A year into the pandemic, it is well understood that COVID-19 has a class character, matching the entrenched inequalities and racial discrimination of financialized capitalism. The disease is especially threatening to those with long-term disorders. The most vulnerable strata are workers, those with low incomes, and the old, each of whom are heavily exposed to persistent long-term health complaints often associated with unsatisfactory environmental conditions and poor diet. They are marginalized by the health systems of even the world’s richest countries.

Powerful states were both unwilling and unable to adopt a grassroots policy of COVID-19 containment. Such a strategy would have entailed a coherent national plan, with international cooperation, focusing on the initial clusters of the disease with widespread and targeted testing. It would have created a network of medical staff at the primary level directed at the areas of mass dispersion, such as workplaces, transport, and education. The aim would have been to identify and trace those infected and to isolate individuals, groups, and spaces, including those most vulnerable due to long-term conditions. Resources would also be urgently required to expand capacity for emergency care in conditions of dignity and safety.

The problem was not resource availability or technological know-how but institutional and ideological failure. A grassroots strategy would have entailed the wholesale rethinking of public health mechanisms imbuing them with public spirit and greater equity. The implications for the pharmaceutical giants and the biomedical sector would have been profound — and neoliberal states were not prepared to disturb their interests. Class set the terms of confronting the pandemic, and that eventually meant restrictions and lockdowns.