Listen To The Data

Bad policy is usually devised in response to public anxiety and uninformed commentators. Better solutions are the result of thorough research and calm assessment. By Nick Cater.

When the solution to a thorny policy problem is difficult to find, we should turn our minds instead to how bad policies are made. 

Bad policies are devised hastily, based on untested data, if indeed any data is available. The haste is usually caused by public anxiety and commentators urging the government to do more even more quickly.

When this untested, rough-edged policy is launched into the world and fails to yield the desired result, those who devised it are reluctant to accept its flaws. Instead they double down, applying poorly aimed blows with greater force, turning it from a sledgehammer into a jackhammer.

Nobody knows if a full lock-down – the indiscriminate stopping of almost all human activity outside the home – will end the pandemic or how long these draconian measures would need to stay in place. We do know, however, that victory will come at an enormous cost to employment, welfare and families.

We know too that some of the best performing countries like Switzerland, Belgium and South Korea have slowed the rate of infection and death to manageable levels while expressly rejecting this blunt-edged strategy.

Circumstances vary so much between nations, however, that we are unlikely to find a universal policy solution until we get a vaccine.

In the meantime, Australia must devise its own solution, informed by the epidemiological data now emerging from the worst hit countries, tempered by our knowledge of what happens when sections of our inter-locking economy shut down and the human misery that follows.

COVID-19: Read the MRC’s coverage of the debate and policy proposals here

The Menzies Research Centre has been crunching the available epidemiological data from COVID-19 affected countries to give us a better handle on the challenge we face. 

The evidence will allow us to find ways of tackling COVID-19 in a more targeted way, and better protect those most at most risk. 

We have enough data to show that those who become seriously ill have a similar profile, regardless of background.

Everybody just about can pick up the virus, and everyone is at risk to some degree. But the risk of fatality varies greatly. Those most at risk, as we have already gleaned, are older people and the seriously ill.

This shows that the government was right to take strong measures around age care homes at a relatively early stage. It supports their heath messaging generally.

But it also suggests we should be providing better protection for everyone at risk by convincing them to enter voluntary isolation and offering plenty of advice and practical support.

The risk of death or acute hospital treatment increases dramatically for those with other serious illness. Among the 105 patients who had died in Italy as of March 4, for example, two-thirds had three or more pre-existing conditions. The most common was hypertension, followed by ischemic heart disease and diabetes mellitus.

We believe we can narrow down those who are in severe danger to around 5 per cent of the population. It would probably include every person aged over 80 (about 850,000), which is a hard decision to take, since the health of the people in that cohort varies enormously. Some are brimming with energy and vigour, others are struggling to cope.

Also among the most vulnerable are those, including children, who have one or more of the conditions that coronavirus fatally exacerbates. Only three children aged under 10 are known to have died with the virus. All were in China, and all had a serious pre-condition, such as leukemia.

The less vulnerable include people aged between 65 and 80, or people of any age who have less serious pre-existing conditions. These people should be urged to seek their doctor’s advice and act accordingly.

Protecting health care workers is a special challenge, and the procedures now in place must be modified and improved as we learn more about the ways in which the virus spreads.

We stress that everybody is at risk. None of the existing measures should be wound back yet. A key element of protecting the vulnerable is stopping the spread.

Greater dissemination of this data will help puts minds at rest. There is no reason, based on the data we have, to close down schools. In fact, the opposite is true. The more time kids spent at school among their peers who are equally low risk, the less time they spend among more vulnerable people, like their grandparents.

Protecting the most at risk most be a prominent part of our strategy. The MRC is working with team of experts to develop ways to do this, and we will share this with you in the coming days.

Those in the at-risk group will be strictly quarantined, mostly in their homes, with a range of practical measures to alleviate their hardship. The focus will be on community groups and business to work out what these should be.

We believe a large number will do so voluntarily, given what people in that cohort are already doing. In this environment, a public health campaign built upon clear advice that appeals to relatives of the most vulnerable as well as the cohort itself would be effective.

The crucial difference of this strategy, rather than a full lockdown, is that the public risk of non-compliance is low. Providing the bulk of people comply, the risk of congestion in ICUs is low.

Our view is that a prolonged lockdown will cause serious damage the economy. The price would be paid not just in jobs and wages, but in loneliness, mental illness, family violence and perhaps even suicide.

We urgently need a range of alternate options for Australian public health and economic responses.

The precision of the data is improving every day, allowing us to develop credible and creative alternatives to the ones we have been pursuing now.

We must continue to prepare for the worst, and increase the supply of vital medicines and equipment. We should find more ventilators and hospital beds.

But having installed new ventilators, the best public policy outcome would be to avoid having to use them.