Necropolitics

In some countries, such as the United Kingdom, Brazil, Sweden and the United States, their respective governments tried, at an initial stage, to let the virus spread as the main strategy for its subsequent containment.

The United Kingdom and Sweden, on the one hand, started from the epidemiological principle of herd immunity, according to which, when 60% of the inhabitants are infected, the transmission of the virus would cease, because the target population will no longer be subject to contagion (^{Mayordomo-Zapata, 2020}). These governments displayed wrong political practices, as the number of cases and mortality in these countries increased dramatically. Because of this, they had to implement the classic measures of social isolation.

The United States and Brazil, on the other hand, implemented similar measures, for a different reason: to avoid damaging the economy. This wrong decision, which led to great mortality of the poor and disadvantaged populations, can be considered as an act of necropolitics. This term has been widely studied by Achille Mbembe, a Cameroonian philosopher who popularized it in his book of the same name. In the aforementioned text, the author places as examples the massacre and segregation of the Palestinian populations in Israel, the lack of solutions to the problems of poverty and hunger in Africa; that is to say, necropolitics is carried out when certain populations are left to their fate, when it is already known that they do not have the resources to be able to solve their basic problems (Mbembe; 2003).

In Brazil, the effect of necropolitics has been observed in the high mortality of the black race. In the state of Pernambuco, for example, 77.7% of Covid-19 cases corresponded to black individuals; and in Alagoas this percentage reached 66.5% (^{Campos, Melo, Santos, Vieira, Silva et al, 2020}). Regarding fatal cases, 68% of the deaths in Alagoas were black, as well as 66% in Paraná, showing a higher proportion than the white race. Likewise, some authors such as ^{Ribeiro (2020}), point out that, to avoid economic losses to large companies, workers were exposed to the virus, with dire consequences.

The president of Brazil, Jair Bolsonaro, minimized from the beginning the scope of the pandemic and the mortality it would generate. He is remembered for his famous phrase: “Some vão morrer, lamento, é a vida” '(Catracalivre, 2020), an expression that suggested that the Brazilian population should accept the possibility of dying, a prospect against which little could be done, just continue with the activities of daily living. More than 6.6 million Brazilians have been infected by the first week of December 2020, and more than 177,000 have died (OlharDigital, 2020).

Most of the factors related to the probability of contagion and mortality from Covid-19 in Brazil are of sociodemographic content. ^{Wollenstein-Betech, Silva, Fleck, Cassandras & Paschalidis (2020}) demonstrated, after reviewing approximately 110,000 cases, that being of the Amazonian indigenous race, living in the northeast or north region, and not knowing how to read or write, was associated with a significant risk of mortality from Covid-19. Similarly, people with an economic income of around 1,000 reais ($ 183) or less per month, made up more than 70% of the affected population (^{de Souza et al., 2020}). The high cost and scarce availability of molecular tests for the diagnosis of Covid-19 were limiting factors for the diagnosis, especially for lower-income citizens. In this perspective, unlike developed countries, the number of diagnostic tests performed was extremely low, being only 3,400 tests per million inhabitants, while in the United States it was 45,000 or in Italy 40,000 per million inhabitants. This would have led to extreme underreporting: only one in 10 cases would have been reported (^{Cobre et al., 2020}).

The subordination of the population's health security to the economy, the marginalization of large sectors of the population due to racial or socioeconomic reasons, the low application of diagnostic tests, the lack of social distancing, the government's campaign, which tried to minimize the pandemic, would have been, among other measures, a form of necropolitics (^{Araújo, 2020}; ^{Ribeiro & Moura, 2020}), in which a large sector of the population was left to their fate. Vulnerable citizens, lacking in resources and forced to work daily to obtain his daily sustenance, contracted the disease in large proportions, with fatal consequences.

In the United States, mortality from COVID-19 was 27% higher in blacks than in whites, after adjusting the rates for age, sex and geographic location (Wrigley - Field, 2020, p 21855), being the number of African American deaths 2.5 times higher than that of Caucasians. In Michigan, for example, despite the fact that African Americans made up only 14% of the population, they accounted for 41% of the deceased and 32% of the infected. In New York (Hopper, 2020), the mortality rate per 100,000 populations in black patients was 73, compared with Caucasians, in whom it was 22 or in Latinos in whom it was 36. Social isolation would have been a privilege that many Americans could not enjoy because they had to work for a living (^{Yancy, 2020}). This was clearly observed in African Americans in Louisiana, who for labor reasons had to continue their jobs and, despite representing only 32% of the state population, accounted for 70.5% of the deceased in the region.

The African American population had a mortality from COVID-19, 2.5 to 5 times higher than the Caucasian population (^{Lovelace, 2020}). Unfortunately, these racial differences also occurred, according to the study The OpenSAFELY (2020), in the United Kingdom, where the risk of dying, adjusted for age and sex, by Covid-19 in the black population was 2.17 times higher than that of the population of the white race. In the United States, the consequences were even more serious because, apart from social and economic exclusion, this population previously had high rates of chronic diseases such as obesity, diabetes, and hypertension. For this reason, this social group had to receive preferential attention and be protected in the same way as was done with the elderly in most countries of the world. President Donald Trump's policy was similar to that of his Brazilian counterpart, since, at first, he minimized the seriousness of the pandemic, and later insisted that isolation not be carried out as it would harm the economy. Finally, he accepted the deadly consequences of the coronavirus and had to take the corresponding biopolitical measures belatedly. This situation became another case of necropolitics.

In Peru, the impact on the indigenous population of the Amazon has been particularly detrimental. The indigenous population, 75% without access to health services, considered that they had been abandoned by the state (Ojo Público, 2020). The isolation measures taken in March 2020 by the Peruvian government led in just one month to the lack of food and medical care in many Amazonian tribes. Those natives who were in transit to the departmental capitals had to sleep outdoors or in boats (^{Sierra, 2020}). Despite being dispersed populations and far from large urban conglomerates, mortality was high: 3,126 natives died during 2020 (Sierra, 2021) according to statistics from the Panamazonic Ecclesial Network (REPAM), a high mortality rate, although lower than that of Bolivia (6,281) and Brazil (25,931).

The biopolitical measures introduced did not take into consideration vulnerable populations such as informal workers, people with low economic resources, Andean and Amazonian ethnic communities, domestic employees, foreign immigrants, among others (^{Vázquez-Rowe, I., & Gandolfi, A. (2020}) The impact suffered by these populations is still under investigation.

Ontopolitics

The ontopolitics is the politics of what exists in the world (^{Law, 1996}). It refers to things that belong to the real and the possibilities with which we live (^{Mol, 1999}). These possibilities of what exists would be enunciated by politics, which would shape reality and would be prior to the definition of things. Law agrees with Foucault in pointing out that there is no innocent knowledge, that all knowledge implies an active participation of the subject (2002). In ontopolitics, the ruler defines the objects and creates the concepts according to his policy, which responds to the interests of the ruling group or the institutions behind him.

There are different definitions of truth. The most classic concept is that of truth by correspondence developed by Aristotle, in which if a person points to an object and indicates: “this is a tree”, and the interlocutor approaches the mentioned object, sees it, feels it, contemplates its leaves and flowers, makes contact with its roots and its trunk, and verifies that it is indeed a tree, it can be said that the person has told the truth. But this is not the only concept of truth, since our senses could deceive us. For Nietzsche, there are no absolute truths; one of the most remembered aphorisms of the German philosopher refers to the fact that there are no facts, only interpretations (^{Schacht 1984}).

Thus, diagnoses and interpretations may differ depending on the person who performs it. However, for the coronavirus there is only one correct way of evaluation and this is the scientific evaluation (^{Zagury-Orly & Schwartzstein, 2020}). An asymptomatic carrier of the virus can say with full subjective conviction that he/she is not infected, but if his/her laboratory result shows otherwise, his/her claim will prove false. Currently, the coronavirus is diagnosed in three ways: by antigen test, by genomic or virus antigen detection test, usually by the polymerase chain reaction (PCR) technique (^{Cheng et al., 2020}), which is performed by taking a sample of the patient's oropharyngeal and nasal discharge, which is usually positive between the fifth and ninth day after the onset of symptoms; and through antibody tests, which evaluate the presence of immunoglobulin against SARS-CoV-2 in the blood of the affected person. The infected individual will initially have the infectious agent in the mucous membranes of their oral cavity, and later, as has been shown in various studies, excrete the virus through tears and even through feces. Over the course of days, most of those affected will form Ig M antibodies as a rapid response against SARS-CoV-2, which will appear on average from the tenth day after the symptoms onset. In parallel, the affected person will form IgG or long-memory type antibodies, which will appear after 20 days and may last up to six months on average. The maximum duration of this immunological response is unknown since the studies in this regard have not yet been completed. This means that, to properly diagnose a patient with suspected SARS-CoV-2 with the symptoms that we already know, such as: cough, fever, general malaise, diarrhea, shortness of breath, among others, the patient should get immediately, an oropharyngeal and nasal swab to find the virus. Another component for the success of the diagnosis at this stage is the adequate collection of the sample, which must be carried out with two special swabs of at least 10 cm in length. This must be processed immediately, and, in the case of studies carried out in populations far from the processing laboratory, the samples must be adequately refrigerated and transported to avoid deterioration. If the mentioned protocol is strictly adhered to and the analysis is adequate at the place where the samples are received, with well-calibrated equipment and the processing done in the correct way, it is possible to know if the patient has the virus or not. Even so, the rate of sensitivity or diagnostic ability of the swab and the molecular PCR test is only about 70%. This means that, in the best conditions, 30% will not be diagnosed. The antibody test, better known as the “rapid test”, because its result can be obtained in 15 minutes, will be positive, as already mentioned, only on the tenth day and only in 40% of cases (^{Deeks et al., 2020}) it can be found if the patient has the virus or not.

The growth of SARS-CoV-2 in lung alveolar cell culture is the gold standard for diagnosis, which if positive would prove that the test performed was correct. Unfortunately, this technology is limited in our country. If the truth wants to be known, that is, how many people have SARS-CoV-2 and if the country had unlimited financial resources, the molecular test should be used universally and determine who are carriers of the mentioned microorganism. However, those newly infected would test negative as they still do not harbor the virus in detectable quantities by sampling. On the other hand, the expenses would be very high.

Despite these considerations, South Korea and other countries have tried to sample a large part of the population, and their results are close to the truth of the virus infection and fatality rate in their country. In Peru, the government has chosen to perform the least expensive and easier to use rapid tests. Unfortunately, these tests take many days to detect the disease, which is why a patient who has just started his symptoms must be managed according to clinical suspicion, even if his test is negative. This leads to many cases not being registered.

In most countries of the world, the diagnosis is made fundamentally based on molecular tests, therefore, the diagnoses are earlier and more accurate than in Perú. This way of diagnosing the disease is important in order to be able to arrive at the truth of its identification, its prevalence and its incidence in the population. In other words, each government chooses its criteria of truth and puts into practice its ontopolitics in detecting cases of coronavirus. Peru has opted for methods that detect cases late and with less diagnostic sensitivity, so its results will obviously be lower than the real number of infected and deceased. In Latin America, only Peru, Ecuador, Venezuela. and Puerto Rico have used rapid diagnostic tests (Valentín, Serrano, Cabral & Huamán, 2020). The differences in use have been significant: in Ecuador only 10% of diagnoses were made with this method, in Puerto Rico, 50% until May 2020, and in Peru, 73% until August 2020.

The decision to use antibody tests in Peru would have been political, according to members of the Covid Committee. Implementing the technology to process the molecular test samples was considered to be a tedious, expensive and complex process, unlike rapid tests which are extremely simple to use. In Puerto Rico (Valentin et al., 2020), local scientific and social organizations put pressure on the government and it suspended purchases of rapid tests, preferring the use of molecular tests; the same did not happen in Peru.

The ontopolitics of the coronavirus in Peru defines Covid-19 cases as those individuals who present symptoms of the disease, mainly using antibody tests, which are usually positive in only 30% of cases during the first week. This reduces the reliable detection and identification of real cases. This translates, at the same time, into a decrease in the identification of COVID-19 among the contacts of those affected and among the deceased, leading to the production of figures far from reality. Epidemiological “fences” do not work, infections increase and the virus spreads, leading to failure of the measures in place.

Choosing an inappropriate ontopolitics, due to ignorance, incompetence, vested interests, negligence, or for whatever reasons, condemns the population to a state of permanent ignorance, from which it is not possible to draw valid conclusions or carry out reliable situational analysis, let alone make an acceptable decision making. In these circumstances, the truth becomes an object of luxury, an unreachable arcanum, a forbidden knowledge. Constructing reality without solid evidence or with mere stories without support is a dangerous ontopolitical exercise, which leaves rulers and the ruled at the mercy of chance and uncertainty. The price of shaping a fictional reality, in the absence of serious epistemological foundations, in the face of a little-known and lethal viral agent, it is the failure of control actions and biopolitical interventions. Furthermore, the ontopolitics of the coronavirus in Peru have revealed a power structure largely underlying our reality: idiopolitics.

Idiopolitics

In this essay I propose the term "Idiopolitics" to define that particular form of government that, in a contradictory and incompatible way with the search for the common good, seeks to manage the resources of a state or nation in favor of personal and particular interests and benefits.

The prefix idios- comes from the Greek adjective ἴδιος, whose main meaning refers to a private person or individual, the opposite of the state (^{Liddell 1996}). It also denotes what is "own, what is private, what concerns oneself" (World Etymology Dictionary, 2020). Among its derived words are: language, idiopathic, idiotic or idiosyncratic, terms that refer to a characteristic or particular characteristic of the language, the disease, the person or the behavior, respectively. The antonyms of idios are "koinos", the common and "demosios", the public (^{Landauer 2014}, p 145).

Thucydides in the "History of the Peloponnesian War" uses the term idios referring to the particular or the private, in the expression "ξυμφέροντα καὶ πόλεσι καὶ ἰδιώταις", when narrating the response of the Corinthians to justify the start of hostilities against the Ionians who besieged their allies in Potidaea: it is "necessary for the common and particular good (idiotais) of each one" (Perseus DL, Thucydides 1.124.1). Aristotle, in "Politics" uses the word idios to indicate that which, because it is particular and private, goes against the common good: the private interest (i - dion), whether of one, or of the few or of the multitude. According to the different translations, these private objectives will be considered "deviant" (Aristoteles, Rackham's translation), "defective" (Aristoteles, Garcia Valdés's translation (Gredos) or "perverse" (Aristoteles, Benjamin Jowett's translation).

Idiopolitics is a form of government in which only the interests of a section of the population are taken into account. Aristoteles (Aristoteles, ed. Ross, 1957) classifies among the types of governments that show a deviant interest in their objectives: tyranny, oligarchy and demagogy, the latter as a degenerate form of democracy. For the Stagirite, it is more important than the type of government established, the fact that it is not aimed at seeking the common good but at particular or private interests (idios). There are numerous examples of this type of government in various parts of the world and in our own history.

Peru has a long tradition of democratic and non-democratic governments that have caused damage to the economy and the national society, many of them as part of the colonial survivals (^{Quiroz, 2013}). Inappropriate management of state funds plague its history across the board. The high rate of corruption of officials in the country is particularly revealing (^{Hunt., 2006}). On a scale from 0 to 10 where 0 indicates maximum corruption and 10 absence of corruption, Peru is internationally rated with a score of 3.4 (^{Boslaugh, 2013}). Although multiple justifications have been made for a series of economic, social, cultural and health failures, coronavirus infection represents a fairly accurate and objective field of experimentation to evaluate the political actions and measures taken to combat it, as well as its different results.

While it is true that corruption is usually present in idiopolitics, the two words are not synonymous. According to the dictionary of the Royal Spanish Academy, corruption consists in the "use of the functions and means of organizations, especially public ones, for the economic or other benefit of their managers." In this sense, corruption would be included as a form of idiopolitics, while the latter would also be present in any case in which there are biased or partial situational analyzes, incomplete views of reality, lack of participation or inclusion of some sector of the population, without necessarily implying the presence of corruption. Only if the true objectives and motivation of those who exercise idiopolitics can be determined could it be determined if it is a disguised form of necropolitics. In the same way, if the government approach is biased due to lack of information or ignorance of reality, the assessment of idiopolitics will be very different from those cases in which decisions are made explicitly based on serving interests outside the those of the nation, in which case it would only be acts of corruption.

Certain ethical approaches would contain idiopolitical elements, such as utilitarianism, in which, by seeking the benefit of the majority of people, minorities are often harmed, which could become a kind of homo sacer without full rights. Forms of government such as the oligarchy, the monarchy, dictatorships, anarcho-capitalism, theocracy, absolutism, ochlocracy, plutocracy, among others, have idiopolitical foundations.

As mentioned, some governments used necropolitical measures, which openly harmed the affected populations, generating high levels of contagion and death. In Peru, the government took apparently good and early measures to control the spread of the disease. On March 16, the President of the Republic ordered the closure of the borders, social isolation and a generalized quarantine. Simultaneously, 12% of the gross domestic product (GDP) was available to assist the poorest families with a social support bonus. The purchase of medical equipment and diagnostic tests to identify sick patients was ordered, and the police, with the help of the army, had the mission of enforcing the measures of force. This biopolitics, destined to preserve the life and health of Peruvians, however, turned out to be ineffective and, when analyzed in detail, it was nothing more than an ineffective regulation, a measure of force internationally applauded but that could not be adequately implemented; therefore it failed and was followed by a high morbidity rate and mortality from SARS-CoV- 2 (^{Welsh, 2020}).

The ontopolics used to identify the cases was not adequate; millions of rapid tests were purchased, which identified the disease late, so the contagion continued and the number of sick and deceased was under-registered. Primary health care was not a priority, unlike what happened in countries with successful experiences such as South Korea, Iceland, Cuba or Taiwan. The epidemiological fences were not adequately complied with, and the indicated security measures were not implemented. Most of those benefiting from the bond had to approach a banking agency to be able to collect - only 12% of the poor in Peru have a bank account -, and this caused the indigenous communities to leave their areas of isolation and move closer to the nearest city. Long lines at the banks and the return of the residents to their communities increased the cases. The population should not leave their homes to avoid contagion, but only 40% of Peruvians have a refrigerator, so they could not store food and had to go out to buy it, an extremely dangerous fact considering that the 86% of wholesale market merchants tested positive for COVID-19 (^{Pighi & Horton, 2020}). The population was asked to wash their hands with soap and water or alcohol, but it was not taken into consideration that 30% of the population does not have drinking water at home. The police and military were sent to maintain order in the streets, but without wearing adequate personal protective equipment, as if it was carried out in China or Europe. For this reason, they soon became the labor group with the most infected and deceased by the disease (Associated Press Television News, 2020). Personal protective equipment (PPE) would not have been adequately distributed to health personnel, which led, among other institutional factors, to high mortality among doctors and other health agents (The Action Network, 2020). Likewise, if one considers that 50% of the country's population is informal, there was no way that a large group of citizens could survive without going to work, preferring the risk of contagion to dying from starvation.

The political measures in place were, from the speculative point of view, the correct ones, but their practical application was not. This dissociation between the theoretical indication and the practical application led to the failure of the social isolation measures established. It is not surprising then that, by not taking into account the most vulnerable populations, such as informal employees, domestic workers or indigenous populations, they have been the least favored (^{Iglesias-Osores & Saavedra-Camacho, 2020}).

Policies were poorly applied due to lack of adaptation to the real situation of the population. On the other hand, economic groups such as banks, news agencies, television programs, pharmaceutical companies, among others, effectively received the corresponding subsidies from the government for their economic reactivation. In this way, these groups were harmed to a lesser extent compared to the poorer population (^{Paucar, 2020}). This second fact highlights that what has happened is the application of idiopolitical measures, which were impossible for the least favored and vulnerable social groups to comply with. Likewise, these measures, for a short period of time, stopped the disease, but later they affected the poorest social classes of Peru with special harshness, while citizens and legal entities with greater resources, assumed less damage.

One can speak of idiopolitics, then, when better subsidies are granted to those who least need them, when tariff benefits are granted to certain business groups, or when someone is favored without mediating need or merit.

The number of deaths from Coronavirus as of December 7 has been officially announced as a number of 36,274 people; However, the analysis of excess deaths in our country yields figures twice higher than the official figures: 80,600 deaths, that is, a value 156% higher than that expected for that season of the year (Financial Times, 2020). The problem of underreporting did not occur only in the United States and Peru, but also in Mexico and Chile. In Peru, this would have reached 79%, in Mexico City 78% and in Chile 61% (^{Pais, 2020}). The underreporting in Peru has increased due to the collapse of hospitals, the lack of diagnostic methods or the use of means of analysis that are not adequate, so that the number of infected would be even higher than reported.

The health system in Peru before the pandemic, with respect to its ability to respond to emerging events, ranked number 179 out of 191 countries in the world, according to statistics from the World Health Organization (WHO, 2000). This diminished capacity to respond to the determinants of health placed Peru at a disadvantage compared to other countries in the region, even more so when, with respect to the equity of the financial contribution in health, it had been ranked 184 out of 191 countries by the evaluation carried out by the WHO (^{Sánchez-Moreno, 2014}). Similarly, high levels of economic disparity have affected the health of Peruvians (^{Samuel, Flores & Frisancho, 2020}). According to the Pan American Health Organization (PAHO), informality reaches up to 52% of men and 67% of women workers who do not belong to the field of agriculture, constituting a population with great difficulties in accessing health (PAHO, 2019).

Despite the limitations mentioned, other Latin American populations in conditions similar to those of Peru achieved better results. There were alternatives that could have contained the spread of the disease. A world-famous example is the case of Guayaquil, in which various segments of the population organized as an emergency measure when the number of deaths was unmanageable. The citizens of Guayaquil, from politicians and businessmen to farmers, workers and informal workers, when they reached a maximum peak of 460 deaths per day and knew that they would not have the support of the central government, met to take effective measures against the disease. To do this, they quickly identified infected patients, not with the tests, which they lacked, but through the symptoms and contacts of the deceased and sick (Gestión, 2020). Organized citizen groups supervised the effective isolation of the population, to which they administered medication and food on a daily basis. In this way, social isolation became effective; The success of such measures was such that, from an average of 400 deaths per day, after 45 days, the mortality rate dropped to one deceased per week, and in September 20 new cases were identified per day, a great difference with respect to the 400 new cases daily from Quito. Faced with adversity, some societies organize to survive. In Peru, some private companies and individuals provided goods and services to help maintain isolation. Unfortunately, these were isolated cases, which helped mitigate the consequences of the pandemic, but failed to control it.

Peruvian society, over the years, has known how to organize itself; An example of this are the peasant rounds, indigenous communities, health committees, glass of milk committees, in a tradition that goes from the mita and the minka in Inca times to patriotic groups in the time of the liberators San Martín and Bolívar. However, in the face of COVID-19, there has been no response capacity from organized society, which has preferred to leave decision-making and the implementation of the regulations aimed at controlling the disease in the hands of the government, with the negative results that have been observed.

In order to end a long tradition of idiopolitics in Peru and Latin America, it is important to revitalize democratic practice, end electoral apathy, and allow society to organize with an eye toward the common good and not the private benefit. Likewise, the resurgence of solidarity and cooperation among citizens is essential, a fact that in some cities of the world the population has known how to put into practice in order to control the COVID-19 pandemic. All social groups, independently of their labor, ethnic, linguistic or cultural extraction, must have effective political representation; they must have a voice that defends their right to progress and existence. In this way, idiopolitics will cease to be the norm of government in Peru and Latin America.