It’s not just the numbers

None of us are getting off this planet alive. We’ve all got to go sometime. But are all deaths equal?

You might die peacefully, medicated, surrounded by loved ones. Or instantly in a head-on collision. Or spend your last 24 hours suffering unthinkable degradation and pain at the hands of serial killer Ivan Milat, or burnt alive in a cage by ISIS.

Contemplating these fates for yourself or your loved ones, it’s obvious a death is not just a death.

How about succumbing to Covid19, in an intensive care unit, medicated and if not comfortable, then not in agony, albeit without your family. Alternatively, you could go very painfully, on the street outside the hospital, along with hundreds of others, among the stench of those who’ve already expired. And, perhaps, dying when you would not have had an intensive care unit bed been available.

This prospect, rather than the raw numbers, is driving countries around the world in their responses to the corona virus.

Months ago I was among those who reckoned this was a lot of fuss about little, breezily contemplating in late February, on that website of record Twitter , the prospect of 25 thousand deaths, on top of Australia’s usual 160 thousand or so, as a statistical speed hump.

And some much more eminent than me, such as Ross Gittens, expressed similar sentiments.

Yet today most of us are accepting this economic deep freeze produced by heavy government restrictions, to keep deaths much far below that. Why?

Those earlier calculations weren’t necessarily wrong. What has changed?

For me at least, the penny dropped that most of that 25 thousand (or whatever) would not be spread in an orderly fashion over a year, meeting their maker peacefully, but over a nightmarishly awful several weeks at the peak of the curve. Those scenes from northern Italy, but much much worse. Tens of thousands suffering terribly, and unlike with the 400-odd who on a normal average day leave this coil, out of sight and mind for 95 per cent of us, we all would be bearing witness.

Perhaps 25 thousand was too low. Estimates of what would be required to achieve “herd immunity” vary, but the top end seems to be around 150 thousand, which you get by taking 60 per cent (a stab at the infected proportion required) of our 25 million population and dividing that by 100 (because the death rate is about 1 per cent). In theory you could do it with fewer deaths by protecting the vulnerable. On the other hand, the overloaded health system would push it the other way.

Still, some of those continuing to push herd immunity have a point.

No, not the weirdos who cite the current low death toll as evidence that the government has overreacted. Using that logic we could conclude that because fatalities from skydiving are so rare, parachutes have been a waste of time.

But most public policy involves trade-offs. If, for example, we truly wanted to slash the 1,000 or so annual car crash deaths, we would just put in place a very low flat speed limit, say 20 km per hour. Or simply ban cars. But the social and economic repercussions are not worth it.

Technocrats apparently put a roughly $5 million tag on avoiding a death when formulating policy, although the figure is lower for elderly people.  Applying $5 million to our 150 thousand deaths gives $750 billion. Aggregating extra government spending and depleted GDP from our responses might or might not get us to this number, depending in part on how long it takes to recover economically. If we slot in $2.5 million instead, because of the high age of prospective fatalities, then saving those lives at all this expense definitely does not pass the cost benefit analysis.

And that’s without taking into account the deaths and misery from suicide and domestic violence that our response will cause.

Economist Paul Frijters believes aiming for herd immunity is justified purely in death numbers alone, estimating deaths that result from the economic downturn.

But none of those who stoically volunteer themselves, or their parent, to take a bullet for society seem to contemplate the reality that the death would very likely be a terrible one, along the lines described above, and in many cases unnecessary, in the sense that they would have lived had the health system not been overloaded. And that because all the beds are used, their other parent is more likely to die from another ailment.

With bodies clogging up the roads outside hospitals. No government, no society, would deliberately engineer such a scenario. That’s why attempting to achieve herd immunity is out of the question.

Every estimate I’ve seen of the length of time it would take to get to herd immunity without overwhelming the health system puts it at years. It can’t be done quickly without that unspeakable carnage. And keeping the numbers of infections down to that acceptable level would still involve restrictions (and quite a balancing act), and it’s not clear they’d be much more liberal than the ones we’re currently labouring under. And in one or two years we will probably have a vaccine anyway. Maybe we won’t. But nor is there a guarantee that immunity is achievable, or lasts very long.

Does our government’s, and most governments’, response to the corona virus pass a clinical utilitarian test? Only if quality of death, and societal trauma from witnessing the outcome of our handiwork under the herd immunity strategy, is taken into account. Can they put a dollar value on that?