Covid-19 – are we supposed to get sick?

Like many Melbournians, I was immensely relieved to hear that the Grand Prix had been cancelled due to Covid-19, but I was puzzled, and angered, by the Federal government’s continuing mixed messages about the virus. On the one hand Scott Morrison says the authorities will put social distancing interventions in place, but not until Monday [March 16, 2020]. And they won’t apply to schools, universities and public transport.

Why give the virus a whole weekend to turn up at the ‘footy’ and in churches and concert halls and theatres etc etc etc.

If these interventions are meant to stop the rapid spread of the virus, why wait?

Why encourage people to ‘go to the footy?’ And why not close schools, universities and public transport?

Is the delay all about the money?

Despite my cynical anger, there was something about all of this that simply did not add up, especially as the Premiers of all states and territories appear to be in agreement with #ScottyFromMarketing. As my state, Victoria, has a Labor government, I would have expected the Premier, Daniel Andrews, to be more caring of people’s lives than old Scomo.

It was at this point that I remembered an episode of The Drum I had watched just a few days ago [the 12th of March, 2020]. On this episode, the panel of The Drum included a guest, Professor James McCaw, a mathematical biologist and Infectious Diseases Epidemiologist from Melbourne University. Apparently, Prof. McCaw and his colleagues have been modelling the spread of the Covid-19 virus and have been advising the Federal government.

Keep that point in mind, ‘advising the Federal government’.

During the course of the discussion, the panel talked about interventions such as forced social distancing – e.g. cancelling the Grand Prix – as a way to avoid getting the virus and jet propelling it through the community.

To explain the reasoning behind social distancing, they displayed this graph:

Those of you who have been following the Covid-19 virus online will be familiar with graphs that look very similar. The sharp peak is what happens if the virus is allowed to spread without interventions. The flattened, ‘fat’ curve is what happens when you slow the spread of the virus via interventions. The important thing to note from this graph is that a slow spread allows hospitals to cope with the influx of desperately ill people infected with Covid-19.

So far so good. But if interventions slow the virus, and slowing the virus is good, why would mathematical biologists and infectious disease epidemiologists have to model anything? Isn’t it obvious?

Going back to Professor McCaw, I think I’ve found the answer, or at least understood it. This is what the Professor had to say about the virus and interventions:

“The really important thing to be aware of, though, is by avoiding that transmission [i.e. of the virus] all of the people who may otherwise have gotten ill, they are all still susceptible. So as society returns to normal…the population is still equally susceptible, and this is where the mathematicians have a role to play.”

ABC, The Drum, March 12, 2020, at minute 19:55

You can find that episode of The Drum on iView
If the link doesn’t take you to the right episode, look for the episode aired on March the 12th, 2020.

So, what exactly does all that mean?

I am no expert so my reading of Professor McCaw’s comment may be completely wrong, but this is how I finally understood it:

1. the whole world is going to get this virus sooner or later, so…
2. if Australia stops the virus from spreading, we’ll simply postpone the deaths until a later,
3. but if a lot of the most healthy people get the virus, they are likely to get only a mild version that does not need hospitalisation.
4. this will leave the hospitals free to deal with those who do get very sick,
5. so it makes logical sense to allow this younger, healthy group to get sick, recover and become immune before interventions are put in place,
6. then, once this first pass of the virus is over, and a vaccine is available, the uninfected members of the population can be protected as well.

From a theoretical perspective, this ‘strategy’, if that’s what it is, would stagger the victims of the virus, making the epidemic manageable. I guess it would also have less of an impact on the economy.

But even in theory, this strategy can only work if the authorities actually know how many cases of Covid-19 there are in the community so they know when to apply the breaks via more draconian interventions. It also assumes that everything else needed to apply the breaks is already in place, ready to go.

Given the lack of widespread testing, I don’t think the authorities do know. I think they are guessing on the basis of how quickly the virus has spread in other countries and extrapolating that to Australia.

More worrying still is the lack of clear, public messaging. People are getting their information from social media, and they’re scared and confused. Getting them to go along with drastic social interventions ‘when the time is right’ can only succeed if everyone understands and agrees with those interventions.

Australia is not a ‘command and control’ country. How are the authorities going to enforce these interventions? Using the police? The armed forces?

People working in the GIG economy, the underemployed and those who think they are immortal will continue doing what they think they need to do for themselves.

This is human nature. Expecting people to behave like robots may work on paper; it will not work in the real world. In the real world, individuals who ignore the interventions could easily infect far more people than the ‘strategy’ anticipates. This will skew the timing and effectiveness of the interventions so when they finally do come, they may not work at all. Or they may not work well enough, allowing the curve of the graph to continue shooting up like a rocket.

But practical considerations aside, nowhere in this strategy is there a recognition of all those who will become collateral damage, the ones who will catch the virus, get sick and die.

According to the statistics, children under the age of 10 don’t die of this virus, but those over the age of 10 do start to die. It’s a small percentage, but it exists:

Taken from a video by Dr John Campbell

So who are these children and teens likely to be?

Right from the start, we’ve been told that people with pre-existing conditions will be most vulnerable to the virus. Well guess what, children and teens have pre-existing conditions too. They have asthma, diabetes, multiple sclerosis, cystic fibrosis, Crohns, ulcerative colitis, leukemia, cancers of all sorts… the list goes on and on and on.

What part of the strategy protects these vulnerable young people when they go to school or university or travel by public transport?

And then there are the older age groups. As we age, almost all of us develop some type of chronic disease. I’m pretty fit and healthy, but I’ve had cancer. If the virus gets out of control and the hospitals can’t cope, will I be triaged to die because I am less likely to survive than someone younger?

That kind of soul destroying triage is already happening in Italy.

And what of remote Indigenous communities? They are already behind the eight ball when it comes to health. How are they going to survive when they are often hundreds of miles from the nearest doctor let alone hospital?

We are people, not numbers, yet the silence about us has been deafening. Self isolation is fine, but where are the systems that will make it effective?

I went to Coles [supermarket] this morning. I arrived at 7am, thinking I’d be almost alone in the store. Thank god I was wearing my mask because there was a conga line waiting outside the entrance. What were they all waiting for? Toilet paper.

Coles is now doling the toilet paper out, one packet at a time, but to get a packet you have to stand in a queue next to people who may already be infected but not showing any symptoms.

Toilet paper aside, whole families packed the aisles of the store, stocking up, and every single cash register was open and working at a feverish pace. Instead of being in and out in ten minutes, it took me an hour and a half to get my shopping and leave. The whole time I stood there, flanked by overflowing shopping trolleys, I was acutely aware of the people around me. I didn’t hear any sneezing, but someone did cough behind me. Just a little cough… Probably just clearing their throat… 😦

Professor McCaw’s models may work on paper, but as they are currently being implemented, they are ensuring that the most vulnerable in our society pay the price if things go horribly wrong.

Meeks