The previous post on this site urged a recognition of tradeoffs in dealing with the COVID-19 pandemic – tradeoffs between the direct effects of the virus and effects on public health of the shutdowns now in place in many countries. I also highlighted a newly visible divide in society between people, like me, whose salaries continue through the shutdowns (the easy side of the divide), and people whose income has, through no fault of their own, suddenly vanished (the hard side). I expressed some approval of the Australian government’s resisting the constant calls (from people on the easy side) for ever-tighter restrictions that will lead to economic disaster (especially for those on the hard side). In the time since that post, things have moved quickly. A number of countries, including Australia, have announced very positive moves in making some money available to those who are the hardest hit. But there has also been in many places a rapid tightening of restrictions on what people can legally do. Where I am now, in Sydney, Australia, people are no longer permitted to leave home at all except for a narrow range of reasons, and social groups in most cases can be no larger than two. In the area of behavior restriction, this is much worse than I expected.
In the Herald newspaper here yesterday, a University of Melbourne epidemiologist, Tony Blakely, wrote a column looking to the next steps. He listed the options as he sees them, and said it was time for input from a range of people in different fields. Here is some input. Though this post will be in part about the Australian case, much of what it says applies more broadly.
Blakely starts by saying that Australia has done pretty well in keeping caseloads down so far, through both good work and good luck. From here, we have three options, though two of them are equivalent in the short term. One (which he mostly discounts) is aiming for elimination of the virus by means other than a vaccine. A second is staying in a state of near-lockdown until a vaccine is available. The third he expresses like this:
The third option is to prepare meticulously for allowing the pandemic to wash through society over a period of six or so months. To tool up the production of masks and medical supplies. To learn as quickly as possible which treatments of people sick with COVID-19 saves lives. To work out our strategies for protection of the elderly and those with a chronic condition (for whom the mortality from COVID-19 is much higher).
I assume that the third option includes getting the economy back onto a more normal track relatively soon. In the light of this discussion and others, including input from my biologist friends, I think there is something closer to a two-way choice here: either a lockdown with massive economic restriction until a vaccine is available, or an easing of restrictions sooner rather than later.
What about the option of very tight restrictions for something less than the time to develop a vaccine (a time Blakely pushes out to over a year)? Here the international side becomes relevant. Without a vaccine, and given global conditions, even if we could entirely eradicate the virus locally, it will return from the outside when we relax. Elimination, difficult enough in one country, would have to be international, and the virus is just hitting many developing countries now.
Suppose we do wait for a vaccine. Blakely thinks this wait might be something like 18 months. And 18 months, as he sees it, is long enough for the lockdown to have its own dire consequences: “Unemployment and precarious housing leads to worse health and premature deaths too – possibly more than a pandemic over 18 months.”
If you think, as I do, that 18 months is probably unacceptable for these reasons, then Blakely’s third option is what is left to us. Other measures are self-defeating. And even if all we care about is health, hospitals, in the medium term, require a functioning economy.
If this is right, then our approach should be to “flatten the curve” in moderate ways that balance the stress on hospitals with the need to avoid economic catastrophe and its consequences. People over 70 and those with relevant health problems can, on this approach, be helped to isolate and looked after – they can be much more isolated and better looked-after than they are at the moment. Waiting a year or more for a vaccine is no longer a problem. Younger people need not face the same restrictions, and a lot of businesses, along with schools, can start running semi-normally again.
We can also, on Blakely’s third approach, abandon the absurdly strict rules covering individual behavior and association. (Now I am writing specifically about the local situation). I am aghast at how this has developed, at the near-instantaneous move to overreach, with people harrassed by police for sitting alone in the sun, and fined for eating take-away food outdoors on their own. For several days, the state government in Victoria was insisting that people were not allowed, one-on-one, to visit boyfriends, girlfriends or other partners, if they happened not to live in the same house or unit. That was not deemed a good reason to leave one’s residence. The penalties for crimes like the solo eating of take-away food are in the thousand-dollar range, and jail time is also an option. When a rule is manifestly absurd, the penalties have to be comparably absurd in order to get some compliance. In such situations, there is no respect-based compliance.
As well as being amazed to find us on this road, I am surprised also at how little push-back has been seen from people in authority and in the media. Not a word has been heard from the center-left Labor party (and the no-boyfriends rule was introduced, and then dropped, by a state Labor government). Very little objection has been raised in the national media, other than growing concern from several columnists in The Australian, a Murdoch-owned paper. It’s never a good thing to have a Murdoch paper as the sole source of good sense in a situation.
I realize that the further reaches of these behavioral restrictions – visits by partners and friends, take-away food in the sun – do not themselves have the effects on life and health that I, along with Blakely, are emphasizing as particular consequences of the shutdowns. Those consequences stem mostly from people not being able to make a living, though as several commentators have noted, domestic violence rates will be adversely affected by confining people against their will. My response to the behavioral restrictions includes a degree of sheer shock at learning that this is what Australians are now like – that this is what our leaders will enact, and this is what most of our media will acquiesce in.
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For columns in The Australian that push back, see here and here. The closest I’ve seen in the non-Murdoch and center-left Herald is here.
Pretty much agree with all of that.
A lot turns on whether a particular country could eliminate and then strictly control it’s borders and test or quarantine every visitor.
I don’t know if elimination by lock down could work, though
If that were possible then the radical lock down might be a much more appealing strategy.
Yes, an alternative is for a country to turn itself into a nearly entirely closed community, eliminating the virus locally and subjecting arrivals to quarantine. (I assume testing would not be sufficient.) This assumes that the local eradication could be effective enough to survive the revival of contact between people once restrictions are listed.
I think that this would probably be better than our present course of action, perhaps not as good as letting the virus wash through while protecting the vulnerable.
I agree very much with the general message. I think there are other options, at least as far as details go. The Imperial team in the UK suggested an on/off approach, with a trigger number of cases for lock-down. Uri Alon at Weizmann has made a similar suggestion, conceptually, but with pre-set on/off days (see here: https://medium.com/@urialonw/containing-sars-cov-2-with-a-two-day-workweek-fbdea4030d30). There are various others.
However, I do think (and the models for the most part agree) that the way to get to these more reasonable solutions should have been to start with a short-ish (2-3 weeks) very strict lock-down first, then relax it in a controlled way. Most countries have moved incrementally, and that is bad both public health-wise and economically.
By the way, this is interesting piece about Taiwan has dealt with the situation, and why it has received very little credit: https://www.thenation.com/article/world/taiwan-who-coronavirus-china/
That Taiwan story is interesting and depressing. Criticism of the WHO seems quite reasonable at the moment.
Agree also that it would have been good to “start with a short-ish (2-3 weeks) very strict lock-down first, then relax it in a controlled way.” But in this case, one can sympathize with the decision makers, feeling their way forward at the early stages in a very uncertain situation.
I’m actually really pleased with the Australian government’s response. Australia is now 4th in the world (and rising) in % recovered. We’re moving through the stages faster than other countries. It’s very very difficult to know where this will lead, but it’s great to have options, unlike almost every other country. Like GPM says, I think elimination (or at least, an elimination-focused strategy) is a real possibility for getting to work again as soon as possible. Economically, our government has behaved like a Scandinavian mixed economy, and it’s as surprising as it is brilliant.
I’m surprised that you are so unhappy with personal restrictions on freedom. Without getting into an infinitely recursive argument about freedom, I think the current restrictions are at least as interesting as they are challenging. One thing that has emerged during lockdown is a worldwide reconsideration of capitalism. Which is weird, right? It’s an unexpected connection: there’s a pandemic – let’s think about how capitalism works. I’m genuinely hopeful that this radically altered social situation will open up new possibilities for our future socio-political beliefs and ambitions.
Or it might not, of course!
It’s indeed a very good thing that rates of infection and death have remained so low in Australia. If a brief lockdown and an extended period with no international arrivals would work, then that would (as I replied to GPM) make more sense than what is being discussed by the politicians now. I remain strongly influenced by those who say that an extended lockdown is likely to produce a worse health disaster than letting the virus move through the younger part of the population. Tony Blakely has continued to make this point in a series of follow-ups to the piece I cite, and so have others, such as Peter Collignon, here. Collingnon also notes that the timing of the ‘flattening’ of the curve reflects on the earlier, less extreme policies that were in place before the NSW and Victorian governments and police forces embarked on their race towards absurdity.
On the question of personal freedom, that is certainly a pretty basic value for me, one that has some degree of philosophical justification as well as a more practical justification deriving from what societies tend to look like after a while of not taking it seriously. And as someone (I can’t remember the source – Tom Switzer?) said a little while back, these sorts of draconian police powers don’t tend to go away when their immediate justification has receded. Just look at what the police have done with their expanded anti-terrorism powers in recent years. A good example is the prosecution of the Canberra lawyer Bernard Collaery and ‘Witness K’ over the (appalling) Australian spying on the East Timorese.*
Collaery: “I doubt that any judicial officer in Canberra would have signed that search warrant. And they knew that, so they used the terrorist power to raid my chambers.” I expect similar downstream consequences from today’s “public health” powers.
On socialism: I think the large-scale change that has really started to look promising as a result of this is Universal Basic Income. UBI can be seen as leftist, but it is sometimes also embraced by conservatives with their eye on the future of work. If societies like ours come out of this looking seriously at something like UBI, that would certainly be a positive. UBI can exist within a capitalist economy.
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* This is not the example I saw the other writer use, but I think it’s an apt one. The other writer used the example of crackdowns on groups of youths hanging out (for example, in Melbourne).
When you say “better than what is being discussed by politicians” I’m not sure what you’re referring to. You are probably better informed than me, but I have read several nuanced strategies being discussed in the media, so I’m assuming they’re a serious possibility. I could be wrong, but I’ll bet you a winter swim in Wentworth Falls Lake that we do not remain at this level of lockdown until the vaccine.
With regard to freedom, it’s possible that we have a core disagreement about its value. In brief (and we’re both drawing on centuries of political thought), I think “the social contract” is far more important than “freedom.” In other words, I would much rather live in Denmark than the USA, and I love it when my government behaves in a Denmark-y way. I call the “freedom” discussion recursive because, of course, as soon you start exercising your freedom, you immediately impinge on other people’s freedom. I just personally prefer it when a society becomes more socially-minded (what’s a fair outcome for everyone) and less individualistic (my freedom vs your freedom).
Anyway – I can see that this could become a meaninglessly expanded discussion. I think you’re absolutely right to be sceptical or cynical about every extension to police powers. The historical precedents are almost universally horrendous.