Wednesday, 22 April 2020

Yes folks, it's real. And unless things on the ground do change, no amount of house arrest will have improved the outcome of the epidemic, it will only have delayed its terrible effects.


Source: New York Times
In recent days, I'm seeing an increase in folk on this freedom side of the aisle who want to avoid acknowledging the reality of this pandemic. They argue about the need (or not) to extend house arrest for those few more days. They argue that the virus is no worse than the seasonal flu. Sadly, however, for all of us -- and that includes all of us who need to get our businesses back up and running -- this is very real. We're lucky to have escaped (so far) so easily) -- but this virus hasn't gone away yet, and it won't go away by pretending that it isn't serious. The reality is, whether or not house arrest extends past Anzac Day or not is trivial in the long run of this virus. Because we are only on the very first leg of a very long and tragic treble, of a virus which as overseas experience is showing is already far, far worse than just another seasonal flu.
"[A] review of mortality data in 11 countries shows ... a clearer, if still incomplete, picture of the toll of the crisis.
    "In the last month, far more people died in these countries than in previous years, The New York Times found. The totals include deaths from Covid-19 as well as those from other causes, likely including people who could not be treated as hospitals became overwhelmed. These numbers undermine the notion that many people who have died from the virus may soon have died anyway...
    "[T]he total death numbers offer a more complete portrait of the pandemic, experts say, especially because most countries report only those Covid-19 deaths that occur in hospitals.
    “'Whatever number is reported on a given day is going to be a gross underestimate,' said Tim Riffe, a demographer at the Max Planck Institute for Demographic Research in Germany. 'In a lot of places the pandemic has been going on for long enough that there has been sufficient time for late death registrations to come in, giving us a more accurate picture of what the mortality really was.' In Paris, more than twice the usual number of people have died each day, far more than the peak of a bad flu season. In New York City, the number is now four times the normal amount...
    "The differences are particularly stark in countries that have been slow to acknowledge the scope of the problem. Istanbul, for example, recorded about 2,100 more deaths than expected from March 9 through April 12...
 
    "In March, the Indonesian government attributed 84 deaths to the coronavirus in Jakarta. But over 1,000 people more than normal were buried in Jakarta cemeteries that month, according to data from the city’s Department of Parks and Cemeteries...
 
    "In many European countries, recent data show 20 to 30 percent more people have been dying than normal. That translates to tens of thousands of more deaths...
Even taking into account the new numbers, experts say the death toll to date could have been much worse.
 
    “'Today’s rise in all-cause mortality takes place under conditions of extraordinary measures, such as social distancing, lockdowns, closed borders and increased medical care, at least some which have positive impacts,' said Vladimir Shkolnikov, a demographer at the Max Planck Institute for Demographic Research. 'It is likely that without these measures, the current death toll would be even higher.'”
Note: that's only the current death toll that Mr Shkolnikov is talking about . . .

But if there's anything that even we non-epidemiologists should be able to work out, it's that we are only in the first few miles of a very long marathon, and getting released from lock-up on Tuesday is not the end, but only a beginning. Because no amount of "social distancing" on its own will kill off this virus. In reality, these kinds of mitigation measures are only a delaying tactic. Because . . .
"For two months of containment to be better than two weeks of containment, the situation on the ground has to change.
"There is a simple truth [here] ... The duration of containment efforts does not matter, if transmission rates return to normal when they end, and mortality rates have not improved. This is simply because as long as a large majority of the population remains uninfected, lifting containment measures will lead to an epidemic almost as large as would happen without having mitigations in place at all.
"Unless things on the ground do change, no amount of house arrest will have improved the outcome of the epidemic, it will only have delayed its terrible effects." Source: 'A call to honesty in pandemic modelling'
    "This is not to say that there are not good reasons to use mitigations as a delay tactic. For example, we may hope to use the months we buy with containment measures to improve hospital capacity, in the hopes of achieving a reduction in the mortality rate. We might even wish to use these months just to consider our options as a society and formulate a strategy. But mitigations themselves are not saving lives in these scenarios; instead, it is what we do with the time that gives us an opportunity to improve the outcome of the epidemic...
That's crucial. That's where reasoned opposition should be focussed. Understand that this is an emergency; that government does have a legitimate role; that if handled properly it will be temporary; and focus on due process and getting things right: Talk about how people can do business safely in this pandemic. (Talk about the need for objective rules, and for due process in introducing regulations and police powers). 
Focus on increasing PPE and hospital capacity, on increasing staff capacity by (say) relaxing occupational licensing restrictions on immigrants with medical training.  
On studying, properly, the effects of herd immunity. 
On removing whatever regulatory restrictions exist on releasing a vaccine -- including anything restricting people taking a proposed vaccine voluntarily in a trial... 
All these things are samples are the kinds of things that need to happen on the ground while mitigation measures are happening. Because mitigation only reduces the emergency's impact; there must at the same time be a focus on ways for the emergency and the mitigation to end. 
Because unless things on the ground do change, no amount of house arrest will have "improved the outcome of the epidemic in this model, it will only have delayed its terrible effects."
"Where we are now
"Nations around the world are staring down a host of terrible options. Business-as-usual means overrun hospitals, and large numbers of preventable deaths. One or two years of suppression measures in wait for a vaccine means a global shutdown whose full ramifications will require input from experts across multiple domains to fully understand. The viability of middle roads, which might attempt to replace suppression efforts with contact tracing while allowing normal social and economic activity, is still debated by experts.
    "What should be absolutely clear is that hard decisions lie ahead, and that there are no easy answers."
But the hard questions don't go away by pretending that this isn't a real problem.  Better to confront those hard questions than to pretend they're not there.
.

5 comments:

  1. And yet, the Government stumbles along ignorant to these facts and boldly states "there is no Plan B". Elimination can only work with a vaccine and that remains a remote possibility. This is my worry for NZ...that we have taken the economic whallop now (much more so than was needed) in forlorn hope of avoiding the health impact, but we'll need to take that as well just later.

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  2. I have no problem with your prescription but we still need to get the economy going.

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  3. How do we know that the "excess deaths" don't include a significant portion of non-coronavirus deaths caused by the lockup and shutdown measures, such as suicides, heart attacks, or repercussions of scheduled life-saving operations not being performed?

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  4. Death to all socialist Governments. Your Government New Zealand is a Socialist nightmare > get rid of it by any means necessary. >Any means<means any means. .

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  5. "They argue about the need (or not) to extend house arrest for those few more days. They argue that the virus is no worse than the seasonal flu."

    To argue that the house arrest is wrong and should be abolished immediately is not the same as arguing that the virus "is no worse than the seasonal flu." One can realise the seriousness of the virus and still say the house arrest is irrational and wrong.

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