As at this morning, 1st April, there have been 855,941 cases of novel Coronavirus around the world. Of those, 636,964 are still active, and 218,977 have run their course either to recovery or death. Of these, 42,069 (19%) ended with the death of the patient.
The infectiousness of this disease, combined with this frighteningly high mortality rate for known cases, is what has convinced me that a tighter lock-down, though horrifying costly (more on that later), is the most responsible course of action.
However, there is a large and possibly growing body of thought that very restrictive government actions are not necessary, and even that those so far implemented are doing more harm than good to overall health and well-being.
For example, over the last few days:
Associate Professor of Medicine Eran Bendavid, and Professor Jay Bhattacharya of Stanford University:
Oxford Professor of Theoretical Epidemiology Sunetra Gupta:
Professor Sucharit Bhakdi, infectious medicine specialist, former head of the Institute for Medical Microbiology at the Johannes Gutenberg University of Mainz:
And just yesterday, a more cautious article in The Lancet:
Those who claim immediate shutdowns are necessary need to acknowledge these variations of opinion, and the widely varying advice being given to politicians.
It is not good enough simply to snipe from Facebook, calling politicians names, or suggesting a lack of integrity, or repeating slogans. Doing so convinces no one, especially decision-makers, and begins to make it look like those in favour of a shutdown have no real case for their point of view. Otherwise, why not make that case instead of throwing insults?
There also needs to be acknowledgement of the horrific cost of restrictions implemented to this point, and a genuine accounting and balancing of the cost of further restrictions.
Simply repeating “Health not wealth” will not wash. The huge improvement in lifespan over the last century, and our amazing good health into much older age, are a product of our prosperity as a nation, and the benefits that flow from that; the ready availability of fresh food, easy access to good medical services, improved working conditions, etc, etc. Undermine the nation’s wealth, and you undermine the nation’s health.
To give just one example of how this works in practice, the latest astonishing cash splurge sees income support for a broad range of workers to the extent of $130 billion. This would be enough to build and staff 200 new regional hospitals in Australia, or to renew and re-equip 300.
It is not only the loss of massive amounts of cash for crucially important infrastructure which needs to be considered, but the impact on business. Again, to give just one example, two days ago the government decreed that no one, and no business, could be evicted for the next six months for non-payment of rent. For businesses, rent can be deferred. But the income from which that rent needs to be paid has not been deferred, it has been lost. It is not recoverable. Even large businesses like Westfield, with billions of dollars invested in shopping centres, do not have large cash reserves. If rent is not paid over an extended period, they will fail. Repeat this a few times, and superannuation funds will collapse, leaving another massive hole government will be expected to fill.
On a more personal level, retail rents are not trivial amounts. The rent on the business Kathy and I have purchased in Townsville is $84,000 per year. Rents in higher traffic shopping centres can be much higher. Businesses will go bankrupt. This ripples out causing further, sometimes breaking point, difficulties to other businesses. There will be massive unemployment and all the evils that go with it; reduced general health, increased domestic violence, family breakdowns and suicide. And of course, further demands on a now massively under-resourced government. Then there is the fact that much of our self-esteem and energy comes from feeling useful. The long term mental health impacts of an extended lockdown/extended period of unemployment are potentially disastrous even without considering other factors.
People in favour of a complete lock-down, which would be even more costly in all these ways than measures so far implemented, also need to recognise and factor into their explanations the fact that a lock-down is not a solution. The virus will not magically disappear. Infection will reoccur and spread, and further lock-downs and restrictions will need to be enforced.
If, on the other hand, if it can be demonstrated by reference to policies and outcomes elsewhere, and known data about infection rates and mortality, that this draconian course of action with no clear end in sight will result in significantly better outcomes for most people than less costly and less disruptive options, then it should be implemented.
Despite everything above, this is still the view I hold.
All of the four articles linked above have one key flaw. They assert mortality rates in some cases more than an order of magnitude lower than the figure for known cases so far. They do this on the assumption that for every one case that has been diagnosed, there are ten or more which have not been. But this is simply a guess, with modelling based on that guess. Just as it is not good enough for people in favour of a complete shutdown simply to assert that a shutdown is required and expect national leaders to fall in line, it is not good enough for researchers with a different view to ask leaders to base life and death policy suggestions on guesses with no discernible basis in reality.
There are no answers. We are in for a long, depressing haul no matter who is right, and no matter which course is decided upon. The best we can do is listen, put our views as clearly and with as much evidence as we can, and be respectful, caring and supportive of people around us, including our leaders.