The need to address both health and economic issues and also for stability

Some of the Covid debate has tended towards health versus economy, but it can’t be an either/or argument. Good health of the population is important for the economy, and a good economy is important for health and wellbeing – “there are many dimensions to health and well-being, many of which build fundamentally on economic stability”.

We had to go into some degree of lockdown, and we have to come out of lockdown. The big challenge is to do this as safely as possible as far as Covid health is concerned, but taking into account the importance of the economy in general, but also specifically in relation to individual and community health.

Many of us have kept a close eye on Covid data, numbers and rates of cases, deaths, tests and more.

Economic signals have been much more mixed, for example share markets plummeted, but have since recovered a lot of the lost ground.

But there’s a key difference – Covid proved to be able to spread fast, and deaths started to surge within a month of an outbreak. Containment has been observable. In contrast a lot of the economic effects are spread over many things, and are likely to lag somewhat. Some companies and jobs will survive, and while some have already been lost the economic impact will take months (at least) to play out.

One of the go to websites for data has been the Johns Hopkins University Covid map.  Caitlin Rivers is an assistant professor in Outbreak science + epidemiology + health security, but she acknowledges the importance of considering both health and the economy,

I’ve been noticing a dangerous polarization in our discussions around navigating our way through the pandemic.

She’s in the US were polarisation has been a growing problem since well before Covid struck.

Reopening is said to be playing games with people’s lives. Continuing stay at home measures is said to be without regard for the economy. This is a false choice.

We were the first group to put out detailed reopening guidance back in March, the same week that many states were issuing stay at home orders. The goal is and has always been to reopen – the question is how to do it safely

Staying home was always meant to be temporary, to prevent the healthcare system from being overwhelmed and to put in place capacities to enable a transition to case-based management. The question is how and when we will reopen. It was never about if we will reopen.

I’ve written about the answers to these questions extensively. The ‘how’ is through test-trace-isolate. The ‘when’ is as soon as we have that in place. The ‘then what’ is by re-introducing low risk activities, waiting to see what happens, and moving up from there. 

As I’ve said many times, what we want to avoid in the reopening process is creating the conditions that led to us having to stay home in the first place. The conditions of NYC, Lombardy, Wuhan. And yes, those places are all urban centers, but rural areas are vulnerable, too.

In April an average of ~2,000 people died of coronavirus in the US each day. That is more than daily average from cancer or heart disease. I fear there is growing complacency that this level of loss is a new normal. Are we really ready to add a new leading cause of death?

My answer to Q’s about whether x, y, z place is ready to reopen is to ask whether those places have the capacities, and if not, how do we build them. Yes, it’s a big lift, but (my current fav phrase) we have done hard things before. We can do this too.

But – and I’ve said this before too – there are many dimensions to health and well-being, many of which build fundamentally on economic stability. I worry as much as anyone about secondary consequences of e.g. poverty and other gaps in care of chronic conditions.

My job is to provide public health counsel, and so that’s what I do. It’s a missed opportunity to have a deeper discussion when I or other experts are set up in an either-or, economy-public health discussion. It’s about how we do both, safely

Again I’ll quote “ there are many dimensions to health and well-being, many of which build fundamentally on economic stability” – this suggests that now is not the time to launch into radical economic or social change, which would be certain to result in instability.

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22 Comments

  1. Alan Wilkinson

     /  11th May 2020

    Time to stop treating the public like children and to let them work out their own safety measures and solutions with the best possible information.

    Send the experts back to their ivory towers.

    Reply
    • Gezza

       /  11th May 2020

      For Christ’s sake ! Stop whining, Al !

      You can make your point without going completely OTT & carrying on like a truculent 2 year old.

      Reply
      • Alan Wilkinson

         /  11th May 2020

        Yes, but I wouldn’t enjoy it as much.

        Reply
        • Gezza

           /  11th May 2020

          Put Mrs Al on your device please. I want to find out if you’ve been foot stamping too.

          Reply
          • Alan Wilkinson

             /  11th May 2020

            I’m keeping away until she finds out what happened to her chocolate cake.

            Reply
            • Tell her that the dogs ate it.

            • Alan Wilkinson

               /  11th May 2020

              I turned on my charm and she couldn’t suppress a grin. Actually, it’s not too bad at all. (I had to have a slice to check.)

            • When my mother was a child, she loved the fruit-laden Christmas cake that her mother made and dosed with some sort of alcohol to make it moist. She made it ages ahead of time and it was really rich and fruity by Christmas.

              Mother decided to take a piece. Then she realised that it would be obvious that someone had cut a piece out, so she had to cut the ENORMOUS cake right across…then had to eat the piece which was the entire width of the cake. The result was predictable, and it was a long, long time before she could even look at a Christmas cake again.

  2. Fight4nz

     /  11th May 2020

    Great post PG.

    Reply
  3. Alan Wilkinson

     /  11th May 2020

    The kind of commentary we don’t get:

    The risk of coronavirus for the young is “staggeringly low”, the UK’s top statistician has said – as he condemned the government’s “embarrassing” handling of Covid-19.

    Professor Sir David Spiegelhalter, chairman of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said he was concerned that the public’s anxiety ought to be “roughly proportional to the risks they face”.

    He made withering criticisms of the Government’s handling of the crisis, saying its treatment of statistics was “not trustworthy” and amounted to “number theatre” rather than an attempt to properly inform the public.

    The statistician said it was “extraordinary” that we still do not know roughly how many Britons have contracted the virus, because sampling of the public only began late last month.

    “Let’s look at the young group. People are anxious about children, and there’s 10 million under 15s in England and Wales, how many of those have died? Had Covid on their deaths out of these 30,000 have died? Two out of 10 million.”

    He said the public were “hungry for details, for facts, for genuine information, and yet they get fed this, you know, what I call number theatre, which seems to be coordinated really much more by, you know, a number 10 communications team rather than genuinely trying to inform people about what’s going on.”

    He added: “I just wish that the data was being brought together and presented by people who really knew its strengths and limitations and could treat the audience with some respect.”

    Sir David said latest figures suggest that in the four weeks ending April 24, there have been around 79,000 deaths – up from the 42,000 average seen for that period in the last five years.

    Of the 37,000 extra deaths, only around 27,000 had Covid-19 on the death certificate, leaving around 3,000 deaths a week “unexplained” he said.

    While some might have been linked to coronavirus, but not recorded, he said he agreed with other experts that the “indirect effects or the collateral damage” – such as that caused by the disruption of the NHS – was likely to be a significant factor.

    And he warned that deaths in care homes are now running at three times the normal rate, but more than half are not labelled as Covid.

    “It seems to me this is unbelievably important – these are short-term immediate deaths due to people not going to hospitals, not calling the ambulance when they’re ill, and so on. And that of course is let alone the damage that’s being done in the longer term by the lack of chemotherapy, radiotherapy, elective surgery, and so on. The disruption to the health service, when we look back, will be seen as a massive issue.” he said.

    https://www.telegraph.co.uk/news/2020/05/10/coronavirus-risk-young-staggeringly-low-says-uks-top-statistician/

    Reply
    • Maggy gave a link that showed that there were 40 deaths more that usual for that time in the first four weeks of lockdown. This was not mentioned on the news.

      3 News mentioned the rise in domestic violence; about time.

      Reply
  4. Alan Wilkinson

     /  11th May 2020

    And:
    Professor Neil Ferguson of Imperial College “stepped back” from the Sage group advising ministers when his lockdown-busting romantic trysts were exposed. Perhaps he should have been dropped for a more consequential misstep. Details of the model his team built to predict the epidemic are emerging and they are not pretty. In the respective words of four experienced modellers, the code is “deeply riddled” with bugs, “a fairly arbitrary Heath Robinson machine”, has “huge blocks of code – bad practice” and is “quite possibly the worst production code I have ever seen”.

    When ministers make statements about coronavirus policy they invariably say that they are “following the science”. But cutting-edge science is messy and unclear, a contest of ideas arbitrated by facts, a process of conjecture and refutation. This is not new. Almost two centuries ago Thomas Huxley described the “great tragedy of science – the slaying of a beautiful hypothesis by an ugly fact.”

    In this case, that phrase “the science” effectively means the Imperial College model, forecasting potentially hundreds of thousands of deaths, on the output of which the Government instituted the lockdown in March. Sage’s advice has a huge impact on the lives of millions. Yet the committee meets in private, publishes no minutes, and until it was put under pressure did not even release the names of its members. We were making decisions based on the output of a black box, and a locked one at that.

    It has become commonplace among financial forecasters, the Treasury, climate scientists, and epidemiologists to cite the output of mathematical models as if it was “evidence”. The proper use of models is to test theories of complex systems against facts. If instead we are going to use models for forecasting and policy, we must be able to check that they are accurate, particularly when they drive life and death decisions. This has not been the case with the Imperial College model.

    At the time of the lockdown, the model had not been released to the scientific community. When Ferguson finally released his code last week, it was a reorganised program different from the version run on March 16.

    It is not as if Ferguson’s track record is good. In 2001 the Imperial College team’s modelling led to the culling of 6 million livestock and was criticised by epidemiological experts as severely flawed. In various years in the early 2000s Ferguson predicted up to 136,000 deaths from mad cow disease, 200 million from bird flu and 65,000 from swine flu. The final death toll in each case was in the hundreds. In this case, when a Swedish team applied the modified model that Imperial put into the public domain to Sweden’s strategy, it predicted 40,000 deaths by May 1 – 15 times too high.
    We now know that the model’s software is a 13-year-old, 15,000-line program that simulates homes, offices, schools, people and movements. According to a team at Edinburgh University which ran the model, the same inputs give different outputs, and the program gives different results if it is run on different machines, and even if it is run on the same machine using different numbers of central-processing units.

    Worse, the code does not allow for large variations among groups of people with respect to their susceptibility to the virus and their social connections. An infected nurse in a hospital is likely to transmit the virus to many more people than an asymptomatic child. Introducing such heterogeneity shows that the threshold to achieve herd immunity with modest social distancing is much lower than the 50-60 per cent implied by the Ferguson model. One experienced modeller tells us that “my own modelling suggests that somewhere between 10 per cent and 30 per cent would suffice, depending on what assumptions one makes.”

    Data from Sweden support this. Despite only moderate social-distancing measures, the epidemic stopped growing in Stockholm County by mid-April, and has since shrunk significantly, implying that the herd immunity threshold was reached at a point when around 20 per cent of the population was immune, according to estimates by the Swedish public health authority.

    The almost covert nature of the scientific debate within Sage, the opaque programming methods of the Imperial team, the unavailability of the code for testing and review at the point of decision, the untested assumptions built into the model, all leave us with a worrying question. Did we base one of the biggest peacetime policy decisions on crude mathematical guesswork?
    https://www.telegraph.co.uk/news/2020/05/10/chilling-truth-decision-impose-lockdown-based-crude-mathematical/

    Reply
    • Fight4nz

       /  11th May 2020

      Actually my impression is that the message of these 2 posts and multiple similar are littered far and wide across this site by yourself and your comrades.
      What isn’t expressed by any of you, explicitly at least, is the conclusion implicit to the call to have never done this. To use the Swedish numbers again, we would have optimistically 1300 dead. This is an acceptable loss.

      Reply
      • Alan Wilkinson

         /  11th May 2020

        We don’t yet know the cost in lives and dollars of what we chose instead.

        And the scaremongering epidemiologists were telling the Swedes their option would cost 3% of 80% of the population: 360,000 deaths. Slight error?

        Reply
        • Alan Wilkinson

           /  11th May 2020

          Oops, should have said 240,000 for 10m – was thinking 15m.

          Reply
      • Pink David

         /  11th May 2020

        ” To use the Swedish numbers again, we would have optimistically 1300 dead. This is an acceptable loss.”

        NZ loses around 400 people every year to car crashes. Should NZ ban cars to save these lives?

        Reply
        • Do you realise that the 1300 (Sweden deaths are actually now 3225) would be additional road deaths?

          And that’s in two months rather than a year?

          I don’t think there’s any serious suggestion that we should just accept additional deaths from any new contagious disease because people already die on the roads or of cancer or heart attacks.

          Reply
          • Pink David

             /  11th May 2020

            “Do you realise that the 1300 (Sweden deaths are actually now 3225) would be additional road deaths?

            And that’s in two months rather than a year?”

            So what? Don’t these 400 people matter to you? I’m shocked at your disregard for life. If we can save just life we should. Isn’t that the argument being used for Covid?

            We will end up spending $50bn plus to save these 1300 lives. That’s $38m per life. What about the children who cannot get lifesaving medication because the NZ government won’t fund it. The limit there is about $40,000 per QALY. We have spent $38m to give an old person perhaps a year more at the cost of a hundred children losing their entire lives.

            How do you justify that trade off?

            “I don’t think there’s any serious suggestion that we should just accept additional deaths from any new contagious disease because people already die on the roads or of cancer or heart attacks.”

            We accept deaths from cancer, downing, road deaths, flu and heart attacks. Is it just because this is new?

            We have spent more of tackling this disease than any other disease in NZ history. In 8 weeks.

            Reply
            • These comparisons with car crash deaths aren’t remotely relevant & its ridiculous for critics to keep bringing them up in arguments.

              By all means cite death rates from flus & other health epidemics, which are self-evidently germane – but road tolls are an inevitability of factors which have nothing whatsoever to do with epidemiological & disease pathologies & command completely different responses from authorities to minimise.

              Banning or limiting cars or travelling in them to try and reduce road tolls is NOT a practical solution option & thus no govt anywhere has ever suggested it should be or tried to do it. Policing of the Road Code is undertaken to try & save lives & it generates revenue as a by-product. But Road Tolls are an entirely specious distraction in this debate.

            • “Don’t these 400 people matter to you? I’m shocked at your disregard for life.”

              Ridiculous.

              “If we can save just life we should. Isn’t that the argument being used for Covid?”

              No.

              “We accept deaths from cancer, downing, road deaths, flu and heart attacks.”

              We don’t. A lot of cost and effort is put into reducing deaths from all sorts of causes, and has been for decades. Our health budget is huge. A lot of our roading budget goes towards better safety. A significant amount of policing resource goes into reducing road accidents.

              Sure the amount of money going towards reducing Covid is huge and what is being done is and should be debatable.

              But if we did nothing it would still be huge. Inbound tourism would still have stopped, many other countries would not allow travel with us. Trade would be in more jeopardy. The international economic impact, whether we end up in recession or depression, would impact here and cost us a lot of what we are spending on Covid.

              The health costs of rampant Covid would be huge regardless.

              Your ‘but other deaths’ argument’ makes no sense – or are you trying to say we shouldn’t spend money on preventing deaths from road accidents, drownings, heart attacks, cancer either?

        • Griff.

           /  12th May 2020

          Sweden has not stopped recording deaths and will not into well the future .
          Despite what the the twit sourced fake news you posted on here a few days ago claimed Sweden is still recording about 100 deaths a day .
          That would be the equivalent of our yearly road toll every eight days.
          We actually spent billion’s a year in NZ on trying to reduce the road toll.

          Can not do simple math, unable to fact check and does not understand the result of time proceeding .

          This graph would be well outside if its intellectual ability to comprehend .
          Years of life by age and chronic conditions from The Economist.
          https://www.economist.com/graphic-detail/2020/05/02/would-most-covid-19-victims-have-died-soon-without-the-virus

          Reply
      • Fight4nz

         /  11th May 2020

        Any figure in the 100k’s has proven ridiculous. I found this on worst case modelling for NZ. https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12321087
        14000 – 28000 – different models?
        Still plenty to scare the crap out of any politician and the public. In addition the overrunning of the health system would mean more loss from other causes. Hard not to see Lockdown as inescapable in our political environment. We live in a country where the peanut allergy of one child will determine the available meal options for a school of 100s of pupils, or the media turn up with crying parents demanding to know why not. I very much doubt it would have made a difference which Party had to make the call.
        So the real question, have we simply traded non-able bodied lives for able bodied?

        Reply

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