Welfare in Post-Quarantimes: Life and Work after the Corona-Camp
Reflections on Corona – an interview
Question: Prof. Marin, you have studied not just welfare, ageing and pensions, but early on also public health policies and AIDS management. How does the Corona crisis compare with the HIV/AIDS and other pandemics?
Marin: The one and only thing we can now be sure in late March 2020 is that never ever in the history of humankind has there have been such far-reaching measures taken on a global scale. At the time of writing, there are 2.6 billion people in quarantine, not accounting for the 700 million Chinese isolated until most recently out of the 1.4 billion persons re-activated by now. And never before did we have to expect such a worldwide economic collapse from an effort to prevent an infectious disease.
In fact, HIV and AIDS were the global public health shock of the 1980s and 1990s. We have done comparative empirical research on Managing AIDS, i.e. coping with the pandemic in six European countries for the period 1983 to 1997. The world was absolutely unprepared for and – most painfully, with all too many disaster victims – had to slowly learn to grapple with the plague.
Yet, after umpteen million dead people by this cataclysm for many years we only had safer sex and more hygiene when abusing and injecting drugs intravenously as corrective actions. After decades of scientific and pharmaceutical research, supported by billions of Euros and Dollars, there are now indeed efficacious mitigating drugs. But still until recently 1.8 million persons died from AIDS year in year out. And there is no cure and no protection provided by vaccination.
An effective inoculation, which has been unavailable against HIV/AIDS, we have with SARS-CoV-2. This is an important and in many ways remarkable development, given for 17 years it wasn’t possible to develop monoclonal antibodies or any vaccination against any of the many corona viruses. Hence, washing hands and keeping physical distance remain, just as during the Spanish flu in 1918, the only provable effective protective measures against the plague.
Question: We have nothing but social distancing to protect against the plague?
No, not at all. There is nothing which protects better against infection than physical distancing (and handwashing); but not social distancing. Just on the contrary: Social distancing may actually undermine trust and confidence, thereby increasing the risk of careless contagion.
My co-Autor Patrick Kenis of the 1997 AIDS management book has only recently – almost prophetically! - simulated the outbreak of a fictitious New Asian Corona Virus (NAC), just before the real Covid-19-pandemic. In a letter to the editor of The Economist, he suggested „the use of physical distancing rather than social distancing. As a sociologist I am stunned at the many ways people have overcome social distancing while having to keep a physical distance.“
In fact, among the most conspicuous features around incarnate, bodily, spatial distancing was frequently a simultaneously increased personalized attention, interest, care, a new courtesy, politeness, civility, gentleness, even a new tenderness, affection or solidarity. Corporal or physical distancing seems often compensated, occasionally overcompensated by ostentatious social closeness and emotional buddying. Physical distancing counterbalanced by social rapprochement may help to maintain or even build-up the cohesion and morale of societies in periods of quarantine.
Thus, let us use “corporal/spatial/physical distancing” and take note of a simultaneous social, psychological and sometimes even perhaps emotional rapprochement, offsetting discomforting “physical distancing“ which creates interpersonal and cultural unease. In any case, “social distancing” is a genuine misnomer and should become the non-word (“Unwort“) of the year 2020.
Several countries, the EU, WHO and other institutions have simulated a pandemic emergency and how to cope with it. Why does it seem as if the Corona crisis caught us unprepared? No precautions against an aggressive and highly infectious virus?
Systematic preparations against a new SARS-corona pandemic were carried out since 2003, but in Asia only. The German Bundestag at least discussed a scenario in 2013. In March 2019, the epidemiologist Peng Zhou from Wuhan predicted a soon-to-be new corona pandemic with a hot spot in China for sure – merely the exact time and place would still be uncertain. Less than nine months later the incident occurred as forecasted. But covid-19 hit our public health policies, in contrast to scientific research, nearly unprepared.
The most precious time was lost between the alarm notification from December 31, 2019 from Wuhan to the World Health Organization (WHO) and the main measures taken in Europe between the end of February and mid March– an incredible eight to ten weeks with almost no provision. Appropriate precautionary arrangements could have saved us all lockdown. Whereas Taiwan, for instance, has successfully implemented its 124 well-prepared preventive measures on the very same day and managed to keep the plague in check without any shutdown, as did other Asian Tiger states too. 24 million people, only 150 kilometres away from mainland China, with direct flight connections from Wuhan, managed to keep infections at a few hundred cases and fatalities at seven dead persons only.
In Europe and the USA, in marked contrast, a fiasco of excessive demand and incompetence could be observed: first hibernation and denial; then shock-induced paralysis; finally tilting within short time into a panic over the pandemic. Panic itself was tipping partly into confused zigzag manoeuvring and partly into more enlightened government action in midst an ongoing ball season and carnival hustle and bustle – from the Mainzer Fastnacht over the Viennese Opera Ball to the Carnevale di Venezia, stopped two days before martedi grasso / Shrove Tuesday only.
Questions: How do you account for what people call “The Italian Tragedy”? And what about the so called “China-virus-connection”?
Italy deserves an analysis of its own, as it is both quite a special unique but also a typical case in point of a tragic pandemic trajectory. Let me first respond to widespread speculations about a “China-virus-connection” and then about both some unfortunate circumstances and also some self-inflicted flaws in mismanaging the crisis. But, in sum, the Italian tragedy cannot be fully understood without the historical failure of EU Member States to help Italy when confronted with misery and life-threatening sanitary scarcity, crying for help via the institutionalized EU civil protection mechanism. In a truly unprecedented, unique breakdown of the much invoked, de facto rudimentary European solidarity, not a single Member State heard the plea from the European Commission and supported the EU country first and most hit by the plague with badly needed medical equipment. While we Europeans were deeply shocked by what we had to see a month later in Bergamo and Lombardy, it seems as if we felt even less responsible for what happened in Northern Italy than a generation ago about the incidents in Sarajevo and Srebrenica.
Till late March several media, including reputable ones – and even some experts - in Italy and all over Europe speculated about an initially not implausible hypothesis that Chinese workers, both legal and illegal, back home from their New Year’s holidays and festivities (25 January to 11 February) might have introduced the virus to Italy.
By January 29, more than three weeks before Italy had to deplore the first dead from Corona within EU-Europe, the EU activated its crisis mechanism. At this time, in fact, almost nobody anticipated what would soon happen first in Italy and then throughout Europe. As long as all merely eight cases of infection in the whole of Europe (four in France and four in Germany) have been detected and as long as all of them have been traced back to travel from the Chinese province of Hubei, both some levity regarding coping with corona in Europe and some obsession with far away China was comprehensible.
The Italian right-wing and extreme right parties such as Salvini’s Lega, Fratelli d’Italia, Berlusconi’s Forza Italia whipped up this suspicion of a Chinese viral invasion politically, and, in Vienna, Herr Strache took over their reasoning. As they started to organize, wherever locally or regionally in power, a total testing of all local Chinese inhabitants without exception, we now dispose of some empirical evidence which interestingly enough clearly falsifies their generalized suspicion against Chinese co-residents.
As an interim result we can report that there was no Chinese “patient zero” bringing in the disease to be found despite great efforts to find one. Through comprehensive testing of all local populations in early hotspots like Vo’ Euganeo und Codogno not a single, Chinese infected by covid-19 could be detected. In addition, there were significantly below-average Chinese population shares in Corona hotspots such as Bergamo and Brescia; and, the other way round, there was a strongly below-average Corona viral contamination rate in Chinese “strongholds” like Milano and Prato, with a registered Chinese population of 40.438 and 25.768 persons, respectively.
Prato declares 25.768 official Chinese inhabitants, accounting for 9.99 percent of the local population. It is the relatively biggest Chinese community all over Italy. Nevertheless, it was hardly affected by the Corona crisis at all: as of early May, there were only 178 confirmed cases of SARS-CoV-2 infection, an infection rate of 0.07 percent only. In the hotspot Bergamo with its miniscule Chinese community of as little as 0.4% population share there were nine (!) times more people infected with corona virus than in Prato, often labelled as „ “Italy’s Chinatown”, and more than three times as many as in Milano.
Question: But this covers regular Chinese migration and residence in Italy only, doesn’t it?
Yes, you hit a main point, as we have to ask: couldn’t there be additional thousands upon thousands, possibly umpteen thousands of irregular Chinese workers in and around Prato alone, even perhaps hundreds of thousands all over Italy, in particular in Northern Piedmont, Lombardy and Venetia? And if so, how would this affect the findings so far?
Indeed, official statistics may just not fully cover all Chinese residents living in Italy, and stories thereon are not just urban legends. But whatever the answer may be, it could either simply confirm or rather actually reinforce the reasoning presented above. In summary: the bigger the number of illegally residing and working Chinese inhabitants as probably also in Prato, the stronger the decisive interrelationship of the empirical evidence reported above; i.e., the more Chinese living in a town or region, the less these areas have been hit by SARS-CoV-2 infections. What hostile prejudice Trump-style has coined as “China-Virus” seemed to have been spreading throughout Northern Italy, where almost all Chinese live, almost without Chinese participation in contagion.
Question: What else do we know and what else don't we know about suspected origins of contagion?
Given the bits and pieces of half-knowledge presented so far, major puzzles remain. Where from does the catastrophic epidemic in Italy develop, which throughout Europe has become a symbol of the Corona tragedy just in the rich North? And what is the relationship with China first hit by the virus, its large-scale traffic with both thousands of Chinese and European travellers in giro from and back to Europa and Italy? To be most honest, we simply don’t know (yet?) for sure. What we do know for sure is that the man 38 years of age and Italian „patient one“ in Codogno has repeatedly been sent away from the local hospital ambulance without any testing, because he has “not been in China recently”!
Significantly, this was exactly the same attitude and even the very same wording with which the “patient zero” has been refused testing for SARS-CoV-2 in Vienna – except that it took the authorities in Codogno “only” 36 hours and fewer additional infections before correcting their stupidity. Whereas the Viennese “patient zero” has already been for nine days in an intensive care unit before medical personnel tested for Covid-19 someone they continued to treat for an alleged serious flu. Quite obviously, bureaucratic simplicity and ignorance work well without borders and across countries.
What is also uncontested is that a Chinese tourist couple asked for help and testing itself once covid-19 symptoms were apparent on January 28 in Rome. As they were identified as positive, isolation measures could be implemented instantly and the chain of infection be broken effectively. Consequently, no relevant spread of contamination was to be observed either in Rome or in the surrounding Latium region. Contrary to the false report of the internet encyclopaedia Wikipedia, they actually were not the “patients zero” introducing the pandemic into Italy. While they have not only not spread SARS-CoV-2 but actually helped to contain it immediately, their case as reported by the media and the short and narrow attention span of the broad public contributed to diffuse a mental prejudice about assumed decisive Chinese traces of the Corona pandemic in Italy. The fact that the two Chinese remained the only cases all over Italy for one whole unending month (Jan28-Feb21) of waiting for an announced outbreak of the epidemic understandably reinforced this misperception.
Question: What about mistakes by government authorities from the national to the local level?
No question about serious institutional failures in Italy, as in many other European countries. Everywhere throughout the EU and beyond the entire UN-European Region of 56 countries, lots of mismanagement could be observed, not just in Italy. Countries actually differed by their very mixes of good or bad luck, fortunate or unfortunate circumstances and basic conditions on the one hand and more or less skilful operational handling and more or less clever strategic choices on the other.
Indubitable, some damage and pain was self-inflicted. A key decision taken by the Cinque Stelle Minister for Foreign Affairs di Maio seemed to have fully fired back, counter-intentionally and counter-intuitively. He had proudly announced to stop direct flights to and from China as the first country in Europe in early February. Paradoxically, this could have not only not protected the Italian population but rather jeopardized its health. For innumerable business people, in particular from the economically dynamic Northern regions, continued to travel many more weeks entirely unrestricted to and back from China. Their circuitous routes and manifold transfer connections via European airports in Germany, France, Switzerland, Austria etc. could hardly any longer be reconstructed in tracking and tracing a posteriori if ever they were identified and tested as virus carriers at all. In the end, nobody knew any longer who came from what high-risk zones in China and – mostly asymptomatic – could have undetected infected many others.
It seems now certain that the virus circulated totally unrecognized after “giorno zero” January 26 almost an entire month in Milano and Lombardy where people were treated for a normal flu before “patient one” was finally tested and confirmed infected 22nd of February in Codogno. Only a bit over one month later, end of March, there were 105.792 people infected rather than merely 2 cases on February 20th; and only two months later after the very first covid-19 death case, there were around 75.000 infected in Lombardy and more than 205.000 in Italy; and tens of thousands of people have died. There was nothing genuinely unique about this very dynamic of events in Italy, except that Italy (as did France and Spain) obviously had the misfortune of being hit seriously by the pandemic about one month earlier than neighbouring Tyrol and Austria, with a corresponding snowballing exponential growth and then an unmanageable pool of infections betimes.
The very same misperception of untested Covid-19 patients and their mistreatment for normal influenza as elsewhere throughout Europe had much more dramatic consequences than somewhere else, for pure bad luck of non-contemporaneous timing. The fact that the first cases of death in Italy appeared not before February 21st, i.e. quite late after non-identified “patient zero”; and secondly, that people dying later in quarantine outside hospitals have probably not been counted as death by or with the Corona virus, both factors must have contributed to a momentous underestimation of the severity of the pandemic in its early stages.
Question: What other mismanagement and misfortune did you observe?
Well, some preconditions made Italy a splendid target for the virus without its fault, much more than other European countries. This ranges from one of the highest median ages worldwide (46.3 years) over a correspondingly high average age of people infected (63 years) to the widespread “Hotel Mama” phenomenon of multi-generation homes with several generations living under one roof for lack of jobs, income and housing for young people. Almost one in four Italians aged 30 to 49 lives with both parents and children in one location as against one in twenty Austrians: 25% compared to 5% close daily inter-generational opportunities for contagion of high-risk age groups.
Other factors of misfortune mentioned have been much more speculative. They range from widespread resistances to antibiotics to high air pollution in Pianura Padana. Finally, there were structural omissions originally self-caused but alarmingly and rapidly amplified by bad luck: the long-term shortage of intensive care units (Austria disposed of 3.5 times the resources of Italy) became critical only with the exponential growth of infections in February and March, overstraining limited ICU capacities. Italian hospitals have been known as most dangerous places for death from hospital germs, with more than 10.000 victims annually long before the Corona crisis, i.e. about 600 – 700% higher a risk than in German and Austrian hospitals. Together with the new virus, this evolved into a most pestilent combination and made infirmaries most pernicious locations for people with fragile health conditions. And everywhere throughout the EU there was a dramatic lack of protective clothing, masks, test kits etc.; but only because of overdemand for medical and care personnel early on, these shortages in equipment for health staff translated into a mind-blowing excessive infection rates among doctors, nurses, carers (“Badante”).
Once this vicious circle was set in motion, destructive ‘eigendynamics’ prevailed: high numbers of infections among health personnel, in turn, led to super-spreading of the virus from medicative staff to fragile but initially uninfected patients, in particular in hospitals and old age homes. In Bergamo, for instance, 20 percent of doctors and health personnel have been infected (of which, again, 10 percent actually died) compared to an only 1% contamination rate and almost no fatal casualties among medical personnel in Austria. In Italy, more than 10,000 physicians and nurses have been infected and one in seven of all covid-19 patients in Spain worked in the health sector. Thus, apart from super-spreading by asymptomatic or not yet detected medical staff, doctors and nursing workforce once identified as carriers of the virus had to be isolated and widespread quarantine in hospitals and wards accelerated the breakdown of critical health infrastructure, in particular in Latin European regions.
The following collapse of the medical care system, in particular of intensive care units, the black despair of medical personnel, the simultaneous strikes of funeral personnel so that corpses had to be taken away in great numbers from Bergamo to neighbouring localities by columns of military transporters; while these horrible events happened in Bergamo only and nowhere else in Northern Italian hotspots, these spooky images deeply annealed themselves into our collective memory.
But whereas we vividly remember these most disturbing pictures of the corona catastrophe, we suppress our share in its causation – outside Italy. The fact that Europe, the EU and all EU Member States without exception could or did not help Italy when it desperately asked for help (February 28) with masks and protective clothing for health care staff despite pathetic solidarity declarations the weeks before soon slipped into selective amnesia – outside Italy. Such a shameful and momentous refusal of help had never happened before since the establishment of the civil protection mechanism in the year 2001. What proved to be a workable arrangement more than 330 times (and failed only once) in successful rescue operations against forest fires, natural disasters, earthquakes and other catastrophes turned out to be a complete flop in the corona pandemic.
Question: How would you summarize what is labelled the Italian Corona tragedy?
As in any tragedy, Italian Corona tragedy protagonists were ‘guiltlessly guilty’. They were as smart and well-intended as the policy-makers in other European countries, but bad luck loaded heavier responsibilities on their shoulders than on almost any other EU government. The virus seemed to have circulated not only one but actually already two months before “patient one” on February 21st. While January 26th has already been known for some time as “momento zero”, in mid June research into wastewater sewage samples in Milano and Torino detected CoV-2 already in December 2019, which extends the period of totally undiscovered infestation to two months. But this catastrophic misfortune through no fault of their own, Italian authorities reinforced institutional failure by some administrative stupidities.
To run an UEFA Champions League soccer match Bergamo – Valencia with 44,000 densely packed Italian and Spanish fans on February 19th was, again, more of a misfortune than organizational failure. It now does not look like a wise move – but only with the wisdom of retrospective analysis can we say this. But there were not yet more than two (sic: two!) persons infected throughout the whole of Italy and not a single fatal casualty till that day. Consequently, the definitive impact of this “partita zero” in “stadio zero” is still somewhat controversial among researchers. Uncontested are the facts that numerous elderly Atlanta fans came from Bergamo and Val Seriana which soon after turned out to be Corona hotspots; in Milano, however, despite many overnight stays and fan parties, contaminations did not jump up.
But yes, in the end there were also some self-inflicted pains by cutting a caper. Let me give you just two examples of conspicuous institutional foolishness. In the midst of Lombardy, with 40 percent of all Italian infections and death cases, the little village of Ferrera Erbognone, just around 50 kilometre from Milano, was miraculously spared from the plague – despite its high percentage of old and “high-risk” population. Uniquely escaping the disastrous regional trend generated both such great hopes and great scientific and everyday curiosity, that the major wanted to order a scientific study at the Fondazione Mondino di Pavia about immunization patterns in this inimitable outlier. But the Health Office of Lombardy prohibited the study as the Pavia institute was considered to be “not authorized” to carry-out Corona studies. Imagine such an institutional arrogance, ignorance and missed opportunity for steep learning curves by paired comparison investigations, due to purely bureaucratic rivalry!
Another case in point of a self-debilitating establishment folly with direct disastrous impact was implemented on March 8, just at the day of lockdown in 13 provinces, affecting 16 million people throughout Northern Italy closed-up by exclusion zones and highly restricted mobility. From this day onwards, covid-19 patients with mild symptoms only were transferred to old age homes with a financial incentive of 150 Euro a day to care institutions for hosting Corona patients in supposedly much less “expensive” settings than already overburdened hospitals. This short-sighted administrative mistake alone turned out to be a most serious strategic flaw. It transformed homes for the elderly exponentially into hotspots of the plague. Carers, nurses, doctors, rescue teams and other health personnel became super-spreaders of the virus just to the most vulnerable of their wards. People with “high-risk health conditions” to be most protected were turned into persons most exposed to the health threat - quite frequently with deadly outcomes.
Institutional failures like these happened everywhere throughout Europe by governments conspicuously unprepared for the pandemic. But it took an entanglement of such seemingly little bureaucratic failures with dramatically varying more or less adverse circumstances in order to produce overall images such as the “Italian tragedy” or the pretended “Austrian success story” or “Austrian miracle”.
Question: How did Austria perform compared to other European countries?
Clearly, Austria has responded somewhat more rapidly and forcefully than some of its European neighbours or EU partners. From an East-Asian perspective, though, it still had the look of a country in the early last century. Ironically of all countries, in Kakania, where each small business enterprise or country inn is being bullied and pestered bureaucratically by work inspectorates, market offices and fire prevention officers for their own “protection“, there was still no national pandemic plan in March 2020, insufficient special protective clothing for medical and care personnel, hardly any relevant data publicly available, including no national inventory of (free or used) regional and local intensive care capacities, and not a single scientific study except for a few model calculations in order to guide decision-making.
In addition, the Ministry of Health was paralysed and dysfunctional by previous reform attempts of the former far right government. Not even an acting Chief Medical Officer (“Generaldirektorin für die öffentliche Gesundheit”) was in office in early 2020; the Austrian High Council of Health (“Oberster Sanitätsrat”/OSR), for the first time since Empress Maria Theresia in 1765, was also not in operation as its mandate was not renewed beyond 31st December 2019 for change in government; and the new government had to confront traditional federalist fragmentation without consolidation itself. For example, it took the Austrian military 61 days (March 18-May18) to mobilize its militia for the first time in the history of the Second Republic, compared to three days after the alarm in Switzerland.
Despite having been so ill-prepared, the federal government presented itself always as a swotty model pupil. In sum, it is quite amazing, perplexing and impressive how the country managed to successfully show off as a premium quality and top performer in handling the Corona public health crisis – notwithstanding its adverse preconditions and objectively quite modest outcomes, both in terms of infections as well as fatal casualties. And in spite of not even half the number of tests than originally and repeatedly announced, namely 15,000 tests per day. Here the gap between words and deeds was most dazzling, as the following example shows. In order to reassure tourists that Austria is a safe spot to spend holidays again, a special testing initiative of 65,000 tests weekly for tourist industry employees (and guests) was solemnly announced before the season started; one month later and good booking in full swing, only 10,200 tests have actually been done in more than four weeks - that is only 3.5% (!) of the grandiloquently promised testing activities. Once the confidence trick has worked, hosting companies - short-sightedly - seemed not to care much any longer about the health and safety of their workers and guests. They, in turn, complain about testing offers not lifelike for tourist business to justify the extremely low take-up rates of an action, mainly PR, budgeted with 150 million Euro. This is paradigmatic about the “Austrian miracle”: it was more one of a spectacular communication management, message control, marketing and PR performance, driven by political or tourist industry self-interest, than of un-contestable, public health management of the pandemic.
But a few most important strategic choices were smart and crucial. The Minister of Health created an advisory expert council and a Corona Crisis Task Force, together with a corresponding crisis team of the Municipality of Vienna, to compensate for the lack of functioning regular structures. They instantly decided for “home containment” and a hotline while closing direct access of potentially infected people to ambulances, medical surgeries, hospitals and old age homes. And, secondly, they made such generous reservations of an already spacious supply of intensive care beds and equipment that even at the peak of infections and medical treatment (on 8 April) not more than over 7 to 10 percent, i.e. 267 out of 2.584 (later topped-up to 3.478) available and “booked” acute care beds had to be used.
Thus, empty instead of overburdened intensive care units, invisible corresponding collateral health damages for non-covid patients and excess supply and panic over-procurement of respirators were the consequential problems of the explicit attempt “to err on the safe side”, as the Vice Chancellor Kogler openly conceded. This happened just a few days after Chancellor Kurz and a few mathematician’s apocalyptic warning (March 30) about an imminent breakdown of the health system and mass death (“Es drohen der Zusammenbruch des Gesundheitssystems und Massentod”, cover page Kleine Zeitung April 3). But dramatically overshooting alarmism was successful a hammer as almost nobody except a few experts accounted for its costs. Contradictory assessments such as the one by The Economist Intelligence Unit (EIU) and the data provided the very same day of publication (June 17) by the European Centre for Disease Prevention and Control (ECDC) of the EU in Stockholm illustrate this most puzzling appraisal of highly divergent if not opposing evaluations.
 Patrick Kenis and Bernd Marin (Eds.) Managing AIDS. Organizational Responses in Six European Countries, Aldershot – Brookfield USA – Singapore – Sydney: Ashgate1997, siehe
 Jörg Raab, Patrick Kenis, Marleen Kraaij-Dirkzwager, Aura Timen, Ex Ante Knowledge for Infectious Disease Outbreaks: Introducing the Organizational Network Governance Approach’ 2017, to be published in Volume 15 Springer series Knowledge & Space: Glückler J, Herrigl G, Handke M (Eds): Knowledge for Governance. Berlin, Heidelberg: Springer 2020
 Patrick Kenis, The Economist, Letters to the editor, Apr 2nd 2020 edition
 Addendum, see https://www.addendum.org/COVID-19/miliz-mobilmachung/
 The Economist Intelligence Unit, How well have OED countries responded to the COVID-19 crisis?, Report June 2020, London – New York – Hong Kong and European Centre for Disease Prevention and Control (ECDC) of the European Union in Stockholm https://www.ecdc.europa.eu/en/covid-19-pandemic (download June 17)
The article gives the views of the author, not the position of the "Europe’s Futures–Ideas for Action" project or the Institute for Human Sciences (IWM).