Coronavirus: We’re in need of objective facts, not ideology

It’s no surprise that the COVID-19 pandemic is rattling a few brains.

Pity the economic commentators who have spent the last twenty years divining political wisdom based on excruciatingly minuscule budget surpluses or deficits and then watching the Commonwealth rack up $184 billion and counting in debt in the space of a couple of weeks.

Feel sorrow for the ideologically obsessed who praised the federal government’s election on small government principles and enthusiastic encouragement for entrepreneurship and private enterprise turn almost in a heartbeat to a large, imposing government that has to nurse the population along financially and emotionally.

Perhaps that’s why Andrew Bolt wrote a column on Monday urging the country back to work in two weeks. He based his claim on declining rates of recorded cases of COVID-19 and he is right about that. Over the weekend recorded cases were in decline. This remains cause for optimism.

He’s not on his own. There are many members of the commentariat of the view that the fit and well should return to work as soon as possible. I actually wish they were right but a few days’ worth of data is no basis for calling an end to a pandemic.

Recorded cases of COVID-19 have doubled in New South Wales since March 25. Victoria showed a decline in recorded cases yesterday but spiked upwards today. The numbers remain small and manageable at this point.

We all have access to general data on COVID-19 infection, transmission rates, death rates, demographic breakdowns. The truly unique aspect of this pandemic is we can see the numbers roll out in real time.

But there is a great gaping hole in the data, something even epidemiologists and immunologists can only guess at.

In Australia, a person may only be tested if they have returned from overseas, been in direct contact with someone who has, is a health care worker, has developed a community acquired form of pneumonia without an established cause, or has had direct contact with an infected person and presents with COVID-19-type symptoms.

The government tells us that we have one of the highest rates of testing in the world and they’re right but only the latter two categories can provide some indication on human to human transmission, perhaps more properly described as community transmission.

We simply don’t have enough data to know where we’re at on this most crucial piece of the puzzle. It may be quite low, but we can’t be sure. Reopening businesses without a proper understanding of the degree of community infection would be reckless and downright dangerous.

Australia’s death rate – a measure of recorded cases divided by deaths as of today is at 0.41 per cent. Relative to the world, it’s almost as good as it gets but it is climbing slowly.

The US is at two per cent and rising. Spain is at 8.82 per cent and France 6.75. All are in the ascendant. Germany, which has a similarly high infection rate to its European neighbours has a death rate at 1.07 per cent but again it is climbing.

Italy’s death rate is at a staggering 11.74 per cent and shows no sign of slowing down.

To date Italy is the best example we have of what happens in a country where the threshold between patients requiring hospital treatment and the capacity of emergency medical response to provide it is crossed.

Australia’s experience of COVID-19 is objectively different to that of Italy but there are differences and similarities that are worthy of note.

Italy first identified two travellers from China as having COVID-19 on January 25. It closed flights from China on January 29; two days before the US and four days before Australia’s shutdown.

There are certain demographics that may have contributed to the extent of the outbreak in Italy. Italy has the second highest ageing population in the world. It has a high smoking rate at 28 per cent of the population above the age of 15. But Japan holds the ageing population title and has a similarly high smoking rate and has recorded just 1,953 cases of COVID-19 and only 56 deaths.

By comparison, 15 per cent of Australians are 65 years of age or older. Australia’s smoking rate is half that of Italy’s.

Population density in Italy, especially in the north is high but again not as high as Japan. Milan has a population density of 7,200 people per square kilometre. Ultimo, in inner Sydney has 19,461 people per square kilometre.

In 2000, Italy’s public health system, Servizio Sanitaro Nazionale, a model not unlike Medicare or the UK’s NHS, was considered one of the best in the world. But austerity measures driven by the economic calamity of the Global Financial Crisis, have meant public health spending has been slashed with Italians having to fund the health system through co-payments running at 23.5 per cent of total expenditure. Australians contribute around 17 per cent.

What this means is a lot of people, particularly in lower socio-economic strata have an almost decade-long history of receiving little or no medical care. Many may be in poor health and thus more susceptible to serious illness and death from COVID-19 infection. Clearly those conditions prevail more in Italy than here.

The remaining contributing factor is the hot issue of the pandemic – the degree and efficacy of testing. In Italy, COVID-19 hit hard and early but fundamentally the testing criteria is the same as Australia’s.

Last month the small town of Vo, near Venice, tested all of its 3000 residents for COVID-19. With or without symptoms, whether they’d been overseas or stayed at home, everyone had the swabs. Eighty-nine people tested positive. They were isolated and provided with medical treatment where necessary. The remaining population was tested again. Six people tested positive. They were isolated. The third round of testing showed no COVID-19 infection. No one died because medical intervention came early. The town went from a hotbed of infection to zero in the space of a Boltian fortnight.

Even if it could be done across a much larger population, it is too late for Italy. While a roll out of universal testing for COVID-19 would be a logistical nightmare in Australia if it is best practice you’re after, it stands as the ideal, bearing in mind testing can only buy time before a vaccine or preventive treatments are established.

The early infection commenced from people who had travelled to northern Italy by air, essentially from China. More infection has occurred in Australia from Europe or the US than came from China. We are at different stages of the pandemic on the basis of transmission alone.

In Italy, 85.65 per cent of those who have died were over 70. More than half of patients who were placed on respirators died. In some hospitals it was as high as 80 per cent.

People who travelled overseas either for holidays or for business purposes or indeed by stepping onto the gangplank of a cruise liner were on the front line of infection.

Behind them on the next line are the elderly and what’s often dismissively referred to as the infirm as if a large chunk of the Australian population is sitting around in wheelchairs spitting into cups in consumption wards.

I can’t tell you what percentage of the population present with high blood pressure, cancer, asthma, is immunosuppressed or compromised, takes tablets for rheumatoid arthritis, or blood thinners for stroke prevention, has diabetes, kidney or liver disease, blood disorders, has fallen pregnant in the previous three months or suffers a range of maladies both pervasive or obscure but on a back of the envelope calculation and combined with the 70 plus age group in, we’d have to be looking at something approaching half the population of the country.

The concept of ‘ring-fencing’ millions of people on the basis of age and/or medical conditions only known by those people and their medicos is unworkable. Let’s start with how the state might enforce it. Any ideas? Anyone? Hello?

While COVID-19 continues to threaten populations, ideology needs to be placed in an induced coma. It is of no utility at present. The very idea of labelling the Morrison government socialist two months ago would have been laughable. It would be accurate now, but it’s not terribly helpful.

To be sure, the back to work crew like Bolt are not cold-hearted robots sitting in front of their adding machines punching in numbers based on the great military euphemisms of our time – collateral damage and megadeaths.

But they are facing a global crisis they’re struggling to comprehend. The response to the COVID-19 pandemic cannot be ideologically based not least of all because the virus itself has no concept of it.

There’s nothing wrong with ideology per se but in the midst of a pandemic, it is a poor substitute for objective fact and when inveigled on what is unknown the consequences can be catastrophic.

This column was first published in The Australian on 1 April, 2020