We need to call out dangerous myth of 'mitigation' on Covid-19

I just received a video this morning featuring an Israeli Minister making an argument supporting "mitigation" as a strategy for combating Covid-19. He explained that since mortality rates are lower than one percent for the young, society just needs to isolate those above 70 years of age and allow the infection to spread through the rest of the population.

After that, about 80 percent of the total population has recovered from being infected by Covid 19, one has herd immunity in the population and this will protect the older members from getting infected.

There are many misconceptions underpinning this line of argument. The first is that the one percent mortality rate for Covid-19 infection is only obtained when the infected patients receive optimum treatment. We now know from the experience of Wuhan and Italy that approximately 10 percent to 15 percent of the Covid infected patients develop respiratory difficulty and suffer a drop in their blood oxygen levels.

Many of them can be managed by giving them oxygen. However five percent of all Covid patients deteriorate even with oxygen therapy, and they require intubation and ventilation in an intensive care unit (ICU). Only when you can provide this level of care to all patients who need it, can you achieve mortality rates of about one percent.

But in both Wuhan and in Italy, the number of Covid cases requiring ICU care over-stripped the capacity of the local health care systems to provide ventilator support to all who need it. And you have to bear in mind that ventilator support is not for a day or two only. On average, these five percent of the illest patients need prolonged ventilation for two, three or more weeks, tying up many ventilators in the process.

That is why the mortality rate for Wuhan was about 3.4 percent and that for Italy seems to be around five percent and rising. So, blithely arguing that mortality is low for the young is a very dangerous misconception. Anyway, even the quoted one percent mortality rate is about 10 times higher than the mortality for influenza.

Those still advocating the mitigation strategy have now changed tack a bit and are now advocating flattening the curve. By this, they mean that the country should practice social distancing so as to allow the infection to spread through the population but at a rate that the health system can handle. Meanwhile, the elderly should be shielded. This is another ill-conceived idea. Let us look at the math.

The UK has a population of about 67 million. If you intended 80 percent of the population to get the infection naturally so that the population develops herd immunity, you are talking about allowing 53 million people to be infected with the caveat that the curve should be flattened so that it does not swamp the health care system’s capacity to give ICU care to those who need it.

We know that with only 40,000 cases, Italy’s health services have been swamped many times over and that the situation there is quite grim. Assuming that the UK system is more robust and can provide optimum care to 50,000 new Covid-19 patients a month, it would take the UK 89 years to develop the herd immunity (53 million divided by 50,000, divided by 12).

Makes much better sense to wait for the vaccine, doesn’t it? Hopefully, we should have one before the end of the year. That would confer us herd immunity much more painlessly than exposing 80 percent of our population to the natural infection.

Luckily, Malaysia is following the other strategy of Covid-19 management – suppression of the outbreak by isolating all active cases and tracing and quarantining all contacts, thus breaking transmission. This is the strategy being followed in Wuhan, South Korea, Hong Kong and Singapore. And to me, this seems to be the sanest and humane way of handling this epidemic.

Wuhan has demonstrated that it can work – they managed to stop the epidemic there with only 70,000 cases out of a total population of 60 million (for Hubei province). The down-side of this approach is that it does not create herd immunity. In Hubei, only 0.12 percent of the total population was infected, far short of the 80 percent required to give herd immunity. Imported cases can re-start the epidemic quite easily if vigilant surveillance and quick action in damping down any recrudescence are not implemented religiously.

This strategy of suppression is quite different from the tactic of flattening the curve, and we should not confuse the two (as some people in Malaysia are doing). Suppression means we aim to bring the transmission of Covid-19 down to zero if we can. Flattening the curve means that the epidemic is permitted to spread through the population but at a controlled rate. The latter approach is a dangerous route to follow.

The US seems to be particularly enamoured with the mitigation strategy, and they are going to find that it is not easy to maintain a controlled spread of the Covid-19 epidemic through the population. It’s like talking about a controlled wildfire. It is sad that many thousand citizens in these two countries will pay the price for this deeply flawed policy.

It is always interesting to try and figure out the ideological basis of differing policies. Is it just a coincidence that the countries that subscribe most to neoliberal theory – the UK, the US and Israel - are the ones most taken up with the mitigation strategy? You see, the suppression strategy is not a final solution to the Covid 19 problem – you need to wait for the vaccine and that might take a year to materialise.

In the meantime you have to keep disrupting production by quarantining contacts, encouraging workers with respiratory tract symptoms to stay at home on full pay, minimising travel overseas and tourism, discouraging mass events such as concerts and sales etc. All these are measures that reduce economic activity and corporate profits.

If somehow you could get herd immunity within four months by letting the epidemic rip through your population, yes, you would suffer horrendous casualties (deaths), but you emerge with a population that can go back to work without worrying about quarantining people and allowing sick leave et cetera.

You would then have an economy that is more lean and efficient than the sissies who mollycoddled their population with the suppression approach. You would be more competitive and could expand your export market. With unemployment high in so many other countries, you could always import some labour if necessary as, after all, you no longer need to worry about importing Covid-19 as you have herd immunity. Another bonus of the “let her rip” approach is that your dependency ratio would be less – you would have lower pension and social security expenses as the mortality rate is higher in the elderly.

Am I being overly cynical, or could this be the reason why certain political leaders are drawn to the mitigation approach? I will let you decide.

Meanwhile, whether we like the present administration or not, we should all fully support the movement control order and other follow-up steps that the government takes to bring down the spike in the infection rate.

The health of our people, as well as our own, depends on it. We all need to work together and for each other to get over this difficult period. - Mkini