A matter of fact

Data released by the Australian Institute of Health and Welfare shows that the coronavirus is not as deadly as we once feared. By Nick Cater.

Gladys Berejiklian’s decision to end daily press conferences was received poorly by journalists, as the NSW Premier would no doubt have expected. Her briefings have been franker than most, making hers a particularly valuable talking head in an era when the demand for fresh angles is insatiable.

Yet Berejiklian is right to insist she has better things to do with her mornings than scaring the public with numbers. The job of a responsible leader at this stage of the pandemic is to dispel the unwarranted fear that makes many people nervous about entering a truce with Covid.

Ironically, the culture of media entitlement reinforced by daily press calls means the public is less well informed than it should be about the threat from Covid-19. Reporters have come to expect the news to break for them, rather than breaking it themselves. The journalists who have genuinely served the public are the ones who have broken with the pack to interrogate sources of information other than politicians.

The belated release of data from the Australian Institute of Health and Welfare on Friday provided reassurance that we can end the lockdowns and open state borders without triggering the “once-in-a-century setback” the ABC’s Norman Swan was tweeting about on Saturday.

The institute’s examination of the direct and indirect effects of the pandemic provides further evidence that the coronavirus is not as deadly as we once feared. As the NSW government now concedes, there is a difference between dying with Covid-19 and dying from Covid-19. The discrepancy in the official number of deaths linked to the pandemic in 2020 between the Department of Health’s 909 and the Australian Bureau of Statistics’ 866 is confirmation that the figure is somewhat rubbery. The AIHW takes a punt by estimating the number of deaths to be “around 900”.

The reason for the uncertainty becomes clear when we read that for 88 per cent of Covid-19 deaths in 2020, associated causes were included on the death certificate. About three out of every four (73 per cent) of people who died had pre-existing chronic conditions.

Public health officials have been curiously reluctant to share this with the public. Reassuring the majority of Australians who are fit and healthy that the risks they faced were considerably lower than the headline figures would have calmed public trepidation. Health officials, however, preferred to feed our anxiety, presumably to force us to comply with their punishing rules.

On average, there were 2.4 associated causes for each death. A third of those with chronic illnesses listed as dying from Covid-19 suffered from chronic heart disease. Other recurring chronic illnesses were diabetes (18 per cent), hypertension (15 per cent), chronic lower respiratory diseases (15 per cent) and cancer (12 per cent).

The most common associated cause was dementia, listed on the death certificates of 41 per cent of those with chronic illnesses who died with or of Covid in 2020. This should not surprise us, since the average age of death was 87.

The average age of death is also a relevant figure the public health gurus would prefer to bury. The notion that we should assign unlimited resources to save each and every life is new to this pandemic. Doctors and administrators were employing the principles of triage long before World War I when the word was brought home from France.

Even under today’s inflated expectations of longevity, 87 is a good innings. Life expectancy at birth for an Australian born in 1934 was about 60. A person with dementia aged 87 has an average of two years left to live.

The institute shies away from the increased risks posed by obesity. One would expect public health officials to be more explicit about the BMI profile of Covid-19 patients, since losing weight and giving up smoking are the most important lifestyle choices one can make to reduce the risk of ending up on a ventilator in an intensive care ward. A frequently cited French study found 48 per cent of Covid-19 patients on ventilators were obese and 28 per cent were morbidly obese. In other words, fewer than one in four had a body mass index of less than 30.

Yes, thin people too have died from Covid-19 and a not inconsiderable proportion of those currently in ICUs are aged under 60. Yet good public policy is driven by data, not anecdotes. Unless we are clear about who is at risk and how large the risk is, getting the settings right is guesswork and, since health officials are in charge, they will err on the side of caution.

The glaring exception to the rule of overcautiousness is the management of outbreaks in nursing homes. Some 75 per cent of those who died from Covid-19 in 2020 were residents of nursing homes, overwhelmingly in Victoria. All but a handful of them died in the first wave of the virus when a decision was made to treat them inside the aged-care facility rather than isolate them in hospitals. Nursing home operators pleaded for a change of policy, but the bureaucrats were intransigent.

As a result, the virus spread quickly between residents and treatment was far less effective than it should have been. The result was a tragedy: the deaths of 687 people who may be alive had the policy been different.

Mercifully, that policy has since been changed. Since January there have been 70 outbreaks in nursing homes but just 19 residents have lost their lives from Covid-19, 2 per cent of total deaths.

When the story of this pandemic is finally told, the bungled management of cases in institutional care will be seen as the biggest scandal, not the behaviour of healthy people sitting or exercising in the sun at the weekend, portrayed in the media as public enemy number one.

The decision to vaccinate the elderly in nursing homes first has undoubtedly saved lives. Yet the risk to the elderly had been considerably reduced by the change of policy before the arrival of the vaccine.

Facts are the antidote to fear, and the AIHW report should give us great confidence that the risks of serious illness or death from Covid-19 are low, even in the face of rising case numbers. With the vaccination threshold now in sight, the biggest obstacle to a normal life is not the vaccine supply, but those in a position of authority who remain parsimonious with the truth.