In an over the top piece Skift founder Rafat Ali wants us to examine travel’s role spreading the SARS-CoV-2 virus, and expresses concern about travel’s re-opening. He calls the U.S. ‘the failed states of America’.
And we have to examine the controversial and unmistakable role of our industry of travel — the movement and the gathering of humans — in this, especially as the reopening of travel is gaining momentum every day. We can’t just hurtle into reopening with fingers in our ears. After all, our industry’s output, the globe of travelers, has been the biggest vectors of spreading the virus around the world.
As horrible as the mistakes were in the U.S., it’s important to focus on the biggest ones including (but not limited to) the FDA refusing to allow tests other than the CDC’s, the CDC’s testing kits were faulty, moving coronavirus patients out of hospitals into nursing homes, failing to screening nursing home employees bringing the virus into that environment.
And it’s important to understand our failures in the proper perspective. The countries with the highest Covid-19 deaths per million population, in order: Andorra, Spain, Italy, UK, France, Sweden, Netherlands, Ireland, U.S., Switzerland. The U.S. is #9.
More importantly, for Mr. Ali’s piece, is to understand that there are two ways travel can spread the virus:
- Bringing infected people from one place to another.
- People picking up the virus while they’re traveling. But flying is far lower risk than you think and for the most part indoor super spreader gatherings have been turned off.
And fortuitously Europe’s CDC has just released guidance on re-opening travel that speaks to the role that travel can play bringing people from one place to another. The conclusion is that people traveling with the virus spread it from one place to another, but once that happens there’s little further risk – except to places that have crushed the virus completely.
- In places where the virus is already spreading, limits on travel don’t help. Bringing in a few extra cases doesn’t materially change the trajectory of the virus.
- If a country really has beaten the virus, then travel restrictions are a different matter. Travel could re-introduce the virus to a place where it isn’t already spreading.
- It’s generally desirable to limit travel from places with high concentrations of the virus to places with low concentration.
- Overall border closures aren’t helpful,
Based on evidence from modelling studies mainly related to influenza pandemics, border closures can delay the introduction of the virus into a country but only if they are almost complete and are rapidly implemented during the early phases of an epidemic, which is only feasible in specific contexts (e.g. for small, isolated, island nations) . Available evidence therefore does not support recommending border closures, which will cause significant secondary effects and societal and economic disruption in the EU.
There are prudent steps to take, according to Europe’s CDC. Tourism can mean dense gatherings – in airports, at resorts – and those contribute to spreading the virus. Large indoor gatherings are a bad idea. Even though physical distancing on planes of 5 to 6 feet isn’t going to be possible, some distancing (eg blocked middle seats) is better than no distancing.
Much of what’s being contemplated is theater rather than prophylactic, for instance “entry screening procedures are ineffective in preventing virus introduction. Emphasis should therefore be placed on discouraging symptomatic individuals from travelling.”
Past experience with entry screening using temperature control shows that it is a high-cost, low-efficiency measure. Current evidence, including evidence acquired in the early phases of the COVID-19 pandemic in Europe, indicates that entry screening is ineffective in preventing SARS-CoV-2 virus introductions.
In a recent review of the public health response by the US CDC, data from incoming passengers in selected US airports revealed that as of 21 April 2020, the screening of 268 000 returning travellers had detected 14 cases of COVID-19 (approximately 5/100 000 screened passengers) . However, based on existing knowledge of the disease evolution, a relatively large number of cases will be in the incubation phase while travelling. COVID-19 has an incubation period of 2−14 days, with 75% of cases developing symptoms in a period of between four and seven days.
These travellers will not be detected by exit or entry screening, even in a scenario assuming high sensitivity detection of symptomatic travellers. This scenario was modelled at the beginning of the outbreak in January 2020, with an estimated 75% of infected passengers exiting or entering the country without being detected .
Moreover, since then evidence has been accumulating to indicate that asymptomatic (or pre-symptomatic and mild) cases play a significant role in the transmission of COVID-19 . It is therefore impossible to rely on exit or entry screening to identify all those infected, as only a portion of them will probably be detected by the available screening tools.
Temperature checks, similarly, aren’t especially useful,
Although fever (body temperature >37.5 or 38°C) is one of the frequent symptoms of COVID-19, it is not consistently reported. In over 100 000 cases reported to ECDC’s European Surveillance System (TESSy) by 21 April 2020, only 48.7% reported having fever . In addition, fever is a symptom that can be temporarily masked by using antipyretic drugs.
Rapid testing on arrival, if scalable and accurate, could help but may be out of reach for most countries and airports.
Ultimately then what should be done? Ali thinks we should re-think all travel,
We have to critically examine our role in encouraging millions more Instagram selfies of a sunset on a beach, blithely, without acknowledging so many lives lost, so much disease spread, so many livelihoods destroyed. We have to examine the role of tourism promotion from here on, if it carries on without any sense of loss in it.
I think he strawmans the value of travel as mere ‘Instagram selfies’ without recognizing that travel has always brought with it good and bad, and that a continued pause on travel shuts the barn door after the horse is out.
Gary, yet many of your readers will agree with that idiot because people want to “feel” good about themselves and the government even if futile economic damage is done
Just watch the parade of condescending folks who will reply
As always when people tell everyone else what to do …. the response should be: YOU FIRST!
Also, newest data shows Covid-19 has an IFR around: .26% POINT26…. (CDC.gov)
(the flu is .1% – .13%).
We were told by the Brits and Dr Fouchi… 3.4%! 7%!!
And it’s less than .3%….
About twice as deadly as the flu. So you go from having almost zero percent chance of dying, to slightly more than zero percent chance of dying if you are even remotely healthy.
As the words immortalized in Dumb and Dumber: “Samsonite… I was WAY off…”
You’re conflating CFR and IFR. The 3.4% from the WHO was a case-fatality rate. The original projections in March from CDC and Imperial College – that came up with 1-2 million deaths – used an IFR of 0.8 and 0.9%, respectively. So, yes, off by a factor of 3 or 4, but not an order of magnitude or more.
CFR will always be higher than IFR because by definition not everyone gets tested or is symptomatic. CFR in the US is currently ~5.8% (103,000 deaths / 1,760,000 cases) and across the whole world it is 6.2% (360,000 deaths / 5, 814,000 cases). So your 3.4-7% is looking pretty good!
Appreciate the note. I do agree with you, that IFR and CFR have been bandied about completely synonymously by the media. That said, if you read the data, they all talk about IFR. Everyone expects the CFR to drop massively as most people got Covid-19, and had no idea… Once you count a representative sample, those numbers drop too.
All four studies are indicating an IFR of .26-.34%:
The one in peer review (second link), points out that it is likely very conservative, and they have reason to believe their data shows Covid-19 is equal, or potentially less fatal than the common flu.
University of Bonn preprint (in English)
Most people say the flu has an IFR of .1-.13%. So, worst case we’re 3x as deadly, and more than likely 0-1x as deadly once more tests are done.
It’s, basically, in the ballpark of the flu.
The UConn medical report points that out.
It’s amazing to see it drop from what was predicted and shouted in scary speeches to the world – to what actual data is showing now.
It’s important to remember that it’s other people’s behavior, almost never our own, that spreads the Covy. Just ask the 66% of New Yorkers who contracted the virus while diligently staying at home isolated. So people who don’t care about travel will blame travel. Those who don’t like sports will insist that starting to play again will cause needless deaths. Those who like sitting at home eating pizza and watching Netflix while collecting a check will blame everyone who isn’t.
We all make excuses to justify whatever behavior we personally find acceptable. And when asked by others tend to omit the behaviors we fear being judged for.
In other words, lockdowns failed and will continue to fail because they don’t account for how people will actually behave rather than how they will claim to behave.
A virus with a 14 day max incubation is still thriving despite 60+ days of our fellow heroes sitting at home watching Netflix.
You can’t fight a battle like this hoping people will behave the way you want. You have to fight it based on how they’ll actually behave. And unless you start shooting people in the streets for failure to comply, lockdowns and travel bans will have limited value compared to their larger economic and social impact.
FYI- not a doctor, expert, scientist. Also not a Trump supporter. Personally can’t stand the Orange Menace. But a never-ending lockdown waiting for a vaccine that may never come is beyond stupid. And that seems to be the message from the Dems. If ever there was a time for a viable 3rd party, it’s now.
That’s really well said. Man, nothing to add to that.
There are many other considerations than the health (or convenience) of western travelers, and the European CDC hit the nail on the head. For many small nations with poor access to health care, complete border closure may be the only measure.
I was in Vanuatu in late February, just before the COVID shutdown. (I left about 2 days before the borders closed.) Vanuatu is a tribal society. The first line of health care defense is native healers. The second line of defense is the local hospital, which is about as well equipped as a U.S. urgent care facility. Patients requiring critical care are taken by air ambulance to Australia.
If COVID hit in that nation, its resources would be quickly overwhelmed. The people there believe it would be similar to the entry of the Christian missionaries in the early 1800’s, who brought measles and smallpox, and killed over 50% of the population when those diseases ravaged the country.
So, they have instituted a complete travel ban — no one in or out. So have several other South Pacific island countries. Vanuatu has had no COVID cases as of today. So far, it has worked. I wish them well, especially the wonderful people we met there.
This is why air travel between the USA and Europe will bounce back fairly quickly once the border restrictions are eased. There’s really no added risk opening this border. Airlines will also benefit from the cargo revenue. The economic problem will be a reduction in older travellers (who are likely to be more risk adverse, given how the virus mostly impacts seniors) and business travellers (whose employers are likely to be more risk adverse). In any event, I would think transatlantic traffic is down no more than 25% next winter. We’ll see.
@Steve – now your the one trying to change the numbers. Of course if you divide deaths by total TESTED cases than the percent looks like 3.4-7 percent. But the REALITY is that as many as 10x people have already had it or been exposed and not gone and got tested. In context that would mean more like 17 million people have had it and 100k have died. As the previous person pointed out, there’s numbers are more reminiscent of the flu.
Bottom line: can someone please point to a flu that caused 100,000 deaths in 2 months by infecting only ~5% of the population?
The spread of (probably politically-motivated) misinformation is amazing.
If travel isn’t a cause of spread, why did the U.S. “close” the border? Shouldn’t the U.S. reopen its borders immediately instead of extending closure to Brazil?
@Doug – Interesting that your condescending comment calls anyone who disagrees with you condescending. Kind of a “I can’t stand intolerant people” view.
“a continued pause on travel shuts the barn door after the horse is out.”
That might be true in the aggregate, but I am only worried about me. The horse has not left my barn. I’ve successfully avoided the virus these past three months, and I have no intention of putting myself at risk by hopping on an airplane and sitting next to a potential carrier of the virus.
I don’t mind people disagreeing but lately when someone does not agree they tend to call people that want to travel, all kind of names, and trashing everybody
If you do not want to travel it’s ok but calling those who want to names is not
This is why the new UK quarantine is silly as it is way too late as the virus is already rampant there. Australia and New Zealand have almost eliminated the virus with border controls that were very strict and done early enough which is great but the problem for those countries is that they will have to keep borders to most other nations closed for a very long time, limiting travel options.
Travel restrictions and lockdowns actually do work – twisting the narrative to suggest they don’t is just plain insanity. Sure they come at a cost. But they do work. All best wishes and good health from here in Australia, at this point in history, a very lucky country of folk who were / are mainly willing to put aside their selfishness for the good of the community and not brandish automatic weapons in threat of parliament buildings, with a national government that moved to put border controls in place early enough for it to make a difference, including an ongoing 14-day mandatory quarantine for everyone, with an egalitarian universal health care system, State premiers who are keeping their borders shut and enforcing social distancing rules, looking to open up travel ‘bubbles’ where people can go about their business without fear or favour once infection rates have ebbed, a generally cooperative position across national and state political leadership representing both major political sides in an uncharacteristically effective and refreshing politics of pragmatism. Many of our new cases are from the post-travel 14-day quarantine and thereby contained – any one of those could have bloomed into another festering cluster (akin the mess up with the Ruby Princess cruise liner). Just over 200 dead against 7,000 odd cases – an amazing result and excellent testament to the temperant of the people. Thank you ongoing border/ travel restrictions and lockdown / social distancing. Thank you to all of those who respected the safety of others and were perpared to moderate their behaviours for such. Please be safe. Please be well.
Scientist here. Not an epidemiologist, but with colleagues and friends who are world leaders in the field.
The consensus view emerging from all of the best work (e.g. the Berkeley study on excess mortality in Italy) is that the Covid-19 infection fatality rate is 0.5-0.8%. So it is probably about five times more deadly than seasonal influenza. What is not widely appreciated is that the infection rate is at least three times that of influenza. This means that when there is an outbreak, and without mitigation (e.g. distancing, masks, etc.), at least three times more people will be infected, and 15 times more people will die, And this is in addition to influenza, which already strains health care systems in many places during outbreaks.
However, and this is crucial, the IFR is very, very strongly dependent on age, much more so than influenza. For example, in the US, only about 2% of all deaths have been in people under age 44 and 80% of all deaths are in people age 75 or older. So only about 2000 of all US deaths from Covid-19 are in people before middle age, and many/most of them had significant risk factors (e.g. morbid obesity, hypertension, cancer). The best estimate is that people who are dying lose 10 years of life on average.
Now consider the economic carnage of the public health measures that have been taken worldwide. I am much less knowledgeable about these, but some things are clear. Over 40M people in the US have lost their jobs, which means that probably 100M total have lost their livelihoods, when their dependents are included. That number is over 1B worldwide. Millions of small business owners have not only lost their livelihoods, but their life savings and their dreams (and health insurance). The World Food Programme estimated that an additional 125M people will go hungry this year because of the global economic shutdown, the majority of them children. A very large (and very difficult to estimate) number of deaths and other negative health outcomes will result, again in mostly younger people. It will be a generational setback. It is very likely that the number of deaths from the economic disruption will exceed those of the disease, not to mention all of the additional misery.
So, taking off my science hat, I think that we need to grapple with the very difficult question of whether it is good public health policy to continue to lock down the world to reduce deaths of the oldest people and other vulnerable groups, when the public health costs alone of the shutdown are likely to exceed those of carrying on, with sensible measures to reduce spread and infection, and letting the disease run its course. I have immediate family members in high risk groups, but can not in good conscience support destroying the world economy and society to reduce their risk from this terrible disease.
Yes, it is terrifying and really sucks for people in high risk groups. However, I don’t see how we continue to discount the massive public and societal health effects of the restrictions, that will mostly affect those with a lot more (life) to lose.
I know that this is an unpopular opinion, but spare me the “you decide who dies then’ comments. The public health officials have already made that call.
@JohnyBoy. Well put.
A few glaring issues with your eugenics diatribe.
Firstly, the mortality rate may vary with the proportion of hospital admissions. A critical point is reached when hospitals become overwhelmed: quality of care provision declines, patients are co-housed rather than in separate rooms, risk of infection to health workers increases as viral load increases, increasing proportions of health workers run into elevated risk. Look st the country by country data.
Of course, you could avoid this by denying hospital care, for example, to people sick in nursing homes, like the UK Government “policy” and sit back and commit de facto manslaughter/murder (the Health legislation in the UK mandates equal care levels for all) on 10,000s of folk whilst exposing others needlessly to higher elevated risk levels. Nice one. In the Uk 2,000 plus nursing homes with rampant infections. Again younger staff put at risk.
So mortality rates may go up as infection rates blossom. This may help to explain the differential between mortality rates in countries whose hospital systems have and have not been swamped.
Secondly, whereas there are apparent correlations between so-called risk factors and mortality, where are proofs of causation? By way of example, why is hypertension a factor? Is it the hypertension itself or the widely prescribed anti-hypertensive drugs that may increase ACEII levels (the protein binder molecule for SARS-CoV-2 virus, which also is the angiotensin converter in our bodies) and thereby increase risk. Arguments on both sides on that one. Add to that, debates about smoking, diabetes, etc etc. Show me the science!
Thirdly, mortality may be related to viral load – higher exposure, increases risk of death, may help to explain the deaths of health workers outside of the demographic you want to effectively “ethanase”. If you let the virus blossom unfettered the viral loads in the community will explode as you trend back to the 3 day doubling exponential function.
Fourthly, your assumptions about mortality rate and the demographic that appears to be most at risk may not hold as the proportion of people infected in the community accelerates.
Fifthly, it’s not just about mortality, but also about the impact of the disease – how long sufferers are sick, unable to work / run their businesses, downstream health effects (unknown). These will also have economic and societal effects.
Sixthly, restrictions are not everlasting – if done properly (Australia, NZ, Taiwan, etc), you take control of the situation and set yourself back on the course of economic repatriation sooner rather than later.
Now do the thought experiment. Take off the brakes. Watch 3.5 million Americans die (based on your figures) and hope that the mortality rate doesn’t escalate to multiples of that. Potentially tens if not 100s million sick.
And who gets to decide who lives and dies in your model? And then where do you draw the line? And if this is acceptable for the coronavirus, why not extend the same logic across the spectrum – stop investing in healthcare for people of a certain age and demographic for other conditions – diabetes, sorry mate, no treatment; cancer, we don’t provide for than anymore. Smoker – nah – you’re a gonna mate. And then go the next step – sorry mate, you come from a marginalised subset of the population with low income in an area that doesn’t vote majority with the government of the day.
And on the issue of travel – why would anybody travel to the USA to spend their money when they know the country is overrun with death and disease, inability to access a hospital system since it is overrun? And why would a country with the virus under some level of control allow somebody from the USA come anywhere near them (without strict compulsory quarantine)?
If you control the virus to you can get back to business!
Unfortunately, some countries have lost control of the virus so subsume to the debate that the economy is more important than people.
(Also a scientist, not epidemiologist)
I can’t help wondering when the “true believers” will figure out they’ve been lied to about this scamdemic. Unfortunately, most will never admit it or even more scary, they’ll never realize it.
Most people are aware well and truly that they’ve been lied to from day one. Even the rusted-on conservatives, or at least those with more than a shred of decency, are losing faith in the band of hucksters in charge in DC. There is light at the end of the tunnel…
I think people are mislead to believe that we have to choose between economic prosperity vs. better (and hopefully near-complete) control of the outbreak. They actually go hand-in-hand. The economic disaster that we are experiencing, especially in the US, is mainly the consequences of poor outbreak management, which has magnified the situation (greater number of cases, greater number of deaths, greater numbers of those indirectly/directly affected by the outbreak, longer period of economic restriction).
Also, Gary really needs to stop cherry-picking random blogger garbage to make an argument to say re-start of international travel will not make this outbreak worse and make it last longer. His expertise is definitely not in this particular area of travel, and he should respect that fact. His blogs appear provocative/interesting, but to those with even a semblance of a clue, it is nonsense.
Platy responded just as I expected. Adding details regarding epidemiological patterns, none of which contradict the facts I provided and most of which I agree with, although not necessarily about their effects, while misrepresenting and totally ignoring the main point of my ‘personal’ comments.
With respect to your eugenics swipe, nothing could be further from the truth. In fact it is the current strategy that is the most deterministic and chooses favorites; protect the wealthy older people, mostly, at all cost. Those costs are borne largely by the world’s least privileged people, everywhere. Who is dying of the disease in the US? Mostly poor people of color, and this is not because of genetics. Step back from your privileged perch and think about it.
And I never said to let it spread unfettered, and I supported a limited pause to let the health care systems prepare and to learn more about the epidemiology. Now that we know a lot about how the virus spreads, though, and it is apparent that a lot of the ‘precautions ‘ are not very effective and come at huge costs.
And all of your examples of places that have controlled the virus, for now, are islands. Sorry ‘mate’, but no man is an island, and neither can their strategy work most places in the world, at least without massive authoritarian intervention.
It is so odd how normally sensible people who purport to be concerned with global social justice, refuse to look at the big picture on this. As a consequence, the world will suffer a generational setback.
Please name 1, just 1, Dem that supports shutting down the economy until there is a vaccine.
And now was acknowledged the presence of the Red Death. He had come like a thief in the night. And one by one dropped the revellers in the blood-bedewed halls of their revel, and died each in the despairing posture of his fall. And the life of the ebony clock went out with that of the last of the gay. And the flames of the tripods expired. And Darkness and Decay and the Red Death held illimitable dominion over all.
@Mb – you won’t find one, it’s a Hard Right ploy as they don’t have any answers and they are governing on borrowed time.
Heck, even the Senate may be in play right now…this could be an all time Blue Wave wipeout election at this rate. The Cheeto has all but given up at this point, basically planning for 2021 as a private citizen and ready to buy OANN.
UA-NYC remains one of the most disgusting posters on this blog. He never posts travel. Other Trump haters (“mind numbed robots”) sometimes make real interesting comments about travel. Instead, all he does is gone on a hate filled attacks against Trump and his supports. Moreover, it is clear, that UA-NYC is one Democrat who does not care about the suffering (read complete devastation) of the working people, like waitresses, busboys, cooks, nail salon, hair cutters, hotels, self employed, and so forth, as long as it gets Trump. I mean, real people. What a disgusting creep!
@OJS – go back to your Three Percenters / QAnon discussion on 4Chan or wherever trolls like that reside. I’ve been reading and commenting on this blog long before you and your light racist cronies came to this site, and I will be here long after you go back underground after November 3rd when your failed leader gets swamped in a Blue Wave. Will be nice to go back to “regular travel” discussions then.
TL; DR: Piss off you twat.
Australia, NZ, Taiwan are not authoritarian states. Whereas Australia is indeed an island nation, the containment strategy for the coronavirus included travel restrictions both between the states and locally: for example, restrictions to leave the house only for absolutely essential reasons (shopping for meds, groceries; care provisions; solo exercise). All of those would be relevant to a non-island nation. In any case, there are many examples of non-island nations who have managed to limit the infection and mortality.
The willingness of the people to forego otherwise assumed freedoms was balanced by the Government instituting a financial safety net to keep people afloat: unemployment payment rate doubled; companies paid a “JobKeeper” allowance; business paid out substantial cash offsets based on their year on year decline, etc.
Guess what. It worked. And far sooner than any of us expected (c. 8 weeks) restrictions are being relaxed as fast the government dares at the risk of a second wave. The economy can be kick-started. We can focus on our lives and livelihoods with a degree of confidence.
Of course, there are some countries where governments made misdirected or late calls. Unfortunately, the USA, UK, Brasil are amongst that list.
There is no halfway house dealing with this virus – you either go hard and pay the cost, or you let the virus spread through your community and pay a different cost. There are enough examples at hand now from around the world to make informed choices in how you want to handle the situation, bearing in mind that one infected person can pass the virus onto dozens of others at one event (known cases from nursing homes, wedding parties, restaurant meals, choir practices, etc., etc., all prove this to be the case).
If you are indeed concerned about global social justice, there might be salient lessons in terms of the relevance of universal health care, the merits of scientifically informed Government policy, the folly of political partisanship and ideology, and the balance between stakeholdership/community responsibility over the idealism of individual freedom, recognition of international social licence, etc.
On these matters, there couldn’t be a starker divide in how Australia and the USA (or the UK for that matter) have faced the crisis. Unfortunately, and very tragically, the data speak for themselves.
Ironically, the Government here now finding they had over-estimated the cost of provision for the safety net for businesses.
Australia is now quickly re-opening for business with the virus (mostly) contained. However, international travel will remain restricted to enable that to happen; state borders will re-open shortly.
Ultimately, this is a health crisis. The economic crisis is an output of that. Fix the cause, rather than wallpaper the symptom.
We doctors in Australia and New Zealand are the only people qualified to answer this: the Europeans and Americans have messed this up totally.
And this article references an organisation which is justifying its own failure.
Aggressive social distancing and lockdown for 6 weeks basically extinguishes this and any other virus. And keeping closed borders stops new cases getting in and seeding.
Every flight from New York to London even now brings in more cases and kills more people. Every single one. No exceptions.
The idiots referenced in this article who say “it’s already there” fail to understand that new people get infected and killed by each arriving flight.
I repeat, no-one in Europe or the USA is qualified to claim expertise on this topic. They are all Failed States in Coronavirus terms. We had it earlier than they did and we controlled it with a textbook Pandemic response, including using Mandatory Policed Hotel Quarantine for Returned Travellers as modern day leper colonies.
And surprise surprise, the tried and tested methods still work.
And please, no more of the Fake News “Australia is an Island with low population density”.
85% of us live in towns and cities – higher than the USA. We have international flights to every major city.
Yet we have fewer cases and less deaths than Nebraska. We have 25 million people and Nebraska has 2 million.
The USA taught the world how to manage pandemics. And those of us who follow those guidelines thrive, while the EU, UK and USA thought and think they can cut corners. And it doesn’t work.
Stop air travel completely.
Quarantine returned travellers and enforce it – not at home.
Test 1-2% of the population daily.
Contact trace every positive case.
It is too bad that you adopt such a self-righteous and condescending approach in your posts, since you are apparently a knowledgeable person. I suspect it is because you are in a vulnerable group and view this debate as a matter of life or death (which is understandable).
Yes, the socio-political issues you raise are critical in determining patterns of global social justice, and also come in to play in how the effects of the pandemic will be distributed. That is not the point. We do not have a world government and can not fix them all. Even if we did and could, it would not be in the time frame relevant to the current pandemic.
No, it is not the case that there are only two extremes in how to deal with the pandemic – total lockdown or unfettered spread- and I vigorously disagree that there are not intermediate strategies that will produce a better public health outcome….if we are willing to consider all of the relevant factors, and not just the ones that we can easily count in the ICUs and ERs of our health care facilities (or excess mortality or however else you want to measure Covid-19 impacts).
Neither of the two extremes that you mention are even close to an optimal strategy from a global, or even a national (for the US), public health strategy, particularly when you take into account the different life expectancies of those killed by the disease and those killed by the effects of the response to the disease. And we will all soon see this, since national and local responses will continue to be all over the place, so it doesn’t matter what we think. That said, I don’t think that we disagree about whether a short initial lockdown was prudent, as I have stated above, particularly given the uncertainty in the biology of the virus and etiology of the disease.
Following your lead, let’s do a thought experiment. If the entire world populace was infected with the virus and general patterns of IFR hold (although the age distribution in places where it has been well studied is substantially older than the global population), then using the highest estimate I have seen, 1%, 70M would die. The mortality associated with the projected increase in those that will suffer from famine (125M people) from C-19 alone may approach that number, if half of them eventually die. In total number of years of life lost, the indirect effects of the global shutdown will be several times that of the disease itself.
And the other people that experience famine and do not die will experience life-long health consequences from their near-starvation.
That does not even include the massive additional mortality and morbidity associated with the shutdowns, including those related to depression, decreased activity, lose of health insurance, homelessness, etc. Do the background reading. That these costs will occur is not debatable.
Yes, it is a health issue, or rather lots of them. Focus on just one, and only the privileged fare well. Consider the big picture, and the entire world fares better.
And on a personal note, in the many instances in the world where health care is already and will be rationed, heck yeah, smokers should be lower priority than folks that don’t smoke, as should people over 75, relative to a young mother. Call me a Darwinist or whatever you want.
Educate people, reduce spread by testing-tracing-isolating, preemptively isolate the most vulnerable (if they so desire), prepare health care resources to the greatest extent possible, open up local and global commerce now, and get down off the virtuous, self-serving high horse and ask the difficult questions.
And yes, all three of those places (Oz, NZ, Taiwan) are still island nations, not just the one you discuss.
One of the best crafted responses I saw in a long time and I could not agree more
And like you, say, most privileged people do not care about collaterals
Here in canada all the white canadian sheep are calling for no tourism until there is a vaccine and they cheer at 7 pm every night, but of course they are not affected financially although here in vancouver homeless are taking over the abandoned dowmtown
It is difficult to change the mind of the privileged
Please refer to the two posts from DavidF above.
The solution to control the virus is known, tested, proven. It is not limited to island nations. You know that it works. You either get on board or you don’t. It matters not whether you regard such as extreme. Apply the solution and you can fix the real issue in a relatively short time frame and limit the economic cost.
As indicated in previous post, it’s the business of good governance to control the economic fall-out and otherwise manage the consequences of the “shut down”: thus in Australia extra attention on mental health, encouragement for folk to maintain their testing/treatments for existing conditions, etc., in addition to the economic interventions.
Obviously, the more you let the situation run away from you, the harder, longer and more costly it then becomes to take back control.
In those countries where matters have gotten out of control, it hasn’t been because the lockdown strategy is wrong – rather the incompetence of the execution.
Just remember that until you know the underlying causes of the apparent correlations between mortality and correlated factor, you are risking your “unnatural selection” deciding who lives and dies on the basis of presumption that the correlated risk factor is the actual determinant, let alone any ethical considerations. (And that has little to do with “Darwinism” if you are effectively allowing the virus to euthanise anyone over breeding age).
FWIW I’m not in a “vulnerable” group directly in terms of the virus. Just happy to take on my share of the financial hit from the “shutdown” for the good of the community and take on board the passing inconvenience of having to defer my upcoming July travel to LA and S. America for another time.
Australia and New Zealand are Island nations, but so is the UK! Unlike Wisconsin or Alabama it means we had flight arrivals from Wuhan and Milan (via Dubai).
If you look at Australia, we minimised spread by closing state borders, and it worked perfectly.
A remote landlocked state like Nebraska with a tiny population should have been easy to secure, yet it has 20 times the infection rate and 30 times the mortality rate of Australia. Yet by American standards it is considered a success story!
There is an underlying reason why the US and UK have failed so badly with Coronavirus. In most western countries the majority of the workforce is on a permanent contract with paid sick leave. But in the US and UK if you can’t work you don’t get paid in most cases…..and will go to work while infectious.
You have effectively built an economy which cannot withstand a pandemic, especially the next two years without a vaccine.
One question, and not being sarcastic
What about the hairdresser or the waiter or the cab driver
Are they also benefiting from paid sick leave?
I know you guys have better economic safety nets but aren’t there jobs where if you don’t work you don’t get paid?
I think that there is no doubt that Australia and NZ have done a better job containing the virus than most other countries.However, it is also at least partly due to being an island nation with only a few ports of entry that could be tightly controlled.
The UK is not a fair comparison, because not only is it an international hub with a much higher number of international arrivals than AU and NZ, but it is not really an island, or even a nation with respect to border control (EU rules, although that is changing). There is also a train line that brings people directly from multiple big urban areas to Central London many times a day with no screening. And there is also the clownish PM who was urging people to go to the pub just a few days before he almost died from a C-19 infection….
I completely agree that preventive measures can make a big difference in the outcomes. My city/area has an extremely low number of cases and deaths both in absolute terms and per capita, on par with almost any other connected community in the world (we are a one hour drive from 5M people and a tourist draw). This outcome is due to an early lockdown, a wealthy and privileged population who could mostly isolate without even bigger immediate consequences, and an educated population who both understood the rules and followed them strictly (and self righteously), while publicly shaming those who didn’t.
And “I” have not built any economy, but the US economy is indeed a house of cards, as are those of most of the globalized nations of the world, of which AU is one, to some extent. Just yesterday, I had a work meeting with colleagues from NZ and Finland, with a Zoom background of my last trip to Queensland, and talked about our work with people in Argentina.
That is not going to stop, although it will slow down for a while, so we need to come up with other ways to deal with the pandemic that don’t require pre-industrial age levels of movement and migration.
And waiting for a vaccine is not good policy, since there is no guarantee of when, or even if, a virus will be available. We have been trying to develop a vaccine for another RNA virus, HIV, for several decades.
And, if I understood correctly that you are a physician, thank you for your service and best wishes in avoiding infection.
Today Greece announced which countries’ citizens can visit this summer – with the UK and US conspicuously excluded.
Meanwhile we learn that the proposed Australia New Zealand travel bubble may well incorporate countries as far away as Israel and Costa Rica.
The world has become a two tier location for travel.
Those countries which locked down aggressively and squashed the virus for now are reopening for pretty much life as normal.
While places like the US and UK haven’t ended community transmission but are reopening anyway, which is wildly irresponsible. They don’t have a plan, other than to deny reality and dream that it will go away.
And so now people from those failing countries find themselves in effect as second class citizens of the world, banned from visiting those countries which handled this pandemic the way we had been taught long ago by the Americans.
It’s so sad for those of us who love the UK and the USA. The people who cite “freedom” as the reason for ending lockdown before ending community transmission are effectively confined to their own country because we can’t afford the risk of letting them bring the virus to the rest of us.
As above, I don’t think that we disagree about the value of the initial strategy for trying to control the spread of the novel coronavirus, to give us time to understand the pandemic and prepare, since it is a novel pathogen in humans. That is the key. In the face of huge uncertainty, an excess of precaution is indeed good policy.
What I have been discussing all along is mostly the way forward, and how I think it needs to change fast, to limit the collateral damage to massive, instead of catastrophic. Thankfully, most leaders agree with this, so are doing what they can to open things back up again as quickly as possible. Let’s all hope that they do it with good pandemic control practices (test, trace, isolate) in place.
Where we disagree, apparently, is in several areas.
First, an aspirational lockdown strategy such as what you support is just not possible in many parts of the world, for many reasons.
There is not anywhere close to enough governmental control or resources to make it happen in many countries, or parts of countries. I have been on every continent and lived for years outside of the US, so am not just speculating.
More importantly, the populace can just not survive with a lock down of the type that I have been experiencing for the last almost three months. Look at what has happened in India.
At least you acknowledge that you are among an elite, privileged and tiny minority in the world who can just ‘take your share of the financial hit’ for the greater good.
WRT your comments on correlation vs causation, we have a pretty clear picture of why the people who die from the novel coronavirus do so in higher numbers than those who don’t,. The assertion that we shouldn’t base policy on overwhelmingly clear patterns with huge samples sizes that are mostly consistent across cultures, ancestry groups and socioeconomic conditions, is absurd, particularly when you also take in to account the life expectancy issue I raise above.
And yes, I understand how Darwinian evolution works and how mortality in post-reproductives is not (generally) a driver in natural selection. I was referring to the ‘Social Darwinism’ movement, and the charge that some have made that it applies to rationing health care to prioritize people who are likely to benefit from it the most.
Most importantly though, is that we seem to disagree about the very nature of the issue. You claim that I am advocating ‘unnatural selection’. In fact, any public health intervention is inherently ‘unnatural’ selection, but some strategies will have more equitable and effective outcomes than others.
True natural selection means no intervention, letting the virus run its course, reducing average age and life expectancy, and eventually building up immunity in humans. Maybe that is what you are advocating, but it doesn’t seem like it.
Again come down off your privileged high horse, and think about how the world actually works and ask the hard questions, instead of signalling virtue and opining about how things should be. And if they aren’t, then the masses be damned. They should have ‘chosen’ better governance.
The safety net is quite generous, but not perfect.
Anyone (permanent resident) who is not working qualifies for an unemployment payment of about AUD525 per week – the usual benefit has been substantially increased as part of the economic response to COVID-19 mitigation measures. The usual “mutual obligation” for unemployment recipients to be actively looking for a job has been relaxed. The government calls this JobSeeker.
Businesses qualify for payments (technically tax offsets) where their tax returns document a reduction in turnover – for example, small businesses are getting AUD20,000.
In addition, businesses can nominate employees and receive an AUD1500 per fortnight payment to be passed onto the employee. In some cases, employees are now receiving more money than they used to earn! This is called JobKeeper.
So if you don’t get the JobKeeper you get can apply for the JobSeeker.
Some inconsistencies inevitably arise. Causal workers don’t qualify for JobKeeper. Temporary residents (we have a lot of foreign students for example with an extensive education sector).
Banks are allowing people to defer their mortgage payments for 6 months.
People are allowed to access up to AUD20,000 from their pension funds (in Australia employers must 9.5% salary into a private pension fund).
Cafes etc have been open for takeaways and now may be open for up to 10 (or more) depending on local state restrictions.
All of my local cafes and restaurants have survived.
The government support initially assigned for a 6 month period although there are moves to limit that now.
So quite generous for most and possibly why we aren’t getting such a great kick-back compared with some other places.
If we can limit travel to my regional area in North Queensland, we could all support the local hotels, cafes and restaurants and etc up a travel bubble with direct flights to NZ!
Quite possibly if you were sitting in a country where the interventions have been a success (to date), rather than only partially successful, you might have a different position. Perhaps not. I regard our position to be lucky (rather than privileged) and I have acknowledged key differences between, say, Australia and the USA – a success story and a disaster. I have also made it clear the health care intervention (“lockdown”) needs to be partnered with an economic support policy – for poorer countries, I would advocate for appropriate global financial aid.
Non-wealthy nations local to Australia (Pacific) have also been in lockdown (French Polynesia for example now just coming out of lockdown). They may even become part of an Australia – NZ – Pacific travel bubble.
The lockdown strategy has not been “aspirational” here: it has been pragmatic and successful.
I haven’t looked at the literature for a couple of weeks, but the last time I did look, the good folk in medical circles were still trying to determine the mechanisms (triggers for Cytokine Storm Syndrome, patterns of blood clotting, etc). Maybe that’s changed.
I’m challenging your presumption of assigning somebody a right to decide who lives or dies – especially when you are relying on “pattern” (correlation) not process (causation). IMO a “rich” country like the USA shouldn’t be entertaining such. But that’s just my opinion.
The Australian Prime Minister has made a clear statement that the option not to “lockdown” would lead to unacceptable mortality in the country.
I realised you were only using the term Darwinian casually / flippantly.
FWIW my wife’s close friend barely survived the virus in New Jersey, my best friend’s work colleague similarly in Moscow, we have “poor” family relatives in “non-privileged” locations in both S. America and USA, my wife has a job in care that puts her at potential risk with no PPE supplied (or would have been very risky if the virus had spread in my home town): my wife’s own work was initially cut back by 90%, but luckily bounced back quickly. Our local hospital has 22 ICU beds for a catchment of 250,000 odd – if the virus had spread here we would have been in the deep. Thank goodness our national and state governments acted when they did and we have an excellent health system and medical personnel to back up the community.