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Stay home. Stay safe. Lessons from the coronavirus.

Early moves to encourage social distancing were a smart play

It is too early to state exactly which countries and which strategies are best for handling coronavirus. But it is never too early to hypothesise. With the coronavirus outbreak we have seen a wide range of strategies for dealing with the disease. From "she'll be right" and outright denial to heavy-handed lockdowns. Early indicators suggest that extensive government-mandated social distancing was a smart move (for example, work from home policies). While lockdowns have instigated a period of severe economic pain, social distancing has saved lives. Countries that have not mandated social distancing face a more drawn-out health and economic crisis.

In this post, I reviewed five countries' efforts to contain coronavirus - Italy, the United States, New Zealand, Australia and Taiwan. At first glance, countries like Taiwan have done well in containing the virus. On the other side of the coin we have the USA and Italy who are clearly struggling. The graphs below illustrate cases and deaths across five countries. Of course, this is not just about the numbers, which as I explain below have issues, but the country's actions.

Coronavirus cases per million - Italy, United States, New Zealand, Australia and Taiwan

Coronavirus deaths per million - Italy, United States, New Zealand, Australia and Taiwan

The Humanitarian Data Exchange, worldometers and analysis

I am weary looking at measures like the number of cases or deaths when comparing efforts to contain the virus. Comparing just the cases and deaths is shallow, there is more to it than that. The graphs above wash over a variety of important factors. Countries like New Zealand benefit tremendously from being far away from the action. Older populations like Italy's will naturally have higher death rates in a pandemic. Also, the coronavirus outbreak is further developed in some countries than others. Not to mention that this is now an economic crisis and a health crisis, so factoring in the impact on the economy is also worthwhile. For those reasons, I am careful about drawing conclusions from the data available. Though some observations are apparent when piecing together this information with the actions taken within countries.

With limited data, judgement is paramount

I have put this one first as I think it is the most important. Judgement distinguishes great leadership and is critical in a fast moving world where rumour and suspicion can come before solid facts. Good judgement has saved lives in this crisis. There was no playbook or mathematical model available at the start of the crisis to tell us exactly what to do. You can't analyse your way out of a judgement call. With the clock ticking, leaders still have to make the right decisions with limited information. That is why they are leaders.

We saw this first hand in New Zealand with the Government's rapid decision to go into home lockdown. Jacinda Ardern and her team's leadership in this crisis has been exceptional. Despite trying circumstances, they have done a wonderful job of encouraging Kiwis to stay home for our collective benefit. No one knows if lockdown was the best idea. That's what judgement is about. People will complain. No one ever gets it 100%. But the numbers speak for themselves. Ardern's swift leadership has saved lives.

Countries that underestimated the exponential nature of the threat like Italy and the USA are in deep trouble

By now, Trump's denial leading up to coronavirus is famous. See Vox, Forbes and the NY Times for a few samples. I have no doubt that this denial will cost lives. Italy's failure to recognise the scale of the crisis and implement strict social distancing will too. The average person with coronavirus infects ~ 2 to 2.5 other people. With an infection rate that high, the number of cases quickly reaches into the thousands. In the early days of the spread of a virus it may not seem seem that bad. Perhaps we think life can go on as normal if there are only a handful of cases. Why not? We tell ourselves that deliberating and responding prudently is sensible so we don't "hurt the economy".

With hindsight, nations that didn't respond quickly were wasting time. Preemption is difficult, but actually we expect national leaders to have that ability. While countries deliberated the number of cases exploded and made coronavirus much more difficult to combat. The underestimation of coronavirus' potential has been disastrous. I suspect that the under reporting of cases has been a contributing factor here.

Be decisive

Rapid and forceful response has been critical to stopping coronavirus in its tracks. Taiwan is a great example here. They learnt how to combat pandemics from the 2004 SARS outbreak and already had a centralised command center for managing such a crisis. They started implementing measures in late December 2019 to control arrivals from Wuhan before there was even a first case. By February, after the first case was reported, Taiwan was postponing returns to school and suspending tours of China. Taiwan's actions have clearly been successful with only 385 cases in a population of close to 24 million.

In New Zealand we went to pandemic level two on March 21st which limited large social gatherings and encouraged greater distancing. As of 11:59pm on March 25th, only four days later, we went to pandemic level four with home lockdown for pretty much everyone but essential workers. Enforcing strict lockdown has been instrumental in reducing the number of cases we now see with only 18 new cases as of April 12th. Australia has operated similarly, though not as strict, by limiting social gatherings, and encouraging people to stay at home.

Gradually increasing restrictions over time has clearly been a bad idea. With people still out and about, the virus continues to spread. Moving quickly to close the borders and enforce social distancing and has been pivotal in containing transmission.

Countries that were late to the party have responded better

This one's logical. Those countries that have had more time to learn from others are doing better than those countries that have had less time to prepare. One of the benefits of being far away from the action like in Australia or New Zealand is you have the opportunity to observe what's worked in countries like South Korea, and what hasn't worked in places like Italy. This gives more data with which to build a response. Of course being an island nation also helps with closing the borders.

Prevention beats treatment

It is best to avoid needing hospital treatment in the first place. Acting fast to control transmission and prevent the health system from getting overwhelmed is better for people's health and is cheaper. Being in hospital can cost thousands per day, let alone being in intensive care. In New Zealand the cost of being in intensive care is about $5,500 per day.

Health systems are not prepared for one in a hundred year pandemics, and often run on slim capacity margins. In Italy there are about 12.5 intensive care beds per hundred thousand people, or ~7,600 beds, though I understand this has increased since coronavirus. Most of those beds will already be accounted for. Italy has had ~3,400 critical cases so far. If all those end up in intensive care there is no way the health system can handle it. Stopping the virus in the first place is much more effective than trying to treat all those cases.

To wrap up

Countries have adopted a range of strategies to combat coronavirus including closing the borders, work from home policies, stockpiling protective gear, limiting gatherings and encouraging social distancing. Most countries have adopted these strategies with varying degrees of strictness and enforcement. Strict measures implemented early have been successful at slowing and even halting the spread of coronavirus.

I have considered the health impacts more than the economic impacts in this post. I think it is fair to say that the stricter the restrictions, the worse it is for the economy in the short term, but possibly not the long term as cases build up. Striking the right balance isn't easy. Only time will tell which strategy was best. To paraphrase Master Yoda - "much to learn, we still have".


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