QED

Please, Let’s All Take a Deep Breath

It would appear the principal component of the coronavirus, now known as Covid-19n, that differentiates it from others of the same family responsible for mild upper-respiratory tract infections is the ‘n-for-novel’ component, which has seemingly never before been encountered by the human gene pool. It is the immune system’s lack of familiarity that significantly boosts covid-19’s mortality factor, especially amongst those with cardio-pulmonary deficits due to chronic disease. This, of course, goes hand in glove with the cohort most at risk: those with a median age of 70. Smokers, unsurprisingly, also appear to be disproportionately represented in mortality statistics out of Wuhan and elsewhere. In light of this, and no matter how ‘clinical’ or coldly rational it may sound, professionals in the relevant fields should be allowed to discuss and appraise the best way forward without fear or favour. If the response to this pandemic becomes overwhelmingly politicised, then the wisest path to navigate the challenge may well be missed or overlooked.

So it was that we had the considered contribution from UK’s chief scientific advisor, Sir Patrick Valance, who posits that covid-19’s lethality will not diminish until such time as there is population-wide herd immunity, which he estimated to be around 60 per cent of the UK population. It would seem such a consideration has taken the broadest of all views of the population-wide implications of this novel virus. His assessment — informed, grounded and sobering — is an affront to the rival camp’s ‘fight it in the trenches’ containment strategies. Not that either strategy must necessarily be at odds with the other, but trying to create an entrenched front of ‘conflict’ with the spread of this disease may prove ultimately futile against a highly transmissible and environmentally stable pathogen such as covid-19. The fact that the end goal of containment is to flatten the bell curve of incidence in the community while providing some capacity to manage the pandemic without overloading and overwhelming concedes that transmission will be widespread indeed.

There has been some emerging and encouraging evidence as to the at least temporary success of very stringent, highly policed containment strategies from the original epicentre of the epidemic, in Hubei province, and South Korea, where transmission rates and mortalities have fallen sharply and plateaued respectively. However, this does not mean transmission rates would not or could not rebound when constraints are relaxed and when climatic considerations, generally increased cold, may yet again exacerbate prevalence, as it so often does in similar seasonal influenza morbidity. That may not occur again in the northern hemisphere until later this year. 

Until such time as an effective vaccine is created or significant swathes of the population have been exposed, then the deadly novel component will persist — and persist in the pool of human vectors it most certainly will, since so many of its infected hosts remain either asymptomatic or only very mildly ill. This seems especially true, thankfully, for the young, for whom so many viral exposures are novel. Indeed, the same general pattern, although both morbidity and mortality rates may differ somewhat, occurs each time a new and novel influenza virus strikes such as H1N1, which is now, incidentally, ubiquitous globally. It is also the reason each years’ seasonal flu vaccine must seek to keep up with the most virulent new strain. The suggestion that no lessons can be taken from influenza viruses such as the “Bird Flu” in relation to how this particular coronavirus will unfold is a nonsense. Both are predominantly upper respiratory tract infections whose lethality resides in secondary sequalae of pneumonia (generally bacterial) and acute organ failure due to an overwhelming immune system cascade. Both spread rapidly, by exactly the same mode of transmission. Both are zoonotic.

Currently, worldwide testing remains relatively low in both outright numbers and as a percentage of potentially affected regional populations. Even China had only conducted 320 000 tests across the country as of late February and the city of Wuhan alone has a population of over 10 million. Worryingly, there now seems to be a paucity of updated figures on a number of important parameters emanating out of China. Without widespread testing, containing asymptomatic or very mildly symptomatic carriers is as remote as ever.

Based on some initial reactions to Sir Patrick Valances comments, it’s as though he were an appeaser to the Third Reich; alternatively, perhaps his appraisal, again based on solid knowledge of the natural history of such coronaviruses, seems counterintuitive to the full frontal embattlement brigade and is seen as a capitulation. More likely, though, is that Valance’s voice is one of stoic pragmatism.

So, is the key to managing the unstoppably transmissible covid-19 virus a balance between slowing it for the pragmatic reason of maintaining a sustainable healthcare system in a protracted crisis and seeking to take the novel out of this particular coronavirus? It is difficult for anyone to be certain, as there is so much that remains unclear and/or unknown about the overall epidemiology, although we can be certain that we remain in an early phase of high virulence. Case Fatality Rates (CFR’s) have varied markedly from less than 1 per cent to the worst-case scenario currently unfolding in Italy which approaches 7 per cent. CFR’s, however, should not conflated with mortality rates, as CFR’s relate only to known and documented cases and cannot account for the severalfold increase in unaccounted cases and asymptomatic carriers. Therefore, true mortality rates are highly speculative and likely closer to the 1 per cent mark on the basis of a global average. This is lower than the mortality rates for Covid-19’s cousins, MERS and SARS, which had mortality rates of 34 per cent and 10 per cent respectively. Again, these viruses have not gone away, contrary to popular opinion; they are simply not novel any longer and have been diminished due to widespread exposure.

As of writing, the CFR for Australia was just 1.3 per cent (5 deaths) and with 375 confirmed cases representing a significant enough case load to start to gain some insight into the lethality in the Australian context. Indeed, very few Australian cases have required intensive care intervention. What is better defined, is the demographic of the high-risk cohort as stated previously and it doesn’t really hold any surprises. The likes of Peter Dutton, Tom Hanks & Co., werere not hospitalised for days on end due to the need for critical medical intervention, rather as a means of isolation and observation.

Given the seemingly disparate objectives of a containment strategy and that of building herd immunity to a predominantly mild illness, how might the two concepts be merged to both protect the excessively vulnerable and simultaneously disarm the lethal ‘novel’ component of COVID-19? Perhaps social-restriction measures should be targeted at the high-risk cohort and high-risk activities, while others from low-risk cohorts are able to keep the wheels of a functioning society turning. Any logic that says such a measure is too unfairly restrictive on certain cohorts ought first answer how restricting everyone equally, even if at low risk of mortality, is any better? To do so, as we seem to be currently doing, runs the very real risk of crippling a modern interconnected society to such an extent that the impact on supply chains, meaning access to goods and services, will be profound, ultimately knee-capping the resourcing of the healthcare sector itself, as is already happening with supplies of covid-19 test kits. Such an outcome would be perversely self-defeating. If lockdown becomes protracted the real risk of flow-on impacts on health, welfare and economic impacts will be reminiscent of the Great Depression with social dislocation and increasing social disadvantage likely leading to a substantial spike in crime and general lawlessness, perhaps even revolt.

People can go without essentials for only so long. While such a scenario may seem fanciful at present, the descent into such unrest amongst the masses throughout the history of civilisation is almost always rapid in its final degeneration.

This is why we must not let the hairs stand up on the backs of our primal selves’ necks when first exposed to the qualified contributions of those such as Sir Patrick Valance, and instead take a deep breath to try and appreciate the very considered pragmatic appraisal it brings to the table and how we might best achieve the balance between containment to protect the especially vulnerable and engendering a deactivation of the lethal ‘novel’ component with the inevitable herd immunity that will ensue either sooner or later. The longer that takes, the deeper the potential impact on every level.  

19 comments
  • ianl

    > ” … targeted at the high-risk cohort …”
    That is, enforce lockdown for months on people 70 and over. Even if they’re healthy and not sick …
    At least this essay is honest – such an action is *not* to “protect” this at-risk cohort, but to push and keep them out sight, to not bother, while the remainder get on with living.
    In short, deliberately let older people die so that others can keep their jobs. Honesty at last. Survival of the fittest … evolution in action. As noted before, “morals” not included.

  • Peter Smith

    This comment of your ianl is similar to a response of yours to my comment on a John O’Sullivan piece. The Weatherall piece is canvassing the two options we have. The one in favour means shutting economies down. This will have very deleterious effects on everyone if it were to last very much longer. The Valance option is to protect the vulnerable while everyone else keeps the wheels of commerce going. That can surely be done effectively without coercing the old to remain isolated. Finally, unless this virus disappears or dies down soon the Valance option will be the only one that is tenable. Otherwise we will face an economic depression.

  • pgang

    I read a report today that an estimated 86 per cent of those of us going about our daily business in public could be carrying the virus. That wouldn’t surprise me. Everyone catches a cold and I’ve already had one in recent weeks. Based on the current statistics that works out to a mortality rate of about one in one hundred thousand.

  • Peter Smith

    As of two hours ago the number of deaths from the virus in Italy – the worst hit country outside of China – had reached 2,500 since the epidemic began there some six weeks ago. I don’t want to minimise this but each week in Italy 12,300 people die of other causes. I would think that most of those who have died of the virus have been old and/or sickly. Best to concentrate on protecting such people rather than panicking and closing down the country.

  • PT

    IanL, I have to say that I agree with Peter Smith. Unless you want a full lockdown, special protection of those most at risk should be high priority. Remember the loss of jobs and crashing share markets affect the elderly very badly – decimating their incomes for instance. The idea of “herd immunity” is similar to the critical rate of immunisation. If you reduce the proportion of people open to infection below a critical threshold, then the propagation of the disease severely retarded. That’s why even those unvaccinated benefit from others being vaccinated!

    That’s the theory anyway. Now whether this strategy will work in practice is something I’m doubtful of. There is apparently a 15% reinfection rate (this could pose problems for a vaccine too). But the concept is logical and is a real attempt to protect those most at risk in the absence of an effective vaccine.

  • March

    They should be crop dusting the country with the virus. Imagine the economic boost it will bring with all those needy dependents gone. Housing crisis solved in a few months! Trickle down effects of all that inheritance would last decades.

  • pgang

    I am predicting about 250 deaths in Australia.

  • rabel111

    The containment strategy espoused by some will fail. At best it is a strategy of delay that attempts to distribute new cases over a broader time frame.
    This is a very contagious virus and we are no more likely to contain the spread of Cov-9 than the common cold and flu. The passionate doom sayers pushing this tripe are just another generation of King Canutes, arrogantly convinced that their lightning bolts of science and intellectual dizziness can turn back the tide, magically stop global warming or stop a virus spreading through densely populated communities.
    Herd immunity is not a strategy, but an acknowledgement that the only way this virus will become less lethal is when we have a population with some degree of prior exposure and augmented immune response. That’s facing facts rather than feeding the funding frenzy of eager academics.

  • Peter OBrien

    Jack, this is a very balanced and timely article and I thank you for it. As one of the ‘at risk’ cohort, although at the lower end I hasten to smugly add, what chills me most about the crisis is what it is doing to our society and our economy. I am a natural optimist, though, and believe we will get this virus under control quicker than many ‘experts’ are forecasting. The herd immunity option offers the chance to minimize the economic damage. Those in the ‘at risk’ demographic have the option to self-isolate to whatever extent they feel is necessary or tolerable. The onus is on them to protect themselves. Measures, such as reserved times for shopping, medical appointments etc, can be implemented to help them. More stringent restrictions could be applied if it becomes apparent that self isolation is not working.
    The upside to this crisis, albeit cold comfort at this time, as Greg Sheridan points out in today’s Oz, is that it will lead to a re-emergence of nationalism.

  • Peter OBrien

    Further to my last, and in support of my optimism, a lot of information is emerging about the (putative) effectiveness of Chloroquine in both treating and, to some extent, preventing Covid 19. I remember taking Chloroquine in Malaysia in the early 60s. Amazing it’s still available in any quantity. Here’s hoping it’s not just hype.

  • ianl

    > ” … That can surely be done effectively without coercing the old to remain isolated.” [Peter Smith, above]

    So detail how this is to be done, Peter. My response to your rhetoric is always the same – please supply hard, practical, useful detail rather than waffle for someone else to do the hard work on. Your response is always the same as well – either silence or more rhetoric.

  • ianl

    I had to leave off my previous comment with a sudden, unexpected change in a deadline.
    My point is that over 60+’s (yes, their survival rate is almost as bad as 70+’s, so they need to be included in the risk demographic) can semi-isolate, or even mostly isolate, themselves to avoid infection as best they may. With that, I have no issue.
    But sentencing 70+ to isolated house arrest for an indeterminate period and pretending this will avoid an economic depression is opportunistically obnoxious. If no one takes any precautions, there may develop intolerable pressure on the ICU capacity, forcing ugly triage decisions – but of itself this does not force economic depression. Fear of infection, and efforts by everyone to avoid it, may well do. Pushing a demographic around based only on age does not save an economy – nor is “herd” immunity guaranteed to do this within a tight time frame. (There seems to be some evidence that corona damages other organ tissues besides the lungs, in all age groups, even after apparent recovery).
    There is emerging empirical evidence that quinine and associated drugs (eg. those anti-virals against HIV) have some efficacy. I invite net searches to explore this. Vaccines may take up to 12 months, perhaps longer.
    Forcing a cohort into isolated misery based purely on age aids none of this. It may make the superstitious feel safer, though.

  • DG

    PT the collapse of the share market doesn’t ‘decimate’ one’s income (destroy every tenth dollar), it devastates it!

  • lloveday

    DECIMATE meaning from 3 dictionaries
    ********
    Cambridge
    decimate verb
    to kill a large number of something, or to reduce something severely: Populations of endangered animals have been decimated.
    *********
    Merriam-Webster:
    decimate transitive verb

    3a : to reduce drastically especially in number: cholera decimated the population; Kamieniecki’s return comes at a crucial time for a pitching staff that has been decimated by injuries.
    b : to cause great destruction or harm to: firebombs decimated the city; an industry decimated by recession
    *********
    Oxford:
    decimate transitive verb
    1 Kill, destroy, or remove a large percentage or part of.
    ‘the project would decimate the fragile wetland wilderness’
    ‘the American chestnut, a species decimated by blight’

    1.1 Drastically reduce the strength or effectiveness of (something)
    ‘plant viruses that can decimate yields’

  • Doubting Thomas

    Like Peter, my wife and I are well familiar with chloroquine from our time in PNG and, later, Malaysia. We are both quite familiar with attacks of malaria, in my wife’s case almost fatally. We are still not entirely sure which was worse, the “cure” or the disease.

  • Alice Thermopolis

    “We are still not entirely sure which was worse, the “cure” or the disease.”

    I listened to the PM’s and RBA governor’s “Bridge over Troubled Waters” speeches this afternoon.

    Almost evangelical. They presumably worked together late into the previous night to come up with the “building the bridge to the future” meme..

    Talk about trying to turn a sow’s ear into a silk purse and failing mightily.

    “Cash rate to remain at this level – 0.25% – for a number of years.” (Lowe)

    As for the” timing/strength of recovery, that will depend on “how successful we are in building that bridge.” (Lowe)

    PM warned naughty folk about stockpiling again. Hardly surprising when you spook a nervous nation by telling it the mayhem your government has created will go on “for at least six months”?

    Will the “cure” – closing down economic activity and disrupting/wrecking so many lives and businesses – turn out to be worse than the disease?

    Financial markets think so, and this is only the beginning.

  • Colin Clarke

    To put this Corona Virus in perspective according to the Australian Bureau of Statistics in in the last several years there were around 1,200 deaths annually from the Influenza virus.
    Also every day in Australia around 440 people die from a variety of causes.
    So last year if we had given the then prevalent influenza virus a name would we be carrying on the way we are destroying our economy and peoples livelihoods?

  • Farnswort

    The economic impacts are going to be profound either way. However, I would imagine that an uncontrolled outbreak that totally overwhelms health services and causes a lot of deaths would be more disruptive economically than a controlled shut down which can be relaxed when conditions allow.

    I encourage everyone to read the recently-released Imperial College London report “Impact Of Non-Pharmaceutical Interventions (NPIs) To Reduce COVID- 19 Mortality And Healthcare Demand.” More information here: https://www.imperial.ac.uk/news/196234/covid19-imperial-researchers-model-likely-impact/

    The report shows that suppression measures will ultimately save many lives and reduce the pressure on healthcare systems. The report is credited with shifting the British government’s response from “mitigation” (which appears to still be the Morrison government’s approach) to more aggressive suppression.

  • Farnswort

    Geoffrey Blainey in The Australian this weekend:

    “In retrospect, the warning that should have been etched in our mind was the influenza disaster of 1918-19. It shook and shocked Australia­. According to professor John Mathews, an Australian expert on pandemics, this worldwide event “proved to have some gene segments like those from pig and bird influenza, which explains why it was new to humans in 1918”. Wartime conditions helped this so-called Spanish flu to spread in crowded army camps.

    Last year was the centenary of that influenza pandemic. As a nation­ we failed to remember it, largely because it coincided with the signing of the peace treaty that ended World War I and created a new Europe.

    I was one of the historians who, last November, should have given the Spanish flu more attention when I spoke at dinners celebrating the Treaty of Versailles and the end of the war.

    It was vital that the tragedies of 1919 should be inside our national memory. They convey the message­: Be prepared. But this year we were not prepared, ­mentally, for a new pandemic.”

    Complacency lulled us into delusion – https://www.theaustralian.com.au/inquirer/coronavirus-complacency-lulled-all-of-us-into-delusion/news-story/de0542e846f29e8ef2bd8011fb4d4c2b

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