Friday, June 5, 2020
Renewables Surpass Coal in US Energy Generation for First Time in 130 Years
‘We are seeing the end of coal,’ says analyst as energy source with biggest impact on climate crisis falls for sixth year in a row
Oliver Milman
https://portside.org/2020-06-03/renewables-surpass-coal-us-energy-generation-first-time-130-years
Solar, wind and other renewable sources have toppled coal in energy generation in the United States for the first time in over 130 years, with the coronavirus pandemic accelerating a decline in coal that has profound implications for the climate crisis.
Not since wood was the main source of American energy in the 19th century has a renewable resource been used more heavily than coal, but 2019 saw a historic reversal, according to US government figures.
Coal consumption fell by 15%, down for the sixth year in a row, while renewables edged up by 1%. This meant renewables surpassed coal for the first time since at least 1885, a year when Mark Twain published The Adventures of Huckleberry Finn and America’s first skyscraper was erected in Chicago.
Electricity generation from coal fell to its lowest level in 42 years in 2019, with the US Energy Information Administration (EIA) forecasting that renewables will eclipse coal as an electricity source this year. On 21 May, the year hit its 100th day in which renewables have been used more heavily than coal.
“Coal is on the way out, we are seeing the end of coal,” said Dennis Wamsted, analyst at the Institute for Energy Economics and Financial Analysis. “We aren’t going to see a big resurgence in coal generation, the trend is pretty clear.”
The ongoing collapse of coal would have been nearly unthinkable a decade ago, when the fuel source accounted for nearly half of America’s generated electricity. That proportion may fall to under 20% this year, with analysts predicting a further halving within the coming decade.
A rapid slump since then has not been reversed despite the efforts of the Trump administration, which has dismantled a key Barack Obama-era climate rule to reduce emissions from coal plants and eased requirements that prevent coal operations discharging mercury into the atmosphere and waste into streams.
Coal releases more planet-warming carbon dioxide than any other energy source, with scientists warning its use must be rapidly phased out to achieve net-zero emissions globally by 2050 and avoid the worst ravages of the climate crisis.
Countries including the UK and Germany are in the process of winding down their coal sectors, although in the US the industry still enjoys strong political support from Trump.
“It’s a big moment for the market to see renewables overtake coal,” said Ben Nelson, lead coal analyst at Moody’s. “The magnitude of intervention to aid coal has not been sufficient to fundamentally change its trajectory, which is sharply downwards.”
Nelson said he expects coal production to plummet by a quarter this year but stressed that declaring the demise of the industry is “a very tough statement to make” due to ongoing exports of coal and its use in steel-making. There are also rural communities with power purchase agreements with coal plants, meaning these contracts would have to end before coal use was halted.
The coal sector has been beset by a barrage of problems, predominantly from cheap, abundant gas that has displaced it as a go-to energy source. The Covid-19 outbreak has exacerbated this trend. With plunging electricity demand following the shutting of factories, offices and retailers, utilities have plenty of spare energy to choose from and coal is routinely the last to be picked because it is more expensive to run than gas, solar, wind or nuclear.
Many US coal plants are ageing and costly to operate, forcing hundreds of closures over the past decade. Just this year, power companies have announced plans to shutter 13 coal plants, including the large Edgewater facility outside Sheboygan, Wisconsin, the Coal Creek Station plant in North Dakota and the Four Corners generating station in New Mexico – one of America’s largest emitters of carbon dioxide.
The last coal facility left in New York state closed earlier this year.
The additional pressure of the pandemic “will likely shutter the US coal industry for good”, said Yuan-Sheng Yu, senior analyst at Lux Research. “It is becoming clear that Covid-19 will lead to a shake-up of the energy landscape and catalyze the energy transition, with investors eyeing new energy sector plays as we emerge from the pandemic.”
Climate campaigners have cheered the decline of coal but in the US the fuel is largely being replaced by gas, which burns more cleanly than coal but still emits a sizable amount of carbon dioxide and methane, a powerful greenhouse gas, in its production.
Renewables accounted for 11% of total US energy consumption last year – a share that will have to radically expand if dangerous climate change is to be avoided. Petroleum made up 37% of the total, followed by gas at 32%. Renewables marginally edged out coal, while nuclear stood at 8%.
“Getting past coal is a big first hurdle but the next round will be the gas industry,” said Wamsted. “There are emissions from gas plants and they are significant. It’s certainly not over.”
New York Police Are Attacking Protesters - They Know They Won't Face Consequences
The abuse has been enabled by laws that shield officers from accountability and by barriers to police oversight — as well as by city leaders who have long allowed police to operate with impunity.
Alice Speri, Ryan Devereaux, Sam Biddle
https://portside.org/2020-06-03/new-york-police-are-attacking-protesters-they-know-they-wont-face-consequences
AS THOUSANDS OF PROTESTERS converged in Brooklyn on Monday evening, NYPD scanners picked up a bit of radio chatter that stood out even in the atmosphere of boiled-over police violence. After a police dispatcher noted protester movement near the 77th Precinct, a voice on the same channel replies clearly: “Shoot those motherfuckers.” Just as clear was the immediate response: “Don’t put that over the air.”
The exchange, at 6:20 p.m., was captured via Broadcastify, one of many publicly accessible websites that allow users to listen in on police and other emergency radio channels nationwide. These sites have “skyrocketed to the top of the App Store” in the wake of George Floyd’s killing by police in Minneapolis, Vice reported this week. An NYPD spokesperson confirmed the radio exchange and told The Intercept that it is under internal review.
After days of increasingly violent repression of protests across the country, and after President Donald Trump called for protesters looting stores to be shot and Defense Secretary Mark Esper called U.S. cities a “battlespace” — the radio message was yet another indicator that police see protesters as enemies to combat rather than the citizens they are sworn to protect. But the chatter was also a sign of how emboldened police have become in calling for violence, and how little they seem to fear repercussions for violent attacks on civilians.
In New York City, as across the country, officers have responded to protests prompted by anger at police violence and lack of accountability with yet more violence and, mostly, no consequence. Over the last several days, NYPD officers have beaten protesters with nightsticks, ripped off masks to pepper-spray them at close range, driven their vehicles into crowds, and in at least one occasion pointed a gun at a group of demonstrators. These incidents, police critics say, represent a significant escalation while also being consistent with a long pattern of violence and lack of accountability by the country’s largest police department. The abuse has been enabled by laws that shield officers from accountability and by barriers to police oversight — as well as by city leaders who have long allowed police to operate with impunity.
“The disturbing videos and reports of the violent attacks by NYPD on protestors and the media, while traumatizing to watch, are all too familiar to us,” a group of New York City public defenders wrote in a statement on Tuesday. “They mirror the stories we hear every day of police acting with impunity, targeting, attacking, beating, lying, abusing, and disrespecting Black and brown people in the communities we serve in all five boroughs.”
In response to the police crackdown, NYPD Commissioner Dermot Shea expressed his pride as he congratulated his officers for their actions — days after condemning the officers who killed George Floyd in Minneapolis, calling their actions “deeply disturbing” and “not acceptable ANYWHERE.” Mayor Bill de Blasio, for his part, who also condemned Floyd’s killing in Minneapolis, continued his long-held practice of defending police misconduct in the face of indisputable evidence and attempted to shift the blame to protesters.
“I’ve seen that video and I’ve obviously heard about a number of other instances. It’s inappropriate for protesters to surround a police vehicle and threaten police officers,” de Blasio said earlier this week, in reference to one of those incidents. “If a police officer is in that situation, they have to get out of that situation.”
The Civilian Complaint Review Board, New York’s independent office for investigating police abuses, has received 467 complaints since Friday, when the protests started, “and is committed to fully investigating them,” a board spokesperson told The Intercept. But the police department is investigating only six, according to Shea. The NYPD spokesperson did not answer questions about several instances of police violence and misconduct that were caught on video. A spokesperson for the Attorney General’s office told The Intercept they are aware of the NYPD radio exchange, but declined to comment further or provide detail on any other ongoing investigation into police actions.
Despite the videos, advocates and victims of police violence fear that the officers involved in these incidents will escape accountability, as a number of officers assigned to protests have begun covering the badge numbers necessary to identify them. The NYPD did not comment on officers covering their badges.
Covering one’s badge number is in direct violation of the NYPD’s patrol guide, which allows officers to wear “mourning bands” covering the seal of the city upon the death of an officer but mandates that the seal number and rank remain visible. In April, Shea wrote on Twitter that some officers would be wearing mourning bands in commemoration of NYPD officers who died of Covid-19.
But covering one’s badge number also violates New York’s Right to Know Act, which mandates officers identify themselves by name, rank, and shield number when they interact with people. The act, which went into effect in 2018, also requires officers to inform those they stop that they have a right to refuse consent for a search, and to document those requests.
“It’s basically protecting NYPD officers from being held accountable in these mass protests, where they’re not actually following the law themselves,” said Jennvine Wong, a staff attorney at the Legal Aid Society’s Cop Accountability Project, in reference to growing reports of cops covering their badges. “Not only are they not following the law when it comes to the way that they’re interacting with individuals, but they’re also not providing the information that they should be providing when they’re interacting with the public.”
Officers had ignored their obligations under the Right to Know Act long before this week’s protest, Wong noted. She called it a “long-standing pattern with the NYPD.”
“It’s really problematic, because it makes it very difficult for advocates for individuals who are the victims of police brutality to hold these officers accountable if we’re not able to identify them,” she added. “And so not only are they acting with impunity, but they are actively trying to hide their identities from people who would hold them accountable. … They’re attacking protesters, and they’re covering their badge numbers. And so, even if we captured them on camera, how are we supposed to hold them accountable?”
For the most part, New York law protects officers from meaningful accountability. For years, before this week’s protests, advocates have lobbied legislators to repeal a decades-old state law known as “50-a,” which makes the personnel records of law enforcement officers “confidential and not subject to inspection or review.” As The Intercept has reported, officials have responded to pressure for greater police transparency with even stricter interpretations of 50-a, making everything from complaints of misconduct to the findings of internal reviews, to body camera footage largely inaccessible to the public. Efforts to repeal 50-a in court have failed, but the legislation was back in the spotlight this week after Floyd was killed in Minneapolis. Derek Chauvin, the officer accused of killing Floyd, had 18 previous complaints of misconduct filed against him.
In New York, which has one of the strictest laws in the country protecting the privacy of law enforcement officers, Gov. Andrew Cuomo surprised advocates this week when he expressed support for repealing 50-a, despite the fact that the legislation has been hotly debated during the nine years he has been in office. “I would sign a bill today that reforms 50-a,” Cuomo said. “I would sign it today.” De Blasio has defended 50-a, and under his administration the city has stopped making the outcomes of internal disciplinary reviews available to the public.
A spokesperson for Gov. Cuomo told The Intercept that “the Governor supports reforming 50-A, and has said he will sign a bill that does that,” adding that Cuomo “has asked the Attorney General to review all actions and procedures used during the protests.”
But advocates were skeptical of the governor’s promise — and insisted that the legislation should be repealed rather than simply amended. “He’s been silent on it previously,” said Wong, of Legal Aid. “This is a movement that advocates have been working on for years and years and years — they’ve been pushing for a repeal of 50-a forever.”
“New Yorkers have been demanding change for years,” Council Member Antonio Reynoso echoed in a statement condemning the NYPD and the mayor’s handling of the protests. “The NYPD needs to immediately release the disciplinary records of all officers, and where patterns of misconduct by individual officers are discovered, those officers must be terminated immediately and prosecuted where appropriate.”
Even before the recent wave of protests, the coronavirus emergency had offered police a new opportunity to escape scrutiny. A city official, speaking to The Intercept on the condition of anonymity, said that the CCRB was already in a tough position before the protests began. With New York City the epicenter of Covid-19, CCRB investigators, like other city employees, have been working remotely for weeks. Although investigations into police misconduct can be done remotely, the official said — much of it involves pushing through cases that came in long before the pandemic — the novel coronavirus has presented unique problems.
First, the official said, the CCRB frequently fields complaints from populations for whom physical visits to the board’s office is a necessity: individuals who lack access to phones or the internet and, in particular, New York City’s unhoused. “The other side of it is the PBA,” the official said — the Patrolmen’s Benevolent Association, the hard-right union representing New York City’s cops. “There have been no officer interviews since the beginning of Covid,” the official said, adding that without cooperation from the PBA, oversight investigators can only go so far. All of this, of course, comes after weeks of controversy surrounding the NYPD’s hard-line enforcement of local social distancing guidelines — and, now, its hammer-fist approach to policing protests. The PBA could not be reached for comment prior to publication.
While few expect the police department itself to conduct fair investigations of officer abuse during the protests, advocates warned that the questionable arrests and excessive force displayed in recent days would likely lead to scores of civil lawsuits against the city. Last year, the city paid $69 million to settle lawsuits over police misconduct, an increase of nearly $30 million over the previous year. And litigating misconduct lawsuits cost the city some $230 million in 2018 and $335.5 million in 2017.
Massive taxpayer-funded payouts over police misconduct are likely to come under increased scrutiny this year, since the economic impact of the Covid-19 crisis is forcing the city to slash its budget for next year by $6 billion. But, as The Intercept has reported, there is one city agency that has been largely spared the across-the-board cuts: the NYPD.
Our History is Our Future
JOHN DAVIS
https://www.counterpunch.org/2020/06/04/our-history-is-our-future/
We can be sure that the public grandiloquence of Barack Obama grated mightily on at least half of the country during his eight years in the Oval Office. Now, we Libtards find every Trump tweet excruciatingly inane – or horrifyingly inflammatory. As ever, it is the style, not the content, of American political leadership that is in question. For Its neoliberal ideology has been unwavering for four decades and is but the contemporary version of an implicitly racist dedication to the well-being of the wealthy that was fundamental to the founding of the Republic. Committed to the economization of all facets of public and private life, we citizens are remade as human capital: mini entrepreneurs whose only civic duty is towards pumping up the GDP. This is what our government demands of us, and we would be foolish to expect more from it than further destruction of the public realm and further trivialization of the democratic process. Having relinquished our individual roles as a necessary part of the Republic’s sovereignty, our vote is rendered superfluous at a time of a viral pandemic, unprecedented unemployment and expectations of further economic dislocation likely to eclipse the melt-down of 2008.
On a weekend when the nation’s streets exploded in violent protest against racialized police brutality, the President and the Vice President chose to attend a manned rocket launch contracted by SpaceX, a private corporation. Politics have been dethroned, the public realm abandoned and the public good forsaken. Trump is ascendant, his sun-bronzed, narcissistic gaze reflected in the ruddy glow of burning streets. His military, on high alert, awaits its orders.
Our smoldering streets may no longer be safe for Trump’s ‘warriors’ attempting, around the country, to fully re-open the American economy. Many will doubtless now enlist as his Law and Order ‘vigilantes’. Neoliberalism demands the appearance of vibrant, life-sustaining markets. Trump has seen the financial
indices decline as the epidemic curve has arced skyward, but his focus has always been on economic rather than public health. He, and his ‘warriors’, are quite prepared to sacrifice ‘flattening the curve’ for the sake of a rising Dow but his calculus must now include appeasing his newly enrolled ‘vigilantes’ while not entirely disaffecting African Americans.
Neoliberalism, as the SARS-CoV-2 viral pandemic and the uprising demonstrate, is this country’s comorbidity – a precondition making it extremely susceptible to both viral disease and to the recapitulation of long-ago racial injustice. In, The Road to Serfdom, 1944, Friedrich Hayek, the Anglo-Austrian economist, explicitly equates the freedom of the individual with the unfettered workings of the market. By way of contrast, he identifies the centralized economic planning evidenced in National Socialism, Communism and Social Democracies as inevitably trending towards totalitarianism. He suggests that governments restrict all attempts to establish social objectives and by extension, any encouragement of the citizen’s role in shaping these objectives. In other words, he recommends abandoning both the social and the political realm in favor of the invisible hand of the market, a goal that continues to inform neoliberalism as it is practiced across Europe and the Americas, and is the ruling ideology that has shaped the United States since the election of Ronald Reagan in 1980. Hayek’s ideas, developed out of his deeply felt reaction to German and Soviet totalitarianism, have had disastrous consequences in the United States where the gross injustices of its past continue to haunt its present, and where its best moments have been enshrined in exactly the kind of social objectives, such as FDR’s New Deal and LBJ’s Great Society, that Hayek spurns.
In the 1830’s, the two signature, home-grown horrors that have shaped American history, the genocidal eradication of indigenous peoples and slavery, coalesced in President Andrew Jackson’s ‘Indian Removals’ which aimed to deport a number of surviving Indian tribes to west of the Mississippi to make way for the establishment of further industrial cotton plantations. This expansion of slavery was partly funded by securitized bonds, sold in New York, London, Paris, and other finance capitals, in a process that involved the financialization of human flesh. The violence necessary to convert slaves into a fungible commodity had existed for over two centuries, practiced in their initial capture in Africa, in their transportation, and in their work. The stain of slavery was then embedded in the capital generated by the cotton crop which went on to be invested in the Industrial Revolution and formed the basis for this country’s extravagant wealth. It is a wealth that has not been shared by most of its citizens.
The highly visible murders of Ahmaud Arbery and George Floyd, performed on the street and reprised endlessly as viral videos on social media, go to the heart of this country’s racialized hierarchies established in 1492 and then compounded in 1619, with the arrival of the first shipment of African slaves introduced to this country as stolen human capital. Neoliberalism has made human capital of us all, but has vastly accentuated the wealth divide because, as Piketty has shown, it is from investment and inherited wealth that the rich are made – not from an honest day’s work. The majority of the U.S. population, and certainly most African Americans, rely not on wealth from inheritance or investments, but on the mythology of the equitable rule of law and equal economic opportunity. As the looting component of the uprising suggests, egregious racialized murder exposes an awareness of this country’s endemic economic injustice.
Nick Estes writes in, Our History is the Future, 2019, “Indigenous elimination, in all its orientations, is the organizing principle of settler society.” In documenting the Lakota tribes’ struggles to prevent the Dakota Access Pipeline passing under, and across sacred indigenous lands, Estes lauds the ongoing struggles of native peoples to resist a colonizing civilization that possesses an overbearing commercial ethic which leaves little room for the recognition of other, non-material values. Across the continent, indigenous peoples regarded the native soil, along with its flora and fauna, as co-creators of their lives, and the concept of its individual ownership was unthinkable. Genocide after genocide has still not entirely eliminated their awareness of belonging to the land – ever in conflict with those who so clearly prize the value of individual ownership, property rights and, of course, the strange notion that the land belongs to them.
It is in this country’s varied civilizational currents that the supreme value of the almighty dollar emerged. As a nation, we have bought and sold people, bought and sold the land’s natural beneficences, and now we have sold our sovereign right to vote to corporations that exist only to give succor to their owners and shareholders. The neoliberalism that was created out of a fear of totalitarianism has now made societies beholden to a totalized economy in which all is subsumed. Its values are those of the market, entirely blind to the human concerns of a richly diverse population many of whom it makes vulnerable to an ever increasing precarity in their livelihood, housing and health care. The current pandemic, natural disasters, debt crises, and recessions expose the venal character of this prevailing ideology, while emergency relief and bailouts are leveraged by the wealthy to expand capital in readiness for the next ‘recovery’ – widening the corrosive gulf between the rich and everybody else.
As a Native American academic, Estes celebrates his peoples’ ongoing resistance to the dominant culture, established shortly after 1492. By declaring that “Our History is Our Future”, he is committing to a continuance of this struggle. White members of the dominant culture can find no such guidance in their past. We see our history reenacted in violence and racial injustice entirely too often to wish it to be our future. We suppress our past and fear our future for good reason.
Neoliberalism has obliterated the conditions for democracy by concentrating wealth, eschewing the public good and causing civility to be drowned out by over-amplified, profit-seeking media. The democracy that now struggles to exist in this country, does so only as a fully financialized product fertilized by corporate money featuring a roster of politicians pitifully beholden to the special interests that support their reelection campaigns. Estes is right to reaffirm his peoples’ history. Our salvation might be in confronting ours.
Leading by Example: Cuba in the Covid-19 Pandemic
HELEN YAFFE
https://www.counterpunch.org/2020/06/04/leading-by-example-cuba-in-the-covid-19-pandemic/
The response of socialist Cuba to the global SARS-CoV2 pandemic has been outstanding both domestically and for its international contribution. That a small island nation, subjected to hundreds of years of colonialism and imperialism and, since the Revolution of 1959, six decades of the criminal United States blockade, can play such an exemplary role is due to Cuba’s socialist system. The central plan directs national resources according to a development strategy which prioritises human welfare and community participation, not private profit.
Cuban authorities reacted quickly to Chinese information about SARS-CoV2 at the start of the year. In January, authorities established a National Intersectoral Commission for COVID-19, updated their National Action Plan for Epidemics, initiated surveillance at ports, airports and marines, gave COVID-19 response training for border and immigration officials and drafted a ‘prevention and control’ plan. Cuban specialists travelled to China to learn about the new coronavirus’ behaviour and commissions of the government’s Scientific Council began to work on combating the coronavirus. Throughout February, medical facilities were reorganised, and staff trained to control the spread of the virus domestically. In early March a science and biotechnology group was created to develop COVID-19 treatments, tests, vaccines, diagnostics and other innovations. From 10 March inbound travellers were tested for COVID-19. All of this was before the virus was detected on the island.
On 11 March, three Italian tourists were confirmed as the first cases of COVID-19 in Cuba. Cuban healthcare authorities stepped into action, organising neighbourhood meetings, conducting door-to-door health checks, testing, contact tracing and quarantining. This has been accompanied by education programmes and daily information updates. The population went under ‘lockdown’ on 20 March, required to abide by social distancing rules and wear facemasks when leaving homes on essential business. Business taxes and domestic debts were suspended, those hospitalised had 50% of their salaries guaranteed and low-income households qualified for social assistance and family assistance schemes, with food, medicine and other goods delivered to their homes. Workshops nationwide began to produce masks, bolstered by a grassroots movement of home production, and community mutual aids groups organised to assist the vulnerable and elderly with shopping for food as long queues became the norm. On 24 March, Cuba closed its borders to all non-residents, a tough decision given the importance of tourism revenue to the state. Anyone entering the country was required to spend a fortnight in supervised quarantine, under a testing regime. Defence Councils in the Provinces and Municipalities were activated.
Video: Cuba’s Isolation Centers
In April payment of utility bills was suspended, likewise local and regional transport, while transport was guaranteed for medical staff and other essential workers. Havana and other cities were disinfected. 20 communities in six provinces were placed under total or partial quarantine. A Cuban-designed mobile phone app, ‘Virtual Screening’, went live with an opt-in application allowing users to submit an epidemiological survey for statistical analysis by the Ministry of Public Health (MINSAP). Measures were taken to keep the virus out of prisons, with active screening twice daily and no reported cases by 23 April.
By 24 May, a Cuban population of 11.2 million had reported 82 deaths and fewer than 2,000 confirmed cases; 173 confirmed cases per million people, compared to 3,907 per million in Britain. Not one healthcare worker had died, although 92 had been infected by mid-April.
Cuba’s exemplary response is based on five features of its socialist development. First, its single, universal, free public healthcare system which seeks prevention over cure, with a network of family doctors responsible for community health who live among their patients. Second, Cuba’s biopharma industry which is driven by public health needs, produces nearly 70% of the medicines consumed domestically and exports to 50 countries.[1] Third, the island’s experience in civil defence and disaster risk reduction, usually in response to climate-related and natural disasters. Its internationally applauded capacity to mobilise national resources to protect human life is achieved by a network of grassroots organisations which facilitate communication and community action. Fourth, the island’s experience in operating infectious disease (border) controls. For decades, Cuba has sent healthcare professionals to countries which have infectious diseases long-since eradicated on the island and has invited tens of thousands of foreigners from those countries to study in Cuba. It has well-developed procedures for quarantining people (re)entering the island. Fifth, Cuban medical internationalism, which has seen 400,000 healthcare professionals providing free healthcare for underserved populations in 164 countries; some 28,000 medical personnel were serving in 59 countries when the pandemic began. By late May, an additional 2,300 healthcare specialists from Cuba’s Henry Reeve medical brigades, specialists in epidemiological and disaster response, had gone to 24 countries to treat patients with COVID-19.
A commitment to high-standard public healthcare
In 1959, Cuba had some 6,000 doctors but half of them soon left; only 12 of the 250 Cuban teachers at the University of Havana’s Medical School stayed. There was only one rural hospital. The revolutionary government faced the challenge of providing a high-standard public healthcare system almost from scratch. To that end, in 1960, the Rural Medical Service (RMS) was established and over the next decade hundreds of newly graduated doctors were posted in remote areas.[2] RMS physicians served as health educators as well as clinicians. National programmes were established for infectious disease control and prevention. From 1962 a national immunisation programme provided all Cubans with eight vaccinations free of charge. Infectious diseases were rapidly reduced, then eliminated. By 1970, the number of rural hospitals had reached 53. Not until 1976 was the pre-revolutionary ratio of doctors to citizens restored. By then, health services were available nationwide and indicators had improved significantly. A new model of community-based polyclinics was established in 1974 giving Cuban communities local access to primary care specialists. Training and policy emphasised the impact of biological, social, cultural, economic and environmental factors on patients. National programmes focused on maternal and child health, infectious diseases, chronic non-communicable diseases, and older adult health.
In 1983, the Family Doctor and Nurse Plan was introduced nationwide. Under this system, family doctor practices were set up in neighbourhoods, with either the doctor or the nurse living with their family above the practice, so medical attention is available 24 hours a day. Family doctors coordinate medical care and lead health promotion efforts, emphasising prevention and epidemiological analysis. They rely on history-taking and clinical skills, reserving costly high-tech procedures for patients requiring them, holding patient appointments in the mornings and making house calls in the afternoons. The teams carry out neighbourhood health diagnosis, melding clinical medicine with public health, and individualised ‘Continuous Assessment and Risk Evaluation’ (CARE) for their patients. Family doctors and nurses are also employed in large workplaces and schools, child day-care centres, homes for senior citizens and so on.
By 2005, Cubans had one doctor for every 167 people, the highest ratio in the world. Cuba now has 449 policlinics, each attending to 20,000 to 40,000 people and serving as a hub for 15 to 40 family doctors. There are more than 10,000 family doctors spread evenly throughout the island.
Primary Health Care as the backbone of Cuba’s response
An article in April 2020 Medicc Review describes Cuba’s primary health care system as a ‘powerful weapon’ against COVID-19.[3] ‘Without early access to rapid tests, massive testing was clearly not in the cards as a first strategic option. However, primary health care was.’ Cuban authorities ensured that everyone in the healthcare system, including support staff, received COVID-19 training before the virus was detected. Senior medics from each province were trained at Cuba’s world-famous hospital for tropical diseases, Instituto Pedro KourÃ. On returning to their provinces they then trained colleagues in the second tier – hospital and polyclinics directors. ‘Then they went on to the third tier: training for family doctors and nurses themselves, lab and radiology technicians, administrative personnel, and also housekeeping staff, ambulance drivers and orderlies. Anyone who might come into contact with a patient’, explained a polyclinic director, Dr Mayra Garcia, who is cited in the Medicc article.
Each polyclinic also trained non-health sector people in their geographical area, in workplaces, small business owners, people renting homes, especially to foreigners, or managing childcare facilities, telling them how to recognise symptoms and take protective measures. Senior medical professionals in the polyclinics were sent to family doctors’ offices as reinforcement. Medical staff were posted in local hotels to provide 24-hour detection and health care to foreigners residing there. Walk-in emergency services were re-organised to separate anyone with respiratory symptoms and to provide 24-hour assessment. Non-COVID-19 related appointments were postponed where possible or shifted to home visits for priority groups.
The Medicc article underscores the importance of the CARE model for combating COVID-19. All Cubans are already categorised into four groups: apparently healthy, with risk factors for disease, ill, and in recovery or rehabilitation. Doctors know the health characteristics and needs of the community they serve. ‘The CARE model also automatically alerts us to people who are more susceptible to respiratory infections, the people whose chronic diseases are the risk factors most commonly associated with complications in COVID-19 patients’ explained Dr Alejandro Fadragas.
Throughout Cuba, CDRs, or street committees, organised public health information meetings for family doctors and nurses to advise neighbourhoods about the pandemic. Once the first cases were confirmed, the family doctors daily house visits were extended and became the ‘single most important tool’ for active case detection, to get ahead of the virus.[4] Some 28,000 medical students joined them going door to door to detect symptoms. This procedure means the whole population can be surveyed.
Video: Cuba’s Door-to-Door Doctors
People with symptoms are remitted to their local polyclinic for rapid evaluation. Those suspected of having COVID-19 are sent on to one of the new municipal isolation centres established throughout the island. They must remain for a minimum of 14 days, receiving testing and medical attention. If the case appears to be another respiratory illness, they return home but must stay indoors for at least 14 days, followed up in primary care. Hospitals are reserved for patients who really need them.
Primary healthcare professionals are also responsible for rapid contact tracing for all suspected cases; those contacts are tested and must isolate at home. In addition, the homes and communal entrances of patients sent to isolation centres are disinfected by ‘rapid response’ teams consisting of polyclinic directors and vice directors, alongside family members. Family doctors’ offices are also disinfected daily. Meanwhile, workers in hotels where foreigners are lodged are checked daily by medical staff. The polyclinic provides them with PPE and disinfectants. Polyclinics and family doctors are also responsible for 14 days follow-up for COVID-19 patients discharged from hospitals.
Home-grown medicine
The Cuban treatment protocol for COVID-19 patients includes 22 drugs, most produced domestically. The focus has been placed on prevention, with measures to improve innate immunity. Early on the potential of Cuba’s anti-viral drug Heberon, an interferon Alfa 2b human recombinant (IFNrec), was identified. The biotech product has proven effective for viral diseases including hepatitis types B and C, shingles, HIV-AIDS, and dengue. Produced in Cuba since 1986 and in China since 2003 through a Cuban-Chinese joint venture, ChangHeber, in January 2020 it was selected by the Chinese National Health Commission among 30 treatments for COVID-19 patients. It soon topped their list of anti-viral drugs, having demonstrated good results.
The drug has most efficacy when used preventatively and at early stages of infection. In Wuhan, China, nearly 3,000 medical personnel received Heberon as a preventative measure to boast their immune response; none of them contracted the virus. Meanwhile, 50% of another 3,300 medics who were not given the drug did get COVID-19. Cuba’s IFNrec is recommended in the medical protocols of several countries, by the World Health Organisation (WHO), Johns Hopkins Medical Centre and the World Journal of Paediatrics among others. The product was already registered in Algeria, Argentina, Chile, Ecuador, Jamaica, Thailand, Venezuela, Vietnam, Yemen and Uruguay. By mid-April requests for its use had been received from some 80 countries and it was being administered by Cuba’s Henry Reeve medical brigades treating COVID-19 patients overseas. On 14 April it was reported that 93.4% of COVID-19 patients in Cuba had been treated with Heberon and only 5.5% of those had reached a serious state. The mortality rate reported by that date was 2.7% but for patients treated with Heberon it was just 0.9%.
Other Cuban medicines reporting promising results include:
+ Biomodulina T, a immunomodulator which stimulates the immune systems of vulnerable individuals and has been used in Cuba for 12 years, principally to treat recurrent respiratory infections in the elderly.
+ The monoclonal antibody Itolizumab (Anti-CD6), used to treat lymphomas and leukemia, administered to COVID-19 patients in a severe or critical condition to reduce the secretion of inflammatory cytokines, which cause the massive flow of substances and liquid in the lungs.
+ CIGB-258, a new immunomodulatory peptide designed to reduce inflammatory processes. By 22 May, 52 COVID-19 patients had been treated with CIGB-258; among those in a severe stage, the survival rate was 92%, against a global average of 20%. For those in a critical condition the survival rate was 78%.
+ Blood plasma from recovered patients.
Cuban medical scientists are producing their own version of Kaletra, an antiretroviral combination of Lopinavir and Ritonavir, used to treat HIV/AIDS. Domestic production will eliminate costly imports from capitalist big pharma and subject to the US blockade. Meanwhile, the homeopathic medicine, Prevengho-Vir, which is believed to strengthen the immune system has been distributed for free to everyone on the island. Medical scientists are evaluating two vaccines to stimulate the immune system and four candidates for specific preventative vaccine for COVID-19 are under design.
By early May, Cuban scientists had adapted SUMA, a Cuban computerised diagnostic system, to detect antibodies for COVID-19 rapidly, allowing for mass testing at low cost. ‘The objective is to find new cases and then intervene, isolate, seek contacts, and take all possible measures to ensure that Cuba continues as it is now’, said Cuba’s top epidemiologist, Francisco Durán during his daily televised update on 11 May. This means the island no longer relies on donated tests or expensive ones purchased internationally. Cuba’s comparatively high rate of testing is set to soar.
BioCubaFarma is mass producing facemasks, personal protective equipment (PPE) and medical and sanitary products, as well as coordinating state enterprises and self-employed workers to repair vital equipment, such as breathing ventilators. Cuban efforts to purchase new ventilators have been obstructed by the US blockade which, for almost 60 years, has included food and medicines among its prohibitions.
Leading the global fight
On 18 March, Cuba allowed the cruise ship MS Braemar, with 684 mostly British passengers and 5 confirmed COVID-19 cases, to dock in Havana after a week stranded at sea, having been refused entry by Curacao, Barbados, Bahamas, Dominican Republic and the United States. Cuban authorities facilitated their safe transfer to charter flights for repatriation. Three days later, a 53-strong Cuban medical brigade arrived in Lombardy, Italy, at that time the epicentre of the pandemic, to assist local healthcare authorities. The medics were members of Cuba’s Henry Reeve Contingent, which received a World Health Organisation (WHO) Public Health Prize in 2017 in recognition for providing free emergency medical aid. It was the first Cuban medical mission to Europe. By 21 May, over 2,300 Cuban healthcare professionals had gone to 24 countries to treat COVID-19 patients, including a second brigade in northern Italy and another to the European principality Andorra.
The threat of a good example
Cuban medical internationalism began in 1960, but the export of healthcare professionals was not a source of state revenue until the mid-2000s with the famous ‘oil for doctors’ programme under which 30,000 Cuban healthcare workers served in Venezuela. US President Bush’s administration responded by attempting sabotage Cuba’s medical export earnings with the Cuban Medical Parole Programme. This induced Cuban professionals, who had paid no tuition costs, graduated debt free and voluntarily signed contracts to work abroad assisting underserved populations, to abandon missions in return for US citizenship. President Obama kept the Programme, even while praising Cuban medics combating Ebola in West Africa. It was ended in his last days in office in January 2017.
Video: Doctors speak (Cuban medical internationalists)
The Trump administration has renewed attacks on Cuban medical missions, fuelling their expulsion from Brazil, Ecuador and Bolivia, and leaving millions of people in those countries without healthcare. The motivation was the same; to block revenues to a nation which has survived 60 years of US hostility. In the context of the pandemic, when the US government’s wilful failures have resulted in tens of thousands of unnecessary deaths, socialist Cuba’s global leadership has represented the threat of a good example. Lashing out, the US State Department has labelled Cuban medics as ‘slaves’, claiming that the Cuban government seeks revenues and political influence. It has pressured beneficiary countries to reject Cuban assistance in their time of urgent need. These attacks are particularly vile; it is likely that Cuba is receiving no payment, beyond costs, for this assistance.
Meanwhile, the criminal US blockade, which has been punitively tightened under Trump, is preventing the purchase of urgently needed ventilators for Cuba’s own COVID-19 patients. A Chinese donation to Cuba of medical equipment was blocked because the airline carrying the goods would not travel to Cuba for fear of US fines. There is now a growing international demand for an end to all sanctions, not least against Cuba which has shown global leadership in combating the SARS-CoV2 pandemic. We must all add our voices to this demand. There are also calls from organisations and individuals worldwide to nominate Cuba’s Henry Reeve Contingents for a Nobel Peace Prize. What is clear from its history of principled medical internationalism is that, with recognition or without, revolutionary Cuba will continue to fight for global healthcare wherever its citizens, and its example, can reach.
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