A Numbers Game: Could The Covid-19 Cure Be Worse Than The Disease?

Planning on how to best tackle the Covid-19 crisis ultimately comes down to numbers. Geoff Russell crunches them for you.

Donald Trump is well known for foot in mouth disease, but what about his recent comparison of Covid-19 with motor vehicle deaths, quoted here.

“You look at automobile accidents, which are far greater than any numbers we’re talking about,” he said. “That doesn’t mean we’re going to tell everybody no more driving of cars. So we have to do things to get our country open.”

As lockdowns get tighter and unemployment queues start appearing and growing, it’s not silly to ask if perhaps the cure might be worse than the disease. I asked myself that exact question a few weeks back. Happily, we have enough data to work out the answer in about five minutes… starting now.

In most rich countries the road toll (fatalities) is about 10 per 100,000 inhabitants per year. China’s rate is about double this, and many poorer countries have about triple this rate. That 10 is a small part of the 1,000 or so people who die annually in most countries… again, this is per 100,000.

Typically, crude annual death rates vary from 650 per 100,000 in Australia to about 1500 per 100,000 in the Democratic Republic of the Congo. Italy, is roughly in the middle, it has an ageing population with about 1,000 deaths per 100,000 per year; meaning roughly 1,600 funerals a day, every day.

If you’ve been watching Italy’s Covid-19 death toll, you’ll see why the system isn’t coping. Adding 600 deaths a day to 1,600 isn’t manageable for one day, let alone for weeks or months. The normal daily death toll is surprisingly stable and doesn’t vary much within a country; even during a bad flu season… see below.

We tolerate the road toll because of the benefits of cars; both perceived and real. As an aside, huge reductions in the road toll are one of the great success stories of public health campaigns over the last half century; but many would reckon we could have done even better with more support for good public transport.

Now let’s think about the possible toll of SARS-Cov-2, the virus which causes the Covid-19 disease.

A do nothing strategy would see, according to UK Imperial College modelling, about 80 percent of the population being infected.

Assuming a very conservative estimate of fatalities at 0.7 percent, we’d be looking at about 560 deaths per 100,000 over the course of the first wave of the pandemic; say 12 months. This is equivalent to about 56 years worth of road fatalities.

The assumption of only a 0.7 percent death rate might be wildly optimistic, but it seems that many more people are infected than have symptoms so assumptions based on the rates of deaths to known infections will be overly pessimistic.

The Imperial College modellers estimated that modest measures of social distancing and home quarantine are expected to reduce the 80 percent to about 20 percent… while leaving schools and universities running. In which case we are looking at the equivalent of 140 deaths per 100,000 during that initial sweep of the virus through the population.

You might look at that number, and think that while it looks horrific, it might still not be worse than a full-blown depression, which is where we might just be heading.

But you’d be wrong.

Do people die in large numbers during a depression? Somewhat surprisingly… no. Suicides rise, but, even during the 1930s, their rise was just 5-7 per 100,000 per annum, which is terrible, but far less terrible when compared to any reasonable estimate of the impact of this virus.

But the direct deaths due to the virus is only the start of the problems.

The Imperial College modelling I’ve been discussing focusses on Intensive Care Unit (ICU) bed requirements; an urgently needed statistic for planning; along with ventilators. The ICU bed requirement would peak at about 30 times the current capacity of ICU beds… and that’s in the UK and US. Poorer countries would be far worse off.

The Economist this week had a special feature on the impact of the virus in poor countries; they noted that Uganda had more cabinet ministers than ICU beds. We don’t only have to halt this virus for our own benefit, but for everybody’s. We really are all in this together.

Let me get back to ICU beds. Many industries have surge capacity; the ability to handle an additional load. High-rise apartment blocks design plumbing to cope with the surge in toilet use during TV ad breaks. Similarly, hospitals can handle disasters like rail crashes, flu seasons and the like.

A typical flu season might kill eight people a day, on average, across the whole of Australia. But the deaths themselves won’t be averaged, they’ll occur over a few months, so we might get, say, 30 on a bad day… a couple in Adelaide and five to 10 in Sydney and Melbourne. But the hospitalisations might be five or six times that. These are small numbers compared to the surge possibilities of this virus.

The Imperial College modelling estimated this surge capacity for ICU beds in the UK at just 10 per 100,000. Australia’s number is slightly less at 8.8. This implies that a city of about a million, like Adelaide would currently have 100 spare ICU beds.

The surge requirement of doing nothing was estimated by the Imperial College modellers at about 300 per 100,000. Implying that Adelaide would need 3,000 ICU beds; not to mention skilled staff to service them.

With a lockdown involving shutting schools and social distancing, the surge load was greatly reduced but still close to 100 per 100,000. This ICU requirement could last for months.

It isn’t unusual for a person to have a night in an ICU after a routine operation. Some of those people would just die. Doctors would need to be making tough decisions about who gets those beds. Nobody, as far as I know, has quantitatively estimated the collateral damage toll of the virus; the deaths and disabilities due to the health system being overwhelmed. Clearly it could be substantial; given what we are seeing in Spain and Italy.

The choice between saving the economy and saving lives is a horrible dilemma but the answer is about as clear as it can be. While everybody wants to minimise financial hardship and should strive to do so; our priority must be to stop this virus.

The Chinese, Singaporeans, Vietnamese and South Koreans have shown (touch wood) that this is possible, so we need to get it done. It’s no coincidence that these countries were all hit by SARS previously.

Let’s hope our politicians stay focussed, keep listening to the best of our experts and are not distracted by Trump’s blustering or his promised day of prayer.