Do the negative social and health implications of lockdown outweigh the benefits?

29 April 2020

Gerhard Sundborn, Senior Lecturer Population and Pacific Health, The University of Auckland.

With Covid-19 bearing down on New Zealand, and fears of an overloaded health system and a death toll numbering many tens of thousands, the Government moved swiftly to implement a national lockdown. The magnitude of this threat is now being questioned by many epidemiologists and statisticians, here and internationally.

Although the lockdown was administered with the best intentions at heart, we at Plan B propose that the stringent five-week lockdown went further than necessary. Consequently, there are real questions to be asked about whether the benefits of the lockdown justify the negative social and health impacts. There is also doubt as to whether draconian measures such as lockdowns are any more effective than less severe measures such as social distancing.

Impact on Health Care Services

A clinician at a local hospital explained that they have been temporarily closed during level 4 and have been working out of a sister hospital nearby for acute patients only. When their hospital re-opens, to clear the accumulated backlog of surgical procedures and investigations it may take at least one to two years’ work including weekends to get back on track.

There are many reports of similar occurrences where hospitals around the country have reduced their provision of standard care and have been eerily quiet only operating at 50% of their usual capacity. The level to which life-saving and prolonging treatment and surgery has been either cancelled and delayed for many conditions including cancers, heart disease, diabetes, fertility, joint surgery and more need to be considered when weighing up whether the lockdown has been justified or has caused more pain, suffering and death than it has prevented and how much longer this can last.

In a recent communication the medical director for the Cancer Society feared that up to 400 cancer related deaths could be seen due to significant delays in diagnostic and treatment procedures resulting from the lockdown. Overseas evidence has shown that only half as many cancer diagnoses have been made during lockdown than normally expected.

Adding to this dilemma is the bizarre situation that many general practice clinics find themselves in where they may be forced out of business due to spiralling costs and falling revenue. One clinic explained that there are significant costs placed on GP practices in acquiring the right supplies in preparation for Covid-19 as well as a significant reduction in business from the lockdown. People have delayed seeking medical advice for less urgent ailments which has meant reduced income. People have also not sought treatment for more serious conditions for fear of becoming infected if they leave the safety of their ‘home-bubble’.

Short-term health and social harms

Domestic Violence – A surge in domestic violence as a result of lockdown procedures has occurred. In the UK, calls to helplines for domestic abuse increased by 25%, visits to their associated websites increased by 150% and cases of actual abuse soared. In China’s Hubei province during February domestic violence reports to police tripled. Regrettably, we (New Zealand) hold the title of having the highest rate of domestic violence in the developed world, meaning that we are not immune to this second ‘silent casualty’. Police statistics showed that just three days into lockdown (Sunday 29th March) a 20% increase in reported cases of domestic violence. I am fearful to know what levels of domestic violence exist in our communities now – 5 weeks on. What do the victims – adults and children – go through and what impact will this have on their future? Added to this, some DHBs have reported rises in the number of drug and alcohol presentations to their Emergency Department and in cases of suicide.

Poverty – In the most recent Salvation Army Covid-19 Social Impact Report and Dashboard a number of measures are cause for concern, including the number of people and families that have become impoverished. The greatest increase was in the food security measure. In the third week of the lockdown, close to 6,000 food parcels were distributed. This is equivalent to what is usually distributed in one month.

Long-term health and social harms

Due to the impending economic downturn as a result of Covid-19, there are several negative health and social harms that are expected to continue over a number of years as a result of loss of jobs and higher poverty. The NZ treasury have predicted that unemployment rates could climb to twenty six percent.

At the individual level we expect increased:

  • Use of primary and secondary care health services
  • alcohol-related hospitalisation and death
  • levels of chronic ill-health
  • excess mortality from: circulatory disease; poor mental health; increased health harming behaviours; self-harm; and suicide

For families – studies have shown that following mass unemployment events there is likely to be increased:

  • levels of divorce,
  • conflict and domestic violence,
  • unwanted pregnancy,
  • levels of poorer spouse and child health,
  • levels of financial hardship affecting parenting,
  • strain of child mental health
  • levels in lower educational attainment1

For communities the experience of mass unemployment is likely to result in less social support networks and community participation, which add to a sense of grief, social isolation and a loss of community identity.

Level 2 Now

The negative implications from the lockdown on our lives as well as on the economy are causing damage that won’t be fully appreciated for years to come. This carnage is the result of business closures, job losses, rising unemployment and the stresses that go with it.

From a public health standpoint, we need to limit the social and health harms to our society, we need to move to ‘Level 2’ immediately. We will need to wrap stronger protection around hospitals as well as elderly care facilities and develop ways in which we can better support the elderly and people with underling health conditions who are living in homes with younger family members. These initiatives will need to be carefully thought out, developed and resourced appropriately. The vast majority of our population, including most working people, students and infants, face minimal risk from the virus and can safely resume normal life.

We need to get our society up and running again and open for business. Students need to be back at school and in tertiary education and all types of workplaces opened immediately.

The sooner the ‘lockdown’ can be lifted the more businesses and jobs that can be saved, the better us all. Unfortunately, the long-term impacts of the situation we find ourselves in will need to be worked off over many years and possibly decades by ourselves and our children and will shape our lives and society in ways that we are yet to fully appreciate.

Should kids go back to school?

25 April

Simon Thornley

The government is now cautiously opening schools, but many parents are reticent, fearing that their child will be exposed to the virus. Let’s take a look at we have learned about childrens’ risk of exposure to Covid-19 at school?

When thinking about the risk of death from Covid-19, it is important to appreciate that the risk is not the same for everyone. As our experience has made clear in the recent weeks, older people, living in resthomes are much higher risk of dying from the virus compared to all other groups. One’s risk of dying from the virus is about the same as our risk of dying that year given our age. This means that children of school age are extremely low risk for having severe complications from the virus.

In a systematic review of scientific studies relating to Covid-19 in children, the authors concluded that children had a much milder response to the virus than for adults. Of three children that required intensive care, all had severe underlying conditions. In one case-series in China, 90% of test-positive cases had no symptoms attributable to the virus. Of all children, infants are more likely to have severe complications.

One possible objection to returning to school is that adults could catch the infection from children. While this is possible, an analysis of cases from Shenzhen, China, shows that attack rates are higher in older adults and the majority of transmission occurs among household contacts. Modellers have concluded that school closures are unlikely to be an effective strategy for halting Covid-19. New Zealand has had a cluster of about 92 students at Marist College in Mount Albert, Auckland. The first identified case was a teacher and 12 students have subsequently tested positive. The majority of cases have been adults and at the time of writing, 79 cases had recovered.

In New Zealand, there is little evidence of risk from spread of infection in children. According to the Ministry of Health, at the time of writing, there were 18/344 or 5% of New Zealand’s active cases in people    under the age of 20 years. Overseas data shows that immunity to the virus is building in populations that have been tested. It is very sensible for the government to open schools. I believe that this will help build higher levels of immunity in children to act as barriers for the spread to elderly and those with pre-existing medical conditions. These people are the ones we really want to protect from the virus.

Should New Zealand be eliminating coronavirus?

24 April.

Simon Thornley

The Government and its health advisers are taking an increasingly hardline against coronavirus, stating that it will be eliminated from our shores. It certainly is desirable, but is it realistic?

New Zealand is one of the only countries in the world to attempt this. Almost alone, we have shifted from agreeing with the international approach of flattening the curve to the objective of either eliminating or eradicating the virus. The latest claim, or clarification, is that the Government’s intention is ‘zero spread’ rather than ‘zero virus’.

We need to consider that the only means of achieving even zero spread are tough social restrictions, only ending when a vaccine is invented and most of the population is vaccinated. Let’s be clear – that means a form of very restricted activity for at least a year.

The Government contends that these are needed because our population is vulnerable to the virus, so the spread must be stopped. It paints a picture that the virus is contained by the current public health measures as well as lockdown, and we are effectively leaping on and isolating each new case.

Evidence emerging in the rest of the world, however, is that this picture of a lockdown-halted virus amongst a defenseless population is inaccurate.

Serological tests from samples of people in New York, Germany and California, in contrast, show that between 4 to 15 per cent of the population have seen the virus, recovered from it, and are now immune. This is a much larger proportion of the population than we have seen from positive swab tests of the virus.

This has important implications. First, it shows that the mortality of the virus is much lower than previously appreciated. Also, it demonstrates why a suppression strategy is better than elimination. China, which is trying to eliminate the virus, is now experiencing a resurgence in cases. The cat is well and truly out of the bag.

To boot, recent analysis from the US shows that lockdowns are not effective in reducing Covid-19 deaths, comparing states with such a policy to those without. The data shows that the strongest factor determining a State’s Covid-19 deaths is population density. The lower it is, the lower the death rate. This is a key factor in New Zealand’s favour.

In New Zealand, until we have some data on existing immunity, we just cannot tell how realistic elimination is. That’s without considering whether the goal is desirable or the means worth the cost.

We are betting the house on something that overseas data is showing to be an increasingly remote possibility. Perhaps the rest of the world knows something we don’t?

No One Has A Monopoly On Being Right

As a scientist I am trained to think critically, to evaluate evidence, and ask questions – lots and lots of questions. That’s my job. In March 2020 the World Health Organization predicted that 3.6% of those infected with COVID-19 would die. New Zealand’s own modelling predicted 80,000 Kiwis would die. These numbers seemed extraordinary to me. If they were accurate the impact of COVID-19 would be enormous. But, as I delved deeper, I began to question the accuracy of the predictions. At the time, the infection fatality rate was calculated as the number of COVID-19 deaths divided by the number of confirmed infections. As a scientist, that seemed overly simplistic. Surely many more people would have caught COVID-19 than had been officially tested? If correct, that would lower the predicted fatality rate dramatically. So I began to do what I’m trained to do: think critically, evaluate evidence and ask questions.

What I found was analysis and perspectives I had not been exposed to in New Zealand. John Ioannidis, Professor at Stanford University, and one of the world’s leading physician-scientists, was particularly vocal. The data collected on how many people had been infected (and used to model the fatality rate) were “utterly unreliable”. Not only was there no reliable evidence for “draconian countermeasures” like lockdowns, but if enacted, the measures would themselves lead to significant long-term social and health harm. His concerns were echoed by Sucharit Bhakdi (Professor Emeritus, Johannes Gutenberg-Universität Mainz, Germany) as well as many other eminent epidemiologists around the world. Why had I not heard these different arguments and perspectives in New Zealand? Where was the balanced debate?

On 31 March Dr Simon Thornley, an epidemiologist at the University of Auckland, published an article entitled “Do the consequences of this lockdown really match the threat?” His questions and concerns about the data resonated with me. It turned out I wasn’t alone. Simon received emails from across New Zealand with similar and related concerns. What impact would the lockdown have on mental health, rates of suicide, long-term unemployment, and poverty? What were the legal and ethical ramifications? The list of questions went on.

Last week our cross-disciplinary group of academics published COVID Plan B. Our aim is to get those different arguments and perspectives heard, expand debate and provide a pathway out of lockdown. We want to help New Zealand navigate its way through this pandemic in a way that mitigates its impact on all kiwis. But, while we have received considerable positive support from concerned members of the public, we have also received criticism because of our desire to widen the debate. We have been criticised, for example, for not focusing enough on the elderly or vulnerable. You may wish to read point’s 2 and 4 of Plan B to learn otherwise. To offer a different perspective is apparently now to be ‘contrarians’: people to be dismissed as outside the scientific consensus. I assume, by association, that Professor Ioannidis and those many eminent epidemiologist are also ‘contrarians’? As Michael Crichton (MD Harvard and author) says…“the work of science has nothing to do with consensus. Consensus is the business of politics… invoked only in situations where the science is not solid enough”. Some commentators and scientists have even suggested that we should remain silent and toe the line. This attempt to stifle debate and marginalise those who offer a different perspective on one of the most important issues of our time is deeply worrying and has more in common with political activism than science.

We must never stop interrogating and adapting our COVID-19 strategy. We should, at all times, be open to new analysis, different perspectives and vigorous debate, however uncomfortable that makes us. Different perspectives should be welcomed, not castigated. There can be few decisions in history that would not have benefitted from different perspectives and wider input. No one is well-served by groupthink. As Galileo said “In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual.”

Dr Michael Jackson is a postdoctoral research at Victoria University of Wellington.

Counting the hidden costs of staying home to save lives

Gerhard Sundborn, Senior Lecturer Population and Pacific Health, the University of Auckland, urges us to consider that while staying home may be saving some lives, it is causing death and devastation to many more.

On Thursday 26th March in response to Covid-19, in an unprecedented action, our government enacted a state of emergency to lock our country down to prevent a purported

The modelling that generated these frightening statistics is questionable. When we look at the actual number of infections of covid-19 in New Zealand in proportion to those deaths ‘possibly’ related to covid-19 it is apparent that this modelling was incredibly misleading. Renowned Stanford University epidemiologist Professor John Ioannidis raised the notion that much of the debate and statistics around covid-19 is a “once-in-a-century evidence fiasco.”

Deaths during the 4-week lockdown
Covid-19 ‘related’ 13 deaths
All other causes 2,688 deaths

After 28 days, 12 elderly people have sadly died in their 70s, 80s and 90s. It has not been established if they died with Covid-19 or from the virus.  Although these deaths are undoubtedly sad, when viewed from the perspective of ‘years of life lost’, this is nothing like a wartime tragedy as modellers have made it out to be.

On average our country has had one Covid-19 related death every two and a half days.

Meanwhile, by comparison, across the country, two hundred and forty New Zealanders die every two and a half days from less publicised but equally tragic health conditions such as: heart disease, cancers, suicide, diabetes, pneumonia, respiratory infections, the flu and old age. Over the four week ‘lockdown’ period to date approximately 2,688 New Zealanders have died from other causes.

Like the twelve Covid-19 related deaths, these 2,688 non-Covid related deaths are not merely statistics. They are individuals – our mothers, fathers, grandparents, children, brothers, sisters and friends. Each loss of life is heartbreaking for those left behind.

Regrettably, the strict conditions imposed during this ‘lockdown’ has meant that for those 2,688 + 12 individuals who have departed – children have not been able to farewell dying parents in hospitals, dying people have not been surrounded by their loved ones during their final days, and funerals have taken place in empty funeral halls with no more than a lonesome widow by the departed one’s casket. These unconscionable conditions are outlined on a pandemic response funeral management plan prescribed by our Ministry of Health and based on a scenario that 32,000 deaths had occurred, which was last updated in 2012.

Within our Tongan community, a friend explained that already his family has endured these restrictions in the passing of four family members on separate occasions since the lockdown began. No doubt, for the close family and friends of each of the 2,688 and 12 deaths during this period – additional stress, depression, and grief is likely to be experienced long into the future as a consequence of not being able to celebrate their loved one’s life with the dignity and respect deserved. Where is the dignity and humanity afforded to anyone or family in such circumstances?

Dr Elana Curtis, Associate Professor in Māori Health has described similar experiences in her Māori community and speaks to the “terror being unleashed on my people”, specifically relating to tangi.

A workmate explained to me her frustrations with this ‘lockdown’ as her first grandchild was expected and she was primed to support her daughter during such a special time. These plans had been derailed. The emotional anguish was clear and understandably so.

My grandmother is 93 and lives in a retirement village close by. Her memory is vague these days and she is thought to have a mild case of Alzheimer’s dementia. She has been accustomed to seeing her family every day or two, does not like to socialise with others and is becoming increasingly agitated, lonely, and confused. She often asks why we have not visited and has spoken of ‘what is the use of being around if I can’t see my family’ even going as far as saying she should end it all. Along with this, our team has received reports of increased rates of suicides from District Health Board members. It was distressing to hear of the 93-year-old man from the Kapiti Coast who developed panic attacks and eventually died as a result of social isolation measures, rather than from the virus. My fear is that my grandmother is giving up and may well die of loneliness and despair before we can see her again, hold her hand, comfort her with idle chat over a cup of tea, a smile or a hug.

The question must be asked how many more of these ‘silent casualties’ is the lockdown responsible for?

While these are anecdotes, our team has received e-mails from District Health Board members who state that suicides have increased during the lockdown. As Treasury forecasts increasing unemployment of up to 26%, this is not unexpected, since evidence shows that suicide risk triples in frequency during similar circumstances.

These silent deaths and silent tragedies combine with growing evidence that the health risk of the pandemic has been exaggerated, to suggest that staying home is saving some lives but taking others.

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.

 

Grant Morris on COVID-19 law

Grant Morris: Liberty in lockdown, Wk 3.

New Zealand has changed dramatically in response to Covid-19.  Fundamental rights and liberties have been curtailed to assist in suppressing the virus.  From a legal history perspective, this is similar to what New Zealand experienced in World Wars One and Two and during the 1951 Waterfront Dispute.  It is unclear how long these measures will be necessary.  At the present time we just don’t have enough data to confirm the true case fatality rate of this virus in New Zealand, or overseas.  In the absence of comprehensive information, the government is now taking the cautious approach with a nationwide lockdown.

Under section 162(4) of the Education Act 1989, universities “accept a role as critic and conscience of society.”  As a New Zealand citizen, I understand and acknowledge the reasons for this lockdown.  As a legal academic and historian, what has concerned me most is some of the language being used by those currently leading the Covid-19 response.

My argument is that our leaders can achieve the necessary public cooperation without recourse to language which engenders panic and fear.  We can acknowledge the tremendous pressure on our leaders while also providing criticism and analysis.

The Prime Minister made the following statements in her lockdown speech on Monday 23 March.  “We currently have 102 cases.  But so did Italy once.”  “If community transmission takes off in New Zealand the number of cases will double every five days.  If that happens unchecked, our health system will be inundated, and tens of thousands of New Zealanders will die.”

We need to carefully analyse the situation in various jurisdictions around the world.  This includes Italy, Spain and New York City.  But it also includes Taiwan, Australia, and perhaps most importantly, Iceland.  Iceland has a population of 364,000.  It has embarked on a massive testing experiment and has currently tested over 36,000 people, both with and without symptoms.  That is 10% of its population.  As at Tues 14 April, there have been 1720 positive cases, many of which have exhibited no clear symptoms.  Thirty-nine people are hospitalised, with 8 in intensive care.  Eight people have died, giving a case fatality rate of 0.46%, compared with approximately 0.1% for the seasonal flu.  Iceland has implemented social distancing measures, but not as strict as New Zealand.  This information is available at the Icelandic government’s excellent website: https://www.covid.is/data.

So which case study is correct: Italy or Iceland?  Or does it all depend on how the pandemic is handled?  I don’t have the answer to this but by continually emphasising Italy and ignoring Iceland we lose balance in the debate and go straight to the most frightening case study.  Our leaders should be encouraging New Zealanders to discuss all the possible outcomes.  Informed discussion can reduce anxiety and panic.  As at Tues 14 April, we have 1366 cases in New Zealand.  Fifteen people are in hospital, with three in intensive care.  Nine people have died.  This is a case fatality rate of 0.65%.  So far our statistics seem to reflect those of Iceland, but we have carried out much less testing on a per capita basis and it will become increasingly difficult to know whether a low death rate reflects the nature of the virus or the success of the lockdown, or both.  The situation is so fluid and fast-moving that the statistics in this article will soon be out of date.

There is currently a big debate occurring in some jurisdictions about the accuracy of coronavirus modelling.  In particular, the work of Professor Neil Ferguson from the Imperial College London, has been challenged.  Professor Ferguson’s predictions of chaos from unchecked Covid-19 spread influenced Prime Minster Boris Johnson’s decision to lockdown Britain.  Professor Ferguson has since heavily revised down his predicted mortality rate, albeit in response to the lockdown decision and its possible effect.  My point is not to agree or disagree with Professor Ferguson’s modelling but rather to point out that there is huge uncertainty about how this pandemic will progress.  Our Prime Minister’s recent statements do not reflect the extent of this uncertainty.

We should be able to trust in New Zealanders to debate our situation without worrying that it will undermine our efforts to contain Covid-19.  The debates can actually act as a safety valve as the days of lockdown go by and provide a space for our right to freedom of expression (section 14, NZ Bill of Rights Act 1990).  The debates should include a rational discussion about how Covid-19 is developing in New Zealand in comparison to previous pandemics, such as the H1N1 Swine Flu of 2009, and comparing the different measures taken.

At the beginning of the lockdown, Police Commissioner Mike Bush was another leader in a position of huge, largely unchecked, power.  In response to the question of whether a citizen was allowed to go for a drive to a local beach or park, Commissioner Bush replied: “There’s a short answer to that – no they’re not.” (Interview, NewstalkZB, Wed 25 March).  This appeared to be in contradiction to the Prime Minister’s earlier advice and the instructions on the government’s official Covid-19 website.  The Prime Minister’s advice suggested more faith in the ability of New Zealand citizens to both help contain Covid-19 and keep an element of normality in their lives, not to mention have some freedom of movement (section 18, NZ Bill of Rights Act 1990).  The Police Commissioner’s language reflects an unnecessarily rigid and draconian approach.

This approach was further evidenced the next day when Commissioner Bush stated that citizens should only drive when absolutely essential and that “We may even have a little drive with you to see where you’re going.” (Interview, NewstalkZB, Thurs 26 March).  For those who don’t follow the rules, the Commissioner warned they would be “having a little trip to our place.” (Interview, RNZ, Thurs 26 March).  While police supervision of the lockdown is necessary, I believe the language used here is unnecessarily intimidating and provocative.  While acknowledging that the police needed to set boundaries early on, the instructions can be phrased in a way that reflects trust in the citizenry and reduces fear and anxiety.

This article is not focused on the specific laws involved in this lockdown.  However, on one hand we have the Health Act 1956, Civil Defence Emergency Management Act 2002 and the Epidemic Preparedness Act 2006 providing authorities with their current powers.  On the other hand, we have Magna Carta 1297 (original Charter signed in 1215), Bill of Rights 1688, NZ Bill of Rights Act 1990 and centuries of common law precedents protecting our freedoms as citizens.  Look carefully at the dates of those statutes.  Our fundamental rights go back over 800 years.  Our legal and constitutional traditions emphasise freedom and liberty.  That is the default option.  Only in times of extreme emergency should those rights be limited.  Even in this crisis, it is imperative that we remember our constitutional heritage.

In 1951, Prime Minister Sidney Holland invoked emergency law powers in an attempt to crush the Waterfront Strike.  This clampdown restricted freedom of association and freedom of expression, amongst other rights.  Holland’s actions could be viewed as a cynical power-play to destroy ideological opponents.  During both World Wars, the state took extreme measures to control the population, including conscription.  This could be viewed as a necessary corollary to fighting a war.  A Stuff poll on the eve of lockdown (Wed 25 March) suggested strong support for the government’s initial decision.[1]  This showed a nation concerned for its public health and its most vulnerable citizens.  Our leaders, including the Prime Minister and Police Commissioners, can do more to maintain this goodwill and reduce fear by the language they use and the information they provide.

The nervousness in our society is understandable.  However, the official talk of carrying papers, reporting on neighbours, mobilising the military, and providing police with massive discretionary powers increases this anxiety.  I trust the New Zealand public to form their views on the current lockdown based on its merits without requiring the additional overt and implied threats from authorities.  That trust comes from our shared democratic heritage and commitment to acting in New Zealand’s best interests.

New Zealand’s streets are currently deserted.  Some have made analogies to the New Zealand movie, The Quiet Earth (1985), in which three survivors wander around an empty New Zealand after an apocalypse.  It is now more important than ever to critically analyse the information available and debate the best way forward in an open and robust way.  We need to make sure that we never get to a situation where the analogies are instead being made to another New Zealand movie from long ago.

Sleeping Dogs (1977).

Dr Grant Morris is Associate Professor in Law, Victoria University of Wellington

[1] https://www.stuff.co.nz/national/health/coronavirus/120534052/coronavirus-poll-shows-kiwis-back-harsh-measures-but-are-extremely-worried-about-virus

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

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