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What level of death can we live with? A thread on an uncomfortable question that needs answered in the coming weeks. It's posed in a remarkable interview in Der Spiegel's English edition earlier this week. If you read nothing else today read this. 
https://www.spiegel.de/international/world/corona-you-need-the-sledgehammer-to-bring-down-infections-a-e939bdf1-6485-4c24-b70e-9ee7a5cdf5b0
https://www.spiegel.de/international/world/corona-you-need-the-sledgehammer-to-bring-down-infections-a-e939bdf1-6485-4c24-b70e-9ee7a5cdf5b0
2./ The interview is with a giant of infectious disease science Gabriel Leung @gmleunghku who played a major role in conqering SARS in Hong Kong, and worldwide. At the beginning of this year Leung was a hardliner advocating throwing everything at trying to stop COVID-19
3./ Here he is on '60 Minutes Australia' in early February saying just that. He said then we'd be extremely lucky to contain the virus. We know now we ran out of luck. In the meantime Leung has turned his attention to what we can do next to get us out of lockdown.
He said then we'd be extremely lucky to contain the virus. We know now we ran out of luck. In the meantime Leung has turned his attention to what we can do next to get us out of lockdown.
4./ Obviously, he says the priority is to get the numbers of new cases down much further. But Leung warns there is no way we will get to zero cases. And no need to either, IF we can get the cases low enough and our testing regime responsive enough to jump on any outbreaks.
5./ How fast and responsive we do testing and the tracing of contacts and how effectively we do distancing will dictate how quickly we can move from lockdown. Both will ensure we can reduce any surges that will inevitably occur, and by extension the number of deaths.
6./ The good news he says is the more effective our testing and tracing of contacts the less we will need to rely on distancing. He even foresees one day handshakes coming back. Come to think of it what could show a bond of trust more than a handshake in a post-pandemic world?
7./ The one thing that might stop us moving soon to restore some semblance of our old way of life...is our understandable fixation on the lives COVID-19 is costing right now. We're going to have to move away from that fixation. As soon as we reasonably can.
8./ That's where that big question comes in. Leung asks, "What is society ready to accept in terms of the number of people infected and hospitalized and the number of people who need to be ventilated and may die?" We already ask this even if we don't like to admit it.
9./ He reminds us "Every year, the flu kills a lot of people in Europe, thousands, even tens of thousands. But you don’t get a riot every year. So, it seems to be acceptable to people to deal with that level of morbidity and mortality."
10./ "Nobody likes it, but it is tolerated. Nobody asks for zero flu deaths. ...So, somewhere between what people tolerate by implication every year and having completely overwhelmed ICUs like in New York City, somewhere between these extremes lie your tolerance levels."
11./ Questions like this are not often posed to the public. We're a squeamish lot. We'd never visit a slaughterhouse but happily buy packaged meat in the supermarket or discuss the tenderness of steak. We're going to have to overcome our scruples in much the same way..
12./ A vaccine most likely won't be available for 18 months. We can't shutter the economy for anywhere near that long without costs in lives and health as high as COVID-19 and devastating our ability to pay for the NHS and the welfare system that's keeping millions fed and alive.
13./ That's not to mention the billions of people worldwide who may be forced into total poverty. As consumers here tighten up on little luxuries like, say, out of season vegetables farm workers in Africa have their family incomes wiped out.
14./ Whatever we do to get out of lockdown will have to be done carefully. As Angela Merkel explained seemingly tiny statistical differences in the rate of transmission can have dramatic consequences. https://www.theguardian.com/world/2020/apr/16/angela-merkel-draws-on-science-background-in-covid-19-explainer-lockdown-exit
15./ But right now the virus of economic dislocation and ruin is being transmitted too. And no one has a handle on its R0 number. The rate of transmission of poverty and wasted life chances is currently incalculable. We can only reduce it by loosening up as safely as we can.
16./ How we do it and when is a debate the govt should be leading. The idea we can't talk about how to get out of lockdown seems to me preposterous. Partly because the public will have to have time to process the reality that it WILL cost some lives.
18./ Admittedly a rational, calm debate about risks and balances will be impossible for as long as the media is still stuck in gotcha mode. And for as long as it and we try to avoid that blunt and troubling question that won't go away: how many deaths can we live with?
