Nobody likes talking about the COVID-19 endgame, but we need to choose one. The appropriate interventions – public health, government spending, and freedom of movement – all depend on the endgame we choose.
The differences between endgames amount to tens of thousands of avoidable deaths, hundreds of thousands of avoidable hospital admissions, and deep and systemic impacts on Australia’s economy and society.
Many discussions are underestimating the likely political reactions when death counts rise.
They are also underestimating the economic and social consequences of an open-ended epidemic that will have enormous real-world impacts on small and medium businesses, as well as many not-for-profit organisations in every sector of the economy and society. We are not facing up to the social consequences if many close, and credit markets collapse.
We see three possible endgames.
None is attractive, but one is better than the others.
Endgame A: ‘flatten the curve’
Endgame A is the plan to “flatten the curve” – restricting movements in order to lower the peak in cases, while accepting that infections will continue to grow until the epidemic has run its course. There will be many deaths.
Imperial College has demonstrated that even if Britain flattens the curve, the peak months would still overwhelm hospital intensive care capacity, (particularly ventilators) by eight times instead of 30, perhaps halving the ultimate death toll.
Australia is also likely to run out of intensive care capacity when there are about 45,000 infections – a small fraction of the population.
In reality, political economy will probably get in the way of continued growth of infections. Public pressure to “shut everything” will become overwhelming as infections rise and hospitals struggle. But by then, with exponential growth in infections from a greater base, the containment challenge will be much greater.
Once infection rates fall in response to the shutdown, there is a risk of public pressure to open again too early, increasing infections until the death rate again becomes unacceptable – what economist Tyler Cowen has dubbed the “epidemic yoyo”.
WATCH: Some of your questions about the virus, answered. Post continues after video.