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/