Canberra – The guidance from the World Health Organization on non-pharmaceutical interventions (NPIs) was published last October based on the “latest scientific literature.” Border screenings and closures, internal travel restrictions, quarantine of exposed individuals and contact tracing were explicitly “not recommended in any circumstances.”
Last month, a study of 50 countries in the top medical journal Lancet confirmed most of this. COVID-19 mortality correlates more with obesity rates than lockdowns, while movement restrictions and border closures lowered cases without saving lives. Dr. Maria Van Kerkhove, head of the WHO’s emerging diseases unit, advises against reimposing national lockdowns owing to health, social and economic downsides. Is this an implicit admission lockdowns were wrong in the first place?
The pandemic was initially declared with little existing science based knowledge of its emergence, growth, curve and retreat. Panicked governments imposed hard lockdowns in a cascading rush, forcing people to live virtually in a state of terror. By definition a pandemic is an international problem yet countries have responded with border closures “to protect my country” or, even more absurdly, “my state.” After examining weekly mortality rates from 24 European countries in the first halves of 2017-2020, Christian Bjornskov found no clear association between lockdown policies and mortality development.
The confusion is evident in divergent and contradictory messaging among countries and the WHO on hydroxychloroquine, school closures and non-surgical masks, which in communitarian-minded East Asia are mostly used by the sick to avoid infecting others, not by the healthy as a prophylactic. They’ve not been proven effective for prevention, are a potential health hazard that can cause serious harm to healthy individuals, and are best used when social distancing is not possible. Yet they are mandatory in a number of countries.
Epidemiologists and experts have been sharply divided over the coronavirus curve, the utility of different control measures, and the collateral damage to other public health, economic and liberal goals that represent the social purpose of the state. Too many Western governments privileged abstract mathematical modeling over actual science based on observational data. The initial explanation was the need to flatten the infection curve to protect the health systems from being overwhelmed. The logic was not to avoid the virus but to slow down its spread over many more weeks and months. This would then help to manage the disease and keep the numbers requiring hospitalization and intensive care within the capacity of health systems to cope.
“Mission creep” is familiar to conflict analysts. It has infected United Nations peace operations, NATO expansion and multilateral operations like Libya in 2011, all with unhappy consequences. The mission creep from flattening the curve to eradicating COVID-19 has been equally ill-conceived and calamitous. The initial goal was reasonable and realistic; the obsession with elimination is not. To ensure compliance from increasingly skeptical and resentful people, the focus has shifted from very low mortality to rising infections in allegedly devastating second waves.
Imagine, if you will, a disease so vicious that millions who are asymptomatic must be tested to know if they’ve had it. COVID-19’s lethality doesn’t compare to the Spanish flu of 1918–19. Scaled up to today’s global population, that would translate to 250 million dead. Our health systems are infinitely better compared to a century ago. Yet authorities did not close down whole societies and economies in 1918. The state did not enter into homes to tell people how to live, who and how many to meet, when, where, and what they could shop for, and which businesses could operate under what conditions.
The global death toll from COVID-19 is around 700,000, making it the 20th deadliest killer on annual statistics. Fourteen causes kill over a million annually. The top killer is coronary heart disease with 9.5 million deaths; influenza and pneumonia kill three million. Screening and treatment for many deadlier illnesses have been deferred because of the obsession with COVID-19. In Australia the average daily death toll from all causes is 432; the total COVID-19 fatalities on Aug. 5 was 255. For that people’s lives, livelihoods, education and freedoms have suffered massively. Melbourne is effectively under martial law masquerading as medical law.
This is public policy insanity. As argued earlier, “coronaphobia” will kill many more than the coronavirus. Almost everywhere, massive harm from lockdowns is easier to document than net public health gains. Project Fear posits a false choice between tough lockdowns and doing nothing. A whole range of calibrated interventions is available. A rational strategy for tackling the virus while learning to live with it would have six components.
First, put in place strong international border checks with prepositioned and pre-approved equipment and procedures for screening passenger traffic at air and sea ports on short notice. Design institutions and procedures that can be activated swiftly and efficiently.
Second, isolate and quarantine the sick. For the first time in history, countries have bizarrely chosen to put entire healthy populations under house arrest. In the United States, more people have died from suicide and drug overdoses than COVID-19, according to Dr. Robert Redfield, the director of the U.S. Centers for Disease Control and Prevention. An official government report estimated 200,000 people could die from the impact of lockdown in the United Kingdom, including an extra 35,000 cancer victims because of missed screenings.
Third, protect the vulnerable with adequate stocks of protective, preventive and therapeutic equipment, and supplies for front-line health workers and the seriously ill patients, a surge capacity to break the bottlenecks when necessary, and the right balance between national manufacturing capacity and diversified global supply lines. The smart strategy for an epidemic that is strikingly age and gender stratified is a targeted approach. Overweight men over 80 are the most and fit young people the least at risk. For the under 19s, the threat is lower than the risk of being struck by lightning.
Fourth, monitor hospitalization and ICU occupancy to stop the health system from capsizing. If infections rise, but hospitalizations and deaths fall, as is happening in Europe, resistance has spread in the general population. “Herd immunity” describes the proportion of the population that needs to be immune to prevent a disease from spreading. The strategy protects vulnerable people from dying by letting the less vulnerable bear the burden of disease while quarantining the sick and locking down care homes.
Fifth, treat people as adults. Give them the scientific guidance on hygiene and social distancing. Transfer the burden of risk back to individuals for assessing the dangers to themselves and the appropriate preventive measures and practices.
Finally, ignore the modelers. Their credibility has been shredded. Professor Karol Sikora, chief medical officer at Rutherford Health in the U.K., refers disparagingly to “epidemiologists of a rather pessimistic stripe” whose “science tracks epidemics and models worst-case scenarios.”
Ramesh Thakur is an emeritus professor at the Crawford School of Public Policy, The Australian National University.
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