QED

Dear PM, a Word to Ponder, ‘Proportion’

Dear Mr Morrison, these are the days where the quality of your leadership is being seriously tested. You are being asked to make huge, life and death decisions, with imperfect information and people madly shouting at you. My heart goes out to you.

But as so many of our businesses are presently shutting down, and countless of our fellow citizens being laid off, I humbly ask you to please re-consider what is happening to the national economy,  our civil rights, and to our next generation of Australians.

I acknowledge that you are working off the advice of public health experts. Still, you have to be very careful about group-thinking, aware that even small wrong decisions may have bad and unpredictable consequences. With this in mind I refer you to the comments of Dr John Ionnidis, a professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University in California. He has pioneered the field of meta-research and is co-director of the Meta-Research Innovation Center at Stanford University. When discussing the death rate for Covid-19, Professor Ionnidis authoritatively stated:

Reported case fatality rates, like the official 3.4 per cent rate from the World Health Organisation (“WHO”), cause horror and are meaningless. The real rate, adjusted from wide age range, could be as low as 0.05 per cent and as high as one per cent.

The 3.4 per cent mortality rate reported by the WHO only tells us about how many who died had been confirmed to have contracted Covid-19. However, nothing is said about the many others who never became sick enough to get tested. The magazine Science reports that 86 per cent of infections are never documented. This would mean that the mortality rate for Covid-19 may be 0.86 per cent but no more than one per cent, according to Professor Ionnidis. If that is the actual rate, paralysing the entire country with tremendous social and economic consequences can only be seen as utterly unreasonable.

I would like to refer also to Dr Steve Woolf, director emeritus of the Center on Society and Health at the University of Virginia. He would acknowledge your lockdown measures might contain the transmission of the virus, but can nonetheless harm public health in other and un-envisaged ways, including at the cost of many more lives. Dr Woolf is concerned about all the stress and mental illness that inevitably comes from the government shutting down of the economy, triggering the massive layoffs we are seeing. “Income is one the strongest predictors of health outcomes – and of how long we lives. The poor, who have suffered for generations the highest mortality rates, will be the most affected”, he says.

Is there another way?

For me, the best solution comes from Dr David Katz, a professor of Medical Studies in Public Health at the Yale School of Medicine, and the founding director of Yale’s Prevention Research Center. In an Op-Ed in The New York Times, Dr Katz made me wonder whether your fight against Covid-19 may end up being worse than the disease. The unique nature of Covid-19, according to Dr Katz, is that it results in only mild symptoms in 99 per cent of cases, and that it appears to pose a high risk only to the elderly, to those with significant chronic illnesses such as diabetes and heart disease, and to those in both groups.

Dr Katz suggests that governments should depart from the “total war” strategy that your government and others are employing – disrupting businesses and restricting the movement of people with no regards to the variance in the risks of contracting the infection – and start adopting instead a rather more “surgical war” approach to the problem.

That surgical approach is focused on protecting and isolating those most vulnerable and at higher risk of dying after contracting the disease – the elderly, people with chronic diseases and with low immunity systems – whereas treating the rest of us in the same way as we have always dealt with other and more familiar types of flu.

For those infected by Covid-19, they should be in isolation for an indefinite period of time and as long as the symptoms last. Those who have developed these symptoms should isolate themselves, with or without tests, which is exactly what one should do when getting the flu. Those who are not suffering any symptom and are part of the low-risk population should be allowed to resume their normal lives, including returning to work and school. Otherwise, our economy risks being seriously affected by the severity of your government action. Hundreds of thousands of people are already jobless because of the draconian measures that have hit in the hotel and entertainment industries in particular. But I needn’t tell you that.

Inevitably, job losses will lead to more homelessness, more financial pressures leading to a higher suicide rate, marriage breakdown and to a dramatic growth in crime, which always increases in times of economic crisis. I am not a medical expert, just a legal academic and former law reform commissioner in Western Australia. Above all, I am a concerned citizen who is deeply afraid for his own loved ones, for his neighbours, and for people everywhere in this country.

Although I recognise that the epidemic poses a serious public health risk, the key word here is proportion.  I am certain that you will know how to protect the most vulnerable. But you should not do so by shutting down our country for months in a desperate attempt to save everyone and everywhere from a virus whose mortality rate may be no more than one per cent – and killing in the process many more people by others means, killing our economy, and even killing our fundamental rights and freedoms.

Yours sincerely,
Augusto Zimmermann
PhD (Mon.), LLM cum laude, LLB (Hons.), DipEd, CertIntArb

 Augusto Zimmermann is Professor and Head of Law, Sheridan College, Perth, WA

23 comments
  • March

    A bit tired of seeing this flattened curve with no precise time frame on the horizontal axis. If the lockdowns continue past Easter it won’t matter as we will be living in Venezuela.

  • Guido Negraszus

    I 100% agree with the article above. It’s the decision the government should have made. It’s just common sense. I am angry, very angry. I will never ever forgive Scott Morrison for what he has done to the country. Future generations will judge him harshly. He simply is not fit to lead the country. But who are these days? Pencil pushing bureaucrats who never had a real job, never had to run a business and never have to fear for their income.

  • Wyndham Dix

    I hope otherwise, but fear Dr Zimmerman’s patent common sense is lost on every politician, bureaucrat, scientist and many normally level-headed people dealing with other causes de jour, including anthropogenic climate change.
    .
    Earlier today I commented on another thread about the knowledge faced by General Eisenhower and his commanders almost 76 years ago that many young men must perish in the invasion of beaches of Normandy on D-Day. Their spilt blood, and that of many others in fighting their way to Berlin, resulted in the defeat of Nazism, freed Europe from its evil grip and, by extension, the rest of the world.
    .
    We need the equivalent of competent generals in positions of power today who can weigh risks and lead us into courses of action that result in least harm to the body politic. Alas, I suspect we look in vain for such generals in today’s feminised society.

  • Peter Smith

    Of course, it is clear from what I have written on Quadrant that I agree with the thrust of what Professor Zimmermann is saying, but you are going to win no argument by being cavalier about a one percent fatality rate. You have to argue that it can brought down, and by a lot, by a targetted strategy. If the virus is infectious enough to infect, say, 50 percent of Australia’s population, as it might be; a one percent fatality rate leaves leaves 125,000 dead. No-one would find that acceptable.

  • ianl

    None the less, until tonight no one has actually spelled out the full proposal in “protecting the vulnerable” (a marketing euphimism). Even Augusto Zimmerman above avoids it: the demographic excluded from his discussion is of course the “elderly”, however defined but seemingly marked as 70+ by those not yet in that category, who are not infected, have no symptoms and are generally active and in good health. I have several friends and colleagues in that category.
    Augusto Zimmerman deliberately avoids discussing this demographic, although he certainly knows that he has, because locking them up in isolation for perhaps > 6 months will cause an enormous outcry.
    Why did I add the phrase “until tonight” above ? Because Bolt, who has been running a campaign to force these people into house arrest, finally said it: “Unclean, unclean”. Even if they aren’t. The ancient and medieval societies when they finally fingered a scapegoat in plague times banished the unfortunates to the badlands or perhaps put them to the stake. The modern way is to just lock ’em up in isolation.
    As an irony, if the notion of incarcerating 70+ people in isolated house arrest were in force in the US, *ALL* the current presidential candidates would be swept up. Just imagine …

  • Alice Thermopolis

    The alarmist horse, alas, has bolted and the outcome will be just as pernicious as in the climate change case.
    Latest US jobless numbers over three million. President Trump may well fill the churches on Easter Sunday, but it won’t be with folk celebrating an economic resurrection.

  • Doubting Thomas

    Truly, while I’m not qualified to dispute the various arguments about what ought to be done, I’m amazed at the way Morrison is being personally vilified in this group of supposed mature adults for his alleged lack of “leadership”, and being threatened never to be forgiven for what he has done to the country as if he, and he alone, could have done anything differently. Please, get a grip.
    He’s not a dictator. He has no personal power to act unilaterally even if there were not a federation of six states and two self-governing territories to deal with. He’s not in unicameral New Zealand. Not only does he have a totally irresponsible Opposition hen-pecking away looking to bring him down by any means fair or foul, just as President Trump has to deal with even worse Democratic sabotage.
    To his credit, he has created an unprecedented “national Cabinet” to negotiate a consensus with the States and Territories as to which actions to take, based on the best available medical and financial advice on an equally unprecedented and fast-moving medical and financial crisis. Politics is the art of the possible, and he is doing what he can, being let down by administrative failures caused by human error that bedevil every bureaucratic system in crises.
    If there is one thing that might have avoided a lot of confusion it is that a single spokesperson or a single small dedicated and coordinated public relations group should have been appointed as the only source of official information for news organisations. But keeping the State Premiers and Territory Chief Ministers away from the TV cameras and microphones, or even just on message, is far too much to expect. Throw in an irresponsible Opposition, the inevitably hostile ABC mischief-makers hell-bent on bringing down Morrison, their hated enemy who proved them to be the incompetent fools that they are, and chaos was always going to be the result.
    Just as the bushfires were not Morrison’s fault and far beyond his power or capacity to control, none of this is his fault either. People should just grow up.

  • Guido Negraszus

    I voted for Morrison and I supported him during the ridiculous bushfire attacks. He is not a great PM in my opinion but he is the best we got. However, on the virus response, he failed. 9 days before he shut down half the country he said he was going to his footy game. No worries. What changed in 9 days that would have warranted such a gigantic decision? We know about this virus for over 3 months now. The facts are the facts. The overwhelming majority of people (95 – 99%) will NOT die. This alone is sufficient enough for me NOT to shut down business. The correct measures are these: close national borders. Nobody in, nobody out. Isolate and protect the risk group (this should have happened early February). Get every citizen tested. Positive tested people have to go into isolation. It’s that simple. The economy can go on except for the travel industry.

    I once owned and operated a Cafe. I can only imagine what these people go through. In small business, you always worry. You have great days and bad days but no one ever expected your own government to put you out of business.

    @Doubting Thomas
    I am aware of the political landscape, Federal vs states, etc. It’s beyond the point. Morrison made the announcement. He put his name to the decision. Therefore I have every right to criticise him.

  • Citizen Kane

    ianl, those over 70 don’t have to contend with losing their livelihood and capacity to provide for their families now do they!

  • lloveday

    Citizen Kane,
    .
    I no longer read ianl’s posts, so don’t know what you are taking issue with, but I do take issue with your claim – this septuagenarian has to contend with losing his “livelihood and capacity to provide for” himself and his wife and is struggling to envisage a legal pathway if the s hits the f.

  • Citizen Kane

    lloveday,. Point taken. However as a general premise those who are 70+ are not raising young children or still in the full time work force but I accept that some small percentage are. When you are considering a population wide problem then population wide statistics and the generalisations they provide do matter despite some exceptions on the edge of the bell curve.

  • pgang

    Here are some numbers based on the information out there, this being, I suspect, a worst case scenario for Australia over the course of the infection.

    Australian population: 25,000,000
    Total infection rate guess: 60%
    Total number to be infected: 15,000,000
    Ratio of the total infected being confirmed by testing: 14% (this is a mathematical, not an empirical estimate, and is therefore meaningless, because we can’t know what we don’t know. The actual ratio could be much lower).
    Number of confirmed/tested with virus: 2,100,000
    Current Australian mortality rate from confirmed cases: 0.46% (relatively low internationally, probably due to quality health care, a healthier population, and more accurate reporting. Might increase as the weather gets cooler, who knows).
    Estimated total mortality: 9,729 (remembering that this will be over several months)
    Mortality as a ratio of total population: 0.04% (4 people in ten thousand or 1 person in 2,500)

  • Rob Brighton

    Whenever one feels the need to be critical of Morrison just recall it could well have been Shorten lisping his way thru the announcements.
    Morrison got the gig by not being Shorten, he still isn’t Shorten and for that much at least I am truly thankful.

  • lloveday

    Citizen Kane,

    Your general premise is correct, of course; in my previous post I was going to suggest you should have written “most of those …”, or even “the vast majority of those..”, but decided against telling someone else what they should do.

  • Colin Clarke

    Pgang, some additional numbers. Around 1200 people die each year from Influenza and around 440 people die EACH DAY from a variety of causes

  • pgang

    Colin, yep. We are now living on the extreme edge of irrationality. We should also keep in mind the crossover in statistics. Many of my 9,729 would die from other causes this year anyway (including, ironically, pneumonia).
    I blame the sheer folly of our humanistic godlessness – an aimless society bereft of reason or meaning. This is the human mind ‘in control’ of human destiny. It never ends well.

  • Geoffrey Luck

    The doomsayers of Imperial College have much to answer for, but they have now been effectively demolished by Henry Ergas today. What is the difference between their computer modelling and that of the climate change campaigners? And how did we come to allow panels of doctors to shut down the whole economy? The dreaded “consensus” again!

  • lloveday

    Not quite “shut down the whole economy” GL; I suggest the doctors and the health system as a whole will likely do well.

  • Homer Sapien

    Well may we say:” It’s the immune system stupid.”

  • pgang

    As regards Sco-Mo, he has backed himself into a corner. But now it’s time for him to start speaking out and reassuring the public that it’s not the end of the world. If necessary he should speak against the state premiers. He should at the very least be telling us to get back onto the sporting fields and churches and into the parks for fresh air and relaxation. He should be encouraging the pro sporting codes to get back to work. You never know, the media might even follow.

  • Doubting Thomas

    Pgang, I’m not sure Morrison is anywhere near a corner, unless it is one carefully constructed by hostile individuals in politics or the media. If I’m wrong, someone with relevant legal qualifications will correct me, but as I said earlier, Morrison has no power under the Constitution to enforce his will on either his own Government, or the Federal Parliament let alone on the States. The office of Prime Minister does not even exist constitutionally. He only has the power to try to persuade and, given his political reality of a hostile media, and opportunistic and demonstrably cynical Opposition, he has a Sisyphean task there.

    I’m quite sure that he and the State Government and Territory leaders have been around these buoys many times since the creation of the National Cabinet, taking in as much professional expert advice as they can assemble. He will do what has been collectively decided should be done, and our second-guessing those decisions is beyond otiose.

  • talldad

    I notice that all the discussion skates lightly over an untested assumption or, rather, a generalisation, which is common, to wit: that “the economy” is a thing somewhat akin to a massive machine, which can be revved up or slowed down by external actions of federal government agencies such as the Treasury (via the Budget) or the Reserve Bank (via interest rates).

    This stems from common political thinking made explicit by Paul Keating who infamously spoke about getting his hands on “the economic levers.”

    Dr Zimmerman and others, by contrast, refer to the many individuals who are severely impacted by the shutdown through loss of work, shortages in stores and the very inability to go about their accustomed daily routines.

    However, I believe we need to explicitly challenge this idea of the economy as a controllable entity, for this distortion of the meaning leads to pseudo-medical prescriptions for curing “its” ills when in fact no such thing is possible. What becomes possible is what we have seen: increased centralism and bureaucratic control over the lives of millions of Australians.

    The present fragile state has demonstrated. Australia (and the G20 nations collectively) have not recovered from the drastic and poisonous prescriptions trying to cure ‘the economy’ of the “global financial crisis” of 2007-08. What has happened is that house prices have multiplied, the stock market is still broadly up and our superannuation balances have been maintained. But this is only by means of Monopoly(R) money calculations.

    Currently, the RBA is obsessed with the “problem” of low inflation (when in fact asset inflation has run riot) and is trying to create more Monopoly(R) money by forcing interest rates to almost NIL. The Governor and his staff are even thinking of the crazy concept of negative interest rates. The theory is that lower interest rates will encourage better investment (say in building houses) so that homebuyers can enjoy lower prices and thus more affordable homes. But the low interest rates make loans more affordable and consequently, buyers are able to push up their buying price as a result.

    The prescription is the same poison as was used before and represents a condition for which the medical term is “iatrogenic,” where the disease is caused by the treatment. Meanwhile, the dollar exchange rate languishes and the RBA fails in both of its primary goals: maintaining a stable price level and maintaining a sound currency.

    The overall effect is that we are much closer to being a Socialist state than we could ever have imagined.

  • joemiller252

    Guido Negraszus, It’s never “that simple”.

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