Data gives hope for quick end to lockdown

After sparking the first serious debate in New Zealand about the best way of beating Covid-19, Simon Thornley, a member of the Plan B group, explains why he has hope for a safe and swift exit.

There are two approaches offering hope for beating Covid-19.

The Government says the threat is terrible, so elimination is necessary, and that will require a long period of management.

The public health professionals in our group say the threat is major for a small number of people, but we can and must protect them, that the virus wave is abating and immunity growing, and that means we can exit early. Fortunately, that also means hundreds of thousands of people can be saved from economic disaster.

The data shows that internationally and here, the threat of Covid-19 is abating. History will tell us whether this was from lockdown, or immunity growing. That doesn’t matter now, because the data points to the same conclusion: we can shift into what our government calls Level 2.

The major threat is not Covid-19, but the talk of eliminating it and hanging on for a vaccine.

Waiting for a vaccine sounds like soldiers telling each other that their misery will be over by Christmas. But Christmas comes and they are still in the trenches.

As an epidemiologist, I know that vaccines often don’t arrive. I remember the first time I heard that a vaccine for rheumatic fever was five years away. That was ten years ago. There still isn’t one.

Elimination is an impressive goal. We will be the first country in the world to achieve it. But I’m not sure people appreciate what that requires. It is only viable if every person who gets Covid-19 is identified, tested, isolated and quarantined. That’s hard, because at least half of people with Covid-19 don’t know they’ve got it.

I found this out in the recent Auckland measles outbreak. Much of the community were immune, and cases presented in typical fashion. It didn’t end because we stopped it, but because the disease burnt out. People who were susceptible to measles developed immunity, until the disease could no longer spread. For measles, we had additional weapons at our disposal too: we had a reliable test for immunity and a vaccination.

COVID-19 is sneakier than measles. Iceland found out that about half of test-positive cases had no symptoms. Almost 1% of the community tested positive. If the same were true in New Zealand, 50,000 people would now have the virus.

To eliminate the virus we have to find every person and quarantine them to prevent further spread. We’re a small country. We could do it.

But is it worthwhile if population immunity is doing the job? The finding of widespread immunity was an important landmark in the fight against swine flu in 2009. The disease was not as serious as first thought – and immunity was high enough to halt the spread of the virus. A German study showed that in one town, 14% were immune, while 2% had active infection. A similar US study reported that about 3% were immune.

In New Zealand, we don’t know the level of immunity to Covid-19. Perhaps our immunity levels are already high and the virus is being eliminated ‘naturally’. Like swine flu, we need to test for immunity before we take on the Herculean task of eliminating it.

Our hope is that immunity is occurring, because that means New Zealand can exit swiftly. Unfortunately, there are signals that it’s not happening as fast as elsewhere.

Since New Zealand started lockdown, active infections have declined from their peak by 22%, whereas Australia has fallen more steeply (44%).

Since the lockdown, cumulative per capita cases have grown at a greater rate in New Zealand compared to most Australian states (Figure 1). Infected cases have progressively declined for the last three weeks in Australia. Australia has had a much looser definition of lockdown, with 90% of the economy continuing to operate, compared to about 50% here.

This is similar to other countries which have soldiered on, albeit with “distance” practices, such as Sweden, Taiwan, Hong Kong, Iceland, and South Korea.

Let’s address again the threat posed by the virus.

In a conservative estimate, Cambridge statistician David Spiegelhalter noticed that age-related mortality rates from the virus in Wuhan closely matched annual mortality rates in the British population.

His conclusion was that getting the virus is like squeezing one year’s mortality risk into two weeks or so – the duration of the illness.

Whether we like it or not, people aged more than 80 years have a one in ten chance of dying each year – that is similar to their chance of dying with COVID-19.

Yes, there have been “thousands of deaths” as the headlines claim – but these are not unexceptional. Overall mortality is indeed high in Europe because Covid-19 does compromise health, but no higher than observed during the 2016/17 influenza season.

This gives hope that, with our lower population density, the virus is not going to overburden our health system – which was one of the main drivers for the lockdown.

The threat of economic disaster scares me personally just as much as the threat of the virus initially scared me professionally. Rising unemployment, business closure and State benefits remind me of my childhood, deeply affected by Dad’s unemployment and consequential mental health.

My hope is that other kids don’t have to experience what I did. The data shows we don’t need to wait until Christmas – we can emerge from our trenches now.

Simon Thornley, Senior Lecturer Epidemiology and Biostatistics, The University of Auckland.

Note: Figure 1. Cumulative cases (PCR positive) of COVID-19 per million, by days since lockdown, comparing New Zealand with Australian states.

Source: Australian and New Zealand Government statistics.

 

Chaudhuri: The ‘contrarian’ view on Covid-19

An article published on Newsroom this week takes potshots at “contrarian” academics who have chosen to question received wisdom regarding how countries around the world, including New Zealand, are responding to Covid-19.

As one of those “contrarian” academics, I would like to offer some additional perspective.

In an earlier piece for Newsroom “A Different Perspective on Covid-19”, I wrote that no one is suggesting that Covid-19 deaths are not tragic. I pointed out that in focusing on how many people died of the coronavirus around the world every day, we are ignoring the fact that as we devote resources to fight Covid-19, we take those resources away from alternative uses. This diversion will also result in the loss of lives. But those deaths will register less on our collective psyche since they will be diffused, scattered all over the world and will not be reported on in the same breathless manner. I called this the distinction between “identified lives”, deaths that happen right in front of our eyes and within a short span of time, as opposed to the more spread-out loss of “statistical lives” that occur in the background, slowly and inexorably.

The Newsroom article challenging this “contrarian” view and others quotes an infectious disease expert who says: “I’m just opposed to the very fundamental values base that they’re coming from, around how it’s okay to let people die of this because they would die anyway, or something? …This comes down to a values thing and what you’re willing to sacrifice for that.”

I agree. This does come down to a values thing. The position taken by many epidemiologists is this: we will minimise deaths from Covid-19 regardless of the cost. The obvious implication is that this is a comparison of lives lost against dollars saved.

This is completely and utterly untrue.

As I point out in my article, there is a trade-off here. We are going to lose lives no matter what. If we shut down the economy and prevent the disease from spreading, then we save lives that otherwise would have succumbed to Covid-19. But in shutting down our economies, we jeopardise the lives and livelihoods of others.

So, no, this is not about lives versus dollars; it is about lives versus lives.

This is because shutting down the economy has other unforeseen consequences. New Zealand’s unemployment rate could hit 13.5 percent. In the US, it is predicted to climb as high as 26 percent.

Is it so hard to believe that such high rates of unemployment are going to cause poverty, hunger, depression and yes…deaths? It is well-known that unemployment leads to lowered life expectancy. This kind of unemployment tears communities apart and results in long-lasting inequality. It tears at the fabric of our societies, destroys social capital and decimates our shared sense of community.

There are already people struggling with mortgage payments, rent and grocery bills. To what extent these people go under, or not,will depend on the extent of government bail outs. Some countries will do better; others less so.

And, much of this burden is falling and will fall on the socio-economically disadvantaged; the ones who are not able to engage in social distancing; the ones who do not have the luxury of working from home; the ones who are spending four weeks cooped up in cramped spaces without access to unlimited broadband; the ones who live from pay cheque to pay cheque, the ones who need to show up at our supermarkets and hospitals as part of essential services; the ones that need to take public transit in order to do so; the ones who are being exposed to the disease every single day since they have no way out.

The infectious disease specialist goes on to say that some countries are “digging mass graves”. This must refer to countries other than New Zealand since at the time of writing, we have had only nine deaths. Yes, other countries are certainly facing catastrophe but in a far different sense than the one she refers to.

A recent article by Ruchir Sharma in the New York Times sums it up: Some countries face an awful question: death by coronavirus or by hunger?

As Sharma points out, while 15 million people have filed for unemployment benefits in the US, in developing countries more than two billion people are facing unemployment without any social safety net. As of now, nearly 80 countries have approached the IMF for bail-out packages.

What do you think will happen when the healthcare infrastructures of these countries collapse? People will die. They will die of easily preventable diseases like cholera. Children will die due to lack of adequate care or lack of vaccination. Diseases that we thought had been eradicated like measles will come roaring back. Confinement in close quarters, even in countries like New Zealand, is going to lead to a resurgence of tuberculosis; especially among the socio-economically deprived.

Imran Khan, the prime minister of Pakistan, recently said that South Asia is “faced with the stark choice” between “a lockdown” to control the virus and “ensuring that people don’t die of hunger and our economy doesn’t collapse.”

Are these lives worthless? Are these lives not worth saving?

Somehow, it seems to have come to the point where arguing for total lockdown is the enlightened, compassionate view and those questioning the wisdom of lockdowns are heartless philistines.

This is completely untrue. I believe our position is the more thoughtful and rational position; not born out of instinctive gut feelings but arrived at via careful reasoning.

We recognise that we are faced with a crisis. Sure, we need to minimise Covid-19 deaths; but in doing so, let us not jeopardise other lives. And yes, other lives are being jeopardised. We are simply saying that we should be clear-headed about the challenges. In this particular scenario I cannot do better than to appeal to the Benthamite principle of greatest good for the greatest number.

We are also arguing for saving lives; but we are saying let us look for options that minimise lives lost whether from Covid-19 or from our efforts to fight Covid-19.

At the end of the day, it is our position that is more humane and rational. Yes, it is a difference in values; except some are suggesting that some lives are worth saving more than others. We respectfully disagree.

First printed: Newsroom. https://www.newsroom.co.nz/2020/04/16/1130087/the-contrarian-view-on-covid-19

Stuff: Coronavirus: Lockdown rules should be relaxed, health experts say

https://www.stuff.co.nz/national/health/coronavirus/120984583/coronavirus-lockdown-rules-should-be-relaxed-health-experts-say

Newstalk: Dr Simon Thornley on why he believes lockdown has been an overreaction

https://www.newstalkzb.co.nz/on-air/mike-hosking-breakfast/audio/dr-simon-thornley-on-why-he-believes-lockdown-has-been-an-overreaction/

 

Media Release: Expert group suggests way out of lockdown

14 April 2020

Expert group suggests way out of lockdown

A specially formed group of local academics, led by public health experts, says New Zealand can and should come out of lockdown, and has proposed a “Plan B” to do that.

The cross-disciplinary group of academics say they understand the rationale for New Zealand’s firm lockdown, but new data and experience of the COVID19 virus signals that it can be managed without the severe health, social and economic effects a lockdown imposes.

Group member Dr Simon Thornley, Senior Lecturer of Epidemiology at University of Auckland, says the lockdown strategy is no longer proportional to the threat posed by COVID-19 to New Zealanders’ health.

“Prolonged lockdown is likely to cause greater harm than the virus to the nations long-term health and well-being, social fabric, economy, and education.

“The real threat of the virus is that it can create more cases than health services can handle. This leads to unnecessary deaths and virus spread. But the risk of this happening is lower in countries such as ours with lower population density, and our health system currently has spare capacity.”

Data shows that a large majority of COVID-19 fatalities have occurred in people due to their comorbidities rather than directly from the virus. Even in Italy only 12% of cases were directly due to COVID.

“If you catch COVID-19 your likelihood of dying is the same as your average likelihood of dying that year anyway. It has been described as squeezing your year’s mortality risk into two weeks,” Thornley says.

“The way we stop the spread of an epidemic virus strain must be proportionate to the threat posed by the infection. The lockdown was appropriate when there was so little data, and when it seemed sensible to try to eliminate it or wait for a vaccine. But the data is now clear – this is not the disaster we feared and prepared for. Elimination of this virus is likely not achievable and is unnecessary. Moreover, elimination will be almost impossible to sustain as the virus is likely to become endemic across the rest of the world, and a vaccine may be years away.”

The group’s Plan B is to end lockdown after the four week period and immediately shift to a risk-based management plan, similar to the Government’s Level 2 format, with the principal aim of preventing stress on the health system.

  1. Low risk people should be allowed to return to their normal daily activities. For example:
    1. Schools and universities should reopen.
    2. All leisure activities are permitted.
    3. People should be allowed to return to work. Those over 60 and/or with underlying health conditions, and uncomfortable returning to work, could continue to work at home with support from their employer and government.
    4. Domestic travel by any means allowed.
  2. People at high risk of severe complications by virtue of age (> 60 years) or medical conditions (such as diabetes, obesity, cardiovascular disease, cancer or immunocompromised) should continue to self-isolate and socially distance. They should receive state-funded support and priority care. e.g prioritised for at-home supermarket delivery.
  3. Health professionals should carry out strict hand hygiene and be provided all necessary personal protective equipment.
  4. High risk communities and groups, with particular focus on rest homes, should be protected from COVID-19 cases or infection and provided government support to do so.
  5. Gatherings of over 100 people are prevented.
  6. Encourage improved hand hygiene and exclusion policies for ill workers.
  7. Border entry is restricted for the near-future to reduce the risk of imported infection.
  8. Monitor hospitals for overcrowding and limited capacity in intensive care.
  9. Contact tracing and quarantine of newly identified cases is essential. Resources should be made available to ensure this is adequately carried out.
  10. Seroprevalence surveys, with PCR, should be conducted as soon as possible to assess the proportion of the population who have been exposed to the virus. This would give valuable information about further risks posed to high risk individuals to facilitate their return to the community.

Founding members of the group are:

  • Dr Simon Thornley – Senior lecturer of Epidemiology and Biostatistics, The University of Auckland
  • Dr Grant Schofield – Professor of Public Health, AUT, Auckland
  • Dr Gerhard Sundborn – Senior lecturer of Population and Pacific Health, University of Auckland.
  • Dr Grant Morris – Associate Professor of Law, Victoria University of Wellington.
  • Dr Ananish Chaudhuri- Professor of Experimental Economics, University of Auckland and Visiting Professor of Public Policy and Decision Making, Harvard University, Massachusetts, USA
  • Dr Michael Jackson – Postdoctoral researcher; expertise in biostatistics and biodiscovery, University of Wellington

Contact: Simon Thornley, 021 299 1752 or Mark Blackham, PR: 021 891 042 | https://www.covidplanb.co.nz/