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.