“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.

End of Life Choice Bill

David Seymour’s ‘End of Life Choice’ Bill was drawn from today’s Members’ ballot. It is unlikely to be debated before the election, so a new intake of MPs will get to decide whether it progresses through Parliament.

I hope that it at least passes the First Reading vote and goes to select committee for consideration and for public submissions. From there it will depend on what form the bill ends up taking, in particular what safeguards are included, and then it should be up to conscience votes.

End of Life Choice Bill

This bill gives people with a terminal illness or a grievous and irremediable medical condition the option of requesting assisted dying.

It is a controversial subject and will no doubt be keenly debated, and there is likely to be  a lot of lobbying.

From ACT: Campaign to legalise assisted dying begins now

The End of Life Choice Bill has been drawn from Parliament’s ballot.

“The campaign starts now,” says ACT Leader David Seymour.

“We are long overdue for a compassionate response to the anguish faced by the small but significant minority of grievously and irremediably ill, or terminally ill, people. Current law leaves them no choice but to endure intolerable suffering and loss of dignity in the final days of their lives. The End of Life Choice Bill would allow people who so choose and are eligible to end their life in peace and dignity, surrounded by loved ones.

“Polling consistently shows strong support for allowing assisted dying for those with terminal illness or who are grievously and irremediably ill. It’s time to translate this support into action. This issue will likely be decided by a conscience vote, so I encourage all supporters of this cause to write to their local MPs and urge them to support the Bill at first reading so that the issue can be thoroughly considered through the select committee process.

“This is a debate which will take place around the country, not just in the media, but online and at homes and churches. I hope people respectfully engage in the discussion with friends and family, and also submit on the Bill as it reaches select committee stage.

“A copy of my Bill, together with further information including answers to common questions and criticisms, can be found on the campaign website, lifechoice.org.nz.”

“Democracy is about choice”

One of the stupidest criticisms of Bill English’s decision not to stand a National candidate in the My Albert by-election is that it is undemocratic.

I’ve seen that said in social media, but nonsense is to be expected there.

But veteran journalist Barry Soper also spins that line in Mt Albert byelection waste of money

It’s hard to envisage John Key chucking in the towel in the way English has done on this one. Democracy is about choice and the people of Mt Albert are now being denied it.

Yes, democracy is about choice, and choosing not to stand a candidate is just as valid as choosing to stand a candidate.

Greens chose not to stand a candidate in the Northland by-election last year, and while Labour chose to stand a candidate they also chose to not campaign for votes for her to help Winston Peters win.

Greens chose not to stand a candidate in last month’s Mt Roskill by-election to help Labour’s Michael Wood. NZ First chose not to stand a candidate (I don’t know why).

National choose not to stand candidates in Maori electorates and I haven’t seen Soper condemn them for that.

Democracy is about choice, and an important choice for parties is whether to stand candidates or not.

Dumping ODT and Sky

Our household has been considering dumping ODT and Sky subscriptions and we have just decided to do that. This will save us over a thousand dollars a year, sort of (depending on what we spend on alternatives instead).

I’m a bit nostalgic about the ODT, having read it often cover to cover for fifty years. But I find that these days I hardly bother reading it. Too busy online, and most of it’s content plus much much more is readily available online anyway. So one phone call and that’s the end of the ODT. All we have to do is find an alternative source of fire starting fuel.

Sky was a different decision. I’m very keen on sport. But the problem with Sky Sport is you have to pay for a whole lot of other crap to be able to get it. That has annoyed me for a long time.

We used to get Rialto but dropped that to reduce Sky costs and because the movie offerings had become very disappointing, there was rarely a decent movie available at a time that suited.

We also used to get the Sky guide which was kinda useful and I don’t like Sky’s online channel guide but dropped that too to reduce the Sky costs. A little.

But it has still been costing $74.75 a month, which is close to $900 a year. For:

  • Some good stuff.
  • A lot of crap.
  • Far too many channels we don’t watch.
  • Too much advertising.
  • Too much self promotional interruptions.
  • A heap of repeats.
  • A lot of crap.
  • Too little choice to just pay for what we’re interested in.
  • And you have to pay even more to get the rugby channel.
  • And you have to pay even more to get decent quality HD.

Unlike ODT you can’t just drop your subscription. You have to give a month’s notice. Why? I have no idea, unless it’s to force you to pay another $75 you don’t want to spend. What this does is deter us from resubscribing for short term things of interest because you have to commit to time you may not want or need.

So early next month we will no longer have Sky.

What will we do without the ODT and SKY. Plenty. We already have the Internet so will stream more. And browse more for exactly what we want, when we want it.

And we have decided to invest in a Samsung Smart TV. This is $1100 up front but we’ll get something for the old TV. And it saves us buying another PC as it is effectively a large screen computer with WiFi and Freeview decoder. So we will have free-to-air channels plus anything from the growing number of online services we want.

Proper choice, unlike the Sky way of forcing crap onto you that you don’t want. Sky charges $48 a month for the crap channels you mostly don’t want before you can get a look in at the ones you want.

And in making these changes we have left the past and joined the future of media information and entertainment. Choice.

With the lost of sports channels we will miss a few games. And go and watch it live a bit more. Or go out to the pub and watch it. Instead of being trapped in a dinosaur TV bubble at home.

Choice of what you watch and choice of when you watch it. And choice of what you want to pay for.

Does Sky have anything like this? I checked their website and they list Sky on Demand. But:

SkyOnDemandThey could get with the future and give me choice at a reasonable cost. Or they could be too late. I didn’t click BACK TO SKY. Too busy on the Internet.

Colin Craig’s evolving ‘choice’?

Colin Craig was recently quoted by TV3 as saying that being homosexual was a choice:

Mr Craig told 3 News that people choose to be gay rather than being born that way, many as a result of being abused as children.

He was so sure that homosexuality was a choice, he bet his own sexuality on it.

“Do you think you could choose to be gay if that is the case?,” he was asked.

“Sure. Sure I could,” he responded.

“You could choose to be gay?,” he was asked again.

“Yea, if I wanted to,’ he replied.

That led to a lot of discussion. The level of certainty there may or may not be TV3 accentuation. That led to a lot of discussion.

More recent were more quoted verbatim in Colin Craig sticking to the facts:

First Fact: I do hold the view, based on research, that adopting a gay lifestyle is a choice.

That’s different, it’s a choice of lifestyle rather than a choice of sexuality.

Third Fact: I have said that to believe that all gays were born that way is narrowminded and ignores the facts and research.

And that leaves the possibility open that some may be born that way, others may be influenced by life or can choose.

He also quotes researchers including:

Kirk and Madsen. (After the Ball [Book]) .. ‘‘..sexual orientation, for most humans, seems to be a product of a complex interaction between innate pre-dispositions and environmental factors during childhood and early adolescence.’’

Dr j de Cecco. If you seduce a straight person can you make then Gay? [Book]) ‘‘ ..scientific conclusion shows that life-long, exclusive homosexuality, as articulated by gay rhetoric, is more a statement about the culture in which it occurs than the essence of homosexuality.’’

Dr D Greenberg (The construction of Homosexuality [Book/Research]). Comment by Chicago University: ‘‘The idea of static homosexual orientation or essence simply does not hold up against the huge variety of homosexual, bisexual and heterosexual patterns.’’

This alludes to a lot more complexity and leaves the potential for variablity.

Some people can obviously swing both ways (bi-sexual) and some live life as a hetero and switch to homo.

But others including myself and I suspect most people are strongly hetero – I’ve never had any homo inclination. So presumably some who are homosexual are strongly that way.

So Craig could be partly right – but does it really matter how much is pre-disposition and how much is acquired through life experiences?

I’ve emailed Craig and asked:

There have been varying quotes of you saying that being homosexual or leading a homosexual lifestyle is a choice.

Have you seen any research on or considered whether it could be different for different people?

That perhaps some people without strong hetero or homosexual feelings could choose either way and switch, but that others may be too strong one way to consider the other as an option?

There’s three things I base this on:
1. I thought it’s a feasible possibility.
2. some people change, many people don’t.
3. I’m hetero and have never felt any inclination to try homo, the idea seems naturally repellant to me.