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).

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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:

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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.

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