Consider the case of India. What exactly does ‘social distancing’ – elegant as it is as an abstract concept – mean in practice in Indian conditions, a country of 1.3bn people with a population density of 464 per km2 compared to 153 in China?
A BBC analysis notes that 100mn homes – 40% of all homes – have only one room and the average family size is five people. In the villages, home to almost 70% of Indians, many families share a single source of water, bathe and wash in the local stream, work alongside one another in the fields, and shop for produce in the daily local market. To India’s equivalent of the deplorables, social distancing is an urban phenomenon. But the urban environment has its own problem.
In the 2011 census, 64mn people in 17% of all households were living in slums, officially described as areas unfit for human habitation. The sprawling Dharavi slum in Mumbai houses over a million people cramped into 2km2 without access to safe water and hygienic sanitary facilities. In sum, under Indian conditions extensive testing to catch the asymptomatic infected, quarantining and social distancing may be not just sufficient, but more effective than total lockdowns. Or the most heretic thought of all: if India’s case and fatality numbers are so low despite all the obvious difficulties and challenges, perhaps coronavirus never was a serious public health threat in India?
As of 30 April, India’s CV death toll was just 1,154, with a death rate of 0.9 per million. It may be the numbers are under-stated, but in India, people dying in large numbers in the slums cannot be kept hidden and we would have known. Perhaps from the extensive range of infectious diseases to which Indians are subject from the cradle to the grave, some existing antibodies are reactivated quickly and massively to fight and kill Covid-19. Is it at least conceivable that contrary to all intuition, the virus spreads and retreats on its own, on a as yet unexplained logic regardless of the strategy in place to fight it? That is, the epidemiological modelling-based forecasts of catastrophe are like the naked emperor?
Back to Australia
To come back to Australia, our modelling was similar to that which informed British and US policy. Our CV mortality has been so low that if we plotted the total number of deaths from all causes and compared it to the figures for the same period from 2019, the dip or bump would reflect causes other than coronavirus. It seems plausible to suggest that with earlier border closure (especially from the US as Robyn Boyle argued on this site), social distancing practices, quarantining for the infected and isolation for the elderly, the effective reproduction rate of the virus (the ‘R’ new infection rate per already infected person) could have been kept below 1 without ever having to go to the stringent stage 3 measures. It would be absolutely astounding if Australia too is not suffering from unintended and mental health consequences from the lockdown measures.
In his analysis presented on 24 April, Chief Medical Officer Brendan Murphy conceded that ‘R’ was under 1 (below which the infection wanes) in every state and territory in mid-March, before the stage three lockdowns took effect on 30 March. This mimics the downward slope in other countries where also the mortality numbers plateaued before lockdowns had time to show results, as reported in the various studies linked above. If this is true, were the economically less punitive stage one and two restrictions working such that Australia did not need to go to stage three lockdown? Murphy’s answer was that until then, about two-thirds of Australia’s Covid-19 cases were imported. Once that wave had died down, there was a risk of a rapid acceleration of community transmission to take R above 1 again and risk an exponential explosion of fresh infections. (This section of the press briefing can be found at approximately 34:00–36:30 minutes on ABC iView.)
This is unanswerable logic. It can neither be proven nor refuted. But it’s intuitively plausible to argue that had Australia introduced border restrictions 4-6 weeks earlier than 20 March (the Ruby Princess fiasco happened on the 19th), stage three lockdown may never have been needed. Three Hebrew University professors – two finance and banking experts and one epidemiologist – claim that lockdown is not necessary in countries that have more than 100 ICU beds per million available for Covid-19 patients. Australia’s total ICU capacity is 6,636, three times the required threshold. Could it be that Australia’s low toll is better explained by physical isolation, vast open spaces, abundant sunshine, low density living, few multigenerational households, the traditional Aussie backyard, high use of private cars instead of mass transit, and sociocultural practices?
Let’s look at the contra-example of Sweden that I referred to briefly yesterday. On 30 April the American Institute for Economic Research published a most interesting analysis by Phillip W. Magness. The mother-model that set off alarm bells all over the world was Imperial College London’s of 16 March. A team from Uppsala University applied that in order to try and persuade Swedish health authorities to emulate stringent European lockdown measures. The team came to two key conclusions. First, the current Swedish public-health strategy would result in a median mortality of over 40,000 around 1 May and 96,000 (range 52,000-183,000) by the end of June. Second, if the government changed course and imposed lockdown by 10 April, the median mortality would fall below 30,000 by the end of June. The result? Sweden did not change course, stayed with its original strategy, and as at 2 May its total mortality was 2,669 according to the Johns Hopkins University’s Coronavirus Resource Centre.
Case closed? Not really. Someone better qualified and skilled than I am needs to do an equivalent study for Australia.
Meanwhile a sober and sobering article in The Financial Times on 26 April notes that according to the Office of National Statistics, non-CV deaths this year are almost one-fifth higher than in the corresponding period last year. An internal memo circulated to the cabinet in mid-April cautioned that, ‘without mitigation up to 150,000’ could suffer non-CV premature deaths from the lockdown. The Guardian UK reported on 28 April that research shows that, owing to deferred consultations and suspended treatments of other diseases as the NHS focuses on the coronavirus pandemic, almost 18,000 cancer patients could die. A story in The Canberra Times yesterday reported: ‘The biggest private pathology laboratory in Canberra is doing 450 fewer tests for cancer a week than it did last year because people have stayed away from doctors’. The UN warns of ‘hundreds of thousands of additional child deaths’ because of the impoverishment caused by the economic downturn. Secretary-General Antonio Guterres is worried about a human rights crisis caused by the coronavirus pandemic, with authoritarian responses, surveillance, closed borders and other rights abuses.
Yet draconian measures are imposed causing significant pain on all sectors and the PM is to be praised for his leadership? He somehow manages to reconcile public professions of Christian faith with inflicting torture-like cruelty on boat people. But now we are to affirm confidence in his compassion for people. And suddenly he is transformed into a genius in his political judgment and administrative competence.
Ramesh Thakur is emeritus professor at the Australian National University and a former United Nations Assistant Secretary-General. Of Indian origin, he is a citizen of Canada, New Zealand and Australia.
Comments
3 responses to “Sound the Trumpists: The deputy sheriff rides again – Part Two: India and Australia”
I tend to agree with George Wendell about Australia low infection and morbidity due to COVID-19, ie low population density, good sunshine, lots of open spaces etc. The good stats for India could be related to the long time practice of “herd mentality” medicine, where there health resources is not available to cover the whole population. In the end, the Indian people are probably more resistant than most people on earth. Natural selection had breed a more robust and resistant to infection human beings. Everyone is familiar with the Ganges River (Ganga) as the most polluted river system in India and yet many people use the Ganges River water in many way and no worries. This is a old story told to me my Indian classmate who said to me in the 1950s : if a foreigner fell accidentally in the Ganges, he may not be drowned by could die later on with infection whereas we Indians treat it as our backyard swimming pool. In Malaysia, the same herd immunity were acquired when we get by swimming in open rivers where sewage is dumped straight into the river without processing.
Hopefully, India could accelerate her economic growth and be on par with China so it can lift millions out of the poverty line in the next 10 years.
” Could it be that Australia’s low toll is better explained by physical isolation, vast open spaces, abundant sunshine, low density living, few multigenerational households, the traditional Aussie backyard, high use of private cars instead of mass transit, and sociocultural practices?”
Exactly, that has been my thinking the entire time. Living in Canberra it is easy to see why the virus was well contained here, in fact we would never had any cases if it were not for the Ruby Princess arrivals and other travellers returning from international flights and cruises. There has been no community transmission and no absurd police reaction to fining of individuals – many of which in other states were simply confused by the plethora of different messages and support of contradictory behaviours produced from the same federal government. The ACT local government appealed to intelligence, and instead educated and cautioned some people rather than insist on draconian somewhat totalitarian measures and disproportionate fines metered out by Mr Plod.
But how could Borderforce (and others) have ever thought it was OK to let these people find their own way home and possibly infect many others on the way? Especially since sister ship the Diamond Princess in Japan had been a disaster in the news for many weeks previously. The government is hiding over its role in through Borderforce, but it was all too happy in the weekend to announce the same organization had cleared the New Zealand Warriors (for the NRL) to come to Australia to practice so they can be ready for the re-opening season. I guess this made Borderforce look good to many NRL loving Australians.
Of course nothing will stop Scotty from marketing from capitalizing on the view that recovery from Covid-19 is all his (and his government’s) doing, and the compliant sycophants in the main stream media will encourage Australians to believe it. But I’m not sure it can last. He’s always out there with the advertising but look into anything they do and it is always on the cheap, ‘ersatz’ as they say, and many thousands of Australians will be falling through the cracks due to the labyrinth of confusion Morrison’s government has made of any stimulus. Small businesses too. Just as it is with drought and bushfire victims.
Big on advertising and being in the limelight, but mean, and tricky on delivery – not to mention the chicanery of applying for anything. Their main media support team will be the winners. I allege that even the push to get the NRL back on the road as well as other observer sports, is really about helping Rupert and Foxtel get back in the income stream more than anything else. A cosy relationship that is rotten to the core in my opinion.
I don’t know many praising scottyfrommarketing for compassion. But pointing out that his actions have saved many lives is important.