It's only fair to share…

Those of you old enough to remember March and April 2020 may recall a term that is not heard these days – “flatten the curve”. The original intent of our response to Covid 19 was not to eliminate the virus but to control the number of cases at any point in time. This was to enable the health system to cope with numbers needing hospitalisation and intensive care treatment. The fear was that health systems world-wide would not cope. Australia was predicted to run out of ICU beds by April 4.

By any objective measure, health systems are coping. At time of writing there are 12 people in intensive care beds in Victoria. The same day last year there would have been far more beds used for normal winter viruses including seasonal flu.

Australia normally has 4000 ICU beds, and this was increased to 7000 in April. Current usage is 0.3% (or 0.17% of increased capacity). At 50 times this number some 15% of beds would be used.

At what point did we change tack from flattening the curve to the impossible task of eliminating a virus? Was the public consulted or even informed about this major shift in approach?

To be fair the Prime Minister Scott Morrison has been upfront about the need to live with the virus and to expect outbreaks. State Premiers on the other hand see every new case as some sort of disaster.

Australia and New Zealand have benefited by having low population density and being geographically isolated. Different Australian states applied differing levels of lockdown. The state with the harshest restrictions (Victoria) is having the poorest outcome in terms of control. There is no correlation between degree of lockdown and cases.

In March we knew little about the virus and were reliant on computer modelling and projections. Some of these grossly overestimated the problem. Now we know a lot more.

Let’s digress for a moment. Imagine a virus escaped from Wuhan province that caused an itchy little finger for a day. Would anyone care? Would any measures be taken to stop the spread? Of course not. At the other extreme, imagine a virus escaping from Wuhan that had a100% mortality rate. We would do absolutely everything possible to stop the spread.

The question then is how far along the spectrum between those two points is Covid19? In turn what is a proportionate response? In clinical medical practice we weigh up adverse or side effects against the benefit of the treatment. Chemotherapy is not used for a cold but in cancers where the benefits justify the harsh side effects. The patient gets to make an informed decision. For inexplicable reasons, this does not apply to public health.

Victoria has had 1444 new cases over the last seven days. Figures suggest 0.8% of these people need an ICU bed. There has been one new death – giving a mortality rate of under 0.1%. There will likely be more, but it needs to be above 0.5% to equate to seasonal flu.

108 people have died in Australia from Covid19. Meanwhile each day 438 people die in Australia of all causes. Those succumbing to Covid19 are generally over age 80 and with other underlying medical conditions. The average life expectancy in Australia is 84 for a female and 82 for a male.

Mortality rates are also inflated by attributing any death where the person has Covid 19 to Covid 19. To give an extreme example, getting run over by a truck and testing positive to the virus would see Covid19 recorded as cause of death.

The central question is not being addressed. What is a proportionate response – one that does not do more harm than good. When swine flu emerged in 2009 economies were not shut down, nor borders closed. Each new case was not breathlessly reported by the media. The passing of a 95-year-old care facility resident was (whilst sad for family and friends) not considered unusual or newsworthy.

Lockdowns are causing harm. Loss of employment, livelihood and businesses closing causes harm. Separation from friend and family causes harm. Delay in treatment of cancer, diabetes and a host of other ongoing medical conditions causes harm. One estimate is that there will be an additional 750 suicides per year in Australia over the next three to five years.

Politicians believing, they can eliminate a virus are like King Canute believing he can hold back the tide. It cannot be done. The CDC estimates that 40% of cases have no symptoms. A large number have mild symptoms. Less than 1% have severe symptoms.

We need to learn to live with this virus. Cases when found should be isolated and contacts traced. This is not a new concept. We cannot continue draconian lockdowns which destroy people’s lives.

The bottom line is that the virus is way less deadly than first feared. The total number of cases will continue to grow. This was always expected and was the reason to flatten the curve.

We need to allow life to return to normal whilst maintaining good personal hygiene and appropriate physical distancing. The longer this is left, the worse the long-term outcome will be for society as a whole.