It's only fair to share…

One thing that has struck me in talking with older patients about Covid-19 is that overwhelmingly they are more worried about the future prospects of their children and grandchildren than the virus itself.

This theme was well described by Stephen Waterson in the Weekend Australian describing a conversation with his father who has pulmonary fibrosis and worries that he may never see his baby grandson.

“Look, son, I’m 88 in August,” he said, cheerfully. “I’ve had a good run. Whatever happens to me from now on, it’s not a f..king national tragedy.”

Waterson adds that his father’s attitude is, he believes, not uncommon among his contemporaries, who understand the tough reality of old age. As his father put it, with his winning sarcasm, “These people in nursing homes aren’t exactly snatched away in the prime of their lives, are they? Half of them don’t know they’re there, don’t even recognise their children when they visit.”

Meanwhile in the UK Graham Medley the government’s chief pandemic modeller told The Times that the country needed to face the trade-off between harming the young versus the old.

He noted “Britain must consider allowing people to catch the virus in the least deadly way possible rather than letting unemployment, domestic violence and mental ill health mount indefinitely”.

There is currently a one-sided case being put. It assumes that all measures being taken will save lives and that any questioning of any action taken is dangerous. To be questioning may see Twitter trolls label you a “dangerous idiot”. We can abide by advisory’s whilst retaining an ability to think for ourselves and ask questions.

Governments have to consider a wider perspective, not just modelling by doctors. The road toll could likely be reduced to zero if the speed limit were uniformly reduced to 1km/hr. However, such a move would have significant other effects. Thus, speed limits are set at what is deemed a reasonable level of risk for the circumstances. Necessarily circumstances vary and hence speed limits differ on different roads.

We can never totally eliminate risk. Our reactions need to be proportionate to the threat. And therein lies the current problem. We don’t know the magnitude of the threat. Mortality rates vary widely between different countries. Yet in all cases we don’t know the true number of cases. It could be five, ten, fifty, one hundred or more times the number of confirmed cases.

We hear about Italy but not Germany. Taiwan and South Korea have done very well. Neither country has enacted lockdowns.

It is very easy for fear mongers to claim that a catastrophe is coming. This is done with no actual evidence. Harms from the response don’t rate a mention or even a consideration.

Which brings me to the critical point. Shutting down the economy and throwing hundreds of thousands of people out of work is not harmless. Some claim that the economy doesn’t matter as much as lives. The reality is that the two are not separate. Life expectancy is higher in countries with stronger economies. These countries can afford better health and welfare systems. Destroy that capacity and life expectancy will drop.

It has also been shown that higher unemployment correlates with increased alcoholism, poverty and poorer health (increased heart disease and diabetes for example) as well as higher rates of mental health problems and suicides. There will not be a daily update on these numbers.

Isolating the elderly will protect them from Covid-19. Yet loneliness is an independent risk factor in all-cause mortality.

Heavy handed police action also does not help. A woman driving with her own daughter was fined $1600. There was no risk to anyone. A man eating a kebab by himself copped a similar fine. If as citizens, we are to accept curtailment of our liberties we must demand that this be applied with decency and logic. If not, public good will may start to evaporate – which is counterproductive.

When better figures are greeted with “ it’s only going to get worse” or “this is just the beginning” we need to know the basis for these claims. Computer modelling had Australia running out of ICU beds on April 5. Suffice to say this was as accurate as the WHO claim in January that there was no person to person transmission.

Most importantly we need to be planning for how this will end. At some point we need to pivot to, as best we can, protecting the vulnerable whilst letting everyone else get on with their lives. This will not be easy in a climate of whipped up fear. Fortunately, more voices are saying we cannot ignore the cost in human and health terms of what we are doing.