JACK WATERFORD. Covid-19 no need to panic yet.

Mar 4, 2020

The risks are two-fold,  First would be in neglecting an attack on the virus in our neighbourhood. The other is from an officious overreach of power by the department of Home Affairs and its armed Border Force officers.

Australia is well served by medical and engineering understanding of the risks of epidemics and pandemics.  There is a long line of successful public health programs since the war that have driven from the community, or most of the community, the scourge of epidemic disease. Australia has not had an outbreak of bubonic plague since we had one in Sydney about a century ago.

Over the 1940s and 1950s, diligent case-finding and antibiotics virtually wiped out tuberculosis. It has only been in recent times, and with particularly vulnerable communities, including Aborigines and refugees, that new cases are being found. Leprosy, once endemic in Northern Australia, is virtually wiped out, even if many hundreds of people, mostly indigenous, still carry its stigmata.

Vaccinations against polio, and, later, against diphtheria, measles, mumps and an array of other conditions have transformed Australian health profiles. it is true that there is a growing population of militant and deluded anti-vaxxers, willing to put the welfare of other people’s children at serious risk by lowering herd immunity, but there are legal measures, if by no means yet severe enough, capable of keeping their numbers under some control.

We have annual vaccines against influenza, free to the elderly and most workers. Its form is shaped by the best guess at the way the virus is mutating. Flu is a serious killer in Australia, and, like Covid-19, it particularly attacks the elderly, and those with pre-existing respiratory conditions. All things being equal, it is not impossible that Covid-19 will come to be regarded by the most healthy part of the population as a particularly unpleasant form of flu, even if, like many of the existing ones, only the very vulnerable end up with a severe acute respiratory infection. In that sense, it will become a permanent, even endemic feature of our society, but not a very mortal one.

Some of those who have been watching the development of the condition in China think that China, in its diagnostics has focused particularly on the pneumonia that has taken victims, most of whom are old. Many of those who have recovered, and who have been less affected, report symptoms rather more like a common cold – with a raised temperature, dry cough and some shortness of breath. It is because of this that epidemiologists who have been in China at the behest of WHO guess that the number of reported cases from China is just the tip of an iceberg – perhaps five per cent of the actual cases. Most of the 95 per cent were probably not even aware that they had it, or that they were capable of passing on the disease to others.

Those who had the more severe infections – mostly people over the age of 65 – were likely to be identified by active case finding (including, now, financial rewards for people who present themselves for treatment). There was a big focus on pneumonia, as opposed to having something in the nature of a cold, a reason many think the numbers are serious under-estimates.

If that is true, it could be that the mortality associated with Covid-19 is not the two or three per cent suggested by the initial figures, but 0.1 per cent, say a fatality for every thousand people. That’s similar to the fatality rate for an ordinary influenza virus. Typically, only about five in a million people under the age of 50 die in such an outbreak. About 75 people aged between 50 to 65 die, and about 1000 people in every million people older than 65 die.

The Spanish flu, about 100 years ago, saw about one in 40 in the population die – a death rate 25 times that of an ordinary flu season. The pattern did not resemble an ordinary flu season, with young people and young adults particularly at risk. About half the population caught it.

Australia has had other flu pandemics – the Asian flu of 1957 — a completely new strain – and a mutated relation, the Hong Kong flu of 1968.  On the evidence so far, Covid-19 will not have the death rates of these, nor their deviation from the norm in killing higher than expected numbers of children and young Australians. It could, however, match the impact of the passing through Australia, in 2009, of the human swine flu. While all of these pandemics provoked a major public health response, none involved the state girding itself  with extra power.

The WHO experts who travelled through China, and had access to Chinese records, believe that the disease plateaued there between January 23 and February 2, and that new cases and incidence have been declining since. Although many have been critical of the slowness of the response from China’s central government, this suggests that measures taken – no doubt including the quarantining of Wuhan Hubei province – were swiftly effective. It suggests that the epidemic reached its zenith – in terms of incidence – within a month of first being identified as a new and serious flu-like condition. That’s pretty smart work by any definition; it is by no means clear that Australia, or the US, or Europe would have been quicker.

Some of those who consider the initial response too secretive, and too concerned about appearances, rating the two-week delay between discovery and public action far too long do not seem to realise that China notified WHO of the new virus entity on December 29. Major public health action, particularly so as to avoid the added confusion of Chinese New Year, made things worse, but if China was concealing the problem from its people, it was not concealing it from the world.

That’s something to bear in mind when one reads commentary focusing on the pandemic as a political crisis for the communist state, or for Xi, its leader. Of course there will be significant economic effects, including a major disruption of trade, further blows to China’s growth, and some weakening of public confidence in both the efficiency of the total surveillance state, and the omniscience of its rulers. It is not clear that infection rates have stabilised in Beijing. And China, like most other nations now trying to cope with the problem, has been caught short with enough supplies, including diagnostic supplies, even in the epicentre of Covid 19.

But one can take this only so far: I would hazard a guess that Xi, rightly or wrongly, has more cred in his domain than Morrison does here.

Some of the commentaries focus more on the hopes and wishes, or the prejudices, of the authors than on the facts as we know them. But then again it is hard to be 100 per cent confident of any Chinese statistics, even when gathered in good faith. It will take time for the economy to begin rolling again, and the hardships will, no doubt, reflect, from local politics up to the central government. But it may be a bit early to forecast a collapse of public confidence in China’s leaders, or the imminent demise of their systems of control.

Likewise with the Australian body politic. So far, all is well on at least this venture of modern government, even if confidence in the management and integrity of many other aspects of government are calculated to make citizens despair. Initially at least there’s no down-side, even if things get worse before they get better.

The big risks are two-fold, it seems to me. First would be in neglecting an attack on the virus in our neighbourhood. The other is from an officious overreach of power by the department of Home Affairs, armed Border Force officers, or anyone else trying to herd ordinary Australians into a political, as opposed to a public health view, of the public response.

Given the authoritarian disposition of the minister, Peter Dutton, his hang-ups about challenges to the authority of the state, and the militarisation of what once seemed a much more efficient quarantine service, that seems inevitable. In a pandemic, there is only limited scope for concentration camps with Serco guards, forced arrests, or bully boy tactics designed to prove who’s boss.  Australians will willingly, even meekly obey the instructions of a bush-firefighter as to not using a road. The prime minister, we might remember, has perfected his argument about rejecting the advice of experts, at least on climate change.

All of the marketing of Morrison,  crisis-mongering by Dutton, or bullying by policemen is unlikely to convey the same sense of emergency as the bushfires. Health expertise will be – should be – respected, but politicians will still be unpopular if they are too draconian in pretending to follow advice.

Jack Waterford is a former Editor of The Canberra Times

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