A Doctors’ Open Letter to Daniel Andrews

A Doctors’ Open Letter to Daniel Andrews, by A Dozen Melbourne Doctors. This letter argues against lockdown, but is blessedly unusual in that genre because it does not rely on biased studies, does not make easily disproved science claims, and does not rely on cherry-picked statistics (it has some, but they are not relevant to its main argument).

For the sake of people in Victoria with other medical illnesses, it is vital that Stage 4 restrictions be lifted on schedule in mid-September. …

As medical practitioners, it is our collective experience that patients are presenting later to us with their medical complaints. Specialist referrals from GPs, and indeed GP workload, have fallen dramatically due to patients’ reluctance to leave home in fear of acquiring the virus. As a direct consequence of this delay, many will have poorer prognoses. This has especially been the case with consultants who treat cancer. A study in the UK estimated an extra 4000 deaths from not screening the four main cancers alone and not from lack of treatment.

In addition, it is our professional opinion that the stage 4 lockdown policy has caused unprecedented negative economic and social outcomes in people, which in themselves are having negative health outcomes. In particular, it has caused or exacerbated depression, anxiety and other mental health issues, as well as contributed to domestic violence, through an extreme and unjustified disruption to family, social and work life. Job losses, home schooling, the isolation of the elderly and single people and the restriction on the number of people who may attend funerals, are but a few examples of how the government’s current response is harming the health of the general population.

In short, the medical, psychological and social costs of the lockdown are disproportionately enormous compared to the limited good being done by current policies, and are relevant factors to be taken into account by any responsible government.

This blog has always taken the view that no one yet knows — even roughly — either the health costs of catching the virus or the economic and other costs of lockdowns. A cost benefit analysis is still not possible, and probably never will be, because the health costs and economic costs are complicated by effects that might only become apparent in the long term, and by comorbidities (the economy had too much debt already, the patient was too fat, etc.).

So comparing the various policy alternatives and making a rational choice is not possible, and might never be, even in retrospect. IMHO, people who definitely reckon they know which choices to make are kidding themselves and ignoring the uncertainties. They usually ignore whole categories of costs, and they engage in often heroic leaps of wishful thinking.

Accordingly, this blog doesn’t have a view on Wuhan-style lockdown versus let-it-rip, and all the shades in between.

Except that Australia should have closed the borders much earlier in order to avoid the virus altogether. We were calling for closing Australia’s borders by mid-February, five weeks ahead of when it finally happened, back when the universities were still bleating about their loss of income if overseas students were not allowed in. It was obvious even then that the cost of closing borders a bit earlier was far less than either the lockdown or let-it-rip required by not closing the borders early enough.

It was also obvious that the Chinese, who knew more about covid than anyone else, took it very seriously indeed. Probably because it escaped from their bioweapons lab, after being found in a cave in 2012 and then “enhanced” in that lab. Given its origins, this virus is more likely than most to have pernicious long term effects, designed to impair rather than to kill. There are many reports of widespread organ damage in recovered patients who had minimal symptoms — the picture is very unclear, but there are some bad signs. In any case, it is hardly wise to be sanguine about being infected by an unknown disease.

The reason the whole western world has chosen to lockdown rather than let-it-rip is essentially quite simple. In a democracy, it is too callous to hang some people out to die. There is no socially acceptable reason to let them die, when we could (easily?) save them.

Also, most people don’t want to get sickened by some unknown disease. Have you noticed the extreme popularity of the political leaders who are seen to have kept their electorate mostly free of the disease? Western Australia’s premier has an approval rating of 90%, an almost unheard of level in a Western democracy.

About 1% of people in Australia live in old-people homes. They cannot really be insulated from the rest of society, because of staff, supplies, and relatives. Let-it-rip condemns a good fraction of this 1% to die soon, which would account for most of the quarter to half a percent of the population that would soon die in a let-it-rip scenario on the March-2020 death rates.

By March the death rate had already dropped to under 1%, from where it has been slowly dropping and is now around 0.5% in most western countries, given current medical practice and the mix of people catching it. As medical knowledge improves, it will drop much further, at which point, with sufficient medical intervention, it will be no more deadly than the flu. But we’re not there yet. Though with a cocktail of cheap anti-virals including HCQ and Bromhexine, perhaps we could be.

Let-it-rip is too callous for democratically elected politicians. None of them went for it, once the deaths started. The UK’s Johnson went for it initially but then backed off and went to lockdown, and even Sweden had buckled by late June and changed course towards more lockdown. Today the architect of Sweden’s policy, Anders, says that if he had his time over he wouldn’t advise Sweden to do what it did. Let-it-rip is politically unrealistic in a democracy, which is why it gets short shrift as a policy alternative in the mainstream media.

Note that the Swedes start half locked down anyway, because more than half of Swedes live alone. In most countries people live mainly in family groups, and most infections are caught from family members. It’s hard to stop a disease this contagious within a household, so everyone gets it. The anti-lockdown crew would like to believe that let-it-rip in the West would be like Sweden, but evidence and logic suggest it would be more akin to Brazil.

The anti-lockdown proponents have been heroic in their insistence that herd immunity is just around the corner — even in April, when infection rates were only around 1% in the West. Normally herd immunity takes around 70 – 80%. Those proponents also like to pretend that everyone will catch covid, that it’s inevitable, just like any virus. Not so. Spanish flu, the black death, Ebola, and HIV were not stopped by herd immunity, but by various forms of lockdown.

Covid is a coronavirus, so the likelihood is that individual immunity only lasts a couple of years. Already there are numerous reports of people catching it twice, probably slightly different strains. We don’t have herd immunity to the common cold. It might take quite a while for covid to evolve into something as “harmless” as the common cold.

Some even claim that lockdowns don’t work. It’s been known since antiquity that lockdowns work. We were reminded of their effectiveness in medieval times with the plague, and in 1920 with the Spanish flu. In March and April 2020, it was noted that about 12 days after a lockdown was tightened, the infection rate dropped. Yep, still working.

The Melbourne second wave must surely convince even the most hardened ideologue that lockdowns succeed in bringing down the infection rate. Melbourne had almost no cases, having previously beaten back a first wave with a lockdown. (If that first wave was defeated by herd immunity, there wouldn’t have been a second wave, would there?) Then there was another outbreak, the second wave, which took off exponentially. Lockdown was applied in increasing severity. Soon the rate of infection stopped increasing, then decreased, and the infection rate is now about a tenth of its peak rate a few weeks ago, and still dropping. We await with interest the explanation of anyone who still claims lockdowns don’t work.

Only one lockdown in an advanced country has failed — the US. It failed because the US didn’t close its borders. The UK likewise locked down without closing its borders at first, but genetic analysis of covid strains soon found that although the lockdown was eventually eliminating existing strains, there was a steady influx of strains from outside that would spread for a while in the UK before eventually also dying off due to the lockdown. (Note that there is still spread in a lockdown, just that each infected person infects fewer than one other on average.) So the UK has increasingly closed its borders, and its lockdown has now succeeding in dramatically lowering the infection rate. The US cannot even close its borders to illegal immigrants/voters, let alone to a virus, for party political reasons.

In any case, the days of lockdowns are fast approaching their end. Not because of herd immunity, but because biotech solutions are within sight. Lockdowns bought us time while we figured out how to deal with covid and until a biotech solution emerges.

The doctors in the article above do not attempt to make a comprehensive cost-benefit analysis, but simply argue that they think lockdown is too costly. Coming from doctors in their area of expertise, that’s an opinion that must be respected and their evidence of non-covid health costs of lockdown must be taken into account. But without addressing the many costs of both lockdowns and their proposed alternative (it was unclear: let it rip from now? lockdown should never have been applied?), it falls well short of a persuasive case.

They also make the common but nonsensical argument that relatively few people have died here, so the costly effort to avoid covid deaths was unwarranted. Umm, few people have died here because of those efforts. No, it’s not just scaring elephants away — witness the overworked crematoria in Wuhan, the overflowed hospitals in NY, and the mass graves in Brazil.

Some say that covid deaths are in fact much rarer than advertised, and that so called covid deaths are usually caused by something else. They quote the recent US CDC figures, that show only about 6% of the official “covid deaths” are due to covid alone — there is usually something else as well on the death certificate. To a logician, this is hilarious. If someone with obesity and covid dies, these people claim that it is not a covid death. Therefore, obese people, or people with diabetes or heart disease, cannot die “of covid”!?! To avoid dying “of covid”, one merely needs to be obese. So eat up! Who needs a vaccine? I suppose if Boris Johnson had died this year after he contracted covid, they would have said obesity caused his death? Sure.

Hey, something’s killing people this year, as shown by the US excess deaths:

Official covid deaths underestimate excess deaths in the US.

There is a sad political aspect to the lockdown controversy. Several people have assumed that this blog is “for” lockdowns because we haven’t run the anti-lockdown diet of biased studies, cherry picked data, claims that the death rate is no worse than the flu, picking extreme studies and conveniently ignoring the rest, and herd immunity fantasies where less than 10% of the population has been infected. Thus, we are not part of the right wing blogosphere that maintains those fantasies. We have said lockdowns obviously work, but that the US lockdown is a sad failure because the US didn’t close its borders. But we haven’t had an opinion for or against applying lockdowns, or expressed a policy preference other than closing the borders way back in February. (Which, with the benefit of hindsight, would have saved an enormous cost, wouldn’t it?)

There is an assumption that one is either “for” lockdowns, or “anti” lockdown. This suggests ideological, political thinking: you’re either for us or against us.

25 years ago in Canberra, Joanne and I witnessed the rise of left-wing  political correctness in Australia. The media echo chamber was forming. Because it excluded arguments and evidence against the PC views, people choosing to listen only to that chamber would never encounter any contrary information. Indeed, they became impervious to contrary information. If it wasn’t in their “news” services then it could hardly be correct, could it? They would have told us, if it was correct. The PC media encouraged moral vanity — you are morally superior if you hold these beliefs. Then the PC news services hooked them on a feeling of virtue and smug superiority, by telling them how it really is, the PC way, and how clever the audience was for believing what they were telling them. It was the birth of the left wing cult of political correctness.

Political correctness was enforced by social ostracism. People in the grip of PC felt entitled to be quite rude to you if you disagreed with the PC position (which threatened their superiority and identity, by the way). Then they would resume normal relations as soon as the topic shifted, as if nothing had happened. They had a certain light in their eye when they were being PC. Hmmm. Ideological fever overrode social niceties and friendships, let alone evidence, as we discovered.

Lately we have been seeing this in the comments section of Joanne’s blog, on covid articles. The only acceptable science stories are those that end with the conclusion that lockdowns are bad. Politeness and accurate language are in short supply in the comments. Where have seen this sort of thing before? Hmmm, Canberra, two decades ago.  Now it’s coming from some of our friends on the right, on, of all things, covid. The right has been blessedly free of PC until now — hopefully I am mistaken in recognizing it now.

Another hallmark of ideologically driven reasoning is that those under its spell never acknowledge points contrary to their sacred beliefs. We never see the anti lockdown people address the obvious points above — even when specifically invited, in the friendliest terms.

Without listening, acknowledgment, and engagement, in polite terms using accurate language, there is no conversation any more. It just degenerates into propaganda to make the speaker and their audience feel good about themselves. It reminds me of that PC town we left. No, we didn’t want to join a club that encourages fantasies in order to feel superior — which is what the smug set in Canberra became. A terrible way of finding the truth and setting policy, btw.

Needless to say, this blog will not be swayed by political correctness, either of the right or the left.

hat-tip Stephen Harper