“How many lives will be lost due to our attempts to prevent loss of lives”

Those making decisions about how to combat Covid-19 have an unenviable job with lives and deaths at stake. Not only do they have to try and limit deaths from the virus, they also need to prevent deaths from increasing due to related effects, in particular re-prioritising of health care.

And important question raised is “How many lives will be lost due to our attempts to prevent loss of lives” but it  doesn’t come close to being answered here.

Ananish Chaudhuri, Professor of Experimental Economics at the University of Auckland has A different perspective on Covid-19 (but I think while some of his arguments are valid he goes off the rails a bit).

In his book “Risk Savvy”, the behavioural scientist Gerg Gigerenzer notes that, in the immediate aftermath of September 11, 2001, many Americans decided that flying was too risky. Instead, they chose to drive. In the 12 months following the attacks, an additional 1,500 people lost their lives on the road while trying to avoid the risk of flying. This is more than the total number of passengers in the planes used in the attack.

A similar phenomenon is playing out right now as the world essentially comes to a standstill to prevent deaths from Covid-19. But in doing so, we are focusing on what the psychologist Daniel Kahneman calls “identified lives”; the loss of lives that are right in front of us. Gigerenzer calls this the “fear of dread risk”: the apprehension about losing a lot of lives within a short time.

In focusing on identified lives, we ignore the loss of “statistical” lives. It is likely that the total impact of that loss will be greater than any loss of lives due to Covid-19. 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 manner.

Like it or not, there is a trade-off here: how many lives will be taken by Covid-19 (identified lives) and how many lives will be lost due to our attempts to prevent loss of lives from Covid-19 (statistical lives).

In fact, at the time of writing, hospitals in Washington State, which has been hard hit by the virus, are engaged in a bleak triaging of which patients should receive treatment and which should not, since providing everyone with adequate treatment is no longer an option.

This is a real dilemma for hospitals and doctors. They have to make life and death decisions all the time, but with the huge added pressure and workload due to Covid-19 these decisions become more complicated and perhaps more critical.

Already, we are seeing a spike in unemployment claims and business insolvencies. We know that unemployment results in significantly lower life expectancy.

But does that apply to short tern unemployment, or long term unemployment. I expect that the shorter the time unemployed the lower the lowering of life expectancy, so you can’t just look at a snapshot and say that doubling unemployment will have drastic impact on life expectancy. If unemployment as a result of Covid-19 has a significant long term impact then reduced life expectancy becomes an issue.

The human cost of job losses and bankruptcies will be massive. Much of the pain of this shut-down will be borne by the socio-economically disadvantaged.

I don’t know how that “will be massive” can be confidently claimed at this stage. We don’t know yet how much extended unemployment there will be, nor what the impact on people’s lives that will have statistically.

Does the Government (or Treasury) have realistic estimates of how much the economy will shrink, how many jobs will be lost, how many businesses will go bankrupt? How large is the relief package required to prevent an economic catastrophe if the lockdown ends after four weeks or if it continues beyond that? Surely, this calculation should play a role and dictate how long a shut-down we can survive.

The Government should certainly be considering all this and they should be weighing up various risk factors, but claiming adverse effects “will be massive” is a bit like warnings of massive deaths from Covid, but based on virtually no data.

It is clear a crucial factor is population density. So a lockdown in places like Auckland or Wellington may make sense. It is not clear to me that large parts of the South Island, with low population density, need to be locked down.

What’s not clear about this – the Southern District (Otago and Southland) is one of the most sparsely populated parts of New Zealand yet it has the has the highest number of cases of any region, and by far the highest cases per head of population.

For much of the country outside the large metropolitan areas, we should be able to do what we were doing before. Avoid large gatherings and implement self-isolation as needed.

Let people decide their risk-tolerances. Offer all those above 60, those with a history of respiratory problems or ones with compromised immunity the opportunity to work from home, should they choose to do so.

Giving everyone choice seems misguided. This doesn’t just involve personal risk, community risk is a key reason for community restrictions and safeguards. Chaudhuri does acknowledge this to an extent.

What we face right now is a social dilemma; those who have been infected need to make sure that they do not spread the infection. But, evidence suggests Kiwis were and are doing a pretty good job with self-isolation.

Evidence suggests that until we went into lockdown the virus was spreading, with major clusters that began before the lockdown being a school, two weddings, a bar event and a farm conference. So self-isolation by choice only was not working.

My research suggests people can be quite good at solving such collective action problems; that exhortative public messages asking people to choose cooperative actions can succeed. It may need to be backed up with sanctions for hard-core violators.

The problem with a virus is that it only takes a few risk takers and violators to increase transmissions, and that can easily impact on those who don’t want to take risks. If someone went to a risky wedding, contracted the virus, and then chose to visit someone in a rest home it could create a serious problem.

At the very least, the Government should track the path of the infection and selectively loosen restrictions in different parts of the country as and when appropriate.

That’s what is being considered and planned.

Ideally, much of the country should be restriction-free before four weeks have passed.

There’s no chance of that withing the first 4 weeks of the lockdown. And it is very unlikely much of the country will be restriction-free for months at least. The best we can hope for is some areas to be dropped to level 3 after 4 weeks, but that will have to be carefully managed and monitored. Coming back to level 2 looks some time away in the best of scenarios.

I started this post thinking the article was exploring “How many lives will be lost due to our attempts to prevent loss of lives”, an important thing to consider, but it paid scant notice of that and switched to nothing more than promoting a big and rapid relaxation of restrictions with very questionable and in some cases straight out uninformed reasoning.