In the wake of our success so far in containing the spread of COVID-19, the prime minister has been prodding us to come out from under the doona.
With the premiers, he has prepared a three-step plan.
The problem, he said on Friday, is that it would be tempting to stay in lockdown tucked up under the doona forever.
And you know, you’ll never face any danger. But we’ve got to get out from under the doona at some time. And if not now, then when?
The treasurer Josh Frydenberg says continuing the lockdown is costing the economy A$4 billion per week.
Economists have sharply polarised positions.
To stay safe, or to live boldly
The preamble to an open letter by 265 Australian economists published in The Conversation last month said that to use those costs as a reason to end the lockdown would represent a “callous indifference to life”.
Others seem to think that the lives lost matter less than the huge economic and social costs staying locked down.
In between those extremes lies a huge band of uncertainty.
A more circumspect comparison of the risks of unlocking compared to the risks of staying locked down suggests that, in purely economic terms, the restrictions make good sense so far.
You start by putting a value on lives
One way to evaluate the merits of relaxing restrictions is to put a monetary value on the fatalities avoided, and compare that cost with the cost imposed by the restrictions.
Putting a monetary value on human life is often viewed as unsavoury. But, whether explicitly or implicitly, it is what is being done every time a government or non government entity makes a decision that affects the risk of increased mortality, from whether to put up a road sign to how to conduct hospital triage.
Being explicit gives some assurance that the proposed measures are proportional. It can alleviate fears that what’s proposed is an under or over reaction.
But numbers alone can not tell us what is the right thing to do. That requires making value judgements - which is the job of politicians.
It is nevertheless helpful to understand how the COVID-19 policy responses measure up to standards used in normal public health decision making.
Making this difficult is the is enormous uncertainty over some of the key variables.
It’s hard to know how many lives
A critical number is the infection fatality rate.
The Oxford Centre for Evidence Based Medicine puts the infection fatality rate at between 0.1% and 0.4% of the population.
For Australia, if 90% were infected, this implies 22,000 to 90,000 thousand fatalities.
This range could further be increased by as much as 50% if not enough intensive care units are available.
Professor Tony Blakely of the University of Melbourne, and Professor Nick Wilson of the University of Otago have reported a larger estimate of 134,000 fatalities.
For planning purposes the Department of Prime Minister and Cabinet values a full statistical life, when converted to 2019 dollars - allowing for inflation and growth - of approximately A$5.1 million.
Reasonable arguments could be made that it should be many times larger or smaller.
Authors: Peter Robertson, Professor, University of Western Australia