Tuesday, May 12, 2020

Bryan Leyland: “Things you know that ain't so" - Covid-19

As the American humorist Will Rogers said: “It’s not what we don’t know that gives us trouble, it’s what we know that ain’t so.” 

“Our government is a world leader in coping with Covid-19

No. When collateral damage is taken into account, the social and economic cost of the shutdown is huge. Thousands of lives have been put at risk because of delayed operations, treatment, and diagnosis. Many people have suffered from depression and domestic violence. The education of our children – particularly those from deprived families – has been seriously compromised.

From the beginning, it was obvious that every effort should be made to limit the risk of infecting old and sick people. But was it necessary to shut down the economy as well?

So let us start with what we did know before the end of March:

Worldwide the vast majority of fatalities have been people in the over 70 age group who have serious underlying health problems.

Younger people are at much less risk and children under 10 frequently don’t show symptoms, hardly ever get seriously ill and none have died. They don’t appear to be a significant source of infection.

Computer modelling in New Zealand is largely based on pessimistic assumptions – some adopted from overseas studies which have since been discredited. These models have predicted worst case scenarios of 14,000 or 60,000 deaths – take your pick.

So far 21 people have died in New Zealand – all were over 70 and all had serious underlying health problems.

It seems that none of the 84 (out of 750) pupils and staff at Marist College who were infected became seriously ill.

Already, the economic damage is huge: billions of dollars have been paid out in wage support and the like. Even more is going to be spent trying to prime the pump with government selected infrastructure projects – some of which are extremely poor value for money.

Domestic violence, poverty and depression have increased, operations, medication and diagnoses have been delayed with potentially serious outcomes and10% unemployment is predicted.

New Zealand imposed level 3 restrictions on 25th March followed by level 4 on the 27th. Before the 25th the public were social distancing and taking other precautions and most people over 70 were isolating themselves. By 27 March, there were clear signs that this was working because the infection rate was levelling. It may well have commenced to decline without the imposition of level 4.

New Zealand already had a pandemic policy based on experience with previous epidemics: it accepted that an epidemic would end only when herd immunity has been achieved. The policy concentrated on protecting the vulnerable until the epidemic had died away.

The Prime Minister ignored the existing policy and decided on the risky option of attempting to eradicate the infection. If it succeeds we will need to adopt a “fortress New Zealand” policy until a vaccine has been developed and distributed or until Covid-19 has died out worldwide. This will produce enormous economic damage and social misery for many months. If we fail and finally elect to let herd immunity build up we will finish up trailing the world.

The lockdown in New Zealand has been much stricter than in most other countries. All but businesses deemed to be essential were shut down rather than allowing any businesses that could operate safely to continue in operation. This has resulted in massive social and economic damage.

The lockdown has put thousands of people out of work and destroyed many businesses. Hospitals have stopped all elective operations and treatment and prepare for a flood of Covid-19 patients. Postponing medical care has put thousands of people at risk of continuing ill-health and an earlier death. 

Shutting down schools and early childhood education ignored the evidence that children are largely immune and do not appear to infect others. Children in struggling families suffer most.

The economic damage is enormous.  Treasury has predicted a $121 billion cumulative drop in GDP. Billions of dollars have been spent on extending the lives of, mostly, old and sick people. If we generously assume that the level 4 shutdown extended the lives of, say, 5000 people by five years then it cost $5 million per year of life saved. If it had saved only 1250 lives, the cost per life saved would have been $20 million!

Billions of dollars have been paid out in wage support and other efforts to mitigate the damage. This is likely to continue for months. It will be years before our economy recovers..

When road transport planners evaluate the cost of safety improvements in road transport they value a life at about $4 million – $50,000 per year of an assumed 80 year life. For every $1 we are prepared to spend on reducing road deaths, we spend $100 prolonging the life of people at risk from Covid-19.

Sweden, on the other hand, adopted a carefully considered approach (similar to our level 1) that aimed to keep infections down to a manageable level without inflicting major damage on the economy and society. Its success is demonstrated by a death rate not much higher than the European average. According to the models, it should be many times higher. Sweden’s GDP will drop by 0.7% while New Zealand’s GDP is predicted to drop by 13.5%. 

By 27 March, the government was – or should have been – well aware that Covid-19 was only a major threat to the old and sick and realised that the shutdown would have a disastrous effect on our economy and the lives of many people – most of them already poor. 

A rational policy would have been to protect the over 70s until the pandemic had died away. There would certainly have been a few more deaths among the old and sick but the lives of many ordinary people would have been saved, much misery would have been avoided and the economic damage would have been minimal.

Whatever happened to “The greatest good of the greatest number”?

Bryan Leyland is a Consulting Engineer with wide interests in modern technology."Things you know that ain’t so" is a column in which he exposes the truth behind popular misconceptions. 


Ross said...

The only thing the Government was "world leading" in was the PR campaign to support the PM.
Everything else has been a complete shambles, as you say Bryan.

Barend Vlaardingerbroek said...

>"There would certainly have been a few more deaths among the old and sick but the lives of many ordinary people would have been saved, much misery would have been avoided and the economic damage would have been minimal."

I have a problem with this mindset. It makes a qualitative distinction between oldies and other people, the former not being 'ordinary', as though a species change occurred upon hitting an arbitrary age such as 70. Having dismissed the elderly as 'non-ordinary', they are then made to appear expendable.
It may make sense to a strict materialist, but I thought we as civilised beings with a duty of care towards vulnerable groups in society had passed that point long ago.

Unknown said...

Thanks for laying the situation out so succinctly!

KiwiBuzz said...

Barend, like it or not, one can only make racial decisions on where to spend money on saving lives if a value is assigned to a life. What they actually use is "quality adjusted" years of life. This except that the death of a young person has a greater economic impact than the death of someone who is old and sick. Valuing all lives equally seriously disadvantages the young and favours the old. (BTW I am 83)

Aletheia said...

A wasp flew into my house. So I burnt it down.

KiwiBuzz said...

Oops! ...RATIONAL decisions...

Blame the dictation software...

John Brett said...

I have the greatest respect for Brian Leyland, and for his judgement as a rule. On this occasion I believe he has missed the mark by a long way.
When such an emergency occurs, it is normal to react assuming the worst case. I was once a Fire Marshall for Rutherford House in Wellington. Whenever a fire alarm went off, everyone evacuated the building, whether there was a blazing inferno (never happened), or as usual, a practice drill.
The Covid 19 emergency was far more difficult to call, as it was an unprecedented situation. Whilst in hindsight it is fine to make a call that it may have been an over-reaction, that it could have been done differently, its the decision at the time, based on what was known at the time, that counts.
In a Fire Drill, nobody makes such judgement calls, its just ALL OUT! NOW!
We made the call ALL LOCKED DOWN! NOW! and then reviewed the situation as it developed.
As a small business owner myself- I say that any small business that cannot survive a month of lockdown in such an emergnecy- is an unprepared business.

John Brett

Coker said...

Sadly, all very true. The PM, whose degree is in communications and so probably last did maths in the 4th form, was spooked by some very dodgy modelling.

Anonymous said...

There is a clear distinction between policies made by governments and public health officials, with a duty of care to the POPULATION AS A WHOLE (the sum of the well and the sick, the old and the young, the poor and the not-so-poor; not to not individual citizens) and decisions made by individuals, who exercise a duty of care to other individuals (as fiends, families, social communities etc). The government has committed a grave dereliction of its duty to the population by prioritising the interests of those individuals likely to get Covid-19 over the interests of the population as a whole. It does not appear that a cost-benefit analysis of the options was undertaken before the decision was made. Furthermore, the requirement for regulatory impact analyses of Covid-19 policies was then retrospectively removed, meaning no such analyses were required for any subsequent decision-making. So "saving lives from Covid-19 outranks saving any other lives" became the sole benchmark for decision-making (an 'individual' decision criterion) and the only measure upon which it seems the government wishes to be held accountable for. This is not "leadership" of a population - it is "followership" biased towards the interests of a selected group of individuals.

Geoff said...

Jacinda has come out of this being able to boast of a very low mortality rate which has made her the darling of the international media and boosted her chances of a job at the UN. The carnage left in her wake will soon be forgotten, except for the NZ taxpayer who will be paying the bill for years to come.

Fang said...

I'm a health professional and hence have made a very close study of how this virus has operated in many areas of the world.
I can assure you that in those areas where a more laissez-faire approach has been employed and the virus has become more established the death rate has not been confined to older people. There are many much younger including now children dying.
I accept that the concept of the whole pandemic is so unbelievable that those who have limited education in biological sciences are sceptical and that's fair to acknowledge but this is not a political issue. It is a very real threat to human life.
No one is protected unless they remain isolated and those of us like myself can manage to do that but not indefinitely. I kid you not.

Mervyn said...

I do not accept the statement that there would have been more deaths amongst the old if we had not continued the lock down. The lock down has meant that medical services for disease other than covid19 have been severely curtailed, Future funding as a result of strain on Gvt coffers will in all probability shorten life expectation. Further more longevity is not eveything. As a result my wife will in all likely hood have to put up with increasing pain and severely restricted mobilityfor longer in hope of knee surgery. The very reasons the Covid 19 is fatal to the old -underlying medical conditions will increase because these conditions are not being adequately treated.

KiwiBuzz said...

Fang: About 500 people die from the flu every year. Most are old and ill. We accept these deaths as a normal part of life. We do not declare that all people over 70 must be forced to have a flu injection – more or less equivalent to a mandated shutdown.

As a result of the strict lockdown, many otherwise healthy people are likely to die or be seriously damaged by depression, suicide and delayed medical attention. The serious damage to our economy will result in additional poverty and unemployment and this on its own will cause more deaths and misery.

The point of my argument is that this second group should be given adequate consideration.

Barend Vlaardingerbroek said...

KiwiBuzz, Re: your response to my earlier post. I have come across the QALY system in relation to the public financing of drugs; I have a huge problem with applying the mindset to individuals through arbitrary evaluations of 'life quality' made by a third party.
A couple of weeks ago, 113-year-old Maria Branjas left isolation where she had been consigned because she had COVID-19 from which she recovered. I'll bet she and her family are glad nobody in a white coat made any value judgements about whether her life was worth saving.

John Brett said...

The "Lockdown"was only for the four weeks, to identify any latent COVID 19 cases as yet undetected.
It is a very long call to say "As a result of the strict lockdown, many otherwise healthy people are likely to die or be seriously damaged by depression, suicide and delayed medical attention. The serious damage to our economy will result in additional poverty and unemployment and this on its own will cause more deaths and misery."
I got attention during the lock-down at our Medical Centre for a small insect bite, that needed some Anti-histamine. My neighbour today went into hospital for a Hip replacement. I am sure no-body else missed out, as they probably would had we not locked down and the doctors been flooded with COVID 19 cases.
Perhaps you think that when there is a fire, or a fire drill, we should leave the oldies behind to get the younger people out first?
If it matters, I am 75, running a business, and doing three times a week cycle racing around a very local circuit during the lockdown.

KiwiBuzz said...

“Unknown", there is ample evidence that many people have suffered from domestic violence and depression as a result of the lockdown. It is not hard to find. It is also well-established that there is a very strong correlation between unemployment and suicide. One of the cancer organisations has already pointed out that thousands of diagnoses and treatments have been delayed as a result of the lockdown. A one month delay in diagnosis or treatment produces a 5% increase in the probability of eventual death.

We never were going to be flooded with Cvid 19 cases. The rate of infection had levelled off before the effect of the level IV shutdown could have been experienced. Your information comes from computer models originating in the UK that have since been comprehensively rubbished.

Regarding the hypothetical fire, both should be given equal consideration bearing in mind the years of remaining life. What is fairer than that?

For the record, I am 83, running a business, and world champion in over 80 single sculls.This

John Brett said...

I apologize for posting as "Unknown". It was not intentional, I had missed out ticking a box.
Dear Kiwibuzz- I agree that there would be a significant downside to a lockdown.
In the position of the Government, they were faced with many unknowns. I hope that they they looked at UK Computer models, I didn't. Maybe you are right- that we were not going to be flooded with COVID 19 cases- but maybe you were wrong. Its like a fire alarm. I believe that they did the best thing based on the information available at the time,
Like a fire alarm, Tsunami warning, or anything similar, immediate action is needed. Debating the probabilities comes later.
Thankfully there was no debate about "leaving the aged to die for the sake of the rest"in NZ. Personally I leave that for trumpland- I think it would be unacceptable to most NZ'ers.
It is good that we can have a respectfull debate on these issues without it turning into a personal slanging match!

KiwiBuzz said...

At the time that level IV was introduced new cases in New Zealand had already levelled off and it wasn't well-established from overseas that it mainly affected the old and sick. A rational decision would have been to carefully isolate the old and sick and especially those in rest homes. It seems that Jacinda was panicked into level IV by anecdotal accounts from friends overseas and New Zealand modelling based on the abysmally bad UK modelling and computer programs.

It is not a matter of "leaving the aged to die for the sake of the rest". it is a matter of also counting the collateral damage resulting from a level IV shutdown – increased suicides, depression, deaths from delayed medical treatment or diagnosis and so on. And don't forget that many who have died would probably have died anyway from the flu. For sure, for most of them, their expectation was a short and miserable life. I have a brother in the UK in this situation and he is now going rapidly downhill because he has been isolated in his flat for the last two months without exercise or social contact. Evidence of collateral damage.

Bruce Tichbon said...

The Prime Minister


Dear Madam,

Under the Official Information Act please provide all information of the calculations, figures and all documents used to inform the cost of each life and/or life-year saved under the government’s response to the Covid-19 virus.

Yours sincerely,
Bruce Tichbon