07/05/2020
Let’s hope we got this right - it is long rant but read it
To fight the Covid-19 epidemic though, decisions had to be made. Now, a few months in, the cost of the measures become clear. It is devastating, but according to the politicians and scientists this is the only way to prevent more deaths. Let us hope they are right.
The scale of the economic impact can best be demonstrated by the US jobless claims. Never before have so many US citizens filed jobless claims so quickly. At the beginning of February the US unemployment rate was near a historic low, but by the end of March, the weekly jobless claims figures were 10 times higher than the peak during the world financial crisis of 2008. Some countries, especially those in emerging markets have performed worse. Being jobless is devastating. Unemployed become despaired, depressed and suicides go up. Those who managed to keep their jobs are often forced to take a pay cut or unpaid leave.
Small business owners must make very tough decisions if they want to survive. Many of their corporate clients have not paid their invoices, at least not in full, in order to preserve their own cash. During the second half of March the Federal Reserve Bank had to quickly step in and provide extra liquidity as many medium to large companies drew all their credit lines available to them. The US Dollar strengthened while emerging currencies collapsed, making it much more expensive for the needy to import medical equipment and supplies.
Closer to home, many industries were brought down to their knees. The whole international film industry is standing idle, affecting thousands of freelance artists and artisans. Restaurants were ordered to close, many will never re-open. The tourism sector is decimated and is unlikely to recover until travelers have got the confidence that they will not get infected. The side effects of the fight against the Covid-19 virus are brutal, but all policies had one goal in mind, to save lives.
When the outbreak started, experts reminded us of two previous Corona Virus epidemies, the Middle East Respiratory Syndrome (MERS) and the Bird Flu, both of which had remarkably high fatality rates. It was estimated that at least 2 million would die in the USA, and worldwide the figure would be in the tens of millions.
Here in South Africa, it was estimated on the 23rd of March that up to 1 million lives would be at risk within the following 40 days.
As the fatality models were updated with more accurate data, the mortality came down significantly. It is not clear how accurate the models would be, because the most important measure to epidemiologists, the percentage of the population that has been infected, has not been determined. Instead everybody relied on tests confirming if a patient currently has the virus. That might be useful to doctors (even though there is no medicine for the disease), but not for epidemiologist. Very few ever questioned the models used, as no one wanted to be responsible for thousands of deaths. Let’s hope we used the right models to predict the development of the epidemic.
When the Covid-19 epidemy started in China, the response from the Chinese government was remarkable and quick. The city of Wuhan was locked down, extra hospitals were built in a week, school kids were sent home and the whole economy was shut down. These stories made us wary of this deadly disease. And our suspicions were confirmed when it spread quickly to the northern parts of Italy, where hospitals resembled war zones. Politicians were scrambling for ways to stop the spread of the virus. Even though personal hygiene, including frequent washing of hands and not touching the face has been the gold standard to prevent respiratory virus infections, governments decided to go further. Their response was modeled on the same draconian measures that China took. Schools were closed, factories were shut down, Mines were ordered to stop mining and businesses asked their employees to work from home. Disturbingly though, no extra special measures were put in place to protect those who were clearly the most at risk of dying – those in the old age homes. All the measures helped to flatten the curve of infection.
As the countries are opening their economies up again, it is a good time to reflect. Not to appoint blame, but to determine if the measures taken have the desired impact?
A repeat of the hospital scenes of Italy were seen at the Elmhurst hospital in New York. Completely overrun and stretched on all kinds of resources the health workers did a remarkable job with the tools they had. The NHS in the UK was also getting busy, as did some of the hospitals in Spain.
But non were as overrun as those in northern Italy or New York, not even those in the southern parts of Italy. We have not heard of shortages of beds in Germany, Netherlands or Australia. Even the developing world did not show any of those chaotic scenes. Here in South Africa, the Life Healthcare Group reported that their hospitals have an average occupancy of 40%, and that their losses amount to a few hundred million already.
As virus tracers in the Netherlands and Iceland have not found a single transmission from child to parent, we must ask if it is the right policy to keep the schools closed as log as possible. They are facing an ever-daunting task in trying to catch up on the lost schooldays, or more likely redo the whole school year, since anything learned at the beginning of the year will be forgotten by now. Children from richer families would possibly have had some lessons on-line, via Zoom or Microsoft Teams, but it is once again the children from the poor communities that will suffer more. Let us hope the closing of the schools brought more relief than it will cause pain.
Now, 40 days on from when president Ramaphosa was advised that up to 1 million citizens could be at risk, we have only had 6 336 confirmed cases and 123 deaths. The strict lockdown surely had something to do with it, but such a huge variance could also indicate that the models used were wrong. And a flat curve does not matter to the starving and hungry, who cue for kilometers in the hope of getting a food parcel. It also does not matter to the immigrants around the world who are at best ignored and in many cases excluded from any relief efforts.
For the people in need this crisis is just about survival, about living or dying. After all, flattening the curve does not mean that people do not get it. The same amount of people get the virus, just over a longer time period, giving the hospitals a chance to cope. Are we better off because of the lockdown? Perhaps, but at an increasing social cost.
As the Covid-19 death toll in the USA surpass that of the 2017-2018 death toll of the seasonal influenza (when 61 000 died according to the CDC), it is obvious that Covid-19 is a very deadly disease. But possibly not as bad as was first expected. Recent antibody tests (which determine if a person has had Covid-19) in the USA suggest that the estimated infected population is between 50 and 80 times higher than first assumed. It might thus be that we are experiencing the tail end of the outbreak, and the only reasons we find increased cases is because every nation is increasing their testing ability. The more you test, the more you will find. These are theories which still must be proven. As with much else about Covid-19, much is uncertain. The economic suffering though is not uncertain. Numbers out this week will show the damage done.
UNICEF has warned that because of the intense focus on Covid-19, 4 million children will miss out getting vaccinated against polio, measles, diphtheria and hepatitis. The World Health Organisation has cautioned that the estimated deaths of Malaria will go up by 300 000 to reach 700 000. Let hope we have the right Covid-19 strategy, knowing that every one of those extra Malaria deaths is because it saved millions from dying from Covid-19. Let us hope we have got this right.
