A group of six New Zealand academics yesterday announced their “vision for a balanced response” to the Covid-19 pandemic. They are calling that vision “Plan B”. They even have a website and a PR firm attached. They are clearly serious.
Their plan is for New Zealand to return “to normality as soon as possible” by moving to something like alert level two. They want most people to be able to get back to work, for schools and universities to open, and for people to be able to travel around the country again.
And the reason they are advocating this plan? Because, they say, “international health data and experience is showing that New Zealand’s lockdown may now be unnecessary, and even more harmful than the problem we’re trying to solve.”
That’s a big statement. It’s an important statement. So let’s look at how their evidence stacks up.
Claim 1: the risks of the virus have been overstated
They present several stats and statements to back up this claim, so we’ll take each one in turn.
“With over 1,300 confirmed and probable cases and four deaths, the overall CFR in New Zealand is approximately 0.30%. … This overall CFR rate is similar to that seen for seasonal flu epidemics and indicates that the virus poses a low risk of fatality to the vast majority of people.”
CFR stands for case fatality rate and it’s a pretty unreliable number in the middle of an outbreak. Saying that, it’s still being widely used, and current estimates put it somewhere between 1% and 5% for China, Canada, Germany and Switzerland, rising to around 10% for Italy, Spain, UK, France, and the Netherlands. On the one hand the CFR depends on how cases and deaths are classified, and this is being done differently in different countries. Some countries are only testing people with severe disease in hospital. Others are testing as many people as possible, including those without symptoms. And some countries are only counting deaths that happen in hospital in people who have tested positive for Covid-19. This likely means that many deaths are being missed. Evidence for this is coming to light by looking at the number of overall deaths different countries are experiencing compared to the same time over the last few years when they weren’t in the midst of a pandemic.
Other things that can influence the CFR are the age and health of the people getting ill – we know that older people and those with underlying health issues are more likely to die. So if most of the cases are in young and more healthy people then the CFR will be lower. The other thing that will be impacting on the CFR is whether health systems are overwhelmed and unable to provide the care that very ill people need.
And lastly, as Spinoff cartoonist Toby Morris and I pointed out recently, it can also take some weeks for people to die from Covid-19. Here in New Zealand that means we need to prepare ourselves for more deaths. Yesterday, just hours after the Plan B academics released their new commentary, four new deaths were announced. It brings our total to date to nine. And almost doubled our CFR.
“An analysis by Professor David Spiegelhalter at Cambridge University shows that the CFR from the disease is conservatively estimated to be about the same as an individual’s average annual fatality rate … If you catch Covid-19 your likelihood of dying is the same as your average likelihood of dying that year anyway.”
They are using this to argue that the people who have died would probably have died regardless. They say it is “likely that some of these deaths were with the virus rather than a direct result of infection”. Note how they emphasise the word with. No less than Professor Spiegelhalter himself has declared that this is a complete misunderstanding of the point he was trying to make.
obviously it could be made clearer, because you have completely misunderstood the point https://t.co/OYA7zUseis
— David Spiegelhalter (@d_spiegel) April 11, 2020
“No deaths have yet occurred in people under the age of 70.”
Because of the lag in how long it can take some people to die, this statement is basically meaningless at the moment. It is important, too, to point out that plenty of young, healthy people have died from Covid-19 around the world, including many healthcare workers. There is nothing about New Zealand that makes us magically different.
Claim 2: Clearly, up to now, the virus has not had the devastating effect on hospital services as it was thought to
This is completely misleading. The reason Covid-19 hasn’t had a devastating effect is because we went into lockdown. If we hadn’t gone into lockdown, cases would have continued to grow exponentially and the same thing that has happened to hospitals in other countries would have happened to ours. I’m reminded of a quote from Peter De Jager about the Millennium Bug: “We’re damned if we do and damned if we don’t here. If there are no problems, then people say, well, there was never an issue.” In other words, we are a victim of our own success. But the difference with this pandemic is that we just need to look around at what is happening overseas to see just how profoundly, painfully worse things could have played out for us. Look at Italy. Look at Spain. Look at Britain. Look at New York City, where there has been an upsurge in mass burials.
Claim 3: Evidence from Australia indicates it is safe to move to a situation similar to alert level two at the end of the four-week lockdown period
Interestingly this group has moved to using Australia as an exemplar of how to deal with Covid-19, instead of Sweden, which a fortnight ago was hailed as “steering a more sensible course through this turbulent time”. Presumably because cases and deaths there are now increasing at an alarming rate, Sweden is not mentioned at all on the new Plan B website.
As for Australia, it’s not quite clear to me what evidence they are using to support the move to level two, given the Plan B website simply points to the Australian government’s emergency response plan.
It’s probably worth noting that different states have been making their own decisions about how to deal with the virus, and usually ahead of government announcements. New South Wales, the state with the highest numbers of cases (2,870) and deaths (26) went into a version of level three lockdown on March 22 and what we could probably call level four lite on March 29. Many businesses are closed, though there hasn’t been a formal closure of schools or universities. Saying that, many schools have shut as parents decide to keep their children at home and universities have shifted to online learning.
It all comes down to what we value
According to Plan B, so that the rest of us can get back to some kind of normal life “people at high risk of severe complications … should continue to self-isolate and maintain social distance”. The idea that this is feasible, never mind desirable, does perhaps depend on whether you fall into the “high risk” category.
It’s worth pointing out, too, that this is the strategy the British government started out with: lockdowns for the vulnerable, while everyone else carries on as normal. They were hoping to maintain this until they could reach herd immunity – which is the strategy implicit in the Plan B argument, though they don’t refer to it as such. Boris Johnson introduced the strategy by telling the British public that everyone should “expect to lose loved ones before their time”.
The UK has since changed course, and is now on a lockdown that looks very similar to ours. Only with thousands of people dead, including plenty who wouldn’t have been classed as vulnerable. In other words, “allowing the population to develop immunity, which is a natural defence for the virus after infection could occur, and manage the spread of the virus while protecting those most vulnerable from the disease” [sic] hasn’t worked in the UK. So why would it work here? Plan B and the herd immunity strategy reminds me of a line by Lord Farquaad from the movie Shrek: “Some of you may die, but that is a sacrifice I am willing to make.”
This type of argument plays into a “health versus economy” fallacy, too. Of course, the public health experts advocating the lockdown strategy understand that it brings serious and real harm to the economy, and that doing so has an impact on the health and wellbeing of people. Those considerations are baked into the thinking. But this is a matter of the least-worst. Again, you just need to look abroad to see how very much worse off we could be.
The level four lockdown has been stressful and difficult for so many people. What’s important now is that we don’t lose the advantage we’ve gained from doing it. If we exit too early and too quickly, any cases of the virus will begin to grow exponentially again. We can’t let that happen. Instead we need to be confident that we can stop the virus using the tools we currently have – testing, contact tracing, and isolation. Because everyone living in New Zealand has the right to a meaningful quality of life, not just those who are young and healthy.
This post was originally published on The Spinoff.