price), but also inflated bubble after bubble, while exacerbating global inequalities and imbalances. It has also accelerated the corporate take-up of cheap labour,¹⁴ land and raw materials, as well as smaller public and private enterprises in new regions and areas, and, through a significant expansion of finance’s traditional role of underwriting current spending with the promise of future production, it stimulated demand by offering unsustainable amounts of credit to a workforce whose wages continued to be attacked by a class of capital owners constantly seeking new sources of profit (based on a “profit maximisation and cost minimisation” approach in general, and “the iron law of wages” more specifically).¹⁵

This subjugation of all sectors of societal life to the logic of neoliberalism can be illustrated, for example, by the gradual elimination of social security systems in the form of unemployment benefits, which had since the 1980s become a thorn in the eyes of neoliberal governments both in the United States and in Europe. This explains how, from the 1980s onwards, neoliberal governments throughout the Western world focused their policies on reducing unemployment benefits, as well as similar systems of protecting labour, such as early retirement systems or career breaks. Whereas with the construction of the welfare states from the 1950s to the 1970s, the need for these systems had been increasingly recognised in order to offer at least some protection to workers against the ruthlessness of capitalist exploitation, the policy approach from the 1980s onwards has been to increasingly abandon these systems as much as possible, even to the extent that the increasingly feeble counter-call for their continuation by left-wing political parties gradually acquired the status of a societal taboo.

Very recently, in the aftermath of the severe financial crisis of 2008 (and in order to help paying back the huge deficits caused by the bail outs of the ailing bank sector), this attitude has been strongly reflected in the neoliberal-driven debate in almost all EU countries to raise the minimum retirement age. The general opinion became that it is not deemed acceptable that the working classes should already be able to enjoy their retirement at a reasonable time in their lives. On the contrary, the retirement age should be set as late as possible in life. In the same vein, it was felt that pensioners, especially if they belong to the working class, are too much of a burden for consumption-oriented societies that do not want to experience wealth-sharing systems with people who can no longer participate in the capitalist production apparatus (and who, therefore, are no longer able to earn their own income to finance their own consumption).

Several other social security systems have, of course, been the subject of many other neoliberal attacks, the most relevant example in the context of this book being, of course, the reorganisation of the sectors of health and elderly care. We shall return to this in Chaps. 5 and 6 respectively.

All this is, obviously, not mentioned to allow us to vent for a moment, but because all these examples given of rock-hard neoliberal logic in the above-mentioned areas of societal life—while there are, of course, numerous other conceivable examples to the extent that neoliberalism has in recent decades imposed itself in all possible areas of social and public service—help to explain that when the Covid-19 pandemic reached the Western would, most Western countries were completely unprepared for it (with all the disastrous consequences that this has entailed).

By way of one more example, consumerism provided various socio-economic ingredients for the outbreak of the Covid-19 pandemic. An obvious illustration has been the entertainment industry, which has become a very important part of the capitalist economy in recent decades. Reading a good book at home is not a leisure activity that fits the neoliberal logic. On the contrary, the little free time that the working person in the West has at his or her disposal must be used as optimally as possible for actions that yield the highest possible profit for the business sector. This explains the emphasis on mass events in many leisure sectors, from culture to sport, often with very high entrance fees. Any academic will recognise the complaints of students when they are asked to buy a book that costs a few dozen euros, a price that is willingly paid to participate in mind-numbing summer festivals or similar events. The same neoliberal logic also explains cheap mass tourism with even companies specialising in selling trips and whose profit margins mainly stem from the large consumer audience they cater to. This also partly explains the rise of big cheap airlines which are based on the same logic of mass consumption. In the logic of neoliberal free societies, during the few weeks of real free time one has each year, everyone should travel as much and as far as possible, without many people still realising that this is but part of an economic logic developed in the 1980s, namely “consumerism”, the idea that one must consume as much as possible to keep the capitalist machine running. Hardly any questions are asked about the impact this has on the environment (think, for example, of the highly polluting aeronautical industry), but also, for example, on cultural pollution: countries that rely heavily on a tourist economy are but a shadow of their former selves, with striking examples being villages all over Greece whose main streets have been reduced to endless lines of souvenir shops (where almost nothing of significance is offered for sale) and cheap mass restaurants, all ready to cater for the benevolent, spending tourist. In a similar manner—and even more relevant in the context of this book—reference can be made to the ski industry that exploded in the last quarter of the twentieth century based on this same neoliberal logic. The reader is asked to keep all this in mind when, later in this book, the case of “Ischgl” will be dealt with as one of the main “events” of the spread of Covid-19 in Europe (cf. Sect. 2.4.1.2.).

2.1.2 Underlying Neoliberal Doctrines

A brief explanation of the underlying neoliberal ideology is necessary to understand the forces behind this ongoing societal reform which on a global scale started in the 1980s, and by 2020–2021 had provided the socio-economic playing field for the rapid and unprecedented spread of Covid-19.

One of the basic tenets of the ideology of (economic) neoliberalism, and thus of the liberal societies and capitalist economies that are organised according to its theories, is that every human being stands alone in life and must act accordingly.

According to the doctrine of neoliberalism, human beings are not only (supposed to be) self-sufficient, but must also behave as selfishly, egoistically and greedily as possible and, when acting (especially at a socio-economic level), not take into consideration the interests of others, nor expect help from others.

The socio-economic order advocated by the adherents of neoliberal ideology is one in which human beings are merely competitors of one another and which is, moreover, characterised by a belief system that, when everyone acts fully in their own selfish interest, an ideal society will emerge in which everyone will prosper. The underlying belief system of this approach to society (insofar as it is still accepted that society exists) is that by behaving as selfishly, egoistically and greedily as possible, everyone will act at their highest level of performance, as a further result of which human resources and skills will be optimally deployed to ensure the overall well-being of society.¹⁶

Hence, solidarity and economic neoliberalism do not mix well.

On the contrary, for neoliberal ideologies, there is no societal need to have (or, where they have been installed in the past, to maintain) solidarity systems, as these are only a means to allow lazy people to profit from the efforts of diligent people. In such a vision of society, there is obviously no room for societal organisation or planning in the socio-economic field. On the contrary, the entire socio-economic field should be left to the logic of the free market.¹⁷

Given these basic premises of neoliberal ideology, it is not surprising that for adherents of neoliberal ideology, there has been a lot of wasted energy in the organisation of (welfare) states in the period from the Second World War until ± the 1970s.¹⁸ This also explains why, from the 1970s onwards, these followers of neoliberal ideology decided to do something about it...¹⁹ Basically, in this approach as, e.g., expressed in the writings of neoliberal economists such as Milton Friedman and Friedrich (von) Hayek, besides Ayn Rand, anything that might impede the free market is economically damaging and should be eliminated as much and as quickly as possible.

The most obvious example of these “barriers” against economic prosperity that had to be eliminated, are the various types of regulations aimed at providing a basic degree of social protection to the weakest members of society, such as social security systems, as well as public services financed by governments. But this neoliberal approach is also about the elimination of certain types of regulation that aims to rationalise economic processes or forms of market behaviour, with obvious examples being anti-trust legislation, alongside prudential financial regulation that encourages financial institutions to behave more reasonable and prudent than they are inclined to do by nature, as well as all similar types of regulation which protect consumer interests or the environment.

According to the doctrine(s) of neoliberalism, to the extent that all these methods of correcting unbridled capitalism are seen as an obstacle to the functioning of the free market, it was assumed that all these forms of regulation had to be eliminated as much and as quickly as possible, a doctrine that resulted in the neoliberal programme of “deregulation” (and “(neo-)liberalisation”) of the (world) economy.²⁰ As a result, over the past four decades, the (Western) world has witnessed such an unprecedented (neo-)liberalisation and deregulation of a vast set of systems that, not long before, had been established to protect the poorer classes of society from exploitative capitalist practices.²¹ Moreover, these neoliberal attempts to make the free market ever freer have in many countries succeeded in seriously damaging the welfare state model, even if they have not yet achieved their ultimate goal of dismantling all welfare state mechanisms worldwide.²²

The result of all this has been that, on a global scale, capitalism has become increasingly “unbridled” again,²³ implying that the entire organisation of the socio-economic order has been increasingly subject to free markets and that there is little room for any form of state involvement.²⁴ As will be developed further in this chapter, it is precisely these characteristics of neoliberal societies that have been among the main reasons for the success of Covid-19.

2.1.3 Possible National Accents

Clearly, there are significant differences between the different “neoliberalised” (Western) countries. As already noted, there is no ideal neoliberal state model against which countries could (would) mirror their neoliberal reform actions. On the contrary, over the past decades, (most) Western countries (and some global supra-national organisations, such as the EMU), have been rather arbitrarily inspired by parts of neoliberal ideology (itself being very diverse to begin with), which explains why each country has given it an appropriate implementation.

However, the common thread running through all of this has been the universal pursuit of the greatest possible freedom of the markets, besides the gradual elimination of public service and social security systems. These in turn have been replaced by similar services provided by private market actors. As a result, the playing field of the free market itself has widened (insofar as the free market has managed to incorporate ever wider areas of societal life that were previously left to government organisation) and the domain of government action—i.e., the domain of the public interest—has progressively shrunk, or at the very least has increasingly become the victim of an explicit or implicit neoliberal austerity policy. All of this is in line with the basic neoliberal principle of their ideology that everyone should fend for themselves (except for large companies that need help from the state, such as financial institutions when faced with market turbulence).

This also explains why there are still large differences between countries, as the process of neoliberalisation has not proceeded in a same manner and at the same speed in all countries. The Western countries that have succeeded most in pushing the neoliberalization process to the top are, for example, the United States and the United Kingdom. Countries where a somehow alternative neoliberal model has been applied are, for example, Germany and Austria, with very successful economies but also still deploying important social accents due to extensive participation models for employee representative organisations (the “Rhine-land model”). In countries like Belgium, neoliberalisation—how could it be otherwise—has taken a rather disordered pace, which may be attributed to the inexplicable Belgian political and constitutional landscape, as a result of which neoliberalisation efforts have not even led to increased market-performance—partly because, due to a disastrous government policy, the decision-making centres of companies operating in Belgium have largely been (re)located abroad. As a result, Belgium has mainly been turned into a sales and transit market for foreign interests and has, furthermore, been characterized by a policy of extreme austerity in all domains of public service and social welfare (with an important exception of the still abundantly available political mandates with which the numerous political parties reward their members very generously for their loyalty). Finally, there are also several European countries that have only modestly succumbed to neoliberal ideology, such as the Scandinavian countries that managed to continue to conform most closely to the welfare state model (as a result of which they remain continually ranked among the “happiest countries on Earth”—the four Scandinavian countries, e.g., all being in the top ten list of the World Happiness Report 2021).²⁵

The American model of capitalism and (some) Western European models—especially those of Germany and the Scandinavian countries—have even been seen by some as opposites: “wild” versus “soft” capitalism’. Wild capitalism is believed to be good for innovation, but is seen as generating extreme levels of inequality, not only in income protection, but also in employment and health; soft capitalism is said to be (somewhat) better at income redistribution and employment and health protection, but—according to some—less good at producing cutting-edge innovations.²⁶

2.1.4 Some Further Specifics on the US Economic and Public Policy in the Period 2016–2018, with Its Impact on Healthcare

2.1.4.1 Overall Intent of the Public Policy of the Trump Administration in Matters of Socioeconomics

One of the countries in which, from the 1980s onwards, public policies have been based in an extreme manner on the theories of economic neoliberalism, and which we therefore mention here as a practical illustration of what neoliberal ideology is all about, is obviously the United States. An additional reason for choosing the United States as an example for illustrating the general impact of economic neoliberalism, is that in the period 2017–2020, under the Trump administration, this country has been once more in its history subjected to this dreadful ideology in an extreme manner.

According to Sasha Bush, from the outset of his presidency, Trump’s socio-economic agenda was primarily aimed at reorienting the activities of the US government along the lines of neoliberal market fundamentalists such as Milton Friedman, who, as explained above, advocate limiting the role of government to market-supporting functions such as national defence and domestic public order.²⁷ As a result, what little money America still spent on (other) government functions at the time Donald Trump came to power, for example in the areas of health care provision or public education, alongside some basic environmental and public land protection programmes, became, under Trump, entirely open to privatisation and disengagement. For Trump, the scope of the federal government was to be reduced to public domains such as infrastructure, national defence, policing and surveillance, i.e., public domains serving the interests of the business community, hence the rich and powerful. In this way, Trump’s socio-economic policy adopted neoliberal advice not only as a guiding principle of economic policy, but also regarding business regulation (= “less is more”) and the role of the private sector in self-regulation (= “industry insiders understand regulatory needs better than government officials”).²⁸

Curiously, Trump’s embrace of the neoliberal agenda at the same time reduced it to the level of domestic policy, while at an international level, from the very beginning of his presidency, Trump strongly opposed globalisation and diminished the US role in several international organisations, as well as the presence of US regulatory or other public institutions in foreign nations.²⁹ In this way, the Trump administration aimed to transform neoliberalism into a geographically fragmented and localised system (an approach which, at the time, could also be observed in other countries; cf., for example, Brexit).³⁰ Trump’s socio-economic programme also aimed to implement a complete merger of state and market interests, but one in which the market and big business have almost total power and freedom of movement (and where labour is treated badly).³¹

According to Chomsky, President Donald Trump’s Republican Party thus became totally dedicated to wealth and corporate power, aiming to subject American society to an even more authoritarian and harsher version of “the neoliberal plague” that already devastated American society for 40 years, except for the very rich and powerful, and that has resulted in a society in which 0.1%—not even 1%—of the population owns 20% of the wealth and has been getting richer like bandits since 2008, having created the Great Recession and since been rewarded for it.³² At the same time, half the US population has a negative net worth, “having more debt than assets”. According to Chomsky, it is hereby even estimated that about 70% of Americans can barely get by from 1 week to the next. Their real wages have virtually stagnated since the 1970s, while at the same time wealth has become extremely concentrated and has reached the stratosphere.³³

As has been phrased in a report by The Lancet Commission on Public Policy and Health³⁴:

Trump has exploited the anger of low- and middle-income whites at their deteriorating life prospects to mobilise racial animosity and xenophobia and secure their support for policies that benefit high-income individuals and corporations and threaten health care. His major legislative achievement, a trillion-dollar tax cut for corporations and high-income individuals, opened a hole in the budget that he used to justify cuts to food subsidies and health care. His appeals to racism, nativism and religious bigotry emboldened white nationalists and vigilantes, and encouraged police violence and, by the end of his term, insurrection. He has selected judges for US courts who despise affirmative action and reproductive, labour, civil and voting rights; ordered mass detention of immigrants in unsafe conditions; and promulgated regulations that reduce access to abortion and contraception in the US and around the world.

With regard to some of the most remarkable and specific achievements of the Trump administration, one can, for example, refer to the passage of the so-called Tax Cuts and Jobs Act of 2017,³⁵ an initiative that clearly demonstrated that the promotion of neoliberal policies had become a key objective of Trump’s socio-economic policy.³⁶ However, as Joseph Stiglitz has pointed out, the act also contained important pitfalls.³⁷ This all was, moreover, based on the classic neoliberal defence of the “trickle-down economics”. However, as Stiglitz warned, it should be clear that this “trickling down” does not usually happen.³⁸

A subsequent example of Trump’s neoliberal approach to reshaping the socio-economic order involved a further deregulation of the financial sector. This initiative was also taken up to mark a new “pro-business” triumph for President Donald Trump.³⁹

2.1.4.2 Healthcare Reform (Attempts)

More importantly, however, in view of the Covid-19 pandemic reportedly affecting the United States early 2020 (cf. Sect. 2.5.1.), is the fact that, reversing promises made during his 2015 presidential campaign, Donald Trump expressed great ambitions to reform the US health care system, which according to him had suffered too much interference from his predecessor, President Barack Obama.

For Chomsky, the US health care system is first and foremost a scandal to begin with and has, moreover, worsened during the neoliberal period (which, roughly speaking, began under Ronald Reagan’s presidency and has since continued its course, with ups and downs, until today). As a result of four decades of neoliberal interference in the health sector, US health care institutions, such as hospitals (cf. Chap. 5.), but also nursing homes (cf. Chap. 6.), were, at the time Covid-19 hit the United States, essentially run on a business model, a key feature of which was that there was no room for either spare capacity or stockpiling of drugs, equipment and medical supplies, as such a pile-up was considered a waste of resources.⁴⁰ It has precisely been this feature of the US health system that was to prove highly problematic during the Covid-19 pandemic. We shall return to this in Chap. 5 when dealing with shortages the US faced regarding all types of medical material.

Throughout his presidency, President Donald Trump’s own main (neoliberal) health policy was aimed at fulfilling his campaign promises to repeal and replace the “Patient Protection and Affordable Care Act” (ACA), better known as “Obamacare”.⁴¹ One of President Trump’s first efforts to achieve this goal involved his support for House and Senate bills that proposed to amend parts of the ACA. E.g., in 2017, the House of Representatives passed a bill aimed to accomplish this goal—under the denomination the “American Healthcare Act of 2017”—but members of the Senate failed to agree on a final replacement plan, which ultimately left most of the ACA’s provisions in place. However, Republicans took a step closer to changing the ACA by removing the individual mandate from the law, an alteration to the ACA that went into effect in January 2019.⁴²

In October 2017, the Trump administration took a new initiative to change the ACA. This led to a presidential directing Trump’s cabinet members to create rules “that would allow small businesses to collectively purchase health insurance through association health plans, expand short-term health coverage, and expand the use of health reimbursement arrangements (HRAs).” The President’s Executive Order did, however, not make direct changes to existing health insurance rules; rather, it directed agencies to consider new rules that would be subject to a notice and comment period.⁴³

Although Trump’s efforts to repeal the ACA failed, he still managed to weaken its coverage and to increase the number of uninsured by two to three million, even before the massive dislocation of the Covid-19 pandemic, and, moreover, to accelerate the privatisation of government health programmes.⁴⁴

Throughout his presidency, Donald Trump continued his attempts to overhaul the US healthcare system, although from 2018 on, these attempts were severely hampered when the Democrats regained the majority in the US House of Representatives.⁴⁵ (Cf. Sect. 5.2.2.6.) Despite this, President Donald Trump has continued to explore the limits of his presidential powers to introduce further cuts where possible.

2.1.4.3 How Donald Trump’s Health Policy Has Undermined the US—and the World’s—Ability to Deal with Covid-19

Unfortunately, Trump’s neoliberal policy of cutting health care spending as much as possible has since been identified as one of the many things that went wrong with the surveillance of dangerous viruses, such as Covid-19, in the run-up to the Covid-19 pandemic that hit the (Western) world.

Specifically, in the 3 years leading up to the Covid-19 crisis, the Trump administration had considered it a good idea to drastically reduce a CDC team working in China, one of whose main tasks was to identify global health threats such as Covid-19.⁴⁶ As a result, when Covid-19 struck, the 11 CDC members originally slated for the initiative, were down to only three people. At the same time, 39 workers listed as local staff had been reduced to just 11.⁴⁷

Prior to Trump’s interference, the Atlanta-based “CDC” was reported to provide public health assistance to countries around the world and to work closely together with them to prevent outbreaks of contagious diseases and to prevent these from spreading on a global scale. When President Donald Trump took office on 6 January 2017, the CDC had been working in China for already 30 years.⁴⁸ After President Donald Trump took office, the CDC’s staff in China was reportedly reduced to 14 people, down from about 47. The losses included both epidemiologists and other health professionals. As a result, the CDC’s Beijing office was according to some turned into “an empty shell”.⁴⁹

As reported by Taylor, after these cuts, the CDC still employed a mere three people in China (namely (1) a country director, (2) an influenza expert, and (3) an information technology expert). A temporary deputy director was afterwards added to this reduced staff. In addition, two Chinese staff members continued to work on specific public health areas, including a training programme.⁵⁰

Separately, the National Science Foundation (NSF) and the United States Agency for International Development (USAID), which oversaw a global relief programme to help China respond to viral outbreaks, also had to close their offices in Beijing under President Donald Trump. The NSF reportedly had to close all its overseas offices later in 2018.⁵¹ The USAID’s Beijing office, staffed by a senior US officer and two Chinese employees, was closed in 2019. In addition, in 2018, the US Department of Agriculture (USDA) moved the head of an animal disease surveillance programme out of China.⁵²

These various reduction of staff and reorganisation measures were reported to be part of an overall policy of the Trump administration to push US agencies that had physical activity in China, to end their programmes.⁵³

According to CNN, when Covid-19 first appeared in China in late December 2020, the Trump administration, moreover, notified the US Congress that it intended to proceed with a plan to shut down an US Agency for International Development surveillance programme, whose mission included detecting new and potentially dangerous infectious diseases and helping foreign laboratories to stop emerging pandemic threats around the world. The Trump administration ultimately reversed course almost 3 months later, deciding to grant a 6-month emergency extension to the so-called PREDICT programme on 1 April 2020. This extension allowed the United States to continue to provide emergency support to other countries for epidemic response. But by this time, the WHO had already declared the Covid-19 outbreak a global pandemic, with 4300 people having already died from Covid-19 in the United States alone.⁵⁴

These cuts to the aforementioned US agencies are reported to have largely side-lined health experts, scientists and other professionals who could have helped China in responding more quickly to Covid-19 at the onset of the outbreak, as well as to provide the US government with more accurate information about what was happening since late December 2019. However, this did not stop the Trump administration, in February 2020, from publicly chastising China for withholding information about the Covid-19 outbreak and for not allowing US experts into the country to help.⁵⁵

2.2 Other Examples of Neoliberal Ideas and Working Methods Which Have Been Ideal for Helping to Spread Covid-19

2.2.1 General

Since the beginning of the twenty-first century, there have been repeated warnings of a possible pandemic. Several reasons for the increased risk of a pandemic have been cited, including: (1) an increase in the world’s population, (2) an encroachment of uninhabited areas, such as forests, so that people come into closer contact with wild (and disease-carrying) animals, and (3) climate change, which leads to heatwaves and floods that, in some countries, can cause an increase in the mosquito population, another cause of the rapid spread of certain pathogens (e.g., the Zika virus). There is also the factor of increased (international) mobility which facilitates the rapid spread of diseases. There are, furthermore, numerous ongoing conflicts and wars which destabilise countries, making diseases more difficult to contain and control.⁵⁶

Early pandemic warnings had already before in recent history been issued as soon as the “SARS” outbreak in China in 2002 spread to Southeast Asia, and the “MERS” outbreak 10 years later caused an epidemic in the Middle East. In both these earlier cases, it was a coronavirus that had been responsible.⁵⁷

There is also a fundamental difference between an epidemic and a pandemic. In a “pandemic”, the sources of infection are spread over several countries and continents. It is not a local problem like an “epidemic”.⁵⁸ While, moreover, the implementation of neoliberal ideas since the 1980s has already been disastrous in itself for the organisation of societies in the Western world, the resulting globalised capitalist world order has even proved to be a further breeding ground for a pandemic, such as the one caused by the Covid-19 virus.

This will hereafter be illustrated below by some striking examples, that characterize the socioeconomics of (neo)liberal societies, namely:

• (1) Capitalist farming methods.

• (2) Travel and tourism (in a globalised context).

• (3) Laissez-faire, laissez-passer.

• (4) The health care sector.

• (5) The long-term care home sector.

• (6) The overemphasis on economic interests, including the hierarchical scale of capital versus labour interests, and

• (7) The organisation of neoliberal education as a childcare system for working parents.

As Alfredo Saad-Filho explains⁵⁹:

The pandemic hit after four decades of neoliberalism had depleted state capacities in the name of the ‘superior efficiency’ of the market, fostered deindustrialization through the ‘globalization’ of production and built fragile financial structures secured by magical thinking and state guarantees, all in the name of short-term profitability. The disintegration of the global economy left the wealthiest and most uncompromising neoliberal economies, the USA and the UK, exposed as being unable to produce enough face masks and personal protective equipment for their health staff, not to speak of ventilators to keep their hospitalized population alive. These insufficiencies were caused not only by the lack of productive capacity due to changing technologies or China’s trade policies but also by deliberate policies: from universities to labs to manufacturing, neoliberalism actively promoted the fragmentation and disarticulation of a wide range of systems of provision as individual firms scrambled for short-term profits. The ensuing shortcomings were exacerbated by the destruction of state planning capacity and the disinclination of neoliberal governments to use all necessary means to mobilize industry, labor and private capital for a common purpose during the pandemic. Under pressure from the pandemic, service provision was transformed beyond recognition; online work became the norm in countless areas in a matter of days rather than the years that this transition would have normally taken, while the neoliberal worship of consumption dissolved into empty supermarket shelves, scrambles for hand sanitizer, pasta and sardines and fistfights for toilet paper.

2.2.2 Capitalist Agricultural Methods

According to Waitzkin, the Covid-19 pandemic—as well as all other major epidemics of a viral nature in the recent past, and probably also in the (near) future—stems from the same (and interconnected) “upstream causes”: (1) capitalist industrial agriculture; (2) destruction of the natural habitat, and (3) meat production.⁶⁰ Moreover, in the recent past, due to the ongoing globalisation of capitalist production processes, there has been a rapid increase in the intensity and global scale of all these practices.⁶¹

According to this author, natural forest habitat provides ecological control of viruses such as SARS-CoV-2, and their hosts, especially bats. More precisely, the destruction of these natural forest habitats for industrial agriculture in China began to occur as a central feature of the post-Mao Zedong “neoliberalisation” of the Chinese economy into a bastion of global capitalism.⁶² As a result, hosts carrying the virus—for example, bats—were forced to migrate, coming into contact with humans which in its own turn resulted in interspecies transmission. Already in the past, similar sources of zoonotic transmission due to the destruction of natural habitats occurred in China with the coronavirus in the case of “Severe Acute Respiratory Syndrome” (SARS) and in Africa with Ebola and Zika, and probably HIV.⁶³

Another practice that has emerged from capitalist agricultural models concerns the industrial production of meat. Particularly in the case of pigs and chickens, but also in other species, the entire meat production process, from the breeding of offspring, growth to adulthood, slaughter and packaging, is increasingly taking place under industrial conditions which, on a global scale, are subject to little or no regulatory oversight or control. As a result, on a global scale, a small number of oligopolistic multinationals dominate what is referred to as “factory farming”. Due to the unsanitary conditions of such meet processing factories, viral contamination and even mutations to more virulent organisms have already, in recent history, led to epidemics such as: bird flu, swine flu, in addition to a variety of (common) flu viruses.⁶⁴

A particularly discouraging earlier example of this problem has been the 2009 swine flu outbreak. Still according to Waitzkin, this outbreak occurred less than a kilometre from a Smithfield Foods-owned factory pig farm in rural Veracruz state, Mexico. Smithfield Foods, a US company, had before outsourced the operation from the US to Mexico at the time, in part to avoid US requirements for professional and environmental clean-up. Although Mexican public health authorities and investigators had at the time found a link between the swine flu epidemic and capitalist factory farming, institutions such as the CDC, WHO and several other international health organisations would, subsequently, rather keep pursuing reductionist strategies, rather than adopting more radical changes in the meat processing industry itself.⁶⁵

Waitzkin, furthermore, has pointed out that the effects of capitalist industrial agriculture on natural habitat loss and meat production only occasionally appear in the mainstream media. Such media attention, albeit limited, has also occurred, to some extent, regarding the possible source of Covid-19. The impact of large food processing companies on emerging epidemics has also appeared in communications or policy papers from international health organisations and the Gates Foundation.⁶⁶

According to Waitzkin, the leaders of international agencies were also well aware that virus-like epidemics could originate from capitalist industrial agriculture. According to this author, this was, for example, clearly demonstrated in the context of “Event 201”, a happening which took place on 18 October 2019, ironically only about 2 months before the start of the Covid-19 outbreak in Wuhan.⁶⁷ After the actual start of the Covid-19 outbreak, the promoters of Event 201 emphasised that (1) they had not meant to predict the timing of Covid-19 and (2) that the death toll they had predicted in their tabletop exercise of around 65 million deaths, would not necessarily apply to the Covid-19 case. According to Waitzkin, said organizers of Event 201 also failed to mention more useful initiatives to eradicate the practices of industrial capitalist agriculture that had led to the hypothetical Event 201 scenario, the current global Covid-19 pandemic, and the inevitable future pandemics that will occur on a similar or worse scale.⁶⁸

Unfortunately, these practices do not only pose problems on farms: Live animal markets, common throughout Asia and Africa, may also pose a particular problem in terms of the emergence and spread of deadly pathogens between species. Another risk, identified by Kuchipudi, is the hunting and butchering of bushmeat, which is particularly prevalent in sub-Saharan Africa.⁶⁹ As this author has pointed out⁷⁰:

These activities, as they threaten animal species and irrevocably change ecosystems, also bring people and wild animals together. Bushmeat hunting is a clear and primary path for zoonotic disease transmission. So is traditional Chinese medicine, which purports to provide remedies for a host of conditions like arthritis, epilepsy, and erectile dysfunction. Although no scientific evidence exists to support most of the claims, Asia is an enormous consumer of traditional Chinese medicine products. Tigers, bears, rhinos, pangolins and other animal species are poached so their body parts can be mixed into these questionable medications. This, too, is a major contributor to increasing animal-human interactions. What is more, demand is likely to go up, as online marketing soars along with Asia’s relentless economic growth.

Recent research by Morand and Lajaunie on the impact of deforestation for industrial agriculture, is along the same lines: Deforestation is in this research mentioned as a major cause of biodiversity loss, with a negative impact on human health. Given the growth in the human population, it even appeared that the increase in zoonotic and vector-borne disease outbreaks between 1990 and 2016 was linked, on the one hand, to “deforestation”, mainly in tropical countries, and, on the other hand, to “reforestation”, mainly in temperate countries. These authors also found that vector-borne disease outbreaks were largely associated with the increase in palm oil plantations. Their study also implied a link between global deforestation and outbreaks of zoonotic and vector-borne diseases, as well as evidence that reforestation and plantations may contribute to infectious disease outbreaks. Their study, furthermore, added to a growing body of evidence that viruses are more likely to transfer to humans or animals if the latter live in or near human-disturbed ecosystems, such as recently cleared forests or wetlands drained for agricultural land, mining projects or residential developments. According to these authors, business patterns and consumer behaviour all contribute to this phenomenon.⁷¹ It was, moreover, predicted by these authors that, by March 2021, a quarter of the world’s forest loss would be due to the production of commodities such as beef, soy, palm oil and wood fibre. Mining further exacerbated this problem by contaminating rivers and streams, which are essential for ecosystem resilience, carbon sequestration and soil quality.⁷²

At the policy level, the research of Morand and Lajaunie showed that disease risks should be added to the risk-benefit analysis of any new agricultural or mining project. Of particular concern in this regard has been the ongoing, deteriorating environmental health of the Amazon rainforest. Under the presidency of the President of Brazil Jair Bolsonaro, deforestation has reached levels not seen for over a decade, while public health systems have been so poorly managed that, as of March 2021, the country had one of the worst Covid-19 mortality rates in the world. (Cf. Sect. 2.4.2.5.) Still according to Morand and Lajaunie, tropical forests in the Congo Basin and Southeast Asia, as well as monoculture afforestation projects in China, Europe and the United States, all raise similarly major concerns.⁷³

In a more general manner, Assa has pointed out that research has linked the spread of deadly viruses to an increasing encroachment of humans on previously untouched natural environments. When species in these areas disappear, disease vectors such as Covid-19 can find a new home in human bodies. According to Assa, this danger of neoliberal “laissez-faire, laissez-passer policy” (cf. Sect. 2.2.4.)—“hurting people, destroying the environment, and thus hurting more people in the name of economic growth”—is becoming a huge problem in many developing countries, where decades of implementing neoliberal policy (based on the so-called Washington Consensus model) devastated social safety nets, commodified the environment, and hollowed out democracy, while, in the best cases, leaving elected governments completely powerless to deal with multinationals and in the worst cases acting in collusion with them.⁷⁴

Given these considerations, a direct link between Covid-19 and neoliberalism has to be established: The increased occurrence of coronaviruses such as SARS, MERS or Covid-19 in the human population is only the predictable result of the devastating impact of capitalist agribusiness on natural ecosystems, rather than the result of isolated incidents.⁷⁵

As Sumonja has phrased this⁷⁶:

What is seen is an interplay between industrial production of food and a growing market for exotic wild food. The multinationals’ land-grab and deforestation pushes wildlife deeper into the remaining primary ecosystems. This enables the spillover of previously boxed-in pathogens to human communities that are forced to breach the natural barrier between them while working.

Capital is spearheading land grabs into the last of primary forest and smallholder-held farmland worldwide (…) As industrial production – hog, poultry, and like – expand into primary forest, it places pressure on wild food operators to dredge further into the forest for source populations, increasing the interface with, and spillover of, new pathogens, including Covid-19.

Capitalist agriculture—with its emphasis on meat production and its tendency to overproduce and even destroy food surpluses, while at the same time global hunger and food insecurity remain huge problems—is in this approach not only ill-suited to feed the world’s hungry, but at the same time appears to carry huge health risks for the whole of humanity.⁷⁷

Al these considerations immediately raise the question of whether there are alternatives to capitalist industrial agriculture. There obviously are. According to Waitzskin, all over the world, often against the resistance of big agribusiness and neoliberal governments, farmers are reportedly reverting to peasant farming practices. According to this author, a range of research has hereby shown that traditional agriculture is safer than capitalist agriculture and is also more efficient and productive.⁷⁸

But being one of the causes of the Covid-19 pandemic is not the only Covid-19-related problem created by the meat (processing) sector. As we shall see in more detail in Sect. 7.11.1, the meat (processing) sector also played a key role in the spread of the Covid-19 virus in the Western world.

2.2.3 Travelling and Tourism

2.2.3.1 General

After Covid-19 was first detected in Wuhan, China, in late 2019, it has since been spread by travellers to almost every country in the world at an astonishing rate. Less than 3 months after its first detection in China, every country in the world had, to some extent, been affected by the disease.⁷⁹

This is a consequence of the globalisation of travel and tourism.

2.2.3.2 Arrival of Covid-19 in Europe

According to Spiteri et al., as of 09:00 on 21 February 2020, 47 confirmed cases of Covid-19 had been reported in the WHO European Region. Of these cases, one had already died.⁸⁰

The first (official) case on the European continent had been reported shortly before, in France, on 24 January 2020. The first death on the European continent had also been reported in France, more precisely on 15 February 2020.⁸¹

As of 21 February 2020, nine countries on the European continent had reported cases of Covid-19 on their territory, namely: Belgium (1), Finland (1), France (12), Germany (16), Italy (3), Russia (2), Spain (2), Sweden (1) and the United Kingdom (9).⁸² Place of infection (assessed nationally on the basis of a presumed incubation period of up to 14 days, in addition to travel history and contact with probable or confirmed Covid-19 cases) had been reported for 35 cases (missing for three cases), of which 14 had been infected in China (Hubei province: 10 cases; Shandong province: one case; province not reported for three cases).⁸³ The remaining 21 cases had been infected in Europe. Of these, 14 were linked to a cluster in Bavaria, Germany, and seven to a cluster in Haute-Savoie, France. The Bavarian cluster cases were reported in Germany and Spain, while the Haute-Savoie cluster cases were reported in France and Spain. Cases linked to the Haute-Savoie cluster had also been detected in the United Kingdom, including the index case of this cluster, a person who had been infected in Singapore before travelling to France. The index case for the Bavaria cluster himself was reported to have been infected in China.⁸⁴ All these cases had a history of travel to or from China. These findings were, moreover, consistent with the epidemiological situation in Asia and supported the recommendation to test suspected cases with a history of travel to China, as well as other areas where ongoing community transmission was at the time suspected.⁸⁵

The situation would however change rapidly afterwards, with the number of countries reporting Covid-19 transmission increasing rapidly, in early March 2020 culminating in a major outbreak of Covid-19 in northern Italy, with 3089 cases reported on 5 March 2020.⁸⁶

Numerous outbreaks of Covid-19 all over Europe have subsequently been attributed to ski resorts. One well-known such source of spread of the Covid-19 virus was the Austrian town of Ischgl, a ski resort located just above the Tyrolean Alps in Davos.⁸⁷ According to Karnitschnig, the Tyrolean village of Ischgl had once been advertised as a “white winter dream”. However, for the tourists who spent their ski holidays there in February 2020, and by extension for the rest of Europe, the town would soon turn out to something “more like a prolonged nightmare”.⁸⁸ Especially the city’s après-ski bar scene, that every winter attracts millions of people, would prove to be a perfect incubator for Covid-19 in the winter of 2020. By the time Austrian authorities realised the scale of the Covid-19 outbreak in Ischgl in February-March 2020, the damage had already been done.⁸⁹ Around that time, health authorities in the Scandinavian countries had already traced several hundred cases of Covid-19 to Ischgl at an early stage. E.g., Norway had reported that almost 40% of its first round of 1400 Covid-19 infections all had originated in Austria.⁹⁰ Despite early warnings from these Scandinavian countries, the Tyrolean authorities first refused to take action for a long time, allegedly for fear of the negative impact on local trade. The reason for this attitude was that the economy of the whole region depended on tourism. The central, Austrian authorities did not intervene either.⁹¹ In the best of neoliberal traditions, “greed took precedence over responsibility for the health of the community and of the customers”, sounded the conclusion reached by the Austrian newspaper “Der Standard”.⁹² In a similar manner, it was for journalist Mayer of “Der Standard” clear that⁹³:

Greed has conquered responsibility for the health of citizens and guests. They wanted to “take” this last “strong tourist week” with them, so that the tills of the lift operators and hoteliers would ring.

Signs of serious problems with Ischgl were even clearer by 1 March 2020, when Icelandic authorities discovered that 15 passengers on an Icelandair flight that had arrived from Munich the day before, had tested positive for Covid-19. Fourteen of those infected had visited Ischgl.⁹⁴ Iceland immediately notified the Austrian authorities, but the Austrian health authorities dismissed the concerns. The Tyrolean authorities even suggested that it was more likely that a passenger on that plane who had visited Italy and who had also tested positive for Covid-19, had been the one infecting the group returning from Ischgl. In the following days, however, similar reports of infections from Ischgl tourists came in from Denmark, Norway, Sweden and Germany.⁹⁵

By 7 March 2020, a bartender at one of Ischgl’s popular après-ski bars tested positive. The Austrian authorities still took no action, until they finally discovered that 15 other people with whom the bartender had come into contact at work, had also contracted Covid-19. In response, on 10 March 2020, the local authorities ordered the closure of all bars in Ischgl. However, ski lifts and hotels remained open.⁹⁶ In the meanwhile, Covid-19 continued to spread in the region. This ultimately forced the Australian government, on 13 March 2020, to take the unprecedented step of placing the entire valley around Ischgl under quarantine. The quarantine included the Paznauntal valley and St. Anton, another popular ski area nearby. Even so, the lifts continued to operate for a few more days.⁹⁷ Still according to Karnitschnig, Christof Lang, a journalist for the German news channel n-TV, arrived in Ischgl on 5 March 2020 with five friends. Three days later, they all left the city infected.⁹⁸ The scandal was that authorities had indications a week before the journalist arrived that there might have been infections, and that these were simply ignored, Lang later declared about the attitude of the Austrian authorities.⁹⁹ According to another journalist, Thomas Mayer, at least dozens of international holidaymakers infected with Covid-19 came from the “Ballermann der Alpen” après-ski bar. Be this as it may, in the days that followed, in Denmark, Sweden and especially in Germany, reports of new positive cases came about people with one thing in common: they all had just returned from a skiing holiday in Ischgl.¹⁰⁰ Still, Austrian officials continued to insist that they had done everything in their power to stop the spread of the Covid-19 virus as soon as they became aware of the severity of the epidemic.¹⁰¹

So much for now about the story of how the merry tourist industry—specifically ski tourism which has a large following among the middle classes of many European countries—attributed the rapid spread of the Covid-19 virus across much of the European continent during February-March 2020. We shall return to this topic in Sect. 2.4, where we shall examine how different countries (initially) reacted to the Covid-19 outbreak in their territories. In the following Sect. 2.2.3.3, we shall first see how another segment of the travel industry, in particular intercontinental aviation, allowed Covid-19 to enter the United States via Europe.

2.2.3.3 Arrival of Covid-19 in the United States (via Inbound Travellers from China and Italy)

Given the consensus that the Covid-19 virus originated in Wuhan, China, it was quickly assumed that, at least during the early period of the Covid-19 pandemic, international passengers, particularly coming from China, brought the virus to the United States.¹⁰²

Indeed, on 21 January 2020, a Washington State citizen who had just returned from Wuhan became the first confirmed case of Covid-19 in the United States. In the weeks that followed, a first cluster of Covid-19 cases was identified in Washington State, including an outbreak in a nursing home that resulted in at least 37 deaths.¹⁰³

However, in February 2020, Italy was one of the first countries on the European continent to experience its own, first major epidemic. Shortly thereafter, the focus of the epidemic in the United States shifted from the West Coast of the country to the East Coast, leading epidemiologists to pay more attention to Europe, and particularly Italy, as a probable source of incoming infections. To validate this shift in focus, researchers began to provide evidence that the East Coast outbreaks appeared to result more from exposure to people traveling from Italy, than to people traveling from China. The research also showed that the strain of the virus in New York was the same as the one circulating in Europe, but different from that in China.¹⁰⁴ The research also linked the predominant strain of the virus in New York City at the start of the pandemic to Europe.¹⁰⁵

Although this research provided compelling evidence that international travel from Italy had increased the spread of Covid-19 in the United States during the first wave of the Covid-19 pandemic, this had occurred at a time when most people were still largely unaware of the virus and the threat it posed.¹⁰⁶

From this, it has been concluded that travellers from Italy have been the ones that led the first wave of the Covid-19 pandemic to the United States, much more than travellers from China.¹⁰⁷ The latter may even have been the result of travel bans that were quickly imposed on travellers from China, but only much later on travellers coming from Europe. Indeed, according to Hood, Covid-19 was still a distant problem in Wuhan when US President Donald Trump announced a travel ban from China in late January 2020. In contrast, it took Trump another 6 weeks, as Covid-19 ravaged Italy, to close travel from Europe as well.¹⁰⁸

Research on the different impact of travellers from China and Italy respectively has, furthermore, shown the following¹⁰⁹:

• (1) US counties that received more passengers from China at the start of the pandemic did not experience higher rates of Covid-19 infection and death than other US counties on average through May 2020; in fact, both outcomes were lower.

• (2) US counties that received more passengers from Italy at the start of the Covid-19 pandemic experienced higher infection and death rates for Covid-19. Specifically, an additional 100 passengers from Italy arriving in a given US county during the fourth quarter of 2019 corresponded to an increase in case and death rates of about 5%.

Based on this research, the relatively early ban on travel from China appears to have been effective in reducing both infections and deaths. At the end of January 2020, just before President Donald Trump made the decision to close flights from China, the Covid-19 virus may not yet have spread sufficiently among travellers from China to have contributed significantly to the first wave of the Covid-19 pandemic in the United States. By contrast, waiting until mid-March 2020 to impose a similar ban on travellers coming from Europe could have been one of the main reasons for the fast spread of Covid-19 throughout the United States.¹¹⁰ This is illustrated in Fig. 2.1 which gives an overview of the early travel pathways of the Covid-19 virus during the first month of the Covid-19 outbreak.

Fig. 2.1

Early travel pathways of the Covid-19 virus, through March 2020 [Source: Hood (2021)]

From this, the quoted study draws two conclusions regarding travel bans: First, if a government is going to impose a travel ban, it must act quickly. Secondly, a narrow travel ban that only targets certain countries makes little sense, not least because the Covid-19 virus spreads so quickly.¹¹¹

2.2.3.4 Provisional Conclusions

It is clear that over the past four decades, travel in general and tourism in particular have grown at an ever-increasing rate around the world.

The neoliberal globalisation of all human interactions, particularly in the socio-economic sphere, has undoubtedly played a crucial role in this regard. Indeed, as capitalist economies have become increasingly interconnected under the impetus of neoliberal economic theories, the need to travel had also drastically increased. For all sorts of reasons (at least until the outbreak of Covid-19), people boarded a plane as easily as a domestic train, both for business and leisure.

The emergence of new low-cost airlines (such as “RyanAir”), furthermore, accentuated this trend, making the purchase of a plane ticket accessible to all. This went hand in hand with the rise of mass tourism, which in Europe, during the summer, mainly focuses on beach holidays in various countries of the Mediterranean world (such as Spain, Italy, Greece, etc.), and in the winter mainly on ski holidays in all kinds of Swiss, Austrian, Italian and French ski resorts.

It is not surprising that while the world economy, measured in terms of gross domestic product (GDP), has grown at an average annual rate of 2.8% since 1995, global air passenger traffic (expressed in revenue passenger kilometres) has grown at an ever higher average annual rate of 5.0%.¹¹² This is illustrated by Fig. 2.2 which gives an overview of the world economic growth compared to the air traffic growth in the period from 1996 until 2012.

Fig. 2.2

World economic growth and air traffic growth [Source: ICAO (n.d.), accessed 12 March 2020]

The ease of travel, both for business as for pleasure, helps explain why an infectious virus such as “SARS-CoV-2” could spread so quickly around the world. The Covid-19 virus was first detected in Wuhan, China, in late December 2019. Less than a month later, the Covid-19 virus was already present in France and Italy (and most likely, be it under the radar, in numerous other European countries as well).

As a result, thanks in part to the ease of travel in the globalised, neoliberal world, the spread of the Covid-19 virus was frighteningly rapid: Barely a month later, the Covid-19 virus had spread to every continent, including large parts of the Western world. As a result, for the first time in over a century, the Western world was forced to adopt lockdown and social distancing measures, which would continue to determine the socio-economic climate of these countries throughout 2020 and well into 2021.

In addition to travel in general, it seems that especially tourism played a special role in the spread of Covid-19. In particular, the massive presence of tourists in bars and restaurants in popular holiday resorts, each year attracting thousands of people at the same time, seems to have become real dispersal events, the most evocative example being the one of Ischgl, Austria. As will be explained later in this book, this scenario was, moreover, repeated a few times thereafter, for example during the carnival festivities in Belgium and the Netherlands at the end of February 2020 (but probably also in other countries where carnival is popular, e.g., in Germany), and in the United States during the Sturgis rally in the summer of 2020 (cf. Sect. 2.5.4.5.).

Be this as it may, the travel frenzy that had characterised the neoliberal world until the emergence of Covid-19 would at least subside for a while due to the emergence of Covid-19 and the measures that were taken to contain it.¹¹³

2.2.4 Laissez-Faire, Laissez-Passer

One of the hallmarks of neoliberal economic policy is the idea that there can only be limited state intervention in socio-economic life, alongside an adherence to both the creation and reduction of budget deficits, and a commitment to the preservation of “laissez-faire”. This policy approach can be traced back to nineteenth century economic liberalism, characterized by liberal governments—despite their highly authoritarian characteristics, e.g., in suppressing the poor and fighting (pity) crime—essentially deploying “laissez-faire” in most socio-economic matters. This has been referred to as the passive role of the state as “night watchman”, basically providing security for its (rich) citizens, rational administration (especially for taxing the poor) and—in Menon’s words—“a minimum of social advance on the basis of which economic progress was supposed to occur”.¹¹⁴

Up to this very date, the idea of “laissez-faire, laissez-passer” still predominates within neoliberal ideology, although the proponents of this doctrine themselves rarely refer to it explicitly or make use of the term themselves. Rather, the proponents of economic neoliberalism rely on an Anglo-American conceptual framework, although the message remains essentially the same: The state should refrain from developing any activities itself in socio-economic areas that are best left to the free market and should interfere as little as possible with free market activities through regulation.¹¹⁵

Key neoliberal concepts are notions such as “privatisation”, “marketisation”, “liberalisation” and “deregulation” of the economy. The first concepts (i.e. privatisation and marketisation) are based on the idea that the state itself cannot be the organiser—or actor—of socio-economic issues and, where it has done so in the past, these must be transferred to private market actors.¹¹⁶ The latter notions, namely liberalisation and deregulation, imply that the state should intervene as little as possible to subject socio-economic activities to rules and regulations, but should let them take place unhindered in accordance with the rules of the free market, including the principle of voluntary association. The latter principle implies that private parties themselves should agree on their mutual relations based on contractual negotiations, and that the state should not interfere in these relations by means of additional regulation.¹¹⁷ In short, one should “let the market do its thing” (= laissez-faire) and intervene as little as possible in what the market brings about (= laissez-passer). Even when things go completely “BZRK”—which, for the followers of neoliberal thinking can only be the result of a temporary failure—this is considered fundamentally good, because the free market is supposed to always correct itself.

Although supporters of economic neoliberalism do not like to hear this, it is precisely this fundamental attitude of neoliberal politics that have determined the disastrous resilience of the Western world to the onset of the Covid-19 pandemic, both in the run-up to this onset and in their reaction once the Covid-19 pandemic had been an established fact.

Indeed, years of neoliberal laissez-faire and laissez-faire policies in Western countries completely undermined the capacity to resist the onset of a pandemic. The traditional application of the laissez-faire, laissez-passer doctrine, in the United States and the United Kingdom from the early 1980s onwards, and in the EU countries, particularly in the run-up to the 1992 Maastricht Treaty, and even more so in the period following the entry into force of that Treaty, has implied that neoliberal Western governments had increasingly withdrawn from many socio-economic areas, both as actors (e.g., through privatisation and commercialisation) and as regulators (through the liberalisation and deregulation of entire markets). The application of these neoliberal methods in the health care and nursing home sectors, which will be explored more closely in Chaps. 5 and 6 respectively, is particularly relevant in the context of this book.

After the financial crisis of 2008, an additional neoliberal sauce would be added to this already disastrous neoliberal meal. While this financial crisis was clearly triggered by the neoliberal policies of the 1980s and 1990s,¹¹⁸ Western countries began to counter its effects with even more ambitious neoliberal remedies, which of course made the situation worse. It is since then that the neoliberal magic word “austerity” has increasingly surfaced in neoliberal rhetoric and policies, leading to huge cuts and savings in many areas of society, such as education (and higher education), but also, more relevant in the context of this book, in general health care and care for the elderly.

In the countries that had been most exposed to this austerity policy, it particularly turned out that there was little resistance to Covid-19. For example, the health sector of these countries was completely unprepared—with, amongst other things, (1) a shortage of hospital beds (especially intensive care units) (one of the most crucial factors in the care for the seriously ill in Covid-19), (2) a shortage of protective equipment (from masks to respirators), (3) underfunding and understaffing in hospitals and nursing homes... As we shall discuss in more detail in Chaps. 5 and 6, all these characteristics had wreaked havoc in hospitals and long-term care homes across the West.

But the neoliberal laissez-faire, laissez-passer approach has had a second, perhaps even more disastrous effect. Deeply ingrained in the minds of neoliberal policymakers and politicians is the view that, as a government, doing nothing and just letting everything happen is always a better solution than bothering to act. After decades of neoliberal policymaking, this attitude has become deeply entrenched in members of successive governments in the United States, the United Kingdom and the EU (both at a supranational level and within the individual EU Member States themselves). This explains why, in all these legal systems, the initial response of governments to the Covid-19 epidemic was: Do nothing, and let it happen (= laissez-faire, laissez-passer). This in particular explains, for example, why, for more or less a month and a half after the first cases of Covid-19 were reported on their territories, Western policy-makers sat back and did nothing, except make (or “tweet”) bold statements such as: “It will pass”; “In good weather, it will just disappear”; “It’s no worse than seasonal flu”; “It will be fine”; “It’s all a hoax”, etc.

In short, the average response of Western, neoliberal governments has been to ignore (e.g., at the EU level) and downplay (for which one needs only to refer to all the idiotic tweets of the then US President Donald Trump in the period from late January 2020 on). What is even worse is that we have seen this pattern play out in almost every country run by neoliberals, with the aforementioned examples of the United States, the United Kingdom and the EU—which are also the special subject of this book—being among the most extreme examples. In these countries, restrictive measures (such as testing or quarantine) were not even considered in the initial phase of the Covid-19 epidemic.

When we shall return to the example of the Ischgl propagation below (cf. Sect. 2.4.1.2.), we shall also look more closely at some of the consequences of this (non-)policy during the initial stage of the Covid-19 pandemic.

Linked to the consequences of decades of austerity, the consequences of this laissez-faire, laissez-passer approach have, to put it simply, been disastrous. For example, in most of these countries there were no decent protocols for responding to a pandemic, as, under a laissez-faire, laissez-faire policy, these were never deemed necessary. Moreover, there were no (effective) public agencies to deal with such an epidemic, and where such specialised institutions had existed in a more distant past (e.g., in the United States; cf. Sect. 2.1.4.3.), they had been largely gutted as part of a logic of large-scale austerity.

According to Assa, by the time Covid-19 was launched, decades of neoliberal austerity had undermined countries’ ability not only to support vulnerable people in normal times, but also to save their lives in the event of a pandemic. Indeed, while viral infections do not, as such, discriminate by income, from the outset of Covid-19, it has been clear that the poorest were the most vulnerable and least equipped to cope, especially in rich countries.¹¹⁹ (Cf. Chap. 10 in more detail.) For Acca, the virus “can be blind to political beliefs, but not the other way around”, referring, by way of illustration, to the fact that the “red states” in the United States clearly reacted more slowly and with less concern than the “blue states” to Covid-19.¹²⁰

From the outset of the epidemic, the Covid-19 virus has also shown that pushing private and economic freedoms to the limit, at the expense of the common good, may bring about disastrous consequences. Prioritizing such political freedoms has more in particular come at the expense of public goods such as health and security and, ironically, at the expense of long-term economic well-being itself.¹²¹

Neoliberals will probably excuse their behaviour by saying that there was no alternative (i.e., the often used “TINA”—or “there is no alternative”—argument¹²²), that no one had experience with such a pandemic and that they reacted as best they could. But this argument is incorrect. Many countries—particularly in Asia—responded well to Covid-19, not by simply letting it all happen for a month and a half, but by reacting in the complete opposite way, based upon immediate government action, leading to measures such as: (1) indiscriminate closure of external borders (especially incoming air traffic); (2) implementing a very thorough screening and testing policy; (3) extensive contact tracing, coupled with immediate quarantine of contacts of those (suspected to be) infected; (4) if necessary, general or local lockdowns; (5) activation of specialised health services (which existed in various countries due to previous experience with infectious viruses, such as the SARS virus), and (6) the application of extensive disinfection protocols (e.g., in China), and all this not from ±45 days after the detection of a first case of Covid-19 (as in the EU), but from the first day (and even hour) after a case of infection was detected, and in some cases even without actual cases of infection already observed in one’s own country. In short, instead of relying on the laissez-faire, laissez-passer idea that the Covid-19 virus was to go away on its own, these other governments based their response on a complete opposite attitude, namely that the entire government apparatus had to be deployed immediately to nip the virus in the bud. Later in the book, when we turn to the example of Taiwan (cf. Sect. 2.4.2.4.1.), we shall also show the extreme success of such an “elimination approach”.

This was in stark contrast to the complete fiasco that neoliberal policies caused in the free West, with as result that the Covid-19 virus was not contained in the immediate aftermath of its appearance on Western soil, but instead continued to run rampant for more than a year afterwards.

Or how neoliberal laissez-faire and laissez-passer have proven to be the worst possible form of policy, both to prevent and to respond to an epidemic or pandemic caused by a virus, which leaves only the question of how many neoliberal policymakers and politicians in the West are likely to feel remorse about this, and how many assume—in the rare cases that they would feel such remorse—that this too will simply go away...

Let us end this Sect. 2.2.4 by referring, once again, to Acca, who rightly held that a pandemic leads a society into war, which implies, by definition, that inaction cannot be an option, but also—as several neoliberal countries have found out since the beginning of the Covid-19 crisis—that Maggie Thatcher was quite wrong: “Society exists”, and it needs to be protected and, certainly in times of crisis, to be led¹²³:

While we need to be cautious not to curtail political freedoms, we cannot sacrifice ourselves to the short-term ‘economic freedoms’ of a minority. If we do, we are all dead, even before the long run.

2.2.5 The (Abominable) Situation of the Health Care Sector at the Beginning of 2020

The submission of Western societies to economic neoliberalism has had a particular influence on the health care sector, which since the 1980s had been increasingly subjected to the principles of (neo-)liberal austerity.¹²⁴

Compared to the long-term nursing home sector, the impact of neoliberal ideology on the organisation of the hospital sector has been less important (but not less significant). Unlike the nursing home sector, the hospital sector has not so much been privatised as (1) partially commercialised, besides (2) increasingly been subjected to the iron logic of the neoliberal austerity principle. Basically, this implies that all health care institutions—especially hospitals—must not only be completely self-sufficient, but also be as profitable as possible.

This neoliberal austerity policy has manifested itself in the following ways: (1) a reduction in staff (especially nurses); (2) a reduction in the number of hospitals, and (3) a reduction in hospital capacity (mainly evidenced by a reduction in the number of hospital beds—ICU-beds and others—available per 1000 members of the population). This will be discussed in more detail in Chap. 5.

This hard and numerical logic that started to increasingly characterise the hospital sector has, in addition, been applied in many other healthcare and related areas that are important for Covid-19, such as (dis)investment in medical and protective equipment stocks.

Under the neoliberal (austerity) logic, there is generally no need to take preventive measures, for example by stockpiling materials to anticipate diseases that are not “current”, such as, regarding airborne viruses, face masks and protective clothing. This would incur too many costs (e.g., storage costs), while generating no immediate benefits. The logic of the free market, on the other hand, is based on the principle that everything produced is intended to be sold as quickly as possible, preferably at a high profit. Any anticipation of future risks at the expense of short-term profitability is, in other words, to be avoided as much as possible.

A similar example concerns access to medicines, especially in cases where the cost of a certain medicine has (still) to be covered by (what remains of) the (public) social security systems. Under neoliberal logic, the latter exist, at best, only to ensure that a member of the working class who falls ill is “patched up” and returned to work as soon as possible. Any long-term illness is monitored with suspicion, especially if it involves too much time away from the workplace. The co-financing of medicines by these public social security systems is, likewise, only still tolerated in cases where the medicines serve to ensure that people remain fit enough to perform labour. The co-financing of medicines already becomes much more suspect in the case of medicines that combat diseases of a rather rare nature, and which, therefore, are not likely to affect a large proportion of the working classes. Insofar as a neoliberal society cannot tolerate that, for example, 10% of the working population would suffer from an illness and remain collectively absent from the workplace, it still allows the (co-)financing of drugs that combat such illnesses by social security money. Woe, however, the individual suffering from a rare disease, especially when the drugs that can be useful to treat such a disease exist but are still relatively new and expensive. A ruthless cost-benefit reasoning will be applied here, according to which a sick individual will easily be sacrificed in favour of balancing social security expenditure.

According to Nelson, as a result of the above, neoliberal policies throughout the Western world in the period 1980–2020 greatly exaggerated capitalism’s innate tendency to downplay the capacities and capabilities associated with health care and, in particular, pandemic prevention measures, let alone preparedness.¹²⁵

The result of four decades of neoliberal policy implementation, as applied to the health care sector, has thus been that by the beginning of 2020 most (Western) countries were completely unprepared for a pandemic.¹²⁶

According to Chomsky, by 12 January 2020, a few days after the discovery of a problem with the Covid-19 virus, Chinese scientists had identified the Covid-19 virus, sequenced its genome, and transmitted all their information to the WHO (and through it, to the world). As a result, by 12 January 2020, all the relevant scientists in the world knew—or could know—what was happening, what to expect and what to do.¹²⁷ (Cf. Sect. 1.1.1.) However, after being informed in this way, countries reacted differently. Most countries in Asia and Oceania—such as Australia, New Zealand, Taiwan, South Korea—responded quickly and effectively, thus managing to contain the spread of the Covid-19 virus at an early stage of the pandemic.¹²⁸ Unfortunately, European countries and the United States (as well as some other countries, such as Brazil and India) responded much less effectively.¹²⁹

In light of the above, it should also be similarly clear that early 2020, when Covid-19 hit the Western world, many Western countries were facing the consequences of a poorly resourced health sector: Health care workers had been paying the price of neoliberal budget cuts for four decades already, with as result that, especially in the first weeks after the Covid-19 pandemic broke out, they had to do their work—and in many cases perish—under the most appalling, even deadly conditions.

The total lack of preparedness of the (neoliberal) Western world was, moreover, linked to the adaptation of the health sector to the long-chain and just-in-time delivery systems of modern capitalism, as well as to a policy of reducing storage space for all possible medical and protective equipment (which, at an early stage of the pandemic and throughout the Western world, made access to personal protective equipment extremely difficult).¹³⁰ Similarly, the globalisation of the “buy from the cheapest source” mentality¹³¹—which had generally led to a decline in manufacturing capacity in the northern hemisphere already during the second half of the twentieth century implied that in many cases there was an exclusive reliance on a few (foreign) suppliers, often located on the other side of the world.¹³² However, when Covid-19 struck, the pandemic broke out in both producer countries (e.g., China) and consumer countries (e.g., the United States and EU Member States) alike, essentially crippling the production of a wide variety of medical equipment, protective gear and even drugs for export and, as a result, proving literally fatal for countries on the demand side of the curve.¹³³

We shall return to this in Chap. 5, where we shall examine in more detail how decades of neoliberal (austerity) thinking in the Western world had weakened the hospital sector, and what this has meant for Covid-19 management.

2.2.6 The (Abominable) Situation of the Nursing Home Sector in Early 2020

By the time Covid-19 reached Western countries—especially the EU countries and the United States—the (long-term) nursing home sector was, if anything, in even worse shape than the hospital sector, as the fury of neoliberalisation had hit the care or nursing home sector much harder than it had hit the general health care sector.

In the United States, a considerable proportion of retirement homes for the elderly had already become in the hands of private market players since the 1980s. Partly as a result of the neoliberalization measures of the Reagan administration, these institutions had increasingly supplanted the former public welfare institutions, as well as the traditional non-profit religious institutions. As a result, retirement homes for the elderly in the United States, had increasingly become in the hands of for-profit corporations, which in some cases even started running large retirement home chains like any other business.

A similar wave of privatisation and commercialisation of the nursing home sector occurred in EU countries as of the 1990s. Whereas in the EU Member States the nursing home sector was previously much more in the hands of the state—or religious institutions—after the entry into force of the Maastricht Treaty (which led to an extreme degree of financialization of European societies), a permanent neoliberal austerity policy led to a radical change in the nursing home sector. As a result, since the 1990s, EU Member State governments have been increasingly unwilling to be further involved in the sector. Through actual privatisations and PPP constructions, but also through intermediate forms that relied on a gradual divestment of certain subtasks, the nursing home sector had in such a manner increasingly been handed over to profit-oriented companies.

The result of these factors, both in the EU and the United States, has been that the for-profit nursing home sector had become increasingly important (although public nursing homes and private not-for-profit nursing homes would still continue to operate in both jurisdictions as well). Indeed, at the time of Covid-19, this process of privatisation of the nursing home sector was still underway. (Cf. also Chap. 6).

Such private for-profit companies are characterised by the fact that they operate according to the principles that apply to all capitalist enterprises, including: (1) the pursuit of the largest possible market share (in so far as this does not reduce cost efficiency); (2) the organisation of the provision of services to the elderly as a commodity, and (3) cost efficiency, which manifests itself in different areas, such as (a) in the area of personnel—as in any private enterprise, the workforce of a private nursing home operating according to capitalist working methods is (in accordance with the capitalist principle of “profit maximisation and cost minimisation”) preferably kept as low as possible for reasons of cost efficiency; (b) with regard to the remuneration of employees (cf. “the iron law of wages”); and (c) with regard to the quality of food, in addition to other services.

The quality of services provided by these private for-profit nursing homes has often been poor.

One of the biggest problems the sector faced when Covid-19 hit, were its low staffing levels. Not surprisingly, these proved to be one of the main reasons for the disastrous impact of the Covid-19 pandemic on the sector, or more precisely on the elderly people living in these for-profit homes.

We shall return to these issues in Chap. 6, where we shall examine in more detail how decades of neoliberal public policy weakened the (long-term) nursing home sector to a point where, by early 2020, it was completely unprepared and unadjusted to deal with the onset of the Covid-19 pandemic.

2.2.7 Supremacy of Economic Interests

The aspect of economic neoliberalism which, both in the EU Member States and in the United States, from the beginning of the Covid-19 crisis, has probably hampered the fight against the Covid-19 pandemic the most, has been the doctrine of the absolute supremacy of the economic domain (which under economic neoliberalism is—always and in all cases—considered to be more important than any other aspect of socio-economic life, including public health).¹³⁴

This prioritisation of economic interests over the common good in most Western countries already dates from the early 1980s.

Any realistic description of the many idiocies which this attitude has caused in relation to the management of the Covid-19 pandemic would defy all imagination, were it not for the fact that, during the period 2020–2021, we have all been able to experience it first-hand. As this is one of the underlying themes of this book, we shall return to this aspect of neoliberal public policy at various points later on—but let’s have a few “tasters” already now.

The fact that the EU was created as a European “monetary” and “economic” union already gives an indication of its main areas of concern. The European treaties, therefore, mainly deal with the economic field and pay much less attention to other subjects, such as social issues, the environment or public health. These are inherently of little economic interest. According to neoliberal doctrine, they are even more likely to be obstacles to efficient free markets, than that they are able to help support them. As a result of this attitude, the EU has virtually no competence, let alone means, to deal with a health crisis such as a pandemic. This explains why, when Covid-19 reached the European continent at the end of January 2020, the EU heard the proverbial “thunder in Cologne” and did virtually nothing for more than a month and a half. (Cf., furthermore, Sect. 2.3.)

The predominance of the economic domain also helps to explain why, even after the WTO in late January 2020 began issuing strong warnings about the seriousness of the Covid-19 situation, the EU continued to focus on all sorts of economic issues that it considered far more important than taking any action that might have nipped the spread of Covid-19 in the bud. Here the EU also stubbornly refused to learn from the experiences of some Asian countries with such kind of health crises. For the EU, even after the WHO announced the seriousness of the situation until at least mid-March 2020, everything else was, hence, deemed far more important than spending time, attention or energy on Covid-19. As a result, during the extremely long period of one and a half months in terms of a virus, Covid-19 had free rein to spread across the European continent, alongside Britain. It is, therefore, not surprising that by the end of March 2020, the centre of gravity of the Covid-19 pandemic had shifted from Asia to Europe, where the number of cases exploded.

The various EU Member States acted accordingly. It was only at the end of February and the beginning of March 2020, after television images made the gravity of the situation in Italy clear, that EU countries started to consider measures, although by then they were completely overwhelmed by the brutal reality of the high Covid-19 figures, which left no other choice than to take real lockdown measures, which most EU countries, reluctantly, started to take as of March 2020.

However, it would soon become clear that neoliberal Europe could not sustain this kind of tough lockdown for long, and certainly not long enough, or tough enough, to keep Europe completely safe from the Covid-19 threat. Indeed, for the only time in decades that EU countries were prepared to prioritise public health over economic interests, protests from the business community soon followed. Concerned about the decline in turnover and profits—which would later turn out to be less than 5% compared to the past—a loud call from the business community rang out in mid-April 2020, proclaiming that “the economy should open up again” (by analogy with a similar slogan that was launched by US President Donald Trump at the time).¹³⁵ In the wake of this, there was an even stronger call to reopen schools as well so that childcare could be provided sufficiently in order to allow the working classes get back to work. In response to this outcry, and with little to no regard for the fact that Covid-19 was not at all contained, let alone eliminated, throughout Europe, containment measures were being systematically lifted as of the end of April-early May 2020.

This newfound freedom would soon turn sour: After the summer months—usually a time when coronaviruses calm down—Europe would soon find itself hurtling towards a severe “second wave” of the Covid-19 pandemic, characterised again by high infection and mortality rates from October 2020 onwards.

The picture in the United States was similar, albeit drenched in the sauce of US President Donald Trump’s sense of drama and controversy. In retrospect, however, one must conclude that in some areas US policy has been more sensible than European policy, though in other areas, if possible, even more foolish. E.g., have made the case for the United States: the swift action to issue a travel ban to and from China, which saved the US from a direct import of Covid-19 from China. Unfortunately, the travel ban to and from Europe was not enacted as quickly and thoroughly, so Covid-19 was able to be smuggled into the United States from Europe, particularly from Italy. Making a similar case for the Trump administration: the fact that the Trump administration had already committed to supporting the development of Covid-19 vaccines in March 2020, and that it had even begun negotiations to purchase vaccines at a time when the EU itself barely realised that it would have to start taking action against Covid-19, let alone that it would have already committed to purchasing Covid-19 vaccines itself.¹³⁶

As was the case with the neoliberal EU, so too with the Trump administration, the dogma of the primacy of economics would, nevertheless, keep prevailing all the time. After lockdown and hygiene measures were enacted in the United States, both at federal level as at the level of some states (but not, or hardly, of others), in March and April 2020, it would be the US president himself who would start to question them most. (Cf. Sect. 2.5.)

What should be clear by now is that the adherents of neoliberal thinking react with horror to anything that undermines the primacy of economics. Presumably, a little less dogma in this area could have prevented a great deal of human suffering, both in the United States, as in EU countries. In adhering to the neoliberal dogma of the primacy of economics at all costs, the many geniuses of neoliberal politics and economics seem to have barely realised that the Covid-19 pandemic, which would continue to rage for more than a year, would ultimately come at a higher cost—even in socio-economic terms—than a fairly short, intense and severe period of tough measures that would have managed to eliminate the Covid-19 virus.¹³⁷

What is probably even worse is that the call to “open up the economies” has not been just once, but repeatedly throughout the Covid-19 pandemic. Indeed, after new, stricter measures were needed, especially in the United States and EU countries, to combat a second wave of Covid-19, these were all too quickly again met with new calls to relax these measures in the light of economic interests. The same scenario was repeated when a third wave emerged after this new period of easing. Thus, neoliberal public policy of combatting the Covid-19 pandemic, both in Europe as in the United States, began to exhibit the characteristics of an “accordion movement”, which has also been referred to as a “mitigation strategy” and which is schematically shown in Table 2.1.

Table 2.1 Schematic representation of the accordion movement characterizing neoliberal public policy regarding Covid-19, esp. in the EU

We shall return to the issue of re-opening the economies in Sect. 7.10, where it will become clear that the biggest victims of this neoliberal public policy have been the members of the working classes.

2.2.8 Neoliberal Education (as a System of Childcare for Working Parents)

One of the most difficult issues to grasp during the Covid-19 pandemic has been the closure of schools. The context of the problem was that when the first wave of Covid-19 hit the world, schools were all over the world closed as part of the response to Covid-19. Moreover, as will be explored in more detail in Chap. 8, these school closures occurred simultaneously in a multitude of countries, with as result that during the period from ±March 2020 to ±June 2020, school-going young people around the world were forced to stay at home and learn from a distance. Although distance learning systems were hastily put in place in many countries in order to deal with this problem, the weeks or months of school closures had a profound impact, both in terms of educational disadvantage, as in terms of damage to the general well-being of the school-going youth.

These issues will be discussed in more detail in Chap. 8.

Because of the profound impact of school closures, several international authorities—such as UNICEF and UNESCO—by the end of the first wave of the Covid-19 pandemic started to make claims that school closures had not only been detrimental to the young people in school, as well as posing a variety of other societal problems—such as an assumed, enormous economic damage due to the educational disadvantage suffered by an entire generation of young people—but that they might not even have been necessary. In support of the latter claim, it was argued that the risk of the Covid-19 virus spreading through schools was extremely low and that this risk, therefore, did not outweigh the great educational and economic damages caused by closing schools.

In addition to this argument, it was noted that part of this economic damage was caused by the fact that, due to the closure of schools, the parents of children who stayed at home were severely hampered in their work, both in the case of working at home, as in the case of having to be physically available at the workplace. Especially for the part of the working population for whom the Covid-19 epidemic was already inherently the most problematic, the problem of childcare became acute. This was especially the case for those parents who had to stay physically at work, such as health care workers, alongside those who were ordered to return to their physical workplace as a result of the reopening of the economy that neoliberal governments started to implement by the end of April 2020 and the beginning of May 2020. The economic damage caused by the school closures was, therefore, partly the result of the fact that during the times that the schools were closed, they were unable to properly fulfil their societal role of childcare, in order to keep the capitalist machine running.

This explains why after the summer of 2020, at the start of a new school year, in many countries that had been hardest hit by Covid-19, neoliberal governments were no longer willing to commit to closing schools. In canon with the call for the economy to reopen as of the end of April-beginning of May 2020, in many (capitalist) countries a similar call started to be heard that schools should also remain open (at all costs).

Given the question of the extent to which the closure of the schools constituted an additional obstacle to the functioning of the business world, the question has since arisen as to the extent to which the call to keep the schools open was echoed by the interests of the school-going youth themselves or being motivated by the concern that the working parents of the school-going youth should no longer be inconvenienced by the closure of the schools at a time when they were needed on the working floor by the capitalist machinery.

2.2.9 In-Between Conclusion: Neoliberal Public Policy Choices Having Delivered Some of the Main Reasons for the Fast Spread of Covid-19

In view of the above—as before, in the run-up to the great financial crisis of 2008—(economic) neoliberalism can be pointed to as one of the main factors behind the disastrous course of the Covid-19 pandemic in many Western countries (in addition to some other countries that had mastered Western socio-economic thinking).

First, while many Asian countries responded to a first outbreak of Covid-19 on their territory—if only in one case—with the most severe tracking and elimination, containment, or similar measures, Western neoliberal governments found it far more appropriate to do nothing for a considerable time.

As Sumonja has argued¹³⁸:

As for the speed at which the virus has spread, the unprecedented physical connectivity in the word of global supply chains and low-cost flying was not the only contributing social factor. It should not be forgotten that the initial reaction from most governments to the outbreak was an exercise in ‘epidemiological neoliberalism’. (…) This policy bluntly exposed the politics of the whole project: pretend to do nothing while making sure that the ‘natural laws’ of markets keep functioning, even if it means allowing people to get sick and die from ‘just another flu’. Encapsulated in social-Darwinian ‘survival of the fittest’ notion of ‘herd immunity’, this solution in practice consisted of voluntary behaviour guidelines – business as usual, just wash your hands and keep your distance. This, in effect, turned a social problem into an individual matter, thus shaking off any responsibility the authorities had for the public health crisis.

Second, in the wake of what was to become the largest pandemic since the Spanish flu, the disastrous effects of 40 years of neoliberal privatisation of public health and nursing institutions were revealed in the most dramatic way as soon as Covid-19 appeared. Namely: A lack of staff and material capacity in underfunded public hospitals, and a total inability of the private for-profit health and nursing sector to provide even the most basic medical treatment in a health crisis. Summonia illustrates this point by referring to what happened in Italy. At the end of February, beginning of March, Italy was one of the countries hardest hit by the pandemic, but at the same time had to face ongoing austerity cuts in its national health system. This had resulted in “an extraordinary 50% reduction in hospital beds between 1997 and 2015, and 46,000 fewer hospital employees between 2009 and 2017”. Add to this: (1) a practice of outsourcing medical and other services in search of cheap labour and (2) the fact that for-profit health institutions have no commercial interest in preparing for or preventing of health emergencies—e.g., by keeping a sufficient number of hospital beds, including intensive care units, empty, or by keeping a stock of masks and gloves available, or even by investing in the development of vaccines—and what you got was a century-long public health crisis that has exploded in the blink of an eye.¹³⁹ (Cf. Chaps. 5 and 6.)

Third, in response to the crisis, the resources of neoliberal states were, after a long period of hesitation (in most cases, plus or minus 6 weeks), finally mobilised in force, with compulsory closures imposed and branches of industry asked to produce emergency medical supplies. However, according to Sumonja, with a majority of workers out of work, global supply chains broke down, demand declined, production collapsed, corporate revenues fell sharply, and stock markets plunged.¹⁴⁰ At a time when lockdowns and similar measures succeeded in lowering mortality and contagion curves, although the Covid-19 virus was still circulating, “re-opening the economy” measures would be taken throughout the Western world. The virus could then simply start to spread again, and take lives to such an extent that valuable time was lost in several countries—including those with more intransigent right-wing neoliberal administrations, such as: the United States, the United Kingdom and Brazil’, as well as many EU member states, even with government attempts to implement a strategy of “herd immunity” (a term previously reserved for farm animal management rather than human epidemiology). According to Saad-Filho¹⁴¹:

This strategy would inevitably lead to the elimination of the old, the weak and those with fragile health (thus cutting their (dead)weight on the fiscus), instead of rapidly imposing a lockdown that, although proven to reduce the loss of life, would hurt profits, while also showing that states can play a constructive role in social life. Mass pressure and the evidence of success in China and elsewhere eventually forced even the most reluctant governments to impose lockdowns, but – just as surly teenagers forced to empty the dishwasher – they often did so dragging their feet, grumbling contradictory excuses, making implausible threats and undermining their own policies with both incompetent implementation [and unclear communication]. In these countries, Covid-19 testing also tended to be restricted and health service staff were often left to cope with unmanageable workloads without adequate personal protection equipment: daily brushes with death gallantly accepted in the name of professionalism.

We shall now explore all these issues in some more detail in the following sections and chapters.

2.3 The EU’s Utter Lack of Coordination in Responding Early to the Covid-19 Crisis During February and Early-March 2020

Throughout the first month and a half of the Covid-19 pandemic, EU countries stood mostly alone in responding to the Covid-19 crisis, while the EU itself did virtually nothing to prevent the spread of Covid-19 from the outset after Covid-19 had first been detected in France and Italy in late January 2020.

In the words of Herszenhorn and Wheaton¹⁴²:

They could have known. They should have prepared. They didn’t listen.

According to Herszenhorn and Wheaton, in the initial period of Covid-19, the EU failed to listen to the warnings about the potential dangers of Covid-19. The EU “ignored experts who said that no country could fight the Covid-19 virus on its own”. The EU “failed to recognise that the world’s most advanced health systems were at risk of being overwhelmed”. The EU also “failed to understand that drastic measures would be needed”. In short, the EU did nothing and understood nothing, until Italy—patient zero among EU member states—in early March 2020, frantically began imposing travel restrictions that would hamper the personal travel and meeting plans of EU leaders themselves.¹⁴³

The European Commission, which has only limited power over health issues anyhow (to the extent that the EU is, in principle, only concerned with economic issues), could already have sensed the danger in January 2020. Yet it failed to convey a real sense of urgency until mid-March 2020. As a result, valuable time was lost, giving Covid-19 time to spread across the European continent and, via travellers from Italy to the United States, to the American continent as well.¹⁴⁴

Given that Covid-19 reached the European continent as early as the end of January 2020 (with the first case reported in France on 24 January 2020), and given the widely available information about what was happening in China, the EU and its Member States should have started to react much earlier, and not have waited until it was basically too late.¹⁴⁵

At the time, as Covid-19 was of little concern to European leaders,¹⁴⁶ these still expressed their belief that the likelihood of Covid-19 being imported from China into Europe was remote, regardless of the fact that the WHO had already declared the Covid-19 virus a “public health emergency of international concern” on 30 January 2020.¹⁴⁷ (Cf. Sect. 1.1.1.)

Still according to Herszenhorn and Wheaton, on 29 January 2020, the European Commissioners for Crisis Management, Janez Lenarčič, and for Health, Stella Kyriakides, held a joint press conference during which they announced that the European Commission had decided to activate its internal crisis response mechanism.¹⁴⁸ Indicating the little importance Covid-19 met throughout the EU, the event itself obtained little or no attention. By contrast, the WHO proceeded with doing its best to prepare the world for what was about to come: By the end of January 2020, 31 of the 53 Member States in the WHO European Region had the capacity to test for SARS-CoV-2, with all countries in the WHO European Region having established viral diagnostic capabilities for SARS-CoV-2. Almost all the WHO European Region countries also had installed national laboratories for SARS-CoV-2 testing.¹⁴⁹

In retrospect, Lenarčič and others admitted that there had been critical gaps in the preparedness of the EU and EU countries, and that the EU had shown little sense to the unpreparedness of the national governments of the EU Member States to adequately respond to the Covid-19 crisis. E.g., neither the EU, nor the European Centre for Disease Prevention and Control, had kept statistics on national stocks of medical equipment.¹⁵⁰

On 1 February 2020, the day after the WHO had declared a public health emergency of international concern (more precisely on 31 January 2020), technocrats from various EU Member States and agencies came together at a meeting of the Health Security Committee in order to debate the threat posed by Covid-19. At this occasion, only four EU Member States formally admitted that they might be facing shortages of personal protective equipment. In reporting about all of this, Herszenhorn and Wheaton even made the observation that China’s announcement on 4 February 2020 that it was about to open a new 1000-bed “pop-up hospital” which had been built in less than 2 weeks in order to cope with the influx of Chinese Covid-19 patients requiring intensive care, did not impress EU leadership at all.¹⁵¹

The disinterest for the emerging Covid-19 threat was mostly to be observed at a political level and less so among career civil servants who had already experienced SARS and swine flu, and who themselves gradually began to recognise the need for “unsexy” measures, such as the purchase of ICU’s and respiratory ventilators.¹⁵²

On 10 February 2020, at a press conference which was held at the EU’s coordinated response centre in Brussels, Lenarčič attempted to make a new appeal to the EU Member States to start taking the Covid-19 threat more seriously. The Commissioner’s message was still largely ignored. On the contrary, just three days afterwards, when the EU Member States’ health ministers assembled in Brussels for an emergency meeting on 13 February 2020, they still demonstrated a huge resistance to taking coordinated action.¹⁵³

Herszenhorn and Wheaton rightly remarked that in China the Wuhan lockdown had begun just two days before the Lunar New Year festivities. According to these authors, this timing reflected the fear of the Chinese government that the holiday festivities, and especially the travelling back and forth to this event, would have become a spreading event for the Covid-19 virus (cf. Sect. 1.1.1.). A month later, at the level of the EU and its Member States, there were made no similar precautions. On the contrary, on Friday 21 February 2020, in most EU Member States, schools closed for the Carnival holidays. In full compliance to the laissez-faire, laissez-passer paradigm (cf. Sect. 2.2.4.), the EU and its Member States simply let this happen, as a result of which families all over Europe were allowed to depart on ski holiday without any reservations in place. In retrospect, this situation—more specifically the masses of ski tourists returning home 1 or 2 weeks later—would be the start of an “avalanche of infections” which helped spreading Covid-19 all over the European continent.¹⁵⁴

Even at the end of February 2020, when Italy was forced to gradually start taking measures to prevent the spread of Covid-19 on its territory (cf. Sect. 2.4.2.3.1.), the EU and its other Member States were still content to watch by and do nothing.¹⁵⁵

On 25 February 2020, the health ministers of Italy and some of its neighbouring countries, namely Austria, France, Slovenia, Switzerland, Germany and Croatia, convened in Rome. Rather than taking serious measures to fight the Covid-19 threat, they easily agreed that closing their borders would have constituted a disproportionate and ineffective measure at that time. They similarly were in full agreement that major events should not be automatically cancelled.¹⁵⁶ Even on the next day, European Commission President Ursula Von der Leyen, still declared that the risk of Covid-19 infection was to be considered “low to moderate” in the EU, as there were “only” 275 confirmed cases in the EU at the time, including eight deaths, most of them among elderly people.¹⁵⁷

Still according to Herszenhorn and Wheaton, the only concern about the Carnival holiday week was that European Commission staff members might have to travel back and forth to high-risk areas in Italy. This led to the enactment of one of the few Covid-19 measures at the time, namely an obligation for Commission staff members to quarantine themselves (and to perform telework) upon their return to Brussels.¹⁵⁸

While the earlier mentioned tragic events occurred in China and gradually started to unfold in Italy as well, EU leaders remained primarily concerned about the side effects of a slowdown in the Chinese economy, showing little interest for the health threat that was looming for the European population.¹⁵⁹ A similar concern was raised about the possible economic side-effects of airport closures in Italy. Another concern that diverted the attention of the EU leadership from Covid-19, was the fear of a new migrant crisis.¹⁶⁰

EU leaders finally began to take the threat posed by Covid-19 more seriously when, at the end of February 2020, Italy formally requested EU assistance to deal with the disastrous events unfolding on its territory. Despite much rhetoric about European solidarity, this request was, surprisingly, largely refused.¹⁶¹ According to Herszenhorn and Wheaton, the sole response of the European Centre for Disease Control (ECDC) was to increase its assessment of the risk of Covid-19 clusters in Europe from “moderate” to “high”.¹⁶² Unfortunately, by then it was too late: by that time, Covid-19 had already been on European soil for more than a month, spreading largely unnoticed and rapidly, with the return of the Carnival week ski holiday in early March 2020 as one of the most crucial spreading events.¹⁶³ One of the first cases of Covid-19 detected in the WHO European Region, more precisely in France, already dated back to 24 January 2020. By the end of February 2020, with virtually no action whatsoever taken in the meantime, Covid-19 was believed to have spread rapidly throughout the WHO European Region. Since this first detection case, it took Europe only 3 months to reach the first one million of Covid-19 cases, and 8 months to reach its first ten million cases.¹⁶⁴

With no policy response at all during the first month and a half after Covid-19 had reached the European continent, by mid-March 2020, the WHO European Region had become the epicentre of the epidemic, at the time accounting for 40% of all global cases.¹⁶⁵

Yet, even then, the fight against Covid-19 was still not high on the European Commission’s political agenda. Instead, as reported upon by Herszenhorn and Wheaton, on Monday 9 March 2020, the European Commission chairwoman Ursula von der Leyen marked her 100th day in office with a press conference that mainly focused on the situation along the Turkish border, but hardly dealt with the spread of Covid-19.¹⁶⁶

Only after the situation in Italy (and especially in Italian hospitals) worsened by the day and Italy was forced to resort to announcing a regional lockdown on 8 March 2020 (which by the following day was extended to the whole of Italy, with all schools and non-essential shops closed), other EU countries finally started to react. Among these first reactions were the closing of internal borders with Italy and export bans of personal protective equipment.¹⁶⁷ The Italian government itself started enacting “progressive mitigation measures” on 9 March 2020 and on 11 March 2020, with the intention of “radically limiting social interactions and preventing the spread of the virus”.¹⁶⁸ (Cf. Sect. 2.4.2.3.1.)

From then on, the EU and its Member States finally started to take Covid-19 more seriously, with the situation in Italy becoming a true deterrent of the dangerousness of the Covid-19 virus when Italian doctors and nurses started to die in large numbers because they lacked adequate protective equipment in the hospitals where they were supposed to cope with an exponentially increasing number of Covid-19 patients.¹⁶⁹ Already on 20 March 2020, Italy reported the second highest number of confirmed Covid-19 cases in the world, second only after China.¹⁷⁰

From then on, things in Europe started moving extremely fast. According to Chadwick, the number of Covid-19 related deaths across the EU and the United Kingdom would rapidly rise in April 2020, with some Western European countries reporting hundreds of deaths per day. This also marked the start for taking Covid-19 containment measures, such as social distancing and lockdown measures: By early April 2020, half the world’s population was reported to be under some form of Covid-19 restriction measure(s). By mid-April 2020, the number of Covid-19 cases on a global scale exceeded two million, with the IMF even announcing that the global economy would experience its worst year since the 1930s.¹⁷¹

As of 19 April 2020, more than 100,000 Covid-19 related deaths and more than one million Covid-19 infection cases had been recorded in Europe, at the time accounting for almost half of all global cases.¹⁷² As of 28 April 2020, 63% of global Covid-19 mortality was reported to originate from the WHO European Region.¹⁷³ Clearly, Europe was experiencing the peak of its first wave of the Covid-19 pandemic, while at the same time having obtained the status of being the epicentre of the pandemic.

By mid-April 2020, several European countries, such as Norway and Austria, started experiencing a decrease in their number of new daily Covid-19 cases, which they deemed a sufficient reason to start relaxing previously imposed Covid-19 restrictions. Soon, showing much more eager to abandon efforts to fight the Covid-19 pandemic than it had ever done to take them in the first place, the EU followed this example: Already on 15 April 2020, the European Commission and the European Council presented their roadmap for “a coordinated approach to lifting containment measures across the EU”. On 17 April 2020, the European Parliament adopted its own resolution in which it expressed its views on the EU’s coordinated approach to dealing with the Covid-19 pandemic. But for giving a further illustration of the EU’s priorities: Faced with ailing airlines and an as ailing tourism sector, a debate among the ministers of transport of the EU Member States was held at the end of April 2020 on important matter such as the rights of EU passengers and the rules applicable to cancelled tickets.¹⁷⁴

During the second half of April 2020, as a result of social distance and lockdown measures, the numbers of Covid-19 contamination cases and related deaths gradually began to fall. Considering what has been explained under Sect. 2.2.7 on the supremacy of economic interests, soon a call for the reopening of the economy gained ground all over Europe. By the end of April 2020 and the beginning of May 2020, more and more EU countries, hence, already decided to relax their Covid-19 measures,¹⁷⁵ although by May 2020, 54 of the 55 Parties to the International Health Regulations (IHR, 2005) in the WHO European Region still reported Covid-19 cases on their territory.¹⁷⁶

As of May 2020, the EU resumed its activities on assuring that travel in Europe could become possible again under certain conditions. E.g., an 13 May 2020, the European Commission published a series of initiatives aimed at providing “a common framework for revitalising the transport and tourism sectors across the EU”.”¹⁷⁷ Furthermore, on 11 June 2020, the European Commission announced that internal borders could reopen again as of mid-June 2020, while the EU’s external borders were announced to reopen as of 1 July 2020.¹⁷⁸ With Covid-19 far from gone, the OECD similarly added to the case for further reopening and easing of the Covid-19 measures, warning that the economic effects of the lockdowns would be both unprecedented and long-lasting, particularly in the euro area.¹⁷⁹

In June 2020, EU leaders failed in a first attempt of agreeing on a EUR 750 billion stimulus package that would have included debt sharing as a tool to help EU countries hardest hit by the Covid-19 pandemic.¹⁸⁰ The failed attempt to reach such an agreement were shortly after revived, leading to a historic EUR 1.82 trillion budget that was agreed upon on 21 July 2020. (Cf., furthermore, Sect. 4.2.3.)¹⁸¹

By 27 July 2020, the first wave of the Covid-19 pandemic had resulted in the loss of 180,000 lives in the 39 countries and territories of Europe.¹⁸²

After the summer of 2020 had brought some temporary relief, probably more because of the good summer weather than because of sound policy from the part of the EU and its Member States, as of mid-September 2020, Europe again witnessed a sharp increase in Covid-19 cases, with numbers of contaminations and deaths even rising at a higher rate than during the previous peak moment of March 2020. During the first half of September 2020, more than half of the EU countries had already reported an increase of more than 10% of Covid-19 cases.¹⁸³ The ECDC called on EU Member States to rapidly implement newly targeted measures in order to address this worrying increase in Covid-19 cases which would soon be referred to as “the second wave” of the pandemic. This at the same time also implied that the “soft measures” which were still upheld at the time, were not working.¹⁸⁴

For the second time in a row, the response of the EU and EU Member States came too late. By the end of October 2020, Europe was clearly in the grip of a severe second wave of the Covid-19 pandemic. During the last week of October 2020, countries across Europe—including Belgium, Croatia, the Czech Republic, France, Germany, Hungary, Poland, Portugal, Slovakia, the United Kingdom and Ukraine—all recorded their highest number of daily cases since the start of the Covid-19 pandemic. Two of these countries stood out. As of 25 October 2020, Belgium and the Czech Republic reported 146 and 115 new daily cases per 100,000 inhabitants respectively, well above the EU average of 33 per 100,000.¹⁸⁵

On 6 November 2020, the New York Times published a detailed report in which it was held that the number of Europeans seriously ill with Covid-19 was higher than ever. The New York Times hereby referred to “new hospital data for 21 countries”, from which it appeared that the new Covid-19 numbers exceeded those of the worst days during the spring of 2020. The New York Times also reported that, once again, the Covid-19 pandemic threatened to overwhelm the European “overburdened hospitals” and “exhausted medical workers”.¹⁸⁶

According to the renowned newspaper, European numbers had begun to gradually increase as of September 2020, as a result of which, by 6 November 2020 and measured on a per capita basis, more than twice as many people in Europe had been hospitalised with Covid-19 than in the United States. Still according to the New York Times, in the Czech Republic, the most affected European country at the time, “one in 1,300 people were hospitalised with Covid-19”. And in Belgium, France, Italy and several other Western European countries, a new batch of patients had filled hospitals at levels even unseen during the months of March and April 2020.¹⁸⁷

According to the UK Office for National Statistics, during the autumn and early winter of 2020, especially some Central and Eastern European countries experienced extreme high levels of excess mortality. Western European countries similarly experienced some excess mortality, but at lower levels than during the spring of 2020. Of all European countries, Poland was reported to have the highest cumulative excess mortality (so-called “age-standardised relative cumulative mortality rate” (or “ASMR”)) which, as of 18 December 2020, was reported to be 11.6% higher than the 5-year average. The highest weekly peak in excess mortality (ASRMR) during the autumn of 2020 was, however, recorded in Bulgaria, at 112.3% (in the week ending on 27 November 2020).¹⁸⁸ This is illustrated in Table 2.2 which points out where people were ill with Covid-19 on 6 November 2020.

Table 2.2 Where people are ill with Covid-19 by 6 November 2020 [Source: Herszenhorn and Wheaton (2020)]

According to the already above-quoted special report that appeared in the New York Times, it appeared that most European policymakers had, once again, “waited too long to impose a full lockdown”, in this way having resisted early warning signs dating back to the late summer of 2020 that the situation was worsening again. By November 2020, these delays would prove very costly. As a result, in the words of the New York Times’ special report, during the fall of 2020, European countries had “to start scrambling desperately to find solutions”. E.g., Swiss authorities approved the deployment of “up to 2500 military personnel” in order to assist hospitals in dealing with the rise in Covid-19 infections, while in other countries, such as France, it was decided to postpone elective surgery. And in Belgium, chronic staff shortages even made some hospitals to ask asymptomatic doctors and nurses who had tested positive for Covid-19 to continue working.¹⁸⁹

Public health officials across Europe soon faced additional challenges during the second wave of the Covid-19 pandemic. E.g., the cold autumn and winter weather made people spend more time indoors, which further facilitated the spread of the Covid-19 virus. Moreover, after having endured lockdown and similar restrictions for the most part of 2020 already, many people across Europe started experiencing what has been referred to as “Covid-19 pandemic fatigue”. This complicated enforcement efforts in many countries even more (= on this so-called “Covid-19 pandemic fatigue”; cf., furthermore, Sect. 2.4.3.3.4.)¹⁹⁰

Finally, the New York Times also reported that, in what was referred to as “a tense exchange at the French National Assembly”, Olivier Véran, the French health minister, had described the situation in the French hospitals as being filled with young patients in critical condition.¹⁹¹

Still according to the assessment made by The New York Times, the huge second wave of Covid-19 infection in Europe was to a substantial part due to the relative normality Europe had allowed itself during the summer of 2020. Unlike the United States, where the epidemic had already reached a second peak as early as July 2020 and where Covid-19 had been breaking records of contaminations and deaths ever since, during the summer of 2020, people were travelling through Europe, students were returning to campuses (especially in September 2020) and many large gatherings simply resumed, all while the Covid-19 virus continued to spread.¹⁹²

Finally, in November 2020, many European countries again started resorting to social distancing and containment measures, while experts across Europe eventually reached the conclusion that the increase in hospitalization cases and Covid-19 related deaths all implied that the restrictions had simply been lifted too quickly before and during the summer of 2020.¹⁹³

Throughout 2020, the WHO European Region was reported to have experienced more than 26 million confirmed contamination cases of Covid-19, and more than 580,000 Covid-19 related deaths. According to Kluge, in the 27 countries participating in the so-called “EuroMOMO all-cause excess mortality surveillance”, nearly 313,000 excess deaths were reported for the year 2020. This marked a threefold increase in excess deaths compared to 2018, and almost a fivefold increase of excess deaths compared to 2019.¹⁹⁴

At the beginning of 2021, more than 230 million people in the WHO European Region were living in countries under full national lockdown, with several other countries expected to announce further lockdown measures. Transmission rates in the WHO European Region were, moreover, reported to be still very high. As of 6 January 2021, across all countries and territories in Europe, nearly half had a 7-day incidence of more than 150 new cases per 100,000 population, while a quarter reported an increase of more than 10% in the incidence of cases during the preceding 2 weeks. Furthermore, over a quarter of EU Member States and territories reported both a high incidence of Covid-19 cases and their health systems being under high pressure.¹⁹⁵ This is illustrated in Table 2.3 which gives an overview of some Covid-19 related figures within the EU/EEA during weeks 7 and 8 of 2021.

Table 2.3 Figures on Covid-19 within the EU/EEA, in weeks 7 and 8 of 2021 [Source: European Centre for Disease Prevention and Control (2021)]

2.4 Covid-19 Response in Some Specific European Countries

2.4.1 First Indications of Trouble (March 2020)

2.4.1.1 An Italian Wakeup Call

By the end of February 2020, it was clear that Covid-19 was present on the European continent, with Italy as its first target, leading to scenes of horror that emerged from the Italian city of Bergamo and that surprised the entire Western world which until then had not taken the appearance of Covid-19 in China very seriously. Italy’s painful example showed the rest of the European continent (in the words of German President Frank-Walter Steinmeier) “the depth and dimension of the crisis”. However, Italy also showed the rest of Europe how things could be turned around, at least temporarily. Indeed, in response to the dramatic death toll that initially emerged in the Lombardy region, the Italian government of Prime Minister Giuseppe Conte quickly sprang into action. The Italian government’s efforts eventually enabled Italy to flatten the curve more quickly than expected,¹⁹⁶ while however not completely defeating the Covid-19 virus. (Cf., furthermore, Sect. 2.4.2.3.1.)

Probably the worst thing that emerged from the Italian experience has been that, at a time when Covid-19 had become spectacularly known because of what happened in Italy, due to a combination of events, on the one hand, spreading events such as (1) the returning ski tourists at the end of February-beginning of March 2020 (cf. Sect. 2.4.1.2.) and (2) the Carnival festivities in some European countries around the same and, on the other hand, a total lack of policy response from EU leaders and European governments, Covid-19 still managed to spread across the whole European continent.

When European leaders finally started to wake up to what was happening in Italy, it was simply too late: the Covid-19 virus was everywhere in Europe and it was there to stay for an extremely long time.

2.4.1.2 The Role of Ischgl in the Contamination of the European Continent Revisited

Shortly after Covid-19 began to spread in Europe, Austria was heavily criticised for having failed to properly deal with a major, early outbreak of Covid-19 in the ski resort of Ischgl in February 2020, and for in this manner having contributed to the spread of Covid-19 throughout Europe. (Cf. Sect. 2.2.3.2 already) It was indeed mainly in the pubs and restaurants in Ischgl that, during the Carnival vacation period, many ski tourists from all over Europe contracted Covid-19 and returned home with it. At the same time, local authorities and pub owners in Ischgl would continue to downplay their role in this, although it should have been clear that the Covid-19 virus was present in the ski resort in February 2020, and that no precautions had been taken to avoid contamination. All this made the Ischgl pubs and restaurants outbreak one of the major early spreading events in Europe.¹⁹⁷

According to the findings of an independent expert commission that thoroughly investigated the Covid-19 debacle in the Austrian ski resort of Ischgl in February 2020 and that released its investigation report on 10 October 2020, local Austrian authorities had piled up mistake after mistake after the discovery of a first Covid-19 outbreak in February 2020. According to the report, the Ischgl authorities had failed to keep up with the Covid-19 outbreak, while the central Austrian government allowed tourists to return home far too quickly, which gave Covid-19 the chance to easily spread to many other countries.¹⁹⁸

According to the report, the local authorities made a series of assessment errors with serious consequences, not least because of “great time pressure and workload”. From this report, it has appeared that at the beginning of 2020, thousands of people were infected in Ischgl, a small town that at the time was also known as the “Ibiza of the Alps”. Covid-19 was reported to have been be circulating in the après-ski bars. This made Ischgl, popular for its nightclubs and après-ski parties, the epicentre of the Covid-19 epidemic on the European continent. An estimated 6000 tourists from 45 countries were reported to have been infected there and to, from there, having further spread the Covid-19 virus all over Europe. The report points out that although it was known that there were local Covid-19 infections, no action had been taken and that, at the end of their respective ski holidays, tourists had simply been allowed to return home without any quarantine measures in place. As a result, winter sports enthusiasts simply took the Covid-19 virus back to their home countries across the European continent. The report is not only critical of the failure of the local authorities of Ischgl, but also of the Austrian Chancellor’s office and of the Austrian Ministry of Health. In particular, the report criticises the total lack of communication between the national authorities and the responsible local authorities in the region. The report, furthermore, mentions that the Austrian authorities, although aware of the Covid-19 epidemic, allowed an uncontrolled exodus of ski tourists to their home country. The report thereby states that foreign guests, at the end of their holiday, should simply not have been allowed to leave immediately and without any quarantine measures. The report even considers that the Tyrolean state authorities deliberately concealed the seriousness of the Covid-19 epidemic in the ski resort in order to avoid of having to deal with it.¹⁹⁹

The October 2020 report also mentions that, after the Covid-19 outbreak in Ischgl during February 2020, on 7 March 2020, a bartender at the Kitzloch bar in Ischgl tested positive for the Covid-19 virus. In the said report, he is considered as “patient zero”.²⁰⁰

However, other research contradicts this latter conclusion.

According to Kreidl et al. (whose findings have been cited hereafter), the first documented case of Ischgl was not the abovementioned bartender, but rather a woman who had stayed in Kühtai (Tyrol) from 24 to 26 January 2020, and who had before been infected by a Chinese instructor in Starnberg (Germany), apparently between 20 and 22 January 2020. According to the quoted researchers, this case must hence be considered as a German case, to the extent that said woman was diagnosed in Munich (Germany), on 28 January 2020. On 25 February 2020, two more cases that had been imported from Italy were diagnosed in Innsbruck, but again no secondary cases appeared in Austria itself. Still according to the same researchers, the first three infection cases among Austrian residents were diagnosed on 27 February 2020, in Vienna. Also according to Kreidl et al., on 12 March 2020, the first fatality of Covid-19 in Austria occurred. It concerned a 69-year-old Viennese man who had died in a Vienna hospital after having participated in a cruise in Italy. On 6 March 2020, three further Austrian cases—with contaminations believed to have occurred in Austria itself—were reported in Tyrol, all of these linked to the ski resort of Ischgl.²⁰¹

Of the first 14 Icelandic Covid-19 cases that were infected in Ischgl, 11 had already returned to Iceland by 29 February 2020. From this, Kreidl et al., conclude that the incriminated bartender who tested positive for Covid-19 on 7 March 2020, cannot have been the primary case, nor a super spreader. For Kreidl et al., an undetected transmission of Covid-19 was already occurring in Ischgl before the first laboratory-confirmed cases among the inhabitants of Ischgl.²⁰² Kreidl et al., therefore consider the aforementioned bartender as “a scapegoat” rather than as “a super propagator”, without however minimizing the fact that the noisy and crowded après-ski bars were a perfect scenery for super spreading occurrences. The conclusion reached by these researchers is that a silent and undetected transmission of SARS-CoV-2 was most likely already taking place in Ischgl some time before the first laboratory-confirmed cases were made known. The crowded conditions in the après-ski bars, with several infected staff members showing mild symptoms during what is in normal circumstances the flu season (from which it may be suspected that these people probably thought that they had the flu), most probably resulted into an uncontrolled transmission of the Covid-19 virus. Then, in cable cars, in queues and in other places where ski tourists gather for prolonged periods of time, as well as during the weekly exchange of about 150,000 “day-trippers” in the Tyrol region which usually happens on a Saturday, the Covid-19 virus has probably been further spread on a large scale. Be this as it may, as of 12 May 2020, Tyrol was believed to be the most affected province in Austria, with 3518 confirmed Covid-19 contamination cases, and with 107 Covid-19 related deaths. Still according to Kreidl et al., the district of Landeck, in which Ischgl is located, reported the highest number of cases (n = 991) per district.²⁰³

In any case, at the time when the first Covid-19 cases appeared in Ischgl, 10,000 winter sports tourists were staying in the Alpine village. The aforementioned Kitzloch bar was reportedly often so full that staff members had to use whistles to move through the crowd, while visitors played games where they had to spit ping-pong balls from their mouths into the drinks of other customers. It was only after all the bar staff members had tested positive for Covid-19 that the bar finally closed. In the meantime, unintentional visitors, who had not been informed about the reasons for the closure of the Kitzloch bar, continued to party in other bars in Ischgl.²⁰⁴

Although there were early indications that Ischgl was responsible for contributing to the spread of Covid-19 across Europe, local authorities would long afterwards continue to downplay their role in the events. For example, in early March 2020, Icelandic authorities had warned their Austrian counterparts of the danger of an outbreak because, after their return from Ischgl, some Icelanders had been found to have contracted Covid-19, with two of these Icelanders stating that they might have fallen ill on the return flight. These statements were then used by the Tyrolean authorities in their public relations machine to deny any responsibility from their part. In an official press release, local authorities simply stated that the Icelanders had most likely been contaminated on the return flight and that this implied that Ischgl had no responsibility for the events. From the investigation report made public in October 2020, it moreover appeared that Tyrolean officials were far more concerned about Tyrol’s reputation, than about the spreading events themselves.²⁰⁵ It was only after the number of confirmed cases in Ischgl began to rise dramatically that the Austrian federal government finally announced the complete closure of Paznaudal. This, in turn, led to a chaotic exodus of thousands of tourists and seasonal workers who rather should have stayed in the quarantined valley, which most probably has made things even worse than they already were. This was only 6 days after the Kitzloch bartender had tested positive.²⁰⁶

2.4.1.3 Attempts at Classification

If one thing has become clear in the aftermath of the events in Italy and around the returning ski tourists in late February and early March 2020, it is that, due to a lack of an overall EU policy, each European country would mainly start trying to tackle the Covid-19 virus in its own way.

According to Stiglitz, this was no different elsewhere. Around the world, there have thus been “marked differences” in the way the Covid-19 pandemic has been handled with by public authorities, both in terms of the success, or failure, of countries in protecting the health of both their citizens and their economy, as with regard to the extent of the inequalities in approach.²⁰⁷

Stiglitz identified the following reasons for these differences (quoted directly)²⁰⁸:

• (1) The pre-existing state of health care and health inequalities.

• (2) The preparedness of a country and the resilience of its economy.

• (3) The quality of public response, including reliance on science and on experts.

• (4) The confidence citizens had in their government’s policies.

• (5) How citizens balanced their individual “freedoms” to do what they wanted with their respect for others, recognising that their actions generated externalities.

Among the EU member states, there was, hence, no unanimous or coordinated approach whatsoever, with the EU itself remaining remarkably aloof. As a result, individual European countries all would react in their own when dealing with the spread of Covid-19 on their territory.

The response of a random selection of European countries is examined below, with countries ranked according to their success rate in the first few months after the outbreak of the Covid-19 pandemic (and without prejudice to whether their actions have been as successful, or less successful, afterwards).²⁰⁹

Three groups of countries were thus distinguished, namely:

• (1) European countries that (initially) reacted well.

• (2) European countries that (initially) responded (more) poorly.

• (3) European countries that (from the beginning) have responded (rather) miserably.

It is hereby striking that some countries that reacted poorly to the Covid-19 epidemic at the outset, such as Belgium and France, have subsequently failed to reverse this trend, illustrating once more that the only way to combat a new virus is to resort to an elimination strategy, rather than to a wide set of unrelated measures that allow the virus to persist. Unfortunately, the latter (elimination) approach has not been chosen by any of the European countries, a mistake that would drag the European continent for more than a year into the biggest health crisis it has witnessed in more than a century.

The fact that countries use different counting methods hereby posed a particular problem when comparing the effect of Covid-19 between countries: For example, Sciensano in Belgium counted suspected and confirmed deaths by Covid-19, while Hungary only counted hospital deaths with laboratory confirmation. As a result, the UK Office for National Statistics simply begun to ignore these national labels and just started looking at excess mortality compared to the 2015–2019 average, normalising the figures to a “standard European” population, in order to account for differences in population size and age structure.²¹⁰

2.4.2 Response of European Countries During the First Year of the Covid-19 Pandemic (±March 2020 to ±March 2021)

2.4.2.1 Countries That Have Reacted—More or Less—Decently

2.4.2.1.1 Nordic and Baltic States

The Nordic countries—Norway, Iceland, Finland and Denmark—all came through the first wave of the Covid-19 pandemic in good shape, which raises the question of whether the fact that all four countries were led by women at the time is not a coincidence. Except for Sweden, the rapid imposition of restrictions by the Nordic countries at the beginning of the Covid-19 crisis helped to mitigate the infection rate from the outset. It even allowed the governments of these four countries to keep shops open and relax most controls in the summer of 2020. This has saved lives, while limiting the economic impact.²¹¹

The same applies to the neighbouring Baltic countries, which were also spared in the first wave of the Covid-19 pandemic.²¹²

In both groups of Nordic and Baltic countries, the effectiveness of the public administration in deploying testing and the willingness of the general public to comply with restrictions were reportedly key to the successful reduction of the spread of Covid-19 at an early stage of the pandemic.²¹³

In Norway, after the March 2020 restrictions, the number of infections initially fell sharply. On 7 May 2020, the government announced the reopening of the economy. This reopening of the economy would, moreover, be based on a phased timetable in function of the further spread of the Covid-19 virus. In addition, non-essential travel to and from other Nordic and EEA countries again became permitted, although such travel was made provisional upon quarantine requirements and upon the level of both the number of Covid-19 contamination cases and the measures the other countries resorted to for preventing the further spread of the Covid-19 virus.²¹⁴ However, despite these precautions, by the end of July 2020, new cases started to increase again, indicating that Norway had also abandoned the first wave containment measures too early.

In Iceland, as of 4 March 2021, only 6058 domestic cases of Covid-19 had been confirmed, of which 11 were still active. Only 29 people had died. Surprisingly, the cure rate for the latest wave of infections in Iceland was reported to be over 99%. Iceland’s strategy for containing the disease was a national pandemic plan that bore enormous similarities to the approach of some Asian countries, with an emphasis on mass testing, contact tracing and quarantines. Less than a year after the first cases of Covid-19 appeared, vaccination of the population was rolled out effortlessly, subject to the availability of vaccines. Nevertheless, the Icelandic economy was hit hard: GDP fell by 6.6% in 2020.²¹⁵

In Finland, throughout the Covid-19 pandemic, the number and occurrence of Covid-19 contamination cases remained relatively low (among the lowest in Europe). In order to deal with the Covid-19 crisis, in addition to the measures taken by the EU, the Finnish government had itself resorted to various fiscal, liquidity and regulatory measures which—in combination with the existing automatic stabilisers—would (when fully utilised) provide a stimulus of almost 30% of GDP.²¹⁶ In addition, on 16 March 2020, the Finnish government made use of the so-called Emergency Powers Act. This Act made it possible to close the country’s borders, to restrict domestic travel and to extent service duties on essential personnel. Unemployment in Finland rose to almost 12% in March 2020. As the containment measures soon proved successful, travel limitations to and from the Helsinki region were already abandoned on 14 April 2020. As of 4 May 2020, the Finnish government announced a plan to replace the general containment restrictions by more specific containment measures. This led, on 14 May 2020, to the reopening of primary and lower schools and to the reestablishment of cross-border essential travel. On 1 June 2020, this strategy of releasing containment measures was completed by a reopening of restaurants and some other public facilities, while the limits for public gatherings were raised from 10 to 50 people. On 31 July 2020, public events of more than 500 people were again allowed. On 16 June 2020, the Finnish government also announced that the powers under the Emergency Powers Act would no longer be used, through which the state of emergency of the country was also ended. On 23 June 2020, the Finnish government also ended internal border control and movement restrictions between Finland and other countries with a similar low number of Covid-19 contamination cases of no more than 8 new cases per 100,000 people during the previous 14 days. On 13 August 2020, the government passed resolutions on recommendations for wearing face masks and on working remotely. However, by 18 August 2020, the Finnish government had to reinstate travel bans between Finland and several countries, based on higher Covid-19 contamination rates during the preceding 14 days. This indicated that, like many other EU countries, Finland had failed to escape the effects of the second wave of the pandemic. On 11 September 2020, the Finnish government thus decided to reinstall internal border controls and travel bans, effective as of 19 September 2020. The Finnish government, in addition, issued a resolution on a “hybrid strategy” for cross-border traffic and travel. This strategy called for a fast increase in cross-border testing and analysis capacity, with as aim to have at least 10,000 tests/day.²¹⁷

As soon as it became clear that the second wave of the Covid-19 pandemic was starting to affect Finland, on 24 September 2020, the Finnish government decided to reintroduce tighter travel bans between Finland and several other Schengen countries. As of 8 October 2020, the Finnish government also imposed new restrictions on the opening and licensing hours of restaurants and bars. On 20 November 2020, these restrictions on the activities of catering enterprises had to be continued in five regions, due to the epidemiological conditions in these regions. On 19 November 2020, the Finnish government decided to extend the restrictions on entering Finland until 13 December 2020, due to the acceleration of the Covid-19 outbreak elsewhere. The Finnish government continued to reiterate that Finnish citizens and residents would avoid all non-essential travel to high-risk countries.²¹⁸ On 4 February 2021, the Finnish government submitted a proposal to Parliament to prolong the duration of the temporary provisions of the Communicable Diseases Act concerning restrictions on catering businesses until the end of June 2021.²¹⁹

However, due to the rise of the third wave of the Covid-19 pandemic, as of 1 March 2021, the Finnish government resorted to a new state of emergency and again decided to close restaurants and bars until 28 March 2021.²²⁰

Already on 10 December 2020, the government passed a resolution on the Finnish Covid-19 vaccination strategy: Vaccination in Finland was to be administered on the basis of medical risk assessments, with priority given to health and social care laborers dealing with Covid-19 patients, home-based laborers, the elderly, and people at high risk of serious illness because of underlying medical conditions.²²¹ Finland also participated in the (initially disastrous) joint supply of vaccines to the European Union. The cumulative number of Covid-19 vaccinations per 100,000 people was about 8900 as of 4 March 2021.²²²

As of 5 March 2021, Denmark had reported a total of 212,798 cases. The country had a total of 2370 deaths. Denmark is one of the EU countries that has proceeded rapidly with its vaccination campaign, choosing to leave intervals between the two doses of the vaccine in order to vaccinate as many people as possible. 466,430 people had received the first dose of the Covid-19 vaccine. Denmark was also about to launch “coronapas”, a digital pass for travelling, eating out or visiting cultural venues.²²³

2.4.2.1.2 Greece

The first official case of Covid-19 in Greece was reported on 26 February 2020. The Greek government responded quickly with strict containment measures, including: (1) a national lockdown that submitted all but essential travel and economic activities to restrictions, (2) school closures, (3) restrictions on internal travel, (4) travel limitations for visitors from third high-risk countries; and (5) quarantines for both international visitors and Greek citizens returning from foreign countries.²²⁴

When Covid-19 first reached the European continent, Greece’s economy was still in recovery from the depression it had suffered as a result of the 2007–2008 debt crisis and the austerity measures international organisations, such as the International Monetary Fund and the EU itself, had imposed on Greece. In addition, Greece had one of the oldest populations in Europe, which was believed to make the country more vulnerable to the worst imaginable impacts of the Covid-19 virus. However, under the able leadership of Prime Minister Kyriakos Mitsotakis, the Greek government quickly and effectively convinced the Greek population that they had to take the Covid-19 pandemic seriously. The Greek population, moreover, obeyed, committing themselves to one of the most severe blockades in Europe, which included the closure of schools and churches. The radical measures taken by Greece from March 2020 onwards soon helped to contain the Covid-19 pandemic, at the same time putting a huge strain on the Greek economy. Because of this, already in early May 2020, the Greek government deemed it necessary to ease restrictions, in the hope of saving at least a part of the 2020 tourist season, one of the main sources of revenue for the Greek economy.²²⁵ As a result, already in the second half of the spring of 2020, the Greek government implemented a gradual reopening of the Greek economy which came close to a full normalisation of economic activity (except for major public events) as of 1 July 2020.²²⁶ Thereafter, for most of 2020, the Greek government, by and large, successfully managed to keep Covid-19 under control.²²⁷

Due to an increase in contamination cases during the second wave of the Covid-19 pandemic, the Greek government found itself compelled to announce a new national lockdown as of 7 November 2020, although some key businesses could remain open.²²⁸

As of 5 March 2021, 197,279 cases had been reported in Greece since the start of the Covid-19 pandemic. There had, moreover, been 6597 deaths in the country. 643,218 people had received a first dose of Covid-19 vaccine.²²⁹

2.4.2.1.3 Germany

Germany recorded its first confirmed case of Covid-19 a day later than Greece, namely on 27 January 2020.²³⁰

In response, the German government adopted a series of measures in the hope of containing the spread of the Covid-19 virus. These included (1) border closures, (2) closures of both schools and non-essential businesses, (3) mandatory social distancing, mandatory masking and (4) a ban on public gatherings. After these measures caused a gradual decline in the number of contamination cases and deaths as of the beginning of April 2020, also in Germany the measures wear eased. Because of this, infections would soon be on the rise again, with new daily cases gradually increasing as of the end of July 2020, soon to exceed the previous peak.²³¹ Most probably because of the efficient German health care system, mortality rates in Germany remained low overall compared to other EU countries. One of the probable explanations is that, contrary to EU countries such as Italy, Spain and Portugal, Germany itself had never been subject to EU neoliberal austerity measures, which had allowed the country to maintain a high number of both regular hospital beds and intensive care units (at levels even more than twice those of the abovementioned southern EU countries that themselves had been subject to severe neoliberal austerity measures). (Cf., furthermore, Sect. 5.2.1.2.)

Germany’s main problem in responding to the Covid-19 pandemic has not so much been the quality of its health care system, but rather its disjointed federal governance structure. Germany’s constitutional system, more precisely, gave responsibility for matters such as health and education to the 16 German states. This made it difficult for the federal government led by Chancellor Angela Merkel to impose national policies. Not unlike the situation in Belgium that faced similar problems (cf. Sect. 2.4.2.3.6.), this attributed to the occurrence of a patchwork of rules and regulations to fight the Covid-19 pandemic which were for the German population more often confusing than helpful.²³² Even so, Merkel’s persistently called on the German population to take both face mask wearing and social distancing seriously, which helped Germany to keep Covid-19, more or less, under control, especially so during the first wave of the Covid-19 pandemic.²³³

Angela Merkel’s government also resorted to some more controversial measures which even questioned the foundations of the EU legal system. More precisely, on 4 March 2020, the German government decided to issue an export ban on all kinds of medical protective equipment. The ban was broadly scoped and applied to all kinds of medical protective equipment in a broad sense of the word, such as goggles, gowns, suits, face shields, gloves, and surgical masks. The ban was, moreover, put in place quickly. It has hereby been assumed that Germany had decided to issue this ban out of fear of running out of the most basic medical supplies itself at a time when the Covid-19 pandemic was hitting Germany extremely hard. The ban, furthermore, coincided with other unusual emergency health measures, such as ordering hospitals to postpone non-emergency procedures in order to keep the intensive care capacity of the hospitals, and especially the number of hospital beds, sufficiently free for Covid-19 patients. The export ban, however, soon triggered a severe backlash. For example, local and decentralized authorities started seizing large consignments of face masks and protective gloves that were either in storage or in transit on their territory, even though being destined for other countries that had already paid for them (notably Italy). Several other EU Member States reacted in an outraged manner, some even accusing Germany of undermining the EU’s single market (which, ironically, in times pre-Covid-19, Germany had always upheld the most as one of the most faithful EU Member States).²³⁴

Later that month, Germany challenged another fundamental rule of the EU, when it took the decision of unilaterally closing its western borders. Again, other EU Member States responded critically, deeming the move in contradiction with the Schengen agreement.²³⁵

For a while, it seemed that Germany, traditionally one of the main driving forces behind the EU machinery, had started to undermine some of the most fundamental pillars of the European unity.²³⁶ However, Germany soon came to its senses and started looking for ways to repair the damage it had inflicted because of its earlier misdeeds. First, Germany amended and then completely lifted its export ban. Second, in a symbolic gesture of adherence to the principle of European solidarity, German hospitals decided to take in 229 Covid-19 patients from France, Italy and the Netherlands. Third, on 19 March 2020, Germany sent 7.5 tonnes of emergency aid to Italy, such as ventilators and anaesthesia masks.²³⁷

Notwithstanding these gestures of atonement, especially Germany’s earlier decision to close its western borders, was especially hard to reverse. This was because other EU countries had been particularly stunned by this decision, especially in light of the fact that Merkel had shortly before spoken out against any unilateral action to fight the Covid-19 pandemic. Only a few days before Germany had closed its borders, Merkel had declared that EU countries “should not isolate themselves from each other” and that there was a strong need to adopt a “unified approach that is, as far as possible, coordinated [among ourselves]”.²³⁸

According to Hall et al., already by 20 April 2020, the Covid-19 containment measures were eased, with small businesses being allowed to reopen subject to social distancing requirements. This measure was soon, on 5 May 2020, followed by the reopening of some school classes, as well as cultural and leisure venues. On 6 May 2020, the German government, furthermore, announced a more general relaxation of the Covid-19 containment measures which covered all shops, restaurants and sports facilities, however with the exact timing for the easing of the closure measures still to be determined at state level. This general reopening was, furthermore, subject to an “emergency brake”. The latter implied that if there were to be an occurrence of more than 50 new infections per 100,000 population, over a 7-day period, state governments would be forced to cancel the reopening and to reinstate the containment measures.²³⁹

Still according to Hall et al., external border controls were being phased out from 16 May 2020 on. A quarantine requirement which had applied to all travellers from EU countries, was abandoned in several states as of 18 May 2020. On 26 May 2020, the federal and state governments also agreed to relax restrictions on public gatherings of ten people or two separate households. This relaxation however remained subject to minimum distance rules and to the overall requirement to keep wearing a face mask in public places. Germany, furthermore, lifted its travel warning to EU countries, Schengen states, the United Kingdom and Northern Ireland on 15 June 2020, albeit with some “high risk” destinations still to be placed under a travel warning when Covid-19 infections resumed. On 16 June 2020, the German government, moreover, launched a “Corona Warning App”. This application allowed users to track potential contacts with Covid-19 infected people on a both voluntary and anonymous basis. On 1 July 2020, Germany lifted an entry restriction for travellers from 11 non-EU countries (three of them on a reciprocal basis).²⁴⁰

As was the case for many other EU countries, Germany did not manage to escape the second wave of the Covid-19 pandemic. The International Monetary Fund thus reported that, in view of an increasing number of new infections that Germany was facing by the end of the summer of 2020, the country deemed it necessary to issue new containment measures. With regard to incoming travellers, these included: (1) a Covid-19 testing requirement, and (2) a 14-day quarantine obligation for people returning to Germany from about 130 “high-risk” countries. Said measures came into effect on 8 August 2020. Moreover, Germany decided to, again, forbid mass events until at least the end of 2020. Local governments renewed their commitment to strengthening Covid-19 containment measures where infections would exceed the “emergency brake”. Germany, furthermore, discouraged all non-essential travel to and from high infection areas. As these measures were not enough to contain the second wave of the pandemic, on 14 October 2020, the federal and state governments reached an agreement on a joint strategy for hotspots: Whenever the threshold of 50 (new Covid-19 cases per 100,000 population, measured over a period of 7 days) was to be exceeded, local governments would immediately respond by reinforcing face mask wearing, restricting all public and private gatherings, and instituting a curfew with regard to visits to bars and restaurants.²⁴¹

However, the fight against the second wave of the Covid-19 pandemic required even further measures, which in November 2020 led to a nationwide “lockdown light”: All restaurants, bars, leisure and sports facilities, and human service providers were closed, with schools however remaining open. Private gatherings were, moreover, limited to a maximum of five people from two households. All non-essential travel was strictly discouraged, with hotels no longer being allowed to offer accommodation to tourists. These containment measures were, afterwards, extended until 10 January 2021.²⁴²

Still according to the International Monetary Fund, from 16 December 2020 onwards, this “lockdown-light” had to be further strengthened because of continuing high numbers of Covid-19 infections and deaths. As part of this new strengthening of the containment measures, all non-essential businesses and schools and childcare centres were closed, pointing to a harder lockdown than its predecessor. These new closures were, moreover, to apply until at least 10 January 2021. Some of Germany’s states also decided to institute night curfews. As even this stricter approach was not enough, on 5 January 2021, the containment measures, including the closures, were further tightened and extended until at least the end of January 2021. On 19 January 2021, the federal and state governments, again, decided to extend the lockdown until 14 February 2021. On 30 January 2021, the federal and state governments, moreover, issued a new ban on traveling from countries with a high incidence of new Covid-19 variants. On 10 February 2021, the lockdown measures were, once more, extended until 7 March 2021. However, states were this time allowed to reopen schools and day-care centres. Hairdressers were also given the permission to reopen by 1 March 2021. On 3 March 2021, the containment measures had, again, to be extended until 28 March 2021. This time, it was however also decided upon a phased reopening of society in five steps, conditional upon the regional incidence of infection.²⁴³

As of 2 March 2021, Germany had reported 2,471,942 Covid-19 cases, as well as 71,240 (+359) Covid-19 related deaths. Initially scheduled to run from 2 to 30 November 2020, the closure of bars, restaurants, cultural and sports venues was prolonged until 7 March 2021.²⁴⁴ On 5 April 2021, more than 4100 Covid-19 patients had been treated in intensive care units, with 55% of them on ventilators. During the Covid-19 pandemic, the highest level of patients admitted to intensive care units had been reached in early January 2021.²⁴⁵

By 2 March 2021, 4,541,389 people had received a first dose of a Covid-19 vaccine.²⁴⁶ About a month later, on 5 April 2020, 12% of Germans had received a first dose of the vaccine, and just over 5% of the population were fully vaccinated.²⁴⁷

2.4.2.1.4 Austria

According to Karnitschnig, the events in Ischgl in February and March 2020 (cf. Sect. 2.4.1.2.) had, not surprisingly, been a huge wake-up call for the Austrian government led by Chancellor Sebastian Kurz.²⁴⁸ The Austrian government responded to the dramatic events that had occurred in and around Ischgl by imposing severe containment measures throughout the entire country. These even included sealing off entire cities in an attempt to control the Covid-19 virus. In general, Austria’s approach for fighting Covid-19 was, from then on, based on prevention and infection control implemented in a wide variety of areas of societal life, and aimed at controlling local transmission. By 16 March 2020, the Austrian government resorted to a nationwide lockdown which was to end on 1 May 2020. This lockdown included severe restrictions on leaving one’s home. The Austrian government also resorted to a wide variety of sanitary rules and recommendations regarding (1) face mask wearing, (2) keeping a physical distance of at least 1 m, (3) frequent hand washing, (4) covering coughs and sneezes, and (5) frequent cleaning of high-contact surfaces. There was, moreover, an obligation of staying at home when ill.²⁴⁹

As reported by the International Monetary Fund, Austria initiated a gradual reopening of its economy by 13 April 2020. This reopening first applied to small shops and to construction and garden centres, while other shops and hairdressers were allowed to open by early May 2020. By mid-May 2020, some other societal activities were allowed to open as well, such as religious services, outdoor sports, museums, libraries and archives. The Bundesliga also received permission to restart. From 1 June 2020 on, certain open-air markets and commercial premises were granted an exemption from the general face mask obligation. With low infection rates occurring during the second half of the spring of 2020, containment measures were even further eased, resulting in the reopening of Austria’s borders with Germany, Switzerland, Lichtenstein, the Czech Republic, Slovakia and Hungary as of 5 June 2020. On 16 June 2020, Austria, furthermore, lifted travel restrictions for most European countries. Adhering to EU policies, Austria more precisely lifted its travel ban to 15 other countries, with as notable omissions the United States, Brazil, India and Russia.²⁵⁰

However, the number of new daily cases increased significantly after these reopening measures. As a result, by October 2020, the number of contaminations even surpassed the previous peak of March 2020 and was characterized by an effective reproduction rate of more than 1. This resumption of the Covid-19 infection rate urged the Austrian authorities to reintroduce new containment measures, amongst which the reintroduction of mandatory face mask wearing as of July 2020.²⁵¹

With the second wave of the Covid-19 pandemic persisting, Austrian authorities decided to announce a second (partial) lockdown which would initially apply to the period between 3 November 2020 and 6 December 2020. Already on 17 November 2020, this lockdown had to be reinforced. Still, the second lockdown remained less strict than the first. E.g., during this second lockdown, businesses could remain open, while restaurants, bars, all non-essential shops, hairdressers and schools were closed. In the period from 26 December 2020 to 8 February 2021, a new lockdown had to be implemented. From 25 January 2021 on, Austria resorted to the remarkable measure of making high quality face mask (FFP2) wearing mandatory in certain public places, amongst which airports.²⁵²

By 3 March 2021, Austria had reported a total of 464,374 Covid-19 contamination cases and 8489 Covid-19 related deaths. By the same date, 339,470 people had received the first injection of a Covid-19 vaccine.²⁵³ These figures, considered together, suggest that Austria had fared rather well, particularly with regard to the first wave of the Covid-19 pandemic, and that the country had managed to keep the numbers, especially the number of Covid-19 related deaths, down.²⁵⁴

2.4.2.2 European Countries That (Initially) Responded (Rather) Poorly

2.4.2.2.1 Sweden

Although Sweden is generally one of the leading examples of the welfare state, it failed on properly answering to the challenge of the Covid-19 outbreak.²⁵⁵

A first confirmed case of Covid-19 in Sweden had been reported on 31 January 2020.²⁵⁶

At the start of the Covid-19 outbreak in Sweden, the Swedish government led by Prime Minister Stefan Löfven, made the decision of putting Sweden’s chief epidemiologist, Anders Tegnell, in charge of the government’s response. However, Tegnell was a fan of unorthodox measures for fighting the pandemic. He, e.g., opposed face mask wearing, and, furthermore, advised against the closing of schools, shops, bars and restaurants. In Tegnell’s vision, such closures were the equivalent of “using a hammer to kill a fly”. Tegnell would later declare that he had “absolutely not been” pursuing “herd immunity” among the Swedish population. From emails Tegnell had exchanged with a Finnish colleague and which had been obtained by a Swedish journalist, it however appears that this may have been the case. Whatever Tegnell’s approach, it has resulted into many more infections and deaths in Sweden than in the neighbouring country Norway.²⁵⁷

Still, notwithstanding Sweden’s unorthodox approach for fighting the pandemic, its number of reported contamination cases and deaths during the first wave of the Covid-19 pandemic turned out to be better than expected. However, during the second year of the Covid-19 pandemic, the situation would be remarkably different.²⁵⁸ Indeed, by 3 March 2021, a total of 680,130 Covid-19 contamination cases and 12,882 Covid-19-related deaths had been reported. 539,387 people had received a first dose of a Covid-19 vaccine.²⁵⁹

But, as we shall see below, Sweden was particularly hard hit during the third wave of the Covid-19 pandemic. (Cf. Sect. 2.4.3.1.)

2.4.2.2.2 Czechia

According to Karnitschnig, the first official case of Covid-19 in the Czech Republic has been reported on 1 March 2020.²⁶⁰

Shortly after this first case of Covid-19 had been detected in Czechia, its government resorted to declaring a state of emergency. This state of emergency was accompanied by a nationwide quarantine, a ban on international travel and a series of socio-economic measures for supporting the population, jobs and businesses.²⁶¹ The Czech Republic was also one of the first countries in Europe to resort to the following containment measures: (1) mandatory face mask wearing, and (2) closures of schools and non-essential shops. Unfortunately, Czechia was also among the first countries to relax these containment measures, already leading to the reopening of small shops on 9 April 2020. Unsurprisingly, that is also when Czechia’s real problems began.²⁶²

After having ended the initial containment measures, the Czech government, which at the time was led by populist Prime Minister Andrej Babiš, made the remarkable decision to side-line epidemiologist Roman Prymula. This was a surprising move to the extent that Prymula had been the architect of the country’s initial, successful response to Covid-19. The decision to remove Prymula would soon prove to have disastrous consequences. Deprived of one of its leading epidemiologists, when Covid-19 cases began to rise again by early August 2020, the Czech government ignored all warning signs, seemingly being more concerned that re-installing containment measures would anger the business world, than with containing the pandemic itself. As a result, no new containment measures were taken. This soon led to new contamination cases exceeding the levels witnessed during the spring of 2020. Czech Health Minister Adam Vojtěch then tried to reimpose mandatory face mask rules applying to certain public areas, such as shops. However, Babiš himself opposed such a return to this kind of measures which resulted in even more new Covid-19 contamination cases. Babiš responded to this rise in the number of cases by firing Health Minister Adam Vojtěch on 21 September 2020. Surprisingly, Vojtěch was replaced by none other than Prymula, Czechia’s leading epidemiologist whom the Czechia government had side-lined for months.²⁶³ On that day, there were officially 49,290 confirmed Covid-19 contamination cases and 503 Covid-19 related deaths, with over 500 people being hospitalised.²⁶⁴

When the second wave of the Covid-19 pandemic broke through in October 2020, Czechia (together with Belgium) reported the highest number of new cases in the European Region.²⁶⁵ On 23 October 2020, the Czech Republic even reached a new daily record of 15,258 new infection cases.²⁶⁶

The magazine Time has reported that, according to Jan Pačes, a renowned Czechian virologist working at the Czech Academy of Sciences, cases in Czechia had started to spike shortly after the schools had reopened on 1 September 2020. “The increase in new infections in September was reported mainly in young people, and now it has reached higher ages,” Pačes was quoted explaining to Time. Czechia’s numbers were at the time indeed impressive: During the first 2 weeks after the reopening of the Czechian schools, 144 of the country’s approximately 11,000 schools (with this number including pre-schools and primary and secondary schools, as well as higher learning institutions) all had reported new cases of Covid-19. It was, furthermore, estimated that 30% of Czechia’s new infections had been contracted by people mixing at home with school-going children.²⁶⁷

Time also quoted Olga Loblova, a research associate in sociology working at the University of Cambridge (in Prague). Loblova was quoted declaring that the increase in contamination numbers could be attributed to the Czechian government having rejected the advice of public health experts during the late summer of 2020. As an example, Loblova was cited referring to the abovementioned fact that, in late August 2020, with daily new infections rising, Prime Minister Andrej Babis had overturned a decision made by the then Czech Health Minister Adam Vojtěch to make face mask wearing mandatory again in public places, amongst which schools.²⁶⁸

During a press conference that was held on 21 September 2020 (on which day Czechia counted 1474 new cases), Babis admitted that having ignored the advice of the former Health Minister Vojtěch might have constituted an error in judgment.²⁶⁹

Again according to Pačes—as quoted by Time—Czech Senate elections may have been another relevant factor for the huge Czechian numbers of new cases. The first round of these elections took place on 2–3 October 2020, and a second round on 9–10 October 2020. According to Pačes, these elections may have attributed to the Czechian government’s decision of postponing further containment measures. Indeed, new containment measures were only introduced after the first round of the elections was finished.²⁷⁰

Be this as it may, on 5 October 2020, Czechia re-instated a new 30-day state of emergency, which has since been extended numerous times—when this book was closed for peer review on 15 May 2021, for the (then) last time until 17 May 2021.²⁷¹

As of 12 October 2020, Czechian authorities also issued a series of further containment measures, such as: (1) banning events with more than ten people inside and with more than 20 people outside, and (2) ordering high schools and universities to switch to online learning. In addition, (3) bars and restaurants were closed, and (4) all public gatherings were limited to six people. Furthermore, one more week later, Babis decided to reintroduce a strict face mask mandate similar to the one that had been in place during the spring of 2020. This requirement imposed everyone to wear a mask outside their homes.²⁷²

According to Pačes (as again quoted by Time), these new containment measures should have been introduced much earlier.²⁷³

The International Monetary Fund has reported that the Czechian vaccination campaign against the Covid-19 initially prioritised certain specific groups, such as health professionals and people over the age of 80. By 4 March 2020, approximately 243,000 people, or 2.3% of the Czechian population, were reported to have been vaccinated (with two doses).²⁷⁴

Covid-19 also had severe implications for the Czechian economy, with GDP falling by 5.7% in 2020.²⁷⁵

2.4.2.3 European Countries That (Already from the Start) Responded (Rather) Miserably

2.4.2.3.1 Italy

According to Kerner, in one version of events, a first case of Covid-19 occurred in Italy on 30 January 2020. A Chinese tourist couple traveling from Wuhan via Beijing was reported to have been admitted to the Spallanzani Hospital in Rome, there to be diagnosed with Covid-19.²⁷⁶

On the same day, the Italian Health Minister Roberto Speranza announced an embargo on air traffic for flights coming from any Chinese city, as well as from the autonomous regions of Hong Kong and Macau. With this travel ban, Italy made its first attempt to block the spread of the Covid-19 virus. The Italian government, moreover, immediately organised a special plane to repatriate some 80 Italians who had been staying in Wuhan.²⁷⁷ In the days to follow the abovementioned Chinese couple’s hospitalisation, a few more cases of Covid-19 were detected in the group of Italians who had been repatriated from the Wuhan area. Thinking they had managed to nip the Covid-19 virus spread in the bud, Italian experts initially felt relieved, with their opinion based on the fact that all reported cases had originated from abroad, and that there had been no local contagion case among these.²⁷⁸

On 31 January 2020, the Italian government took the precaution of declaring a state of emergency. The Italian government also allocated $5.5 million to address the Covid-19 crisis. These decisions were not accompanied by strict containment measures. Instead, it would take almost one more month before Italy decided to adopt such further containment measures.²⁷⁹

The immediate declaration of a state of emergency was, in this regard, rather to be seen in the context of a WHO declaration of 30 January 2020. (Cf. Sect. 1.1.1.) On the latter day, the WHO had announced that the Covid-19 virus constituted “a public health emergency of international concern” and had asked all its members to closely monitor the situation in their respective territories. The decision of Italy to declare a state of national emergency was thus to be seen as a response to this invitation from the part of the WHO, and not as much intended to already deploy a true containment strategy.²⁸⁰

At the time, the Italian Health Minister Roberto Speranza explained to the press that the state of emergency status would grant the Italian government more powers to deal with the threat posed by Covid-19, but that it would not affect daily life. Speranza also declared that Italy was resorting to efforts to trace all places the infected Chinese couple had visited since their arrival in Milan on 23 January 2020.²⁸¹ The Minister, furthermore, explained that the 18 other tourists and the driver who had been travelling with the couple in a bus, had also been tested and placed under observation. As a further tracing measure, at the hotel where the couple had been staying before being admitted to the hospital, their room had immediately been closed and subjected to decontamination.²⁸²

Fournier mentions that by 23 February 2020, once it had become clear that the Covid-19 outbreak had resurfaced (with 30 new cases in Lombardy and Veneto), 11 Lombardy cities in which more than one contamination case had been detected, had been placed under lockdown. With the situation in Italy becoming more worrisome by the day, other EU countries resorted to imposing ad hoc travel bans to Italy. E.g., during the night of 23 February 2020, Austrian authorities were reported to have stopped a train driving from Venice to Munich in order to investigate two suspected contamination cases. Moreover, the French police similarly cordoned off a Lyon bus station after a driver of a bus from Milan had demonstrated possible symptoms of Covid-19.²⁸³

On the same day, the Italian government decided to adopt a (presidential) decree-law.²⁸⁴ This decree-laws provided for urgent measures relating to the containment and management of the rising Covid-19 emergency,²⁸⁵ “taking note of the evolution of the epidemiological situation, in particular the widespread nature of the epidemic and the increase in the number of cases and deaths reported to the World Health Organisation” and “considering the extraordinary necessity and urgency of adopting measures to counter the epidemiological emergency of Covid-19”.²⁸⁶

The decree-law of 23 February 2020 provided for a non-exhaustive list of containment measures which were to apply to the entire Italian territory, such as: (1) a ban on entering or leaving a given area, (2) the suspension of public events, (3) the suspension of educational and cultural services, (4) the application of quarantine measures, (5) the suspension of all non-essential commercial and public activities... The decree-law also provided for a criminal sanction based on Article 650 of the Penal Code, consisting of 3 months’ imprisonment and a fine of 206 euros in case of non-compliance with the containment measures.²⁸⁷

According to Fournier, the decree-law was of a “programmatic” nature. This was because it was deemed impossible to foresee the evolution of the Covid-19 threat and, hence, to predict the exact measures which had to be resorted to at any given moment in time. Moreover, the application of the containment measures was deemed to be of a “progressive” nature, with: (1) on 4 March 2020, the closure of schools and universities; (2) on 9 March 2020, the closure of public areas all over the country; (3) on 11 March 2020, the closure of all non-essential businesses; and (4) on 22 March 2020, the suspension of non-essential economic activities.²⁸⁸

According to Hall et al., on 8 March 2020, the Italian government implemented some further, extraordinary containment measures. These included restrictions on travel in the Lombardy region and were issued in order “to minimise the likelihood of uninfected people encountering infected people”.²⁸⁹

At the time, Italy was facing dramatic figures. While because of having been exposed to severe EU austerity measures in the aftermath of the financial crisis of 2008, Italy had but 5200 available beds in intensive care units (ICUs) left, of these, as of 11 March 2020, 1028 had already been assigned to Covid-19 patients, with this number still gradually growing from day to day. It was hereby increasingly feared that the Italian hospitals would reach a point where thousands of beds would be occupied by Covid-19 patients. This implied that the number of Covid-19 infected people in Italy were expected to soon put a strain on the Italian ICU capacity, with, furthermore, many hospitals lacking sufficient resources or staff to deal with such a catastrophic scenario. Especially in the Lombardy region, there was a growing concern among health professionals that the number of Covid-19 patients who appeared at the doors of hospitals’ emergency departments would become much larger than the system would still be able to handle. Health professionals themselves were reported to work day and night, in many cases under dangerous circumstances (especially due to a lack of protective material). By 20 February 2020, about 20% (n = 350) of these health professionals were reported to have been infected with Covid-19 themselves, and some of them had even died.²⁹⁰

Still according to Hall et al., in a time period of less than a month, hospitals in the region had been overwhelmed with contamination cases. Around that time, images of dead bodies being evacuated out of hospitals by military trucks started to be broadcasted around the world.²⁹¹ The dramatic events occurring in the Lombardy region helped trigger changes in responding to Covid-19 all over the world. The Covid-19 pandemic that took place in Italy, in the spring of 2020, has in this regard been compared to “an explosion, with an epicentre whose blast dissipates outwards”.²⁹²

Both Italian health experts and figures in authority would later share their belief that the horror that had unfolded in the Lombardy hospitals in March 2020 had been shaped by a series of small but crucial local decisions with a global impact.²⁹³ E.g., days after Italy’s first citizen had tested positive for Covid-19, the Italian Prime Minister Giuseppe Conte blamed the Codogno hospital for having failed to contain the Covid-19 virus. According to Conte—as quoted by Hall, Chazan et al.—the hospital had, more precisely, neglected to comply with health protocols. In the viewpoint of Conte, this was one of the causes for the spread of Covid-19 on the Italian territory.²⁹⁴

During the second week of March 2020, the number of patients in Lombardy’s hospitals were reported to still increase. Of the 750 or so ICU beds the region had at its disposal, more than 600 were occupied by Covid-19 patients, with doctors fearing that the system was approaching its breaking point. Scientists all over the world who, until then, had only limited data on the Covid-19 disease at their disposal, became increasingly worried by the disease’s high mortality rate—more than 5% of the cases diagnosed in Lombardy at that time—as well as by the large number of Covid-19 patients who had to be admitted to intensive care units. After having processed the information stemming from Lombardy into their models, a group of scientists led by Professor of Epidemiology Neil Ferguson of the Imperial College London, published an alarming report on 16 March 2020. In this report, said researchers made the prediction that ICUs in the United Kingdom would quickly face capacity problems as well, as a further result of which hundreds of thousands of people were likely to die. Regarding the United States, the number of deaths was even expected to amount to 1.2 million people.²⁹⁵

In Italy, the (first) nationwide lockdown ended on 4 May 2020. On that date, businesses were allowed to reopen, however with new, less severe containment measures put in place (such as (1) staggered hours, (2) spaced work stations, (3) temperature controls, (4) obligations regarding face mask wearing...). Retail shops, restaurants, bars and hairdressers were allowed to reopen on 18 May 2020 (although the original reopening date had been set on 1 June 2020). Sports facilities could reopen on 25 May 2020, soon followed by cinemas and theatres on 15 June 2020. Regional authorities were, however, granted the power to adjust the reopening dates in both directions. Regional travel also became possible again, while travel restrictions between regions were lifted on 3 June 2020. Italy’s borders were also reopened again without restrictions for people traveling to and from other EU countries.²⁹⁶

The International Monetary Fund, furthermore, reported that following an increase in the number of contamination cases in early August 2020, the Italian government soon issued new containment measures. These included: (1) closing nightclubs; (2) limiting the capacity of cultural sites; (3) mandatory face masks wearing in public places (both indoors and outdoors); (4) increased fines for those who failed to comply with infection control and quarantine rules; (5) mandatory Covid-19 tests for travellers returning from a number of European countries; and (6) allowing for the use of Covid-19 tests in schools.²⁹⁷

Still according to the International Monetary Fund, a series of additional containment measures had to be put in place as of mid-October 2020, to be extended until mid-February 2021, and then again until early April 2021. The Italian government hereby resorted to more targeted containment measures. E.g., service closures and mobility restrictions in response to the second wave of the Covid-19 pandemic varied in accordance with the risk levels assigned to a given region. Based upon this new, more targeted approach, (only) areas with the highest level of infections had to close schools, bars, restaurants and most non-essential shops. Moreover, travel in such high-risk areas (and between municipalities in these areas) was limited to essential work and health-related reasons. In early 2021, a new interregional travel ban was also introduced for traveling between low-risk areas.²⁹⁸

By early November 2020, the Italian government announced some new, more severe containment measures. These included: (1) a nationwide overnight curfew; (2) early closure hours for bars and restaurants; and (3) new traveling restrictions for people travelling between regions with high infection rates. Moreover, several regions—including Lombardy which had, as explained above, already been the epicentre of the first wave of the Covid-19 pandemic—were again declared “red zones” to be placed under lockdown.²⁹⁹

By 4 March 2021, the number of active contamination cases had risen to approximately 437,000. By the same date, almost 99,000 people had died because of Covid-19.³⁰⁰

On 21 April 2021, the Italian government approved a so-called “reopening decree” which covered the period from 26 April 2021 until 31 July 2021.³⁰¹

Through all of this, the Italian state of emergency has been re-installed and/or extended a couple of times.³⁰²

2.4.2.3.2 France

France is said to be the country in the WHO European Region having experienced the first confirmed cases of Covid-19 on its territory. Three such cases were, more precisely, detected in France on 24 January 2020. All these three cases had a history of travel to Wuhan, at a time when some European leaders were still implying that the likelihood of Covid-19 being imported from China to Europe was remote. The first Covid-19 death case in Europe, on 15 February 2020, moreover, also occurred in France. Less than a month later, by 21 February 2020, a total of nine European countries had reported Covid-19 cases, more precisely: Belgium, Finland, France, Germany, Italy, Russia, Spain, Sweden and the United Kingdom.³⁰³

According to Herszenhorn and Wheaton, France’s initial response to Covid-19 hitting its territories, has been both “unclear” and “disastrous”. According to these authors, at first, it appeared that France did not possess a strategic stockpile of face masks, nor the industrial capacity to produce Covid-19 tests. Then, once the French government had somehow succeeded in assuring that everyone had face masks at their disposal, many French people started objecting government guidelines making it mandatory to wear such masks, as these were deemed to be too coercive. Second, Macron’s government failed at effectively implementing testing and tracking. Third, the French government failed in issuing consistent safety guidelines. Needless to say, all these elements attributed to sullying the overall confidence of the French people in its government. Then, to make things even worse, on 3 March 2020, the French government announced that it would (1) take control itself of the production of personal protective equipment, (2) requisite existing face masks and (3) cap the price of disinfectant gel. These measures had little effect but for triggering a domino effect that would prompt Germany to extend an export ban on such equipment, even prohibiting sales to other EU countries.³⁰⁴

Hall et al., furthermore, reported that when the French President Emmanuel Macron visited a nursing home in Paris, on 6 March 2021, he had an urgent public message to declare, namely pointing to a duty to protect the vulnerable against Covid-19. According to these authors, the French president explained hygiene and warned against physical contact. However, neither visitors, residents nor staff members were at the time wearing face masks, as the practice was not yet official policy. At that time, France had officially recorded only nine Covid-19-related deaths, including the first reported death on the European continent, an 80-year-old Chinese tourist from Hubei province. President Macron seems to have realised that the elderly were far more vulnerable than the young, but he and the health officials and carers who accompanied him during said visit to the Parisian nursing home seemed to have had no clue about the disaster that was already sweeping through France’s nursing homes, besides these located elsewhere across the European continent. Some weeks later, thousands of people throughout Europe would be dead. (Cf. Sect. 6.2.1.2.)³⁰⁵

By mid-March 2020, the French government introduced a first series of containment measures, including: (1) closing schools, (2) banning all non-essential activities, outings and long-distance travel, and (3) introducing a night-time curfew in some cities. These measures would initially lead to a decline in new contamination cases, but shortly after, infections would be on the rise again.³⁰⁶

According to Karnitschnig, as of 11 May 2020, France decided to relax its containment measures, starting with a reopening of primary schools, shops and businesses, on a regionally differentiated basis. By 22 June 2020, France had abandoned most of these “first generation” containment measures (including travel restrictions).³⁰⁷

Some months in the Covid-19 pandemic, the French government did still not seem to have a clue how to handle the crisis. Of particular concern was the fact that France seems to have simply avoided implementing stricter containment measures during the summer of 2020, for fear of a social revolt that could have been worse than the Gilets Jaunes movement that had occurred in the year before the pandemic. This however also implied that no adequate containment measures were in force during the entire 2020 tourist season (when traditionally many foreigners hold their holidays in France). As a result, France would rank among the European countries with the worst initial response to the Covid-19 crisis.³⁰⁸ Moreover, through this omission, France has also been preparing for the second wave of the Covid-19 pandemic.

Indeed, according to Karnitschnig, a resurgence of contamination cases occurred at the end of August 2020. This initially prompted the French government to implement, at first, regional night-time curfews, and then a second lockdown that was to start on 30 October 2020. During this second lockdown, schools were to remain open, but all non-essential shops and services were ordered to close. In addition, France issued both regional and international travel bans.³⁰⁹

According to the International Monetary Fund, France again started to gradually lift its containment measures by the end of November 2020. E.g., retail shops were allowed to reopen. Moreover, as of mid-December 2020, the lockdown was replaced by a curfew during the hours between 8 pm to 6 am. The curfew was then tightened in mid-January 2021, to start earlier at 6 pm, and has remained in force since then across France. Bars, restaurants, sports and cultural facilities were all mandated to close again.³¹⁰ By 15 May 2021, the French curfew was still listed as being in force on the official website of the French government.³¹¹

Hall et al., made the general assessment that the first wave of the Covid-19 pandemic that had hit France during the spring of 2020, had been the worst in the east of the country and in the Paris region. With regard to the Grand Est region (bordering Germany), it has even been assumed that two thirds of the region’s 620 nursing homes for elderly people had been affected by Covid-19 and that 570 residents living in these nursing homes had died. During the second wave of the Covid-19 pandemic, the cities of Paris, Lyon, Marseille and Lille were the ones most affected. During this second wave, however, the nursing homes for the elderly had been better equipped and prepared for dealing with the ongoing pandemic. Of the 1512 active Covid-19 infection clusters which had been identified by the French authorities by mid-October 2020, still 293 were in nursing homes.³¹²

According to the International Monetary Fund, the French economy contracted by 5.9% in Q1 2020, compared to the previous quarter, and by 13.7% in Q2 2020. Activity rebounded strongly in Q3 2020 (= the tourist season), with GDP growth of 18.5%—but shrank again by 1.3% in the last quarter of 2020 (when further containment measures were taken). In total, France’s GDP contracted by 8.3% in 2020.³¹³

Covid-19 vaccinations in France started on 28 December 2020.³¹⁴

As of 5 March 2021, approximately 3,810,125 contamination cases had been reported. On Thursday 4 March 2021, there were, moreover, 293 deaths reported in 24 h. The total number of deaths in nursing homes was on this date said to be 24,973. 62,862 people had moreover died in hospitals, bringing the total of Covid-19 related deaths in France to 87,835. On the bright side, 984,202 people had received a first dose of a Covid-19 vaccine,³¹⁵ but another source mentions that more than three million people had been vaccinated with at least one dose of a Covid-19 vaccine by the same date.³¹⁶

2.4.2.3.3 Spain

Spain also ranks among the European countries hit hardest by both the first and the second waves of the Covid-19 pandemic.

According to a special report that appeared in The Financial Times in October 2020 (and that was written by Hall et al.), in February 2020, Fernando Simón, head of both Spain’s health emergency coordination centre and of Spain’s task force for dealing with Covid-19, could not have been clearer when he declared, on 23 February 2020, that there was no Covid-19 in Spain. In reality, the situation in Spain was already extremely bad at the time. As would become clear afterwards, Simón had simply been wrong to insist that there had been no true Covid-19 contamination cases in Spain. On the contrary, Covid-19 had already been spreading rapidly in Spain, which would soon even appear to be hit much harder than any other EU country. Spain’s main problem was that public health procedures were not adequate to track the extent of the Covid-19 spread in the country.³¹⁷

Still according to Hall et al., on 25 February 2020, an Italian couple on holiday in Tenerife had tested positive. While local authorities acted quickly and ensured that several hundred people staying in the same hotel all got quarantined, it would appear that Covid-19 infections had already been spreading in an undetected manner throughout Spain’s largest cities.³¹⁸

Moreover, even after Italy had imposed strict containment measures for the north of the country (cf. Sect. 2.4.2.3.1.), it would take Spain several more days to consider taking similar measures. On Sunday 8 March 2020, only a few hours after Italy’s dramatic interventions, Spain’s Health Minister Salvador Illa still referred to the Italian lockdown measure as “very drastic”, implying that Spain itself had no need for resorting to a similar approach. Furthermore, on that same day, the Spanish government authorised an International Women’s Day march in Madrid in which 120,000 people were expected to partake. This decision would later be criticised as “a criminal act” that had been carried out in the name of feminism. Still, many epidemiologists believe the march had not been a major vector of infections. According to Hall et al., of far bigger concern was the fact that, around the same period, still nearly three million people kept using Madrid’s metro and commuter trains on a daily basis, while millions of people also kept visiting the city’s many bars and restaurants. It was around the same time that the Spanish Ministry of Health started receiving first reports that Spain was starting to face an increasing surge in Covid-19 infections. E.g., from official data of 8 March 2020, it appeared that the number of official Covid-19 contamination cases had increased by 70% in just 24 h to a total of 999. These official figures would initiate Spain’s first containment measures. As a result, on 9 March 2020, several Spanish regions, amongst which Madrid itself, announced the imminent closure of schools. On 12 March 2020, the Madrid mayor José Luis Martínez-Almeida, even formulated the suggestion that the city might have to go into lockdown.³¹⁹ Still according to Karnitschnig, it would from then on take Prime Minister Pedro Sánchez another two more days to declare a national lockdown. Spain thus finally committed to what had become the standard Covid-19 response pattern of first declaring a “(national) state of emergency” and then applying containment measures which were among the tightest restrictions on the European continent.³²⁰ At that point, the official figures had only revealed the proverbial tip of the iceberg as underneath these official figures, there had been occurring a very high level of transmission of the Covid-19 virus.³²¹

The fact that Spain in mid-March 2020 finally acknowledged that Covid-19 was posing a serious problem on its territory, did not mean the end of Spain’s ordeal. Having been another victim of a severe neoliberal austerity policy to which the EU had subjected the country in the aftermath of the financial crisis of 2008, Spain now had to face another wake-up call, more precisely a confrontation with its completely underfunded and understaffed health care system which soon proved to be no match for the Covid-19 pandemic. As a result, the country got stuck with one of the highest Covid-19 death rates in the world (namely 72 per 100,000).³²²

For Hall et al., the country was virtually running blind. According to these authors, Spain’s response to the Covid-19 pandemic was severely hindered by a highly partisan political climate, as well as by a fragmented health care system that lacked all central coordination. But it was above all Spain’s inability to have spot the early spread of the Covid-19 infections, with all its resulting delays for implementing containment measures, that contributed most to the tragic outcome the country had to undergo: Soon, Spain would count the second highest number of Covid-19 related deaths in the EU, preceded only by Italy.³²³

According to the International Monetary Fund, in response to the first wave of the Covid-19 pandemic, Spain issued a state of emergency that came into effect on 14 March 2020. This state of emergency was initially announced for 15 days only, but it would soon afterwards become extended a couple times, ultimately until 21 June 2020. The state of emergency was, moreover, accompanied by a wide arsenal of containment measures, such as: (1) travel and movement restrictions, with moving only permitted for essential purposes; (2) severe limitations on activities of a commercial, cultural, and recreational nature, as well as on hotels and restaurants; and (3) a reduced availability of public transport. From 30 March until 9 April 2020, these measures were even enhanced further, with all non-essential activities being halted.³²⁴

According to Hall et al., less than a month after Simon’s declaration, more precisely on 23 February 2020, Spain was, almost ironically, recording 10,000 new contamination cases per day. The true level of Covid-19 contamination cases may probably have been several times higher. According to official numbers, probably more than two million people contracted Covid-19 during the first wave of the Covid-19 pandemic. Hall et al., furthermore, reported that during the first week of April 2020, overcrowded hospitals set up beds in all kinds of facilities, such as corridors of the hospital buildings themselves, besides sport buildings, libraries and emergency tents. In Madrid, ranking among the most affected regions of the country, the number of people who required intensive care was about three times above the pre-pandemic capacity. These numbers basically forced hospitals to set up makeshift intensive care and respiratory units wherever possible.³²⁵

According to the International Monetary Fund, Spain also resorted to temporary travel restrictions that were imposed from 15 to 24 May 2020 at entry points to ports and airports, even to other Schengen countries. Only people of Spanish nationality and residents, besides cross-border laborers and health and elderly care professionals were still allowed to freely enter the country. From 15 May 2020 until 21 June 2020, Spain implemented a 14-day quarantine requirement for all people arriving from abroad. These containment measures would eventually result into a significant drop in contamination cases during the remains of the first half of 2020. However, this was soon afterwards followed by a partial rebound in the number of contamination cases during the second half of 2020.³²⁶ Indeed, after an initial steady decrease in the number of contamination cases and Covid-19 related deaths in the period from April 2020 until mid-July 2020, new daily infections would start to increase again in the late summer of 2020, reaching a peak in mid-November 2020.³²⁷

Hall et al., reached the conclusion that, like many other European countries, one of the main problems that Spain had to endure during the first wave of the Covid-19 pandemic, concerned its limited testing capability. Because of this, Spain had been incapable of detecting at an early stage if the Covid-19 virus was spread over the country’s territory. When it would later become clear that the Covid-19 virus had, most probably, been present in Spain during the whole month of February 2020, it was simply too late. In fact, a later post-mortem examination even revealed that a Covid-19 patient had already died on 13 February 2020, days before the Spanish government still declared in public that Spain had been spared of the Covid-19 virus so far. According to the quoted authors, the holes in the official data and the completely flawed testing capability had resulted into a fatal complacency. While critics reached the conclusion that both national and regional authorities had been too slow to impose controls, these errors would be again repeated during the summer of 2020, when containment measures were relaxed too soon thus allowing for the second wave of the pandemic to take hold.³²⁸

The International Monetary Fund reported that the first state of emergency was lifted on 21 June 2020. This allowed for unrestricted traveling in all provinces of the country and for the reopening of the borders with other countries. Moreover, as of September 2020, Spain allowed for the reopening of its school based upon physical teaching activities at all levels, albeit at the same time resorting to a series of containment measures, such as compulsory face mask wearing for every one of the age of 6 years and older. According to the International Monetary Fund, the following further containment measures were also kept in place: (1) social distancing requirements, (2) limitations on the capacity of people allowed indoors, and (3) sanitary measures on the workplace. The latter measures included mandatory face mask wearing in confined spaces as well as on the streets in cases where a safety distance of at least 1.5 m was unable to maintain.³²⁹

By the time Spain’s first state of emergency expired on 21 June 2020, Sánchez’s government had notwithstanding all of the foregoing, somehow, managed to smooth out the curves. However, the latter effect did not last. Already by mid-July 2020, at the height of the Spanish tourist season, the number of Covid-19 contamination cases in Spain was on the rise again.³³⁰ Moreover, 6 months in the Covid-19 pandemic, Spain had still not managed to implement an effective regime of tracking and tracing the spread of the Covid-19 virus on its territory, a flaw that would keep on frustrating all efforts to contain the spread of the Covid-19 virus.³³¹

As reported again by the International Monetary Fund, a national closure of nightclubs and bars had to be reintroduced on 14 August 2020, while restrictions on sports gatherings were reinstated as of 28 October 2020. On 30 September 2020, a coordinated action plan was agreed upon between the Spanish government and the local communities. This included triggers for regional containment measures which could be implemented as of October 2020. The Spanish government also declared a new state of emergency on 25 October 2020, initially for 15 days, but afterwards prolonged until 9 May 2021.³³²

2.4.2.3.4 The Netherlands

With regard to the situation in the Netherlands, the International Monetary Fund has reported that, by means of an early response to the first wave of Covid-19 infections which had occurred in late February 2020, the Dutch authorities had adopted a series of containment measures. Following a gradual relaxation of these measures as of 11 May 2020 and a resurgence in the number of Covid-19 contamination cases during the late summer of 2020, The Netherlands issued new containment measures on 6 August 2020, 18 August 2020, 25 September 2020, 2 October 2020, 14 October 2020 and 4 November 2020.³³³

Indeed, a second, even worse wave of the Covid-19 pandemic had begun to occur during the late summer of 2020, leading the Dutch authorities to implement its most severe containment measures since the start of the Covid-19 pandemic. This new set of containment measures involved: (1), the closure of all non-vital businesses, schools (some cases excepted) and day care centres, besides many public spaces, such as parks and zoos; (2) a recommendation to work from home, unless this would not be possible; (3) a recommendation to avoid public transport; (4) a requirement to restrict gatherings to one guest belonging to another household (with this number increased to three during the Christmas holidays), (5) a requirement to maintain social distance, and (6) a discouragement of travel abroad. These measures were first only in force from 15 December 2020 until 9 February 2021 but were later extended until 15 March 2021. Furthermore, between 23 January 2021 and 15 March 2021, a curfew from 9 pm to 4.30 am applied. Moreover, a negative PCR test was made compulsory for people travelling to the Netherlands from certain high-risk foreign territories.³³⁴

The International Monetary Fund also mentions that the Dutch vaccination plan started on 6 January 2021, initially targeting health professionals, the elderly and people with pre-existing health problems, in succession. As of 3 March 2021, the containment measures were relaxed very gradually. Secondary schools were to be allowed to reopen (after primary schools had reopened earlier). This was also permitted to certain professions requiring close physical contact, such as hairdressers, albeit subject to severe conditions.³³⁵

2.4.2.3.5 The United Kingdom

2.4.2.3.5.1 Failed Attempts of Coping with the Covid-19 Pandemic

The first confirmed case of Covid-19 in the United Kingdom has been reported to have occurred on 31 January 2020.³³⁶

According to Karnitschnig, most of the European countries hardest hit by the Covid-19 pandemic mainly suffered because they had basically been caught off guard. According to the same author, the United Kingdom, by contrast, slipped into Covid-19 oblivion with its eyes wide open.³³⁷

In an opinion piece of 17 March 2021, Dr. Chaand Nagpaul, at the time the Chairman of the British Medical Association, assessed the UK government’s response to the Covid-19 outbreak during the initial phase of the pandemic. From this, it appeared that when Covid-19 arrived in the United Kingdom, the country was both defenceless and unprepared. E.g., the NHS had already been facing record waiting times for medical procedures such as operations, cancer treatment and GP appointments, for a long while. After decades of neoliberal austerity, successive cuts to psychiatric and social care, as well as severe staffing shortages, had left health services exposed and unable to function properly in normal times, let alone during a pandemic.³³⁸ As a result, the UK health care sector has been basically unable to cope with as good as all “normal” medical treatments during the first wave of the pandemic: E.g., there have been around 2.5 million fewer first outpatient appointments, and around 280,000 fewer urgent cancer referrals between April 2020 and June 2020 compared to the same period in 2019. Less than half of the planned number of operations could be performed, creating a backlog in other types of care and a record waiting list of 4.6 million people, with over 220,000 patients being put on waiting lists for more than a year already for all types of non-Covid-19 treatments by March 2021.³³⁹

On a general policy level, according to Saad-Filho, the haphazard administration led by the “ever-unreliable” Boris Johnson soon found itself faced with two evils: First, increasing estimates of the Covid-19 related death toll, and second, increasingly gloomy estimates of the country’s probable GDP decline.³⁴⁰

Pressed early on by the Conservative Party, amongst which some of the strongest supporters of Brexit, the UK government had in its early response to Covid-19 purportedly appealed to its medical experts in order to justify protecting (business) profits and the idea of a small state that was not to interfere with the proceeds of a disease in the name of science. This basically implied that the conservative Johnson government at first wanted to pursue herd immunity, which would most likely have killed hundreds of thousands of people. However, soon running out of serious arguments to justify such an approach and, moreover, being faced with an increasingly angry public, the UK government was forced to make a dramatic U-turn by mid-March 2020, but by then it was too late. Because of its earlier decision to delay action, compounded by both a lack of preparation and by an overwhelming ineptitude, the United Kingdom would inevitably find itself in the worst of both worlds: countless deaths (literally countless, since there had been a deliberate effort to under-report casualties) and economic losses running into the hundreds of billions of British pounds.³⁴¹

According to Karnitschnig, even in early March 2020, at a time when the Covid-19 pandemic held northern Italy in its deadly grip, not unlike the US President Donald Trump, the British Prime Minister Boris Johnson had seemed oblivious to the danger caused by the Covid-19 threat. At the time, Johnson even boasted at a press conference that he had visited a hospital treating Covid-19 patients and that he had “shook hands with everyone”.³⁴²

According to the International Monetary Fund, the first nation-wide lockdown in the United Kingdom started on 23 March 2020 (already to be relaxed in early-May 2020).³⁴³ This first lockdown was characterized by a range of measures, such as: (1) travel restrictions, (2) social distancing measures, (3) closures of entertainment facilities, (4) closures of bars and restaurants; (5) closures of non-essential shops and indoor premises, and (6) increased testing protocols.³⁴⁴

Early April 2020, the UK Prime Minister Boris Johnson had to spend some time in intensive care after having tested positive for Covid-19.³⁴⁵ According to some, he barely survived.³⁴⁶

When looking at contamination cases in general, one must remark that contamination cases had peaked for a first time in April/May 2020. After a period of decline, a second, and then a third wave of the Covid-19 pandemic set in, with the number of Covid-19 cases significantly higher than during the first peak.³⁴⁷ However, these findings did not prevent the UK government from continuously striving to relax its Covid-19 containment measures. E.g., after the first wave of the pandemic, on 18 May 2020, individuals were again given more freedom to meet outdoors, and a gradual reopening of schools began on 1 June 2020.³⁴⁸

By June 2020, England was on top of the statistics with the highest “age-standardised relative mortality rate” (of 7%) among 21 European countries. For England, the impact on mortality was wider, longer and more even across the entire country, so that, when looking at regions, of the 20 areas in Europe with the highest peak of mortality, only four were to be found in England (more precisely Brent, Enfield, Ealing and Thurrock). At that time, on the level of comparing countries, Scotland came third (at 5%), ranking just behind Spain (at 6%).³⁴⁹

Already at an early stage of the Covid-19 pandemic, criticism started mounting over the UK’s lack of preparedness and adequate response to the Covid-19 pandemic.³⁵⁰ According to Nagpaul, UK policymakers have throughout the pandemic especially been slow and indecisive in their policy decisions. E.g., the BMA only called for precautionary face masks to be worn in April 2020, when face mask wearing was already the norm in most other European countries. Yet, in the words of Nagpaul, the UK government “dithered” for more than 2 months before requiring face masks to be worn. At first, these were, moreover, only required for people traveling on public transport, although they were ultimately applied more widely by July 2020.³⁵¹ Among the many further public policy issues, Nagpaul says that one of the longest-standing problems that has also been detrimental in the fight against the Covid-19 pandemic, has been the utter failure to address structural inequalities. Indeed, throughout the first wave of the Covid-19 pandemic, around a third of the patients ending up in intensive care beds have been identified as black, Asian or minority ethnic (= “BAME”). By May 2020, it was even reported that six out of ten healthcare workers who had died from Covid-19 had been from BAME backgrounds. According to this same source of information, ethnic minority populations were up to four times more likely to have died from Covid-19, while people living in the most deprived areas of England and Wales were around twice as likely to have died from Covid-19.³⁵² (Cf., furthermore, Sect. 10.3.2.2.)

Karnitschnig has, furthermore, pointed out that the UK government’s total lack of preparedness allowed the Covid-19 virus to hit the country extremely hard. England was even reported to having experienced the worst mortality rate of any European country between January 2020 and June 2020. According to this author, the main failings of the UK government included: (1) a huge number of deaths in nursing homes, and (2) the failure to rapidly build up significant testing capacity.³⁵³ Throughout the Covid-19 pandemic, Johnson’s government also continued to struggle with articulating a long-term strategy, and/or clear messages to the general public (a failure that some would argue could be attributed to being torn between scientific advice and the neoliberal political viewpoint that individual freedoms always should take priority over containment measures, a problem that, as we shall explore later (cf. Sect. 2.5.2.), also hugely impacted the fight against Covid-19 in the United States).³⁵⁴

Most of these findings and criticism were, subsequently, confirmed, to a large extent, by a National Audit Office (NAO) report of 13 May 2021.³⁵⁵ This NAO report has, more precisely, been particularly critical of the fact that the UK government did not seem to have any specification whatsoever for many aspects of its response. E.g., the pre-existing pandemic contingency plan was criticised for not including detailed plans for³⁵⁶:

• (1) Identifying and supporting a broad population of counsellors.

  According to the NAO report, testing plans and policies for identifying and protecting clinically extremely vulnerable people (CEVs) were not the aim of Exercise “Cygnus”, an exercise that had been conducted in 2016 in order to assess the UK’s preparedness for an influenza pandemic.

• (2) Employment support schemes.

  According to the NAO report, the HM Treasury and HM Revenue & Customs (HMRC) said that they had drawn on: (i) an economic contingency plan designed for financial rescues and developed in the wake of the credit crisis of 2008, (ii) draft policy work on wage subsidy schemes, and (iii) lessons learned from other countries, such as Germany.

• (3) Financial support to local authorities, such as compensation mechanisms for authorities in case of revenue shortfalls.

  According to the NAO report, the Ministry of Housing, Communities and Local Government (MHCLG) said it had tested its response to an economic shock as part of its contingency planning. However, the economic impact of the Covid-19 pandemic largely exceeded the economic shock assumed for this stress test.

• (4) Managing a massive disruption to schooling, on the scale of that caused by Covid-19.

  According to the NAO report, the Ministry of Education’s emergency response function was designed to deal with disruptions due to localised events such as flooding, but not at all for disruptions due to the magnitude of a global pandemic.

While recognising that no manual could have covered all the specific circumstances of every potential crisis, the NAO felt that more detailed planning for the main impacts of a pandemic and other high-impact, low-probability events would have improved the government’s ability to respond to this type of emergencies.³⁵⁷

The NAO report was also critical of the fact that the UK government’s communications had not always been clear and timely. The report, e.g., made reference to the following³⁵⁸:

• (1) The PPE guidance (published jointly by the DHSC, Public Health England and NHS England & NHS Improvement) had been amended 30 times up to 31 July 2020, including significant and relatively minor changes.³⁵⁹

• (2) The Ministry of Education has calculated that between 16 March and 1 May 2020, it had published 148 new guidance documents and updates to existing documents.³⁶⁰

By contrast, the NAO report praised the fact that, as soon as the scale of the Covid-19 outbreak in the United Kingdom had become apparent, the UK government had managed to make several rapid and large-scale spending decisions and to implement some measures at a rapid pace. E.g., the NAO report referred to food box deliveries for people with CEV which had been put in place within days of their announcement. Similarly, within weeks after having reached the relevant decisions, (1) the purchase of personal protective equipment (PPE) and fans was put in place, (2) employment assistance and business loan programmes were operational, and (3) the rough sleeper accommodation and school meal voucher campaigns had been both designed and implemented. According to the report, the UK government has also been remarkably fast in announcing unrestricted funding (for an amount of £3.2 billion between March 2020 and April 2020) to help local authorities cope with the financial pressures caused by the Covid-19 pandemic.³⁶¹

As has been, furthermore, reported by the International Monetary Fund, as early as 10 May 2020, the UK government set out an initial roadmap for easing the lockdown measures in England (with Scotland, Wales and Northern Ireland having separate rules). Specifically, the reopening was announced to take place in three stages. In a first stage, the reopening was supposed to start on 13 May 2020. During a second phase, the reopening was to continue until July 2020, with in the third stage, an eventual reopening of schools by September 2020. However, due to significant increases in contamination cases that appeared after the summer of 2020, the UK government had to ease down on its reopening plans, thereby initially opting for localised restrictions based on a three-tiered intensity system, but eventually choosing for a second country-wide lockdown which got implemented on 5 November 2020 (with similar restrictions in Scotland, Wales and Northern Ireland). During the latter lockdown period, some entities, such as educational institutions and construction and manufacturing businesses were allowed to remain open.³⁶²

Following the relaxation of the national lockdown as of May 2020, more localised responses came into force. In England, such local restrictions were introduced in Leicester from 29 June 2020, and in other cities, including Manchester, parts of Yorkshire, and later Newcastle, from 30 July 2020. From October 2020 on, these stand-alone restrictions (introduced as regulations under the Public Health (Control of Disease) Act 1984) were replaced by three levels of more restrictive measures across England (at Level 3).³⁶³

All by all, the response of the Johnson government to the Covid-19 pandemic has been rather messy. Research has shown that England has experienced higher Covid-19 mortality and more excess deaths during the first half of 2020 than other European countries for which comparable data are available. This is not just a factor related to the age structure of the UK population, or to high unemployment rates in certain sectors, or to just the management of the Covid-19 pandemic itself, although these have all been indicated as major factors. According to this research, the main cause for the disastrous response of the UK government to Covid-19 is related to the UK’s less favourable health conditions prior to Covid-19: England’s poor position relative to excess mortality in other countries, therefore, came not unexpected, given that, after having endured years of neoliberal public health policy, the improvement in life expectancy in the United Kingdom between 2011 and 2018 had been the lowest among OECD countries, with the exception of Iceland and the United States.³⁶⁴ As a result, by the end of August 2020, the United Kingdom had the highest mortality rate for an English-speaking OECD nation, with 621.3 deaths per one million population.³⁶⁵

On 19 December 2020, with the United Kingdom suffering under a severe second wave of the Covid-19 pandemic, the UK government decided to introduce a fourth tier (stay at home) approach, which closed non-essential shops, besides some other venues (including sports venues), and which, moreover, restricted almost all contact between households. In December 2020, the UK government again reverted to a national policy approach.³⁶⁶

According to the Public Administration and Constitutional Affairs Committee, on 4 January 2021, amidst increasing contamination numbers and confronted with a rapid spread of a new (the—at the time—so-called “British”) strain of the Covid-19 virus, Prime Minister Boris Johnson decided to impose a third Covid-19 lockdown across England (effective on 5 January 2021). This time it concerned a level four lockdown, based on closing schools, restaurants, bars and non-essential shops and on ordering the public to stay at home. Northern Ireland, Scotland and Wales also went into lockdown.³⁶⁷

Leach, Clarke and Kirk have made the general observation that, when looking at the United Kingdom during the Covid-19 pandemic, cases in the United Kingdom first peaked in early April 2020, before falling in late spring and during the summer of 2020. Numbers began to rise again in the fall of 2020, then fell back briefly in November 2020, before reaching a new peak in January 2021. Since then, probably due to the progress of the successful vaccination campaign in the United Kingdom (cf. Sect. 9.4.4.), cases fell sharply, although this fall stabilised in March 2021. However, it is taken into consideration that the number of tests available has also influenced the number of official cases recorded.³⁶⁸

Be this as it may, on average, 2021 saw a steady decline in the number of Covid-19 related deaths in the United Kingdom, while the rate of Covid-19-related deaths in Italy and France was ten times higher than in the United Kingdom. This was most likely due to the success of the UK vaccination campaign, with vaccines racing against the Covid-19 virus and its variants.³⁶⁹

Similarly, the number of people hospitalised due to Covid-19 had also risen sharply by the end of March 2020, reaching a peak in April 2020, to then go down again. The number of hospitalisations started to increase again in September 2020, and reached a new peak in January 2021, although, in line with the evolution of the number of contamination cases, it decreased thereafter.³⁷⁰

2.4.2.3.5.2 Economic Impact During 2020

2.4.2.3.5.2.1 Overall Economic Consequences

As the International Monetary Fund has observed, the biggest blow to the UK economy came in Q2 2020, when GDP fell by 19.8% compared to Q1 2020, reflecting a sharp contraction that had started in April 2020. GDP grew again by 15.5% in Q3 2020, while still remaining 10% below its pre-Covid-19 level.³⁷¹

Overall, during 2020, the UK economy contracted by 10%. However, this has not solely been attributed to Covid-19 itself. According to International Monetary Fund estimates, in 2020, the friction of implementing the post-Brexit trade regime also weighed heavily on economic activity in the United Kingdom (which is believed to be at least a short-term effect of Brexit). In addition, after social distancing had somehow subsided in the summer of 2020, a period of “corporate balance sheet repair” was expected to depress investment, while labour reallocation was expected to again proceed gradually. The International Monetary Fund, moreover, made a projection that (1) the pre-crisis level of economic output would be restored by the end of 2022, but also that (2) by 2025, the economic output would remain about 4% below the pre-2020 trend.³⁷²

Butler has made some more specific assessments of certain economic activities in the United Kingdom during 2020. According to this author, in 2020, online sales in the United Kingdom surged during the Covid-19 shutdown, while the forced closure of high street shops hurt the UK retail sector as a whole. According to further economic reports quoted by Butler, after having experienced the largest decline ever during the first wave of the Covid-19 pandemic, the total volume of retail sales then gradually returned to near pre-pandemic levels. Butler also observed a remarkable shift in consumer spending which may have contributed to somehow containing the economic shock caused by the pandemic. With pubs and restaurants closed and people spending less on services during the first lockdown, supermarket sales by contrast jumped, as did spending on DIY-articles (= “do-it-yourself articles”) and gardening material. The latter has been attributed to the fact that more people spent more time at home. By contrast, clothing sales fell, with many city centre shops being pushed to the brink of collapse as their doors had to remain closed during prolonged periods of time.³⁷³ According to Butler, more than 11,000 retail outlets permanently disappeared from the high streets in 2020.³⁷⁴

According to Partington, in 2020, in addition to having experienced one of the highest Covid-19 mortality rates in the world, the United Kingdom was also confronted with an economy which was performing the worst among the G7 group of most wealthy nations. According to this author, this was to be attributed to the fact that the UK government had initiated containment measures, amongst which lockdown measures, at a much later stage in the pandemic than many other countries, as a further result of which, moreover due to the persistence of Covid-19 contamination cases caused by poor policy decisions, the United Kingdom also had to wait longer to ease down on its restrictions. The specific structure of the British economy, with a huge reliance on so-called “social consumption”—such as face-to-face spending in restaurants, bars and shops—has, amongst other factors, also been referred to as one of the causes having contributed to this greater decline.³⁷⁵

Also according to Partington, the number of journeys undertaken on Britain’s roads, as well as the number of rides on public transport, also plummeted during each period of severe containment measures. According to this author, this at the same time reflected the weaker degree of economic activity during these periods, characterized by fewer people leaving their homes for work or leisure. Partington, furthermore, mentions that, during these periods of severe containment measures, especially during the first wave of the Covid-19 pandemic, the UK roads have been the quietest since the 1950s. On the bright side, this was believed to help reducing pollution levels. By contrast, cycling was reported to have boomed during these periods, probably because more people stayed at home, allowing them to use their bikes more than when commuting to go to work. International air passenger arrivals also collapsed, down 91% in January 2021 compared to the same month in the preceding year.³⁷⁶

Partington made a further observation that a decreasing demand for goods and services during the Covid-19 pandemic drove down the rate of inflation, with the consumer price index (CPI) even coming close to zero. This was, moreover, attributed to lower energy costs and to the fact that many businesses resorted to cutting prices in the hope of attracting reluctant buyers.³⁷⁷

Again according to Partington, Covid-19, furthermore, has resulted in the fastest rate of redundancies ever recorded, even far exceeding the damage caused by the financial crisis of 2008. Among the people hit hardest were: (1) young workers, (2) people in precarious employment, and (3) people working in the hardest hit sectors, such as hospitality. The unemployment rate was hereby reported to have risen to 5%, (implying that, at its peak moment, 1.7 million people were unemployed), coming from 4% before the Covid-19 crisis. However, the unemployment rate slightly fell in January 2021, which was at the same time the first drop since the start of the Covid-19 pandemic. Still according to Partington, in July 2020, the Office for Budget Responsibility nevertheless forecasted a further peak unemployment rate of 12% (the equivalent of about four million people).³⁷⁸

Partington made the further observation that, in 2020, the UK government pumped more than £400 billion into the UK economy by means of emergency response to the Covid-19 pandemic. This happened while tax revenues at the same time collapsed because of the decline in economic activity. It was, hence, not surprising that, due to these combined elements, the UK government’s budget deficit for 2020 was expected to reach “a peacetime high” of £355 billion, or 17% of GDP for the financial year ending March 2021. By that time, the UK national debt exceeded £2.1 trillion, or almost 100% of GDP, the highest level reported for the United Kingdom since the 1960s. However, the cost of servicing the UK’s debt also plummeted to historically low levels,³⁷⁹ which was probably due to low interest rates.³⁸⁰

As furthermore observed by Partington, several official figures have confirmed that, in 2020, the UK economy has been exposed to its biggest annual decline in 300 years. However, said author also made the remark that, by the end of 2020, a double-dip recession has nevertheless been avoided. Throughout 2020, the UK GDP has been reported to have fallen by 9.9%, which was indicated as the biggest drop since the “Great Freeze” of 1709. However, as the nation gradually adapted to the Covid-19 containment measures, further falls in economic activity were to a large extent prevented during the second and third lockdown periods. Moreover, thanks to a remarkable rapid progress in vaccine delivery (cf. Sect. 9.4.4.), the UK economy was expected to return to its pre-pandemic size earlier than expected in 2021–2022, albeit with lasting scars likely to persist.³⁸¹

Partington made the further remark that, unlike previous recessions during which property prices generally followed a decline in economic activity, the Covid-19 crisis itself has by contrast been accompanied by a rise in property prices. This has been, in part, attributed to the fact that the UK government’s “stamp duty exemption” fuelled market growth, while at the same time making people revalue where they lived during the shutdown and making some decide to move—in search of more (garden) space, or in search of a home further away from urban centres. According to the same author, the housing market was probably also supported by wealthier households who have been able to save money during the Covid-19 crisis while working from home. There was, by contrast, at the same time a vast number of low-income workers who did no longer manage to pay for their rent. Still, Partington also noted that real estate experts warned that property prices could again drop after the end of the tax break and because of rising/structural unemployment.³⁸²

Partington finally also noted that the UK government’s lay-off scheme—which had been committed to pay 80% of a worker’s salary, up to £2500 a month—has been deployed to protect more than 11 million jobs in the United Kingdom since it had been launched in March 2020, at a total cost of more than £57 billion by March 2021. Moreover, almost nine million jobs had turned redundant by May 2020 (i.e., at the height of the first wave of the Covid-19 pandemic). The use of the lay-off scheme then started decreasing steadily through the summer of 2020, to remain above two million thereafter. The number of layoffs was reported to again be rising sharply during the second wave of the Covid-19 pandemic, to reach a lower peak of almost five million as employers started adapting to the containment measures. According to the latest UK official figures, as again quoted by Partington, around 4.7 million people were still on unemployment leave by the end of February 2021. The highest take-up rates occurred in London, among both women and younger workers, and especially in the accommodation and catering sector.³⁸³

2.4.2.3.5.2.2 Estimates About the UK Government Spending

By the end of March 2021, the estimated financial cost of the support measures resorted to by the UK Government in its response to Covid-19 was £372 billion. The largest programmes, in terms of estimated lifetime cost were: (1) the Coronavirus Job Retention Scheme (£62 billion), (2) NHS Test and Trace (£38 billion) and (3) income support for the self-employed (£27 billion).³⁸⁴

The largest spending departments were: (1) HM Revenue and Customs (£111 billion), (2) the Department of Health and Social Care (£92 billion), (3) the Department for Business, Energy and Industrial Strategy (£59 billion), (4) HM Treasury (£46 billion), (5) the Department for Work and Pensions (£21 billion), (6) the Department for Transport (£18 billion), and (7) the Department for Housing, Communities and Local Government (£11 billion). Other core departments together were reported to account for £12 billion.³⁸⁵

Figure 2.3³⁸⁶ provides a breakdown of the estimated lifetime costs of the UK government’s response to the Covid-19 pandemic, by programme, with respect to the situation at the end of March 2021.³⁸⁷

Fig. 2.3

Breakdown of the estimated lifetime costs of the government’s response to the Covid-19 pandemic by programme, March 2021

2.4.2.3.5.3 The UK Roadmap Out of Lockdown

Already by the end of 2020, the United Kingdom had started its (successful) vaccination campaign (cf. Sect. 9.4.4.). Based on the success of this vaccination campaign, on 2 February 2021, the UK Prime Minister Boris Johnson announced a “roadmap” for exiting the (subsequent) UK lockdown situations.³⁸⁸

The roadmap was made conditional on four key indicators³⁸⁹:

• (1) The vaccine roll-out program continuing to be successful.

• (2) Evidence that vaccines would be sufficiently effective in reducing hospitalizations and deaths among those vaccinated.

• (3) Infection rates not likely to lead to a further increase in hospital admissions that would put unsustainable pressure on the NHS.

• (4) The risks not fundamentally changing because of “new variants of concern” of the Covid-19 virus.

According to information provided by the Committee on Public Administration and Constitutional Affairs, it was announced that the at the time still prevailing full emergency lockdown which was originally scheduled to end on 15 February 2021, would be lifted in phases. In a first phase, there would be a reopening of schools and outdoor public spaces, which was to take place on 8 March 2021. In a second phase, a reopening of shops, hairdressing salons, gyms and open-air hotels was announced to happen on 12 April 2021 (in England). In a third phase, the reopening of non-core facilities (e.g., outdoor leisure facilities and indoor facilities, such as gyms and swimming pools) was announced for 17 May 2021. In a fourth phase, which was about to start on 17 May 2021, most of the still prevailing social distance rules would be lifted, with indoor hotels and hospitality facilities allowed to reopen. By 21 June 2021, all legal social contact restrictions would have been completely removed, and the reopening of all sectors of the economy would be an established fact.³⁹⁰

However, around mid-May 2021, the fourth condition would start to cause reasons for concern. While the 17 May 2021 date approached, by 12 May 2021 to be precise, UK scientists began to worry that a dramatic increase in the number of UK cases of the Indian variant of the Covid-19 virus (cf. Sect. 1.1.2.) would jeopardise the country’s roadmap for reopening. Already shortly before, on 7 May 2021, Public Health England had designated the “B.1.617.2.” variant as a “variant of concern”. Through this, PHE seemed to have acknowledged that the variant was at least as transmissible as the UK variant, while it was at that moment still unclear whether and to what extent the B.1.617.2. variant could also reduce vaccine effectiveness. Professor Christina Pagel, director of the clinical operational research unit at University College London and a member of the independent Sage panel, was quoted saying that the growth of the number of B.1.617.2 cases might be(come) worrying enough to delay the next stage of the roadmap due by Monday 17 May 2021. At that time, 1393 cases of the B.1.617.2. variant had been identified in the United Kingdom, which made it the second most common variant in the country. In addition, it was also reported that approximately 6.1% of Covid-19 genomes in England sequenced in the 4 weeks prior to 24 April 2021, might have been attributed to the B.1.617.2. variant. While the absolute numbers of the B.1.617.2. variant were believed still not to be very high, they nevertheless had been doubling every week, all within a brief period of but 3 weeks.³⁹¹

2.4.2.3.6 Belgium

2.4.2.3.6.1 Introduction

Among European countries, there is probably no country that has gone through such an arduous process of dealing with Covid-19 as the Kingdom of Belgium.

Foulon noted that, to start with, Belgium had consciously ignored all early warning signs at the beginning of the Covid-19 outbreak. E.g., at the end of January 2020, the Belgian government deliberately ignored the fact that the WHO had declared Covid-19 an international medical emergency, and that China had already made it very clear how fast the disease was spreading on (and beyond) its territory.³⁹²

Moreover, on 31 January 2020, Joseph Wu published an article in “The Lancet”, in which he explained in detail about what was happening in Wuhan, while at the same time warning the world that Covid-19 was on the way of becoming a pandemic and explicitly urging countries around the world with reported Covid-19 cases on their territory to immediately start taking containment measures³⁹³:

On the present trajectory, 2019-nCoV could be about to become a global epidemic in the absence of mitigation. Nevertheless, it might still be possible to secure containment of the spread of infection such that initial imported seeding cases or even early local transmission does not lead to a large epidemic in locations outside Wuhan. To possibly succeed, substantial, even draconian measures that limit population mobility should be seriously and immediately considered in affected areas, as should strategies to drastically reduce within-population contact rates through cancellation of mass gatherings, school closures, and instituting work-from-home arrangements, for example.

This urgent appeal went completely unnoticed in Belgium, although it was known that the first cases of Covid-19 were already present on the European continent, more specifically in France, one of Belgium’s neighbouring countries.³⁹⁴

More decisive action was also called for from within the country itself but even so completely ignored, albeit this happened much later (more precisely after Italy had already been facing a disastrous Covid-19 scenario). When some more time later, namely on 8 March 2020, virologist Marc Wathelet wrote an open letter to the Belgian Prime Minister in which he stated that the response to a pandemic could be summed up in one word, “Urgent”, and that every hour lost meant more infected people,³⁹⁵ the Belgian Health Minister De Block simply responded—in a way that might even have inspired US President Trump—with the shortest of tweets, in which she called Wathelet a “drama queen”. (Cf. Sect. 2.4.2.3.6.3.)

In other words, the Belgian political system completely failed. According to Foulon, the Belgian political leadership hereby very consistently ignored all medical expertise, in this way rapidly dragging Belgium into an avalanche of Covid-19 contagion cases and deaths. For Foulon, the Belgian system had several opportunities to take immediate action but preferred to let things take their course (= thus resorting to a so-called “laissez-passer” approach; cf. Sect. 2.2.4.). Asian countries that reacted quickly, such as Taiwan, Vietnam and Singapore, and immediately resorted to an elimination strategy (based on testing, contact tracing and quarantine measures), did not experience any excess mortality. If Belgium had also acted so quickly in such a manner, its mortality rate from Covid-19 would probably have been much lower: instead, Belgium would soon lead Europe in both the number of infection cases and Covid-19 related deaths.³⁹⁶

2.4.2.3.6.2 February 2020: “Laissez-Faire, Laissez-Passer” (or “No Need To Be Drama Queens”)

On 2 February 2020, quarantine measures were resorted to with regard to nine Belgians who had just been repatriated from Wuhan. One of them, the 55-year-old West Belgian Philip Soubry, tested positive for Covid-19 but showed no symptoms. The first official case in Belgium of a person infected with Covid-19 was thus confirmed. This was on 4 February 2020.³⁹⁷

A few days later, a new indication of the extreme weakness of Belgium’s pandemic preparedness made newspaper headlines. Specifically, on 6 February 2020, it was officially established that the Belgian emergency stock of FFP2 masks had been destroyed shortly before, allegedly because their expiry date had passed and/or because Belgium was lacking storage space. Two renowned Belgian virologists, Erika Vlieghe and Marc Van Ranst, among others, immediately requested a new strategic stockpile. A day later, the WHO itself explicitly warned against of a shortage of medical supplies.³⁹⁸ Belgium being Belgium, it took a few more months before new FFP2 masks could be purchased (with producers on the world markets no longer being able to meet the growing demand, but with Belgium itself making a complete mess out of its procurement strategy). And this was how specialists Erika Vlieghe and Marc Van Ranst made one of their first appearances in front of the Belgian public; in the following year, both would appear almost daily in the Belgian media.³⁹⁹

As of 20 February 2020, more and more Belgian scientists expressed their concern about the shortage of protective equipment. On 22 February 2020, Van Ranst also warned for the first time about a pandemic. The Federal Minister of Public Health, Maggie De Block, reacted by asking the virologist not to create unnecessary panic.⁴⁰⁰

In the meantime, there was a growing concern about the return of tourists from their skiing holidays, which had been a favourite pastime of the Belgian elite and middle classes during early spring vacation periods for years already. Despite this concern, on 24 February 2020, microbiology professor Herman Goossens stated that he considered the risk of Covid-19 infection in ski resorts to be “infinitesimal”.⁴⁰¹ As a result, the Belgian authorities did not bother to develop a quarantine procedure for returning ski tourists, a mistake that would soon prove detrimental. The return from the Austrian ski resort of Ischgl, amongst others, turned out to be one of the main spreading events, resulting in the first wave of the Covid-19 pandemic in Belgium (alongside a number of other European countries) which, moreover, quickly put Belgium in the leading position in terms of both the number of Covid-19 cases and the number of deaths during the first wave of the Covid-19 pandemic.⁴⁰²

On 26 February 2020, a tender for the purchase of face masks was again launched. Shortly afterwards, it became apparent that even a task as simple as the purchase of face masks was turning into a classic Belgian farce scenario of mismanagement and accumulated errors, for which politicians, in the best of Belgian traditions, would be very inventive in producing a wide variety of excuses.⁴⁰³

On 28 February 2020, Belgian experts called for the activation of the epidemic crisis centre. With the Belgian financial markets crashing, Health Minister Maggie De Block tried to reassure the population. Even one more week later, with Covid-19 spreading through the country, Minister De Block called virologist Marc Wathelet who had (rightly) warned that Belgium was not responding to the rising Covid-19 pandemic, a “drama queen”.⁴⁰⁴

Shortly afterwards, there was officially a new case of infection with Covid-19: a woman who had just returned from a business trip to France.⁴⁰⁵ Steven Van Gucht, virologist at Sciensano, later explained that the particularity of this case had been that the woman had no direct connection with China or Italy. According to Van Gucht, this was an indication that the new coronavirus was spreading in Europe. Van Gucht, furthermore, explained that before this case, the Covid-19 virus had in Belgium mainly been considered as “a traveller’s disease”, and not as a pandemic virus. According to Van Gucht, it became increasingly clear that the Covid-19 virus had most likely already spread secretly throughout Belgium (and Europe).⁴⁰⁶

From this, it appears that some Belgian experts may not have paid much attention to what had at the time already been published in medical journals for more than a month (such as the above-mentioned publication by Joseph Wu, which had been published in “The Lancet” already on 31 January 2020, and in which the authors of the study had explicitly warned against the outbreak of a pandemic).

2.4.2.3.6.3 March 2020: Containment Measures

In March 2020, the Belgian government finally started to act, albeit far too late, especially given Marc Wathelet’s warning that every hour lost would lead to more contagion cases and deaths. In the best of traditions of Belgian governments, not just a few hours, but more than a month had been wasted.

On 6 March 2020, the FPS Foreign Affairs issued a negative travel advice for school trips to Italy, following a cancellation decision by the Italian government.⁴⁰⁷

On 10 March 2020, the first National Security Council was held, resulting in a series of recommendations based on the principle of “social distancing”. The following concrete recommendations were issued:

• Wherever possible, working from home was recommended.

• It was suggested that schools would cancel school parties and multi-day school trips.

• There was a recommendation to cancel events with more than a thousand people.

On 12 March 2020, the Belgian federal government decided that from midnight on 13 March 2020, until 3 April 2020, the following measures would be in force:

Cafés, restaurants and nightclubs were closed.

• Takeaways could remain open.

• Hotels could remain open, but their indoor restaurants and breakfast rooms had to be closed.

• All shops providing essential services, such as food shops (including supermarkets), pet food shops and pharmacies would remain open as usual, including at weekends. Other shops could remain open during the week but were told to close during the weekend.

• Markets could take place, subject to certain adapted guidelines, on weekdays. During the weekend, only food stalls were allowed.

• In nursery, primary and secondary schools, classes were suspended from 16 March 2020 to 3 April 2020.

• Crèches remained open.

• All major “events” were cancelled. This implied that sports and cultural events were no longer allowed, and that amusement parks and museums would be closed.

On 13 March 2020, the Flemish Government took a series of additional measures concerning the closure of service centres, residential care centres, crèches and day-care centres, driver training institutions, vehicle inspection institutions, bus tickets selling places, and schools.⁴⁰⁸

On 17 March 2020, a national “lockdown light” was decided, to become effective on 18 March 2020, at noon. All non-essential shops were hereby closed until at least 5 April 2020. By contrast, supermarkets, food shops, drugstores and pharmacies were allowed to stay open. People were still allowed to go out to walk, jog or cycle. Working from home became the norm. All non-essential travel was prohibited, as well as non-essential travel abroad.⁴⁰⁹

A more comprehensive set of Belgian government decisions was published on 18 March 2020, soon to be replaced by a new set of measures on 23 March 2020. From that date onwards, the Belgian and local (Flemish, Brussels and Walloon) governments regularly modified their Covid-19 containment measures, often causing great confusion among the Belgian population.⁴¹⁰

2.4.2.3.6.4 April 2020: Reopening of the Economy

In the period to follow, containment measures were continuously modified, until by the end of April 2020 and the beginning of May 2020, the Belgian governments (federal and regional) decided to gradually relax the Covid-19 containment measures. On 24 April 2020, a first such decision was taken to relax the Covid-19 measures, while the general rules on hygiene and social distance were kept in force.⁴¹¹

It had hereby been clear from the outset that part of the Belgian population was not inclined to the Covid-19 containment measures and had had difficulties with their follow-up. Moreover, while the number of Covid-19 infections and deaths decreased somewhat from end-April 2020 onwards, the pressure from retailers and the business community to “reopen the economy” became stronger and stronger. Belgian governments started to give in to this pressure as of the end of April 2020. It would later turn out that the easing of containment measures had come too soon, although the onset of the summer period (characterized by long school holidays and the possibility of outdoor social activities) postponed the effects of the easing of measures until the fall of 2020, when Belgium found itself confronted with a severe “second wave” of the Covid-19 pandemic (to a much worse extent than most other countries).⁴¹²

2.4.2.3.6.5 In-Between Assessment of Belgium’s Handling of the First Wave of the Covid-19 Pandemic

Karnitschnig’s analysis of Belgium’s (initial) response to the Covid-19 virus threat leaves little to the imagination⁴¹³:

If the EU mandarins needed a reminder in recent months of how bad the crisis could get in Europe, they only had to look out their own window.

Theories abound as to why Belgium, especially in the first months after the outbreak of Covid-19 on its territory, was unable to adequately manage the Covid-19 health crisis, whether because of the country’s status as a diplomatic and transport hub, or because of its densely populated urban population.⁴¹⁴

However, one of the most likely explanations for Belgium’s total inability to deal with the Covid-19 pandemic in an appropriate manner, is Belgium’s total political dysfunction. According to Karnitschnig, “Belgium barely functions at the best of times, due to its fragmented provincial structure and regional rivalries”.⁴¹⁵ Unfortunately for the country, the Covid-19 pandemic, moreover, struck during one of the country’s frequent political interregnums, specifically at a time when Belgium was ruled by an “ad interim” government with limited powers. As a result, the enormous task of combatting the Covid-19 pandemic was left in the hands of interim Prime Minister Sophie Wilmès, who lacked all experience of running a government, let alone of running a country facing its biggest (health) crisis in over half a century.⁴¹⁶

When Covid-19 struck Belgium by early March 2020, the Belgian interim government’s overall communication with the general public proved disastrous. The non-traditional methodology used by Belgium to count Covid-19 deaths further confused the situation (while the number of deaths in the first months of the Covid-19 crisis was particularly high among residents of nursing homes for the elderly). As a result, it is even now still difficult to compare Belgium with other countries based on its government’s own data collection method.⁴¹⁷

But what is clear is that the situation in Belgium has been extremely bad. Already in March 2020, Covid-19 wreaked havoc in Belgium.⁴¹⁸ Both death and infection rates reached an all-time high, especially in nursing homes.⁴¹⁹ At the end of August 2020, Belgium had the highest mortality rate among OECD Member States, with 860.9 deaths per million inhabitants.⁴²⁰

2.4.2.3.6.6 May 2020: Towards the Second Wave of the Covid-19 Pandemic

According to the International Monetary Fund, in early May 2020, Belgium established a reopening plan conditional on health outcomes. This resulted in the reopening of the country in four phases, with economic sectors and activities of socio-economic life being treated differently according to their degree of contact intensity. However, following a resurgence of cases as of mid-July 2020 onwards, the fifth phase of the reopening plan was eventually put on hold, with some containment measures again being tightened. Because of this, and despite a partial relaxation at the end of August 2020, social distancing rules in Belgium had to remain in place for most of 2020.⁴²¹

2.4.2.3.6.7 October to November 2020: Belgium’s Second Wave

While Belgium had already been hit very hard during the “first wave” of the Covid-19 pandemic, in October 2020, when the “second wave” of the Covid-19 pandemic started affecting more and more EU countries, Belgium once again soon ranked among the most affected countries on the European continent.⁴²² One of the main reasons for this seems to have been that the Covid-19 pandemic containment measures had been relaxed too early and too much in the summer of 2020, so that by the end of September 2020, the country was struggling to adapt to the danger of colder weather and was eventually caught blindsided by a catastrophic second wave.⁴²³

In early October 2020, the new Belgian government of Prime Minister Alexander De Croo promised better coordination in the fight against Covid-19.⁴²⁴ In the face of a sharp increase in cases and hospitalisations in early October 2020, extensive activity and mobility restrictions were imposed from 19 October 2020.⁴²⁵

These measures included⁴²⁶:

• (1) Close contact (so-called “cuddling”) was limited to a maximum of 1 person.

• (2) Private meetings were limited to the same four people every fortnight.

• (3) Gatherings in public spaces were limited to a maximum of four people.

• (4) Working from home became the rule, for those jobs that allowed it (and provided that the continuity of companies’ operations, activities and services could be ensured).

• (5) Markets and small fairs were allowed to remain open, but the consumption of food and drinks on such markets became prohibited. Flea markets and small Christmas markets got prohibited.

• (6) Bars and restaurants were closed. They were to remain closed for a period of 4 weeks, with this measure to be evaluated after 2 weeks. Meals could be collected until 10 p.m. Receptions and banquets provided by a professional caterer were prohibited, except in hotels for guests staying there and with regard to gatherings after funerals (attended by maximum 40 people).

• (7) Night shops had to close at 10 pm. The sale of alcohol was prohibited from 8 p.m. onwards.

• (8) A ban on entering the public space between midnight and 5 a.m. was issued, except for essential travel that could not be delayed, such as for urgent medical reasons, business travel and commuting.

• (9) For indoor activities, the existing protocols would continue to apply until a further assessment (announced for 23 October 2020). The sale of food and drinks during such gatherings was prohibited.

• (10) With regard to competitive sports, the number of spectators was halved from 400 to 200 (professionals) or limited to members of the same household (amateurs). Canteens and drinking establishments were closed.

When the second wave of the Covid-19 pandemic broke out across the European continent in October 2020, Belgium (together with the Czech Republic) reported the highest number of new cases in the European Region.⁴²⁷ On 24 October 2020, Belgium set its new record with 17,709 new daily contamination cases. Belgium even became the epicentre of the second wave in the EU, with the highest case rate per capita on the continent (besides Andorra). Belgium at the time also recorded the third highest number of Covid-19-related deaths per capita in the world, after Peru and San Marino.⁴²⁸

The “intermediate” measures of 19 October 2020 were soon deemed insufficient.⁴²⁹ With the new Minister of Health, Frank Vandenbroucke, warning of a virus “tsunami”, Belgium then decided to impose some of the strictest containment measures in Europe, which started on 2 November 2020 and were largely to continue until early 2021. As a result, Belgium closed most non-essential shops, as well as all restaurants, bars and hairdressers. Belgium, furthermore, imposed a night-time curfew and allowed only one close contact from outside one’s household. The latter restriction even applied on Christmas Eve, one of Belgium’s most important holidays, which was in stark contrast to the much looser socialisation rules that applied in Belgium’s neighbouring countries. Nevertheless, the new lockdown was less strict than the one in spring 2020, with e.g., non-essential shops allowed to reopen as of 1 December 2020.⁴³⁰

In response to a stagnation in the decline of infection rates and the emergence of new, more contagious strains of the virus, the rules and controls on travel and teleworking were gradually tightened (based on decisions of the Advisory Committee of 30 December 2020 and 22 January 2021), with containment measures several times being extended throughout the winter of 2020–2021. Some contact-intensive businesses were allowed to reopen in stages on 8 February 2021, 13 February 2021 and 1 March 2021. Further relaxation was considered premature during meetings of the Advisory Committee of 26 February and 3 March 2021.⁴³¹

Over-mortality during the fall and winter of 2020–2021, saw one or more areas in Poland, Belgium, Bulgaria and Switzerland reach record levels of 160.0% or more.⁴³²

One potential factor for explaining the extreme second wave in Belgium may have been its relatively high population density. “You have to look at Belgium as a big city,” said Marc Van Ranst, one of Belgium’s leading virologists. “That’s why in Brussels, where the population density is particularly high, the problem is acute.” For Pierre Van Damme, one of Belgium’s leading epidemiologists, the reopening of universities at the end of September 2020 has also been a major driver of transmission in the country. As students usually went home at weekends, they then exposed the infection to their parents, favouring transmissions in the 40–60+ age group, who were the people who then entered the hospitals during the second wave of the pandemic.⁴³³

However, considering the mortality rates of Belgium and the Czech Republic due to the first and second waves combined, it is not surprising that, according to the Johns Hopkins University Data Repository, these countries had the second and first highest Covid-19 mortality rates per million inhabitants, respectively, as of 24 March 2021.⁴³⁴ This is illustrated by Fig. 2.4 which gives an overview of the Covid-19 mortality rate in some countries per million population, as of 24 March 2021.

Fig. 2.4

Covid-19 mortality rate per million population, as of 24 March 2021 [Source: Ravi (2021)]

2.4.2.3.6.8 Early 2021

Belgium effectively banned non-essential travel from 27 January 2021 to 1 March 2021, which de facto forced Belgians to spend their traditional February “Carnival” week off at home.⁴³⁵

The latter measure was most likely motivated by the assumption that, in February 2020,⁴³⁶ Carnival festivities might have been a key factor in the spread of Covid-19 during the initial phase of the Covid-19 epidemic in Belgium. This was highly likely because in February 2020, holidaymakers returning from Italy and Austria were believed to have brought the Covid-19 virus back with them. As neither Italy and Austria, nor Belgium, had quarantine measures in place at the time, these infected holidaymakers were then able to participate freely in the Carnival 2020 festivities, thus spreading the Covid-19 virus further. It should hereby be noted that carnival festivities in Belgium involve a lot of loitering and drinking in (often cramped) pubs, similar to foreign ski resorts, such as Ischgl (Austria). This clearly indicates that visits to pubs, both in Belgium and abroad, were among the first spreading events that triggered the first wave of Covid-19 in Belgium. This has, since then, been confirmed by the (already cited) research published in “Nature” on 11 November 2020, which shows that most (new) cases of Covid-19 were found in places like cafés, bars, restaurants, gyms and grocery shops.⁴³⁷

At the time of the mingling of the returned ski tourists with other Carnival feast attendants during the late winter of 2021, the question had not yet been scientifically researched, but it had been convincingly voiced by, amongst others, Joris Van Duin, a Dutch journalist who reported on the spread of Covid-19 in the Netherlands in early March 2020.⁴³⁸ According to Van Duin, there were indications that the Carnival festivities of 2020 (in the Netherlands) had accelerated the spread of Covid-19 in the areas of Tilburg, Loon op Zand, Breda, Prinsenbeek and Uden. E.g., an employee of the Amphia hospital in Breda was quoted having stated that the carnival festivities had been “hotbeds” for the spread of Covid-19 in Brabant.⁴³⁹

By October 2020, this suspicion about the impact of the return of ski tourists (in February 2020) on the Covid-19 figures was confirmed by researchers from the Leiden University Medical Centre (LUMC). The LUMC researchers also found that Carnival had already been responsible for an increase in the number of flu cases in 2018. The LUMC researchers published their findings in the scientific journal “BMC Public Health”. Their research showed that the number of Covid-19 cases after Carnival 2020 was much higher in regions where Carnival had been celebrated, than in municipalities that did not celebrate.⁴⁴⁰

The Belgian October 2020 travel ban has been continuously extended since then, albeit with variations, and was still being maintained at the date this book was prepared to be sent to peer review (i.e., on 15 May 2021).

As reported by the international Monetary Fund, the Belgian economy contracted by 3.4 and 11.8% (q/q) in the first two quarters of 2020, followed by a rebound to 11.6% in Q3 2020, and a further contraction of 0.1% during Q4 2020; bringing the contraction for the entire year 2020 to 6.3%.⁴⁴¹

As of 5 March 2021, there had been a total of 780,157 Covid-19 contamination cases and of 22,169 Covid-19 related deaths.⁴⁴²

The vaccination campaign in Belgium was officially launched on 5 January 2021, prioritising the inoculation of residents of nursing homes and healthcare workers, with the aim of immunising nine million (adult) Belgians by September 2021—but supply constraints already from the start of the vaccination campaign led to constant delays.⁴⁴³ As of 5 March 2021, only 524,775 people had received a first dose of a Covid-19 vaccine.⁴⁴⁴

The dramatic situation Europe was at the time facing is illustrated by Fig. 2.5,⁴⁴⁵ which gives an overview of the cumulative relative age-standardised, all-cause mortality rates by sex in selected European countries, during the period between the week ending 3 January 2020 to week ending 12 June 2020.

Fig. 2.5

Cumulative relative age-standardised, all-cause mortality rates by sex in selected European countries, week ending 3 January 2020 to week ending 12 June 2020

2.4.2.4 By Comparison (1): The Successful Examples of Taiwan, New Zealand and South Korea

2.4.2.4.1 Taiwan

There is much to be learned from comparing the policies of an Asian country that has been extremely successful in its fight against Covid-19 (especially during its first wave), notably Taiwan, with a Western, neoliberal country that has largely failed (especially until the start of its vaccination campaign), notably the United Kingdom.⁴⁴⁶ This is exactly what a number of authors have undertaken. It concerns the authors: (1) Graham-Harrison and Davidson,⁴⁴⁷ (2) Summers et al.,⁴⁴⁸ (3) Nachman,⁴⁴⁹ and (4) Farrer.⁴⁵⁰ This section has largely been based on their findings, from which there has also been directly and indirectly quoted, as indicated in the footnotes.

The contrast between how Taiwan and the United Kingdom managed to handle (the first wave of) the Covid-19 pandemic, could hardly have been greater: While Taiwan emerged virtually unscathed from (the first wave of) the Covid-19 pandemic, the United Kingdom has—as explained above (cf. Sect. 2.4.2.3.5.)—been crippled both economically and humanely, with deaths, illnesses and mental health crises taking an extremely huge toll.⁴⁵¹

As elaborated upon by Graham-Harrison and Davidson, the two countries show remarkable similarities: both countries are islands ruled by democratic governments, with their large populations—over 22 million people live in Taiwan and over 68 million in the United Kingdom—to a large extent crowded into cities, and both countries have (traditional) public health systems that imply that (general) medical care is widely available. According to the same authors, by the end of 2019, both countries were at high risk because of Covid-19 travellers: the United Kingdom because of its status as an international travel hub; Taiwan because its close cultural and economic ties implied that hundreds of planes crossed the narrow strait to mainland China—where the Covid-19 virus had first been detected—every week. But this is where the similarities ended. Just over a year after the initial outbreak of Covid-19, by mid-March 2021, the United Kingdom had one of the worst Covid-19 mortality and contamination rates in the world, with over 130,000 Covid-19 related deaths, and more than four million people having contracted the Covid-19 virus. By contrast, Taiwan had lost only 10 people to the Covid-19 virus, and had only 1000 official contamination cases, the vast majority of whom were travellers from elsewhere put in quarantine.⁴⁵²

The first confirmed case of Covid-19 in Taiwan was reported on 21 January 2020. It concerned a woman, over the age of 50, who had been travelling back to Taiwan from attending her teaching position in Wuhan. By August 2020, Taiwan had reported Covid-19 contamination cases in 20 of its 22 administrative divisions, with the more geographically isolated eastern counties of Taitung and Hualien having reported no cases. Taiwan also reported an even gender distribution of confirmed contamination cases up to 31 August 2020, with 51.2% recorded as male.⁴⁵³

According to Nachman, two key backgrounds have set the stage for Taiwan’s successful handling of Covid-19. The first and perhaps most fundamental key to the success of Taiwan’s response to Covid-19 has been that the country had several strong health institutions. Because of these, Taiwan not only had the capacity to manage a large-scale viral outbreak on—or better: threatening to approach—its territory, but it also had the in-house experience to do so. The 2003 “SARS” outbreak, although this had occurred 17–18 years earlier, was hereby still fresh in the minds of many Taiwanese, especially the officials and experts running Taiwan’s public health sector. Taiwan had, more precisely, experienced 73 deaths during the SARS outbreak of 2003, which had been the third highest number of deaths in the world, after Canada and China. At the end of 2003, Taiwan’s health system had not only passed the SARS resistance test, but, more importantly, it had also learned how to better protect itself against a viral outbreak in the future. Precisely this experience has been of huge importance in dealing with the Covid-19 outbreak itself. The second key factor that ultimately proved vital for Taiwan’s successful response to Covid-19, has—rather surprisingly—been its historic exclusion from the WHO. Indeed, while because of its special international status (of not being fully recognized by China, besides other countries, as an independent state), Taiwan had only been granted limited observer status in the WHO, as in the past, under Kuomintang (KMT) administrations, China had summarily prevented the country from actively participating to the WHO after the Democratic Progressive Party (DPP) came to power. This had already been the case in 2003, during the SARS epidemic and under the presidency of Chen Shui-bian, and it was (and remained) so under the Tsai administration. Taiwan’s exclusion from the WHO, obviously, prevented local health officials from coordinating and exchanging information at an intergovernmental level, which added to the isolated status of Taiwan. But—according to Nachman—the positive aspect of Taiwan’s exclusion has been a perpetual need to rely entirely on itself; as a result, Taiwan did not need, or have the means, to wait for the WHO, or other countries, to act or to ask for advice. Based entirely on its own expertise and insights, Taiwan instead began preparing for a pandemic as soon as it had heard of a new pneumonia disease in Wuhan. Its unfortunate autonomy in this manner allowed Taiwan to respond much timelier, and in a far more efficient manner, than any other country in the world.⁴⁵⁴

According to Graham-Harrison and Davidson⁴⁵⁵, the difference in the handling of the Covid-19 crisis between Taiwan and the United Kingdom (and, by extension, a variety of other Western countries) may also, in more practical terms, be explained by the approach resorted to by their respective governments. Taiwan’s political leaders, aided perhaps by the presence of an epidemiologist in the vice-presidency, or by the experience the country had because of the “SARS” coronavirus outbreak of 2003, immediately recognised the terrible threat posed by Covid-19 as soon as the first data from China came in. They decided that the only way to protect their country, its people and its economy, was to keep the virus completely out. This implied, from the early start, that the country would resort to a severe elimination strategy. By contrast, the United Kingdom, led by a convinced neoliberal government whose natural reflex it is to always minimise such a situation (cf. Sect. 2.2.4, with regard to the “laissez-faire, laissez-passer” paradigm), instead made the catastrophic decision to deal with the threat as with a common flu outbreak, aiming to limit or control its spread, rather than to completely eradicate it.⁴⁵⁶ Such a flu response plan—which was the method resorted to by most neoliberal Western countries at the time—broadly aims at mitigating the spread of the virus, with a focus on preventing that the number of contamination cases would start to exceed the capacity of the health care sector. By contrast, the “SARS” model, as deployed by Taiwan, aimed at a radical and instantaneous elimination of the virus, under the argument that because of the potential number of victims, it was necessary to suppress the disease with an intent of completely eliminating it. To phrase this difference in approach in another way: the prevailing viewpoint in the United Kingdom (and in many other Western countries) in February 2020 was that of “we will have to live with it, we can’t eliminate it”. By contrast, the point of view that reigned in Taiwan was that the virus had to be cost wat cost eradicated. Yet even then, there were sufficient other international examples, particularly from Asian countries, of how Covid-19 could indeed be successfully eliminated. The success of countries such as Taiwan shows that the UK tragedy—and, with it, that of many other Western countries—had in the early stage of the Covid-19 outbreak not been inevitable, and that lives and livelihoods could have been spared if authorities in Western countries had taken the Covid-19 outbreak more seriously, and if they had showed a willingness to better manage it from the early start.⁴⁵⁷

Taiwan even never needed to resort to one of the most radical tools for dealing with a viral pandemic, more precisely lockdown measures. This is because the country had acted so quickly with an effective set of policies aimed at eradicating the spread of the virus from the early start, including: (1) border controls, (2) effective tracking, tracing and isolation systems, (3) testing and quarantine measures, and, above all (4) the immediate and widespread use of face masks.⁴⁵⁸

It has been assessed by the earlier quoted authors that the Taiwanese government has been among the first (if not the first) to realise the seriousness of the threat posed by the new Covid-19 disease. Already on 31 December 2019, when China had reported cases of the outbreak of a mysterious new disease to the WHO, Taiwan immediately started screening incoming travellers from Wuhan. Taiwanese officials, though barred from the WHO, still tried themselves to raise the alarm internationally about (at the time still “unofficial”) reports that the disease could probably be transmitted between humans, which Beijing itself did not want to confirm for three more crucial weeks. From 24 January 2020, Taiwan closed its borders to incoming travellers from China. As Covid-19 started spreading around the world, Taiwan tightened its control measures even more by requiring 2 weeks of strict hotel quarantine with regard to all arrivals to the country. In mid-January 2020, Taiwan activated its “Central Epidemic Command Centre”. This move brought together government officials, members of academia, health workers and the private sector in a unified fight. The immediate actions of this Centre included: (1) rationing face masks, so that everyone in the country could have access to them, combined with (2) intensifying mass production, besides (3) launching a strong public communication campaign about the new control measures and why these were necessary. The Centre also resorted to (4) modern data collection methods while temporarily allowing to use these for disease control purposes, such as the use of mobile telephone data for electronic “fencing” of individuals isolated after possible Covid-19 contacts. These measures were, moreover, widely accepted by the general public.⁴⁵⁹

In addition, Taiwan also provided social and financial support to its population during the Covid-19 pandemic, while its people could also keep relying on Taiwan’s existing universal health coverage.⁴⁶⁰

An anecdotical illustration (as referred to by the earlier quoted authors) sheds a light on how the approach deployed by Taiwan, functioned at a practical level. At the beginning of the Covid-19 pandemic, an outbreak of Covid-19 had occurred on “the Diamond Princess”, a cruise ship that shortly before this outbreak had briefly visited Taiwan. When the ship had visited Taiwan, passengers had been allowed to disembark for a day trip. This had taken place on 31 January 2020. Said day trip fell 5 days before the first Covid-19 case was confirmed on board of the ship. The Taiwan CDC, when hearing about the confirmed contamination cases, immediately responded by publishing the locations where all the passengers on the ship had been, and by instructing people who might have come in contact with these passengers to self-monitor and quarantine in their homes, if deemed necessary. All of the people in Taiwan who had been considered as possible close contacts of the passengers of the cruise ship, eventually, tested negative for the SARS-CoV-2 infection.⁴⁶¹

Another, comparable cluster of Covid-19 infection in Taiwan occurred in March 2020 on the fast combat support vessel “Panshi”, with 36 confirmed contamination cases. The news about this outbreak immediately led to extensive testing, both on board of the vessel itself, as among potential contacts on shore.⁴⁶²

In both of these cases had the reported potential and/or confirmed outbreaks/clusters of Covid-19 contamination prompted public health officials to immediately implement testing and control procedures. In accordance with established protocols, response measures included: (1) contact tracing, (2) testing and isolation of possible cases, and (3) quarantine measures for close contacts.⁴⁶³

As mentioned earlier, one of the key factors that helps explaining Taiwan’s enormous success in containing the spread of Covid-19 within its borders, has been its face mask wearing policy. As in many Asian countries that had experienced SARS, Taiwan had already before the outbreak of Covid-19 a well-established culture of face mask wearing by the general public. After its experiences with SARS, the country had adopted a very proactive policy of supporting both the production and the distribution of face masks to all residents, in this manner securing supply and guaranteeing universal access to face masks. This implied that—contrary to the situation that occurred in a lot of Western countries—the population of Taiwan was able to obtain face masks already at a very early stage of the Covid-19 pandemic. Taiwan, moreover, immediately resorted to an official obligation to wear a face mask in confined indoor environments (including subways), even during periods when there was no community transmission.⁴⁶⁴

By the end of 2020, Taiwan would be one of the only places on Earth that had only marginally been affected by Covid-19, and where life still seemed more or less normal. Throughout the Covid-19 pandemic, Taiwan in this manner managed to maintain some of the best Covid-19 statistics in the world, despite its continued marginalisation on the world stage and despite a lack of international recognition of its de facto independent status. By 25 January 2021, Taiwan had officially recorded only seven deaths from Covid-19 and had, moreover, experienced 250 subsequent days without domestic transmission of Covid-19. Even as the disease spread across the world, Taiwan’s institutional response prevented the emergence of new cases on its own territory. Similarly, despite the ravages of the global Covid-19 pandemic on the world economy, Taiwan also managed to be one of the few economies in the world to experience economic growth in 2020, which was, moreover, expected to continue in 2021.⁴⁶⁵ Taiwan’s public health response, in which there was no need for implementing containment measures, is hereby believed to have put Taiwan in a stronger economic position during and after the Covid-19 pandemic when compared to most other countries.⁴⁶⁶

According to Graham-Harrison and Davidson, there was nothing to stop the UK government, or other Western governments, from learning from the Taiwan experience. But perhaps because of British exceptionalism, perhaps because other coronavirus outbreaks—SARS and MERS—had been contained away from Europe, the United Kingdom, and with it a lot of other Western countries, preferred to go their own deadly way instead.⁴⁶⁷

While Taiwan had managed to prevent a local case of a Covid-19 virus contamination on its territory during a long time, on December 22, 2020, concern was high after health authorities had announced that they had diagnosed a woman in her 30s of having contracted Covid-19. The woman was a friend of New Zealand resident and pilot who, being in his 60s, had shortly before flown from the United States to Taiwan and who had then travelled to Taipei while being contagious, without having disclosed his symptoms or his previous whereabouts to the authorities. The public health department in Taoyuan, where the man lived, was of the opinion that the man had violated the Communicable Disease Control Act by failing to provide detailed and accurate information on his health status and, moreover, declared that the man would face the maximum penalty of 300,000 Taiwanese dollars (£8000). His employer, EVA Air, launched its own investigation and was reported to consider dismissing the pilot. From this investigation, it also appeared that the man had flown with two co-pilots while coughing and not bothering to wear a face mask.⁴⁶⁸

Davidson has reported that Taiwan’s health authorities, in response to this event, announced new regulations on social distancing. These included the following measures: (1) Standing tickets for indoor events were banned; (2) spectators to events were required to wear face masks and not to eat; (3) people were urged to consider staying home for the New Year celebrations, and (4) new restrictions on foreign flights were issued, with more severe reporting obligations and quarantine arrangements for flight crews (with a mandatory quarantine stay at a government facility for 14 days).⁴⁶⁹

On 12 May 2021, local media, furthermore, reported that, in response to two new clusters of Covid-19 cases, the government was about to raise the Covid-19 alert to level three, just 1 day after it had been raised to level two. Under level two, Taiwan was already subject to severe restrictions, amongst which a cap on indoor gatherings of 100 people and on outdoor gatherings of 500 people (until 8 June 2021), as well as a ban on stand-up ticket sales for the country’s high-speed rail network.⁴⁷⁰ Level three would imply a mandatory use of face masks in all public places, and limits of five people for private gatherings and of ten people for public gatherings. Level 3 would also imply stricter restrictions—including the closure of schools and restricting people to their own neighbourhoods—that would apply to areas of community transmission. Health and Welfare Minister Chen Shih-Chung told a legislative session that took place on 12 May 2021 the following⁴⁷¹:

Taiwan currently has more than two chains of transmission for which we have yet to identify their sources. We are in critical condition now, and this is not a joke.

2.4.2.4.2 New Zealand

New Zealand recorded its first case of Covid-19 on 28 February 2020. This contamination case concerned a woman in her 60s who, on 26 February 2020, had arrived in New Zealand from Iran via Bali. By August 2020, more confirmed contamination cases of Covid-19 were reported from all 20 District Health Board areas in New Zealand. New Zealand, moreover, reported 47.0% (656/1397) of its confirmed cases in males up to 31 August 2020. The largest proportion of confirmed cases were in the 20–29 age group.⁴⁷²

New Zealand’s initial response to the Covid-19 outbreak had followed its pre-existing influenza pandemic plan. This plan had for the last time been revised in 2017 and was (1) similar to plans in other Western countries, and (2) based on a mitigation strategy of “flattening the curve” and delaying the epidemic peak to reduce the impact of a pandemic on health care services.⁴⁷³

Although New Zealand already in February 2020 resorted to entry restrictions and self-isolation/quarantine requirements for travellers coming from various Covid-19 hotspots, cases in New Zealand were increasing significantly by early March 2020. New Zealand’s original pandemic plan entirely focused on diseases similar to influenza, with limited applicability to other pandemic diseases, such as Covid-19. Furthermore, at least until early March 2020, New Zealand had no established infrastructure to deal with a pandemic such as Covid-19. As was the case in most other Western countries, New Zealand’s original plan was, moreover, largely oriented towards mitigation and not in as much towards elimination of the virus. However, early evidence from China indicated that a mitigation strategy to deal with Covid-19 might not have been optimal, given, on one side, the high transmissibility and, on the other side, the relatively high case-fatality rate of SARS-CoV-2 infection. New Zealand, hence, soon reached the conclusion that continuing with a mitigation policy would likely result in thousands of deaths and that it would rapidly overwhelm the New Zealand health system (in a similar manner to what was happening in the United States and in Europe). At the same time, New Zealand was persuaded by evidence from China that the Covid-19 pandemic could be contained with a sufficiently robust response. These considerations, together with the need to protect Māori and Pacific populations (who had already before been suffering from severe health inequalities due to other endemic and pandemic infectious diseases) and the need to intensify testing and contact tracing, would ultimately lead to a new policy approach. This new approach first started with New Zealand’s decision to implement high-intensity border controls and physical distancing measures, with an aim of extinguishing community transmission of SARS-CoV-2.⁴⁷⁴ However, by mid-March 2020, it was clear that, notwithstanding the foregoing, community transmission was occurring in New Zealand and that the country did not have sufficient testing and contact tracing capacity to contain the Covid-19 virus. This insight led to some new policy changes.⁴⁷⁵

On 21 March 2020, in order to better prepare the public for the rapidly changing situations due to the Covid-19 virus and to be itself better equipped to adapt policy responses, New Zealand thus introduced a new “four-level warning system”. Based on an existing system of forest fire warnings, the new system would clearly indicate the risk situation at any given time and provide a simple overview of the social distancing measures that would apply on each of these levels.⁴⁷⁶ New Zealand’s “four-level warning system” is explained in some more detail in Table 2.4.

Table 2.4 New Zealand’s the four-level approach [Source: New Zealand Government (2020)]

On 21 March 2020, the new system was set at “alert level 2”. However, already on 23 March 2020, Prime Minister Jacinda Ardern announced that New Zealand had moved the alert system to “alert level 3”, with immediate effect. On 25 March 2020, the alert level was again raised to level 4. The latter alert level triggered a total nationwide lockdown, with only essential services running and everyone being asked to stay at home in their bubble. A national state of emergency was declared at 12.21 p.m. of the same day.⁴⁷⁷ This state of national emergency was intended to support containment and was accompanied by legislative changes passed by the New Zealand Parliament, allowing for special powers granted to the government to deal with the pandemic situation.⁴⁷⁸ At that time, New Zealand had recorded only 102 Covid-19 contamination cases and no deaths. At around the same time, the United Kingdom recorded over 6500 contamination cases and over 330 Covid-19 related deaths.⁴⁷⁹

During the period of containment from 26 March 2020, with local cases of Covid-19 still increasing exponentially, many people wondered whether the new intensive controls would really work. However, after 5 weeks, and with the number of new cases falling rapidly, New Zealand was again able to move to alert level 3 which had to be maintained for a further 2 weeks, leading to a total of 7 weeks of what was essentially a national “stay at home” order.⁴⁸⁰

This situation of alternating situations of full lockdown (at “alert level 4”) with situations of partial lockdown (at “alert level 3”) was to continue until 13 May 2020. During these lockdown periods, most workplaces, schools and public meeting places were closed, with travel being completely stopped at level 4, and severely restricted at level 3.⁴⁸¹

According to Summers et al., from an April 2020 poll (conducted by “Colmar Brunton”), it appeared that there was at the time a huge public support for New Zealand’s official response to the Covid-19 outbreak. This support was said to be well above that of the world’s wealthiest countries. The survey, more precisely, found that 83% of respondents had “confidence in the [New Zealand] government to successfully address national issues”, while 88% “trusted the [New Zealand] government to make the right decisions about Covid-19”. The average approval rate for G7 countries at the time was 59%. Other polls conducted in New Zealand around the same time were said to give comparable results.⁴⁸²

During the first outbreak of Covid-19 in New Zealand (from late February to May 2020), 16 clusters of ten or more cases of Covid-19 had been reported. Of these clusters, many were from stays in (private) nursing homes and similar health care institutions, with others linked to overseas travel, secondary schools and cruise ship visits.⁴⁸³

Because of New Zealand’s rapid improvements in both screening capacity and case management, by the end of April 2020, the average time from symptom onset to notification had been reduced from 9-7 days to 1-7 days, and the time from symptom onset to isolation from 7-2 days to 2-7 days. This implied that people started isolating on average 2-7 days prior to disease onset. This had as result that contamination cases were quickly isolated from the community, even before the disease itself had manifested, which significantly reduced the risk of local transmission. From mid-April 2020, New Zealand started targeting high-risk groups for testing through population-based screening surveys, a policy which was particularly aimed at avoiding undetected circulation of the Covid-19 virus.⁴⁸⁴

The new approach in New Zealand was remarkable in both its thoroughness and brevity: the daily number of cases fell below ten by mid-April 2020 already, which was less than a month after New Zealand’s alert level had been raised for a first time. In addition, although most of the Covid-19 cases reported in mid-March 2020 had been imported to the country by travellers, almost no new imported cases were detected 2 weeks after the first travel bans and isolation orders had been implemented: While imported cases accounted for 58% of cases before 15 March 2020, they accounted only for 38% of the total of all cases New Zealand had to endure.⁴⁸⁵

It has, generally speaking, been observed that the successful control of both imported cases and local transmission cases in New Zealand has been achieved through rigorous non-pharmaceutical interventions (NPIs) implemented quickly when the total number of infections in the country was still sufficiently low. In order to illustrate this, it has been observed that the alert level was raised from 1 to 4 in only 5 days at the end of March 2020, while the number of cases had just exceeded 1000.⁴⁸⁶

By early May 2020, the last known case of (the first wave of the) Covid-19 (pandemic) in New Zealand was identified, with the contaminated person placed in isolation. This marked the end of the identified spread of Covid-19 within the New Zealand community. On 8 June 2020, the government announced the move of the country’s status to “Alert Level 1”, effectively declaring the end of the Covid-19 pandemic in New Zealand. Only 103 days since the first identified case on New Zealand territory had passed.⁴⁸⁷

New Zealand would during the rest of June 2020 remain at Alert Level 1, with all people arriving to the country (regardless of origin, or symptomology) being placed in managed isolation/quarantine facilities (mainly reassigned hotels) for 14 days, and with a subsequently introduced requirement that each such person would undergo two Covid-19 tests on days 3 and 12 of their quarantine period respectively.⁴⁸⁸

However, Summers et al., reported that after an initial period of successful elimination of Covid-19 on the New Zealand territory, in August 2020, a new outbreak of the Covid-19 virus occurred in Auckland City. All cases in this August 2020 outbreak appeared to be infected with exactly the same strain of Covid-19 virus, but New Zealand health authorities were unable to identify the source of this outbreak (although it was suspected that a breakdown in an inbound traveller quarantine facility might have been the most probable cause).⁴⁸⁹

While in the fall of 2020, other high-income countries (located in the northern hemisphere) reported increasing numbers of cases which could not be contained, New Zealand’s experience showed that the success of non-pharmaceutical interventions (NPIs) largely relied on a combination of early decisive responses from health authorities, effective surveillance systems and targeted testing strategies, as much as on rigorously applying these NPIs.⁴⁹⁰

In each of the cases New Zealand was confronted with, both the reported potential Covid-19 outbreaks, as the confirmed Covid-19 outbreaks prompted public health officials to implement the same infection control procedures. Response measures in each of these cases included: (1) contact tracing, (2) testing, (3) isolation of confirmed cases, and (4) quarantine of close contacts of these confirmed cases. In addition, throughout the pandemic, New Zealand kept providing both social and financial support to its population, while its people were also still able to rely on the existing universal health coverage.⁴⁹¹

Because of all these reasons, New Zealand’s response to the Covid-19 threat has been considered as one of the most effective in the world, similar to the early response to the Covid-19 threat by several of the Asian countries, such as China, Taiwan and Thailand. By mid-December 2020, the country of five million people had only experienced 25 Covid-19 related deaths, while it was assumed that it had successfully managed to stop the spread of Covid-19, which allowed people to return to their workplaces, schools and leisure activities, without restriction, as early as in the fall of 2020.⁴⁹² Table 2.5 gives an overview of the limited number of active Covid-19 cases in New Zealand on 1 April 2021.

Table 2.5 Number of active cases in New Zealand on 1 April 2021 [Source: New Zealand Ministry of Health (2021), as accessed on 2 April 2021]

On 18 January 2021, New Zealand’s Covid-19 Recovery Minister Chris Hipkins announced that the Covid-19 vaccines would be available to the public by mid-year 2021. The vaccine rollout was billed as the largest mass vaccination campaign in New Zealand’s history. On 20 February 2021, New Zealand was reported to have started administering Pfizer/BioNTech’s Covid-19 vaccine to cleaners, nurses and security staff members working at Auckland’s Jet Park quarantine hotel. The country, moreover, planned to vaccinate 12,000 isolation, quarantine and border workers over the next few weeks afterwards. The Ministry of Health explained that in the event of a Covid-19 outbreak, the at-risk population would be next to receive a jab of one of the Covid-19 vaccines, only next in line to health and border workers.⁴⁹³

2.4.2.4.3 Some Ups and Downs of the Covid-19 Containment Attempts in South Korea

In the early days of the global Covid-19 pandemic, South Korea, a country of about 51.64 million people, appeared to be one of the hardest hit nations. According to Ryall, South Korea soon feared that the Covid-19 disease would spread through all sectors of society, kill thousands of people, leave health care institutions on the brink of collapse, and bring the country to its knees. This scenario was exactly what happened to several other countries that had even had more time to prepare for the arrival of the Covid-19 virus on their territory than South Korea itself. Nevertheless, already in the early days of the Covid-19 crisis, South Korea managed to gain control over the Covid-19 virus. This was mostly because of the attitude of the South Korean people themselves.⁴⁹⁴ The extent to which South Korea, ultimately, managed to contain the Covid-19 virus clearly appears from the numbers of both Covid-19 contamination cases and Covid-19 related deaths, especially in comparison to the numbers of some other countries. By the end of October 2020, South Korea had, more precisely, witnessed “only” over 26,000 confirmed contamination cases and 461 Covid-19 related deaths. By comparison, Germany had recorded 463,419 contamination cases and over 10,000 Covid-19 related deaths, while the United States, at the time, reported over 8.8 million contamination cases and 226,681 Covid-19 related deaths.⁴⁹⁵

At the early start of the Covid-19 pandemic, the people of South Korea relied on an approach to combat Covid-19 that was based on two leading principles: (1) a common sense approach that involved the cooperation of all of its citizens, and (2) trust in scientists and medical experts.⁴⁹⁶

Different from the population and policymakers of some Western countries, the South Korean people took the Covid-19 threat very seriously from the early outset. One of the best indications for this attitude has been the fact that most of South Korea’s inhabitants spontaneously started wearing face masks, even before this practice had been recommended, or mandated, by the South Korean government itself. The people of South Korea did, moreover, not demonstrate any of the cynicism or resistance towards face mask wearing, and/or towards any of the other Covid-19 containment measures, which could be witnessed throughout the Western world. The South Korean people simply complied with these measures because they knew that the threat caused by the Covid-19 virus was to be taken seriously, but also because of a fundamental trust in their government and its capability to protect public health. A similar respect and obedience were shown towards the advice given by South Korea’s health professionals. This trust the South Korean people put in their government and its advisers was, moreover, quickly rewarded, to the extent that the government of South Korea managed to quickly establish clear containment protocols based on but a few simple guiding principles: (1) effective testing and tracing, (2) clear communication, and (3) a minimal disruption of normal life.⁴⁹⁷

According to Ryall, this attitude of trust explains why the vast majority of the South Korean population had no problems whatsoever with the following measures: (1) face mask wearing when being outside; (2) keeping a physical distance from other people at all times, and (3) having one’s temperature taken when entering certain public premises, such as schools, hospitals and shops.⁴⁹⁸

Traditional attitudes and curtesy customs are also believed to have created this attitude of compliance among the South Korean people: Compliance with face mask wearing and similar precaution measures was, hence, not only because people did not want to get ill themselves, but also out of respect for other people. This was basically a matter of politeness, as it would have been considered rude to demonstrate any form of behaviour that could have put the health of other people at risk. This applied thus the more in public places, such as on public transport or in shops.⁴⁹⁹

If the people of South Korea ever demonstrated any form of criticism towards their government, it has not been because the latter resorted to containment measures as such, but rather because it had taken some time to have these established to begin with. Indeed, upon the outbreak of Covid-19, many people were wondering why the authorities did not act much faster, e.g., by immediately imposing a ban on incoming travellers from China. Nevertheless, the “system” soon kicked in. Strengthening the innate responses by the general public itself, the South Korean government has especially been credited with immediately deploying a very efficient tracking and tracing system that was to become one of the main instruments of the South Korean government in its fight against Covid-19. Reference is made to the fully automated “Epidemiological Investigation Support System” (abbreviated as “EISS”), a tracking and tracing system that operates based on data collected from the use of credit cards and mobile phones. EISS went operational on 21 March 2020, which was about a month after the first Covid-19 cases had been detected in South Korea. Prior to EISS, it took on average 48 h to obtain information on the routes and interactions with others of people who had been contaminated with the Covid-19 virus. EISS managed to reduce this average time window to just 4 h. This implied that in case a person got tested positive for the Covid-19 virus, health authorities could immediately start tracing, and subsequently testing, over 100 people with whom the former person had been in contact with. EISS also allowed the health authorities to close places of frequent social interaction that such an infected person had attended, such as a gym, a church, a bar or a similar high-traffic area, which then could also immediately be ordered to comply with disinfection procedures.⁵⁰⁰

Ryall, furthermore, quoted education professor David Tizzard of Seoul Women’s University, according to whom South Korea had learned its lessons from its experiences with MERS only some years before, which had resulted in 186 contamination cases and 36 deaths.⁵⁰¹ The South Korean government of the time had, more precisely, been severely criticised for its failure to manage this former MERS outbreak. This explains why the government in place at the time of the Covid-19 outbreak itself, reacted with such extreme diligence. Another important factor has been that Covid-19, and especially the measures for fighting it, did in South Korea not get politicised as has happened in some Western countries.⁵⁰²

However, after these first successful attempts to contain the Covid-19 virus, it had not yet been completely defeated. During the second half of August 2020, overconfidence in the victory over the Covid-19 virus has thus been blamed for a new upsurge in Covid-19 contamination cases, with especially public places, such as churches and bars, but also public demonstrations against the Covid-19 containment measures, being held responsible for this resurgence.⁵⁰³

On 15 August 2020, South Korean President Moon Jae-in had held a special speech to the Kingdom of Belgium and the European Union. During this speech, the South Korean President had proudly declared that South Korea had (already) managed to “overcome” the Covid-19 crisis.⁵⁰⁴ Making the case that one should not tempt fate, only some five days after this statement, new Covid-19 contamination cases were on the rise again, with South Korean epidemiologists soon warning that the country’s overburdened health care system—particularly in the Seoul area—was again at a risk of collapse.⁵⁰⁵

The government’s initial optimistic assessment had been based upon the fact that just two days before President Moon Jae-in had delivered his speech, i.e., on 13 August 2020, there had only been 56 new contamination cases in the country. The enthusiasm about this low figure has probably also been fuelled further by the fact that one of South Korea’s most important holiday weekends was near, which helps explaining why the President was keen of delivering the good news to his people and to the rest of the world. Regretfully, the message was premature. Already by 16 August 2020, the South Korean health care system reported 279 new Covid-19 cases, which was, moreover, the first time that the daily average exceeded the 200 mark since early March 2020. The daily average continued to climb to 297 Covid-19 newly reported contamination cases on 19 August 2020. As had been the case for many Western countries, albeit to a far lesser extent, South Korea came to the realization that, after having started thinking that it had done well in dealing with the first wave of the Covid-19 pandemic, it had relaxed containment measures too soon. However, this was at the same time where all similarities with EU countries ended. Indeed, contrary to what happened in Europe (where authorities would wait until deep in the fall of 2020 to re-install containment measures), South Korea immediately resorted to new severe measures to stop the further spread of the Covid-19 disease. Already by 19 August 2020, the following measures were re-enacted: (1) Enhanced social distancing guidelines, including (2) a ban on outdoor gatherings of more than 100 people, and of 50 people if the event was to be held indoors. (3) This implied that sports games (e.g., baseball games) could only be played in empty stadiums. (4) All high-risk venues, such as karaoke bars, (ordinary) bars and buffet restaurants, were, moreover, ordered to close. Still, health experts warned that, even in the case of South Korea, these new measures came too late, and that a second wave of the Covid-19 pandemic had already taken hold of the country.⁵⁰⁶

Although some of the August 2020 cases have been linked to public venues such as bars, schools, and distribution centres, it was especially churches and their religious leaders that were to blame for the new wave of Covid-19 cases. As had already happened in an earlier stage of the pandemic, some churches had more in particular disobeyed government and health experts demands to limit physical church services, or to at least ensure that church members would always keep a safe distance from each other when attending church meetings.⁵⁰⁷ Especially the “Sarang Jeil” church was criticized for having defied Covid-19 safety guidelines on several occasions. As a result, hundreds of the church members tested positive for the Covid-19 virus. Jun Kwang-hoon, the church’s leader, had moreover organised street protests against the Covid-19 measures, demanding that he and his followers would be guaranteed religious freedom. In answer to this appeal, thousands of people, many of whom not wearing face masks, had attended demonstrations on Gwanghwamun Square in central Seoul. Still, karma seems to have been on watch, as on 17 August 2020, it got announced that Jun himself had been diagnosed with the Covid-19 virus.⁵⁰⁸

As the church resistance against the Covid-19 rules persisted, the South Korean government decided to order all churches in Seoul to stop all in-person services until at least the end of August 2020. This order was given shortly after Sarang Jeil’s leaders had refused to provide health authorities with a list of their followers, in this way refusing to comply with tracking and tracing protocols as well. This even made the city of Seoul file a formal criminal complaint against Jun for “wasting administrative resources and budget by evading, lying or disobeying during screening and tracing procedures.”⁵⁰⁹ Jun, at the time 89 years old, was arrested on 1 August 2020. The branch of his church located in the southern city of Daegu had already before been indicated as South Korea’s largest cluster in late February 2020, deemed responsible for more than 5200 Covid-19 contamination cases, which amounted to 36% of the total number of cases in South Korea at the time.⁵¹⁰ In August 2020, the church was again believed to be the main source for the new surge in Covid-19 infections.⁵¹¹

2.4.2.4.4 Lessons from the Approach of Taiwan, New Zealand, and South Korea for Other Countries

According to Joseph Stiglitz, if there have been two countries that are most likely to illustrate the lessons to be learned from Covid-19, it is the United States that represents one extreme, and New Zealand that represents the other. According to Stiglitz, contrary to the United States, New Zealand demonstrated the following qualities in responding to Covid-19⁵¹²:

• (1) A competent government, which relied on science and expertise to make decisions.

• (2) A high level of social solidarity—with citizens recognising that their behaviour towards Covid-19 may affect each other’s wellbeing.

• (3) Trust, including trust in government.

The question has arisen as to what lessons other countries (particularly high-income, Western countries) can learn from the Covid-19 experience in countries such as Taiwan, South Korea and New Zealand.

According to Summers et al., there are many such domains that could be explored further in order to improve the response of other countries to the ongoing Covid-19 pandemic, and to prepare for a next pandemic which could even appear to be more severe. The authors’ recommendations are as follows⁵¹³:

• (1) Create or strengthen a dedicated national public health agency to manage both the prevention and control of epidemics and pandemics, besides other public health threats. This agency could take the form of a “Centre for Disease Control and Prevention”, or a broader national public health agency, and should be invested with the power to coordinate the policies of other ministries/departments (similar to the CECC in Taiwan).

• (2) Formulate a generic pandemic plan in order to be able to respond to different pathogens showing distinctive characteristics.

• (3) Invest more in infrastructure that will enable a government to respond quickly to future disease threats.

  Specific of the authors’ recommendations include:

  • (a) Strengthening national and regional disease and epidemic surveillance systems, such as sentinel surveillance, as well as more specialised systems, such as wastewater testing.

  • (b) Developing effective border management policies and associated infrastructure that can be implemented quickly.

  • (c) Establishing stricter quarantine rules, besides secure facilities where incoming travellers can be tested and, if needed, isolated and quarantined.

  • (d) Continuing to develop both conventional and digital solutions for contact tracing, as well as for isolation and quarantine control.

  • (e) Developing effective means of producing, distributing and promoting face masks when border controls fail.

• (4) Review the workforce needed to support effective pandemic management, besides public health development more generally.

• (5) Improve training programmes of staff members dealing with fighting epidemics and pandemics accordingly.

• (6) Develop systems for evaluating and auditing pandemic responses, as well as for exercising capacity to respond to emerging infectious diseases.

• (7) Establish the cultural, societal and legal acceptability of all these pandemic response measures.⁵¹⁴

There may, in a similar manner be some other, more specific lessons to be learned from New Zealand’s response to the Covid-19 pandemic as well. According to Baker et al., these include⁵¹⁵:

• (1) The importance of rapid, science-based risk assessment.

• (2) The importance of keeping an open mind, including a level of preparedness to change course, if necessary.

• (3) The implementation of interventions at different levels (e.g., border control measures, community transmission control measures and case-based control measures).

According to Baker et al., also New Zealand’s Prime Minister Jacinda Ardern’s empathetic leadership and talent of effectively communicating key messages to the general population—e.g., having portrayed the fight against the Covid-19 pandemic as teamwork of the entire population—helped establishing elevated levels of public trust in the country’s both relatively new and heavyweight set of Covid-19 pandemic control measures. Lessons for New Zealand itself include the need for further strengthening its public health agencies, and providing greater support to international health organisations, such as the WHO.⁵¹⁶

The main lessons to be learned from South Korea are: (1) the importance of developing an efficient tracking and tracing system, besides (2) cultural adherence to containment measures.

But the Western, neoliberal political elites may even have more to learn from these examples. Unfortunately, during the Covid-19 pandemic itself, it appeared that the (neoliberal) governments of most EU countries, besides these of countries such as the United States, Brazil …, stubbornly refused to take to heart the lessons of the group of countries that had better dealt with Covid-19.

The main reasons for this surly attitude may have been the following:

• (1) Adherence to basic neoliberal dogma, which always gives priority to the economy—especially the economic interests of the rich—even if this comes at the expense of not being able to contain a pandemic, and thus basically of human lives. This, furthermore, helps explaining (1) why Western, neoliberal countries were so hesitant in starting to take measures to fight the spread of Covid-19 on their territories in the first place, besides (2) their constant desire to stop measures far too early in order to “reopen the economy” (in the broadest sense of the word) (cf. Sect. 7.10 and Sect. 8.4.), and

• (2) The related, erroneous “idea of liberty” on which the political system of Western societies as of the late eighteenth century onwards has been based, and which implies that everyone should be able to do freely what they want, even if this is at the expense of general safety, society and/or the welfare of others.⁵¹⁷

  When comparing the extremely selfish behaviour that some individuals in Western countries deployed against e.g., face mask wearing, with the manner in which the South Korean people complied with this practice simply because it was the polite and considerate thing to do, one can but hope that there will ever again occur a change in attitude in the Western world, away from Ayn Rand and her gospel of selfishness and egoism, towards some more care and consideration for one another.

All these factors help to explain why, even after information provided by countries such as Taiwan, New Zealand, and many others, which had adopted a much better approach to tackling the Covid-19 pandemic, was widely disseminated (and, through scientific publications, and other methods, made broadly available to everyone), EU leaders simply chose to ignore it. Even calls that the WHO itself—or WHO staff members—specifically addressed to European leadership in which the latter were urged to start taking said better examples of dealing with the pandemic, more seriously, were in most cases simply ignored. (Cf. Sect. 2.4.3.1.) The extent to which this truth even continued to apply during the so-called third wave of the Covid-19 pandemic, will be discussed in a further Sect. 2.4.3, but not before having taken a closer look at the way Brazil dealt with Covid-19.

2.4.2.5 By Comparison (2): The Failed Example of Brazil

If there has been one country that has put the neoliberal approach to managing Covid-19—and thus sacrificing workers’ lives for the benefit of the economy—even more to the fore than the United States, alongside a wide variety of EU countries, it has most probably been Brazil, where—in the words of Saad-Filho—President Jair Bolsonaro’s handling of Covid-19 has made former US President Donald Trump look like the “stable genius” and “gentleman” he likes to portray himself.⁵¹⁸

When Covid-19 first appeared in Brazil in February 2020, it was, like elsewhere, mostly considered a threat to the elderly and the infirm. However, by April 2021, as Brazil grappled with its most traumatic phase of the outbreak of Covid-19 on its territory, a disturbing trend emerged, namely that of intensive care units in hospitals filling up with younger patients, some of whom, moreover, appearing to be fighting a more severe form of the Covid-19 disease. This also implied that an unusually high number of infant deaths were reported, whereby it appeared that more than 1000 Brazilian babies had died because of Covid-19 in 2020, compared to 43 in the United States.⁵¹⁹

Lotta et al., have made the observation that Brazil, supposedly the largest economy in South America, had from the early start of the Covid-19 outbreak on its territory in early-February 2020, been relatively well equipped to deal with the Covid-19 pandemic. Lotta et al., have mentioned the following reasons for this:

• First, Brazil had a strong national health system, the so-called “Sistema Único de Saúde”, or abbreviated “SUS”.⁵²⁰ This health system had been established in the early 1990s. Despite chronic underfunding, SUS had nevertheless been successful in ensuring a broad access to health services, mainly through a health programme that had been given the name “family health strategy”. Through this programme, SUS had gotten extended throughout Brazil and had managed to cover 74% of the Brazilian population, with family health teams, furthermore, tackling health problems on the ground and at local level. As universal health coverage has all over the world proved to be one of the key factors in managing the Covid-19 pandemic (cf., furthermore, Chap. 5.), Brazil was, therefore, well placed to prevent, detect and respond to the Covid-19 threat when this for the first time manifested on its territory in February 2020.

• Second, Brazil had as one of the rare countries worldwide, relevant experience of having successfully combatted epidemics in the recent past, such as “yellow fever” and the “Zika”-virus. These earlier outbreaks had, moreover, proven to be a stress test for the SUS primary health care system. With, according to Lotta et al., as many as 286,000 community health workers on the front line of the country’s health care system, SUS had because of these earlier epidemics, acquired both a proven track record and relevant expertise in epidemiological surveillance. As a result, SUS’ health system dataset (named “DATASUS”) provided rich and relevant information on both national health and access to care, which could have been an important policy instrument in the fight against the new Covid-19 pandemic.⁵²¹

These factors implied that Brazil has been in a relatively strong position to fight the Covid-19 pandemic, both in terms of its economic strength as in terms of a performant and experienced health system. This makes it thus the more incomprehensible that Brazil did such a lousy job of dealing with the Covid-19 pandemic.⁵²²

According to Lotta et al., the reasons for Brazil’s catastrophic management of Covid-19, have not been so much related to the performance of its health system, as to political factors: On the one hand, the federal government had resorted to an extremely neoliberal “laissez-faire, laissez-passer” approach. This implied that the few and minor public health interventions that Bolsonaro’s government has resorted to, have always been secondary to the government’s main desire to keep the Brazilian economy, cost what cost, going. On the other hand, there have been many state and municipal officials who had sought to protect their citizens through public health measures. However, these have in most cases been seen as political opposition by the Bolsonaro government, than as initiatives that merited support and respect. This attitude of Bolsonaro’s government to question all possible initiatives of local and decentralized authorities, even resulted in litigation by which Bolsonaro tried and combatted these measures. But there was more than just a lack of will and coordinated action to combat the Covid-19 pandemic: According to Lotta et al., Bolsonaro’s federal government, moreover, deliberately acted to spread the Covid-19 disease. In particular, Bolsonaro encouraged people, especially the most vulnerable, to expose themselves to the Covid-19 virus. Lotta et al., have illustrated this observation with the following quotes stemming from Bolsonaro himself⁵²³:

“So what?” Bolsonaro asked after 5,000 deaths. “What are you afraid of? Face it!”, he commanded when Brazil reached 91,000 deaths; after all “everybody dies”. At 100,000 deaths, the president felt only that “we have to go on”. And with 162,000 Brazilians dead, the president held a ceremony at the presidential palace to warn that “we can’t run away from it, run away from reality; we have to stop being a country of faggots”.

A further factor having contributed to Brazil’s disastrous handling of the Covid-19 pandemic, has been Bolsonaro’s exaggerated tendency to express populist and anti-scientific opinions, which would ultimately come at a significant human cost. Some remarkable illustrations⁵²⁴:

• (1) Against all expert advice, Bolsonaro encouraged large public gatherings,

• (2) Where he met with people without wearing a face mask himself,

• (3) Where he mingled with other people also not wearing face masks,

• (4) Where he promoted the use of unproven drugs for treating Covid-19, and

• (5) Where he even made speeches aimed at discouraging people from participating in any future vaccination campaign.

• (6) Bolsonaro also went out of his way to often express his opposition to containment measures in general, and lockdowns more specifically.

• (7) Bolsonaro continuously downplayed the seriousness of Covid-19.

• (8) Bolsonaro has been witnessed walking the streets, going to shops and shaking hands with admirers, all of this without wearing a face mask.

• (9) Bolsonaro on more than one occasion openly plotted against his own health minister and against state governors, mayors and the media, in what has been referred to as “a dismal spectacle” that would ultimately drive Brazil’s middle classes into a frenzied opposition to Bolsonaro’s administration.

By July 2020, Bolsonaro’s federal government had invested only 30% of the country’s emergency resources that had been made available for dealing with the Covid-19 pandemic into health-related measures. In the best of neoliberal traditions, Covid-19 priority emergency aid went mostly to large companies, to the detriment of small and medium-sized enterprises and independent entrepreneurs. The disbursement of the emergency cash transfer programme for socially vulnerable people, at the same time, occurred both late and in an inefficient manner.⁵²⁵

It has, furthermore, been remarked that, with regard to the monitoring and the understanding of the spread and the impact of the Covid-19 virus itself, the Ministry of Health has failed to produce a systematic and timely indicative system (e.g., a testing and/or contact tracing programme) that would have enabled Brazilian policymakers to better coordinate a more effective response. Instead, federal data continued to lack consistency with other sources, while the government did not even bother to collect many important data. To phrase it differently: Epidemiological surveillance was completely neglected. The federal government in the end opted for a surveillance system based on “rapid” serological tests instead of more reliable RT-PCR-test, even when the latter got universally acknowledged as the most effective method of diagnosing Covid-19.⁵²⁶

Ferigato et al., have made the following, quite remarkable general assessment of the Brazilian government’s response to the Covid-19 pandemic, which was published in “The Lancet”⁵²⁷:

The federal government’s denial of science and, consequently, of the seriousness of the pandemic to the health and wellbeing of Brazilians has led to a failure to coordinate, promote, and finance internationally sanctioned public health measures. The ministry of health has not developed a national plan to combat the pandemic, nor has any other federal government agency. States and municipalities continue to be neglected and receive insufficient assistance. Influenced by political interests, the federal government has disrupted the flow of financial transfers and slowed the deliveries of essential supplies to certain regions. Furthermore, Brazil’s public health system, Sistema Único de Saude (SUS), is the largest in the world and provides universal coverage without any cost to patients. It is accessible nationwide and provides community-based primary healthcare to more than 70% of the population. Yet, primary healthcare has been overlooked by the federal government as a key element in this public health crisis response. Financial emergency aid to the most vulnerable populations was gravely delayed, insufficient, and cumbersome to obtain. Moreover, the federal administration denies international recommendations for non-pharmacological interventions, refusing to establish a national mandate for social isolation and mask use.

Yun made a similar observation that experts kept confirming that the Covid-19 crisis in Brazil has to a substantial extent unfolded in such an extreme manner because of the mismanagement of the Covid-19 pandemic by Bolsonaro’s federal government. Yun pointed to the further facts that Bolsonaro had opposed curfew restrictions and that he had even gone to court to fight local containment measures which had been imposed by both mayors and state governors to whom Bolsonaro referred as “tyrants”.⁵²⁸

Neuroscientist Miguel Nicolelis has defined Brazil’s approach of dealing with Covid-19 as “an open-air laboratory for the creation of the most dangerous mutations of Covid-19 and possibly even a new virus, an even more infectious and lethal SARS-CoV-3”. To back this bold statement, Nicolelis referred to the emergence of the more contagious “P.1” variant of the Covid-19 virus, which at the time was suspected of causing reinfections and of being resistant towards the Covid-19 vaccines. Nicolelis also argued that the mismanagement of the Covid-19 pandemic in Brazil has in this way posed serious dangers, not only for the Brazilian people itself, but for the entire human race. For Nicolelis, Bolsonaro’s approach can even be considered as the result of a “criminal herd immunity policy widely adopted by the world’s ruling classes, and most aggressively promoted by the Brazilian government, which deliberately allowed the virus to spread through society”.⁵²⁹

Lotta et al., reached the general assessment that, because of the combination of all these actions by its federal government, Brazil’s response to the Covid-19 pandemic ranks among the worst in the world.⁵³⁰

By August 2002, when the WHO made a recommendation that the rate of positive Covid-19 test results should not exceed the threshold of 5% of the totality of tests taken over a 14-day period, this rate for Brazil amounted to 33.2%. This was at the same time the second highest test rate average in the world. By that time, Brazil also had: (1) the highest rate of deaths among Covid-19-infected nurses, and (2) the highest number of Covid-19-related maternal deaths, most of which because of severe care failures. Researchers in mortality studies have even qualified these high number of deaths among women as a form of state-directed “femicide”.⁵³¹ Covid-19 around the same time also rapidly gained ground in Brazil’s countryside, resulting in alarming mortality rates and in the collapse of local health systems.⁵³²

By 11 November 2020, 871 of Brazil’s indigenous people had died of Covid-19, while there had moreover been 38,978 confirmed contamination cases among this people. There were, not surprisingly, commentators who spoke of a form of “genocide”.⁵³³

By 24 March 2021, there had in total been nearly 300,000 Covid-19 related deaths since the outbreak of the pandemic, a toll which at the time was only second to the one of the United States.⁵³⁴ The total number of contamination cases since the outbreak of the pandemic was at the time estimated at 11 million.⁵³⁵ By then, a further report confirmed that the Covid-19 virus had disproportionately affected Brazil’s indigenous population. According to an investigative report titled “Brazil’s Indigenous People Articulation”, more than 51,000 indigenous people had tested positive for Covid-19, of which 1022 people had died. The highest number of deaths among the indigenous people had been reached in the state of Amazonas, where 242 indigenous people were reported to have died because of Covid-19.⁵³⁶ The dramatic situation in Brazil is illustrated by Figs. 2.6 and 2.7. Figure 2.6 gives an overview of the Covid-19 deaths in Brazil compared to a selection of other territories until 4 April 2021. Figure 2.7 gives an overview of the Covid-19 Cases (7-day avg., per 100K) in Brazil compared to other territories until 4 April 2021.

Fig. 2.6

Covid-19 deaths in Brazil compared to selected other territories (until 4 April 2021) [Source: Yun (2021)]

Fig. 2.7

Covid-19 Cases (7-day avg., per 100K) in Brazil compared to some other territories (until 4 April 2021) [Source: Yun (2021)]

In April 2021, there occurred a worrisome increase in the number of young patients contaminated by the Covid-19 virus. The press reported about hospital intensive care units that increasingly had to admit young victims contaminated with the Covid-19 virus and aged in their 20s or 30s, while the average age of Covid-19 patients who were being admitted in the hospitals, had decreased from age 80 to age 40. Although the reason for this “generational shift” was not yet completely clear, some held the new, highly transmissible “P1” variant of the Covid-19 virus responsible. Another scientist was quoted saying that behavioural factors were most probably also at play. This referred to the fact that younger people had been more likely to have been frequenting places where they might have been exposed to higher doses of the Covid-19 virus on more often occasions. This had, obviously, also to do with the complete lack of containment measures in Brazil, which was itself due to the fact that Bolsonaro’s government opposed such measures. As a result, Brazil’s younger population had kept attending work, parties, restaurants and nightclubs, as if nothing was going on. This suspicion seems to find confirmation in the fact that many of the hospitalised Covid-19 patients in their forties, or younger, were domestic workers, cleaners, retail salesmen and waiters, all of whom had one thing in common: they had to leave their homes in order to work.⁵³⁷

By Thursday 29 April 2021, Brazil became the second country to officially surpass the 400,000 mark in Covid-19 related deaths. By that date, Brazil was reported to have lost another 100,000 lives during the time frame of just 1 month. Some health experts even warned that there would be worse days ahead as the southern hemisphere was entering winter. Be this as it may, April 2021 was at the time the deadliest month of the Covid-19 pandemic for Brazil so far, with thousands of people dying every day in Brazil’s overcrowded hospitals.⁵³⁸

A 2020 OECD economic survey of Brazil came to the conclusion that while Brazil’s response had spared it from a more severe economic impact, the Covid-19 pandemic had still significantly affected general welfare and prosperity. Covid-19 had especially taken a heavy toll on common people and small businesses, especially on those active in the informal economy. The OECD survey estimated that the Covid-19 crisis would, by and large, lead to a 5% contraction in GDP in 2020, followed by a return to economic growth of 2.6% in 2021, and of 2.2% in 2022.⁵³⁹

2.4.3 Second Year—and Third Wave—of the Covid-19 Pandemic in the EU and Its Member States

2.4.3.1 When, Despite Several WHO Warnings, the Third Wave of the Covid-19 Pandemic Still Hit Europe

By early March 2021, the WHO warned that the number of Covid-19 cases reported on the European continent was increasing. According to Khan, Hans Kluge, WHO Director for Europe, had urged EU leaders to “go back to basics” and to re-engage their populations in the fight against the Covid-19 pandemic.⁵⁴⁰ According to the same author, the WHO, in particular, warned about “Covid-19 pandemic fatigue” that could (again) cause people to start ignoring Covid-19 containment and social distancing measures. This concern was becoming all the more acute, as EU vaccination efforts finally were gaining pace, which made part of the European population think they could finally start relaxing⁵⁴¹ (cf. Sect. 9.4.3.). Similar warnings had, shortly before, been issued by the ECDC. Reference can, e.g., be made to an ECDC “update” of 15 February 2021, in which the ECDC had pointed out that the European vaccination programmes had not yet progressed in a sufficient enough manner to already start reducing the spread of the Covid-19 virus. The ECDC also warned about anti-lockdown protests and civil unrest in some European cities, which were indicators of Covid-19 pandemic fatigue that could undermine public acceptance of, and compliance with, NPI measures still in force.⁵⁴²

The WHO from its part showed a keen insight in the European situation. In their assessment of the situation in Europe, WHO officials clearly alluded to the total failure of both EU countries and the EU itself in managing the Covid-19 pandemic in its beginning phase (cf. Sect. 2.3.), but also throughout its further duration. The same concern about the failure of EU’s leadership to adequately deal with the Covid-19 pandemic, had already before made WHO officials express their strong concerns about a possible third wave of the Covid-19 pandemic in Europe. E.g., in an interview that was published in the “Solothurner Zeitung” in Switzerland, on 21 November 2020,⁵⁴³ WHO Special Envoy for Covid-19 David Nabarro had declared that Europe was likely to experience a third wave of the deadly Covid-19 pandemic in early 2021 and before it would be possible to start administering the Covid-19 vaccines.⁵⁴⁴ Nabarro, a London-born doctor⁵⁴⁵ and experienced health officer, had in the past led the UN’s fight against viral outbreaks such as the bird flu, Ebola and cholera in Haiti. In 2017, Nabarro had, moreover, been defeated for the post of WHO chairman by Dr. Tedros Adhanom Ghebreyesus, the latter himself being a former Ethiopian health minister.⁵⁴⁶ Nabarro had, subsequently, been appointed as WHO’s special envoy in the fight against Covid-19.⁵⁴⁷

According to Nabarro, EU leaders had failed to draw any lessons from the experiences with Covid-19 so far. They had especially failed to put the necessary infrastructure in place during the summer months of 2020, after the first wave of the Covid-19 pandemic had been contained. Nabarro explained that this failure had been the main cause for the severe second wave of the Covid-19 pandemic that had hit the European continent in October-November 2020. Nabarro had also warned that if European leaders would persist in this failure to install the necessary health infrastructure, a third wave of the Covid-19 pandemic was likely to occur in early 2021.⁵⁴⁸

Nabarro had phrased this concern in the following manner⁵⁴⁹:

They missed building the necessary infrastructure in the summer months after getting the first wave under control. And now you have the second wave. If they do not build the infrastructure now, they will have a third wave, early next year.

Nabarro, furthermore, had shared his concern that EU countries should have shown more willingness to learn lessons from more capable Asian countries, such as South Korea (cf. Sect. 2.4.2.4.3.). This criticism, basically, implied that the EU and its Member States should have responded much more quickly, robustly and decisively to the threat caused by the Covid-19 virus, especially during the early phase of the Covid-19 pandemic, when the number of cases was still low and the virus had not yet been very present on the European continent. By instead having reacted half-heartedly, the EU and its Member States had, in essence, made the problem even worse. According to Nabarro, the EU and its Member States had, furthermore, not been making good use of the lower figures during the summer months of 2020, thus paving the way for the success of the second wave of the Covid-19 pandemic on the European continent.⁵⁵⁰

According to Nabarro, one of the main problems in all of this has been that al lot of European policymakers simply refused to understand that the Covid-19 virus was spreading exponentially, rather than arithmetically.⁵⁵¹

By contrast, Asian countries had managed to keep their contamination and deaths numbers relatively low in the period during and after the summer and fall of 2020. Still according to Nabarro, this was because Asian politicians and their people were far more committed to fighting the Covid-19 pandemic. This in its own turn resulted in a far greater willingness to continue to deploy the behaviours needed to fight the Covid-19 virus, amongst which: (1) keeping physical distance, (2) wearing face masks, especially when being outdoors, or when being indoors in the company of other people, (3) isolating one’s self when sick, (4) washing one’s hands, (5) cleaning surfaces, and (6) remaining committed to protecting the population groups most at risk, such as people suffering from a pre-existing medical condition, and the elderly.⁵⁵²

Nabarro also pointed to the fact that, unlike the leadership of the EU and its Member States, leaders in Asian countries had not prematurely relaxed containment and social distancing measures, implying that by having refused to wait until the number of Covid-19 cases was sufficiently low, the response in European countries by the end of the first wave of the Covid-19 pandemic had simply been incomplete. Nabarro at the same time praised the approach of Asian authorities’ communication strategies, which had in most cases been based on a single, clear and simple message: “If we want our economy to be strong and if we want to keep our freedoms, we all need to stick to a few basics.” By contrast, already as early as the summer of 2020, the leaders in EU countries had been all too eager to open up everything, from the economy and businesses to schools and universities, and this as soon as a part of the European population had started whining that the measures to combat the Covid-19 pandemic were just too much to bear. It has precisely been the latter attitude that has resulted in not only the second wave of the Covid-19 pandemic by October-November 2020, but, in full accordance with Nabarro’s predictions of 21 November 2020, also the third wave of the Covid-19 pandemic by the spring of 2021⁵⁵³ (while, in some countries, such as Spain, there was already talk of a “fourth wave” of the Covid-19 pandemic).

As Nabarro has explained these concerns⁵⁵⁴:

My colleagues in WHO, the head of the regional office in Europe, and my WHO colleagues in Geneva unfortunately always have the same experience: they have to say repeatedly that there is no alternative. We must implement the strategies described. In this way we can help maintain freedoms and freedom.

Be this as it may, as a result of the failure to deploy structural measures to combat the Covid-19 pandemic as successfully as many Asian countries, by mid-March 2021, many of the EU countries witnessed the start of a third wave of the Covid-19 pandemic, while the EU vaccination campaign had far from advanced enough in order to protect the European people from a new surge of contamination cases and deaths, and while, moreover, new, more contagious variants of the Covid-19 virus in some areas started to account for the majority of new cases.⁵⁵⁵

Connolly et al. have quoted Christian Drosten, a leading virologist at Berlin’s Charité Hospital, who at the time shared his deep concern about the exponential increase of the spread of the B.117 variant of the Covid-19 virus, which already by mid-March 2021 accounted for around three quarters of the new contamination cases in Germany alone, as well as about the decision made by Germany to temporarily stop using the Oxford-AstraZeneca vaccine.⁵⁵⁶ Drosten was, furthermore, quoted warning the German people that by Easter 2021, German cases could reach the same high levels that had been witnessed around Christmas 2020. Drosten’s stark warnings came at a moment when some regions in Germany—besides many other EU countries as well—were starting or considering to reopen, after a lengthy period of lockdowns, with the hope of being in time before the Easter holidays.⁵⁵⁷

Shortly after, in his weekly “Corona Virus Update” podcast, Dorsten warned the German public that the situation could become “particularly tricky” for people over 50. The reason for this was that most people under 80 had not yet received a jab of a Covid-19 vaccine. Moreover, because of huge delays in the EU vaccination campaign, it was still unclear when this part of the German population would finally receive their jab. The fact that people in their 80s themselves had already been vaccinated, at least in part, thus implied that the group of people aged between 60 and 80 had become the main risk group, especially in light of the variants of the Covid-19 that were circulating throughout Europe.⁵⁵⁸ At the time, the European vaccination programme, which had, mainly due to a shortage of supplies (cf. Sect. 9.4.3.1.), been very slow and hampering from the early start, was rolling out even slower than expected. This implied that German Chancellor Angela Merkel’s promise that every German adult would be vaccinated by 21 September 2021, had started looking increasingly uncertain.⁵⁵⁹

By mid-March 2021, Covid-19 contamination cases had again drastically increased in Italy as well. On 16 March 2021, the country recorded a daily death toll of 502, its highest number since January 2021. Italian Health Minister Roberto Speranza was quoted declaring that in Italy as well, more than half of the new infection cases were due to the UK variant of the Covid-19 virus. Already the day before, on 15 March 2021, Italy had intensified its containment measures, as a result of which more than half of the country was put back in the most severe “red zone” category. It was estimated that the UK variant of the Covid-19 virus had spread around 35–40% faster, and that it accounted for 54% of the total cases. At the same time, also the South African variant of the Covid-19 virus was present, in particular in the Bolzano region, while the Brazilian variant of the virus was mainly active in the centre of the country.⁵⁶⁰

A similar evolution was taking place in Poland. By 17 March 2021, the UK variant there also accounted for the majority of new Covid-19 infections, with reports of a daily number of 25,000 new cases in the preceding 24 h.⁵⁶¹

In France, speculation started increasing about an imminent new lockdown, in addition to the already prevailing daily 6 pm–6 am curfew in both Paris and the Ile-de-France region. Hospitals in the Paris region had started moving ICU patients to less affected areas of the country, while in the far west of France, eight people who had contracted the so-called “Breton” variant which had not been detected by existing tests, were reported to have died.⁵⁶² Also in France, on 22 March 2021, Labour Minister Elisabeth Borne was said to have become the fifth member of President Emmanuel Macron’s cabinet—besides the president himself—to have tested positive for Covid-19. In the meantime, the 7-day average of new daily Covid-19 cases in France exceeded 30,000, up from a mere 10,000 in December 2020. It was, furthermore, reported that, in the Paris region, there were more people in ICUs than there had been during the second wave of the Covid-19 pandemic in November 2020. This implied that hospital capacity in Paris was saturated, explaining that ICU patients had to be moved to hospitals located in other parts of the country. Moreover, according to a study by the Pasteur Institute of March 2021, workplace contamination was reported to account for 15% of new Covid-19 cases.⁵⁶³

But it was especially in Central Europe, the Balkans and the Baltic States that the incidence of new Covid-19 contamination cases, hospitalisations and Covid-19 related deaths, had become among the highest in the world.⁵⁶⁴

On 18 March 2021, the WHO sounded the alarm bell at a press conference. According to the information provided by the WHO, the number of people dying from Covid-19 in Europe—which was around 20,000 per week—had even gotten higher than it had been around the same time in 2020.⁵⁶⁵ During this press conference, Dr. Hans Henri P. Kluge, WHO Regional Director for Europe, gave the following assessment of the European situation⁵⁶⁶:

Last week marked 1 year since WHO announced that the Public Health Emergency of International Concern declared on 30 January 2020 represented the first ever pandemic caused by a coronavirus.

Since then, we have seen nearly forty-two million cases in this region alone, and more than 120 million globally. But we’ve also seen giant scientific leaps and the introduction of effective tools that give us power over the virus, when used.

The power of the collective. The heroism of our frontline. When I look back at the past year, I see remarkable attributes we have all expressed to limit the spread of the coronavirus. Ultimately, our behaviour is saving lives.

The danger, however, is still clear and present.

The current situation is most acute in parts of the Region that were successful in controlling the disease in the first 6 months of 2020. It is in central Europe, the Balkans and the Baltic states where case incidence, hospitalizations and deaths are now among the highest in the world.

Case incidence continues its increasing trend and is moving eastwards. We have now seen three consecutive weeks of growth in COVID-19 cases with over 1.2 million new cases reported last week across Europe.

Last week, deaths in the Region surpassed 900 000. Every week, more than 20 000 people across the Region lose their lives to the virus. The number of people dying from COVID-19 in Europe is higher now than it was this time last year, reflecting the widespread hold this virus has.

We are yet to see the widespread health impact and benefits of vaccines, which I can also assure you will come. But for now, we need to remain steadfast in our application of the full range of tools to respond.

Some forty-eight out of 53 European countries or territories have reported the B.1.1.7 variant of concern, which is gradually becoming predominant in our region. And yet, in the context of this faster spreading variant, several countries – including but not limited to Denmark, Ireland, Portugal, Spain and the United Kingdom – have rapidly reduced transmission with public health and social measures to levels that can, and must, be kept low.

Five countries in the Region have received vaccines from the COVAX Facility – fair and equitable access to vaccines, the overarching concept of COVAX, is happening in reality. The gap in access to vaccines in our region is narrowing, yet inequity persists, with all high-income countries having rolled out vaccination, but only 60% of middle- and lower-income countries having done so.

As of today, a total of forty-six countries in the Region have administered more than 107 million doses of vaccine. Three percent of the population in forty-five countries have received a completed vaccination series, and data from twenty-three countries indicates that 51% of health workers have received at least one dose.

While twenty-seven countries are currently in a partial or full nationwide lockdown, twenty-one are gradually easing restrictive measures. Some are doing so based on the assumption that increasing vaccination uptake in countries would immediately lead to an improved epidemiological situation. Such assumptions are too early to make.

Let there be no doubt about it, vaccination by itself – particularly given the varied uptake in countries – does not replace public health and social measures.

With vaccination coverage in the Region ranging from less than 1% to 44%, it is also far too early to demonstrate the effect of vaccines on overall COVID-19 hospitalization and deaths. Nonetheless, early data from Israel, Scotland and the UK, linked to effectiveness against severe disease by the Pfizer/BioNTech and AstraZeneca vaccines, is promising and show lives are being saved.

As vaccine uptake increases, their broader impact will become visible, and studies like these will guide policy and improve our understanding of how the different vaccines contribute to our response. We welcome these studies, stressing that the available data is limited – and that further research is urgently needed.

The WHO Regional Office for Europe and the European Centre for Disease Prevention and Control have developed a robust protocol to study vaccine effectiveness in community settings to allow effective comparison of the results between countries.

A number of countries in the Region have temporarily suspended use of the AstraZeneca vaccine as a precautionary measure, based on reports from a few countries of rare blood coagulation disorders in persons who had received the vaccine. The detection, investigation and assessment of these cases is a testimony to strong surveillance and regulatory mechanisms.

In vaccination campaigns, it is routine to signal potential adverse events. This does not necessarily mean that the events are linked to the vaccination. Venous thromboembolism is the third most common cardiovascular disease in the world. It happens in populations regardless of whether they are vaccinated or not. COVID-19 vaccination will not reduce illness or deaths from other causes.

As of now, we do not know whether some or all of the conditions have been caused by the vaccine or by other coincidental factors. WHO is assessing the latest safety data, and once completed, the findings will be made public. At this point in time, however, the benefits of the AstraZeneca vaccine far outweigh its risks – and its use should continue, to save lives.

Vaccines work and will eventually allow a return to a new normal. But for that to happen, we need to rely on science and have confidence in the incredible protection afforded by vaccines against all vaccine-preventable diseases, including COVID-19.

Meanwhile, we have one eye fixed on the future. This week, the Pan-European Commission on Health and Sustainable Development, chaired by Professor Mario Monti, issued a call to action – to rethink policy priorities in the light of pandemics, to fix the fractures and address the conditions that allowed COVID-19 to happen. This is a concrete step towards making health a centrepiece of society, preparing for future health emergencies and making sure that the notion of health as peripheral is a thing of the past.

Stay safe. Thank you.

According to Mallet et al., in early April 2021, the French Prime Minister Jean Castex told the French Parliament that in a fortnight, the official number of new Covid-19 contamination cases had increased by 55%, to around 38,000 per day.⁵⁶⁷ This growth in a single fortnight in France compared to a 95% increase of contamination cases in Belgium, and of 48% in the Netherlands, both in a similar time frame.⁵⁶⁸

In Spain and Italy too, the situation severely deteriorated in the month of April 2021.⁵⁶⁹

In Spain, by 9 April 2021, the 14-day cumulative number of cases per 100,000 people had risen to 174.52. This meant that it was gradually approaching the threshold of 250 cases which was by the Spanish government considered to indicate a situation of “extreme risk”. On 8 April 2021, the Central Ministry of Health published a new report on the Covid-19 situation. This report showed a gradual increase in the 14-day cumulative number of Covid-19 cases per 100,000 people. From this, it appeared that the national average had risen from 167.97/100,000 on 7 April 2021 to 174.52/100,000. Some regions had already passed the 250/100,000 mark, namely Madrid, the Basque Country and Navarra, besides the North African cities of Melilla and Ceuta.⁵⁷⁰ The Ministry, furthermore, reported 9901 active infections cases, which was almost 3000 more than on 1 April 2021, when the figure had amounted to 7041. On 25 March 2021, the number had only amounted to 6393 cases, which was 3500 fewer than on 8 April 2021.⁵⁷¹ From this, it appeared that by 8 April 2021, Spain was experiencing a fourth wave of the Covid-19 pandemic, with the ICU departments of its hospitals being under great pressure.⁵⁷²

Eastern Europe had also been hit hard. In Poland, the third wave of the Covid-19 pandemic was even reported as the worst so far, with the number of daily infections at record levels. This also put a huge strain on the country’s health care system. At the beginning of April 2021, there were more people in Poland in hospitals and/or on ventilators than at any previous point in time since the beginning of the pandemic in China in December 2019.⁵⁷³

By contrast, in Czechia, where the government had resorted to a new, strict lockdown following a severe outbreak of Covid-19 in late February 2021, cases were going down. In Slovakia, however, cases were on the rise as in most other European countries.⁵⁷⁴

However, probably the most remarkable events during the third wave of the Covid-19 pandemic occurred in Sweden. As has been explained before, Sweden had from the early start of the Covid-19 pandemic chosen for a totally different approach in dealing with Covid-19. This approach had neared striving for herd immunity, although Swedish authorities had refused to indicate their approach under this denomination. Notwithstanding this, the country had still withstood the first wave of the pandemic rather well. However, after the winter months of 2020–2021, things would start to change. By 13 April 2021, Sweden for the first time reported the highest number of new Covid-19 contamination cases per capita in Europe. The country also had more Covid-19 patients in ICU’s than at any other moment during the Covid-19 pandemic. This situation had brought Sweden to the move of adopting containment measures after all, which before Sweden had refused to even consider. Then, with cases dropping again, Sweden had started to gradually tighten its mostly still voluntary restrictions, until the date of 13 April 2021, on which the country experienced a 7-day average of 625 new cases per one million people. On that same date, that figure was 521 for Poland, 491 for France, 430 for the Netherlands, 237 for Italy, 208 for Germany, 132 for Norway, 111 for Denmark and (only) 65 for Finland. Moreover, on 12 April 2021, 392 people were being treated in ICU units. This was more than the peak number that Sweden had experienced during the second wave of the Covid-19 pandemic, which then—in January 2021—had only amounted to 389, but still less than the number had been in the spring of 2020, when there had, at a certain moment in time, been 558 ICU patients. Surprisingly, while the numbers of new daily cases and of patients in ICU care had been increasing, the number of Covid-19 related deaths had not been rising as sharply. According to the Swedish national health agency, this may have been due to the fact that many of Sweden’s most vulnerable people, including nursing home residents, had already been vaccinated by April 2021.⁵⁷⁵ The rising numbers in Sweden made Prime Minister Stefan Löfven’s government decide to postpone an earlier announced easing of restrictions that had been planned for the end of March 2021. The government, instead, announced that it would be necessary to uphold existing containment measures until at least 3 May 2021, however while insisting that there was no need to resort to even stricter measures. The initial plan had been to relax some measures, e.g., by raising the limits on the number of people who could attend theme parks, concert halls and sports events. This easing down had been foreseen to enter into force no later than at the beginning of the Easter holidays, but Swedish public health agency now advised to wait a bit longer. In the meanwhile, non-essential shops had been continuously allowed to remain open, although with limits on the number of customers. Also bars and restaurants had been allowed to continue to function, albeit with increasingly severe restrictions on opening hours and regarding the sale of alcohol. The situation of mid-April 2021, moreover, made the government tighten the rules on public gatherings, although schools could remain open, be it with variations between regions.⁵⁷⁶

Sweden has justified its policy under the argument that its aim had all the time been to strike a balance between the following goals: (1) prioritising life and health; (2) protecting the health care system as much as possible, and (3) ensuring a variety of important societal functions in order to allow society to continue to function, without (4) unduly disturbing people’s privacy.⁵⁷⁷ By 13 April 2021, Sweden had experienced more than 13,000 Covid-19-related deaths. This implied a death rate per million persons of almost 1350, which was several times higher than the death rate in Sweden’s Nordic neighbouring countries, but also lower than the death rate in several other European countries that had opted for lockdown measures. For the whole year 2020, Sweden’s increase in excess mortality was also lower than that of most European countries. Health officials made the remark that, although Sweden’s results were not to be taken as evidence against lockdowns, it had still to be acknowledged that Sweden’s numbers could indicate that the country’s overall approach for fighting the Covid-19 pandemic showed some characteristics worthy of further investigation.⁵⁷⁸ Eurostat statistics more in particular showed that in 2020, Sweden had 7.7% more deaths than its average during the four preceding years. This figure was lower than in 21 other of the in total 30 surveyed countries.⁵⁷⁹ By contrast, Spain and Belgium, both countries that had opted for strict and repeated lockdown measures, had a much higher excess mortality of 18.1% and 16.2% respectively.⁵⁸⁰ However, the number for Sweden was at the same time much worse than the one of its Nordic neighbouring countries, with Denmark having recorded an excess mortality of only 1.5% and Finland of 1.0%, while Norway had even shown no excess mortality for 2020 whatsoever.⁵⁸¹

2.4.3.2 End-March 2021 Containment Measures

Throughout the month of March 2021, it was getting clearer and clearer that a third wave of the Covid-19 pandemic was unavoidable, which made most EU countries—albeit reluctantly—decide to reintroduce or extend Covid-19 containment measures.⁵⁸²

In Germany, containment measures were at the time still in force, albeit there were plans to ease down on these measures before the Ester holidays period. Instead, Germany saw itself forced to prolong the measures until at least 18 April 2021. There were even talks to have a new, full 5-day national lockdown which was decided to take place during the first 5 days of April 2021. However, the latter plans met much public backlash and whining, which made the German Chancellor Angela Merkel ultimately decide to reverse this decision.⁵⁸³

On 31 March 2021, France decided to put the city of Paris under a new 1-month lockdown—by the French press referred to as a “light lockdown”—along with some other regions. Travel between French regions was prohibited for the duration of this light lockdown period, except for “compelling” or work-related reasons. This light lockdown was expected to affect the lives of 21 million people in 19 regions of France. At the time, there was for the whole of France still a national curfew in force as well, notably between the hours from 7 pm until 6 am.⁵⁸⁴ The lockdown-light was accompanied by two important further restrictions, namely: (1) the closure of all non-essential shops, and (2) a ban on inter-regional travel. These measures were announced to last at least 4 weeks, but were considered less strict than previous lockdowns, with some health experts even questioning whether they would be sufficient. E.g., the following “shops” were allowed to remain open: (1) Hairdressers, (2) bookshops, (3) chocolate shops, (4) music shops, (5) car dealerships and (6) florists. People were, moreover, allowed to exercise outdoors as often as they wished, albeit under two conditions: the permission only applied during daytime and within a radius of maximum 10 km (6 mile) of their homes. In addition, schools were required to remain open (with senior secondary education however reverting to a “hybrid” half-distant learning from home, half-being physically at school schedule). Finally, all employees who could do their job from home, were required to do so.⁵⁸⁵

In Italy, as of 15 March 2021, the government of Prime Minister Mario Draghi decided on some new, severe containment measures which met severe protest from the part of the Italian population. These involved: (1) the closure of shops, schools and restaurants in a variety of major Italian cities, including Rome and Milan, besides (2) a nationwide closure during the 3-day Easter weekend and starting on Good Friday, 2 April 2021.⁵⁸⁶ The latter measure implied that the whole of Italy got “red-listed” for the duration of the Easter weekend, with people mandated to stay at home, except for work, health care or other essential reasons.⁵⁸⁷

On 17 March 2021, Poland as well resorted to a 3-week partial lockdown. The accompanying containment measures included a complete closure of (1) schools, (2) shopping centres, (3) swimming pools, (4) gyms, and (5) restaurants (which however had already been closed before). People were, furthermore, advised to stay at home.⁵⁸⁸

Although Greece had previously announced that it was making plans to again welcome tourists from abroad during the European summer of 2021, it too had to resort to new containment measures regarding the areas where cases were at the time most prevalent. E.g., in Athens, all non-essential shops and barber shops had to remain closed.⁵⁸⁹

Spain simply decided to prolong its existing restrictions until May 2021, and to restrict all non-essential travel outside the country.⁵⁹⁰

Also in the Netherlands, on 23 March 2021, under explicit reference to the fact that a third wave of the Covid-19 pandemic had started, the government of Prime Minister Mark Rutte decided to extend the country’s strict Covid-19 lockdown. This lockdown decision was accompanied by the following further measures: (1) A 9 pm–4.30 am curfew (which had already been in force), although as of 31 March 2021, the curfew would start at 10 pm, (2) a request to the population to avoid all but unavoidable foreign travel until at least 15 May 2021, (3) a permission for secondary schools to open one day a week, (4) allowing hairdressers and other “contact professions” to return to work, (5) a permission to visit non-essential shops upon appointment, and (6) bars and restaurants remaining closed.⁵⁹¹

2.4.3.3 Looking for Explanations

2.4.3.3.1 Introduction

Needless to say, the containment measures that the governments of several EU countries had to resort to by the end of March 2021, in many cases, came as a heavy blow to their already Covid-19 pandemic-weary populations.⁵⁹²

The population of most EU countries had by then already been living under intermittent restrictions for a year, or more.⁵⁹³ Many of the EU countries that had to resort to new, tough containment measures in order to fight the third wave of the Covid-19 pandemic were, moreover, the same ones that had endured a severe first wave of the Covid-19 pandemic (that itself had only—more or less—ended after taking recourse to severe containment measures in the spring of 2020), followed by an as severe second wave of the Covid-19 pandemic (that likewise had to be fought by applying severe containment measures during the second half of the winter of 2020–2021). This implied that, in March 2021, the European people were facing a third severe wave of the Covid-19 pandemic, again resulting in new, restrictive containment measures. This obviously led to the questions as to where things had gone wrong, and what could be further done to prevent the situation from getting even worse.⁵⁹⁴

In the search for explanations, three new such explanations entered the picture, namely:

• (1) The role of new variants of the Covid-19 virus.

• (2) The disastrous EU vaccination campaign, which had failed to inoculate enough people during the first 4 months of 2021, as a result of which a too large part of the European population had still not been protected by a Covid-19 vaccine.

• (3) Covid-19 pandemic fatigue (which especially during the second wave of the Covid-19 pandemic had led to a rejection to comply with former containment measures among a part of the European people).

2.4.3.3.2 New SARS-CoV-2 Variants

New variants of the Covid-19 virus are believed to have played a key role in the development of the third wave of the Covid-19 pandemic.

According to an ECDC report of 15 February 2021,⁵⁹⁵ several EU/EEA countries had experienced a decline in the overall incidence of Covid-19 in the weeks preceding the date of said report. This was to a large extent attributed to the impact of increased NPI’s which many EU/EEA countries had resorted to. Still, the epidemiological situation remained of great concern with most countries belonging to the EU/EEA still experiencing high and, in some cases, even increasing contamination rates and Covid-19 related deaths.⁵⁹⁶

The good news was that the roll-out of the vaccination campaigns had finally started in all EU/EEA countries. The bad news was that this vaccination campaign was, due to several mistakes that the EU had made in the procurement phase (cf. Sect. 9.4.3.), only progressing at a very slow pace. During the months of January and February 2021, the EU vaccination campaign only targeted some specific priority groups, namely: (1) the group of people who were at risk of developing severe disease if contracting Covid-19 (such as the elderly and, more in general, residents of nursing and/or long-term care facilities), as well as (2) healthcare workers and other frontline workers. By 15 February 2021, it was however still too early to detect any impact on Covid-19 related mortality and/or hospitalisations. A second matter of concern that the ECDC raised in its 15 February 2021 report concerned the fact that, while most EU/EEA countries were starting to witness a decline in the total number of contaminations in response to NIP’s, the introduction and increased spread of new variants of the Covid-19 virus that had for the first time been identified in the United Kingdom (= the “B.1.1.7”-variant), South Africa (= the “B.1.351”-variant) and Brazil (= the “P.1” variant)⁵⁹⁷ (cf. Sect. 1.1.2.) created a new factor of uncertainty.

In its 15 February 2021-report, the ECDC made the following observations about these three variants of the Covid-19 virus⁵⁹⁸:

• (1) Since 21 January 2021, several EU/EEA countries had witnessed a substantial increase in both the number and proportion of Covid-19 cases linked to the B.1.1.7 variant.

  E.g., Ireland had reported in detail that the B.1.1.7 variant was the main circulating strain of the Covid-19 virus on its territory. Several other EU/EEA countries expected a similar situation in the weeks to follow.

  The B.1.1.7 variant caused the following reasons for concern: (1) it appeared to be more transmissible than the previously predominantly circulating strains of the Covid-19 virus, and (2) it was considered to cause a more severe infection than these other strains.

  According to the ECDC’s own assessment, several of the countries where the B.1.1.7 variant had become dominant had experienced the following: (1) a rapid increase in incidence, leading to (2) increased hospitalisations, (3) overburdened health systems and (4) excess mortality.⁵⁹⁹

• (2) Variant B.1.351 of the Covid-19 virus had also been increasingly showing up in several EU/EEA countries.

  According to the ECDC, this variant showed the following characteristics: (1) it was often, albeit not in an exclusive manner, linked to travel; (2) it was associated with new epidemics and (3) with increased transmissibility, and (4) there was evidence that the efficacy of some of the Covid-19 vaccines with regard to this variant was reduced.⁶⁰⁰

• (3) The third variant of concern was the “P.1” variant of the Covid-19 virus. This variant had so far only been reported at lower levels, probably because it was mainly linked to travel from Brazil where it was at the time creating more havoc (cf. Sect. 2.4.2.5.).⁶⁰¹

According to Khan, it would, furthermore, soon appear that, during the months February and March 2021, especially the Lombardy region in northern Italy got particularly affected by the variants. This was thus the more dramatic as it had been the same region that had already experienced an extremely high number of Covid-19 cases during the first wave of the Covid-19 pandemic less than a year before. This implied that, by March 2021, ICU’s in the region were once again filled with Covid-19 patients, two-thirds of whom infected with Covid-19 variant B.1.1.7.⁶⁰²

By contrast, the B1.351 variant had been identified in much smaller quantities in several other European countries, such as Spain, Germany, France and Italy, where it was carefully monitored by local authorities.⁶⁰³

Based on this epidemiological situation in the EU and/or EEA, the ECDC indicated in its 15 February 2021 report that “immediate, strong and decisive public health interventions were essential to control transmission and preserve health care capacity”. The challenges EU (and EEA) countries were thus confronted with, were twofold: (1) how to strengthen existing or new NPI’s in order to reduce the incidence of Covid-19 to the lowest possible level, and (2) how to proceed at a faster pace with the roll out of the Covid-19 vaccination campaign, especially with regard to the segments of the European populations most at risk of high morbidity and mortality because of Covid-19.⁶⁰⁴

The ECDC itself pointed to the following elements: (1) optimisation of NPI’s—in particular by dealing with issues related to community use of face masks and considerations for school settings, (2) a more optimal use of vaccination, (3) testing and tracing approaches, including robust surveillance and sequencing, (4) more consideration for travel-related measures, and (5) more attention for effective risk communication.⁶⁰⁵

2.4.3.3.3 The EU Vaccination Disaster

In addition to all that has been discussed in the previous Sect. 2.4.3.3.2, a second factor that helps explaining the severe third wave of the Covid-19 pandemic EU countries had to endure, concerned the worrisome slow pace of vaccination deployment in the EU Member States.⁶⁰⁶ (Cf., furthermore, Sect. 9.4.3.).

By the end of 2020, the EU had ordered 300 million doses of the BioNTech-Pfizer Covid-19 vaccine (also known under its mark name “Comirnaty”-vaccine; cf., furthermore, Chap. 9.). However, already in January 2021, it was clear that delivery of these vaccine doses to the EU was delayed, allegedly because the plant where the vaccine production for the European market was foreseen, was being renovated in order to increase long-term production.⁶⁰⁷ In addition, because of contractual obligations, Pfizer/BioNTech was giving priority to the delivery of its Covid-19 vaccine to the United States (besides some other countries, such as the United Kingdom and Israel), which implied that the EU was de facto on Pfizer/BioNTech’s waiting list until there would have been delivered at least enough doses of the vaccine to the United States for all Americans who wanted to be vaccinated to be able to receive their two doses of the vaccine first.

The supply of the Oxford-AstraZeneca vaccine to the EU (Member States), similarly, became a “contentious issue” (worthy of a bad TV soap) as of January 2021. Early 2021, AstraZeneca had claimed to have supply chain problems at its factories in Belgium and the Netherlands, as a further result of which AstraZeneca made way fewer deliveries to the EU than had been contractually agreed upon (cf. Sect. 9.4.3.). The EU was, as a result of this, under the impression that the United Kingdom received priority treatment with regard to the vaccine deliveries, even though the latter country had signed its purchasing contract with AstraZeneca later than the EU. In addition, in January 2021, although the EMA had deemed the Oxford-AstraZeneca Covid-19 vaccine “safe and effective for all age groups”, there were several European countries, such as France, Belgium, Germany and Sweden, that made the decision that the Oxford-AstraZeneca vaccine should not be used for people over 65. When shortly afterwards other countries stopped using the vaccine completely because of reported side-effects, the combination of all these decisions largely undermined public confidence in the vaccine, further slowing its roll-out and administration. Still some more time later, Germany, Belgium and Sweden reversed their decisions, declaring that the vaccine was indeed effective in all age groups, while France approved it for people aged 65–74. But at a time when scepticism about the Covid-19 vaccines was already high, there was no doubt that these decisions deterred some people from wanting to take the Oxford-AstraZeneca vaccine.⁶⁰⁸ To add to the confusion, on 7 April 2021, Belgium decided that, for 1 month, it would use the Oxford-AstraZeneca vaccine only for people over 55,⁶⁰⁹ precisely (at least in part) the age group that had just over a month before been told that the vaccine would be as good as ineffective for them.

Then, nearing the end of March 2021, there were reports about the fact that the Oxford-AstraZeneca Covid-19 vaccine might be linked to the occurrence of blood clots. These allegations were quickly dismissed by the EMA that, after having reviewed the data on the vaccine for a first time, initially came to the conclusion that there was no such link between blood clots and the Oxford-AstraZeneca vaccine.⁶¹⁰ However, only a little while later, more precisely on 7 April 2020, the EMA already reversed this assessment, this time stating that there was indeed such a link but that the benefits of the vaccine still far outweighed the small risk of such blood clots occurring.⁶¹¹ (Cf., furthermore, Sect. 9.3.1.4.1).

Be this as this may, the slow deployment of the Covid-19 vaccines in general, in combination with all the confusion reports about both the effectiveness and safety of the Oxford/AstraZeneca vaccine more in particular, strongly limited the progress of vaccinations in the 27 EU Member States, and through this, especially during Q1 2021 and the month of April 2021, of their capability of containing the Covid-19 pandemic. This was in stark contrast to the speed of vaccination deployment in certain other Western countries such as Israel, the United Kingdom and the United Sates.⁶¹² It was, also assumed that the various delays in, and other problems with, the EU vaccination campaign (cf., furthermore, Sect. 9.4.3.10.) was not only giving the Covid-19 virus opportunities to spread further, but that this also allowed for some variants of the virus to become ever more dominant. The new and/or more severe containment measures that were put in place by governments of EU countries as of the end of March 2021 were, therefore, intended to: (1) stop the spread of the Covid-19 virus in general; (2) reduce the risk that existing variants (cf. Sect. 2.4.3.2.) would spread further and/or would become the dominant strain of the Covid-19 virus in certain regions/countries, and (3) contain the emergence of new variants (under the fear that one or more such new variants could be resistant towards the already existing Covid-19 vaccines, besides being more infectious and/or more likely to cause more severe symptoms). The identification and isolation of outbreaks of such “variants of concern” of the Covid-19 virus, therefore, became of paramount importance as long as vaccine deployment in the EU remained disastrously slow.⁶¹³

2.4.3.3.4 Covid-19 Pandemic Fatigue

A third “new” crucial factor that has, undoubtedly, contributed to the third wave of the Covid-19 pandemic in several of the EU Member States was a phenomenon that has been referred to as “Covid-19 pandemic fatigue” that increasingly started to affect a part of the European population, amongst with a lot of young people.⁶¹⁴

While behavioural scientists even question the existence of such a thing as “pandemic fatigue” to begin with,⁶¹⁵ throughout the Covid-19 pandemic, the term has still become a means of justifying a variety of nonsense, from private persons organising forbidden lockdown parties and/or rave protest parties against the Covid-19 containment measures, besides being an excuse to no longer wear face masks where mandated, to encouraging politicians and policymakers to release Covid-19 containment measures much earlier than scientifically or medically justified.

Already in 2020, the WHO even published a brochure on the subject, entitled “Pandemic Fatigue - Reinvigorating the Public to Prevent COVID-19”, in which the phenomenon has been defined as follows⁶¹⁶:

We consider pandemic fatigue as an expected and natural reaction to the prolonged nature of this crisis and the associated inconvenience and hardship. However, it poses a serious threat to efforts to control the spread of the virus. Until a vaccine or effective treatments are available, public support and protective behaviors remain critical for containing the virus. The gains that each nation collectively achieved through lockdowns and other measures – sometimes at high social and economic costs – must be safeguarded.

Although the occurrence of this “Covid-19 pandemic fatigue” had already been reported in the fall of 2020 (hence, during the second wave of the Covid-19 pandemic on the European continent), the phenomenon was said to have even become worse in Q1 2021. Especially after having been subjected to constant confinement for more than a year, while feeling that there was no perspective for this situation to end due to the slow progress of the EU vaccination campaign, a large part of the Europeans were becoming gradually more tired about the whole situation. This Covid-19 pandemic was enforced because in some countries, such as Israel, the United States, the United Kingdom, various Arab (oil) countries …, the Covid-19 vaccination campaigns were proceeding much faster, which created the impression that the EU was running completely behind.

According to the WHO, pandemic fatigue especially may create or enforce a lack of motivation to follow recommended protective behaviours. This was deemed likely to occur gradually over time and to be affected by a variety of emotions, experiences and perceptions. With regard to the Covid-19 pandemic fatigue itself, this was expressed in: (1) a lower perception of the risks posed by the Covid-19 threat, (2) decreasing efforts to stay informed about the pandemic, and (3) an increasing number of people not wanting to follow recommendations and restrictions in a sufficient manner anymore. E.g., previously communicated, effective core messages with regard to sanitary practices such as handwashing, wearing face masks and practising proper hygiene etiquette, besides basic behavioural recommendations, such as keeping one’s physical distance, were no longer seen as effective or necessary. Still according to the WHO, this growing de-motivation was, moreover, considered of being part of a complex interplay of many factors which help determining protective behaviour. Said factors, furthermore, related to individual motivation and capacity, as well as to the opportunities created by the cultural, social, structural and legislative environment. As a result, each of these factors could be either a barrier to, or a driver of, protective behaviour.⁶¹⁷

Several of the individual motivation components were believed to have become strongly impacted by the long duration of the Covid-19 pandemic. First, the perceived threat of the Covid-19 virus gradually decreased as people became more accustomed to its presence within society. This even occurred in cases that the epidemiological data were showing that the risks from Covid-19 were, in fact, increasing. Second, the perceived losses of possibilities and opportunities resulting from the Covid-19 (containment) measures (such as closures of shops and leisure facilities, restrictions on work, travel and social interaction…) were increasing over time, while (some) people started suffering from the long-term personal, social and even economic consequences of the restrictions to a growing extent. Third, for some people, the balance started shifting when the perceived personal and socioeconomic costs of the containment measures started to outweigh the perceived risks of the Covid-19 virus itself. Fourth, and differing from country to country, a need for self-determination and person freedom developed when containment restrictions kept on continuing for long and indeterminant periods of time. This effect was felt more to the extent that the (containment) measures started imposing inconveniences on every daily life or got continually altered in ways over which people had no say or control.⁶¹⁸ Fifth, people became accustomed to the threat Covid-19 posed which led to complacency, implying that people bothered lesser and lesser about (other) people becoming contaminated and/or getting sick. According to the WHO, all these factors contributed an increasing Covid-19 pandemic fatigue.⁶¹⁹

Another possible explanation for the fact that Covid-19 pandemic fatigue happened much more in Europe than in other regions (e.g., Asian countries) may have been the higher degree of individuality—and selfishness—characterizing large sections of the Western population who, e.g., started to question the usefulness of measures concerning a disease to which only (or at least mainly) older and weaker people were succumbing.⁶²⁰

These attitudes had already during the first wave of the Covid-19 pandemic been present in Western countries. Moreover, some of these attitudes had even been deliberately created or stimulated by neoliberal politicians and policymakers who, already as early as April 2020, started advocating that “everything”, ranging from the economy, shops, schools, bars, restaurants … should reopen as soon as possible, and that existing NIPs had to be abandoned, or reduced, as soon as possible. However, it was especially during the second, and later third wave of the Covid-19 pandemic, that Covid-19 pandemic fatigue became a far more widespread phenomenon. It was also then—as of early October 2020—that the WHO itself issued its first Covid-19 pandemic fatigue alert.

In the weeks leading up to the third wave of the Covid-19 pandemic, the impact of Covid-19 pandemic fatigue was believed to have been even worse than ever. Especially the prospect that foreign travel, for many Europeans one of the most important methods of spending one’s summer vacation, would again be severely restricted was believed to be severely demotivating.⁶²¹

Covid-19 pandemic fatigue manifested itself both among (some) EU citizens, expressing itself through a growing personal disobedience to the containment measures, as among part of the EU politicians an policymakers, who started calling for the relaxation of containment measures, and even started initiating decisions to relax them at times when it was clear that they still needed to be enforced.⁶²²

2.4.3.4 End-April 2021: Relaxing the Covid-19 Lockdown Measures

By 30 April 2021, relying on the acceleration of the vaccination campaign to contain new infections, much of continental Europe, once again announced plans for a gradual exit from lockdown and other containment measures over the weeks to follow, as the number of contamination cases and Covid-19 related deaths (again) began to decline. The situation was, in headlines, as follows⁶²³:

• (1) Belgium (with at least one dose of a Covid-19 vaccine administered to 25% of the Belgian population by 30 April 2021) aimed to allow open-air dining in restaurants and bars again by 8 May 2021, with a mandatory 10 p.m. closing time and tables limited to groups of four persons. The reopening of non-essential shops and hairdressers was announced for Monday 3 May 2021.

• (2) Denmark was considering reopening bars, restaurants, cafes, museums, libraries and football stadiums as of the last week of April 2021. At the same time, the country announced that people would need to have a “coronapass”—in the form of a digital certificate—in order to be able to enter such promises.

• (3) France announced that it would start easing Covid-19 containment restrictions as of Monday 3 May 2021, with restrictions on domestic travel to be lifted and high school and university students being allowed to resume classes after a 3-week closure. From 19 May 2021 on, most non-essential shops would be allowed to reopen, as well as museums, theatres and cinemas, concert halls and café and restaurant terraces. The national night-time curfew would be maintained during the hours from 7 p.m. to 9 p.m. as of the same date. The resumption of indoor service in cafés and restaurants was announced for 9 June 2021. Sports halls were announced to reopen, with the curfew ending hour to be extended to 11 p.m., before the curfew would entirely be lifted on 30 June 2021. Major summer events, such as festivals, were announced to be facilitated by a “health passport”. Vaccinated foreign tourists would again be welcomed as of 9 June 2021.

• (4) Germany announced that, given a 12% week-on-week drop in Covid-19 infections and an acceleration of vaccinations, the country’s week-old “emergency brake” measures—including (1) a 10 p.m.–5 a.m. curfew, (2) limiting customers in shops, (3) closures with regard to leisure centres, and (4) restrictions on family contact in areas where infection cases exceeded 100 cases per 100,000 people (i.e. most of the country)—would be lifted earlier than expected.

• (5) Greece announced that it would reopen restaurants and bars on 3 May 2021, after Orthodox Easter, and that it aimed to reopen for fully vaccinated tourists as of 15 May 2021.

• (6) With three quarters of the country’s regions downgraded to the low-risk “yellow” category, Italy announced the reopening of restaurants and bar terraces, museums, theatres and cinemas (at 50% capacity) in most of the country as of Monday 3 May 2021, with a return to indoor dining as of 1 June 2021. However, a 10 p.m. curfew was to remain in place. Swimming pools, gyms, sports events and theme parks were to follow suit as of 1 July 2021.

• (7) The Netherlands lifted the night-time curfew and allowed bars and restaurants to serve on outdoor terraces—with a maximum of two guests per table—between noon and 6 p.m. Shops could again welcome more customers, and individuals were allowed to receive two guests instead of one per 24-h period.

• (8) Poland announced the reopening of shopping centres and museums as of 4 May 2021, with hotels due to reopen on 8 May 2021 and bars and restaurants on 15 May 2021. Domestic service was expected to resume as of 29 May 2021, when theatres and cinemas would also be able to reopen.

• (9) Portugal, which at the beginning of 2021 had experienced the largest increase in cases in Europe, entered the final phase of its relaxation on 1 May 2021, when restaurants and bars were again allowed to remain open until 10.30 p.m. and all sports were allowed to resume. Major outdoor and indoor events were also allowed, albeit with capacity restrictions. Moreover, the reopening of the border with Spain was announced. With 23% of the population vaccinated at least once, schools, shopping centres, non-essential services and restaurants had already been reopening since March 2021.

• (10) Spain aimed to end the national state of emergency on 9 May 2021, by which time its autonomous regions—responsible for implementing the Covid-19 containment restrictions—started ending many measures.

2.5 Covid-19 Response in the United States

2.5.1 The Early Days

On 21 January 2020, an inhabitant of Washington State was reported to be the first person in the United States having contracted Covid-19, after returning from Wuhan on 15 January 2020. The case was by the CDC reported to have been discovered quickly thanks to “overnight polymerase chain reaction testing”. The CDC reacted by deploying a team to help investigate what had happened, including a potential use of contact tracing.⁶²⁴

The CDC also issued a press release on 21 January 2020 that mentioned the following⁶²⁵:

The Centers for Disease Control and Prevention (CDC) today confirmed the first case of 2019 Novel Coronavirus (2019-nCoV) in the United States in the state of Washington. The patient recently returned from Wuhan, China, where an outbreak of pneumonia caused by this novel coronavirus has been ongoing since December 2019. While originally thought to be spreading from animal-to-person, there are growing indications that limited person-to-person spread is happening. It’s unclear how easily this virus is spreading between people.

The patient from Washington with confirmed 2019-nCoV infection returned to the United States from Wuhan on January 15, 2020. The patient sought care at a medical facility in the state of Washington, where the patient was treated for the illness. Based on the patient’s travel history and symptoms, healthcare professionals suspected this new coronavirus. A clinical specimen was collected and sent to CDC overnight, where laboratory testing yesterday confirmed the diagnosis via CDC’s Real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test.

Less than 2 weeks later, on 3 February 2020, the Trump administration declared a “public health emergency” due to the Covid-19 outbreak on American soil. This announcement came only 3 days after the WHO itself had declared Covid-19 a “global health emergency” (with at the time over 9800 confirmed contamination cases of the Covid-19 virus, and over 200 Covid-19 related deaths on a global scale).⁶²⁶

On 13 March 2020, President Donald Trump declared the new “Covid-19” coronavirus a “national emergency”. This decision came with a releasing of billions of dollars in federal funds in order to combat the spread of the disease.⁶²⁷ On the same date, the Trump administration issued a blanket travel ban for non-Americans who had visited one or more of the 26 European countries in the 14 days prior to their date of arrival in the United States. Those travelling from the United Kingdom and the Republic of Ireland were exempt.⁶²⁸

2.5.2 President Donald Trump’s Many Political Shenanigans in (Not) Dealing with the Covid-19 Pandemic

The Covid-19 pandemic became, from the outset, yet another excuse for a lot of political frivolity from the part of US President Donald Trump, who saw the challenges posed by Covid-19 more as an opportunity to bolster his political constituency than as a challenge to develop a responsible strategy to deal with it.

According to Krugman, it initially appeared that President Donald Trump’s mishandling of the emerging Covid-19 crisis was essentially “willful neglect”, i.e. that Trump failed to understand the seriousness of the threat because he did not want to hear about it, in this manner abstaining from action that could have prevented the death of thousands of Americans.⁶²⁹ This probably helps to explain why President Donald Trump first reacted to the Covid-19 progression by calling it a “hoax”, before shortly thereafter claiming, also inaccurately, that the United States had already completely contained the Covid-19 disease.⁶³⁰

However, it quickly became apparent that President Donald Trump’s initial negligence in responding to the threat posed by Covid-19 was not simply recklessness, in that, already in early February 2020, Trump had been fully aware of the characteristics of Covid-19.⁶³¹ From this, it follows that, from the early outset, President Trump began to deliberately diminish a disease that he knew was both deadly and easy to spread.⁶³²

Throughout the Covid-19 crisis, credible sources have speculated that President Trump wanted to downplay the health crisis for fear that untoward news would hurt the US economy in general, and the US stock markets more specifically.⁶³³

However, Paul Krugman’s assessment of President Trump’s (initial) response to the Covid-19 crisis is much less willing to accept the existence of such noble motivations⁶³⁴:

The bottom line is that it’s wrong to say that Trump mishandled Covid-19, that his response was incompetent. No, it wasn’t it was immoral, bordering on criminal.

According to Saad-Filho, the US reaction was, in this extreme way, determined by⁶³⁵:

Donald Trump’s narcissism, crude electoral calculations and dysfunctional administration engaged in successive scrapes against China, the WHO, journalists, civil servants, state governors and assorted politicians in order to distract attention from the President’s imbecility, callousness and disregard for “the Other.

Looking at how US Republican politicians more in general reacted to the onset of the Covid-19 pandemic in their respective home states, one can but see a great deal of “scientific denial”. According to Paul Krugman, some US Republicans in this regard even went “full Trump”: (1) questioning the usefulness of face masks, and (2) both encouraging and initiating potential super-spraying events (many of which have been organized, or initiated, by President Donald Trump himself).⁶³⁶

Trump’s toxic relationship with and interaction with Dr. Anthony Fauci, one of America’s leading infectious disease experts,⁶³⁷ also illustrates President Donald Trump’s aversion to science. In an interview with the New York Times after Donald Trump left office, Dr. Fauci explained that his time of advising President Donald Trump’s coronavirus response team was complicated by Trump’s tendency to listen to the advice of his unqualified friends,⁶³⁸ rather than the one of qualified experts, as well as by his aversion to being contradicted or challenged.⁶³⁹

Paul Krugman, however, blames not only President Donald Trump’s disastrous leadership and aversion to science for America’s adverse reaction to Covid-19, but also Ayn Rand—or, more generally, what he describes as “libertarianism gone wrong, a misunderstanding of what freedom is”.⁶⁴⁰

To fully appreciate the implications of this statement, the importance of Ayn Rand in developing the philosophical backbone of neoliberal ideology cannot be overemphasised.

Ayn Rand is the author of several novels, such as “Atlas Shrugged”, but she also wrote non-fiction works, which she claimed to be philosophical in nature. Through her books “The Virtue of Selfishness”⁶⁴¹ and “Capitalism: The Unknown Ideal”,⁶⁴² Rand has in particular attempted to elevate selfishness and self-determination to the highest moral values. Thus, when comparing Rand’s writings to earlier philosophical and religious systems, such as Christianity, Rand’s works have contributed strongly to a reversal of values that still permeates neoliberal politics and economics to this very day.⁶⁴³ It is not surprising that Rand was also one of the strongest advocates of the doctrine of “voluntary association” as the sole principle that should determine private relationships.⁶⁴⁴

A first example of the negative impact of Ayn Rand’s neoliberal and semi-philosophical thinking on politics and economic policy (as indicated by Paul Krugman), is the strong influence Rand has had in the past on a wide variety of American policy makers. A notable example has been Alan Greenspan, the longest serving former chairman of the US Federal Reserve (1987–2006). Greenspan’s monetary policy (and consequently the monetary climate he created of “too easy money creation”, based on “too easy credit”) was strongly influenced by Rand, who in this manner indirectly contributed to the severe financial and economic crisis of 2007–2008. Rand’s famous novel “Atlas Shrugged” also has many politicians among its admirers, including former vice-presidential candidate Paul Ryan, who is known to have cited Rand’s novel as one of his main inspirations for entering politics, and to have even distributed copies of Rand’s books to his interns. In all of this, Rand herself seems to have been well aware of her enormous influence on many (American) policymakers, where she has, e.g., spoken of the three A’s who determined the history of philosophy, namely Aristotle, St. Augustine and herself...⁶⁴⁵

And so, once again, in 2020, the way Republican policymakers across the United States would deal with Covid-19 was based on Rand’s libertarian rhetoric—amounting to a lot of idle rhetoric about “freedom” and “personal responsibility,” all central themes in the works of Ayn Rand and the likes. Even politicians still willing to say that people should wear face masks and avoid indoor gatherings were reluctant to use their political influence to impose rules to this effect, insisting that it should rather remain a matter of individual choice.⁶⁴⁶

Notwithstanding the above, Paul Krugman does not believe that opposition to the Covid-19 containment measures on libertarian grounds has merely been the result of a deeply rooted cultural phenomenon.⁶⁴⁷ For him, the anti-mask agitation was not just about (individual) freedom, or individualism, or culture, but rather was a method of cultivating and “expressing political allegiance”, driven by President Donald Trump and his allies themselves.⁶⁴⁸ Responding to the question of why make a partisan issue out of what should be a simple public health policy, Paul Krugman expressed his belief that the obvious answer has been that face mask refusal was just one of many efforts by an amoral politician to salvage his then troubled presidential campaign.⁶⁴⁹

All the while, Trump’s policy (or lack of it) was in total denial that controlling a pandemic primarily required individuals to change their behaviour—in the case of Covid-19 by wearing face masks and refraining from hanging out in indoor public spaces.⁶⁵⁰

All (scientific) knowledge was soon completely denied when, shortly after the initial outbreak of the Covid-19 pandemic in the late spring of 2020, the Trump administration (and its allies in other countries around the world) pushed for a rapid reopening of the economy, deliberately ignoring the warnings of epidemiologists and other experts. This was coupled with a continued and pathological opposition to obvious precautions such as the wearing of face masks, with ongoing discussions about freedom rights to justify the refusal to wear them (even inciting real culture wars which, not only in the United States, but also on the European continent, have continued ever since).⁶⁵¹According to Krugman, as far as wearing masks reminded people that the Covid-19 pandemic was still ongoing, President Trump’s opposition to the practice also wanted the American people to forget this inconvenient fact.⁶⁵²

Republican politicians have also tried to mitigate the Covid-19 crisis by ceasing to release Covid-19 contamination and death figures and by simply stopping Covid-19 testing. This (criminal) strategy was, e.g., deployed by Florida in late April 2020. At that time, state officials simply stopped publishing the list of Covid-19 related deaths compiled by Florida’s medical examiners, which had sometimes revealed a higher number of Covid-19 related deaths than published by the state. This withholding of information came at a time when the number of Covid-19 deaths in Florida was on the rise and when state officials were in discussions about when and how to reopen their economy.⁶⁵³

One of Krugman’s other points has been that the willingness to reopen the economy as early as the beginning of May 2020 did not reflect a considered assessment of the “risks and rewards”. Instead, it was to be seen as an exercise in “magical thinking”. President Trump and conservatives, in general, seemed to believe that if they pretended that Covid-19 was not a permanent threat, it would somehow (magically) disappear, or at least that people would forget about it. Hence Trump’s war on face masks, which helped limit the pandemic, but which, even in an explicitly visual way, constantly reminded people that the Covid-19 virus was still around.⁶⁵⁴

Robert Reich made the following overall assessment of Trump’s intention in May 2020 to reopen the economy at the expense of public health⁶⁵⁵:

The first responsibility of a president is to keep the public safe. But Donald Trump couldn’t care less. He was slow to respond to the threat, then he lied about it, then made it hard for states – especially those with Democratic governors – to get the equipment they need.

Now he’s trying to force the economy to reopen in order to boost his electoral chances this November, and he’s selling out Americans’ health to seal the deal. This is beyond contemptible.

Paul Krugman, moreover, shared his view that, when looking at the failure to contain the Covid-19 pandemic in the United States, it is remarkable how “top-down” everything has been. E.g., the protests against the containment measures were not spontaneous and popular affairs. Instead, many of these were called for or organised and coordinated by conservative political activists_, some even with close ties to the Trump administration itself, and in many cases funded in part by right-wing billionaires. Moreover, the rush to reopen in Republican states was less a response to popular demand, than a case of Republican governors following the lead of President Donald Trump. The main driving force behind the economic reopening was the Trump administration’s desire to achieve significant job gains by November 2020, so that it could boast about its economic successes during the presidential election campaign.⁶⁵⁶

One of the most surprising things in all of this, still according to Paul Krugman, is that President Donald Trump and his allies did not seem to have thought through what to do if the overwhelming expert opinion was right, when their gamble to ignore the Covid-19 pandemic would appear not to work.⁶⁵⁷

And so, under this Republican leadership, the United States was preparing for disaster.

2.5.3 America’s Withdrawal from the WHO

Before outlining the disastrous situation resulting from the Trump administration’s handling of Covid-19 during the March-December 2020 period (as supported by the policies of various Republican governors in red states), it is worth mentioning that, on 29 May 2020, President Donald Trump pulled another unexpected stunt when, in the midst of the worst pandemic the world had faced in over a century, he publicly announced that the United States would withdraw from the WHO, the only international organisation dealing with international health crises such as pandemics. This unexpected move was thought to be a wild attempt to look for a scapegoat for blaming the Covid-19 crisis.

According to Sridhar and King, at the time, the WHO had already undertaken several attempts to address the Covid-19 pandemic. (Cf. Sect. 1.1.1.) After China had reported the outbreak of Covid-19 on its territory to the WHO country office on 31 December 2019, the WHO had immediately published a bulletin to warn of the new disease. While new data were emerging, the WHO had also helped develop test kits that could be sent to areas of the world without laboratory capacity. The WHO also made attempts to encourage the sharing of data from China, so that other countries could learn from the Chinese experience. Furthermore, on 30 January 2020, the WHO had declared Covid-19 a public health emergency of international concern, a strong warning that the Covid-19 virus was on its way, and that countries should have started preparing.⁶⁵⁸

By 24 February 2020, the WHO mission to China announced its findings on the epidemiology of Covid-19 and China’s response. At the same time, the WHO sent a clear message to prioritise the following measures and strategies for fighting the disease: (1) testing, (2) contact tracing, (3) isolation of identified carriers and their (traced) contacts, (4) physical removal, if necessary (including quarantine measures), (5) protection of health care workers by, at least, providing them with adequate protective equipment, and (6) increasing hospital capacity.⁶⁵⁹

All these measures did, however, not correspond well to the Trump administration’s views on how to (not) handle the Covid-19 crisis. Moreover, from the outset of the Covid-19 pandemic, President Donald Trump had been highly sceptical of the way the WHO had cooperated with China, and of the WHO’s assessment of how China had handled the Covid-19 pandemic. These factors, ultimately, triggered President Trump’s decision to withdraw from the WHO.⁶⁶⁰

At the time, the United States was, obviously, one of the largest contributors of “extra-budgetary funds”, which accounted for 80% of the WHO’s total budget. Although other organisations, such as the Bill and Melinda Gates Foundation and the European Commission, were also major contributors to institutions such as the WHO, the financial gap left by the US withdrawal would have been difficult to fill.⁶⁶¹

On 7 July 2020, the same day the United States had reported three million Covid-19 infections, it began its effective withdrawal from the WHO. The Trump administration also notified the UN of its decision. However, the withdrawal was not to take effect until 2021, and would then be reversed by President Joe Biden.⁶⁶²

2.5.4 Practical Handling of the Covid-19 Crisis in the United States by the Trump Administration

2.5.4.1 The Missing First Six Weeks

According to Pilkington and McCarthy, the occurrences on 20 January 2020 are in many ways central for understanding what went wrong in the United States at the outbreak of the Covid-19 pandemic. According to these authors, 20 January 2020 was the day on which a 35-year-old man living in Washington State had just come back from a visit to his family in Wuhan (China) and was diagnosed as the first man living in the United States with the Covid-19 disease.⁶⁶³ (Cf. already Sect. 2.5.1.) At the same day, the first case of Covid-19 was also detected in South Korea. According to Pilkington and McCarthy, the confluence was striking, but that was where all other similarities between the two countries ended. In the 2 months afterwards, the response of the United States and South Korea to Covid-19, could not have been more opposite.⁶⁶⁴ South Korea was reported to have acted in a quick and determinant manner in order to detect, isolate and virtually eliminate the Covid-19 virus on its territory, and, in doing so, largely succeeded in containing the Covid-19 crisis. In this manner, South Korea did what many other Asian countries have done as well (cf. Sect. 2.4.2.4.3.). By contrast, in the words of Pilkington and McCarthy, the United States, in the best neoliberal tradition of “laissez-faire, laissez-passer”, “dithered and procrastinated”, quickly became “mired in chaos and confusion”, and got “distracted by the individual whims of its leader”, soon to be faced with a health crisis of catastrophic proportions.⁶⁶⁵ The United States, moreover, in essence did what many other Western countries managed to do, more precisely giving the Covid-19 virus all opportunity to spread over their territories, which makes the difference in reaction between Asian and Western countries all the more striking. (Cf. Sect. 2.4.2.4.)

According to Terhune et al., within a week after the confirmation of the first cases in each of the two countries, South Korea’s authorities had urged 20 private enterprises to ask them to develop a test for the Covid-19 virus as soon as possible. Only a week later, the first of these diagnostic tests was approved and went into action, which allowed South Korea to quickly identify Covid-19 contaminated persons who could then be quarantined in order to contaminate the Covid-19 virus. According to the same authors, after about 357,896 tests, the country had to a bigger or lesser extent contained (the first wave of) the Covid-19 outbreak on its territory. By Friday 27 March 2020, a mere 91 new cases of Covid-19 had been detected among a total population of more than 50 million people.⁶⁶⁶

The story, while probably more exciting to tell, did not go so well in the United States. Two days after Washington state had been confronted with its first Covid-19 case, US President Donald Trump, in the best neoliberal tradition of laissez-faire, laissez-passer, boasted on CNBC that the United States had the virus totally under control, that there was only one case of “someone from China”, and that everything would turn out fine. A week later, the Wall Street Journal published an opinion piece from the hand of two former senior health policy officials in the Trump administration, Luciana Borio and Scott Gottlieb, under the headline “Act Now to Prevent an American Epidemic”. The two authors of said opinion piece described a scenario of what needed to be done instantly in order to prevent a massive public health disaster. This boiled down to one basic piece of advice: Cooperate with private market players to develop a “rapid, easy-to-use diagnostic test”—or, phrased differently, follow the example of what South Korea had been doing. However, it was not until February 29, 2020, more than a month after the abovementioned opinion piece had been published, and by then nearly 6 weeks after the first case of Covid-19 had been confirmed in the United States, that the Trump administration would finally start to take this advice seriously. By that date, US laboratories and hospitals were finally given the permission to start conducting their own Covid-19 tests. Afterwards, things went surprisingly fast: By 28 March 2020, a total of Covid-19 contamination 86,012 cases had been confirmed in the United States, gradually putting the country at the top of the global Covid-19 pandemic rankings, even though on the other side of the Atlantic, the EU and its Member States, besides the United Kingdom, were doing their utter best to ensure that Covid-19 was as rapidly spreading throughout Europe as well (cf. Sect. 2.4.).⁶⁶⁷ Of the 86,012 (official) cases of Covid-19 as of 28 March 2020, more than a quarter were reported to be in New York City, with very high numbers in New Orleans as well. On a national scale, 1301 people had died because of Covid-19. Most worryingly, the curve of infection and death was still rising steeply, with no sign of a flattening of the curves that ultimately had spared South Korea.⁶⁶⁸

Pilkington and McCarthy have argued that the four to six missing weeks serve as a warning of the potentially disastrous effects of failing political leadership.⁶⁶⁹ Ron Klain, who had led the battle against the Ebola virus back in 2014, was reported of having declared during a Georgetown University panel at the time, that the response of the United States towards the outbreak of the Covid-19 virus on its territory was bound to set the worst example on how to react to a pandemic. Klain, moreover, was reported of having expressed his belief that the response deployed by the Trump administration had been “a fiasco of incredible proportions”.⁶⁷⁰

Pilkington and McCarthy similarly quoted Jeremy Konyndyk, who had led the United States’ response to various disasters of international proportion in the period between 2013 and 2017, of having shared his viewpoint that the response to Covid-19 by the Trump administration to the outbreak of Covid-19 was “one of the greatest failures of basic governance and leadership in modern times”.⁶⁷¹ According to Konyndyk’s analysis as quoted by Pilkington and McCarthy, the Trump administration had been in possession of all the known facts about Covid-19 by the end of January 2020 needed for acting in a more responsible manner. Instead, Trump repeatedly responded by (1) downplaying the seriousness of the Covid-19 threat, (2) putting the blame on China for what he started referring to as the “China virus”, and (3) continuing to falsely insist that the partial travel bans that he had resorted do with regard to travelling to and from China and Europe were all that was needed to deal with the Covid-19 pandemic.⁶⁷²

Pilkington and McCarthy, furthermore, quoted William Schaffner, an infectious disease specialist at Vanderbilt University Medical Centre, in whose viewpoint the complete lack of immediate, massive testing largely failed to adequately address the Covid-19 threat, as it did not allow the United States to define the extent of the spread of the Covid-19 virus within its borders.⁶⁷³

As there had at the time been hardly test kits available, the US CDC had initially kept a tight rein on testing. This had basically created a huge bottleneck. This testing disaster had at the same time been one of the first signs that the Trump administration was faltering, as the health emergency because of Covid-19 gained momentum all over the United States (see also Sect. 5.2.2.6.).⁶⁷⁴

The Trump administration continued its remarkable early efforts to combat Covid-19 by creating a “Special Coronavirus Task Force” on 29 January 2020. Trump, however, immediately handed the post of presiding this Task Force to Vice President Mike Pence. Pence, in his own turn, quickly named Deborah Birx as “coronavirus response coordinator”. Shortly after, another federal emergency agency named “Fema” began to take over key policy domains of dealing with the pandemic. And to add to all this confusion, Jared Kushner, the president’s son-in-law, created a shadow team that to an increasing intent made it look like it was in lead. As a result, according to Pilkington and McCarthy, there was no central point of responsibility, while no one seemed to want to claim ownership of the problem.⁶⁷⁵

To make things even worse, amidst all this organisational chaos, the day-to-day responses for dealing with the Covid-19 crisis often came directly from Donald Trump himself, albeit via social media only. With, according to Pilkington and McCarthy, more concerned about the impact of the Covid-19 pandemic on the New York Stock Exchange, the US President consistently, and in full accordance to the neoliberal principle “laissez-faire, laissez-passer”, downplayed the scale of the crisis. E.g., on 30 January 2020, on the date that the WHO had declared Covid-19 a global emergency (cf. Sect. 1.1.1.), Trump had tweeted the following⁶⁷⁶:

We only have five people. Hopefully, everything’s going to be great.

On 24 February 2020, Trump made a new false claim that the Covid-19 crisis was largely under control in the United States. However, on 25 February 2020, Nancy Messonnier, the CDC’s top respiratory disease official, decided to tell the American people the truth by warning that the impact of Covid-19 on daily life could become severe. Still according to Pilkington and McCarthy, President Trump was reportedly so enraged by Mrs. Messonner’s action, and especially by the impact of her message on the stock exchange prices, that he immediately called Messonner’s boss, Health and Human Services Secretary Alex Azar, to confront him about the matter.⁶⁷⁷

And so it was: In the wake of this initial “testing (and tracing) disaster”, there came a “personal protective equipment (PPE) disaster”, soon to be followed by a “hospital bed disaster” (especially with regard to ICU-beds), and then by a “ventilator disaster”—all of which US hospitals faced huge shortages of while there were no federal or state plans in place to help to procure them. (Cf., furthermore, Sect. 5.3.2.2.)

The solution to these shortages that the US President came up with mid-March 2020 may very well be as historic as any of his other early responses to the Covid-19 crisis, and can certainly be seen as one of the textbook responses of neoliberal thinking. In a tweet message that will, purportedly, stand alongside 20 January 2020 as one of the most telling actions in Covid-19 history, Trump was reported of having formulated the following advice⁶⁷⁸:

Respirators, ventilators, all of the equipment – try getting it yourselves.

By 27 March 2020, the Trump administration finally managed to provide 400 ventilators to New York hospitals. However, about 30,000 were needed. Meanwhile, US hospitals did their best to manage the flood of hospitalizations with severe Covid-19 symptoms while lacking the most basic equipment and material to both fight the Covid-19 disease as to protect their medical staff from getting contaminated themselves.⁶⁷⁹

We shall return to this in Chap. 5.

2.5.4.2 March 2020 to April 2020: On Proclaiming Covid-19 a Hoax, Advising the Use of Hydroxychloroquine, Disinfectant, and UV Light, and Saying It Will All Go Magically Away

2.5.4.2.1 Overview of the Trump Administration’s Health Policy of March 2020

Because of President Donald Trump’s idiosyncratic approach to the Covid-19 pandemic, it would soon hit the United States extremely hard. Due to Trump’s policy decisions (or lack thereof) in the first few weeks of Covid-19’s presence on American soil, the United States would soon have the highest number of Covid-19 contamination cases and Covid-19 related deaths in the world.⁶⁸⁰

This was all the more dramatic because the resurgence of Covid-19 was both entirely predictable and had, moreover, also been effectively predicted by many US virologists and other experts.⁶⁸¹ Indeed, as soon as the US President Donald Trump had in early May 2020 declared that the United States would “transition to greatness”—referring to a hasty and premature reopening of the American economy despite a still-creeping pandemic—epidemiologists had rightly warned that this would trigger a new wave of Covid-19 infections.⁶⁸² Similar warnings from economists, such as Paul Krugman and Joseph Stiglitz, that a relaxation of social distancing and containment measures could lead to a brief period of job growth, but that these gains would be short-lived, as a premature reopening of the economy would ultimately fail in economic terms as well, were similarly completely ignored.⁶⁸³

On 16 March 2020, President Donald Trump, moreover, began referring to Covid-19 as the “China virus” which led to an increase in anti-Asian hashtags on social media and a rise in hate crimes that has not stopped since.⁶⁸⁴

One of the remarkable consequences of President Donald Trump’s aversion to science has, furthermore, been that, very soon after Covid-19 arrived in the United States, a debate was launched around the Western world about some of Covid-19’s alternative medical treatments, such as the use of the malaria drug “hydroxychloroquine”. (Cf. Sect. 2.5.4.2.2 and Sect. 9.3.2.10.) Unfortunately, this debate also diverted much of the attention from more effective methods of dealing with the Covid-19 crisis, such as NPI’s (e.g., face masking wearing and hygiene and social distancing measures). The assessment, since, has been that Trump’s utter disregard for science that emerged from this advice—as well as from cuts to global and national health programmes and public health agencies—severely hampered the response to the Covid-19 pandemic, causing tens of thousands of unnecessary deaths (as well as having jeopardised advances against HIV and other diseases).⁶⁸⁵

On the same date, CMS—in full: “the Centres for Medicare and Medicaid Services”—expanded its so-called “telehealth rules”. This expansion allowed for the use of telehealth procedures during the Covid-19 pandemic, especially in order to protect elderly patients from becoming exposed to the Covid-19 virus. This relaxation allowed Medicare to cover telehealth medical visits in the same manner as regular in-person visits.⁶⁸⁶

Just two days later, on 19 March 2020, California became the first state to issue a stay-at-home order. This required all Californian residents to remain in their homes, except to get to an essential job, or to make essential purchases. The order also required health systems to give priority to the sickest people.⁶⁸⁷

But a week later, on 26 March 2020, the US Senate passed the “Coronavirus Aid, Relief, and Economic Security (CARES) Act”, which provided USD 2 trillion in aid to hospitals, small businesses, states, and local governments, as well as eliminating the Medicare sequester from 1 May to 31 December 2020.⁶⁸⁸ Shortly thereafter, the US House of Representatives approved the CARES Act, with soon thereafter Trump signing it into law.⁶⁸⁹ We shall come back to this later (cf. Sect. 4.4.2.).

2.5.4.2.2 The Political Debate on Hydroxychloroquine

Meanwhile, President Trump had not forgotten about hydroxychloroquine, which caused the FDA on 30 March 2020 to issue a so-called “emergency use authorization” (EUA) for “hydroxychloroquine sulphate and chloroquine phosphate products”, to be donated to the Strategic National Stockpile and hospitals in order to treat patients infected with Covid-19.⁶⁹⁰

On April 8, 2020, President Donald Trump posed the question “What do you have to lose?” when he touted the malaria drug “hydroxychloroquine” and the related drug “chloroquine” as possible treatments for Covid-19. Combined with an antibiotic, azithromycin, this drug cocktail was recommended as an early candidate to avoid hospitalisation or death due to Covid-19. The US President Trump’s promotion of this cocktail, despite known cardiac risks for some patients, soon prompted the American Heart Association, the American College of Cardiology and the Heart Rhythm Society to jointly warn that these drugs were not suitable for everyone.⁶⁹¹ (Cf., furthermore, Sect. 9.3.2.10.)

The marketing authorization (EUA) for hydroxychloroquine was afterwards to be cancelled (except for patients participating in clinical trials) approximately two and a half months later, on 15 June 2020, following reports of heart rhythm disturbances in some patients.⁶⁹²

Incidentally, the advice to use hydroxychloroquine as a drug for treating Covid-19 was not the only strange medical advice from the part of President Donald Trump. On 23 April 2020, the US president even more surprised the attendants to a press conference, when he suggested that people could be injected with a disinfectant to cure a Covid-19 infection. At the press conference, the US President had dealt with new government research into how the Covid-19 virus reacts to different temperatures, climates and surfaces, adding his own, following comment⁶⁹³:

And then I see the disinfectant, where it knocks it out in a minute. One minute! And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that. So, that, you’re going to have to use medical doctors with. But it sounds interesting to me.

The US President also came up with the idea of treating Covid-19 patients with ultraviolet (UV) light in order to remove the Covid-19 contamination. The US President had, reportedly, asked Bill Bryan, then Under Secretary of Homeland Security for Science and Technology, the following questions⁶⁹⁴:

So I asked Bill a question that probably some of you are thinking of, if you’re totally into that world, which I find to be very interesting. So, supposing we hit the body with a tremendous – whether it’s ultraviolet or just very powerful light – and I think you said that that hasn’t been checked, but you’re going to test it.

(…)

And then I said, supposing you brought the light inside the body, which you can do either through the skin or in some other way, and I think you said you’re going to test that too. It sounds interesting.

While Dr. Deborah Birx, the at the time coordinator of the Trump administration’s Covid-19 task force response, had remained silent when the US president had made all of these curious statements, soon afterwards social media erupted in outrage against the US president. E.g., several doctors began to warn the American public against consuming or injecting disinfectant, or using UV light, and a major manufacturer of household cleaners explicitly urged users not to inject its products into their bodies. Doctors also pointed out that UV light is “a type of invisible radiation that can penetrate and damage skin cells”, and that “overexposure can cause skin cancer”.⁶⁹⁵

2.5.4.3 May 2020 to June 2020: Reopening the Economy, While Facing Rising Figures

After Trump had first, briefly, played with the idea of reopening the US economy in time for Easter Sunday 2020, the Trump administration then began issuing broad guidelines on “how people could return to work, church, restaurants and other places”. This plan of the Trump administration to reopen the economy was based on the concept of “trigger criteria”, whereby states or metropolitan areas would have to reach benchmark criteria in reducing the number of Covid-19 contamination cases and Covid-19 related deaths, before being allowed to take a next, specific step towards reopening.⁶⁹⁶ (Cf., furthermore, Sect. 7.10.)

On 12 May 2020, Dr. Anthony Fauci, MD, testified before the US Senate that the then officially published US death toll of 80,000 was, most likely, underestimated. Dr. Fauci also warned against the relaxation of containment measures. Dr. Fauci, moreover, announced that he was “cautiously optimistic” that a Covid-19 vaccine would be effective and could already be achieved within 1 or 2 years.⁶⁹⁷

On May 28, 2020, the CDC declared that the surpassing of 100,000 deaths was a “sobering development and a heart-breaking reminder of the terrible toll of this unprecedented pandemic”. At the same time, the CDC urged Americans to continue adherence to local and state containment and sanatory measures, such as (1) social distancing, (2) good hand hygiene, and (3) face mask wearing in public.⁶⁹⁸ Around the same time, a “Statista survey” conducted from 23 March 2020 to 31 May 2020 found that US adults were consistently less satisfied with their government’s response to Covid-19 than e.g., their German and British counterparts.⁶⁹⁹

Less than 2 weeks later, on 10 June 2020, the number of confirmed cases of Covid-19 in the United States reached the number of two million, while new contamination cases continued to rise in 20 states.⁷⁰⁰ A study published in the journal “Science Translation Medicine” on 22 June 2020 even suggested that 80% of Americans who had been dealing with influenza-like symptoms in March 2020, had in fact been infected with Covid-19. According to this research, if a third of these patients had sought testing for Covid-19, this could have accounted for 8.7 million Covid-19 contamination cases.⁷⁰¹

On 30 June 2020, in an appearance before the US Senate Committee on Health, Education, Labor and Pensions, Dr. Fauci warned that while the daily number of new contamination Covid-19 cases in the United States was around 40,000 at the time, that number could soon reach 100,000 new contamination cases per day, given the trajectory of the Covid-19 epidemic that was then prevalent.⁷⁰²

2.5.4.4 Summer 2020: New Signs of Trouble

On 2 July 2020, in light of a growing number of contamination cases across the United States, several states, including California and Indiana, announced that they were postponing, or cancelling, plans to reopen their economies. On the same date, New Mexico extended an existing public health emergency order until 15 July 2020, and also introduced a USD 100 fine for those failing to comply with the face mask wearing requirement.⁷⁰³

In May 2020, the states with the highest Covid-19 contamination numbers among non-elderly adults without insurance, were Florida, Texas, Oklahoma, Mississippi, North Carolina, South Carolina, and Georgia. As of 12 July 2020, these states also reported the highest number of new Covid-19 contamination cases per 100,000 people.⁷⁰⁴

On 16 July 2020, the United States reported a record of 75,600 new contamination cases of Covid-19 in a single day, thus breaking a record that had only been a week earlier.⁷⁰⁵

While still only a presidential candidate, Joe Biden called on 13 August 2020 for all US governors to require their citizens to wear masks whenever they were to go out in public until November 2020. Biden also announced that that he would make this practice mandatory if elected. At that time, there were 165,000 American Covid-19 related deaths. It was, furthermore, estimated that a face mask wearing requirement would save 40,000 lives during the months to follow.⁷⁰⁶

On 28 August 2020, it was, furthermore, made public that a 25-year-old man from Nevada had been reinfected with Covid-19 in May 2020, after having before recovered from a mild case of Covid-19 in April 2020. This was the first reported case of Covid-19 reinfection in the United States. The second such reinfection occurrence resulted in a much more severe case, requiring hospitalization and oxygen. A full review of this case was published in “The Lancet Infectious Disease Journal” in October 2020.⁷⁰⁷

2.5.4.5 August 2020: The Sturgis Motorcycle Rally

It is incomprehensible, to say the least, that an event of such magnitude as the “Sturgis Motorcycle Rally”, with participants from every possible region of the United States, could still be taking place in mid-August 2020, when the Covid-19 pandemic was raging around the world, and the United States itself ranked as one of the hardest hit countries on Earth.⁷⁰⁸ As a result, during the summer of 2020, the Sturgis motorbike rally became a major spreading event (comparable to the return of tourists from the Ischgl ski resort in Europe; cf. Sect. 2.4.1.2.).

Dave et al. have described the policy decisions that resulted in The Sturgis Motorcycle Rally becoming one of America’s main spreading events in detail. Their description of the events has largely been used for the explanation in this section. First, the absence of containment measures in South Dakota at the time, amongst which a lack of rules containing a maximum crowd limit and of a face mask requirement, had made it impossible for the city of Sturgis to prevent the Sturgis Motorcycle Rally to begin with. Second, when the Sturgis City Council had consulted with the South Dakota state government about its ability to restrict, or revoke, camping permits with regard to nearby campgrounds where most of the rally attendees would be staying, this request had simply been denied. As a result, in April 2020, the Sturgis City Manager and City Council reached the conclusion that it was unavoidable that people would travel to Sturgis in large numbers, even in case the rally would have been cancelled. In light of this insight, the City Council decided to allow the event to go through, while only imposing some minimal requirements. Third, although the city did its best to take precautions, these were not commensurate given the size of the event, the number of people attending and the wide variety of activities, both in numbers as in nature, that had been announced. E.g., in order to prepare for the arrival of people who would be attending the festival, the city of Sturgis had taken the decision that all Rally workers and emergency staff had to be tested for Covid-19 on a daily basis. The city moreover resorted to a variety of other preventive measures, such as: (1) stockpiling personal protective equipment (PPE), (2) donating such PPE to local businesses that needed it, (3) disinfecting restrooms and pavements, and (4) making hand sanitizer dispensers available in all public areas of the city. In addition, the city increased hospital availability, with a mandate being issued to expand local ICUs with an additional 500 ICU beds to be available within 48 h, if needed. The city also announced that, after the rally, access to low-cost testing would be made available to all local residents and business owners. But no similar testing and tracing or containment measures were taken (or even contemplated) with regard to the influx of visitors coming from all over the United States.⁷⁰⁹

According to Dave et al., the Sturgis Motorcycle Rally was eventually held from 7 to 16 August 2020, thus lasting for 10 days, with pre-rally events already starting on 3 August 2020. The estimated number of participants was 462,182. The Rally included the following events and activities: (1) motorcycle rides and races (including drag racing, motocross and motorbike racing), (2) motorbike shows, (3) poker tournaments, (4) boxing matches, (5) exhibits, (6) contests, (7) all kinds of vendors (including tattoo artists, people selling Rally merchandise, motorbike washes, and sales of clothing), and (8) musical events (including concerts, disc jockeys, and dancers). Over 30 entertainment groups were reported to perform or organise events over the time period of the festival. These venues were, moreover, held both indoors and outdoors. Most of these events and activities were located in Meade County, but also included bars on Main Street in Sturgis. There were, moreover, campgrounds that were made available outside the city limits, such as the “Buffalo Chip”. As of 3 August 2020, Buffalo Chip had also hosted dozens of events which took place every day throughout 16 August 2020. One of the highlights of these performances was a headlining performance by the band “Smash Mouth”. Face mask wearing was imposed on the backstage crew during the concerts. However, concert attendees were only required to have a face mask in their possession upon entering the premises. Bars and restaurants were open during the entire time of the events, with a possibility of consuming or dining indoors. Some owners even announced that they remained open for 24 h per day. Liquor shops reported an increase in sales in Sturgis up 27% compared to the previous year. This may have been representative of a less risk-averse participant crowd, given that attendance was, moreover, down 7.5% compared to the previous year, indicating that fewer people had still managed to consume more alcohol.⁷¹⁰

By the end of the Rally, public health officials expressed their concerns about the likely contamination effects of the Rally, not only in and around Sturgis itself, but also in the residential counties of those who had attended the event and then went back home afterwards.⁷¹¹

Dave et al., subsequently, found that the Sturgis rally had indeed led to a spread of Covid-19 cases. This had, moreover, been the case both on a local level, as well as in the home counties of people who had attended the Sturgis rally and had then travelled back home afterwards. For the state of South Dakota as a whole, it appeared from the research of Dave et al. that the Sturgis event had increased Covid-19 contamination cases from 3.6 to 3.9 cases per 1000 population as of 2 September 2020. This represented an increase of over 35% from the 9.7 cases per 1000 people in South Dakota, on 31 July 2020. In addition, the spread of infection was even felt on a national level, depending on the influx of visitors from each state who had attended the event. Dave et al., e.g., found that outside the state of South Dakota itself, US counties with relatively large numbers of visitors to the Rally would be experiencing much larger increases in Covid-19 contamination cases than US counties with no visitors. Measured after about 2 weeks after the Rally had ended, the case rate for these US counties from which many visitors had attended the Rally, had increased from 6.4% to 12.5%. According to said researchers, these estimates indicated a total of 112,195 to 263,708 additional cases in these US counties because of a large number of their population having attended the Sturgis Motorcycle Rally. When adding the number of new cases in South Dakota itself because of the Rally, the total number of cases amounted between 115,283 and 266,796. In addition, it appeared from the research of Dave et al. that US counties with the highest number of Sturgis attendees, had witnessed an increase of Covid-19 contamination cases from 6.4 to 12.5% after the Sturgis event, compared to US counties from where there had been no visitors to the Rally. Dave et al., furthermore, made an estimation of the total health cost: from this, it appeared that The Sturgis Motorbike Rally had generated substantial public health costs, ranging between USD 3.8 to USD 8.7 billion.⁷¹²

During the period August-September 2020, the MDH—short for “the Minnesota Department of Health”—made its own investigation of the outbreak of Covid-19 contamination cases to be associated with The Sturgis Motorcycle Rally, especially among Minnesota residents. From this research, it appeared that there were 51 primary Covid-19 contamination cases directly associated with the event. There were, moreover, a further 35 secondary or tertiary Covid-19 contamination cases identified among family members, social and occupational contacts. This brought the total of Covid-19 contamination cases to 86 cases. Moreover, four of these patients had to be hospitalised, and one these had died because of Covid-19. According to this same research, approximately one-third (34%) of the 87 Minnesota counties had at least experienced one primary, secondary or tertiary Covid-19 contamination case associated with The Sturgis Motorcycle Rally. Genomic sequencing, furthermore, confirmed these associations with the Rally. According to Fireston, these results were of great importance in the subsequent recommendations regarding containment measures, such as: (1) face mask wearing, (2) maintaining physical distance, (3) reduction of event attendance, (4) isolation of confirmed Covid-19 patients, and (5) quarantine of close contacts. In addition, although this study did not measure the impact of The Sturgis Motorcycle Rally on residents of all other states, the findings of the study still demonstrated the need for consistent mitigation measures across all US states.⁷¹³

2.5.4.6 September 2020: Some New Insights and Measures

On 14 September 2020, the Trump administration announced that it would end the Covid-19 screenings that had begun at some US airports as of January 2020. (Cf. Sect. 2.5.1.) Previously, in March 2020, flights from high-risk countries, such as China, Iran and much of Europe, had been diverted to 15 designated airports in order to have testing performed more efficiently, but from 14 September 2020 on, these flights would no longer be diverted, with all passenger screening announced to be stopped.⁷¹⁴

According to a study published in “The Morbidity and Mortality Weekly Report” on 15 September 2020, it appeared that people testing positive for Covid-19 were 2.4 times more likely to have shortly before been out. In this study, restaurants that had been taken into consideration included restaurants with terraces, as well as restaurants with outdoor seating and indoor seating. In addition, this contamination likelihood was found to be almost 4 times higher for participants who had been to a bar or pub. Most of the participants (71%) to the study had, moreover, claimed to have worn face masks in the 2 weeks prior to their diagnosis of Covid-19.⁷¹⁵

During September 2020, Midwestern states saw a dramatic increase in Covid-19 cases. South Dakota alone witnessed a 166% contamination increase, while 10 other states reported record 1-day increases as well. The annual Sturgis Motorbike Rally (which has been discussed in the previous Sect. 2.5.4.5.), but also school and university reopenings and Labor Day weekend festivities have all been cited as links between contamination cases.⁷¹⁶

2.5.4.7 October 2020: The US President and First Lady Catch Covid-19

On 2 October 2020, US President Donald Trump made the surprising announcement that he and First Lady Melania Trump had both tested positive for Covid-19. After initially experiencing only mild symptoms of the Covid-19 disease, Trump was then taken to the “Walter Reed National Military Medical Centre”, allegedly “out of an abundance of caution” (in the words of press secretary Kayleigh McEnany).⁷¹⁷ However, it would become clear much later that Trump’s symptoms had in fact been much more serious than initially reported.⁷¹⁸ During his hospital stay, President Trump’s treatment was reported to have consisted of Regeneron’s experimental antibody cocktail “remdesivir” and “dexamethasone”,⁷¹⁹ an at the time still experimental life-saving treatment that was not available to the average person.⁷²⁰ (Cf., furthermore, Sect. 9.3.2.6.) After a stay of 3 days, US President Trump was discharged from the hospital. After his return to the White House, The US President would continue to receive treatment for Covid-19, while his health situation was further monitored.⁷²¹

After his return from hospital, President Trump tweeted a video saying “don’t be afraid of Covid-19” and “don’t let it get the best of you”, although his usually frantic tweets had diminished considerably during his hospitalization. President Trump’s severe Covid-19 infection also had little or no impact on the president’s precautions, or lack thereof, in preventing the spread of Covid-19. He afterwards continued to regularly gather thousands of mostly unmasked supporters in rallies across the country right up until election day.⁷²²

2.5.4.8 New England Journal of Medicine Editorial Interim Evaluation

On 8 October 2020, in an editorial that was published in The New England Journal of Medicine (NEJM), entitled “Dying in a Leadership Vacuum”, 34 editors of the Journal publicly denounced the Trump administration’s response to the Covid-19 pandemic, stating that US leaders had “taken a crisis and turned it into a tragedy”.⁷²³ Given the importance of this statement in assessing what went wrong in the United States, some of its most relevant parts have been quoted below⁷²⁴:

Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.

The magnitude of this failure is astonishing. According to the Johns Hopkins Centre for Systems Science and Engineering, the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost fifty, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost two thousand. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.

(…)

Why has the United States managed this pandemic so badly? We have failed at almost every step. We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to healthcare workers and the general public. And we continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have. Moreover, a lack of emphasis on developing capacity has meant that US test results are often long delayed, rendering the results useless for disease control.

Although we tend to focus on technology, most of the interventions that have large effects are not complicated. The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.

The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized, appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

(…)

Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.

2.5.4.9 October 2020 to December 2020: Rising Number of Cases and Deaths

On the same date—October 8, 2020—that the aforementioned editorial in the “New England Journal of Medicine” gave a grim assessment of the Trump administration’s handling of the Covid-19 crisis, 39 states reported that they were experiencing an increase in Covid-19 contamination cases. Nine states reported to have set 7-day infection records, with Wisconsin and Hawaii also reporting a record number of Covid-19 related deaths over a 7-day period.⁷²⁵

According to a poll released on the same date (i.e., 8 October 2020) by “Gallup-West Health”, albeit conducted before President Trump’s Covid-19 diagnosis, it appeared that more Americans had confidence in presidential candidate Joe Biden to lead the United States for dealing with the Covid-19 pandemic. From this poll, it was noted that Biden had the support of 52% of the voting public on this matter, compared to 39% of the voters reaming alleged to Trump, with the rest of the surveyed people still being undecided.⁷²⁶

By the same date, information was made available about the number of people that had been infected by the Covid-19 virus upon having attended Supreme Court Justice Amy Coney Barrett’s graduation ceremony in the Rose Garden that took place on 3 October 2020. This number was reported to have increased to 34. It was also reported that, amongst these affected, there had been several White House staff members.⁷²⁷

On 15 October 2020, the United States reported 60,000 new contamination cases of Covid-19, a number that had not been seen since early August 2020. The number of cases had increased nationwide, with 44 states even having reported more Covid-19 contamination cases than in mid-September 2020. More rural states had been experiencing even higher numbers of Covid-19 contamination cases and Covid-19 related deaths than during the first wave of the Covid-19 pandemic that had occurred during the spring of 2020.⁷²⁸

On 4 November 2020, the United States was reported to have reached an ominous milestone with 100,000 new contamination cases of Covid-19 reported in a single day for the first time. This unprecedented spike in Covid-19 cases was, moreover, attributed to a shortage of N95 face masks in healthcare facilities all over the country, although the production of such masks had been increased. Healthcare workers reportedly continued to ration and reuse face masks with no end in sight.⁷²⁹

By 9 November 2020, President-elect Biden announced the names of the science, medicine and public health experts who would serve on his in-between Covid-19 advisory board upon taking presidential office.⁷³⁰

On November 20, 2020, the CDC urged Americans to stay home for Thanksgiving. By then, Covid-19-related contamination cases and hospitalizations were skyrocketing. The CDC, hence, recommended that people would avoid mingling with people who had not been residing in their homes during the preceding 14 days. With the number of contamination cases in the United States having surpassed 11 million, CDC officials were increasingly concerned that the situation could even worsen over the holiday season.⁷³¹

On 29 December 2020, a new variant of the Covid-19 virus (strain B.1.1.7), discovered shortly before in the United Kingdom and known as the UK variant (cf. Sect. 1.1.2.), was detected in the United States as well. The contaminated person concerned a man from Colorado in his twenties who had no previous travel history. Scientists said that they were concerned, albeit not surprised, as viruses are known to mutate.⁷³²

Be this as it may, by the end of 2020, the United States had surpassed the threshold of 20 million Covid-19 infections and over 346,000 Covid-19 related deaths. Globally, contamination cases had reached 83,832,334 and 1,824,590 deaths.⁷³³

By the end of May 2020, many states had begun to lift containment restrictions and to reopen their doors to boost their economies, despite warnings from virologists (and even economists) that it was still too early. As a result, the number of new daily contamination cases began to rise again in July 2020, and by December 2020, the United States reported the highest number of new daily Covid-19 cases in the country since the start of the pandemic. This was largely attributed to the policies of the Trump administration, with many pointing to conflicting statements from the White House regarding the severity of the Covid-19 pandemic and a general lack of leadership and direction.⁷³⁴

During the months December 2020 and January 2021, there were two additional factors that would have a significant further impact on the course of the Covid-19 pandemic in the United Nations. First, from December 2020, there was the start of successful Covid-19 vaccinations from the outset, as in the course of 2020, the Trump administration had ensured that contracts were signed with Covid-19 vaccine developers that guaranteed the United States priority on delivery of Covid-19 vaccines over other countries. Such contracts were concluded with, amongst others, vaccine developers BioNTech-Pfizer and Moderna. As a result, from December 2020 onwards, the United States was able to start vaccinating its population at a rapid speed, in contrast to other regions, including the EU, which, due to less favourable contractual arrangements, barely received deliveries of these Covid-19 vaccines. A second important factor was the inauguration of Joe Biden as the new President of the United States on 20 January 2021, ending the ambivalent countermeasures policy of the previous US President, Donald Trump, with the Biden administration, most definitively, opting for a policy aligned with scientific findings, including in the area of non-pharmaceutical interventions (NPI’s). Both of these factors implied that the Covid-19 pandemic in the United States would (or could) be gradually brought under control. As a result, on 10 March 2021, at a White House press briefing, it was reported that the most recent CDC data indicated a downward trend, with a new 7-day average of “only” 56,000 cases per day. New hospital Covid-19 admissions also declined compared to the previous weeks (with an average of “only” 4900 Covid-19 patients admitted per day in the preceding week). In addition, while deaths hovered around 2000 per day during previous weeks, the 7-day average prior to 10 March 2021 fell to “only” 1600 Covid-19 related deaths per day.⁷³⁵

2.5.5 Assessment of the Trump Administration’s Policy on Covid-19

According to an article that appeared in “The Lancet Commission on Public Policy and Health”, US President Donald Trump’s term in office has brought nothing but misfortune to the United States and to the entire world. In 2020 alone, Donald Trump was said (1) not only to have accelerated the spread of Covid-19 in the United States, but, moreover, to (2) have deserted the WHO when the world needed this organization the most, and in the meantime to (3) have responded to largely peaceful protests against racist policing by stirring up hatred and unleashing the military force, as well as the vigilante violence he then mobilised for an insurgency.⁷³⁶

During a CNN documentary broadcast on 28 March 2021, Dr. Deborah Birx, coordinator of the “White House Coronavirus Task Force” under the Trump administration, declared that the “vast majority” of the nearly 550,000 Covid-19 deaths in the United States could have been avoided if only Donald Trump and the Trump administration had acted earlier, and in accordance with scientific advise and with more conviction.⁷³⁷ To back up this statement, Dr. Birx referred to an October 2020 study by the “National Centre for Disaster Preparedness” at Columbia University’s “Earth Institute”, which had found that 84% of US deaths could have been avoided with an earlier shutdown.⁷³⁸ The Columbia researchers had, more precisely, built a model to look at Covid-19 transmission rates between 15 March 2020 and 3 May 2020—and determined that if the United States had shut down but 2 weeks earlier, 84% of the Covid-19 related deaths at that time would have been prevented.⁷³⁹

In the same research, the Columbia University researchers had compared the number of deaths in the United States and its policy response to six similar high-income countries: South Korea, Japan, Germany, Australia, France and Canada. According to the researchers’ report, entitled “130,000 - 210,000 Avoidable COVID-19 Deaths - and Counting - in the U.S.”, between 130,000 and 210,000 Covid-19 related deaths in the United States could have simply been prevented if the Trump administration would only have quickly and effectively implemented a consistent public health response to the threat posed by the Covid-19 virus. The same report also suggests that if the United States would have followed similar policies and protocols as some other countries, such as (1) providing sufficient testing capacity, (2) adopting early containment measures, (3) issuing a national face mask wearing mandate, and (4) providing federal guidance on physical and social distancing, it could have prevented at least 130,000, and potentially as many as 210,000 Covid-19 related deaths. The report concluded that the death rate from Covid-19 had been disproportionately high in the United States compared to other countries, because of bad public policy, even when the average age of the population and obesity were taken into account.⁷⁴⁰

The United States thus has been reported to have the ninth highest proportional mortality rate in the world, with on average some 66 deaths per 100,000 population. The United States ranked only behind Peru, Belgium, Bolivia, Brazil, Ecuador, Chile, Spain and Mexico in these statistics.⁷⁴¹

As shown below, Fig. 2.8 (developed by Redlener, Sachs and Hansen), the US death rate per 100,000 population was 50 times that of Japan, and more than twice that of Canada. Although both the United States and South Korea had their first confirmed case of Covid-19 on 20 January 2020, South Korea had been able to immediately implement an aggressive diagnostic testing and tracking strategy and to isolate infected patients and quarantine their traced contacts, so that the proportional mortality rate had been 78 times lower than in the United States.⁷⁴² Figure 2.8 gives an overview of the number of Covid-19 deaths in these countries per 100,000 inhabitants, in the period from March until May 2020.

Fig. 2.8

Deaths per 100,000 (March to May 2020) [Source: Redlener et al. (2020)]

According to the Columbia University report, the discrepancy in Covid-19 contamination and fatalities between the seven nations investigated it in its study could likely be explained by the slow and disorganized response by the Trump administration in both the early days of the Covid-19 pandemic and afterwards. South Korea, which had reported its first Covid-19 contamination case on the same day as the United States had, by contrast, quickly enacted stringent measures to fight the Covid-19 virus that attributed to a low mortality rate among its population. (Cf. Sect. 2.4.2.4.3.) Still according to the report, the US death toll stood apart from nearly all high-income nations. From this data, it was deducted that a significant number of lives would likely have been spared if the Trump administration had acted more on the advice of scientists and health experts. The researchers calculated that if the United States had followed the policies and protocols of⁷⁴³:

• (1) Australia, there might have been as few as 11,699 deaths, sparing 206,018 American lives.

• (2) Canada, there might have been as few as 85,192 US deaths, saving as many as 132,525 lives.

• (3) France, there might have been 162,240 US deaths, saving as many as 55,477 lives.

• (4) Germany, there might have been as few as 38,457 US deaths, saving as many as 179,260 lives.

• (5) Japan, there might have been as few as 4315 US deaths, with 213,402 deaths avoidable.

• (6) South Korea, there might have been just 2799 US deaths—only 1.2% of the actual US death toll at the time, saving as many as 214,918 lives.

In addition to the international comparison to calculate the avoidable death toll, the Columbia University report also made an early attempt to dissect the “collateral damage” that these Covid-19 tragedies had on American families. It thus noted emerging data on long-term health impacts of Covid-19 infections, increasing statistics on children left without parents, and bereavement rates among families of the deceased.⁷⁴⁴

During the abovementioned press conference of March 28, 2021, Dr. Birx, more generally, pointed to the Trump administration’s overall failure to learn from or respond quickly to the first wave of Covid-19 infections that had swept the country in early spring 2020. According to Birx, while regarding the first wave of the Covid-19 pandemic on American soil, the Trump administration may still have had an excuse, all of the death that have occurred after the first wave of the Covid-19 pandemic should have been mitigated or decreased substantially.⁷⁴⁵

To summarize, Trump was criticized for (1) downplaying the seriousness of the virus; (2) making numerous false claims, including that its effects were no worse than the flu; (3) having predicted that Covid-19 would “just disappear”; (4) referring to it in racist terms; (5) pressing for cities and states to reopen throughout the early summer of 2020, as a second wave of the pandemic pushed the death toll higher; (6) ridiculing the wearing of face masks, and (7) having made outlandish claims, such as suggesting injecting disinfectant into the body could be a legitimate Covid-19 treatment, which experts slammed at the time as dangerous.⁷⁴⁶

2.5.6 Situation in the United States Early-March 2021

Since the outbreak of Covid-19, until early March 2021, the United States had performed over 348 million tests, purportedly the most of any country in the world. The number of infections was still rising dramatically during the first week of March, 2021, and the United States was reported to have had more confirmed contamination cases and Covid-19 related deaths than any other country in the world. All 50 states of the United States were reported to have been affected, with California reporting the highest number of Covid-19 related deaths and the highest number of Covid-19 contamination cases in the United States. By the end of March 2021, it was estimated that over 90% of the American population was still under some kind of stay-at-home order. To further prevent the spread of the Covid-19 virus, most states continued to keep bars and restaurants closed, to still forbid public events, and to still maintain a ban large gatherings.⁷⁴⁷

Table 2.6 gives an overview of the number of US Covid-19 cases and deaths by state on 4 March 2021.

Table 2.6 US Covid-19 cases & deaths by State on 4 March 2021 [Source: USAFACTS (2021); data update of March 5, 2021, as accessed on 6 March 2021]

2.5.7 The Third Wave of the Covid-19 Pandemic in the United States

By April 10, 2021, there were ominous signs of a new wave of Covid-19 infections building in the US Midwest, even as vaccinations continued to gather pace across the country (cf. Sect. 9.4.2.).⁷⁴⁸ The fresh wave of Covid-19 cases even clouded optimism spurred by the speedy Covid-19 vaccines rollout.⁷⁴⁹

In Michigan, hospitalizations soared, and intensive care beds were being rapidly filled. An average of 7226 cases a day had been confirmed in the state during the preceding week, approaching record highs seen in November 2020. Michigan’s public health system was overwhelmed, sounded the warning of the state’s top medical official, Joneigh Khaldun.⁷⁵⁰ The new surge of Covid-19 cases even prompted Governor Gretchen Whitmer to urge people to restrict activities and to keep wearing face masks, and for schools to keep halting in-person learning.⁷⁵¹

Covid-19 was also making a resurgence, albeit to a lesser degree, in Minnesota, where cases also had jumped since March 2021. On 9 April 2021, 2659 new infections were reported, the most in a single day since January 2021. Governor Tim Walz was reported saying that he was not planning new restrictions, while calling on the federal government to speed up Covid-19 vaccine delivery.⁷⁵²

Illinois reported 4004 new cases on 9 April 2021, also the highest number since January 2021, with the number of seriously sick people in hospital rising.⁷⁵³

Public health experts blamed the rise in cases on the spread of the highly infectious Covid-19 virus variant B.117, which had first been identified in the United Kingdom, along with the relaxation of Covid-19 restrictions in the wake of dropping cases and the uptake of vaccines.⁷⁵⁴ According to the CDC, the B.1.1.7 variant had become the most common source of new infections in the United States. The agency also announced that it was attempting to track the spread of the variant to help states clamp down on its spread.⁷⁵⁵

Of particular concern was that, by the end of April 2021, children got to an increasing extent affected by Covid-19. E.g., in Colorado, children made up for more than 25% of all new Covid-19 contamination cases, which was attributed to the spread of more-contagious variants of the Covid-19 virus and by the reactivation of physical school activities.⁷⁵⁶ Among the further reasons for these high numbers among children were, besides highly transmissible variants, the lack of Covid-19 vaccination available for children, as well as loosened Covid-19 restrictions. Colorado, furthermore, had reported the presence of four variants. Moreover, according to the Centers for Disease Control and Prevention, data indicated that 49% of the confirmed Covid-19 contamination cases, regardless of age, were to be attributed to the B.1.1.7 variant of the Covid-19 virus. Moreover, due to the reopening of schools, children in the state had resumed physical classes at the beginning of the 2020 academic year, though in most cases based upon face mask wearing and physical and social distant requirements. There had also been a lot of after-school activities occurring. According to a report by the American Academy of Pediatrics and the Children’s Hospital Association, during the last week of April 2021, Colorado reported 210 active Covid-19 outbreaks in schools, the highest number since 2 December 2020 when there had been only 211. Covid-19 outbreaks had dropped in January 2021, to again increase during the months of March and April 2021. Since the outbreak of the Covid-19 pandemic and until 29 April 2021, 847 children and young people under 19 had been hospitalized, while 13 of them had died. The fact that children were at the time not yet eligible for a Covid-19 vaccine was indicated as another reason behind the spread (to the extent that, by 5 May 2021, no authorized Covid-19 vaccine was available for those younger than 16).⁷⁵⁷

It was, moreover, not only in Colorado where children and young people were, to an increasing extent, contaminated with the Covid-19 virus. According to the American Academy of Pediatrics, as well as the already above-quoted Children’s Hospital Association report, by 5 May 2021, children all over the United States made up 22% of recent Covid-19 cases. Especially during the months of March and April 2021, there had been a substantial increase of the number of Covid-19 contamination cases of children and young people. There were, more precisely, about 72,000 new contamination cases of children reported for the period from 22 April to 29 April 2021, which accounted to a 4% increase in the cumulative number of child Covid-19 contamination cases compared to the 2 weeks prior. Counting back to the start of the Covid-19 pandemic, over 3.78 million children had been infected with the Covid-19 virus, which amounted to about 13.8% of all nation-wide reported Covid-19 contamination cases.⁷⁵⁸ Still, severe illness due to Covid-19 remained rare among children, although experts worried that the Covid-19 virus might be of harm to the long-term physical health of contaminated children, as well as causing severe emotional and mental health effects.⁷⁵⁹

Table 2.7 gives of summary of the child case data in the United States from 16 April 2020 until 29 April 2021.

Table 2.7 Summary of child case data from 4/16/20 to 4/29/21 [Source: American Academy of Pediatrics (2021)]

2.5.8 Tragedy in the US Prisons

According to Olla, for many Americans who were imprisoned during the Covid-19 pandemic, the situation soon became a true disaster.⁷⁶⁰

On 17 April 2021, The Guardian reported how, briefly before, namely on 4 April 2021, the prisoners of the St. Louis jail had started an uprising. According to The Guardian, it concerned the second major uprising at the St. Louis jail within the time frame of a year.⁷⁶¹ One of the many problems that the jail was facing was that a lot of the inmates were in pre-trial detention only since shortly before the beginning of the Covid-19 pandemic, while because of Covid-19, there had been a lot of trial suspensions. One of the main demands of the protesters was that court dates would be set soon. The protesting prisoners also demanded for a more humane treatment in light of the Covid-19 pandemic. It had, e.g., appeared that many of the prisoners felt isolated from their families and worried over the fact that the prison had taken no effective precaution measures for preventing the spread of the Covid-19 virus within the jail premises.⁷⁶²

The uprise the St. Louis jail was, moreover, far from a unique case. Already shortly after the Covid-19 outbreak, similar outbreaks in jails across the country had been occurring for protesting similar situations. According to Olla, the United States should have seen the situation created by the Covid-19 pandemic as a chance to review its jailing policy, especially given the fact that in the United States, the jails were at the time overcrowded with people from immigrant backgrounds, poor people, and Black Americans.⁷⁶³

However, no such thing happened. In contrast, the Covid-19 outbreak in the American jails turned into what has been referred to as a murderous happening. While, due to the disastrous public policy of the Trump administration, the Covid-19 pandemic in general hit the United States very hard, the situation appeared to be the worst for those who had been incarcerated in jail at the time of the outbreak. More in particular, due to the cramped and unsanitary settings in many of the American jails, these had appeared to be ideal for transmitting the Covid-19 disease.⁷⁶⁴ In many cases, there were no or no sufficient Covid-19 containment measures in place. E.g., social distancing was in most cases impossible and Covid-19 tests were not available. At a policy level, there was also no willingness or interest for dealing with the matter.⁷⁶⁵

According to Olla, many of the American prisoners were simply left to die because, according to the value scales of Capitalist America, they were simply too deprived to be deemed worthy of having resources spend for their survival during a pandemic. From another report by the University of Texas referred to by Olla, it indeed appeared that 80% of the prisoners in Texas county jails who died because of Covid-19 were simply poor.⁷⁶⁶

It is, hence, in the further opinion of Olla, no surprise that already briefly after the outbreak of the Covid-19 pandemic, the protests and uprising in the Americans prisons started. On a more political level, a memo by “Data for Progress” reported that the majority of the American voters initially started to support the demands for a more humane treatment by the protesting prisoners. This implied that, contrary to conservative propaganda, support to the American protesters was not an unpopular leftist policy, but a truly humanitarian demand that most Americans supported.⁷⁶⁷ However, while initially several local and state governments seemed to be willing to comply with some of the demands made by the protesters and supporting public health officials, this did not lead to concrete results, implying a loss of momentum for changing the dramatic situation in the American prisons. From a February 2021 article by Rebecca Buckwalter-Poza and Sean McElwee,⁷⁶⁸ published in “The Appeal”, it even appeared that there soon occurred a return to the pre-Covid-19 pandemic norm⁷⁶⁹:

Florida’s Broward county, which reduced its jail population early in the pandemic to under 3,000 “for the first time in decades”, now has about 3,500 people incarcerated – putting its jails at nearly 80% full. Even more dire are the situations in Texas’s Harris County, which has jailed more than 9,000 people and has just twenty-five beds left, and California’s Los Angeles County, where more people are being held before trial for longer than this time last year, before the pandemic.

When after the presidential elections, the newly elected American president Joe Biden made it one of his main policies to go through with the US Covid-19 vaccination campaign at rapid speed, people in prisons were not considered as a primary group. Moreover, Biden did not commit to stopping the Trump-era policy of massively imprisoning low-level offenders belonging to the deprived groups of society.⁷⁷⁰

As Olla concluded her remarkable contribution⁷⁷¹:

The United States, from Biden’s executive office down to the municipal level, must commit to releasing and providing care for as many people as possible – whether they be in jails, prisons or the concentration camps we’ve created for immigrants fleeing political realities created by US foreign policy. Prisons and jails have always served as warehouses in which our country can hide away the societal crimes of racism and poverty. The uprising at the St Louis City Justice Center was necessary and justified. It was a wake-up call and reminder that there is a hidden pandemic in the United States: our addiction to incarceration, which has led the supposed land of the free to become the home of the largest prison system on the planet. That sickness far predates Covid-19.

2.6 Conclusions

Arguably, one of the greatest lessons of the Covid-19 pandemic has been that, besides doing all that is in one’s power to conduct a “prevention policy”—an approach that had been completely lacking in both the United States and in most European countries—an “elimination strategy”—as e.g., deployed by Taiwan, next to several other Asian countries, and New Zealand—is the optimal response for a moderate to severe pandemic. The strategy provides a vivid example of how protecting public health, including the safety of all members of society, also protects the economy, when compared with “mitigation” or “suppression” strategies—these having been deployed by most European countries, with all known disastrous consequences.⁷⁷²

According to Baker et al., a successful elimination approach however requires decisive science-backed government action and outstanding communication to create the social license needed for an effective response.⁷⁷³

One of the major difficulties in fighting the Covid-19 pandemic has been that compliance with scientific advice in many cases clashed with some of the basic principles of neoliberal ideology—especially the principle of the primacy of economic interests over all other (societal) interests, including public health⁷⁷⁴—which helps explaining that, especially in neoliberal jurisdictions, a policy was pursued that in many cases ignored scientific advice (in some cases even explicitly trivializing it). A simple comparison between the countries in which scientific advice was very faithfully followed, e.g., in Taiwan and, from a certain point in time, in New Zealand (cf. Sect. 2.4.2.4.), with countries in which neoliberal leaders—sometimes even leaning towards populism—did not make much attempts to hide their aversion to science, especially the United States (under US President Donald Trump) and Brazil (under President Jair Bolsonaro), already speaks volumes in this regard. This leads to the finding that the Covid-19 pandemic has not just been due to the “SARS-CoV-2”-virus itself, but also to the poor policy response of many (Western) governments, especially those pursuing a strong neoliberal course.⁷⁷⁵

At a technical level, this Chap. 2, furthermore, has shown that Covid-19 transmission is mainly through airborne spread indoors, often from pre-symptomatic people. This highlights the value of face mask use and good ventilation, next to avoiding indoor activities with a multitude of people, while the risk from contaminated surfaces may have been overemphasized (especially during the first months of the Covid-19 pandemic). The Covid-19 virus, moreover, shows large “transmission heterogeneity” (only about 20% of infected cases are responsible for most of the transmission; so-called “super spreaders”), further underlining the importance of preventing super-spreading events.⁷⁷⁶

Baker et al. gave an overview of the most important key challenges that especially New Zealand will be facing the coming years. However, these recommendations can easily be generalized as best practice recommendations which may be useful for all countries. In the approach of Baker et al., countries, hence, face seven key challenges over the next years to weather the Covid-19 pandemic—and, by extensions, similar epidemics, or pandemics—and deliver a valuable and lasting public health legacy⁷⁷⁷:

• (1) Improving border biosecurity: Preventing the (re-)introduction of Covid-19 virus—or similar viruses yet still unknown—into one’s country remains the single most important short- to medium-term challenge to sustained elimination of a given virus. There are obvious benefits in taking a highly systematic approach to this process by considering the entire journey of travellers: from their week prior to departure, their flight in (during which they can become infected), a 2-week stay in MIQ facilities (where they can again become infected), and the period after leaving MIQ, when they remain at elevated risk of being infectious. The goal of having no infected people arriving in one’s country, should become increasingly realistic. This should allow for the careful introduction of quarantine-free travel with other parts of the world that have also achieved elimination. Investing in purpose-built but versatile quarantine facilities at or near airports may offer important short- and long-term benefits.

• (2) Enhancing outbreak detection and management: For the near future, countries will need to maintain and enhance their systems for rapid detection and control of Covid-19 outbreaks—or considering warnings about other, near-future virus-related threats: outbreaks of similar viruses—as a backup measure for border failures. Promising enhancements include: the use of daily saliva testing of border workers and wastewater testing to detect community transmission sooner, as well as continuing improvements to contact tracing. The use of Covid-19 tracer apps (or, by extension, apps that trace other viruses as well) is still underdeveloped in most countries. An obvious improvement would be to make the use of such apps mandatory, e.g., when entering high-risk venues (nightclubs, indoor bars and restaurants, gyms, churches, entertainment venues …) and by MIQ workers and recently returned travellers.

• (3) Simple and transparent methods of communicating measures of fighting Covid-19 (or similar, other viruses): Countries may benefit highly from the experience of New Zealand’s four phases-alert level system. (Cf. Sect. 2.4.2.4.1.) The advantages of such a clear, simple, and transparent system are obvious, certainly for those living in a country such as Belgium, where Covid-19 measures have been changing every so many weeks (or even days) and even have a tradition of being conflicting among the layers of competent authorities—federal, communal, regional, provincial and local—making it impossible for the average citizen to keep track. By comparison, a system based upon threat level categories such as the one deployed by New Zealand is far simpler and clearer, practically eliminating the risk of not being able to keep track any changes in applicable measures.

• (4) Crowd and event control systems: There, obviously, needs to be a greater focus on limiting crowding in high-risk indoor environments, promoting face mask use (which is effective at reducing transmission) and using more geographically targeted and less disruptive “circuit-breaker lockdowns”, and all this as soon as possible upon detection of a possible virus-related threat. The way Taiwan responded once it found out about a possible viral threat in China, has in this regard been exemplary. (Cf. Sect. 2.4.2.4.1.)

• (5) Delivering vaccinations more effectively and equitably: The matter of Covid-19 vaccines and vaccination campaigns shall be dealt with in Chap. 9 in more detail. Suffice here to mention that vaccination strategies should never follow the example of the early phase of the EU vaccination Covid-19 campaign (cf. Sect. 9.4.3.), but should prioritize effective border control, protect the most vulnerable and promote health equity. Achieving high coverage will depend on social engagement, community networks, and high-quality, comprehensive information systems such as an upgraded national immunization register (au lieu, as has been the case in Europe: on lying, twisting information, withholding information, and even threatening people having doubts about a given vaccine…).

• (6) Establishing an effective public health agency: The Covid-19 pandemic provides a vivid illustration of the need to invest in effective public health infrastructure (as has also been pointed out, on numerous occasions, by the WHO and/or by WHO officials). A dedicated national agency is needed everywhere to create the critical mass of expertise in strategy and delivery. Such agency has been missing at the start of the Covid-10 pandemic in most countries, while the one Western country that had such efficient, abroad institutions, namely the United States, had managed to castrate them just before the Covid-19 outbreak (cf. Sect. 5.2.2.6.). The presence of such an agency has, e.g., been a key feature in the highly effective Covid-19 response of Taiwan. The existence of such an agency may provide the critical mass needed to put disease prevention and preparedness at the core of government fields of interest.

• (7) Establishing optimal emergency decision-making processes: Countries such as Taiwan having such processes, benefited highly from them in their fight against Covid-19, as, more in general, from having a government that values scientific advice and is concerned with general well-being. Unfortunately, these are all qualities which have been low to inexistent on the agendas of many neoliberal governments all over the world.

  One of the greatest legacies from the Covid-19 pandemic could be to institutionalize an improved set of processes for decision-making in emergencies that do more to foster learning, innovation, continuous quality improvement and transparency, next to a willingness to learn from countries that know better. Key changes could be:

  • (a) Political processes that enable highly informed debate and scrutiny, while aiming for cross-party support of key response strategies (such as an ongoing epidemic response committee of parliamentarians).

  • (b) Advisory processes that ensure high-level, multidisciplinary science input into the all-of-government response (e.g., the formation of a Covid-19 or virus-science council).

  • (c) A well-resourced research and development strategy to ensure an elevated level of scientific evidence to shape the response and its evaluation.

  • (d) Commitment to, and a timetable for, an official inquiry to assess a pandemic response and drive wider system improvements.

It should be clear from the foregoing that a fundamental change of course is imminent, one that calls for the replacement of the (neoliberal) myopic public policy of prioritizing economic interests, at the expense of all possible other interests—ranging from tracking health, to care for the environment—that inherently results from the dictates of economic neoliberalism, with a policy that again puts the common good, alongside care for the planet, first.

We have already urged the need for such a fundamental change in direction in our previous writings.⁷⁷⁸

In addition to the need to work towards a fairer socio-economic order (than has ever been possible under the dictates of economic neoliberalism) and care for the planet (particularly in view of climate change policy), Covid-19 has added a new, pressing reason for this already existing necessity, namely, to work towards a serious health policy focused on prevention. Whereas a planned approach is simply incompatible with the neoliberal dogmas that the government should interfere as little as possible with socio-economic themes, including health policy, but should leave these as much as possible to the dictatorship of the free markets, a small first step in the right direction could be for neoliberal governments all over the world to start abandoning “the laissez-faire, laissez-passer” axiom, and instead gradually taking responsibility for the interests of their entire populations, instead of just prioritizing the interests of the rich.

We shall come back to this in the following chapters.