While it’s tempting, and even invigorating, to experience a shiver of schadenfreude at the resurgence of COVID-19 in Victoria on the watch of Australia’s most punitive premier, you should let the sensation pass quickly.
The fact is theCOVID-19 is a feature of our lives now and we need to learn to live with it. Even if a vaccine is found, it is unlikely that it will be 100% effective, so, like the flu, it will be an ongoing risk in what is intrinsically a risky business – living.
For every Ruby Princess debacle in New South Wales or the Stamford Plaza in Victoria, there will be others in every other state, unless economic winter is legislated forever with citizens in a state of semi-permanent hibernation.
The virus has been around for at least seven months now, and we know so much more about it, which is why 30 of us signed an open letter to the PM and premiers calling for a change of policy and suggesting a more sensible, flexible and effective policy framework.
We shouldn’t repeat the same policy with each new outbreak just because that is the policy that we are most familiar with. There is no sense in giving primacy to precedents just because they are prior. If we did that in health matters we’d probably be bleeding patients and putting leeches on them to treat the virus rather than putting them on ventilators, or remdesivir (or even chloroquine). If we wouldn’t do it in medicine, we shouldn’t do it in public health.
One of the ironies of how we’ve approached COVID is that rather than adapt practices from countries with recent experience of epidemics, and governance systems similar to our own, like Korea, Singapore or Japan, the off-the-shelf methods we adopted came straight from the only communist hegemon in the world, China.
So instead of trusting our citizens to make their own choices, we’ve imposed totalitarian, uniform straight-jackets, with ludicrous one-size-fits-all regulations. If you had any faith in central planning you should have lost it by now.
There was some sense in the lockdowns in the first place. The first academic work I saw out of reputable journals like the Lancet suggested this might be worse than the Spanish flu which killed 50 million out of a world population of 1.6 billion.
Pro-rata that would mean that 800,000 Australians might have died as a result and it seemed worthwhile to pause the world for a little until we understood the virus better.
Pretty soon it was apparent that this was not the case. The government predicted 50,000 to 150,000 deaths, based on epidemiological models, like the one at Imperial College London.
But sharper minds, like that of Professor John Ioannnidis at Stanford and Sunetra Gupta at Oxford, using actual data from the real world, like the Diamond Princess, predicted death rates more in line with a severe flu.
Amongst western countries, Sweden practised the most adult approach, leaving decisions to its citizens. If you project Sweden onto Australia, then we might have had 13,550 fatalities by now.
This is severe, but much less than the official projections. And it is only a measure of those deaths we can see.
The AMA estimates that as a result of the lockdowns there will be an additional 750 to 1500 suicides per annum. Based on a UK estimate of death due to people deferring procedures or consultations, you can add another 10,000 to the likely total.
Then there is the susceptibility of those affected.
Instead of looking at absolute mortalities, we should really be looking at excess deaths – the increase over what would happen in a normal year, a concept encapsulated in the colloquial “When your number’s up, your number’s up”.
Again, projecting the Swedish figures, since the beginning of 2020 they have had an excess of deaths over the average of 3,785 up until June 18, which scales up to 9,460 in Australian terms (and this figure is likely to drop as the year progresses).
Then you have to take into consideration the average age of those affected by COVID, plus their remaining quality of life. There are two reasons when they are allocating lifeboats they say “women and children first” – chivalry towards women, and quality and length of life for children.
Yet in our rush to save baby boomers we’ve thrown the kids overboard.
Once you take into account Quality-adjusted life years (QALYs) or Wellbeing-adjusted life-years (WELLBYs) then the cost to life from the shutdowns is staggering, and something like 24 times higher in lives lost compared to lives saved.
So we are killing more people because of the lockdown than we are saving.
Many of my friends object to these calculations as being cold-blooded, and they are, but they are also just and fair and equitable, even while they are emotionally difficult to make. How else are we to allocate scarce resources other than thoughtfully and with calculation? Why should the lives of those likely to be killed indirectly by COVID be valued by orders of magnitude less than those directly killed by it? The premium we have put on COVID is unjustifiable and unaffordable.
How did we get here?
In the view of those of us who signed the letter, it is a failure of science and governance. In the first place, we put our trust in worst-case models produced by people whose models have proven to exaggerate beyond reason in the past – like Neil Ferguson of Imperial College whose miscalculations on Bovine Encephalitis is legendary.
Second, we ignored new data as it came in.
Third, we didn’t encourage healthy debate or debate of any sort. This isn’t just YouTube purging “misinformation”, but most of the measures put in place by governments were never properly debated in parliament and were implemented by regulation, and then interpreted and extended by “oracles” called public health officers.
Fourth, there was no attempt to do the simple public health sums that I have run through above, nor the courage to put the arguments to the public, so that now we live in a surreal bubble world where state governments act as though the virus can be eliminated, and the news media feed us COVID porn every day based on often meaningless statistics and the hope of a happy, COVID-free ending.
There are governance measures that can be put into effect to address these issues and make these miscalculations less likely (although they can’t guarantee absolutely against harm).
No forecasting model should be used where the program code is not publicly available for analysis and download. Public health cannot hang on opaque black boxes owned by organisations like Imperial College, which when they are eventually analysed turn out to be hopelessly constructed.
The models need to be available for critiquing, as do the inputs. Even climate change models pass this test.
Then we need to do proper cost-benefit analysis and make this public and explicit. The false media narrative valorising a decline in COVID deaths without highlighting the rise in other deaths is partly driven by a lack of understanding and education, which is driven by a lack of explanation from the top. People can get their heads around the idea of opportunity cost, even when it is applied to life and death, but they need to understand that it can be a matter of life and death.
The cost-benefit analysis also needs to be ongoing, and change as facts change – you might call this a Bayesian approach.
We also need meaningful statistics. At the very least the government should publish weekly statistics showing total deaths, as well as epidemic deaths, and media should be encouraged to do the same. Most of us are unfamiliar with the amount of death around us, and generally feel we are immortal, apart from when we get sick ourselves. This leads us to overweight the deaths caused by COVID (in this case), just as we tend to overweight deaths caused on purpose compared to those that happen routinely.
Just as importantly the government needs to broaden the range of people involved in making these types of crises public health decisions. The composition of the advisory groups isn’t well-known, but observation of their decisions suggests it is heavily-biased to hospital administrators and perhaps some epidemiologists.
Yet some of the best analysis has come from mathematicians and economists outside the industry groups. The decision-making process also seems to have been captured by groupthink, a process which turns smart people into the same kind of dumb. It is important in any process to have a channel for “devil’s advocacy” – what they call Red and Blue teams in the military.
There is a tendency, even for very smart people, to think the same way when they are in groups. The form of diversity that matters most is viewpoint diversity.
Without a diversity of viewpoints, and an infrastructure that supports dissent, decision-making can go right off the rails, as we would contend it has here.
The last thing that is required is for parliament to actually step-up and play its part. In most of our jurisdictions, parliament has gone on half-speed or slower, with crucial events like budgets even being postponed, or in the case of Queensland, abandoned.
While there is a need for emergency legislation in times like these, it has to be subject to frequent review. That means properly debating legislation in parliament – not just shoving a range of amendments through with very little notice – and review of regulations no more than a month after they are made.
We’re on a chocolate wheel with COVID – it is going to come around and around, time and again – but we shouldn’t leave any more things to luck, or precedent, than we have to. If you agree you may want to add your name to our letter by clicking here.
We’ve taken a radical, unconventional approach as a country. It’s past time to see what worked, what could have worked better, and then communicate to the people. The PM seems to be onside. He says we “can’t stay locked down forever,” but if we’re not careful, that’s exactly what our state premiers will try to do.
Got something to add? Join the discussion and comment below.
Got something to add? Join the discussion and comment below.