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Life and death restarting the Australian economy

[This article uses data current as at 8 April 2020. The COVID-19 issue is moving so fast that the article’s relevance may change with circumstances. Some principles will prevail which might guide a risk-managed return-to-work strategy.]

Australia needs to get back-to-work. The tricky part is how to go about it. For example, the Government has enforced a 14-day quarantining of all arrivals and overseas travel is banned (with some special exceptions). These two provisions need to continue until all major foreign countries have minimal active cases of COVID-19. We must not be intimidated into stopping this too early by airline and travel lobbies. The major source of our cases so far is contact made outside Australia by returning travellers. We do not need the arrival of people to keep our economy going.

Strength of our health system

Having isolated the older population of people over 70, we should have some confidence that our unique universal health care system can build extra capacity and allow a risk-managed return-to-work strategy. This is subject to giving top priority to looking after our health care workforce and ICU and ventilator capacity. The Government appears to be well on the way to achieving this.

The ‘flatten the curve of cases’ has been a simplistic strategy to show the initial largely imported cases have been accommodated. The future course of locally-transmitted cases, however, remains a big unknown. It will probably take building a model of the virus in action in an isolated region to determine its characteristics in a typical Australian flu season.

Overseas experience in the UK and Italy almost certainly indicates a high level local transmission although data is not yet available. I have therefore focused on death numbers to imply the level of stress on health systems. Proportionate to these death numbers will be the much larger numbers (possibly 3 to 5 times) of admissions to hospitals, some of whom will have already recovered and majority of whom may still be in care.

Table 1 below presents the latest data available (as at 8 April 2020) on the age distribution and other statistics of deaths in Australia, United Kingdom and Italy. It highlights the nature of the virus in other regions and small amount of data that we have to judge Australia's circumstances.

Some observations on the figures are:

  • The percentage concentration of deaths in the over 70 age groups and the rationale for over 70s isolation is self-evident.
  • The distribution of deaths in UK and Italy extend down into more younger age groups than Australia has experienced to date. A possible explanation is the number of the Australian deaths related to cruise ships and returning overseas travellers, who are often retirees. This suggests we need to build a database of the population with respiratory system risks (particularly under age 70) from a range of sources (Medicare claims, eHealth etc.).
  • The numbers on the right-hand side show the deaths from COVID-19 as a percentage of 'normal' deaths which could be expected to occur (using for simplicity of calculation, Australian Life tables). Thus normal deaths plus COVID-19 deaths indicates the extra pressure on health system on average over the period.
  • The more exceptional case of health system peak stress might be indicated by peak daily deaths (to date) relative to ‘normal’ daily deaths. This is shown in the table below.

The back-to-work strategy

The top epidemiologists in Australia are well aware of the risk of Australian  transmissions breaking out to extreme levels as displayed in the UK and Italy, if current restrictions in place are released. The Government is being advised by the Doherty Institute. The Director of the Institute, Professor Jodie McVernon, is (based on seeing her in forums) a very experienced epidemiologist with a clear awareness of risk of such a breakout and able to communicate advice forcefully.

A back-to-work strategy must be carefully risk-managed based on advice from expert epidemiologists. We also need to consider the human health risks of people currently staring at screens at home and in isolation and the businesses that are shut down.

First, the small business sector is the major employer of people of all ages in our communities. These people take greater financial and personal risks than most corporations contemplate. They mortgage their houses to obtain capital, and must survive in industries with failure rates of 40% or more in the first five years. An enforced government shut down for six months may mean that when they start trading again, half their clients have gone or will be severaly strapped for cash. The health stress here extends to family and future life prospects and needs consideration.

Second, another imperative to get people back to work is social. Many people derive their main social satisfaction from work mates and customers. Sadly, some men and women find time at work is an escape from relationship tensions in the home. This extends to concern about domestic violence risk.

Third, adolescent and young adults at high school and university face mental health issues which can quickly become catastrophic. The lack of social groups and peer support will be an increasing health risk.

The back to work strategy is therefore a judgement between, on the one hand, confidence of epidemiologists in the future behaviour of the virus in Australia versus the concern for population health of the unemployed and socially excluded. The limit of financial budget support is the time pressure to put the best minds available into action advising government.

The population needs to trust the difficult government decisions and balancing act.

Possible principles and frameworks for a risk-managed return-to-work and school

To allow (almost) everyone to go back-to-work and school will need a clear communication programme which enforces a reframed approach to isolation, risk management and social behaviour. This Includes the rational segregation of high-risk people who need continued isolation, operating as follows:

  • Isolation to be required for all people over the age 70 (with extra social support) and anyone suspected of having COVID-19 and awaiting test results.
  • Isolation to be required for all people (and school children and teachers) with significant comorbidity conditions (particularly respiratory) who have been shown to be in high-risk conditions associated with coronavirus. There may need to be some ‘conscientious objector’ isolation provisions for teachers who feel uncomfortable returning to classrooms.

With this in place, businesses would be allowed back-to-work and workplace social distancing requirements could be made case-specific or generally slightly relaxed. A permanent reminder on washing hands and encouraging people to stay away from others (and absent from work) if they get a cold or flu would ne required.

Some lateral thinking might be needed, such as for workforce segments which do not have a current open workplace. Converting foreign students to online courses and making them resident back home would take pressure off local casual employment options.

Like the engineers who stayed in the Fukashima reactor to stabilise it, it may take a brave, isolated region of Australia to take the first step so epidemiologists can learn from this before a major city attempts a back-to-work strategy.

 

Bruce Gregor is a Demographer and Actuary, and Founder of Financial Demographics. This article is general information only and does not consider the circumstances of any investor.

 

13 Comments
Bruce Gregor
April 20, 2020

Hi John from Adelaide
Only fair I should share the basis of my recommendation re Adelaide - see the data I referred to here http://drive.google.com/file/d/118odWflMZRInPKnI4LLYnQYAoxDP0LxK/view?usp=sharing It is also an interesting reference point for number of Covid cases (now) versus flu in 2015 - see weekly graphs on first page.
cheers
Bruce

AlanB
April 16, 2020

Flattening the curve means extending the time over which the population gets infected so as not to overwhelm the health system at any one point.
It does not mean trying to eliminate all infection, only to manage it through delay.
The only way infection is eliminated is for the whole population to remain in complete isolation forever, or until an effective vaccine is developed.
As no vaccine is imminent, assume the whole population is likely to be infected with this virus, just as with other viruses.
When that happens the vast majority of the population will be only mildly affected, with a higher death rate for the elderly and those with a pre-existing medical condition. That has been prior experience.
It is therefore irrational to destroy the economy and remove the civil liberties of the whole population in a futile attempt to prevent the vast majority of the population being afflicted with mild symptoms of a flu-type virus, which will reoccur in the future, as often as it has in the past.
It is also wrong to assign the same risk factor to Australia as UK/Italy because our age structure and living conditions are more favourable to containment.
The suggestion in the article that "Isolation to be required for all people over the age 70" is neither rational or humane.

Bruce Gregor
April 18, 2020

Hi Alan
You have highlighted that my article did not make clear my intention for how long the isolation if over 70s and vulnerable should last. My intention is that as the epidemiologists develop confidence in the local data model of transmission, within the safe tolerance of health system capacity, isolation would be relaxed. My expectation is that this would require an early experience of flu season in a small location so the observance of Covid-19 alongside normal flu could be obseved. I would expect this would be possible in the southern lattitudes of Australia by May/June. I do not yet see evidence that medical research so far has discounted a higher risk of Covid-in flu season. I think I agree with all your other comments.

Martin Mulcare
April 16, 2020

Thanks, Bruce,
We need some balance based on facts and actual Australian experience. The reality is that, as of today, there are less than 2,700 known, active cases in the whole country and probably only 10,000-15,000 active cases in total (and falling). A strategy based on strict isolation, enhanced testing and robust tracing may be viable by the end of this month if we can be confident in these elements and ,maintain disciplined hygiene practices.
In terms of the risk of returning to work, there are plenty of workplaces that are currently open for business in the construction, mining and manufacturing industries (not to mention shopping centres and racecourses). It shouldn't be difficult to check how many transmissions have taken place since 23 March in these environments.

Steve
April 16, 2020

I also applaud some balanced data as presented here. If one were to believe the usual media one might think no-one actually dies except from CVD. Presenting the number of deaths as a percentage of 'normal' at least allows some relativity to be seen. Also very clear, even in disaster cases like Italy and the UK that most people of working age (call it less than 60 for simplicity) are pretty well OK. So for people under 60 going back to school or work should be largely OK. And it is also simple and obvious for those over 70, who feel particularly vulnerable to continue some form of isolation until a vaccine or better treatments become available. At the most basic level a one-size-fits-all approach cannot be sustained, the government knows they can't prop up the economy forever, so given the relatively low risk to the under-60 population we should be able to start some loosening, sensibly, sooner rather than later.

Barry (not Bruce) Gregor
April 16, 2020

This strategy is fine if you are a young person - but it destroys the final decade of life for older people by isolating from their joys eg time with family & friends, grandchildren, participating and spectating in sporting events, attending church or other gatherings fitting their life values, etc, etc. What a price you are asking the elderly to pay. Most would say: forget it, I'll take my chances.
A better strategy, still recognising that older folk are at risk, is to focus on finding the carriers and transmitters of the virus, and isolate them until they are no longer infectious.
What you are proposing is an easy but poorly focused approach. We need to find a better way rather than destroying the joy of people's final years. Too easy to just put the old folks out of the way.

bruce
April 16, 2020

Hi Barry
I know it's a tough proposal for over 70s particularly if living alone. I would think that having a guest also over 70 who had not been overseas and are similarly isolated would be a sensible relaxation of social distancing. In case you were wondering, my wife and I are in our 70s. We are coping ok with facetiming grand kids, catching up on home maintenance and the occasional walk and outing for extra food items. If all your maintenance is done and you have researched all your family history why not do a few free courses on Coursera. Phone calls to all those people you haven't caught up with for a while is good. Buy some outdoor carpet and a putting kit from rebel and have a putting comp with your yourself or a house mate. If you look at the concentration of deaths over 70s, that a pretty good incentive. Hope these suggestions might help you.
cheers
Bruce

Barry (not Bruce) Gregor
April 16, 2020

You are missing the point -- its not fair and just to focus on the potential impact. You need to focus on the cause and that's the infections.
Find & isolate the infectious -- then the rest of us can get on with what lives we have left.
BTW: a facetime screen with grandkids is nowhere near the same as a hug.
I'm not advocating people violating the present restrictions - but in terms of a strategy for going forward, focus on the cause. not the effect..

Steve
April 16, 2020

Destroys the final decade is a bit over the top?? I don't recall anyone saying isolation will last a decade. 12-18 months for a vaccine as a worst case scenario. Either way, asking everyone to stay at home (for a decade!) because over 70's are more vulnerable sounds more like an attitude we associate with 20 year olds.....

Ian Taylor
April 16, 2020

Thanks Bruce, probably the most balanced discussion I've read to date about the difficult balancing act our leaders face.

John
April 16, 2020

I volunteer (and live in) Tasmania as a pilot.

Bruce
April 16, 2020

Hi John
Good call. I think either Tas or SA best fit. This is where flu can hit early with earliest flu climate change. Probably Adelaide is best fit. It already has 50% school attendance and a smooth distribution of flu incidence to compare to and similar shape to Sydney and Melbourne. 2015 data is a good example of this.
cheers
Bruce

John
April 19, 2020

Hi Bruce

I think the best fit for your "experiment" is the area in which you live. Makes sense to me.
Regards,
John from Adelaide.

 

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