The Fear Factor

Fear is a dangerous public health instrument to employ in a liberal democracy. By Nick Cater.

Two years ago, influenza A was ripping through South Australia. By early July 2019, 20,000 South Australians had tested positive to the virus and 86 nursing homes were infected.

Perhaps the Premier and his chief health officer were asleep at the wheel a few months earlier when the warnings came that it was going to be a shocker of a flu season. Think of the lives that might have been saved if Steven Marshall had slammed the borders shut, frightened everyone witless and warned them they would be arrested if they stepped outside their own homes.

On July 7, 2019, 37 new flu deaths were announced in South Australia, bringing the total to 82. The state’s chief public health officer, Nicola Spurrier, called a press conference to remind South Australians to wash their hands and cough into their elbows if they were caught without a tissue.

“It’s very unfortunate to see this number of people that have died,” she said, “however, the influenza virus this year is not considered to be any more deadly than the viruses in the past.”

The killer flu of 2019 claimed more than 800 lives in Australia, most of them elderly and most in nursing homes. Yet the authorities refrained from panic. There were no daily press conferences and no breathless reporting of the latest number of infections, which in NSW alone were averaging 826 a day in the first two weeks of July.

There were no instructions from the chief health officer not to browse in shops, no police warnings that they would be watching to make sure people didn’t buy non-essential items like shoes, and no limit on the number who could gather to mourn their dead. In short, the public health response was commensurate with the risk, encouraging vaccination and good hygiene while recognising it was not in their power to bestow immortality.

Scaring the wits out of people by declaring a state of emergency is one way to manage a public health crisis but it doesn’t come cheap. “Emergencies have always been the pretext on which the safeguards of individual liberty have been eroded,” wrote Friedrich Hayek. Outrageous impositions on everyday liberties we never imagined possible in a country like Australia are now greeted with a shrug.

The police in NSW right now are not citizens in uniform, keeping public order by consent. They are enforcing government fiats by coercion. They are not appealing to our better instincts, encouraging people to make voluntary sacrifices for the common good. They are urging citizens to spy on their neighbours so they can sting unauthorised visitors to private homes with a $1000 fine.

Switching from the politics of fear to the politics of proportion is proving harder than we might have imagined. A year and a half of exaggeration and finger-wagging has taken its toll and people are frightened. A survey of 1000 Australians last week by True North Poll asked people to estimate how many of the thousands of Covid-19 cases in Australia this year had resulted in death. The average estimate was 255, with 21 per cent of people estimating that there were more than 500. The right answer, chosen by just 18 per cent, was one, or zero if overseas cases are excluded.

The arrival of the Delta virus as the predominant Covid-19 variant in Australia was an opportunity to flick the switch from ebola to flu. Since Delta is far more infectious, it will be far harder to stop it spreading in the community, as the NSW government is discovering.

More than half of the recent cases in NSW have come into contact with an infected person while shopping, we are told. Eradication? You must be dreaming.

Yet the Premier says normal business will not resume until the number of those infected falls close to zero. That, as some of her ministers are prepared to concede, may prove an impossible task.

“If individuals don’t hear (NSW chief health officer) Dr (Kerry) Chant’s message, then at some point we’re going to move to a stage where we’re going to have to accept that the virus has a life which will continue in the community,” Health Minister Brad Hazzard said last Wednesday. A day later he was obliged to reel in his comments after being accused of arguing to let the virus rip, which he clearly didn’t say.

“We could live just our normal lives,” epidemiologist Nancy Baxter told Nine newspapers, “but I just think we’d have a lot more dead people.” It depends what you mean by “a lot”. Of the 239 new cases between July 3 and 10, 224 were aged under 70 and so have a very low chance of dying from Covid-19.

Chant made much of the fact that a teenager with Covid-19 is in an intensive care bed. Journalists on Saturday asked for details. How many of the younger people in hospital had comorbidities? Chant’s response: “I will have to get back to you with that information.”

We hope she does, for if the public are to be forced into the discomfort of extreme lockdown, they deserve an honest assessment of the risks. Are these drastic measures really necessary, or does the isolation of nursing homes, a less deadly variant and the arrival of vaccines allow us to change tactics?

One of the biggest mistakes the political and medical establishments have made in this pandemic is to attempt to silence dissent. They have been too eager to write off alternative strategies and condemn their proponents as crackpots.

As a result, cognitive bias has been allowed to set based on assumptions made in the early months of the crisis when the risks of the virus in a country unprepared for a pandemic were far greater than they are today.

Unconscious group bias is the scourge of public policy, which is why good policymakers consult widely, are willing to be proved wrong and are open to other approaches. The inflexible approach to Covid-19 displays optimism bias, the tendency to overestimate the chance of success, and the anchoring effect, the tendency to give undue weight to the first piece of information offered. There are signs of perseverance bias, the tendency to hold on to beliefs and act on them despite disconfirming evidence. As philosopher Lee McIntyre writes in his 2018 book, Post-Truth, it is often in the moments when we feel most rational that we are most mistaken and most deceived.