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“The Hammer and the Squeeze” (FT 28/3/2020)

28/03/2020

The Hammer and the Squeeze (FT 28/3/2020)

In my last post, I had suggested to readers a wonderful article by Tomas Pueyo “The Hammer and the Dance” spelling out in great scientific detail how any country’s coronavirus might evolve, if it took a weak approach (“Do Nothing” or “Mitigation”) or if it took a strong approach (the “Hammer”).

Drawing on a number of other experts as well, Pueyo showed, a week ago, with very clear modelling that with the “weak” approach, the cases would blow out into a mountain of cases, totally overwhelming the public health system, resulting in a massive number of acute cases and deaths.

This has indeed happened in countries like Italy and Spain, and sadly, is happening right now in United States, as I show below with easy to understand graphs.

Pueyo showed that with a strong approach (even if considered brutal) on the other hand (the “Hammer”) and with the public co-operating fully,  the mountain peak  of infections would be much lower (“flattening the curve”), and much further down the line, thereby allowing the country’s public health system to cope a bit better, with fewer infections, fewer severe cases and fewer deaths.

This has indeed been the experience of China and South Korea (see my graphs below).

Pueyo acknowledged the experts’ view that the virus might recover when the “Hammer” was eventually relaxed, but by that time, the authorities will have understood how to rigorously test, to energetically trace all suspected infections, test again, and trace again… what Pueyo called “the Dance”.

But I call it the “Squeeze” whereby all traces of the coronavirus are brutally squeezed out of existence, as other deathly diseases have been over the decades.

Pueyo very sensibly argued that such measures (the “Hammer and the Dance”) would hopefully (because no one knows for sure) will “buy some time” until cures and vaccinations are found.

This approach, he argued, will also reduce the eventual economic cost of the pandemic and recovery, even if the costs are going to be horrendous, possibly thrusting the world into global recession.

Pueyo’s article also issued the grim warning that the more people are infected throughout world, the greater are the chances of the coronavirus mutating into others forms, some of which may be resistant to the yet-to-be discovered vaccinations. Such mutations are already happening and no one knows the likely end result.

So it is absolutely vital that the Fiji public understand why they must make the sacrifices now and cooperate with the firm measures recommended by government and health authorities, in order to avoid not just a massive health disaster but also economic disaster.

I give below the up-to-date experience of a number of countries with close family connections to Fiji people, as well as our important tourism markets from where visitors to Fiji will come in future.

  • China which shows what “flattening the curve” means in practice
  • The good example of South Korea (whose statistics are not in doubt);
  • The bad examples of United States and Italy with weak political leadership and communal irresponsibility
  • And our largest neighbour Australia and Canada, which are both still stumbling along.

The data is derived from a website which students and teachers can explore for months, including comparisons of countries, by age, gender and medical conditions.

https://corona.help/country/australia

 China: where the “Hammer” worked:

I first give the extraordinary example of China, which may have been the origin of the virus, but showed extraordinary political leadership and people’s collaboration in eventually containing the virus.

Graph 1 for China starts at 21 January and ends with 27 March.

The solid line at the bottom of the graph (with the small hill) is based on actual Active Cases data for China.

Remember, that Active Cases = Total Infections – Recoveries – Deaths.

The bottom solid line in Graph 1 with the low hill is the number of actual  Active Cases, with a maximum of just around 58,000 cases, even though the maximum total number of Infections in China  was around 82,000.

This low hill is the result of “flattening the curve” that global health experts are hoping for all countries.

The top heavy dashed line gives a very understated “imaginary” result for “Active Cases” had China followed a weak approach that many western countries have followed.

Note that I arbitrarily assumed this to be a mere five times that of the actual Active Cases recorded, with a mountain top of only 300,000.

[Note if China’s population had been infected at the same rate as Italy, the peak of China would already be 1,7000,000 and rising.]

But even these imagined 300,000 cases would have totally overwhelmed the number of ICU hospital beds available (the dotted line which I have also arbitrarily chosen for illustrative purposes).

Also remember that most of the ICU beds in any country (and especially developing countries like Fiji and Solomon Islands) are already occupied with other severe cases and cannot be vacated just for the coronavirus cases.

But by “flattening the curve”, China performed an incredible miracle, with the population now slowly returning to their normal activities as the number of “active cases” has shrunk to a mere 4,310. WOW.

China is now also offering help to the whole world such as to Italy (and hopefully to Fiji also), not only with expertise but also testing equipment and kits, and is also likely to develop cures (if they have not already done so) and vaccines.

South Korea

As there are many who doubt the accuracy of China’s statistics, I give the example of South Korea with Graph 2, showing total Infections and Active Cases from 9 March to 27 March.

Note that while the total number of infections is still slowly rising, the total number of Active Cases has been on a relatively steep downward trend, rare among other countries.

Why countries like South Korea, Singapore and Taiwan (and apparently Germany as well) have been successful has been attributed to governments and their health authorities issuing firm social distancing guidelines right from the beginning, disciplined forces, and communities themselves being decisive and disciplined in following social distancing, self-quarantine, rigorous testing and rigorous tracing of infected cases.

Perhaps these have all been helped by their previous SARS experience.

What is extraordinary however, is that many western countries (including Australia) have refused to learn from the example of China, South Korea and Taiwan. Why haven’t they?

All the graphs below have the same time frame from 9th of March to 25 March and are based on actual data.

 The Weak Approach: Italy and US

Graph 3 shows Infections and Active Cases for Italy and US which I group together for convenience, even though the population of Italy is only 60 million compared to 327 million for United States.

The world has had a field day discussing the difficulty which a socially gregarious country like Italy could ever practice “social distancing”. And so it proved.

The world (and US public health officials) have looked on incredulously at the astonishing reactions of US President Trump to the virus and his continuing wrong messages to the American public (even as you read this article). And Graph 3 shows the increasing nightmare for Americans today.

The top dashed line gives the total Infections for Italy, still rising dramatically.

Also rising but diverging somewhat now is the dotted line showing that Active Cases for Italy are still rising, but the growth is slowing.

In even worse situation is the most powerful country in the world, United  States, for whom the solid line shows both the Total Infections and Active Cases are indistinguishable on the graph, and still rising rapidly.

That steep path will see US overtake Italy in the next four days at the latest (by Sunday) indicating the terrible speed with which this virus can spread.

What a horrible indictment of the American public health system and the absolutely confused and inane leadership by its President Donald Trump.

One must also wonder at the lack of discipline of the American people and media, who, are typically convinced of the superiority of the American way of life and not known for being aware of what is happening in the rest of the world.

America may yet be “Great Again” for all the wrong reasons.

Canada and Australia

It is useful to compare Canada with Australia, with similar populations (Australia with 25 million and Canada with 38 million), similarly large land masses, and both prosperous well developed economies with good public health systems.

The top two lines of Graph  4 shows Canada’s Total Infections and Active cases, both rising incredibly rapidly.

Of course, Canada’s proximity to United States must have been a nightmare for Canadian health experts to manage, given that US has been virtually out of control.

The bottom two graphs show that both Infections and Active Cases have also been rising for Australia but the growth appears to have slowed down ever so slightly.

Sadly, the steep lines for Australia were predicted two weeks ago by several heath experts because of the very ambivalent responses of the authorities who continued to give weak guidelines such as allowing gatherings of 500, with the numbers slowly being reduced day by day as the severity of the virus became evident.

But even then, there was the ridiculous standard of allowing gatherings as long as there was a average of 2 square meters per person when commonsense would indicate that any gathering inside a room had the capacity to transmit the virus.

Then there have been confusing signals given by the different political leaders at the federal and state levels, another curse of the Australian system of politics.

On the one hand, the Australian Prime Minister Morrison has been recommending that schools be kept open, and on the other, state premiers have been asking that schools close, given that children can also transmit the virus not just to each other but also to and from teachers.

While health officials were asking that only essential services be kept running (and we all pretty well know what that means) Australia’s Prime Minister declared publicly that “every person in employment” was an “essential worker”, understandably criticised by the Opposition Leader Albanese as a political gimmick sending wrong signals to the Australian population.

Then there was the massive blunder of the NSW officials allowing some 2700 passengers disembarking last week in Sydney, with 50 of them were later identified as carrying the virus and many of them then travelling to other states as well as around NSW which has the highest number of cases of all the states.

Given that Australia is our largest neighbour, donor and source of the majority of our tourists, Fiji should keep an eye out on the coronavirus developments here.

New Zealand

New Zealand, also our large neighbour with many former Fiji residents, initially seemed to have very few cases of the virus (perhaps because of insufficient testing) but that has changed in the last ten days.

Graph 5 shows how starting from very low numbers on 15 March, the numbers have risen dramatically, both for Infections and Active Cases.

Both are on a steep paths although the two curves are diverging and NZ should also be watched closely by Fiji.

 Conclusion

Readers can see from the above graphs that if Fiji follows the paths of Italy and United States, our public health systems will be overwhelmed, given that they have already been under severe stress, as Dr. Eddie McCaig has been warning.

If on the other hand, the country (Government, the health authorities and the people) take the “Hammer” approach with strict social distancing, rigorous testing, tracing of contacts and further testing, there is a possibility that Fiji can avoid the worst, and more closely follow the paths of South Korea and eventually China.

It is good that Prime Minister Bainimarama is finally accepting the advice given by health authorities and taking a tough stance with the offenders in the population.

The public can also take some comfort that Opposition political leaders like Sitiveni Rabuka (SODELPA), Professor Biman Prasad (NFP) and Mr. Savenaca Narube (Unity Party) are all offering solid constructive advice on how to take the country out of this terrible health and economic crisis.

The Bainimarama Government and its Ministers would do well to heed the advice that is being given, for the people’s sake, if not for their own reputations.

Note that it does not help that Fiji’s Commissioner of Police gives out fuzzy public advice that “people stop drinking yaqona in big numbers”.  Health experts would advise that even small numbers should be banned.

I remind that if Fiji is able to weather this health crisis successfully, it will have enhanced its reputation internationally, and especially Australia and NZ, as a desirable tourism destination.

This will be a valuable asset not just to our tourism industry and to Fiji Airways but to the Fiji economy in general.

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