Balancing public health and economic recovery
A way forward during the Covid-19 crisis is an important discussion to be had. The Government seems very rightly concerned about balancing the public safety with the rights of the people to live their lives and reopening the economy.
By background, I'm a firefighter and paramedic with my college education in emergency management, which included infectious diseases. I also took extensive medical and scientific studies (almost another degree in itself) as a prerequisite for medical school (immunology, biology, chemistry, anatomy and physiology, etc).
I'm not a doctor or an epidemiologist, but I'm reading their opinions on a daily basis and forming what I feel is the best long-term solution we can take based on what we know at present.
We have two options in the present situation until a vaccine (12 to 24 months away) or an effective treatment is found (maybe never, maybe three months):
• Continue the lockdown until a vaccine has been found
• Reopen society under social-distancing while sheltering our vulnerable population
I contend the best solution is to protect the most vulnerable while reopening society, schools and businesses. We shelter in place and lock down the vulnerable community until we have either an effective drug treatment or we have a vaccine.
So in Bermuda, what should be our goals?
• Reduce/prevent the spread of Covid-19 into the vulnerable parts of our society
• Keep hospital use at a manageable level
• Allow society to reopen as soon as possible
The Government should take strong measures in reopening the economy and trying to generate economic activity. We cannot afford the mountain of debt Bermuda had before Covid-19 and we're now discussing $300 million or more additional debt and 10 per cent or higher loss of gross domestic product per the finance minister's report on April 15. Britain is predicting 35 per cent loss in GDP.
The Government has taken measures to help people during this crisis and should be applauded for doing so, offering a maximum $500-per-week income replacement and dedicating funds for business loans and recoveries. However, the true depth of this crisis is too large for the Government to fill. These measures can only help ease the initial shock. But we can intelligently reduce both loss of life and economic damage.
At present, we have no treatment or vaccine options, but in terms of real lives lost in shutting down the economy to keep Covid-19 contained, I would argue it's a losing proposition. Public health policy is difficult: it must take into account the existing crisis coupled with the tremendous future years of life lost in an economic downturn.
GDP has a direct correlation with the health of a society, so it is counterproductive to continue the closing of society if the mission is to save lives. This includes suicides: “ ... an increase in unemployment of more than 3 per cent increased suicides in those younger than 65 years”.
A study done out of the University of Bristol is making the case that the drop in GDP will cost move lives than Covid-19 will.
According to Philip Thomas, a professor of risk management at Bristol university, the coronavirus pandemic will severely disrupt businesses for at least a year, leading to a drop in economic output of 6.4 per cent per person in Britain.
In such a scenario, fewer people in Britain would be employed, and workers would generally bring home smaller paycheques. His recently published research concluded such a downturn will lead to more deaths than the pandemic itself.
“It so happens that the UK experienced a similar drop, of 6 per cent in GDP per head, between 2007 and 2009 in the financial crash,” Thomas told Al Jazeera. “This led to a stalling in the growth of life expectancy, cutting at least the tipping-point figure of three months off average life expectancy.”
In his paper, Thomas showed that life expectancy flatlined in Britain, and in some cases decreased, a few years after the Great Recession of 2007 to 2009. He reasoned when a country's wealth declines, citizens are exposed to greater health risks.
Covid-19 will spread throughout the population and, with social-distancing or not, many experts are looking at 50 per cent to 75 per cent of the population to become infected in time. Ideally, it is recommended that this is done in a controlled fashion so that we do not overwhelm the resources of the country; hence, the entire discussion around social-distancing and flattening the curve.
With regards to the spread, many people have no symptoms and many more have symptoms akin to cold or flu; nothing serious enough to bring to your doctor or the hospital. “In one of the places where there has been extensive testing, the nursing home in Washington State, 56 per cent of those who tested positive had no symptoms when they got tested.”
In closed systems, where you would expect near 100 per cent transmission, the results are also a bit more positive than the worst-case scenarios.
“Aboard the Diamond Princess cruise ship docked in Japan, February data showed that up to 50 per cent of the people who tested positive showed no symptoms at the time.”
“As of February 20, tests of most of the 3,711 people aboard the Diamond Princess confirmed that 634, or 17 per cent, had the virus; 328 of them did not have symptoms at the time of diagnosis. Of those with symptoms, the fatality ratio was 1.9 per cent, Russell and colleagues calculate. Of all infected, that ratio was 0.91 per cent. Those 70 and older were most vulnerable, with an overall fatality ratio of about 7.3 per cent.”
This is an important case study, as the Diamond Princess — a Bermudian-registered ship — had a passenger list of people in the older range and likely more underlying illnesses per person than a younger population, but showed that the overall rate of illness was much lower than expected even in a more vulnerable population.
I also advocate a “modified” herd immunity approach. Once enough of the population has had Covid-19 and developed antibodies, we have a strong chance for the virus to burn out in the population, while protecting those who have a high-risk illness and could die if they come into contact with the virus. This is the course Sweden has taken and received a lot of negative comments for. But are they right?
Sweden as of today is sitting at 150 deaths per one million people, placing it in the top ten of such ratios worldwide. However, its predicted total deaths is expected to peak at 5,900 in June, well below other countries even at this time.
This is not a “great” number, as for its size Sweden is on the upper end of deaths, but there is a major silver lining to be had. If Sweden potentially reaches a status of herd immunity in the coming weeks, one could argue they are on a great track to controlling Covid-19 well ahead of many other countries — all while keeping a majority of the country operational.
I would note that every country is all over the map when it comes to reporting standards. Some countries include any death that tests positive for Covid-19 as counting towards the total; other countries count only if the person died specifically from Covid-19 and/or respiratory failure.
Sweden falls into the first category, which leads me to believe its numbers of actual deaths directly caused by Covid-19 are inflated.
There is a strong fear of a second and third wave of infections hitting countries in the coming year. Many epidemiologists are concerned that Covid-19 will follow a similar pattern to the Spanish flu, whose second wave accounted for a very high death toll. Sweden will have already developed a shield against this onslaught.
Many of the models and estimates used to show mortality have been wrong so far, thankfully, showing that the hospital utilisation is lower than predicted and the overall deaths are lower as well. H1N1, a pandemic disease in 2009, was predicted to have a 5 per cent to 10 per cent rate of death upon infection; researchers, however, have reviewed all of the data and determined the actual rate is 0.02%.
“In 2013, Reuters reported that at least one in five people worldwide were infected with swine flu during the first year of the 2009-2010 H1N1 pandemic, according to an international research group at the time, but the death rate was just 0.02 per cent.”
The flu, a common illness that preys upon the elderly and those with weakened immune systems, killed 35,000 people in the United States last year alone. Globally, the flu killed 750,000 or more. This is a disease that we deal with every year and have a somewhat effective vaccine for, which because of mutations of the flu, has only a 50 per cent chance of producing antibodies for the particular strain of flu in that season.
This is not to play down the deaths caused by Covid-19, but rather to put into context that we already deal with horrible diseases every year and a loss of life that Covid-19 has yet to eclipse. We should put all of our efforts into containing the disease and developing a vaccine while we look for an effective trial of drug therapy in the short term.
In closing, the evidence shows that Covid-19 is thankfully not as bad of a disease as feared, but we must take it very seriously and shore up our defences, protecting our vulnerable population.
In doing so, we must also not cause unnecessary damage to the health and safety of our population, which includes reopening the economy as soon as possible. This also means taking bold future measures into account to rebuild the economy stronger than before. A strong economy directly correlates with the wellbeing of our citizens.
Sources: https://www.thecitizen.in/index.php/en/NewsDetail/index/4/18535/Consequences-to-Indian-Economy-Set-to-Exceed-Loss-of-Lives-by-Coronavirus https://covid19.healthdata.org https://www.worldometers.info/coronavirus/ https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368579/ https://www.washingtonpost.com/health/2020/04/06/americas-most-influential-coronavirus-model-just-revised-its-estimates-downward-not-every-model-agrees/ https://theconversation.com/coronavirus-what-causes-a-second-wave-of-disease-outbreak-and-could-we-see-this-in-australia-134125
• Gilbert “Artie” Darrell is a technology entrepreneur and a certified New York State fire instructor