Choose your own apocalypse: COVID and bushfires.

As many others have noted, the coronavirus pandemic is illustrating the peculiarities of our relationships to one another as individuals within a society. Indeed, most historians would argue that communicable diseases initiated the modern state as we know it. In short, there’s death and taxes but the buck stops at plumbing.

I used to live in California, and my friends give an interesting and troubling insight into daily life in the age of the pandemic. Most of my contemporaries have children, all are educated and financially secure, and all have been self isolating to various degrees since about February. I should say, I haven’t lived there for years so I can only make statements on what I see from my friends and in the news.

School goes back in California this month and Governor Newsom has declared that children will return to online learning only. For my contemporaries this means they continue to live in isolation whilst working from home. In some ways our lives are similar – I’m working from home, although I could go into the office and be relatively safe. I would be temperature checked, logged in and there would be a limit on the number of people I could be in a room with. However, in other ways I’m realising that we’re on quite different trajectories.

For us in NSW, schools closed for 6 weeks early on in the pandemic (about March). Despite some local cases, schools have remained open with some restrictions around adults on campus, hand hygiene and group gatherings. Mostly though, school is back to normal.

I can go walk down the street in my local town and see maybe only one or two people wearing a mask. I can go shopping more or less as normal. I can visit friends for a cup of tea. e’d probably sit outside. Many councils are now relaxing rules on outdoor seating so cafes can close their indoor spaces.

In areas where social distancing is not possible, people are asked to wear masks, and almost entirely comply. In short, the government has explained the risk and the conditions under which masks are appropriate, and by and large, most people follow the guidelines. Our local supermarket is sometimes quite busy and has asked all patrons to wear masks. Everyone does. It’s not ‘required’ and no-one will be thrown out of the shop, but so far I’ve not seen anyone without a mask. Other smaller shops, the butcher for instance, have limits on customer numbers. People wait outside until they can go in. It makes sense – you’re just waiting anyway.

Mostly though, people aren’t wearing masks unless they’re asked to (the chemist for instance, asks people to do so, and people do). Aside from a bit less social interaction, our lives are more or less unchanged.

For my friends in California, life seems to me to be more restricted. People appear to be consciously living in ‘bubbles’, children largely remain within their family ‘bubble’ and food/supplies is managed either through online ordering or strategised procurement.

A friend’s online posts on show her hiking in the wilderness with a friend, for miles in solitary wilderness, both of them wearing cloth masks. I wonder if the cloth masks (rather than N95 masks) are to protect others – it seems to be the case, signalling inclusion in a community of likeminded people who care about one another and have a sense of social solidarity. When venturing out of this community, however, they will encounter much larger groups of people who’re not wearing masks – generally poorer people who’re performing essential work (like delivering groceries) and will likely get the virus soon if they haven’t already.

And this is the point: In essence, my friends are waiting in virtual gated communities for the virus to reach some level of herd immunity in the surrounding population. In other words, at a certain point, rumoured to be around Christmas, the virus will reach a tipping point between susceptible and infected in the population at large.

Let me tell you about birds.

Last month a flock of black cockatoos stripped every nut off our huge macadamia tree, screeching and dropping the shells onto the driveway. We’ve always had black cockies in the trees out the back but this is the first time they’ve been hungry enough to have a crack at the tree.

They’re here because we live in a small patch of unburned bush, not more than about 20 square kilometres in size. The fires that ripped through our area on New Year’s Eve and then twice more in the coming weeks were stopped by the river, a natural firebreak, on our northern boundary.

This small oasis of bush, which is now a refuge, groaning with hungry birds and animals, is now considered ‘safe’ – because it’s been effectively back-burned. 

I can’t help thinking of my friends in California, living in small, largely COVID-free havens where people work hard to reduce both their personal risk and the risk to others in their small, likeminded community, waiting for the surrounding population to backburn an ‘asset protection zone’ around them and effectively reduce the risk to zero.

Of course, you can’t account for a random lightning strike.

In Australia, we’re all more or less susceptible to COVID19.  The numbers of cases in Victoria are shocking for us, but they’re actually comparatively small. In NSW for instance (my state) we’ve recorded 3 new cases today, all linked to existing clusters. The numbers are declining daily. We may get to ‘effective elimination’ where we assume the disease is still around, but in very low numbers. There’s an enormous, continuous testing effort, and an elaborate contact tracing and testing program. We are unburned forest. Our ‘asset protection zone’ is the ocean. It’s no surprise that so much focus is on Australia’s borders. New Zealand is in a similar situation.

In a way, California seems more like a tale of two cities – a small, relatively wealthy community of people living amongst a much, much larger service class. This itself isn’t new –  California’s economy is often described as suffering from a form of Dutch disease – there’s a huge discrepancy between the small, high income elite and the much poorer, much larger majority who’re participating solely in a domestic economy (both working and consuming in the service and retail sectors).

Will these ‘two countries’, one ‘letting it rip’, the other ‘waiting it out’ make it to the Christmas herd immunity, with a small non immune population surrounded and protected by a much larger immune population?

In Australia we’re all sitting it out, waiting while the rest of the world ‘burns’, only our borders between the two groups is physical, whereas in California, it’s simply money and fragile networks of separation.

Interesting times.

When ‘both sides’ are faces of the same coin.

Increasingly, the management of COVID19 has become politicised. With that comes the usual ‘both sides’ arguments. In some countries and contexts, it’s impossible to have a ‘both sides’ discussion. For instance, if you’re in the US, one side might claim that the disease is caused by God or pixies or lizard people or something. With a population of over 300 million you’re going to suffer the effects of critical mass pretty smartly. It’s not a situation given to nuance.

In Australia and other nominally secular, science leaning nations, COVID19 has been managed by the technocrats. Broadly, the politicians listen to the scientists and follow their recommendations – even when they might seem extreme or draconian. In these contexts, ‘both sides’ are generally engaging with one another on similar terms, to the exclusion of lizard people.

Unsurprisingly the argument ends up over over the details. To what extent should states ‘lockdown’, and to what end?

I like to think I’m not hide-bound by dogmatic thinking. This means, necessarily, that I read widely on topics. The one thing that occurs me about my reading on COVID19 is that generally, there’s little debate about the numbers themselves. What differs is their interpretation.

For instance, this Swedish ER doctor has written about his experience in a large hospital in Stockholm. His post is widely circulated on what might be called ‘contrarian’ sites, that is, people who think various governments’ reactions to COVID19 have overreached. Lockdowns, they generally argue, cause more deaths, through medical neglect (failure to treat patients with other problems) and economic decline.

Dr Rushworth argues that his hospital saw an initial spike in cases and deaths, followed by a steady decline. Dr Rushworth suspects that although antibody tests show that only relatively small number of people have had the virus, more than 50% of people have T cell immunity, which is much harder to test for. Broadly, he surmises, Sweden has reached a type of herd immunity (although this is not strictly the definition of herd immunity).

Dr Rushworth cites around 6k deaths from COVID19 in Sweden, a number he expects to top out at around 7k, as the (short) tail comes to an end.

His numbers and logic work out, and are not in dispute. Here’s the bit that struck me:

Let’s repeat that. Sweden has around 700 deaths from the flu, every year. Sure, if you average out COVID19 over a year, now that it’s run its course through an immunologically naive population, it ends up with a similar CFR. But what happens before you get there?

And here’s the rub. Australia has just over twice the population of Sweden. This death rate would translate, pro rata, to around 12k in just a few months. That’s twelve thousand dead people by now. And that’s assuming that our hospital and health system would cope and we’d still be able to treat all the other people who staggered in through our hospital doors.

It also assumes one other thing: a relatively healthy population. In New York city, where the virus ‘let rip’ initially, the death rate is almost three times that of Sweden’s. Three times. 

88% of Americans have metabolic disease, a significant risk factor for COVID19 morbidity. Swedes are much healthier. It’s worth noting that the majority of younger deaths in Stockholm were concentrated amongst its (large) immigrant population, many of whom have worse health in general that Swedish born Swedes.

What does all this tell me? Where you sit determines where you stand. Your country’s basic level of health and healthcare should determine how you deal with COVID19.

Currently Victoria is undergoing a serious and wide ranging lockdown to reduce the case numbers. This is predominantly because Australians are shocked by the large numbers of deaths as the virus moves through aged care facilities. Dr Rushworth is more cavalier – many of these people would have died within the year anyway. This ‘harvesting effect’ certainly does account for some of the deaths, but not all. In Britain, for instance, where the general level of health is far below that of the average Swede, fatalities are losing many years from their lives.

I think, from what’s emerging now, Dr Rushworth is possibly right about T cell immunity. COVID19 is hugely infectious, and even with Sweden’s low level of restrictions it should be assumed that infections have reached 50% in Stockholm.

In my state of NSW that’s not the goal we’re aiming for.

It seems the aim is to allow for a small amount of community transmission and to limit the virus’s access to aged care homes especially until effective treatments are found. This does require borders to be closed for another year or two, at least, but there’s simply no way to ‘let it rip’ in Australia that doesn’t result in unpalatable political casualties. Australia will remain largely immunologically naive probably until a vaccine is developed, which could be a while. There will be ‘spot fires’ and some deaths. Australians will accept that.

The US, on the other hand, has a completely different scenario on its hands. Having lived in the US what’s striking is the general level of ill health. If there’s one country where a total lockdown could be justified, it’s probably the US. And yet, it’s the least likely to get one.

I’ve got no insights into the ‘rights or wrongs’ of lockdowns. I personally agree with NSW’s epidemiology informed approach at the moment, and its commitment to changing things according to the level of risk.

My point is that there’s little doubt now in my mind about the actual dynamics and pathology of the disease, because both the public health hawks and bulls seem to be using the same numbers.