No Price Too High?

by | Mar 23, 2020 | Health Care Costs, Health Policy, Infectious Diseases, Public Health, The Practice of Medicine | 0 comments

It's only fair to share…

Notice to readers. At this time we must all comply with directives and advisories. This is not a time for glueing oneself to the road. The purpose of this article is to raise questions – not give any advice.

“There is an old adage about a week being a long time in politics. At present a day is a long time in the unfolding Covid19 situation. Every day we see more countries enact more restrictions on the activities of citizens.

New Zealand is moving to a lockdown on Wednesday. My sense is that Australia will soon follow. Yet as John P Ioannidis points out in this brilliant piece– all these decisions are being based on false or incomplete data. The view that is holding sway at present is that this virus will have a high mortality rate and that no consideration can or should be given to the harms of reacting to it. As Ioannidis says – “How can policymakers tell if they are doing more good than harm?” He suggests the fatality rate could be as low as 0.05%  which is less than seasonal flu.

As I wrote previously, this cold like virus is and will continue to spread like a virus. Mortality data is based on confirmed cases. But for every one of these there may be ten, 50, 100 or even 1000 cases in people who have no symptoms at all or ones, which are so minor as to not seek medical attention. Some 60-70 percent of the world population may get it.

Normally in medicine we do a risk benefit calculation. If the treatment may significantly harm the patient, then it  might or might  not proceed. In fact, doctors are legally bound to explain to patients the pros and cons of treatment. Side effects are not a reason not to proceed but people have a right to know and make an informed decision..

Reliable information can be hard to come by. The WHO on January 14 tweeted that preliminary investigations by the Chinese authorities have found no clear evidence of human to human transmission of Covid19. But of course, any criticism of the Communist regime in China is dismissed as “racism” by the usual suspects.

The virus will not be contained. No virus of this type can be. The focus needs to be on, as best we can, identifying and isolating actual cases. This means much more testing. It also involves isolating those at risk such as the elderly rather than isolating those at minimal risk.

The public is not being provided with informed consent. This is from a piece by Nathan Grills on MJA Insight about the costs of shutting down the economy.

“Such a financial crisis worsens population health and increases poverty, malnutrition and infant mortality. During the GFC, people earned less, ate less (and worse) foods and withdrew children from school. The impact in low- and middle-income countries is more dramatic and those in poverty are more inclined to fall ill and not be able to afford health care. During the GFC, for example, deaths from cancer rose by an estimated 500 000 as the ill could not afford or access the necessary treatment. Even in the US the suicide rate increased by about 10 000 people. These are just two examples of how poverty can kill and many others have been documented such as malnutrition, alcohol usage, and violence.

Although the extent of the economic downturn associated with containment and quarantine measures is not yet fully known, we can estimate that it will push many millions into poverty and result in excess mortality”.

When the suicides occur, there will not be a daily toll reported. Neither will the cancer toll or that of depression or a host of other illnesses. Why? Although the numbers will be greater it will be slower and hidden.

Informed consent means knowing the cost of steps taken. If the public knew, they may fully support this approach.Nobody is asking or even informing the public.

The narrative is being driven by the most extreme scenarios. The media always loves a big claim. Those screaming death and destruction get the most attention. 

Collateral damage is not a consideration.

Politicians and bureaucrats  have no skin in the game. If a bureaucrat can’t work for a month or so it doesn’t matter. Their job is there on return and they will be paid. Likewise, doctors will continue to work. It is the case that some are on the absolute front line in hospitals. Most are not. If a café, gym, restaurant or travel business closes it may not be able to reopen. Those thrown out of work still have bills to pay. The destruction of businesses built over time is not a “minor matter”.

The lack of acknowledgement of this by those screaming no reaction is too great is disappointing. They claim that those who raise questions don’t care about lives. Pot, kettle, black!! 

There is a final consideration.And it is difficult to do so.  Humans are part of nature, although we believe that natural law does not apply to us. The slowest gazelle is eaten by the lion. The medical profession has convinced itself and society that it may be  capable of stopping the slowest gazelle being eaten in each and every situation.

Viruses take a greater toll on those who are already closer to death due to disease. Most deaths are in those over  80 with at least two underlying medical conditions.There are some overwhelming cases in those previously fit and healthy for reasons we never understand.This  happens each winter from seasonal viruses. In this modern age many live beyond what, in any previous time they would have. That is a  wonderful thing but perhaps it is not a given.