COVID19 Thoughts

A month and a bit ago, I wrote up my take on covid19 on facebook. At the time, Australia was at 1300 cases, numbers were doubling twice a week, and I’d been pessimistically assuming two weeks between infection and detection.That led me to pessimistically estimate that we’d be at 20,000 cases by Easter, and we’d be close to capacity for our hospital system, but I was pretty confident that the measures we’d put in place by then would be starting to have an effect and we’d avoid having an utter catastrophe. I’d predicted by late April we’d be “arguing about how to get out of the shutdown” and have a gradual reopening plan by May — that looks like it’s come about now, with the PM and state premiers coordinating on how that should work, and the Queensland one, at least, beginning next week.

The other “COVID SAFE checks” also seem good to me: widespread testing, effective tracking and tracing of outbreaks, and having each stage conditional on the outbreaks being contained. We’re in a much better state to do those things than we were two months ago, There’s also (as I understand it) been a lot of progress on increasing the capacity of hospitals to respond to outbreaks, so as far as “flattening the curve” so that we can go back to living a normal-ish life, without exponential growth causing a disaster, I think we’re doing great.

It’s a more cautious reopening than I would have expected though: the four week minimum time between stages is perhaps twice as long as the theoretical minimum, but even that was twice as long as what I’d have expected the minimum time people would tolerate at a political level. It’s not clear to me how bad the economics is — I think we’ll get the first real economic stats next week, but the numbers I’m seeing so far (7% of payroll employees out of work, eg) aren’t as bad as I was expecting, while the forecasts (which are expecting a sluggish recovery) are worse. Maybe that just means we’ll be able maintain patience in the short term, but should still expect things to be painful while the world tries to recover its supply chains over the next year or two?

The thing that has perhaps most impressed me about Australia’s response, especially compared to the US, has been the lack of politicisation. I don’t think you can have an effective emergency response when the people in charge of that response are pointing fingers at each other, and wasting time with gotcha questions to make each other look stupid.  The National Cabinet approach, the willingness of the both the federal government to bend to some of the states’ concerns (particularly Victoria’s push to close schools prior to Easter), the willingness of states to coordinate under federal leadership and be aligned where possible, and above all mostly managing to work together rather than the usual policy of exaggerating disagreements has been great. Unlike Soraya Lennie I think that’s a massive achievement by the PM and also the opposition leader. Morrison cancelling his trip to the footy was a good move, and Dan Tehan’s walkback of his criticism of Daniel Andrews was too — but forgiving both those mistakes rather than the usual approach of continually bring them back up is also important.

Where I got things wrong, was that it appears the virus is easier to limit than I’d expected. While I thought we’d be screwed for weeks yet, instead we started turning the corner just five days after my post, which itself was ten days after the government had started issuing bans on large gatherings and requiring overseas travelers to start self-isolating. We’ve also apparently had a much lower percentage of cases end up in the ICU — I think 1.75% of cases ended up in ICU in NSW versus figures like 5% from China, or 2.6% from Italy? We’re currently at 97 deaths out of 6913 confirmed cases, which is 1.4%, so double the 0.7% reported from non-Wuhan China.

That fatality rate figure still makes it hard for me to find “herd immunity” strategies plausible — you probably need about 60% or more of the population to have been infected to get herd immunity, but 0.7% of 60% of Australia’s population is 103,000 deaths; compared to 3500 deaths per year from the regular flu in Australia, that seems unacceptably many to me — and perhaps you have to double that to match our observed 1.4% fatality rate anyway. And conversely, it makes it seem pretty unlikely that there’s already herd immunity anywhere — if there haven’t been that many unexplained deaths, it’s pretty unlikely that covid19 swept through somewhere prior to this, granting everyone left alive herd immunity.

Nevertheless, that seems to be the strategy Sweden is taking; currently they have over 3000 deaths, so if the 0.7% ratio holds that’s 430,000 cases, fewer if the ratio’s more like Australia’s 1.4%. However they are currently only reporting 24,000 cases — which adds up to to an 12.5% fatality rate instead. Things seemed to have stabilised for them at about 60-100 deaths per day; so to get from 430k cases to 6M to achieve herd immunity, that’s presumably going to result in a further 39,000 deaths, which at 80 deaths per day will take another 16 months. And Sweden’s reportedly doing some lockdown measures anyway, so even if that number of deaths is acceptable, it’s not clear to me that it’s an argument for “life as normal” rather than “we can deal with this via modest restrictions over quite a long time”. And additionally, I think Sweden has doubled their normal ICU capacity, and may have needed that extra capacity already.

Still, that Sweden’s death rate has stabilised rather than continuing to double also seems to be evidence that the virus does end up limited almost no matter what — though my guess is that this is more because once it becomes obvious to everyone, people start voluntarily limiting their exposure without needing government to mandate it. So perhaps that means the best thing governments can do here is force people to make good choices early, when they have access to good advice that hasn’t percolated through to the rest of the public, then ease off once that advice has spread. Having leaders do the opposite, and spread bad advice early — Florence’s “hug a chinese” day, New York’s “keep going to restaurants” or Boris Johnson “shaking hands with everybody” — might therefore have been spectacularly harmful.

The US numbers don’t make sense to me at present: the CDC reports 1.2 million cases and 73 thousand deaths, but that’s a 6% fatality rate. If the deaths figure is accurate, but the real fatality rate is more like Australia’s 1.4% that would mean there’s really 5.2 million cases in the country (which is still only 1.6% of the population, miles away from herd immunity); while if the cases figure a fatality rate like Australia’s would imply only 17 thousand of the deaths were due to covid19, and 56 thousand were misreported. There’s certainly been reports of deaths being wrongly reported as due to covid19 in the US, but there’s also plenty of indications there hasn’t been enough testing, which would let to the reported case numbers being way too low.

I don’t really have a further prediction at this point; I think there’ll be people worried the staged reopening is both too slow (people need to get back to work) and too fast (there’ll be actual outbreaks that could perhaps have been prevented if we stay in lockdown), and maybe the timeline will get tweaked as a result, but there’s already some flexibility built in via the “COVID SAFE Plan” that will presumably allow things to open up further after some sort of government/health review, and the ability to defer stages if there’s an undue risk. As far as the economy goes, I expect we’ll see a quicker than expected recovery mostly: tourism and exporters will find it difficult but scrape by, I think — lack of international competition will probably mean some tourist places end up with a blow out year; industries relying on immigration such as higher ed and real estate will still be in trouble for a while; but I can’t put a figure on where that will all end up. The budget will be a mess, and worse for the fact that we didn’t get back into surplus between dealing with the last crisis and this one coming along. I expect we’ll be stuck with having to take effort to deal with avoiding covid19 until it either mutates into something more like a normal flu, dies out everywhere, or we get a vaccine, which seems likely to be years away.

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