Wednesday 4 March 2020

The flu normal?

Over at Newsroom (drafted before the first case here was confirmed), I worry about what happens if Covid-19 isn't a one-off but a new normal with a regular season, like the flu season, that comes each year.

Policy designed around a one-off might be different than policy designed around something that will recur annually and that will require annual preventative measures.

In both cases, measures to reduce the peak load will save a lot of lives: New Zealand's health system is too easily swamped if the peak is high.

But if travel restrictions, and likely school closures, and likely regional quarantines, and likely work stoppages - if all of that has to happen every year, rather than just as a one-off, you're pretty quickly reducing the benefit side of the calculus.
Imagine that Covid-19 is a one-off. Those who’d catch it would be immune forever, the vaccine under development will be deployed broadly by the middle of next year, and if we just hunker down for a while we could all take a really big economic hit – but eventually it would be over.

In that situation, strict quarantines, school closures and even internal travel restrictions might make sense. The costs would be borne once, but the benefits of protecting people from the virus would extend over a long period. Temporary quarantine clinics for those with milder cases could be established. Elective surgery could be delayed until the crisis had passed as the hospitals in affected areas would be overwhelmed and staff may need to rotate in from other regions to help share the load.

If about 5 percent of cases wind up in the Intensive Care Unit, Wellington Hospital’s 29 ICU beds would serve only Covid-19 cases if 600 people in the region caught it. And remember, Italy went from 16 confirmed cases in Lombardy on February 21, to 60 cases the next day, to 400 cases on the 26th.

The costs in the short term would be severe. In addition to the obvious difficulties facing the health system and the human tragedy of deaths and severe illness, tourism would collapse, regions dependent on tourism would falter, businesses would struggle with loss of staff when schools are closed along with loss of access to critical materials and affected universities would likely demand hefty bailouts.

But the threat would pass. The country could wear the short-term costs because the benefits would be substantial. If 2 percent of those catching the disease die and if every adult is susceptible, preventing it from spreading everywhere has enormous value.

For every million people protected against catching Covid-19, 20,000 lives would be saved. And if you will forgive an economist for being gauche enough to put a dollar value on that, that’s about $87 billion, using standard New Zealand figures. A proper accounting would reduce the figure somewhat because of the age profile of those most affected by Covid-19, but even very costly measures can be justified on that kind of accounting.

This would change if Covid-19 instead is the flu normal. This week, James Hamblin warned in The Atlantic that epidemiologists are starting to see it as a fifth “endemic” coronavirus. Just as we have cold and flu seasons now, we could have a Covid-19 season.

Future waves would likely be less fatal, as those most susceptible would tragically have died in earlier waves. But it would mean that measures taken this year would need to be repeated again, and again, and again.
Measures that would make a lot of sense if they are seen as saving 20,000 lives full-stop would perhaps make less sense if they save 20,000 lives for a year, and then need to be repeated. If Hamblin is right about the flu normal, the response might need to be different.
I am really rather amazed that we have not yet had a real outbreak here. I had expected that at least one case would have made it in ahead of, or despite, the travel ban. If that case was a mild one, as most are, it would be chalked up as just a normal cold. It would spread and not be noticed until a more serious case showed up at hospital.

The ban has been in place almost a month. Symptoms normally come up within a week; 21 days at an outside edge (with rare cases beyond that). There could be cases of NZ citizens or residents coming home with it and that kind of scenario still playing out from it. But either nobody came in ahead of the ban that was infected, or they've not passed it on, or any cases that have passed on have been mild.

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