The UK government’s response to the Covid-19 pandemic has exposed not only the ineptitude of the current government but the sorry state of our National Health Service, which has been pushed to breaking point by successive administrations.
On 28 March The Lancet shared the insights of front-line NHS staff. Their comments demonstrate the scale of the crisis the NHS faces in the battle to save lives from Covid-19 and the lack of direction, testing and PPE – any real support – from the government. The article is worth quoting at length:
“’When this is all over, the NHS England board should resign in their entirety,’ wrote one NHS worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause.
“The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to ‘test, test, test’ every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque.
“The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come. I asked NHS workers to contact me with their experiences. Their messages have been as distressing as they have been horrifying.
“’It’s terrifying for staff at the moment. Still no access to personal protective equipment [PPE] or testing.’ ‘Rigid command structures make decision making impossible.’ ‘There’s been no guidelines, it’s chaos.’ ‘I don’t feel safe. I don’t feel protected.’ ‘We are literally making it up as we go along.’ ‘It feels as if we are actively harming patients.’ ‘We need protection and prevention.’ ‘Total carnage.’ ‘NHS Trusts continue to fail miserably.’ ‘Humanitarian crisis.’ ‘Forget lockdown – we are going into meltdown.’ ‘When I was country director in many conflict zones, we had better preparedness.’ ‘The hospitals in London are overwhelmed.’ ‘The public and media are not aware that today we no longer live in a city with a properly functioning western healthcare system.’ ‘How will we protect our patients and staff… I am speechless. It is utterly unconscionable. How can we do this? It is criminal… NHS England was not prepared… We feel completely helpless.’”
The UK’s mortality rate is now higher than Italy’s. On 13 April the death toll stood at 10,612 and showed no sign of slowing. Among the dead are 19 NHS staff. The Institute for Health Metrics and Evaluation (IHME) has estimated that the UK will suffer the highest number of deaths in Europe, 66,000 but potentially as many as 220,000. Italy was identified as the country likely to suffer the next highest number of fatalities, estimated between 19,000 and 23,000 – an order of magnitude below the UK. Wellcome Trust director Sir Jeremy Farrar agreed, telling the BBC’s Andrew Marr Show the UK was likely to be “one of the worst, if not the worst affected country in Europe”.
The government has been criticised for not adequately preparing for the virus to hit the UK, for its initial “herd immunity” strategy, for delaying emergency measures such as the lockdown, for lagging far behind other countries in testing and in the provision of PPE to health workers. The fatalities predicted by IHME demonstrate the potential cost of these decisions and failings.
As revealed in late March, the government was warned three years ago that the NHS was not prepared to cope with a severe pandemic but no action was taken. The results of the exercise foreshadowed the experience of Covid-19 and demonstrated that NHS underfunding, structural problems and staffing shortages have left us with a health system ill-prepared to cope with seasonal flu, never mind a pandemic.
The NHS, the jewel of the post-war settlement, has been so significantly undermined over the past 30 years that it has been pushed past breaking point before we even reach the peak of this outbreak. Successive governments have focused their efforts on planning its obsolescence while singing its praises. They have proved they cannot be trusted to safeguard our health.
Every life saved in this pandemic will be saved by health workers, literally risking their lives to provide the best possible care in impossible conditions. These are the people who can be trusted to make decisions about healthcare, during Covid-19 and beyond. When we emerge from the other side of the crisis the struggle must start in earnest to save the NHS – to fund it, re-nationalise it, restructure it and place it under the control of workers and the communities it serves.
The failure to “test, test, test”
On 20 January 2020, it was confirmed that coronavirus was transmissible between humans. Cases had been confirmed in China, Singapore, Thailand, South Korea and the United States. On 30 January, the WHO declared the virus a Public Health Emergency of International Concern and advised that “all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection”. The first UK case was confirmed on 31 January.
In the following two months, the UK government started and stopped both contact tracing and community testing. Its initial “herd immunity” strategy was scrapped when data released showed a potential 250,000 deaths and the scale of the crisis became clear to the public. On 12 March Prime Minister, Boris Johnson had warned, “Families are going to lose loved ones before their time” but took little action to impede the spread of the disease. Four days later the lockdown was announced, but despite those measures, the virus continues to spread through the UK, overwhelming the health service.
Other countries have demonstrated that lockdowns alone are insufficient. Health services require widespread testing, adequate Personal Protective Equipment (PPE), and enough staff, hospitals beds and equipment to deal with the disaster. They also need clear a clear and coordinated strategy. All of which is lacking.
The WHO’s message was clear, “test, test, test”. South Korea has the capacity for 140,000 tests per week, using drive-through centres replicated by numerous other countries and establishing a network of 96 laboratories. Germany is conducting 500,000 tests per week. On 18 March, Hancock claimed that the UK would be testing 25,000 people per week within four weeks but as of 11 April fewer than 20,000 per day are being tested and it seems the government might miss even this meagre target. Rather than address this failing, Hancock announced on 2 April that 100,000 tests per week would be available by the end of the month. On 19 March, Boris Johnson promised 250,000 tests per day but neglected to give a timescale. As it stands, only those in hospital and small numbers of NHS staff are being tested for Covid-19, a world apart from the community testing and contact tracing advised by the WHO.
The government’s focus appears to be on a yet un-invented finger-prick antibody test rather than the tried and tested laboratory analyses for both live Covid-19 and anti-bodies. On 24 March, Hancock claimed 3.5m of these finger-prick tests for NHS frontline staff would be available “very soon”. However, trialling of these tests soon revealed they are wholly inadequate, only providing accurate results 70% of the time. The tests are unusable and the government is back to square one, having ordered and paid for 3.5 million tests without specifying that this was on the proviso that they worked. Imagine the uproar if this money had been spent within the public sector.
Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine (LSHTM) commented that such tests are notoriously inaccurate and urged the government to instead focus on laboratory testing.
On 31 March, Anthony Costello, a global health professor at University College London (UCL), criticised the government for not making use of all available testing facilities. He argued that, even just by utilising the UK’s 44 molecular virology labs, the government could perform 88,000 tests per week. Public Health England has been criticised by experts for being slow to roll-out testing to other laboratories, initially only utilising one facility limited to 500 tests per day.
At the very least, NHS frontline staff need to know whether they have or have had coronavirus so they know whether to self-isolate or go to work. Beyond that, testing allows the government to identify and contain infection hot-spots and monitor the rate of infection to inform decision-making. Just testing those already admitted to hospital only really serves to provide fatality statistics. The UK has the capacity to test but the government is focused on fanciful testing solutions and PHE’s bureaucracy has been painfully slow to utilise available laboratories. Without testing, the government is flying blind.
British ventilators for British lungs
It has emerged that the UK government either refused the offer of ventilators from the EU or missed an email. Initially a spokesperson for No 10 claimed “We are no longer members of the EU… we are conducting our own work on ventilators and we have had a very strong response from business. We have sourced ventilators from the private sector and international manufacturers”. Under pressure, it was clarified that a “communication problem” meant the UK was not invited to apply for the scheme. However, after the EU replied that the UK government had ample opportunity to participate, it was further clarified by No 10 that someone had missed an email. Whether the opportunity to procure life-saving ventilators was refused for ideological reasons or missed through incompetence, the government must be held to account for the consequential loss of life.
Having lost out on the EU scheme, the government set about trying to increase the number of ventilators available to the NHS from a measly 5,000 to the 30,000 it is estimated will be needed at the height of the pandemic.
In mid-March the NHS warned that it still had only 8,000 ventilators and the government kicked into gear, apparently ignoring offers from existing UK ventilator manufacturers or any offers of ventilators from abroad, instead asking UK-based engineering companies to design, test and produce entirely new ventilators over a two-week period. Ford, Honda, Rolls Royce and JCB were all asked to re-invent the ventilator while offers from companies claiming they could supply existing models have been ignored. Penlon, a firm already making ventilators has claimed “Nobody from the Government has put in a purchase order yet” and Direct Access has said that it offered the government 5,000 ventilators but received no response.
While the recruitment of big-name British companies to a national effort in the country’s hour of need may have played well as a headline for Johnson’s Brexit government, the failure to actually procure ventilators meant that as of 10 April the NHS was still 20,000 ventilators short.
With the UK’s death rate rising rapidly, we must demand urgent action from the government to secure any suitable ventilators. Where none are available as a result of inaction, there is no time to waste investing in new models – the manufacturing designs for existing ventilators should be taken, factory space requisitioned and work begun immediately to supply the NHS.
Government blames health workers for PPE shortages
On 11 April, Hancock blamed NHS staff for PPE shortages, saying, “Everyone should use the equipment they clinically need in line with the guidelines, no more and no less. There’s enough PPE to go around, but only if it’s used in line with our guidance. We need everyone to treat PPE like the precious resource that it is”. He then tried to dismiss concerns that the lack of PPE caused the deaths of 19 NHS workers, saying he was “not aware of any link to shortages of PPE in any of these deaths”.
Unions and professional bodies representing NHS workers were quick to respond to these outrageous statements. The Royal College of Nursing (RCN) replied, “There is no PPE equipment that is more precious a resource than a healthcare worker’s life, a nurse’s life, a doctor’s life… Any suggestion that nurses are overusing personal protection is absolutely something we would like to dismiss.” The British Medical Association revealed that more than 50 per cent of doctors do not have the supplies they need. Labour leader, Kier Starmer, called Hancock’s claim “insulting”.
The government has managed to pass some of the blame for the ineffectiveness of its pandemic response by focusing on individual behaviour and turning people against their neighbours, for example those sunbathing in parks or buying Easter Eggs for their kids. But Hancock’s attempt to scapegoat NHS workers was a step too far in that strategy.
The government’s denial of the PPE shortage is contradicted by numerous photographs of NHS staff improvising wholly inadequate PPE. Three nurses, who were photographed using bin bags and tape in a desperate attempt to protect themselves, have all contracted coronavirus. However, we are unlikely to hear much more directly from NHS staff as they have been forbidden from speaking out about coronavirus.
Emergency measures to simplify NHS procurement are proving insufficient, and it is questionable whether, with clear evidence of shortages, the government’s move to daily deliveries will sufficiently increase the supply of PPE. As with ventilators, the solution must be do whatever is necessary to supply the NHS, including the requisitioning of manufacturing capacity and distribution networks.
A lack of beds
The NHS is not only suffering from a lack of ventilators and PPE but also a basic lack of capacity – a lack of beds and of Intensive Care Unit (ICU) beds in particular.
The global comparison of ICU beds shows the UK to have only 6.6 beds per 100,000 inhabitants compared to 34.7 in the US, 29.2 in Germany, 12.5 in Italy and 10.6 in South Korea. China had fewer than the UK, with only 3.6 beds per capita but in the space of two weeks had built two hospitals in the Wuhan province providing an additional 2,600 beds for the city of 11 million people. The NHS Nightingale hospital, which could eventually provide 4,000 beds, took just 9 days to construct, but only after months of prevarication.
For years, it has been evident that the NHS lacks the capacity to even deal with seasonal flu outbreaks. In the winter of 2017-18, three times more people than expected died from flu. In 2018-19, the occupancy of hospital beds in general was well above the level many consider safe and the NHS was at breaking point for the whole year, not just the winter months. In the 2019-20 winter period, specialist lung doctors and nurses were surveyed about hospital capacity and 47% reported that the emergency overflow beds opened up the previous winter had never been taken out of use. Over the past 30 years, the number of NHS beds has halved while the number of patients treated has increased
The NHS has bought access to 8,000 private sector hospital beds and numerous temporary hospitals dedicated to dealing with the outbreak are due to open. However, it is clear that the UK is starting from a far worse state of preparedness than other developed countries and is now running – and failing – to catch up.
A chronic shortage of staff
Research by The Health Foundation published February 2019 looked at NHS staffing trends from the previous year and the picture is one of accelerating decline.
The NHS employs over 1.2 million workers and in 2019 was carrying more than 100,000 vacancies – 41,000 of which were nursing posts, leaving the profession 10 per cent below capacity. Though the overall workforce had grown by 1.8% that year, the vacancies grew at a faster rate and management posts were the largest area of recruitment, continuing a trend from the previous year.
Boris Johnson may give a public thank you to the staff who saved his life, praising two nurses for watching over him every night, but the truth is, in St Thomas’ where he was being treated, the ratio of ICU nurses to patients has shot up from 1:1 to 1:6. His government’s cuts nearly cost him his life.
Current NHS plans – a move towards primary and community care – are undermined by the fact that the number of nurses and health visitors working in community health services are falling.
The government had committed to increasing the numbers of nurses in training but have taken no action to deal with the underlying causes of the shortage of nurses namely, university fees and the hostile environment towards immigrant workers.
When the NHS bursary was withdrawn from new student nurses in 2017, applications across the UK fell by 18 per cent. In 2018, applications in England fell by a further 12 per cent, i.e. the number of new nurses has declined by over a quarter in two years.
The report explains that, while the NHS long-term plan notes that recruitment from abroad is vital for maintaining staffing numbers, immigration policies and uncertainties around Brexit meant that “the total international intake of new nurse registrants in 2017/19 [was] less than a third of that of 2015/16”.
Furthermore, the retention of existing staff has worsened since 2011/12. In community trusts, 1 in 5 staff left their role in 2017/18. The House of Commons Health and Social Care Select Committee report in January 2018 said, “The nursing workforce is overstretched and struggling to cope with demand… Major changes have recently been made to routes in to nursing. However, too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it.”
While many who had left the NHS, whether for other jobs or retirement, as well as final year students, have volunteered in the effort to combat Covid-19, the NHS is, again, starting from a position of crisis in trying to deal with this pandemic. The commitment and resilience of NHS staff are the only things keeping the health service going.
Matt Hancock has said, “Now is not the time to discuss pay rise for nurses.” But this suggests that pay rises for NHS staff are a reward of some sort, that the current rates of pay have not directly contributed to the poor state of the health service. This is far from the truth. NHS workers have been subject to a seven-year pay freeze, eroding their real income; nurses’ pay, for example, has fallen by 5 per cent in real terms since 2010.
This, and intolerably high workloads, have caused the issues with staff retention. Many have found they simply cannot afford to work for the NHS, both in terms of remuneration and their mental and physical health. Many young people have found they cannot afford to train to be nurses. Many migrant workers cannot afford to pay to work for the NHS and, while this fee has been suspended during the pandemic, it is scandalous that it exists in the first place.
Now is the time to discuss and implement pay rises, the re-introduction and raising of the NHS bursary, the scrapping of the surcharge for migrant workers and entitlement of all migrants to citizenship. While the state of near-collapse of the NHS is exposed for all to see, it is time to press for it to be fixed.
Profit over people
Much has been made of Hancock’s announcement that £13.4 billion of NHS debt will be written off to help deal with the coronavirus crisis. Unfortunately, this is merely a publicity stunt, being an arrangement discussed for the past 20 months and now repackaged as a response to the pandemic that will have no impact on the actual resources available to hospitals .
Without significant changes to the funding and structure of the NHS, hospitals will simply build up debt again. So the real question is; why are public sector hospitals in debt in the first place?
Successive administrations since Margaret Thatcher’s 1987 government have sought out ways to introduce market competition into the NHS. Thatcher introduced the internal market in 1990 – splitting the NHS into commissioners (those who request and pay for treatment) and providers (the hospitals). In Thatcher’s day they were called health authorities and trusts, but subsequent restructuring has renamed these bodies on multiple occasions. They are currently known as Clinical Commissioning Groups (CCGs) and NHS Trusts or Foundation Trusts.
The concept of the internal market was that patients could choose between providers, and payment by results would mean the best hospitals would receive more funding (with other hospitals presumably going bankrupt, though this was never explicitly stated). This belief, that market forces would drive efficiency, was unfounded and only a very small number of patients were able to exercise choice, e.g. for elective surgery. Despite failing to meet its stated objectives, the internal market is very expensive. Though its cost has proven hard to estimate, government figures suggest scrapping the internal market would save 1-2 per cent of the NHS budget.
While some private sector involvement in – and profiting from – the NHS was introduced by various governments (e.g. the Labour government’s use of PFI contracts under Tony Blair), the internal NHS market was truly opened up to external competition by the Conservatives via the 2012 Health and Social Care Act. Under this act competition was encouraged and private sector providers were able to tender alongside NHS providers, cherry-picking profitable treatments and services and leaving the NHS to provide the rest at a “loss”. The proportion of the NHS budget handed to the private sector continues to rise, reaching a record £9.2 billion in 2018/9.
In the past two years, even the Conservatives have reached the conclusion that some of the changes introduced by the 2012 act were counterproductive. Their solution, however, opens the door to a far larger incursion by private companies.
The Chief Executive of the NHS in England, Simon Stevens, divided the English NHS into 44 “footprints” which encourage collaborative rather than competitive working. Then he announced the introduction of Integrated Care Systems and Accountable Care Organisations, the aim of which are to move towards long-term contracts for the provision of NHS services in large areas of the county by NHS or private providers. While this reduces the competition in the NHS, it provides a potentially lucrative opportunity for large-scale privatisation based on a US model. Each contract would be worth billions, last for ten to 15 years and make the provider, in collaboration with the commissioner, responsible for providing healthcare for up to half a million people.
Given the example of how dearly PFI and PPP contracts have cost the NHS over the years or the experience with the train operating companies (which continue to drain the public purse in subsidies, crash periodically and have to be hastily re-nationalised) this is a risky and doomed strategy by the NHS and the government.
New Labour’s Gordon Brown championed Public Finance initiatives during the Blair years, tying all new hospital investment to these rip-off schemes. Hospital Trusts typically pay £100 million pounds a year to these private consortia, some spending a third of their budget on them. By 2050, when the last current schemes run out, the NHS would have paid £80 billion for work worth just £13 billion.
Government after government has focused its NHS policy not on improving the health of the population but, on trying to prove that the market is a better model for public health in order to further open up the NHS to that market.
This is all in spite of the fact that in the US health system, on which the latest restructure is based, the cost of state-provided healthcare far outstrips that of any other country despite the majority of Americans having private health insurance.
To reduce NHS bureaucracy and free up all funding, for the benefit of the population rather than private shareholders, the internal market must be eradicated and all private healthcare providers inside and outside the NHS should be nationalised without compensation. All PFI contracts should be annulled and all trusts brought into a unified NHS. NHS staff in consultation with the wider working class should draw up the plan for how to provide the best possible healthcare.
Alongside marketisation, the NHS suffered a severe funding deficit over the past decade. Every government claims to have increased NHS funding but, to avoid a decline in healthcare provision, it must not only increase to match inflation but also to match the growth and ageing of the UK’s population. So in reality, these funding increases are actually cuts; when considered on a per capita basis, average annual healthcare spending per person was about 3.3 per cent between 1949-50 and 2016-17, but if we look at the period between 2009-10 and 2016-17 that average drops significantly to 0.6%, far below inflation.
The Kings Fund has commented that, “Though funding for the Department of Health and Social Care continues to grow, the rate of growth slowed during the period of austerity that followed the 2008 economic crash. Budgets rose by 1.4 per cent each year on average (adjusting for inflation) in the 10 years between 2009/10 to 2018/19, compared to the 3.7 per cent average rises since the NHS was established.”
Spending stalled, or even fell, in the years after the 2010-11 coalition government and, while it has picked up a in recent years, this has not been enough to undo the damage done to the NHS or seriously tackle the debts accumulated in those years of underfunding.
In 2018 the Conservatives announced an increased spend on NHS England of £20.5 billion by 2023/24 (an increase of 3.4% per year) but the Institute of Fiscal Studies said this money would “help stem further decline in the health service” but only increases of at least 4% per year would allow the NHS to improve services.
A crisis of capitalism
The managed decline and marketisation of the NHS meant our health service was already at breaking point when Covid-19 hit. It is desperately short of the staff, beds and equipment required to cope with normal demand.
The government’s inaction, stemming from incompetence, a desire to keep accumulating profit no matter the human cost, nationalism and its preference for ‘herd immunity’ compounded the existing problems of a catastrophically mismanaged and underfunded health service to create the severe threat to public health now posed by the pandemic.
The Conservative Party is ideologically opposed to the NHS. The current Deputy PM, Dominic Raab, was recently forced to admit he co-authored a pamphlet which argued the NHS should be “broken up” and “New non-profit and private operators should be allowed into the service, and, indeed should compete on price.” Hancock has received tens of thousands of pounds in donations from a think tank advocating NHS privatisation. His predecessor, and architect of the 2012 Health and Social Care Act, Andrew Lansley, has taken a job advising a company which promotes the incursion of the private sector into the NHS.
Not just in words but in deeds, we can see the long-term policy of the Conservative Party has been, from the introduction of the internal market to PFIs, to the opening up of public health to market forces.
The cost of this policy and the current government’s strategy can now be counted in the daily Covid-19 death toll. In New Zealand, three people have died and in South Korea the mortality rate is 0.6% but Britain, one of the richest countries in the world, is a basket case. This is not a “national emergency” where we must all pull together; it is a crisis of capitalism and we must fight for a working class, socialist response.
A socialist solution
Urgent measures are required to deal with the current crisis and at the heart of them is the question of control. Our government cannot be trusted to prioritise the saving of lives over the rescuing of a struggling economy for the benefit of the rich. Socialists and trade unionists, women and youth, must demand measures that can draw in ordinary working people to plan and carry out the changes we need and in doing so transcend the laws of the market and the bosses’ state.
Meeting the present challenge means laying the foundations of a truly public health service, not only free at the point of use but free of private interests, run by its workers and users, drawing on the advice of experts in all fields of medicine. We must expect and prepare to meet the challenge of the next pandemic through global and national epidemiological research, with pharmaceutical and health care systems run on the same basis.
• Protect the people: institute mass testing starting with essential workers and the vulnerable; scrap prescription charges, abolish NHS charges for migrants.
• Healthcare for all: cancel PFI deals without compensation, end the internal market; nationalise the pharmaceutical and medical equipment manufacturers and merge them under workers’ control; immediate pay rise for all NHS staff to real pre-austerity levels; full bursary and living grants or full pay for student nurses, trainee health and social care workers.
• No privileges for the rich: expropriate private hospitals and clinics, no private testing.
• Immediate closure of immigration detention centres and access for all UK residents to housing and benefits.
• Equal access to healthcare for prisoners and no forced “Do Not Resuscitate” orders.
The rich must be made to pay for this crisis with a 100% tax on incomes of over £150,000 and massive fines and confiscation of the property of those seeking to profit from the pandemic. Any property required for the pandemic response must be requisitioned with no compensation.
To flatten the curve and reduce pressure on the struggling NHS we need a more effective lockdown, but this is not the same as a more draconian lockdown. The government’s existing strategy is to allow the economy to operate as freely as possible, while shifting responsibility to individuals. The solution is not to fine people for sunbathing but to relieve overcrowded living conditions by requisitioning empty properties. The solution to “non-essential” use of the London tube system is to order non-essential businesses to close and provide staff with full pay for the duration of the lockdown.
The government’s NHS Volunteer Workforce is “paused” after being overwhelmed by applications, volunteers are reporting they have not been given tasks, all while the vulnerable wait alone in social isolation. The government advice for other forms of volunteering is to contact charities. Clearly this effort is failing to meet the needs of the population in a time of crisis.
Mutual Aid organisations sprang up in February, long before the government scheme, and are running a far more effective response. These organisations, with the trade unions, local Labour Parties and socialist organisations, should lead the effort to deliver prescriptions and food to the vulnerable.
But they could go much further, organising flying pickets of non-essential workplaces to force their closure, preventing evictions, requisitioning empty houses and controlling the price of food and other essential goods.
Whether the government or the working class controls society during this pandemic will determine how many lives are saved. When we come out the other side, we will face the question of who pays for the greatest economic crisis of our lifetimes. We know from experience that the government will demand we pay- through cuts to our NHS, schools and benefits. We know that, left up to them, the companies will be bailed out and we will be sold out, with hundreds of thousands, if not millions, thrown out of work.
If we leave power in Boris Johnson’s hands, the rhetoric of “national emergency” will be used to make us pay for the crisis. Fighting then, and now, for workers’ control to save our NHS, our jobs and public services by making the rich pay, is our weapon against the pandemic and the great recession of 2020.