miércoles, 20 de mayo de 2020

La historia sobre los hombros

“La Historia demuestra que las sociedades que mejor sobreviven y se adaptan a las catástrofes ya eran fuertes (antes de la catástrofe) Gran Bretaña se alzó frente al desafío nazi porque estaba unida; Francia no lo estaba, y sucumbió”, escribía hace poco en el Economist la historiadora Margaret MacMillan.

 La diversa respuesta de las diferentes países ante la catástrofe del covid confirman este principio de manera casi matemática. En Portugal los partidos políticos pusieron a un lado sus desavenencias para actuar al unísono. En Alemania el gobierno central y los territorios de la federación han demostrado un ejemplar comportamiento de coordinación. En los países nórdicos la enorme cohesión social y confianza de la ciudadanía en sus instituciones han sido claves en la lucha contra la pandemia. Taiwan, Nueva Zelanda o Corea del Sur nos ofrecen ejemplos semejantes.

 Por el contrario, los países más divididos antes de la crisis del covid son los que peor han reaccionado: Reino Unido, el país con más muertos por covid en Europa, es una nación profundamente rota en dos por las heridas del Brexit, por no hablar del problema secesionista escocés o de la tremenda división social de una ciudadanía clasista y estamental como pocas. En Estados Unidos ya no cabe hablar de una sola sociedad, si no de dos( pro Trump y anti Trump), y la fractura entre ricos y pobres, así como las líneas de división entre WASP y las diversas minorías se han profundizado intensamente desde la crisis financiera de 2008. Italia, Francia o Brasil , todos ellos países en los que la pandemia ha causado o causa estragos tremendos, nos ofrecen otros ejemplos de fractura política, económica y social de gran calado.

 Con tales mimbres es difícil dar una respuesta coherente, eficiente y consensuada ante una tragedia de esta dimensión.

 Y finalmente tenemos el caso de España, un país machacado por la pandemia, en un contexto de tormenta perfecta para la falta de unidad y cohesión: la vida política llevaba años polarizándose, especialmente desde el surgimiento de Podemos y de Vox, hasta despertar ese espíritu fratricida de las dos Españas; el consenso sobre la articulación territorial del Estado, siempre muy imperfecto, fue dinamitado a partir del Procés y la reacción al mismo; y en cuanto a la fractura socioeconómica, hemos pasado de ser uno de los países con mayor equidad económica de Europa a, desde la crisis, convertirnos en una nación de dos velocidades, con pobreza crónica de un lado, y un segmento pudiente cada vez más rico, del otro lado.

 La peor crisis nos ha llegado estando ya más divididos que nunca, tanto social como política y económicamente, con una tremenda desconfianza en las instituciones, un tejido productivo todavía tocado y unas desavenencias sobre el modelo de Estado todavía sin resolver. En fin: la tormenta perfecta.

 Las crisis pueden servir tanto para reconfigurar por completo aquello que antes no funcionaba y abrir nuevos consensos...como para terminar de destruir los pocos consensos que todavía existían y dinamitarlo todo, con consecuencias imprevisibles.

 La crisis del 29 fue brutal tanto en Estados Unidos como en Alemania. Pero mientras que en la nación norteamericana provocó en New Deal, que vigorizó e impulsó a ese país a nuevos niveles de confianza y prosperidad, en Alemania acicató el surgimiento del nazismo. Que el resultado tras de un crisis sea uno u otro ( vigorizante o destructor) depende de las actitud de cada ciudadano.

La Historia no está escrita. La escribimos todos y cada uno de nosotros cada día, con nuestra manera de ser y hacer.

miércoles, 15 de abril de 2020

Tapar la realidad

Es casi imposible luchar contra una pandemia cómo esta de modo eficiente, si no se disponen de datos lo más fiables posible sobre su evolución.

Sabíamos ya que las cifras oficiales de contagios en casi todos los países del mundo sólo reflejan una porción mínima de la realidad, debido al reducido número de test que se hacen y que los casos asintomáticos, así como los casos confirmados en diagnóstico clínico, pero no verificado con test, no se computan. Se calcula que el número de contagiados en el mundo es, como poco, 10 veces superior a la cifra oficial de 2 millones de casos.  Es muy posible que, solo en España, el número de contagiados sea dos o incluso tres veces superior a ese dato ‘oficial’ de casos en el mundo entero.

Ya sabíamos , también, que los datos oficiales de mortalidad no eran exactos. En Italia no se reportaron como muertes por Covid19 las sucedidas en las primeras semanas de la expansión. En España los datos de muertes por cualquier causa en marzo eran significativamente más altos que los de los años anteriores - mucho más que lo que lo atribuible al coronavirus en función del conteo oficial.

Pero la noticia que ya ha estallado esta semana de forma explosiva es que la cifra oficial de muertos en el mundo (126 mil a día de hoy), no es ya que simplemente contenga un cierto margen de error, si no que se trata de una entelequia, de una fantasia. La realidad es mucho, mucho peor.

La prensa británica reveló ayer que los datos oficiales de mortalidad que ofrecen las autoridades de Reino Unido sólo incluyen a los fallecidos en hospitales, no a los casos confirmados de muertes por Covid19 ocurridos en domicilios y residencias de ancianos. En realidad la cifra de muertos sería casi un 50% superior a la ofrecida hasta ahora.

También ayer, la Comunidad de Madrid y el Estado de Nueva York reconocieron exactamente lo mismo. Así, los muertos en la Gran Manzana por Covid19 no son 7 mil, si no 10 mil. En Irán hay cada vez más evidencias de que la cifra oficial de muertos (5 mil) sólo refleja un 10% de la realidad; y la comunidad científica ya considera un hecho incuestionable que el dato de 3 mil muertes en China es una burda manipulación. Nadie sabe cuántos muertos por la pandemia se produjeron allí. Algunas estimaciones hablan de 40 mil. El colmo del disparate parece ofrecerlo Chile, que cuenta como 'casos recuperados' a los muertos por coronavirus, porque 'no son una fuente de contagio'.

Saber cuánta gente muere en una pandemia es esencial para proseguir su evolución y lidiar mejor con ella. Luchamos con esta epidemia a ciegas, porque muchos países siguen prefiriendo autoengañarse, o carecen de la capacidad de producir datos fiables, o simplemente quieren ocultar la realidad a la población.

 Pero la realidad siempre termina estallando en la cara a quien no sabe mirarla de frente.

martes, 14 de abril de 2020

Indonesia: The pandemic tsunami

Indonesia is likely going to become one of the main hotspots Covid19 soon and perhaps the first country in the Global South badly affected by the pandemic.

In Indonesia, number of Covid19 deaths is doubling every week . As of 14 April there were 460 confirmed deaths because of Covid19. Number of confirmed cases was close to 5,000. There is clearly a severe underreporting given that there have been only 27,000 tests conducted (one of the lowest test x population size rates in the World: only 100 tests per million people).   

Social distance is not yet too strong. As of 5th April, mobility trends in public transportation hubs were only 58% per cent less than normal, and shopping centres or restaurants only saw a 43% decline in mobility. It’s important to keep in mind that most of the confirmed cases  and deaths are concentrated in Java, which includes several large urban areas (including Jakarta) and has a total of 150 M inhabitants and more than 1,100 people per square kilometre (one of the highest population densities in the World). In such a context, and without strict social distance, rapid spread is really unavoidable.

Given this background, a 10% infection rate would not be an unrealistic horizon for Indonesia. This would mean, as per the East Anglia University calculator  (which fully keeps in mind the age population structure of every country) around 300,000 deaths. That number would be reached by mid-June. In fact things can easily get even worst, given the limited access to intensive medical care  available in the country, which might increase the mortality rate even higher.

Given this perspective, its of the utmost importance that means are put in place for the urban poor across the country to get access NOW to food, hygiene items and other basic needs so they can limit social interaction to the much possible extend (while keeping basic livelihoods). it will also be key to promote community-based quarantine models for rural areas, so farmers can keep producing food -while communities are protected from the spread of the virus.
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(picture: Al Jazeera)

El Reino Herido

Noticias my desalentadoras en el Reino Unido. El 47% de los fallecimientos ocurridos en Londres la semana pasada fueron por Covid19. Las muertes diarias no paran de aumentar (ya son mas de 11,000) y eso que allí los datos oficiales sólo reflejan muertes en hospitales. Fuentes oficiales reconocen ya que hay más de dos mil residencias de ancianos con infectados, y ya han muerto varios cientos en ellas. Dos de las principales empresas que gestionan residencias de ancianos acaban de informar de al menos 500 muertes por Covid19 en sus centros.

 La demora de las autoridades británicas en decretar medidas de distancia social y confinamiento (debido a las dos o tres semanas que pasaron tonteando con la absurda idea de promover un 'control inteligente' de la inmunidad de grupo) va a costar muchisimas vidas.

 Los retrasos en tomar medidas en Italia, Francia o España en la respuesta al coronavirus son una broma comparados con lo ocurrido en Gran Bretaña, sobre todo teniendo en cuenta que allí hubo bastante más margen de maniobra porque la transmisión comunitaria comenzó más tarde.

 Existe una alta probabilidad de que, an final, Reino Unido sea el país de Europa con mas muertes de Covid19 - si, mas que Espana o Italia.

 Si el Brexit fue la agonía de un país que parece haber perdido el norte, Covid19 puede llegar a ser la tumba final del esplendor de esta gran nación que, desgraciadamente, nunca supo digerir que ya no era Imperio.

Reino Unido, probablemente, va a vivir el momento moral y sociológico más bajo de su historia desde la Segunda Guerra Mundial. Que desgracia.

 Muchísimos ánimos a todos mis amigos británicos. Las crisis también abren rendijas a cambios y tal vez a un futuro mejor.

lunes, 6 de abril de 2020

Food Security during quarantine

Ensuring access to food and water during lockdowns is a must to avoid the spread of the COVID-19 pandemic in Africa 


 Abstract: Community transmission of COVID-19 is now happening in many parts of Africa. There is no evidence that warm climate will slow down the epidemic. According to estimations, at least 2.6 million people (and probably much more) may die in Sub-Saharan Africa due to COVID-19 in the upcoming months. Strict social distance measures (‘lockdowns’) are needed to reduce the transmission and mortality rates of the pandemic, but these processes will require a careful planning of how the poor will access food (with differentiated approaches for rural and in urban contexts) during the lockdowns. There are probably still a few weeks’ window of opportunity to contain COVID-19 in Sub-Saharan Africa. But unless decisive measures are undertaken to secure the food security of the poor, it will remain impossible to implement appropriate quarantine measures, and many lives will be lost. 

 Millions at risk 

As of 31 March 2020, and according to the 5,287 total COVID-19 cases and 172 deaths have been reported in 48 African countries. In fact, case numbers of COVID-19 are increasing exponentially in the region . The possibility of unreported cases is also a matter of concern, given the weak health-care systems of most countries in the continent, and limited availability of testing facilities .

Current evidence does not support the hypothesis that the coronavirus will spread more slowly in countries with warmer climates, so it is anticipated that the spread rates will be similar to those we have seen in China or what we see in Europe or US now. Africa may  start facing the severe impact of the pandemic  in  late April or early May.

The calculator developed by the University of East Anglia estimates that COVID-19 deaths in Sub-Saharan Africa may reach 2,6 Million people, based on a 50% total infection rates.

The calculator applies the relevant mortality rates for each age group. In that regard, the total death rate for Africa is significantly lower than in China, Europe or US, where the percentage of the elderly is higher. However, the calculator does not consider the potential of higher-than-average mortality rates by patients with pre-existing medical conditions particularly predominant in Africa, such as HIV-positive population (34 million people in Sub-Saharan Africa ). Although there is not yet  specific information about the risk of COVID-19 in people with HIV, it seems that the HIV-positive population is more likely to require hospitalization for influenza-linked pneumonia. High levels of endemic malaria might also be a serious complication for COVID-1 cases. The calculator does not consider, neither, many COVID-19 fatalities that are avoidable in contexts of well-developed health systems (like China, Europe or US)  but will not be avoided in Africa: between 1 and 2% of COVID-19 patients need respiratory ventilators for life support and many more need access to Intensive Care Units (ICUs) -without which they would likely die. Most African countries have very limited access to these facilities/equipment (e.g.: Uganda has only 55 ICUs and only 13 nurses in the whole country with training in critical care nursing) and so, with high infection rates, the mortality rate in the region could in fact be much higher to what we see in Europe or China, and the total number of deaths in Sub-Saharan as high as 5 Million people.

In short: African countries should not expect a ‘mild’ version of the disease. To avoid millions of deaths, it will be critically important to slow down the spread of the epidemic (to protect limited health resources, so that hospitals are not rapidly overwhelmed) and to protect vulnerable groups .

Social distancing saves lives 

A combined approach of physical distancing - comprising quarantine, school closure, and workplace measures - is the most effective way at reducing the number of novel coronavirus cases. Social distancing is a term used by epidemiologists to refer to a conscious effort to reduce close contact between people to minimize or stop community transmission of the virus.

 Introducing social distancing measures early in an outbreak of COVID-19 delays the introduction of the pandemic to a country or area or may delay the peak of an epidemic in an area where local transmission is ongoing, or both and hence, contribute to reduce the number of deaths. What has happened in China shows that quarantine, social distancing for the entire population via home confinement, and isolation of infected populations can contain the epidemic. The purpose of these drastic measures is to reduce the number of people each confirmed case infects.

Should strict social distance measures (including home confinement for the entire population) be applied in Sub-Saharan Africa in the same fashion as in China’s Hubei province, European countries and now in most US States, the infection rate of coronavirus could be minimized to a 10% infection rate or bellow, given the still relatively early stage of the pandemic spread in the continent. As per the East Anglia University calculator, that would mean that mortality rate would be reduced by 80% in Sub-saharan Africa (521,000 people would die compare to the at least 2,6 Million deaths in a non-quarantine scenario). Furthermore, that would also reduce the number of cases that would require intensive medical care and hospitalization, helping to avoid the collapse of the already weak health systems in African countries.

Instituting quarantines is a measure of last resort but one that, in the context of COVID-19, Africa will unfortunately have to apply.


Livelihoods at risk 

Quarantines involve restricting people's liberty and freedom of movement, as well as access to their livelihoods, and to healthcare, food, and water. International human rights law requires that any restriction to human rights in the name of public health meet certain requirements, as laid out in the Siracusa Principles. The Siracusa Principles sets that States imposing these measures have “burden of justifying such serious measures,” i.e. they must demonstrate that the restrictive measures are necessary to curb the spread of infectious disease.

Although quarantines have been praised by WHO as a mean to reduce the spread of COVID-19, the possibility of imposing these measures in less developed countries, raises important questions. Quarantines have been used effectively in Africa in the past to contain the spread of Ebola, and other infectious diseases. In 2014, under the threat of Ebola, a number of rural communities in Sierra Leone successfully kept out cases of the disease through vigilant community control of local borders. Reduction in the number of Ebola cases in certain areas of Sierra Leone was largely attributed to quarantine strategies. But there were also significant challenges and ethical considerations . Home confinement may cause severe negative impacts, including insufficient access to food and medical care. People need to secure their livelihoods during quarantines. In fact, the Siracuse Principles set that when quarantines are imposed, governments have an obligation to ensure access to food, water, and healthcare.

With modern supply chains and home delivery, and governments able to guarantee incomes for a period, countries such as China, Italy or Spain have been able to impose home quarantine for many weeks, that are now successfully flattering the spread of the disease and reducing the number of  further potential deaths. But in Africa, for most people no work means potential starvation for many within a matter of days. WHO recognizes that ‘if a decision to implement quarantine is taken, the authorities should ensure that the quarantine setting is appropriate and that adequate food, water, and hygiene provisions can be made for the quarantine period’.

Since late March 2020, many Sub-Saharan African countries started imposing lockdowns and social distancing norms, often in a non-planed and disordered manner. In DRC a three-week lockdown imposed in Kinshasa had to be postponed amid fear of price speculation on basic goods and increased insecurity in the city . In Kenya excess use of force deployed to enforce the curfew aimed at combating spread of the virus resulted in shootings and deaths . In South Africa, police shoot rubber bullets and water cannons to disperse homeless people lining up for food. Similar situations have been also reported in Uganda, Zimbabwe and various other countries. As written in a recent media article, ‘currently the only model available to governments in this part of the world is restricting movement, but this has already backfired spectacularly’ .

On the other side of the spectrum, some countries in the region have been slow to respond. Until Burundi recorded its first two cases on March 31, the government  claimed it was protected from the virus because it “put God first” and Tanzania refused for too long to undertake some basic control measures such as to close massive gatherings for worship .

Top-down curfews that don’t consider the needs of the people during the lockdown are not an option. Neither is an option not to act. Countries in Sub-Saharan Africa require feasible social distance measures that can avoid the spread of the pandemic, while ensuring the basic livelihoods of the population at the same time.

Ensuring food security during the quarantine  

Rural contexts: Village-level community quarantine 

During the 2014 Ebola outbreak in Sierra Leone, quarantines were imposed on individual houses, neighborhood’s and villages (community quarantine), and in a few cases in entire administrative districts. In practice, quarantines normally lasted for 21 days.

In community quarantine, the movement of people is limited to accessing basic services and going to work within the limits of a certain geographical area, generally the village (including the farmlands around). The use of community quarantines proved very helpful in holding back the 2014 Ebola outbreak in Sierra Leone. Compared with household-quarantine, community quarantine allows the community to continue accessing the water sources and keep the farming activities.

In village-level community quarantine, movement restrictions apply to communications with those outside the village, which are limited to cases of emergency, but not within-the community (excepting in the cases of symptomatic or tested positive cases, which should undertake home confinement if the symptoms are mild, or have to be referred  to health facilities if they require intensive care).

Given that most rural communities in Sub-Saharan Africa are engaged in primary production, community quarantine allows to preserve basic food security  during the lockdown period, which should normally take between 4 to 6 weeks.

However, certain disruptions in the food supply are probably unavoidable: most rural communities depend, to one extend or another, on external food supplies to ensure nutrition diversity. Income may also be disrupted given the inability to reach the markets outside the community. Finally, access to seeds, fertilizers and other agriculture inputs will be affected during the quarantine weeks. But, in any case, all these negative impacts would be even more intense in a scenario of household-level quarantine. We also need to keep in mind that we are not talking about several months of quarantine, but some weeks, and that not ensuring social distancing means the threat of millions of lives lost. 

More than 80 per cent of the food in Africa is produced on smallholder farms, so ensuring that the farmers can continue producing during quarantine weeks will be critically important for the food security during the recovery phased as well.

The experience from the Sierra Leone Ebola pandemic demonstrated that involving local leaders during planning and implementation can help ensure community needs are met . It will also be important to announce the start of the quarantines well in advance, for communities to stock production and prepare themselves for the 4 to 6 weeks in isolation. Fundamental human rights should be respected and access to basic supplies should remain possible during the quarantine.

Village-level community quarantine is not a perfect solution, but is a realistic model to push back the pandemic expansion while preserving the basic rights of the communities and avoiding the much higher impact on the food security of the population that household confinement may entitle. Finally, it also provides better living conditions, helps social distancing for in-house suspected causes, reduces the impact of gender-based violence (compare to household-confinement) and preserves the social-cohesion fabric of the community: Village Saving and Lending groups, care groups and all other types of community organizations can continue meeting and providing support to their members during the quarantine.

The village-level community quarantine model should be applied as early as possible, once community transmission of COVID-19 starts in a territory. By a territory we mean either a country or, in case of large countries, the specific portion of the country where community transmission has started taking place.

Governments and donors should start now by providing production means to the communities (seeds, fertilizers, storage equipment) to enhance the ability of the community to remain self-sufficient during the quarantine period.

Urban contexts- Cash, vouchers and/or food aid for the poor 

 Most households in urban Africa depend on daily wages, so total lockdown is tantamount to starvation unless that loss of income is compensated by other means.

Urban areas, and specially crowded slums and refugee camps, however, will require different approaches than rural areas. Neighborhood-level controls in cities are difficult to apply. Furthermore, in most African countries, the majority of the COVID-19 community transmission cases are already happening all across urban settings, so clustering the population in specific neighborhoods with high incidence is probably not an option anymore. It seems that urban areas in Africa, especially large cities, will require at some point to apply households-confinements to contain the virus.

As the early examples of lockdown in DRC, Kenya and other countries have demonstrated, household confinement is not sustainable unless the basic needs of the poor (food, water, hygienic items) are granted during the quarantine. The poor lack savings and relay on their daily income to survive. The only feasible way to make sure that they can remain home for a given number of weeks is to provide them access to their basic needs during that period. Most African countries lack the safety nets that could cover those needs during the quarantine.

Call for an African-wide 6 Billion food security program now 

 Implementing these initiatives will require decisive political will by African governments and the full support by the international community.  They will also require mobilizing fast significant financial resources.

Two main continent-wide initiatives would be required:

 -A massive program to supply seeds, fertilizers and other means of production, aimed to support rural communities to undertake community village-level quarantines if and when needed: Cash and/or vouchers could be distributed to smallholders across Africa in the relevant regions. Around USD 3 Billion would -at least- be needed (50M smallholders’ households X USD 60 per household)

 - A cash, vouchers and/or food aid program to cover basic (food, water and hygiene) needs during quarantine for 50 million Africans households living in conditions of extreme urban poverty. Funding requirements than can be roughly estimated on USD 3 Billion too (50M x 30 days x USD 4 household family ration)

The cost of these massive initiatives is significant, but, with a joint effort with support from WB, AfDB, IFAD, regional development banks and bilateral donors (including USAID, EU and others), plus budgetary-allocations from the governments in the region (especially if there are debt-relief measures granted) should make the effort possible.

 There are probably still a few weeks’ window of opportunity to contain COVID-19 in Sub-Saharan Africa. But unless decisive measures are undertaken immediately to secure the food security of the poor, it will remain impossible to implement the type of strict social distance measures that containing the pandemic will require, and millions of lives will be lost.


martes, 7 de enero de 2020

España Vaciada: (1) La Raya


Una larga franja semi despoblada ,de unos 50 kilómetros ancho, se extiende de modo casi ininterrumpido a lo largo de la frontera con Portugal, desde el Oriente de la provincia de Orense, hasta el norte de la de Badajoz. Unas 140,000 viven en esta extensa zona, de tamaño total comparable a la extensión de un par de provincias de tamaño medio (18,800 km2). 

Ciudad Rodrigo es la única población con algún carácter urbano en toda el área, la mayor parte de cuyos pobladores residen en pueblos pequeños y de población envejecida. La densidad poblacional es algo mayor en Orense y Extremadura, siendo sus mínimos los de las comarcas de Sanabria y Carballeda, en Zamora (con apenas 3,5 h/km2) y La Cabrera, en León (4,1 h/km2), ambas de un marcado carácter montañoso.


Salvo tales excepciones, el resto de este desierto poblacional, al que podamos llamar la Raya (el apelativo tradicional de la población local para referirse a la frontera portuguesa), es de hecho territorio de orografía más bien suave, abundante acceso al agua (el rio Duero forma un tramo considerable de la frontera en Salamanca) y clima no demasiado riguroso. Debido a tales condiciones positivas para el poblamiento humano, la región no estuvo en absoluto tan despoblada en el pasado: el proceso de declive poblacional se inició aquí, como en casi todo el resto de la geografía de la España Vaciada, a partir de los años 60 del siglo XX. Si la emigración fue en La Raya mucho más acusada que en las comarcas vecinas, situadas más lejos de la frontera se debe, precisamente, a ese carácter fronterizo de la región, que la ha mantenido relegada durante décadas en términos de inversiones en infraestructuras y accesos a servicios. 


Es una zona escamante articulada, de personalidad difusa, de la que poco se habla y cuya crítica situación de despoblamiento ha atraído mucha menos atención que al de otras partes de España.  

Además de moribunda desde el punto de vista demográfico, la Raya es también un enfermo terminal sociocultural. El asturleonés, la lengua románica que aquí se habló durante siglos, es hoy un idioma al borde de la extensión. La Raya es, a fin de cuentas, la victima historia de un país donde lo ‘periférico’ parece importar poco.