Suppress, trace, test, repeat

When the Covid-19 pandemic started, it was generally assumed that the only serious policy option was to “flatten the curve”: that is, keep the spread slow enough that the hospital system was not overwhelmed, until either a vaccine was developed and generally available or most of the population had caught the disease giving rise to herd immunity. Both approaches looked likely to take at least a couple of years to work.

In retrospect, this assumption was surprising. China suppressed the initial outbreak in Wuhan, as well as the spread to other provinces, and held case numbers close to zero thereafter. But for a variety of reasons, good and bad, people either distrusted Chinese numbers or thought that the lockdown measures used there couldn’t be applied elsewhere.

It’s now clear, however, that these assumptions were false. Most* developed* countries have applied measures sufficient to reduce Covid-19 from an epidemic to a set of localised clusters. At this point, a full lockdown is no longer needed. Social distancing can keep R below 1 for the general population, so that local clusters don’t grow exponentially. And, as long as the numbers are small enough, contact tracing, testing and localised lockdowns can keep the disease under control.

That’s been the experience in East Asia, Australia and New Zealand and now, it appears in most of Europe. Progress hasn’t been uniform, but no country that’s managed suppression has gone back to uncontrolled spread.

The next step, evidently is reopening borders between jurisdictions where the virus has been suppressed. The most limited form, but still a significant step would be allowing entry subject to 14 day quarantine. That could be relaxed, conditional on returning a negative test. Finally, there’s the ‘bubble’, reopening borders without quarantine or specific testing.

There’s nothing particularly novel in what I’ve written above, but I don’t think the implications have fully sunk in. Indeed, I haven’t thought them through in detail myself. To give just one example, what if the US remains isolated from the rest of the world while travel to and from China is reopened?

  • Sweden didn’t attempt this, the US started but couldn’t persist long enough, and is now completely distracted by the collapse of the Trump Administration.
  • It’s still unclear what’s happening in middle-income and poor countries, where lockdown doesn’t seem feasible. There’s some hope that the disease will be less severe in the tropics where most of these countries are found. Younger populations means less vulnerability. And sadly, there is already such a large toll from endemic diseases and poverty that Covid looks less exceptional.

27 thoughts on “Suppress, trace, test, repeat

  1. John, It’s probably a minor quibble since I know you’re talking about politics here but the general strategy assumed within public health at the beginning of this pandemic was containment for elimination, referenced in this Lancet editorial by the WHO team. This is what WHO was aiming for and it is what China, Taiwan, Japan, South Korea, Vietnam, Singapore, Australia and New Zealand basically followed, though with varying degrees of success. The European nations made a decision to ignore this strategy and instead went for this “flattening the curve” nonsense, which is probably also why your title doesn’t include a key word from the WHO mantra: test, trace and isolate.

    Given how far the European nations and America have deviated from WHO advice, this statement of yours is premature:

    Most* developed* countries have applied measures sufficient to reduce Covid-19 from an epidemic to a set of localised clusters. At this point, a full lockdown is no longer needed.

    It is highly unlikely that the epidemic is going to remain a set of localized clusters in a lot of these developed countries, and we should expect flare ups and possibly a second wave (except in the US and UK where they may never escape the first wave). This is because they have not followed WHO advice. What’s likely then is that countries that have established bubbles will kick these European nations out of their bubbles (or not let them in). You can see the way this works from China’s struggles with nationals returning from Russia. The epidemic in Russia was way less vigorous than that in America, but returning nationals were generating constant clusters that led to cities being locked down again. China, Japan and South Korea are unlikely to open up to the US, UK or parts of Europe while they have the scale of infection we’re seeing.

    finally I would suggest it’s not entirely true that “no country that has managed suppression has gone back to uncontrolled spread”. Singapore suppressed but had a huge outbreak in its migrant worker population and as a result is still under a very strict lockdown; South Korea has had a few scares and isn’t out of the woods yet; Japan was down to 30 cases a day when it reopened but things are already looking shaky. Avoid the risk of speaking too soon!

  2. Might a geographically differentiated approach help? For example, designate regions, cities, or perhaps even suburbs as “green”, “orange”, “red”. So when an outbreak recurs, the relevant area would be designated “red” and revert to lockdown. Travel would be allowed within green zones only. Red and orange zones would be isolated*, but containment measures would be tighter in red zones, looser in orange zones.

    This differentiated approach might strengthen incentives to practice social distancing and good hygiene. Local businesses and communities will have stronger incentives to monitor each other to promote social distancing and good hygiene. If an outbreak happens locally, they would be affected. If the outbreak happens elsewhere, they can continue life as normal.

    (*People leaving red or orange zones would have to be quarantined for 14 days before moving around green zone areas.)

  3. Kien Choong, I think that is relatively easy to do internationally but it’s very difficult to do sub-nationally. The political consequences of isolating marginal seats, etc. …

  4. Exhibit A for faustusnotes’ take on the WHO is Kerala (pop. 34m, GDP per capita about $3000, covid deaths 4 last time I looked). It’s a federal state not a country, without a foreign service, and too poor to develop its own wrong policy, so just followed WHO advice to TTIS. In turn this followed the standard playbook developed in the Gilded Age for animal diseases. The net benefit from fancy mathematical modelling has been roughly zero.

  5. The radically different experience of different parts of the world is still a genuine puzzle. Different countries have had very different responses, but their outcomes do not appear to correlate very closely to their response. This actually means that we cannot answer questions like “was the lockdown worth it?” because we can’t know the likely counterfactual.

    From a global persepctive it appears that the virus is simply not as virulent as early experience in Wuhan and northern Italy led us to believe (the Italian case, BTW, illustrates this capriciousness – why is it so deadly in the north and so relatively innocuous in the south?). I think this lower virulence is the reason so many countries have found it relatively easy to control; perhaps it’s just a matter of different strains (coronaviruses mutate rapidly, and in social animals a virus that does not incapacitate its host has an evolutionary advantage as it will be spread more).

  6. The politics in Europe seem to work against border controls as strict as they should be and even more so against borders within a nation which have not been established anyhwere. Even Sweden isnt really locked out entirely. They don´t get free tourism movment, but they do get free businesspeople movment with no quaranteen already.

    Germany also never closed down the borders for work commuters from/to France and Switzerland. That seemed rather dumb, and it shows in regional case numbers. But it was never ever discussed. On the contrary, all the framing was about the racism of having any border at all aswell as the racism of regarding French commuters as particular high risk group. The nations who are less inhibited by multilateralism also seem to be under pressure from economic interests in tourism to open very rapidly.

    Now what really was racism was when Leipzig football club security kicked out some Japenese visitors from a football game because they thaugh they were Chinese and thus a higher covid risk than the Germans. Well turns out at that point, they would have been lower risk even if they had been Chinese and the game should have never had an audience of Germans.Nevermind that in that case the reporting about the incident was very non critical – more abou the tone of the security people and less about the substance of kicking them out.

    At some point there will probably be a region system as the one already in place in Germany for the entire EU so that travel bans can be disconnected from nationality discrimination arguments. So far that is not the case. As a further problem, it is almost predictable that the regional numbers will be doctored in more or less overt ways, at least in inbound tourist areas. The way regional officials here already pretend infetected refuges don´t count as risk factor for the non refuge population despite all the intercontectedness of the refuges to everyday life through school visits, public transport, sometimes work and the like already suggests as much.

  7. I agree with James Wimberley about the example of Kerala, and I suspect that its good work is going to be tragically undone by the national government forcing it to open to domestic travel. I think James is also right that there’s nothing special about the required response, and it’s amazing to me that countries in the developed world seem to have abandoned basic principles of public health that have been know for at least a century. The recommendation from the WHO – test, trace, isolate – is pretty straightforward and not high tech (except the PCR part, but it can be done with just x-rays and clinical judgment). It’s a failure of policy, plain and simple. I slightly disagree about the fancy mathematical models comment though – basic SIR models were sufficient to show what a trainwreck it was going to be, and the Japanese cluster-busting response was based on some fairly fancy modeling (though in the end not that important compared to the WHO’s basic principles). It’s true that the Ferguson model and the IHME’s work was largely irrelevant, and I think Ferguson’s early work underestimated the true transmission risk, but I don’t think the UK’s problems were their scientific advisors so much as their terrible leadership.

    derridaderider, you’re completely wrong. The virus has been everywhere as virulent as expected, and “so many countries” have not “found it easy to control”. In the USA and UK at one point case numbers were doubling every three days, and they had to introduce strict lockdowns that they maintained for months just to reduce daily case numbers by half. Outcomes also do correlate pretty well with response: early and rapid response in Japan and Vietnam and Kerala slowed growth and allowed for shorter, more effective lockdowns, while slower and more relaxed response in the US and Europe led to longer and more aggressive and less effective lockdowns. I have a case study comparing the UK and Japan which shows how much more Japan did and how much earlier; Vietnam was even more aggressive early on, and correspondingly more effective. There is, as James says, no mystery here. It’s just that some rich western countries thought they could get away with ignoring the WHO and 100 years of basic public health principles.

  8. Faustusnotes: I think the playbook mow has four elements: test, trace, isolate and support. The nost striking tecnological innovation in this pandemic has been the new ways of communities’ supporting their members, from balcony singing to zoomed worship. Governments don’t seem to have contributed much here, beyond delivering food to the quarantined, and that not everywhere. Income support has been better though.

  9. Iran (not a fully developed country) illustrates what happens when suppression is incomplete and you relax suppression measures. Iran is approaching a second wave peak which likely will become worse than the first. This will happen in each and every country as soon as they relax full internal suppression lock-down and cease isolation from the rest of the world. Every country will have a second wave if that is done.

    The only safe approach, country by country, is full internal lock-down plus international isolation until full eradication. Further, since many countries cannot or will not attempt full eradication, then what is required in a country like Australia is “autarkic eradication” (eradication in one country with autarkic quarantining from the world) until if and when an effective vaccine is made.

    Countries which do not eradicate COVID-19 are leaving themselves open to comprehensive collapse. The USA is the object lesson of this reality. So far, the USA is regressing towards comprehensive collapse. Britain also is and probably the E.U. It is clear that neoliberalism plus COVID-19 is enough to collapse any nation. Permitting COVID-19 to run rampant risks a worse mutation which will run through nations just as the second and worse wave of the Spanish Flu ran through nations.

    The situation circa 2020 is profoundly different from that of circa 1920. There will be no recovery comparable to the growth period of 2020 to 2070. The world is now greatly over-populated and in over-shoot. Environments are stretched beyond their limits. Collapse is on the cards everywhere. If we continue on our present path, near annual mutations of COVID-19 plus decadal outbreaks of other novel zoontoic diseases are possible and indeed more likely than not. Add in climate change and sea-level rise. The only correct path is eradication of COVID-19, cessation of fossil fuels use and a change to a world of autarkic, quarantined regions via a great reduction in global inter-connectivity and people movements.

  10. For a lowish income country like India the best course may be to reduce public gatherings and activities that are likely to spread the virus while enforcing public mask wearing where people are likely to come within 2 meters of each other. If low cost approaches like these can reduce the reproduction rate below one then the loss of life may be minimized. (Reductions in lives lost due to the reduced spread of other diseases should also be taken into account when determining costs.) More expensive measures that greatly restrict economic may cost more lives in the long wrong by, in some cases, literally starving people to death. But, there is a huge difference between a reproduction rate of 1.05 and 0.95. Clearly it’s still worth spending a considerable amount to get it below 1.0.

    While not really a serious suggestion, an alternative approach would be to send everyone over 40 out of town for three weeks and intentionally infect everyone who remains. Then maintain low cost precautions afterwards until the disease dies off. Note this is not an easy thing to do. Maybe some locations could try it.

  11. Until there is a standard procedure for the retrieval and analysis of COVID data, national comparatives cannot be definitive and are pretty meaningless.

    Without any proper studies to the contrary we have to assume that the virus is at least as deadly as it was in the first outbreak.

    Historically it’s obvious that quarantine works and with modern screening tools the suppress, trace, test & repeat strategy is a strategy that also works. What’s more, without the availability of a proper vaccine it is the only strategy that works.

  12. Social distancing can keep R below 1 for the general population, so that local clusters don’t grow exponentially. And, as long as the numbers are small enough, contact tracing, testing and localised lockdowns can keep the disease under control.

    Does this mean R=0.9 is okay? There will be a lot more dead people than if R=0.5. What is the right R for governments to aim for?

  13. JQ, it seems to me your account of the history of assumptions made misses to emphasise decision making under uncertainty with Bayesian learning.

    My understanding of the arguments presented by medical experts and politicians in Australia and in Germany is that ‘flattening the curve’ was the first objective to gain time for the hospital and public health system to gear up and for scientists to learn more about the new virus. This phase was also referred to as suppression. Only after new information about the virus became available could the medical experts provide further advice and governments could decide what to do next, given this advice and the public response to the measures that had been taken and their effectiveness. Step by step. This process is not completed.

    The UK failed incredibly badly in the suppression phase. It now has more cases and more dead than Italy on a per million population basis. In contrast to Italy, the UK had plenty of warning.

    Sweden is discovering it has more cases and more dead per million population than comparable countries, Norway and Denmark, but the economic impact is similar. The Swedish medical adviser has acknowledged their policy has not worked well.

    Greece introduced a relatively hard restriction measure and very early. The outcome so far is they rank with Taiwan …., NZ and Australia among the countries with least cases and least dead per million. Greece, like South Korea, doesn’t have a long land border with other countries.

    All EU countries got caught out with their dependence on China for the least expensive and technologically least demanding items, namely protective equipment that is crucial in a pandemic. This dependence will not last long anywhere in Europe.

    The Chinese lockdown in Wuhan was brutal by all accounts. Angela Merkel publicly said the Chinese method is inconsistent with the fundamental principles of a democratic society. In Australia and in Germany the politicians provided public education on a more or less continuous basis with the involvement of medical experts. They appealed to the public to cooperate because it will only work if people follow the advice and are self-disciplined. They also acknowledged the efforts of people.

    It seems to me it is impossible to find one right or wrong answer to what is best because the circumstances in countries and even regions within countries are too different and the spread of the virus is neither even nor simultaneous.

    For example, Australia is self-sufficient in food. Closing its borders to all other countries for a period of time is therefore not a problem. By contrast, none of the EU countries is as self-sufficient in food as Australia and the common market encouraged interdependence. Seasonal fresh food producers and dairy producers depend on selling their produce and wastage of food and gradually malnourished people is not a good idea.

    Highly automated production companies continued working in many countries in the EU because the social distancing measures could be applied.

    Movement of goods between EU countries was possible throughout the suppression phase.

    But Chinese workers of construction companies buying up medical supplies in Australia and shipping it to China was possible, too (apparently an export license is not required).

    hix is right when he says the borders between France and Germany never closed for work commuters (in the border region). The same applies for Germany (State NRW) and The Netherlands and Belgium. However, it is not the case that this was never discussed. Not long ago, the Premier of the State NRW explained that health departments on both sides of the borders had agreed on procedures. Borders for goods transports were not closed at any time.

    The EU is about to arrive at a coordinated opening of the borders with mutually agreed conditions including responses to outbreaks. The planned opening for tourists is the middle of June with the proviso that restrictions may have to be reintroduced if the infection rates become a problem.

    I understand the severe infections rates in the SW of France are related to a Church event and those in the SW of Germany are related to a ski resort in Austria and Carnival rather than work commuters.

  14. For the Netherlands I can confirm what Ernestine Gross is writing. There was some talk about suppression and herd immunity in the beginning, but soon it became clear that in any case the spread of the virus had to be stopped to prevent the health system becoming overwhelmed. Hence the lockdown.

    Now we seem to be (slowly) going back to some kind of normal except that 1.5m distance must be kept at all times and face masks are compulsory in public transport. Furthermore anybody feeling slightly ill is encouraged to get tested: test capacity seems to be large enough now.

    A conglomerate of Dutch manufacturers took up production of (medical) face masks to become independent of imports (should start full throttle about now).

    The border with Germany was not closed, but the border with Belgium was for a while.

  15. The COVID-19 pandemic will clearly affect our immigration policy. I am a zero population growth (ZPG) advocate for Australia and indeed for the world. However, here in Australia we only have the potential to control of Australia’s situation, not the world’s situation.

    ZPG for Australia, in normal times, would mean Births – Deaths – Emigrants + Immigrants + Refugees should equal approximately zero each year and average nearer to zero over longer time periods. In a time of pandemic, that policy clearly has to be altered. Immigrants are not coming in and very possibly many intending emigrants are not going out.

    “Anna Boucher, global migration expert and associate professor at Sydney University, tells ABC RN’s Life Matters that people on temporary visas make up “about 10 to 12 per cent of the workforce”. – ABC.

    “The Government has advised them (temporary visa holders) to return home, arguing we’ve got enough to worry about with our own citizens, but experts say we need to support migrant workers both for moral and economic reasons.” – ABC.

    We should permit these temporary visa holders to apply for permanent residency in Australia and citizenship and give them full access to welfare etc. The logic is that these people can about replace the immigrants who will not be coming for the next x years.

    When full emigration / immigration patterns are re-established (if ever because the world might be permanently changed) then a ZPG policy and formula can and should be applied for Australia.

  16. faustusnotes says “the general strategy assumed within public health at the beginning of this pandemic was containment for elimination,” 
    yes, see WHO link at end

    James Wimberley says “Exhibit A for faustusnotes’ take on the WHO is Kerala” … “… so just followed WHO advice … net benefit from fancy mathematical modelling has been roughly zero.” See Mongolia. 

    Mongolia does not even get mentioned in the statistics because they… acted on 22 Jan 2020. What is the opportunity cost of acting this earlly?

    Mongolia puts the lie to many of the words and actions by many commenters,  governments, China and WHO detractors. Why didn’t we / they take action  this early? They even ceased coal exports. See WHO “Novel Coronavirus (2019-nCoV) SITUATION REPORT – 1 

    21 JANUARY 2020” below. Thailand, Japan & Korea mentioned as only countries with reported cases..
    ***

    Newspaper in Mongolia Publication date: 2020-01-22…
    “Health Ministry advises not to travel to region affected by coronavirus

    Ulaanbaatar /MONTSAME/. Concerning the outbreak of a new coronavirus, which has spread to several other countries, Ministry of Mongolia, joined by the World Health Organization (WHO) Mongolia organized today a press briefing to share information with the public on novel coronavirus (2019-nCoV) and preparedness action taken by the Ministry.

    As the coronavirus is identified to be transmitted via the air and the respiratory tract between humans and Mongolia is at risk of coronavirus spread, officials from the Ministry warned people not to travel to the region, where the outbreak began, or with risk for the coronavirus transmission, if not necessary. 

    The Health Ministry has also sent warning and precautionary measures to Ministries of Foreign Affairs, Environment and Tourism and Specialized Inspection Agency and General Authority for Border Protection 

    The Health Ministry informed that no cases of coronavirus reported in Mongolia. Six people were screened for coronavirus after returning from China and Hong Kong with respiratory illnesses since January 10, but none were found to have been infected with the new virus. 

    Sergey Diorditsa, WHO Representative in Mongolia, who was present at the press conference, informed that the WHO is working with the Health Ministry to take all the steps to prevent the spread of the deadly virus to Mongolia.”
    https://www.montsame.mn/en/read/213636
    ***

    Source article re Mongolia.
    “COVID Underdogs: Mongolia
    The best COVID-19 response in the world

    “China has just shut down Hubei Province, the largest cordon sanitaire in human history. What would you scream to your leaders? What would you tell them to do?

    You’d tell them that this was serious and that it’s coming for sure. You’d tell them to restrict the borders now, to socially distance now, and to get medical supplies ready, also now. You’d tell them to react right now, in January itself. That’s 20/20 hindsight.

    That’s exactly what Mongolia did, and they don’t have a time machine. They just saw what was happening in Hubei, they coordinated with China and the WHO, and they got their shit together fast. That’s their secret, not the elevation. They just weren’t dumb.

    January 22
    If I could tell you the one secret to Mongolia’s success it’s this:
    JANUARY!! JANUARY!!!! JANUARY!!!!!
    I don’t know if I mentioned this but
    JANUARY!!!!!!

    This is also when Mongolia told people to wash hands, wear masks, and all the other things many of us only heard later. Mariah Carey didn’t teach Americans how to wash their hands until mid-March.

    On the 27th, [of JANUARY!!!] started negotiating the return of 31 students from Wuhan. On February 1st they flew them back and quarantined the lot, including the flight crew. This began an ongoing process of repatriating and quarantining Mongolians, first for 14 and then 21 days. There wasn’t a mad rush back, they controlled it. This enabled them to manage imported cases and, again, reduce local transmission to zero.

    For example, when they heard of a case across the border (ie, not in Mongolia) South Gobi declared an emergency and put everyone in masks. The center also shut down coal exports — a huge economic hit, which they took proactively.”
    View at Medium.com
    ***

    And here is WHO published in the Lancet of Feb 22.
    “COMMENT| VOLUME 395, ISSUE 10224, P542-545, FEBRUARY 22, 2020

    “COVID-19: what is next for public health?

    The WHO Scientific and Technical Advisory Group for Infectious Hazards (STAG-IH), working with the WHO secretariat, reviewed available information about the outbreaks of 2019 novel coronavirus disease (COVID-19) on Feb 7, 2020, in Geneva, Switzerland, and concluded that the continuing strategy of containment for elimination should continue, and that the coming 2–3 weeks through to the end of February, 2020, will be crucial to monitor the situation of community transmission to update WHO public health recommendations if required.”
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30374-3/fulltext
    ***

    And here is the first WHO situatuon report.
    “Novel Coronavirus (2019-nCoV) SITUATION REPORT – 1 

    21 JANUARY 2020
    Data as reported by: 20 January 2020
    SUMMARY 

    Event highlights from 31 December 2019 to 20 January 2020: • On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China. From 31 December 2019 through 3 January 2020, a total of 44 case-patients with pneumonia of unknown etiology were reported to WHO by the national authorities in China. During this reported period, the causal agent was not identified.
    • On 11 and 12 January 2020, WHO received further detailed information from the National Health Commission China that the outbreak is associated with exposures in one seafood market in Wuhan City.
    • The Chinese authorities identified a new type of coronavirus, which was isolated on 7 January 2020.
    • On 12 January 2020, China shared the genetic sequence of the novel coronavirus for countries to use in developing specific diagnostic kits.
    • On 13 January 2020, the Ministry of Public Health, Thailand reported the first imported case of lab-confirmed novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.
    • On 15 January 2020, the Ministry of Health, Labour and Welfare, Japan (MHLW) reported an imported case of laboratory-confirmed 2019-novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.
    • On 20 January 2020, National IHR Focal Point (NFP) for Republic of Korea reported the first case of novel coronavirus in the Republic of Korea.

    Situation update: • As of 20 January 2020, 282 confirmed cases of 2019-nCoV have been reported from four countries including China (278 cases), Thailand (2 cases), Japan (1 case) and the Republic of Korea (1 case);
    • Cases in Thailand, Japan and Republic of Korea were exported from Wuhan City, China; • Among the 278 cases confirmed in China, 258 cases were reported from Hubei Province,”…
    https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
    ***

    We always miss the outliers! Like Mongolia.
    “Out-of-Sync ‘Loners’ May Secretly Protect Orderly Swarms

    Studies of collective behavior usually focus on how crowds of organisms coordinate their actions. But what if the individuals that don’t participate have just as much to tell us?

    https://www.quantamagazine.org/out-of-sync-loners-may-secretly-protect-orderly-swarms-20200521/

  17. I’m not entirely sure I understand what you’re saying here John. You seem to be saying that the assumptions you (and many others) made about the nature of the COVID 19 pandemic were wrong, and that therefore the pandemic can be suppressed using less restrictive measures than originally assumed. Does this imply that you think the advice you gave for total lockdown of society in order to control the epidemic was also wrong?

  18. John Goss,

    You are misunderstanding or forgetting precisely what J.Q. wrote in two earlier posts. Below are two key quotes.

    “The problem is essentially one of benefit cost analysis: which measures can be relaxed at least cost in terms of increased R relative to the benefits that relaxation will generate. The epidemiologists have the expertise to answer the first question (as well as can be done in the light of very limited evidence), economists and social scientists the second.

    The other key issue, which I’ve mentioned before, is that of option value. If a decision is easily reversed, at relatively low cost, it has an option value relative to a decision that is effectively irreversible. That’s why it made sense to lock down early, rather than waiting to see if the virus spread.” – J.Q.

    “Any policy which leaves R > 1 (the pandemic keeps spreading) is dominated by stricter policies that ensure R 1 policy in Australia are prepared to spell out the trade-offs they envisage. That’s because any attempt to do so would expose the bankruptcy of their reasoning.” – J.Q.

    The incorrect assmumption that many of the “lock-downers” made, including me, was that “flattening the curve” (getting R to about 1) would be the best we could do. It turned out that even a somewhat belated lock-down like Australia’s could get R well below 1. In that case, near-eradication become a real possibility and one well worth pursuing. This is what Australia and New Zealand have done.

    Recently, completely consistent with J.Q.’s recommended approach, it became possible to relieve some aspects (not all) of lock-down. This is fine provided R remains at no more than 1. A situation with 10 cases a week and R at 1 is very different from a situation of 5,000 cases a week and R at 1. The first is near-eradication, the second is the curve flattened at a “hang on by your fingertips” level for Australia. The second situation could rapidly get out of control.

    If Australia had let it rip we would now look like Sweden or Brazil on a per capita basis. Most of us would have lost a loved one or acquaintance, or two or several. I am not sure what you advocated in detail early on but it was certainly less than a full non-essentials lock-down. I don’t recall if it was a “let it rip” position or something more nuanced so I can’t say what the outcomes might have been. Indeed, if it was half-way between a full non-essentials lock-down and let it rip, then we can’t really say what would have happened. That empirical test was not undertaken for Australia.

    J.Q.’s approach was for caution in the face of considerable uncertainty and the utilization of two key principles which when used in tandem addressed that uncertainty; benefit cost analysis and option value. Nothing that has happened since those earlier quotes above and nothing J.Q. has written since, has obviated the validity of his position. That position is consistent and it still stands.

  19. The BLM (Black Lives Matter) protestors have unilaterally put us all at risk. How much risk, from slight to great, yet remains to be seen. The BLM protest was morally justified from the perspective of hundreds of years of white oppression, exploitation and police brutality all backed up by conservative and capitalist greed and callousness. However, the BLM protest was not morally justified in that it possibly has put many vulnerable lives at risk; meaning all those groups seriously at a risk from a full COVID-19 outbreak. In some ways, it was a classical moral dilemma. I know those protesting injustice are tired of being told “now is not the time to protest.” However, this was one of those rare times when the statement was actually true.

    Notwithstanding that, the protests have occurred and that fact cannot be changed now. The authorities made the correct call in not opposing the marches with legal bans and physical force (except physical force was used in a railway station in Sydney I believe). The authorities attempted persuasion and it failed. So be it. Once it was clear that the protest was going ahead, permission or not, the least worst option was to permit it. We needed neither more close confrontations, nor arrests nor people in holding awaiting bail. That would have only increased pandemic risk.

    This event illustrates one of the grave hidden costs of oppression. There is pent-up demand for equity and justice in the system and this pent-up demand can be released almost spontaneously and certainly somewhat uncontrollably from the civic perspective, at an historical juncture which is in many ways is the wrong time for civil disobedience. If we hadn’t had this rightful pent-up demand for equity and justice, this event would have been a non-risk and we need not have faced it.

    The BLM organizers should now attempt to negotiate from a position of strength. They should attempt to wring, not concessions, but rights and programs from the system which oppresses them. The elephant in the negotiating room will be the potential for more and even larger protests. I would prefer the BLM movement to use the threat of action rather than actual action at this juncture. Of course, if no just concessions, rights and programs are “granted” then the moral opprobrium and the next round of outcomes will rest on the conservative capitalists’ heads.

  20. Ikonoclast

    I never advocated for a let it rip position such as Sweden. I did support a less restrictive position than the stage 4 lockdown position of NZ or the stage 3 restrictions that Victoria fully adopted. I advocated for a less restrictive set of rules, such as SA and WA adopted, on the basis of the data. Our Ro was below 1 well before the end of March and the growth rate of new community transmission cases was declining, so there was no reason in the data to move to stage 3 restrictions. This was the position of the Commonwealth’s Brendan Murphy and Paul Kelly. Victoria’s Brett Sutton took a different position.
    John Quiggin’s argument for stage 3 or stage 4 restrictions was as you say based on the option value argument. But I also allowed for option value in my position. Without option value I would have argued for even less restrictions than stage 2. But it is indeed better to be safe than sorry, so I argued for stage 2.
    The problem with stage 3 or stage 4 restrictions is that they do lead to some irreversible wellbeing losses which can never be recovered, and as I argued, without any significant health and wellbeing benefit. Thankfully the stage 3 and 4 restrictions did not last for a long period in Australia and NZ, so I think the irreversible wellbeing losses turned out to be minor. But still, it would have been better not to have had those stage 3 and 4 restrictions at all.
    All I am saying is that, with the benefit of hindsight, the hardline restrictions that you and John advocated for, and Victoria and NZ adopted, turned out to not be the optimal policy response. When our policy recommendations turn out to be wrong, we should ask the question why they were wrong.

  21. Yes, I admit I did not possess a crystal ball and yet I advocated for a hard-line lock-down. However, you cannot use hindsight to say the recommendation for early lock-down was wrong. That’s like saying I took an exhaust jack on my outback trip but I was wrong because I never got a flat tire, let alone a flat tire in sand or mud.

    In addition, we don’t actually know that the R value would have come down soon enough or as soon as it did if we just went to stage 2 initially. Tiny variations in initial conditions can cause very big subsequent variations in a chaotic complex system. It’s called Chaos Theory. Look it up on Wikipedia. Chaos theory is actually just for deterministic complex or dynamic systems. Human society is very arguably, a hyper-complex indeterminate system which is probably even more sensitive to initial or stepped condition changes. Look at what one policeman choking one black man to death has done to the whole world. The outcomes and ramifications of that single bad act are astonishing and will reverberate on pandemic outcomes as well as on all sorts of social and political outcomes for months or years to come.

    If one key person did not get COVID-19 because of stage 3 / stage 4 restrictions, that person could have been the very person who seeded a set of clusters and outbreaks which have took us up to 2 to 10 times our current death toll. We cannot know for sure. The initial hard lock-down was indeed justified until R was below 1 and total infections per day was very low (say less than 10 a day nation-wide). If that means the initial hard lock-down only had to last a relatively short time then well and good.

    From a social and psychological realism point of view it does seem most people can’t submit to / tolerate hard lock-downs for too long. Given that fact, the climb-down from hard lock-down probably realistically has to follow your prompt model. Because I am inured, out of misanthropic necessity, to little social interaction at times (outside domestic life and blogs) and can tolerate quite long periods of relative wider social isolation, I thought everyone could do it quite easily. My mistake, I admit. Most people like more face to face social interaction than I do and I freely admit that they and society are probably better off overall for that in normal times.

    But these aren’t normal times. Quite a few social species and “phase change” species (can’t find the technical term for it right now) actually benefit from having a mix of gregarious or combining individuals and non-gregarious and non-combining individuals. This is because environmental challenges can throw up cases where the massed individuals survive better and conditions where the outlier individuals survive better. So some species hedge their bets and have both types. The species can gain extra fitness from this. That’s my excuse for being a misanthrope. Evolution appears to have selected for a scattering of relatively misanthropic (and pessimistic) individuals even in social or eusocial species. I am one of these and “I yam what I yam!” as Popeye says. And just occasionally the one who utters imprecations and jeremiads is correct. In some cultures and belief systems they were called prophets. 😉

  22. I accept Iconoclast that jeremiads/prophets are sometimes right. I am interested in the proportion of times they are right!!

    What fascinates me about this COVID 19 issue is how different the debate has been as compared to many other public health issues. Normally it is the public health experts who take a risk averse approach, and argue for saving lives whatever the cost, and it is the economists who argue that risk is part of life and one must take into account tradeoffs and opportunity cost blah blah blah. In this case most economists argued for the risk averse and ‘give priority to lives saved’ approach, and the public health experts were divided. The only explanation I have for this is that this issue developed into a culture wars issue – a shibboleth. And with culture war issues the evidence goes by the board – on both sides. I don’t know whether this happened across all countries. It certainly became a culture wars issue in the US, the UK, Australia and NZ. I don’t know about Canada, the rest of Europe and Asia. A sociological/political analysis of this would be fascinating.

  23. John Goss,

    I think the debate is different because the infectiousness of COVID-19 at least equals that of serious influenzas and the death rate is about a factor of 10 higher than any flu in living memory. A factor of 10 is big enough to change any game. It tends to concentrate the mind. Evidence did go by the board for the neoliberal supporter demographic in some countries. I don’t agree that evidence went by the board for the “lock-down” economists or the “lock-down” public health experts. Public health experts got politically pressured and bullied in some countries like the UK and the USA. The “lock-down” economists tended to be academics who don’t suffer direct political pressure and bullying from a national government.

    In Australia’s case, Scomo was bruised after failing to heed warnings about a possible horror bush-fire season.which actually arrived as warned. He was worried about ignoring another set of expert warnings and being wrong again. That must have played on his mind. He pressured his health advisers considerably less than Donald and Boris and actually listened to his advisers. Equally as importantly, our state Premiers were quite “militant” early on about locking down and often went ahead of Scomo. They too were politically “scarred” by bush-fire season I think.

  24. Iconoclast. You have demonstrated my point by saying that your tribe did not ignore evidence, but the other tribe did. Its an important part of the scientific method to learn from our errors, and tribal instincts is one factor which makes it difficult to learn from our errors.

  25. John Goss,

    What unambiguous and “extant at the salient and given point in time” evidence did I ignore? You need to be specific and also to remember that a person cannot be adduced to be ignoring evidence when that evidence arises at a date later than the uncertainty and risk assessment they make.

    My “tribe” did not ignore evidence so far as I can see. Rather we said, “we don’t have a lot of detailed evidence yet, although we do have some important basic evidence (an R0 of well over one and a lethality of about a magnitude greater (ten times) than most influenza)”. These basic facts alone indicated the need to proceed with great caution and to lock-down hard first to flatten or eradicate the incipient curve, given the clear possibility of overwhelming the health system.

    The fact that we did not have an uncontrollable outbreak might be attributable to the relatively early hard lock-down or it might not. But you cannot know that either way either before or after the fact. You need to consider what I said about chaotic systems and small changes in initial conditions making big differences later. I’m not sure you have taken proper note of that point yet.

    It’s like me topping up the radiator of an old, borrowed car which we know little about and also when we don’t know how hot the coming day will be. Assume we are in Brisbane. The weather has been changeable lately and neither of us has heard the weather forecast. You are understandably impatient as you have an important appointment in Toowoomba. You criticize me for wasting time to top up the radiator. (Forgive me for this example, I once had a friend who was just like this.) It turns out to be a cool day, the radiator shows no signs of boiling even as we climb the range and we reach our destination, albeit a little late. I have in a sense wasted some of your time and obstructed your felt or real need to do something important at the necessitous right time while “only trying to help”. (Assume you could not drive for some reason.) Yet, you cannot have known (a) it would be a cool day or (b) how the radiator would have performed without the top-up even on a cool day. After all, we were still climbing the Toowoomba range in old car of unknown capability and performance.

    I hope this all helps illustrate my point. If it still does not or you don’t accept my argument then logically it means you knew something more about epidemiology and this specific virus than I and my “tribe” did at the outset of the uncertainty/risk problem we were all set. What more did you know, specifically?

  26. I’m late to this but John Goss what are you talking about? Epidemiologists and public health experts have been the only people pushing extreme measures, and economists have consistently wanted to loosen the lockdowns and ignore the rules because omg the economy. What world do you live in where the opposite applies?

  27. faustusnotes,

    Not quite completely correct. Some government-employed medical-epidemiological experts (ones in Sweden and UK come to mind) were saying don’t lock-down too hard (UK) or at all (Sweden). A lot of neoliberal governments were saying the same thing (but were ignoring their medical-epidemiological experts.)

    Some neoliberal economists (maybe many world-wide) were saying “Let the virus rip. The economy is more important.” But key economists in Australia of academic and public note (but not neoliberal), like Prof. J.Q. were saying “lock-down” and work towards “flatten the curve” and then were saying “eradicate” when that clearly became a real possibility.

    But from an overall world perspective you may well be right. Here in this little-big Island of Australia (little population – big land area) it maybe looked a bit more like what John Goss was saying at least until our public medical-epidemiological experts became less bullied and neoliberal leaders like Scott Morrison became more afraid of having another crisis failure of leadership like their bush-fire fiasco.

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