Watch your life slide out of view, and dance and drink and screw ...

Watch your life slide out of view, and dance and drink and screw …

On the same day as it publishes a review of a “deeply silly and ruinously pricey” steak-and-lobster restaurant, that serves beef at $100/kg (minimum order 600g; “At that price they should lead the damn animal into the restaurant and install it under the table so it can pleasure me while I eat”), the Guardian also publishes a stinging critique of the UK government’s policy on poverty and equality, by the UK government’s own “Social Mobility Commissioner.” At the same time, the Washington Post publishes a simple graph that shows how college-educated poor kids do no better than rich high-school dropouts economically. None of these articles, of course, bother to question what this social mobility is, and what a long-term commitment to the concept of social mobility – rather than equality – does to the structure of our societies. The hint is in some of the statistics, published by the UK’s social mobility tsar (do they get the irony of this title?), which show how in the modern economy even people in their 30s are being “priced out of the UK.” How is it that in an ever-wealthier society, with increasing technological advancements and growing wealth, we can have got to the point where a generation of 30-somethings is unable to afford the basics that their parents took for granted? The answer is simple: when you set up social mobility as your vehicle for insuring equality, you don’t actually create a society of equal wealth, but of equality in failure, and because nobody likes to fail the people who already have all the advantages use them to ensure that their own kids don’t lose the social mobility race. By focusing on ensuring everyone equal access to the biggest slice of the pie, you slowly reduce the size of the smallest slice. This is a vicious circle: as life at the bottom gets harder, the people who already own the majority of resources and have the biggest share of advantages work even harder to ensure their own kids don’t fall. Which is why after 20 years of talking about “social mobility” the US is stuck with a situation where 16% of college-educated kids from the poorest 20% of society stay there, while only 16% of high school dropouts from the top 20% end up there. Sure, there is social mobility in this system, but there is also grinding poverty in an age of excess.

But what’s more important than the way the rich mobilize to protect their status for their children, is the immorality of what happens to those who end up at the bottom. Let’s look at that, and ask ourselves about the ethics of a system that guarantees some people have to fail.

What being at the bottom means

In amongst the debate about this issue, there is discussion of increasing the minimum wage in the UK to 8 pounds. Let’s think about what that means. Suppose you are 20 and earning the minimum wage. If you work 40 hours a week, you’ll get 320 pounds, or 1280 pounds a month. Supposing that you don’t pay any tax (which will not be the case, but let’s see what happens there anyway), how will your expenses pan out? Living in a room in a share house in any UK city will cost 500-600 pounds a month, so even if you can somehow live on just 10 pounds a day (unlikely; utilities and travel will probably consume most of this), that leaves you realistically with 300 pounds of savings a month. That is, 3600 pounds a year. After five years you will have the money for a deposit on a 150,000 pound flat. Which does not exist within 20 miles of your workplace. So if you live in a share house until you are 25, don’t go on a single overseas holiday, don’t have any other expenses (such as, for example, a computer or a car or even a new tv) and live on 10 pounds a day for 5 years, you can afford the smallest, shittiest place on the British real estate market, though it will be too far from your work to buy it. More realistically, you’ll have to save for 10 years under those conditions.

This may seem like carping – oh poor diddums had to give some things up just to get onto the property market – but it means something. Our parents’ generation took it for granted that if you saved at a reasonable rate you could expect to marry, buy a small place, and start a family by the age of 25 or 28. This kid in our example can only get to such a state by eschewing all forms of ordinary life, and not paying taxes. The more realistic situation is that this kid will be forced to work 6 day weeks for 10 years, living on next to nothing, avoiding almost any frivolity, in order to have enough money for a deposit – only, probably, to be turned down for a mortgage by every bank.

If a kid like this wants to “get ahead” in the modern world, their only hope is a second job and a NINJA loan. Is it any wonder that the housing market was prone to fraud and speculation, when standard financial options are not available to a growing class of people looking at their life sliding out of view … and being told at the same time that it’s all their own fault.

Making sure they stay there…

Of course, the rich are uniquely empowered to protect their children from sliding into this class, and that is exactly what we see in the statistics. For example, the newspaper reports that

Only 7 per cent of all young people attend private schools, and less than 5 per cent attend grammar schools, but combined, they accounted for 44 per cent of last year’s UK-schooled fast stream applicants in the civil service, and 46 per cent of those who succeeded

and the Washington Post article notes that rich people have unique privileges to prevent their children falling through what it calls the glass floor, and identifies the phenomenon of “opportunity hoarding,” which the New York Times summarizes succinctly as a simple problem the architects of the “equal opportunity society” don’t want to talk about openly:

It is a stubborn mathematical fact that the top fifth of the income distribution can accommodate only 20 percent of the population. If we want more poor kids climbing the ladder of relative mobility, we need more rich kids sliding down the chutes.

But of course the rich have much more control of both the ladders and the chutes. The game is loaded, and the more dangerous life at the bottom gets, the more viciously the rich will need to fight it. Improving the quality of education for the poorest will simply mean the wealthy will invest more in their childrens’ education, or come up with mechanisms to protect their children from poor competitors – utilizing existing networks of friends and fellows, and developing new barriers such as unpaid internships or higher qualification requirements, or simply pricing the top schools away from a larger share of the middle class. There is no way this can be prevented in a liberal market society, and the more we push this idea of social mobility as the key solution to inequality – the more we try to push people up into the top 20% and encourage the weak and stupid in that tier to fall down to the bottom – the more we will encourage the people at the top to protect their status and resources, the harder life at the bottom will get, and the more vicious the competition will become. Is this how we want our late capitalist society to greet its new graduates?

The morality of the fall

Is it really fair to anyone to have this situation at the bottom, though? Does it really matter whether the people who are stifling in the bottom 20% with no life choices and no future are really just the idiots and lazy bastards from every stratum of society? If our system of social mobility worked as the social mobility “tsar” wants it to, and the people at the bottom were simply those who couldn’t be bothered studying or trying to better themselves, or the dumbest and least talented of every class, is that really how things should be? It may satisfy the schadenfreude of a small number of class warriors, but is it really fair that just because Little Johnny Trustfund was dumb and lazy at school, he should be forced to spend the rest of his life locked out of financial security, home ownership and even the chance to raise a family with dignity and security? Is that a fair price to extract from him for being a bit dumb and lazy when he was 16?

It is tempting here to ask rhetorical questions that postulate some worthiness to poor fallen Johnny Trustfund. Perhaps he wanted to play football, so he didn’t concentrate on his grades but then failed to make the sporting cut. Perhaps he was in a car crash that wasn’t his own fault – it mustn’t be anything we could ascribe to a higher moral tale! – and had to drop out of school. Perhaps he was sexually abused, we all know the effect that has on school achievement. Surely such a person doesn’t deserve to spend his life in poverty just because of problems beyond his control? To this temptation I respond with a resounding “fuck it!” Why should the fruits of society only be available for nice people who never did anything wrong? I don’t want to live in a society where the punishment for being a dumb, lazy arsehole is a lifetime in penury. If that’s what “social mobility” means – that some smart, honourable poor kid gets to live a life of models and blow at the expense of some dumb, lazy rich arsehole being forced to live a life of unstable accommodation, poor healthcare and insecurity and worries – then I say our society has been designed by arseholes, and is broken. Just because Johnny Trustfund was a dickhead who squandered his daddy’s money and the opportunities he was given doesn’t mean he should be thrown on some kind of zero-hours-contract scrapheap for the rest of his life, or even 10 years of it. We can do better than that.

Wrapped up in the middle of our “social mobility” society is a moral tale that is offensive and cruel. We can build a better society than one in which, even though someone is always going to have to do the shit jobs, the people who are forced to do those shit jobs are also forced to live insecure, unstable and unfair lives. Why not look for something better?

The changing nature of a basic living

One unfortunate consequence of the changing nature of modern life is that our expectations of a basic living change with it. While 100 years ago the idea of a basic living might have been “shelter and food,” now it is different. In the modern world we expect that a basic living means not just shelter and food, but the ability to access to certain communications devices, to read and write and do maths (at an increasingly sophisticated level), to be able to deploy these skills for leisure (i.e. able to afford books at some basic level), the right to at least basic healthcare, and the rights to a sexual existence and ultimately a stable family that loves you. For women it includes the right to work and have a family without killing yourself. It is not possible to sustain these rights in the UK on a basic wage, or really at any part of the bottom 20% of the income distribution, but the fact that this is impossible in this income bracket doesn’t mean it should be impossible. With our current level of wealth we could easily redesign our social economy so that people in the bottom 20% of the income bracket could afford to live differently, and the fact that they can’t is a political choice not an economic fact. The “social mobility economy” is a political choice intended not just to ensure that the people in the bottom 20% of the income distribution earn much, much less than the top 20%; it is also designed to punish them for being there. The moral reasons for this punishment may vary depending on who you ask, but the presence of morality in the structure of our society is inescapable. And the consequences of this morality play in the modern world are real, and growing.

Unemployment as a generational strike

The Guardian reports that the “Saturday job” has become a thing of the past for young people, with the proportion of people who are studying and working dropping by half over the past 20 years. The unemployment rate in the UK is near 6%, and yet somehow all these young people are not able to do a Saturday job. Given the growth of cafe culture and large retail and services businesses that depend on casual labour, it seems unlikely to me that young British are dropping out of casual labour because the jobs aren’t there. Those jobs are going to Europeans, especially Eastern Europeans, and they’re going there for two reasons: because eastern Europeans will work for less, in cash; and because UK citizens won’t work for the poor wages they’re being offered – or at all. This is often portrayed in the right wing press as a sign of the unworthiness of the poor, but another way to see it is as a generational strike. A whole generation of young, poor people have watched as their working conditions and salary become increasingly difficult and disconnected from the lives and rights of the rich, and they have decided not to bother. They can also see that while to a poor Briton 8 pounds is 8 pounds, to a poor eastern European it is worth much more, because in their home countries the price of living is not so high. Basically, the minimum wage in the UK is designed to pay for the cost of living of an eastern European country with a much lower cost of living, but for some reason the UK’s leaders think that the British poor should be thankful for the chance to work for a wage that will only cover their needs if they move 1000km east. Not only is this an insult – an implicit version of Freud’s statements about some people not being worth 2 pounds an hour – but it’s also blindingly obvious to anyone who cares that working hard in this economic environment is a chump’s game. You won’t get ahead, or even get even – you’ll be working ever harder hours just to keep your head above water, and every time the government ratchets up the opportunity economy your lifestyle will be ratcheted down. Why bother? You’ll be worse off on welfare, but at least you won’t be spending 40 hours of your week making someone else richer.

The solution to this problem for the ruling class is simple: bring in more European cheap labour, and pay it less. The government doesn’t bother cracking down on paying illegal immigrants from outside Europe, and is barely able to catch people paying cash salaries, so why worry about those laggards? This vicious cycle only has one ending – given how easy it is to convince British people that their problems are based on race, not class – and that ending is UKIP. The short term consequence of this generational strike is the rise of UKIP, and maybe the disconnection of the UK from Europe, but in the long term this won’t solve anything because UKIP is as wedded to the concept of social mobility as anyone else in British politics, so the problem will simply be temporarily averted by a reduction in foreign competition amongst the poorest jobs. Once the working poor realize that UKIP were happy to kick out the foreign workers but not to address the poverty that opened up the job opportunities for those people in the first place, they will turn on UKIP. Where will that end?

A better way: ending welfarism and social mobility

When I was young and first at university 20 years ago, “equal opportunity” did not mean that everyone in every stratum of society had the same opportunities to screw up and fall into grinding poverty. Rather it meant that certain institutions and opportunities in society should be opened up to those from whom these institutions had been traditionally protected. This meant ending boys’ clubs, giving access to universities and the public service (and hospitals and schools!) to black people, Aborigines, and women. It did not mean that taking advantage of this access should become the pre-requisite for a fulfilling life. Somehow this idea sprang up in the interim, perhaps as a post-reaganite reaction to the growing equality of gays, women and Aborigines. I don’t know how this happened, but the modern notion of social mobility as a “cure” for inequality seems to have a lot more to do with Victorian morals about the deserving and undeserving poor than it does with any genuine political measures to cure inequality. It doesn’t solve any of those problems, only serves to widen the pool of people who can suffer at the bottom. The proper cure for inequality is to make life better for those at the bottom.

We don’t do this through increasing the education of the poorest, or through expanding the range of welfare protections for those people, though both of these things may be good in their own right. We do this by making work rewarding, stable and empowering for people in this position. This means ensuring that someone who is working on minimum wage can afford to live their whole life on that wage. The government cannot make this happen by itself, because the wage is paid by businesses. Something needs to be done to either lower the cost of living for poor people, or to increase their wages, and the latter depends on businesses recognizing their social responsibility to their poorest staff. Sure, housing costs and health costs can be partially controlled through government planning, but ultimately we need people at the bottom of the income scale to be able to afford to save a bit of money, to pay for their wedding and to raise kids and ideally buy some kind of house on their minimum wage. They need to have a path to secure long-term employment, and confidence that they can be sick or go through trauma of some other kind without their lives falling apart. This used to be possible through a range of corporate welfarism: cradle-to-grave jobs, employee holiday camps, union-run holiday homes, cheap home loans supported by the company, and so on. As a result of these rights, it was once possible for a working class family in industrial America to have a holiday cabin and visit there once a year, and to be able to save for a kid to go to college. Now they have the chance to leave their mortgage underwater and flee to the exurbs, where they will work a hyper-insecure job just to keep their car running. In the 40 years between those extremes, our societies have become immeasurably richer, so how is it that a modern US family can no longer afford to own their own home, and a modern single British youth cannot even afford to live alone, let alone buy a place of any kind?

The answer of course is that they were robbed. The people at the bottom of the income pile – whether generationally there or forced down there to make way for someone ambitious – have been robbed by the richest corporations. Wealth has accrued in the hands of a smaller and smaller number of people, and somewhere in the middle of all of that we lost track of the need to put limits on how much rentiers can gouge from renters. Capital has gotten out of control, but our past shows it doesn’t have to be that way. Political choices were made to steal from the poor and give to those who didn’t need it. These political choices are cloaked in the moral language of those who deserve and those who don’t, “strivers” and “leaners,” the 47% and the people who think they made that. The language of “social mobility” and modern neo-liberal concepts of “equal opportunity” are built on this language of the deserving and the undeserving. We need to recognize that this morality is 100 years out of place, and start working to regain that social order in which working was rewarding regardless of how noble the job might have been.

This will mean forcing corporations to pay their workers properly, flattening income scales and redistributing wealth not through welfare but through corporate pay structures. It will mean reining in the powers and privileges of the corporate elite and forcing them to reconnect with their employees. In some countries and some places, it will mean changing a wide range of social organization so that the price of living goes down for the poorest. In Japan it is still possible for someone on minimum wage to live alone in the heart of any city, though it may not be easy. This should be possible in any country with a modern capitalist economy, but sadly it is not. These problems in the price of living need to change.

Our moral yardstick should not be that some bright, smarmy kid from the poorest family can, through incredibly hard work and good luck, escape from a life sentence of grinding poverty, social insecurity, and limited lifestyle choices. It should be to eliminate that grinding poverty and social insecurity, and ensure the basic lifestyles of the poorest in our society. This means that regardless of your particular political perspective, if you truly value the rights of all people you should reject the language of “social mobility” and instead accept the importance and continuing relevance of that old and tired ideal, equality.

Today’s media are breathlessly reporting that the WHO is predicting 5,000 – 10,000 new cases of Ebola virus disease per week by the beginning of December. There is no written documentation on this, but I did find this study in the New England Journal of Medicine (NEJM) from the WHO’s rapid response unit which suggested 20,000 cumulative cases by 2nd November, which would be 10,000 more cases than we are seeing now (roughly) in just two weeks, so 5,000 per week in November. Given the doubling times in that study were estimated to be approximately one month, that does suggest a rough number of 10,000 cases per week by December (if anything that number is probably slightly optimistic). If so we can expect to see 40,000 cumulative cases by the start of December (20,000 to 2nd November, then 20,000 more in November), and 80,000 by the end of the year. Assuming the same doubling, we will see another 20,000 a week in January, which takes us to a rough 150,000 by the beginning of February, assuming that there is no successful intervention by then.

The case fatality rate is now estimated to be about 70%, so those time frames would give respectively (and approximately); 30,000 deaths by the start of December; 55,000 by the end of the year; and about 100,000 by February. Those are large numbers, but on a national basis what does that mean? In this post I want to look at the implications of these numbers under three different scenarios, but first let’s just look at the number of deaths by the end of the year, and do some rough calculations of the implications.

First, let’s look at just Liberia. The NEJM article puts about 50% of all cases in Liberia, so if we follow that proportion forward, we can expect about 27,000 deaths by the end of the year, and 40,000 cases. It’s not necessarily wise to assume that proportion is static, since the disease appears to have taken hold in the capital of Liberia and Liberia seems to be the worst affected, so the disease may spread faster there or may burn out sooner; but for lack of better evidence let’s just go with that proportion. Liberia, according to Wikipedia, has a population of 4 million, and its capital Monrovia has a population of about 1 million. At first blush, 27,000 deaths is not a lot of people in a country of 4 million … but in 2005-2010 Liberia’s mortality rate was 12 per 1000, for a total of 48,000 deaths in 2014 (my estimate). The 30,000 extra cases of Ebola in Liberia that will occur by the end of the year will cause 21,000 deaths, 50% of its annual total. In just 2.5 months the disease will kill as many people as usually die in 6 months. That’s a traumatic increase in mortality, such as usually happens only in times of natural disaster and war.

In addition, however, controlling the epidemic requires isolation and monitoring of an enormous number of people. Consider this report of an outbreak of Marburg disease in Uganda in September. The disease – which is very similar to Ebola – was identified in a single person in a small town in Uganda, and killed the index case after 17 days. Contact tracing was carried out, and the WHO reports that

As of today, a total of 146 contacts have been identified and are being monitored for signs and symptoms compatible with MVD. Eleven of the contacts developed signs and symptoms compatible with Marburg virus disease.

In order to properly contain this disease, the doctors had to track down 146 people, and of those 11 developed signs and symptoms (fortunately in this case none of them were positive). In the Liberian context this would mean that for every case, more than 100 people need to be traced and 11 isolated as suspected Ebola. Even if we assume that people are starting to catch on to the risks, and so are having less contacts and less need for isolation, we can probably still safely assume that to properly control the disease we need to isolate 4-10 people and trace 100 or so. For 30,000 new cases from now till the end of the year that will mean isolating 120-300,000 individuals, for a period of as long as 21 days. The top end of that figure is about 8% of the population of the country.

Finally, the toll on health care workers of the first 10,000 cases has been genuinely shocking. The latest WHO situation report tells us that 201 health care workers in Liberia have caught the disease, and 95 have died. Assuming that rate persists, adding 30,000 more cases will lead to the death of 300 more health care workers. Wikipedia, again, tells us that Liberia had 5000 full- or part-time health care workers in 2006, of whom 51 were doctors. By December Liberia will have lost almost 20% of its entire health workforce, leading to huge setbacks for health in one of only seven countries in Africa to have met its Millenium Development Goal 4 (under-5 mortality) targets.

So let’s bear those basic figures in mind. 40,000 cases= 28,000 deaths, 120-300,000 isolated individuals, 1.2 – 3.0 million individuals being monitored for signs and symptoms, 20% of the health workforce dead. Also, a very large number of foreign health workers coming in to help, and entire new hospitals being constructed in a country with no suitable infrastructure. Now let’s consider three different scenarios, based around the UN’s 70-70-60 goal, which is to be able to isolate 70% of cases and bury 70% of bodies safely, within 60 days. The low basic reproductive number of Ebola – below 2.0 in most cases – means that preventing 70% of secondary cases should be sufficient to kill the epidemic (just!) So let’s assume that if this goal is reached and maintained, the epidemic will plateau and then begin to decline, in about the same time that it took to escalate. For simplicity we’ll count that time period in terms of numbers of cases – so after the disease peaks, we will assume as many new cases occur as the disease fades away as occurred in its growth. This is not unreasonable – most epidemic patterns don’t crash, but tend to go through a decline that looks roughly symmetric to the increase. This may not apply with a disease as fatal as Ebola, but no one will know till we come out the other side, so let’s assume it will behave as most other epidemic patterns do. This means that if we have x cases by new year, and the UN goal is attained at new year, we should expect to see a further x cases before the disease is gone.

The best case scenario: Liberia meets the UN goal on time

If the sudden inrush of aid workers and soldiers enables Liberia to meet the UN goal on time, we will reach 70-70 in 60 days from now, i.e. by mid-December. That means there will have been 60,000 cases by the time the epidemic begins to decline, or maybe 100,000 by its end. This means 70,000 deaths, 300-700,000 isolated individuals, and pretty much everyone in the country being monitored. About 50% of the workforce will be dead. If we assume the decline takes a few months, say until March, we can guess that we will see nearly two years’ mortality in just 6 months. Between 10-25% of the population will have been isolated for about one month during this period, unable to work or care for others. The goal of safely burying 70% of the dead means 50,000 bodies will need to be buried by specialist teams. The difficulty of their work can be seen in this excellent brief report from the NY Times, but I think it’s obvious that burying 50,000 bodies is going to have to be done in a very different way to this. I wonder if there is even a protocol for mass burial of highly-infectious bodies?

This is the best case scenario. On the basis of the numbers alone it is clearly a catastrophe for Liberia, but it isn’t enough to bring the country to its knees (at least with outside help). Less than 2.5% of the country is dead, and although the economic effects are alarming and the long-term destruction of the health system will set the country back years from its health goals, it doesn’t appear to be a recipe for total collapse (at least on paper). There is hope here, and if the containment efforts are good so that the epidemic crashes really fast, then we can expect it to have a much less significant effect on the health workforce.

The realistic scenario: Attaining 70-70-60 a month late

Suppose instead that the UN goal is missed by a month, taking us to mid-January. That will correspond with about (very roughly) 100,000 new cases by the time the epidemic peaks, or 200,000 by the time it finishes in probably March or April next year. From our calculations, this means 140,000 deaths, 600,000 – 1.5 million isolated individuals, and the remainder being monitored. The entire health workforce will die in this scenario, and about 100,000 bodies will need to be buried safely. Only 54% of the Liberian population are working age, or about 2 million; it’s quite possible that a large part of the adult workforce will be in isolation for more than 3 months, with a large part of the rest involved in basic Ebola-combat activities (burying bodies, contact tracing, logistics). The death toll is equivalent to three years’ mortality in 6 months. What this would mean for the agriculture sector I cannot guess, but it doesn’t seem good. At this level of disease spread, I think we are looking at a society on the verge of collapse, where trade-offs have to be made between isolation/contact tracing on the one hand, and maintaining basic functions of civil society on the other. If the UN goal is missed by a month, alternatives will need to be found to isolation systems, and a huge increase in available health workers will be needed.

The worst case scenario: Failure to contain the epidemic by February

Failure to contain the epidemic by February means 150,000 cumulative cases by February, and probably at least 300,000 (maybe more) over the next few months, with no sign of a slowdown. Every month we will see another doubling of the rate (40,000 per week in March, and so on). Just taking the minimum value here of 300,000 cases, there are 210,000 deaths, 840,000 – 2 million individuals in isolation, and the entire health workforce decimated. In this scenario most of the adult working-age population is isolated, and the entire economy has shut down. Without a huge influx of foreign aid – in food, water, field hospitals, and probably thousands of medical staff – the disease will break out of any containment system that might be left in place, and the only limit on its spread will be its own voracity. This suggests to me that we have until January to get an effective containment system in place, or Liberia as a country will cease to exist in any functional sense. We should assume, furthermore, that in the general breakdown of the social order that will ensue many people will leave the country, and the risk of the epidemic spreading to Nigeria will be very great.

Caveats and limitations

These figures are all rough guesses based on huge assumptions. The number of people who need to be isolated will not scale linearly with disease spread, for example, because one individual will begin to have multiple case connections, and as the disease spreads and social contact reduces, the number of people a new case will have actually touched or been near will decline rapidly. So my estimates of effects on the working age population are inflated, and these are the key cause of social breakdown, I think. Without the effect of isolation and disease containment efforts, even 300,000 cases and 210,000 deaths is not a society-ending event in a country of 4 million people, though nobody wants to think about how horrible that will be. My assumption that the downward side of the epidemic will cause as many cases as the upward side is based on the assumption that the basic reproduction number will be reduced only just below 1 by the 70-70-60 plan; this means each existing case gets a chance to cause another, but if the epidemic is contained more effectively once the plan is in place that assumption could be an over-estimate. Also there are geographical limits on the spread of the disease (especially once things get desperate and all travel within the country is shut down); this will mean that the disease rapidly burns through its available cases and dies out before it can spread fully. And finally, I don’t know what the time trend in deaths of health workers is, but I suspect these deaths were mostly in the early stage of the disease before the word was out, and that deaths are now declining rapidly towards zero. Given all these constraints, I think that an aggressive plan enacted now, aiming to achieve the 70-70-60 goal, and followed through aggressively thereafter, will probably stop the disease somewhere before the numbers provided in my best case scenario. This will still cause a years’ worth of mortality in a couple of months, take up to 10% of the working age population out of work for isolation, and kill up to 20% of the Liberian health workforce. It won’t cause a national collapse, but it is a catastrophe easily as bad as a tsunami or some other huge natural disaster.

What should this mean for the future of health planning in Africa?

We often talk about “fragile health systems” and “extreme poverty” in Africa, but in the rich nations we’re used to thinking of health system failure as poorly-managed diseases and unpleasant medical experiences, but it’s worth remembering that at the extremes of medicine there are disasters: car accidents, pandemic influenza, and incredibly horrible diseases like Ebola. In the best of times in Africa, “fragile health systems” means excess deaths due to preventable infant, maternal, HIV- and malaria-related mortality. But in the worst of times it means huge waves of mortality due to natural disasters, war or epidemics. This Ebola outbreak is showing the rich world what “fragile health systems” really means, and also showing us that we are not able to completely disconnect ourselves from these failures. We can’t expect to isolate ourselves from emerging infectious diseases forever, except perhaps at the cost of our humanity, so instead of trying to isolate ourselves we should try to seriously tackle the fundamental problems affecting health systems in Africa and some parts of South Asia. This is not like a military intervention where the best of intentions can bring about the worst of results; we know what works and we simply need to find the political will to make it happen. Once this disease is back in its box, and all three affected countries are able to contemplate a return to normality, we in the rich world should make a serious, final effort to fix global poverty and most especially to end the grotesque inequality in health systems around the world. It’s almost certainly not going to happen, but we have to recognize that any country with a fragile health system is one weird event away from a terrible humanitarian catastrophe, and we need to start thinking about how to stop this from happening again. That means we have to act to help those countries to genuinely strengthen their health systems, and achieve the kind of economic state that is able to sustain them. This may mean we fat, rich westerners pay a little more for our chocolate, coffee and clothes, but it’s a price I hope we are all going to be a little more willing to pay now that the threat of dying horribly in our own body fluids has begun to make itself felt.

This situation should also serve as a warning about the dangers of ignoring very rare but high-risk events. Ebola has been known for 40 years, and this is the first time it has ever escaped containment. Work on a vaccine has been delayed or ignored partly, I think, because the risk of this disease escaping its bounds is so low that people considered it negligible. I hope my calculations show that the cost of this disease is only negligible provided it never happens, and that once it does happen all our risk assessments look incredibly stupid. We need a new way of assessing risk which puts a serious value on low-probability events. In the era of climate change the implications of this are obvious. At the tail end of some of the global climate models there are some extreme, civilization-ending events that have been largely overlooked by policy-makers because they are so unlikely to happen. Hopefully this Ebola outbreak will convince the world that it is time we started looking more at the tails of our probability distributions, and not at the comforting bulges down near the low-cost events.

Commencing case isolation protocol 666

Commencing case isolation protocol 666

Media reports today that the Spanish government has killed a dog. Not just any dog – this was Excalibur, the hapless pet of the nurse who is quarantined for Ebola in Spain. The nurse, Teresa Romero Ramos, is being treated for Ebola after contracting it while treating a returned missionary; her husband is in isolation to be monitored for signs of the disease, and there are fears that the dog might have it too. It’s not clear whether dogs can get or transmit Ebola, though there is some vague evidence that they are at least at risk, so in theory there was some justification for the execution of an innocent dog, but in my opinion this is a huge public health mistake.

Because there is no treatment for or vaccine against Ebola, our only effective intervention to prevent its spread is case isolation, which in turn depends on early identification of cases, and rapid and effective contact tracing. This method alone has been effective in every previous outbreak. Although not airborne, Ebola is highly infectious with close contacts, so early identification is important to reduce the subsequent contact tracing burden, but symptoms are vague (fever) and easily confused with other possible illnesses – especially as influenza season approaches. So it’s really important that people with fever be willing to attend a doctor early, and that they be willing to risk putting their lives into the hands of public authorities on the basis of nothing more than a suspicious fever.

This kind of early identification, case isolation and contact tracing depends fundamentally on trust. The person with a fever needs to trust that they and their loved ones will be treated well, and that people contacted through them will be treated well. In general – I’m going to go out on a limb here – shooting someone’s dog does not fall under the definition of “treating them well.” It is, in fact, kind of mean.

Of course we all know that in times of emergency, the government will kill our dogs. If Ebola jumps the shark, you can bet that pets of all kinds will be seen as mere collateral damage in an extremely authoritarian and aggressive public health response. But since we don’t want our society to get to that point, our first goal in public health responses should be to ensure that everyone who might need to attend a doctor does so as early as possible, without fear of the consequences. Notice the emphasis on might – that is an important word in this context. If you want to give people the impression that they don’t need to fear the consequences of reporting their fever, you probably shouldn’t shoot their dog.

Now, many people might think that this is a public health emergency and in public health emergencies dogs aren’t very important. This is probably very true. But a public health response has to be built on the possibility that not everyone will agree with you about that; or that they might not understand the dynamics of infectious diseases enough to realize the dangers of letting their dog go; or that they might not have the same understanding of their own disease risk that you do. If anyone who thinks in any of those ways gets Ebola, and you have given them reason not to trust the authorities, they will delay their attendance to a hospital, and/or lie about their circumstances. This doesn’t just extend to crazy scenarios like refusing to admit they have Ebola because they don’t want you to kill their dog. The most likely scenario is much more bland: someone with a fever misjudges the risk that it is Ebola, and because they have a general worry that their dog will be shot if they go to hospital, they decide to just “wait and see” for a few days. During that few days they definitely infect their dog, and a few other people, before they finally accept that the bleeding eyes are the giveaway that they really do have Ebola.

But shooting a dog isn’t just about dogs: it’s about the general possibility that you’ll be treated like shit just because you have a fever. There are lots of other situations where such a fear could cause delay: the dude who has a fever but spent last night cheating on his wife, and is worried that a government that shoots dogs won’t be particularly discreet about contact tracing; the potential Ebolaee who has friends with prizewinning breed dogs, and doesn’t want to have the government shoot their friends’ dogs so decides to just wait a few days to be sure it isn’t Ebola; the person who gets really sick at work, but whose cat is outside, decides to check himself in to hospital but figures cats don’t talk to strangers, and doesn’t want all the cats in the neighbourhood being shot, so doesn’t mention it; the dog lover who doesn’t think they have Ebola and doesn’t want to take the risk, so hands their dog to a neighbour before going to hospital. Any one of these scenarios is a potential nightmare of contagion, and they can break down at any point in that identification-isolation-contact tracing process.

Obviously when the outbreak goes epidemic, this will all become academic, but right now it’s not epidemic: there are a few people under observation, and two people in quarantine. The decision to kill the dog sparked a global protest. Would it really have been so difficult to tranquilize the dog, put it in some kind of quarantine, then tweet pictures of it with a dumb-arsed chewy toy and the phrase “Spanish healthcare: no dog left behind”? A tiny bit of extra work, for a huge public relations win. You can always shoot the dog a few days later and claim it got Ebola and it was the “humane thing to do.” If you really really can’t figure out a way to keep a dog alive for a few days without touching it, I think you aren’t really trying – and I think every pet owner will agree with me about this. Also – and this might prove important later in the epidemic – we don’t know if dogs can transmit or even become symptomatic for Ebola. It might be nice to know that, and right here we have a dog with potential Ebola. More specifically: there are a lot of cat owners out there, and cats wander, and fight. If one of those cat owners has Ebola and lets their cat out at night, it would be really really handy to know whether domestic pets are a risk. If only we had a dog with Ebola … oh, but we shot it.

Basically the Spanish government just told everyone who thinks they might have Ebola that even though they are nowhere near emergency stage, they’re already willing to act like complete dickheads. So anyone who has a fever and something to hide, a pet, or a group of people they really don’t want to annoy, is going to be thinking that maybe they should be really sure that it’s Ebola before they cash in everyone they know to a pack of ruthless dog killers. That suspicion may only delay their presentation for a day or two, it may only make them lie a bit during the contact tracing phase, but that’s enough – the disease gets spread. And as we have seen from Africa, stopping the spread of this disease early is crucial to stopping it at all.

Also, if I survive Ebola, I would quite like to go home to rapturous greeting from my (uninfected) dog. Shooting Excalibur was just a dick move.

Since I’ve been talking a bit about HIV lately, I’ve also been thinking about Ebola, and so while I’m here I thought I’d make a few other points about the media treatment of Ebola, and the associated public perception, that I think are important. I also would like to share the Science collection of articles on Ebola, which have been made open access for the duration of the epidemic. These include some fairly accessible media descriptions of the issues, and also some interesting survivor interviews. The Guardian has also devoted one of its (horrible) live “Blogs” to a day of coverage of Ebola, which is reasonably informative (it also includes survivor interviews). Make no mistake: this disease is easy to prevent and really, in the modern era, should not be a serious public health threat, but it is a terrifying phenomenon once it gets wild.

Ebola is not less important than Malaria and HIV

Quite a few media articles have been complaining that Ebola is getting more attention than malaria and HIV, which are the worst killers in Africa. Articles on this theme usually show  a mixture of motives, primarily a desire to criticize media sensationalism, complaints about westerners just throwing money at dramatic attention-grabbing problems rather than core health problems, criticisms of the amount of money available in aid[2] for these major diseases, general bullshit about the WHO[1], or misjudgments about risk. But let’s be clear about this: it’s a completely bullshit argument, probably racist and definitely annoying. First of all, huge amounts of aid money are committed to malaria and HIV every year: the Global Fund, Bill and Melinda Gates Foundation, WHO, PEPFAR, GAVI – there are billions and billions of dollars, whole inter-governmental organizations (e.g. UNAIDS!) and large portions of international aid budgets devoted to the biggest killers in Africa. They are not under-resourced, though of course all these diseases could (and should) have more money. Also this disease is not something you can sensationalize enough: read the reports from survivors, and you see that it is a truly terrifying and destructive phenomenon. It is also possible for us to walk and chew gum at the same time: pouring resources into Ebola doesn’t suddenly mean HIV will lose its money, and if anything the opposite will happen: a society forced to commit all its medical resources to a sudden wildfire epidemic will not be able to maintain routine health care, and other conditions (in Africa, maternal and child mortality) will get worse. This is a fairly obvious thing to say, but because opinion writers are usually idiots, it needs to be spelled out: a society facing a medical apocalypse cannot also maintain routine maternity services. As an example of this, I know a man whose cousin had arranged work as a paediatrician in Sierra Leone, starting in November. She’s now changed her plans, and will be starting work in an Ebola containment ward next week. That’s what happens when a hemorrhagic virus goes full retard: paediatricians don 77 layers of rubber and head into the hot zone.

But the thing that’s most annoying about this article is its reduction of all of Africa to a single entity, or as the infectious disease blog haba na haba put it, Ebola is only the Kardashian of diseases if you think Africa is a country. Yes, malaria and HIV kill lots of people in Africa, but the death numbers for these diseases cover the whole continent. Ebola is killing people in just three countries, and it has probably now killed more people this year than HIV and malaria combined in those countries. Unless you think national boundaries don’t matter for health and economic policy, it should be fairly obvious that while most of Africa is struggling primarily with HIV and/or malaria, in these three countries Ebola is a catastrophe unfolding on a grand scale.

This last argument comes down to another simple problem with modern media and their interpretation of health policy: misinterpretation of risk.

Ebola is only harmless while we make it so

Ebola is not as infectious as measles or mumps, or even HIV, but it is remarkably virulent and its ability to infect people after death means its growth is not necessarily constrained by its high case fatality rate. This makes it a rather unique virus. But there are many articles in the media suggesting that we are over-reacting to Ebola, and that it is not that serious a concern. These articles are largely based on past experience of Ebola, but they miss an important point about how we manage disease outbreaks: Ebola is only not a threat so long as we take it very seriously. Provided we take Ebola seriously, and act quickly to stamp out even the smallest evidence of it, it is not a serious concern. If we decide that therefore it is not a concern, and lower our guard, it will spread and cause huge damage. But the various critics of epidemic policy are always looking for the latest disease threat that didn’t materialize – SARS, avian flu, H1N1 – and claiming that the health authorities overreacted, when in fact that “overreaction” is the main bulwark between civilization and chaos.

And if you want to see what happens when that bulwark collapses, visit the Ebola zone now. In this article, Senga Omeonga talks about his colleagues who were struck down by Ebola. He is a doctor, and only just survived the disease. He says, of his small unit,

In total two brothers, a Spanish priest, a sister, two nurses, one x-ray tech, one lab tech, and one social worker died. Two other doctors, two sisters, and one orthopedic tech survived. They closed the hospital after the outbreak.

So many skilled health workers died because of one index case. Ebola preferentially targets healthcare workers, and the associated people who are needed to support the work of doctors. Even if these countries manage to defeat the disease, they are facing a future with a massively depleted healthcare workforce. Some of these countries have less than 100 doctors, and less than 1000 nurses: every single death in this workforce is a huge loss, and the loss of a massive amount of national capital. Even if the disease doesn’t spread enough to decimate the population – a possibility that is looking increasingly likely – it is probably going to set the health development program in these countries back by decades. The result of this epidemic will be a long-term reduction in capacity to handle HIV/AIDS, malaria and maternal and child mortality. But a lot of coverage of this disease is predicated on the assumption that health systems are overreacting, and that the disease can be assessed simply in numbers of deaths, rather than their strategic location; and a lot of media reports (and let’s face it, probably a lot of government policy) has been focused on the risk of rich nations being infected, rather than on the threat to health systems in poor countries.

Once the health system collapses, any disease gets a free run. The health systems in these countries are on the brink. Even the World Bank – which has spent years resisting Universal Health Coverage – has been forced to recognize that these health systems are fragile and underfunded. When these countries emerge from this epidemic, let’s hope that western governments will have finally learnt the lesson global health policy makers have been pushing for years, and recognize that in an interconnected world robust health systems are a social good. Maybe then they will start to find creative ways to create the fiscal space for effective health systems in even the poorest countries. Any program that looks for such a fiscal space is going to need to recognize that poverty and underdevelopment do not support universal health coverage, and make policies to genuinely support economic growth. Let’s hope Ebola is a turning point towards shifting the economic relations between low- and high-income countries, to the unequivocal betterment of the former.

fn1: If you google “ebola WHO priorities” you’ll find this article by Henry I Miller being syndicated across the world. It’s incredibly negative about the WHO – the organization that eradicated smallpox! – and also incredibly wrong. It’s worth noting that Henry I Miller was specifically identified as an advocate for Big Tobacco in the Tobacco Papers. The campaign against tobacco is one of the WHO’s greater success stories, so it’s no surprise that he takes every opportunity to slander the organization, and no surprise that the Hoover Institute is willing to employ someone this oily. It should come as no surprise, then, given the history of Big Tobacco in funding global warming denialists, that this greasy little man is also a global warming denialist. Yet idiot newspapers around the world have reproduced the anti-WHO rantings of this paid defender of Big Tobacco. Do they have any understanding at all of how to check sources?

fn2: I particularly like the use of a picture of a semi-naked dead person being sprayed with disinfectant at the top of an article about our “empathy deficit.” Stay classy, Huffington Post!

He likes the smell of new viruses in the morning

He likes the smell of new viruses in the morning

This week the journal Science reports a new study finding HIV first emerged in Kinshasa (now the Democratic Republic of the Congo) in the 1920s – not the 1970s or 1980s as previously suspected. The disease was likely introduced to Kinshasa through bush-meat, but spread rapidly across the Congo through mobile workers moving on Belgian-built train networks. At that time the region was a Belgian colony, and labourers were moving across large areas of the country as they moved to and from the capital and large mining areas in the hinterland. The article also reports that Kinshasa itself had a large and active sex industry in support of he transient labourers, and this may have helped to spread the disease. It’s an interesting story of virology, archaeology and globalization.

What I find fascinating about this story is that HIV took hold in the 1920s, but wasn’t identified as a disease until the 1980s, despite the presence of medical and public hygiene programs in Kinshasa, the growth of tropical medicine as a discipline, and the presence of major militaries in the area during both world wars (most notably the Force Publique, a force of some tens of thousands of black Congolese soldiers led by white Belgian officers). Typically the military establishment pays careful attention to hygiene and to STIs, especially since the work of Florence Nightingale, but somehow during all this period they missed HIV as a disease. In fact, this new research suggests that the success of the entire discipline of Tropical Medicine should probably be reassessed.

The reason that HIV was not identified is, I think, quite simple: it has a very long asymptomatic period, up to 12 years, and it does not manifest through a single set of coherent symptoms, like measles or flu, but through a complex of opportunistic infections. The case definition for AIDS is complex and depends on a list of AIDS-defining conditions that have few commonalities, so it is extremely hard for a doctor seeing these cases in disparate people to identify a single underlying condition. Instead the symptoms are treated, and the patient dies. From the point of view of a doctor in 1920s Belgian Congo, finding an underlying cause would be almost impossible. First the doctor might see a soldier with recurrent herpes, then a miner with a rare and untreatable cancer, then a sex-worker with repeated bacterial infections. Some of these people might have got the disease sexually, some through infected needles during a vaccination drive, perhaps the soldier might have exchanged blood in a fight – 10 years ago. It’s just not possible to identify a cause in this case, or to see a common pattern.

So why do we even know about the existence of HIV at all? It was first identified in 1984, but if it had been around since the 1920s it should surely have been identifiable in the modern era, at least since the program to eradicate smallpox, when modern public health was really beginning to come to terms with infectious disease. Why so late? I think it was identified because of a stroke of luck: a group of cases in the USA that all happened in gay men, and with a disproportionate number of Karposi’s Sarcoma (KS) cases. KS is usually limited to elderly southern European men, and so its presence in young American men was highly unusual. But the real trigger was that it occurred in gay men. Its presence in gay men meant that they were all visiting the same small number of gay-friendly clinics, and they were definably different to other men. They all shared a single common factor: their sexual identity. Of course all those patients in the Congo also shared a common sexual identity but nobody thinks of heterosexuality as a defining characteristic. It’s a background property, a default setting. Whereas homosexuality is a definable strand of difference. I think this coincidence set people thinking, first because a small number of doctors saw all the cases, the diseases these cases were experiencing were very unusual for men of their age and race, and they all shared a different sexuality. This of course tripped the doctors into thinking that they must have a common condition, and that it must be related to their sexuality. This in turn sparked a search for a common cause, probably infectious, and in 1987 HIV was identified. Had HIV instead spread into America through heterosexual carriers those carriers would not all have gone to the same doctors and the disease would not have been linked to their sexual identity. This link is essential for HIV because the symptoms occur so long after the transmissive act that it is not possible to connect them without a symbolic link. Without the sexual link, doctors would not have considered an infectious cause of the range of AIDS-defining conditions they were witnessing, and they would not have sought a virus. Had the Morbidity and Mortality Weekly Review reported on a sudden rash of deaths due to Karposi’s Sarcoma, there might have been discussion, but occurring in only heterosexual people widely separated in the community, an infectious cause might not have been considered. This is especially likely since KS is just the first manifestation of AIDS, and not necessarily the killer – people travel through different trajectories of opportunistic infections to their eventual (horrible) death, and in the absence of deaths, given KS is not notifiable, it would probably simply never have come to anyone’s attention – or would have taken so long to be noticed that HIV would have been entrenched in the wider community before it was identified, if it were identified at all.

So I guess we have the unfortunate sacrifices of a significant proportion of gay men in one generation in the USA to thank for our discovery of HIV. By the time the full scope of the disease and its origins were understood, HIV was already out of control in Africa, to the point where it was causing major social and economic problems, and it’s possible to imagine real economic and social collapse happening in some parts of Africa if the disease hadn’t been identified for another 10 or 15 years – especially if by the time of its identification the rich countries were also burdened with a generalized epidemic and facing their own public health (and potentially economic) emergencies.

Which leads to a horrible speculation about the past. Would human society have survived if HIV had emerged 500 or 1000 years earlier? With death following a pattern similar to non-communicable disease and old age, no coherent virological or bacteriological principles, and the point of infection distal from the point of symptom onset, it would have been almost impossible for human society to identify the existence of the disease, let alone its cause. Worse still, HIV is transmitted from mother to child, with very high mortality rates in children, so it would have spread rapidly over generations and had huge mortality rates. Once widespread the disease is economically highly destructive, since it forces communities to divert adult resources to caring for sick adults who should be in the most productive part of their lives. In the absence of a known cause it would simply be seen as “the Scourge,” but in the absence of well-kept statistics on life expectancy and mortality rates, it might be difficult for societies to realize how much worse their health was than previous generations.

In that period there were other diseases – like the Black Death – that had an unknown transmission mechanism, but these were identified as diseases and (mostly erroneous) methods put in place to prevent them, with of course the final method being case isolation and quarantine, a technique that usually has some success with almost all diseases. But these diseases differ from HIV in that there is a rapid progression from symptom onset to mortality and the symptoms are visible and consistent, making the Black Death clearly definable as a disease, which at least makes quarantine possible. With a diverse range of symptoms, a long period from symptom onset to death (often 2-3 years) involving an array of different infections, in a society where death from common infectious diseases was normal, people just would not notice that they were falling prey to a single, easily preventable disease, so even quarantine or case isolation would be unlikely to be implemented. Another difference between HIV and the Black Death is the long asymptomatic phase of HIV guarantees its persistence even though it has a nearly 100% case fatality rate; whereas the Black Death spread through communities so fast that it soon burnt out its susceptible population, leaving a community with some immunity to the disease. HIV is not so virulent, or so kind.

I think if HIV had spread from Africa 500 years earlier, it’s possible that the majority of the human race would have died out within a century or two, leaving whole continents almost empty of people. I guess the Indigenous peoples of the “new” world would have escaped the scourge, leaving the earth to be inherited by native Americans, and most of Europe and Africa to fall to waste and ruin. It’s interesting to think how different the world might have been then, and also chilling to think how vulnerable our society was in the past through ignorance and happenstance. A salutary lesson in a world where we live ever closer to nature, but where many societies still have health systems that are too fragile to handle the challenge presented by relatively preventable diseases like Ebola virus. The Science paper also presents a timely reminder of the importance of being prepared for the unexpected, and the dangers of complacency about the threats the natural world might offer up to us in future …

1st September, 2177.

Weather: rainy.

Outfit: today I punk styled, because I was shopping for some bullet belts when the call came in. Misfits t-shirt, tartan mini, black tights and sensible boots, pony tail, no heavy guns. My e-bags were patterned to “lacrima is my drug,” and that cheerleader squad Nirvana Crush from the computer game I haven’t played, because their punk stylings matched my mood. I set my synthnails to black-and-skulls, that pattern has been a real winner since I downloaded it. I was out on my scooter so the assault rifle was with me, which turned out to be a very good idea. I think I need a better pistol – New Horizon is getting way nastier than I expected.

Feeling: Enervated [Pops taught me this word today!], but then excited. It was a good fight and I killed three guys. The dude in the stairs looked so cool as he fell down the well, and it’s been ages since I heard an assault rifle on full auto, the sound of the gun in the courtyard really got my heart kicking.

My counsellor at the institute told me that I should keep a diary to try and get a grip on my feelings and thoughts. At first I thought it was a stupid idea, and he was really creepy the way he sometimes touched my leg, so I didn’t want to listen to him. Maybe killing him on the way out made me think more about what he said though, because now I think it might be a good idea, so I’m going to give it a go. This is my first entry and I think it’s a pretty good one, though it’s a bit long. I hope they aren’t always this long! I don’t know how it will help me with my feelings and thoughts, since I don’t really have any, and I don’t know what the counsellor thought I would get out of it since he’s dead and he didn’t say anything sensible before I killed him, he just kept saying “Please no!” But I think he might have had a good idea, so I’ll try it.

Before I say what I did today, I should mention that things are getting a little bit hot around here. Pops had a ping out on my name, and we found out today that the contract on me has been sold on to Arasaka Industries. We don’t know why but Arasaka are deep corporate, they don’t mess around and they don’t waste time, and they have top flight mercenaries, so we need to get money together before they start to pay attention to us. That means we need real work, not this stupid Armoured Entourage gig. John was doing some dumb investigation of a cyberpsychotic down in the Indo quarter today in exchange for a free meal, but we’re gonna need better pay than that. We have to get serious. But there’s gotta be work available. Some biotech company on Deck 4 has declared a whole section of Deck to be industrial and is moving all the residents up to Deck 3, but they’re rioting, so there’s a lot of trouble down there, we can probably get work flatlining leaders. John doesn’t like that sort of work – he once told me they had this thing called democracy where he lived, and everyone got to have a say on how the govt did stuff. Can you imagine? That means Smelly Sally down on the garbage level might get to say what happens in the block. They certainly had some dumb ideas in America, no wonder they collapsed. Anyway he won’t like killing rioters, but it’s money, and we need a lot. If they’re doing bounties on heads then I could probably clear the debt if I set up a good nest and John collects heads. Just gotta convince him.

But it turned out that we don’t need to do high turnover whack jobs just yet, because a job came through. Pops knows this dodgy dude called Coyote who has got like the worst facial tattoo ever, who sometimes gets jobs through this fixer called Twitch (real paedo chic), and Twitch has scored a real win job: we have to flatline some cyberpsycho drug dealer, and some gang boss called Alt will pay 10,000 for it but better yet this drug dealer dude is sitting on a mountain of Ghostshock which is worth like fat wads, and Alt doesn’t care about loot, just wants this cyberpsycho flatlined for some old gangland slight. Twitch gets 20% of the 10k, but then we split the drugs evenly and Ghostshock is worth a lot if we can shift it (and this Coyote dude shifts drugs for a living, so like yeah), so we can maybe get most of our debt together in one easy hit. Pops loves whacking chromes, so it’s a buzz. We gotta meet this Alt guy first but the big problem is we need a hacker – everyone says that the cyberpscyho has gone to ground in the lower decks, and we’re gonna need a hacker to get through his defenses. Twitch knew a hacker we could deal with, but because of reasons there is a hit job on him so we need to get to him fast and cancel the hit.

So we had to rush. Coyote and Twitch took his car, me and John took the scooter, and we got to the hacker’s place pretty fast but a team were obviously already there – two cars parked in the lot, tinted windows, two obvious gangbangers in the yard, the whole place gone real silent. While Coyote and Twitch argued about tactics me and John walked up to the two dudes, doing our lover’s tiff act, and then hit them hard and fast. John took his down with one shot in the face but I was using my rippers, and I didn’t quite get my guy. Everything’s too fast now that they’ve taken my ‘ware, and he got away. He had a shotgun, he shot at me a few times and missed, then ran back to the doorway. He shot us both from there but it didn’t really hurt. I thought I should drop the pretty girl act so I called my scooter to me but for some reason it didn’t come, so I ran back to it to get my assault rifle. While I was taking it out I noticed there was this kind of glass walkway from one high-rise to another, that led straight into the level where our hacker was, and there were two heavily-armed dudes walking in there, obvious trouble. So while John pinned down shotgun dude, I let rip on the glass walkway – full magazine, suppression shot. That got their attention, though they were too far away to hurt, and they went into shooting mode, which means they weren’t going to get our hacker. But then my scooter went crazy, fired up and started spinning in circles. It hit me in the head but I ducked, and ran to John. This has gotta mean they’ve got a hacker ghosting them, which I told John, and then ran in. Shotgun dude – who was pretty persistent for a toerag – had done a runner inside, so I sprinted after and John followed, with that Coyote dude behind us.

We shouldn’t have crowded into the entry way of the apartments, because shotgun dude was waiting in an elevator – he tried to stick his arm out and take a shot at us, which could have been bad news, but he mistimed it and the elevator doors closed on his gun – mangled it and didn’t shut. We moved up for the kill but then all the lights went off, the doors clattered shut, and the lift doors slammed shut too (that shotgun dude is fast). The team’s hacker was working fast to shut us down, and our hacker was obviously doing nothing to stop this squad – did he even know they were coming. How good was this guy? Well, to find out we had to take the stairs (five flights! Of course pops complained about his knees), so we took them. It felt like ages but really it was pretty fast, but when we got near the top who should we see but shotgun dude, leaning over the banister and trying to shoot into the darkness his hacker had made. Rookie error! I dropped to a squat and squeezed off a few shots while the others ran past me, and I think I scored a couple of good belly hits, ’cause shotgun dude flipped over the railing and took the long dive. That was one persistent problem fixed. I mean really – if you wanna be serious in this business you need an assault rifle, not some kind of second rate blaster. Also, leaning over railings really isn’t the best move. Rookies! It was like poetry when he flopped over the railing and took that dive. What a swansong!

We hit the 5th floor and we could hear a whole lot of damage going down, gunshots and yells. It was just a short run down a corridor, then one corner and the battle was there. Of course I went round first (pops’s knees are crap, and that Coyote dude is wrestling with congestive heart failure, he’s so slow). There were three guys in some kind of bizarre fight – two white trash gang bangers and a guy in full body armour, one gang banger literally trying to wrestle with the armour dude. I guessed this was our hacker’s body guard, so I took down the nearest white trash with a shot to the knee. The other dude looked around at me and seemed pretty angry, so when John finally arrived (!!!) I told him to shoot the white trash dude. Of course he missed. Someone else inside a room off the corridor was also shooting at white trash dude, so he realized he was out of his depth here and decided to do a runner. This bodyguard guy he was fighting was weird – dressed in some serious combat dress but carrying the girliest pistol you’ve ever seen, and slow as a chump. I got to the end of the hall and blew both the runner’s legs off before the bodyguard had his silly little pistol up, and I’d tapped the dude twice in the head and had my rifle raised and pointed at the bodyguard before he had his pistol on me. Meanwhile John was dispensing the other dude, tap!tap! Then the lights went on and twitch was yelling in Coyote’s ear “Goliath cops! Goliath cops!” So we had to get out. I guess that means the Hacker figured out he was toast if he stayed, and did a runner. dThere was some girl in the room – nondescript Chinese, self-defense pistol, you know the drill – but she came out and Coyote told us we had our hacker so off we went. We ran straight to the smashed up glass corridor, called our vehicles to it, hopped on and flew away before the Goliath cops could reach the scene. Final damage: 4 guys we took down, we dragged some unconscious dude out with us and it turns out that the Chinese girl put a cap in another dude (head shot!) in the room, so all up not a good night for whoever these dudes were.

We stopped a little way away to have a chat with the dude we dragged out, and things got a bit messy here. John broke a few of the dude’s fingers and I cut off a few more, and then he got cooperative, he was speaking English – all these dudes are pasty white American weirdos – but he told John the name of the fixer who got them the job whacking our hacker, some guy called “Blue,” and he was obviously just a low-level grunt, so John and I were going to let him go, but Twitch tried to kill him. I stopped that (Twitch is real slow, I just stepped in and the gun was mine) but while we were talking about mercy and mortality, this Coyote dude pulled out some kind of insane cyber chainsaw and cut our prisoner from one end to the other. There was blood everywhere. Nasty. So then John pulled his gun on Coyote and pointed out to him that that kind of arbitrary slaughter isn’t very collegiate, and Twitch busted out this tiny little blaster, so I had to stick my rifle in Twitch’s face (and I have to say, waxing that paedo-looking dude would be justified on style grounds alone). So it was a classical Mexican stand off until Coyote agreed he’d been a little rash and promised us that Twitch wouldn’t cause anymore trouble, and then it was all roses until someone (Twitch?) told us that this chinese chick was not our hacker. Actually our Hacker was the dude in the full combat suit, apparently his name is Ghost but this girl was just some random he had in his room. So then me and John were like “who are you?” and she turned out to be a paparazzi, which is kind of disastrous right because we are on the run and she was surely filming this hit. So we had a chat, with my gun in her face, and she agreed to cancel uploading any film of our little raid in exchange for joining our hit and getting exclusive interviews with all the people we don’t kill straight up. Easy.

So our Hacker Ghost was in this full battle dress all along and we didn’t even need to run up those stairs. I guess paranoia has its uses.

From there we went to the Firefly bar – I swear I’m gonna get the Sarge, its owner, to smile at me one day – and we had a drink and a chat about what to do next. I think it was a pretty easy job – 5 dead, me with a few shotgun pellets, our hacker safe, and some paparazzi chick who seems to be a real ace with a pistol on our side. We can sell wetjob footage, everyone tells us that is worth a mint if you do it right, and this chick seems pretty professional. Maybe things are looking up.

From now we go to meet Alt, and then the wetwork starts. I’ve had a good day, it’s nice to be doing what I do best. I can smell freedom from here…

Drew out.

Footnote: what actually happened in the hacker’s room. So basically while we were fighting with the guys downstairs, the hacker ghost and another PC called Huang Lin (Lin) were trapped in the hacker’s tiny room, with some enormous cyber-enhanced arsehole smashing his way through the door. The hacker was off in cyberspace trying to work out what was going on, but the enemy’s hacker got to him and started frying his brain. Lin, seeing things going wrong but guessing that the raiders didn’t know she would be there, hid in the bathroom. A huge gangster musclehead burst in and went forward to kill the supine hacker. Lin saw her chance and took a called shot on his head from the bathroom. She was successful, and blew his brains out. So while we were fighting our way past shotgun dude and running up stairs, her and Ghost were able to take up defensive positions and take the fight to the two guys that Drew saw going through the glass walkway. Ghost’s ludicrously effective battle dress prevented him from suffering damage, but both of them were having real trouble actually hitting their two enemies. It was a stand off until Drew and Pops turned up with real weaponry. Then things went south fast for our white trash foes, who were all originally American …

Main lesson about cyberpunk: don’t take a knife to a gunfight. This is a one-hit-down system. Act first with extreme prejudice. And carry an assault rifle wherever possible.

On Wednesdays we wear subdermal armour and a smartgun link

On Wednesdays we wear subdermal armour and a smartgun link

The Druid is on the run and out of work, but in the towering ocean megacity of New Horizon, life without money gets real dangerous real fast. Even the desperate people who flee to the lowest deck to hide amongst the sewage and the storm swells still need money to smooth their way through the conflicting networks of crime and policing that make daily life hazardous for those without connections. If you have money you can live a normal life on the lower decks, even though the people on the upper decks have sent their chrome-killers and agents looking for you – it’s the money that keeps you hidden, buys the silence of your neighbours, gets a roof over your head and a safe place to bolt to. But paradoxically, making the money gets you noticed. The Druid needed to find a way to earn money, but her only skill is killing. She can’t work as a Solo on normal jobs though – word is out that a tall, slightly gangly pretty girl with no obvious cyberware is being hunted, and that she’s a Solo. Those kinds of Solos are pretty rare, and if she joined any job she would stand out like dogs balls. She needed occasional work where she could blend in, but do the only thing she does well – kill.

Fortunately, 22nd century life provides just such an opportunity: the armoured entourage. With the rise of New Horizon and its huge media complex, the liberalization of sex work and pornography, and the huge diversity of cyber-enhanced entertainment, a new tier of high-value, short-lived z-list star was born, young men and women who have little fame in the mainstream press but bring in huge amounts of cash for the second-level entertainment companies, whose fame is short-lived and whose fans are often dubious. This low-status, high-profit tier is populated with interactive porn stars, all-girl unit bands with some kind of niche appeal, reality show winners and losers, and a new kind of girl-next-door cam girl who makes her money by filming her daily life and selling it to sad and lonely men whose addiction to girls they’ll never have is as deep as their wallets. In New Horizon there are a lot of lonely men, a lot of socially disconnected people, and a lot of freaks. The less scrupulous media companies make a lot of money from selling these men interactive porn, and voyeuristic vision of the ordinary lives of pubescent beauties whose physical affection would no doubt earn them a long period of chemical castration.

The stars in this industry are short-lived for two reasons: their fame is only as fleeting as the illusion of illegality that their age can conjure, and their fans often turn into vicious stalkers. The obsession this industry profits from draws stalkers the way a shark attracts pilot fish, and these girls are always one fan away from disfigurement and violent early retirement. Most of these girls harbour innocent dreams of fame, because they haven’t been warned that interactive porn and lolita peep shows are a death sentence to a star career; but because of these dreams of fame they need to keep their girl next door appeal, which means no serious cyberware beyond the implants they need to ensure interactivity. They also need to go out and do the things that wannabe stars do: go shopping, go to awards, do charity work. And they inevitably draw an entourage of lower-tier stars, for whom there is no letter in the alphabet. You can see them on Deck 2 or Deck 3, swanning around the cheaper glamour districts in little squads of perfume and pouts, the star at the front and her little entourage clustered around her, acting like it all matters, trying to catch the eye of paparazzi and talent scouts. And it’s in these public spots that their stalkers will find them. The acid attack, the sudden lunging monster with the cheap rippers he bought on Deck 1 for just this final apotheotic moment of stalker sin, the enraged beat down, or just the creepy guy who won’t let her out of his sight. Every girl in this scene needs to keep her fans hooked to her, and every girl knows that some are just a bit too into her; but if her management skills aren’t just right, one day she’ll get a message from some sad dude in the lowest deck, telling her what he’s got planned.

But she can’t break her image, and if the corporation that markets her still has a use for her, it can’t let her go out in a bloody mist just quite yet, so it needs to find a bodyguard it can fit into that entourage. And that’s when the Druid steps up. She wears her humanity and her femininity like a mask, as changeable and malleable as that z-tier cam girls eyelashes. She can fit whatever fashion that inter-porn star is into this week, and she can titter harmlessly with the most vapid of all-girl units. She is just girly enough to blend in to any group of z-tier stars, and just bland enough not to interfere in their shopping and coffee. She’s also just deadly enough to deal with any slobby fan, and boosted fast enough to have his arm from his shoulder before he can get the acid vial out of his bum-pack. But most importantly of all, she doesn’t stand out. She can work alone, in amongst a group of air-headed teens who know nothing about the world of Solos, corporate extractions, wet work – no one who might think that her presence is unusual. She’s just a girl who’s been sent to keep an eye on them. So no word filters back to anyone who matters, unless she has to step out of her feminine role for the split second required to disembowel some creepy old dude with a cupboard full of used undies. At which point her job is done and she can melt away. These companies that hire these teenage inter-porn thrillers and loli-cammers are themselves just one step ahead of the law, and they certainly don’t want to be broadcasting the hazardous side of their dubious work to the authorities, so they’re more than happy to pick up bodyguard work from a reliable, invariably fatal, and extremely discreet young lady who is interested in staying out of the limelight.

And so it is that, since she hit the skids and went lower deck, the Druid has been paying her way as an armoured entourage girl. She’s not the only one, but she’s good – she has a sixth sense for trouble, and when it fails she is so fast that her ward is unlikely to even feel a bruise. The creepy paedophile who wanted to make his mark, though – he won’t be buying any more subscriptions to lolicam, and the girl he “loved” is gonna have to go back to her fans and work a little harder to make up the shortfall. But really, who’s counting? What’s one less weirdo in a world of nearly infinite isolation and sadness?

A relic of days gone by

A relic of days gone by

Today’s Guardian reports possibly the most pathetic and desultory news in the history of war: two British Tornado aircraft destroyed an ISIS pick-up truck. Two jets that cost $27 million each managed, between them, to blow up a battered Toyota pick-up truck, that ISIS probably scored for free but will probably cost a maximum of $5000 to replace. Fortunately the pilots of these two hyper-sophisticated jets made it back safely to their base in Cyprus without being shot down and beheaded. All in all, a good 6 hours’ work!

This story is so full of pathos and futility that it is hard to stop laughing. Is this our contribution to the protection of Kobani and the hundreds of Kurds fixing to die there? We fly two planes for six hours, and use a $50,000 bomb to blow up a pick-up truck? This is how the mighty West is going to stop ISIS from executing every Kurdish soldier in Kobani?

Media reports that hundreds of Kurdish Peshmerga have crossed the border into Syria to fight thousands of ISIS soldiers who have captured many villages in the area and are closing in on Kobani. Assuming those thousands are actually 1000, and that they are all in pick-up trucks, how many missions will the RAF have to fly and what will it cost? Sky news reports that the cost of operating one Tornado on one mission is 210,000 pounds, without dropping a bomb. A single paveway bomb costs 22,000 pounds. So for two Tornadoes to blow up one pick up truck cost 442,000 pounds. Of course, they might have dropped all four of their paveways, and two Brimstone missiles (105,000 each), destroying six pick-ups at a total cost of 708,000 pounds.

If we assume that those 1000 soldiers are all in pick-ups, and all the pick-ups have a weapon on, we could guess 4 dudes in the back (around the gun) and 2 dudes in the seats. Assuming that the Tornado hit the pick-up truck in tandem, that kills 6 men. With 6 men per truck you need about 150 trucks to get to Kobani, and at 6 trucks per mission (assuming full use of all those super-cool weapons) then you’re looking at 40 or so missions, minimum. That’s 28 million pounds to blow up 150 pick up trucks and kill 1000 ISIS soldiers. Of course this estimate is ludicrously optimistic, and if the report is to be believed (and previous reports in which the RAF flew 5 missions without finding a target) then probably it’s more likely that one mission= one pick-up truck, on average. So 150*444,000 pounds, or about 70 million pounds.

Of course, those pick-up trucks had weapons mounted on them. News reports suggest that ISIS captured 50 or so M198 Howitzers, which cost $500,000 each. If we assume that 10 of them are being used in Kobani then the attacks might cost them $5 million. So for 70 million pounds, we can degrade $5 million worth of weaponry and maybe $1 million worth of pick-up trucks. It appears that the RAF is flying a couple of missions a day, so even at its most optimistic this task will take 7 days (more like 10 or 20, assuming it’s possible at all). Will Kobani still be standing in 7 days’ time?

ISIS are rumoured to have $1 billion in reserve, and 30,000 soldiers. If they capture Kobani they will replenish all the pick-up trucks the RAF destroys (newsflash! pick-up trucks are ubiquitous, and Tornadoes are not). It’s probable that all those Kurdish fighters coming into Kobani are bringing weapons, probably heavy weapons supplied by the Australian army to the Kurds in Mosul. So ISIS will win back everything they lose without expending a cent of their savings. Once they’re in the city bombing them will be impossible. Meanwhile ISIS are said to be at the gates of Baghdad, even attacking a prison and the HQ of the Badr militia two weeks ago. It seems pretty obvious to me that air strikes are not working, troops on the ground are the only solution, and the Iraqi army is either sympathetic to ISIS, or not willing to stick around to be executed after they lose. So long as ISIS keep moving, and US and British air strikes are being launched from bases many hours’ flight away, it’s going to be impossible to seriously impede their combat ability. Two tornadoes fly out, locate a squad of ISIS trucks, blow up the best target, return home; three hours later two more Tornadoes turn up, but they have to look around to find the targets, because the trucks have moved. It appears that they frequently fail to find a target, and return without firing a shot. If air war is going to work, it is going to need close air support weapons – A10s and helicopters – but no one dares to deploy a helicopter near ISIS since they captured US anti-aircraft missiles, and the only country capable of deploying A10s in range, Turkey, was denied access to them. So we have high speed jets at the limit of their range scouring empty desert looking for pick-up trucks. This is how we are going to stop ISIS from killing a couple of thousand Kurdish men (and any civilians without the means to escape).

This is so pathetic. The journalists reporting on this intervention are so chuffed about all this hardware and blowing-up-stuff. My god, the Europeans even have a cruise missile named after a GI Joe character (Storm Shadow! What’s not to like?!) How can they not be devastating? But the sad fact is that ISIS have pick up trucks, and dudes with attitude. Spending a quarter of a million pounds to blow up a battered technical and a dude with attitude is not efficient. Nor is it going to help the people fighting those dudes. ISIS are fighting a classical war of movement, and given their numbers and the tools they’re using, it’s ridiculously inefficient to try and destroy them using modern air warfare. Boots on the ground, or go home!

The sad reality is that there’s nothing we in the West can do from afar to stop this monster.  ISIS is the Middle East’s Khmer Rouge, and they have arisen from the same hellish swamp: just as the Khmer Rouge seized power violently in the aftermath of the US destruction of Cambodia, ISIS are seizing power violently in the aftermath of the mess created by the US in Iraq, and by the US and Europe in Syria. It’s an object lesson in failed states: create them, and the psychopaths will come. The best way to stop ISIS was to stop the second Iraq war, but our leaders (of all political stripes) were so stupid, vain and cruel that they thought the second Iraq war was a grand idea. ISIS is the brainchild of Tony Blair, John Howard and George Bush. They made it, and their inheritors cannot stop it unless they are wiling to expend the lives and blood of western soldiers that they were so loathe to shed in the past war. Of course that’s not going to happen, so instead they’ll spend millions of dollars blowing up pick-up trucks for a year, until they have trained a force of rebels who will enter Syria just to die. This is what our “civilized” society created, and what our leaders refuse to commit to fixing.

So what should Barack Obama do? I think he should take the $70 million required to defend Kobani, and invest it in a time machine. It doesn’t matter that we don’t have any idea how to build it, so long as the money is put down, and a law passed to guarantee a million bucks a year until the thing is made, everything will be fine. Eventually (maybe a thousand years from now), someone will finally make the time machine. Then the first thing they will do is go back in time and deliver the plans to Barack Obama, at the opening ceremony of the research project. Brilliant! Then someone can go forward in time far enough to get a mind control machine; then they can go back in time to 2003, and stop the second Iraq war. Then ISIS will never happen, and everyone will be happy.

Or we could spend $70 million blowing up second-hand Toyota pick-up trucks, at half a million bucks a pop. Which do you think is the more cost-effective strategy?

 

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