Ordinary Gweilo

Paul Christensen posted a comment and directed my attention to something he had written in the SCMP

The cold, hard maths of whether a coronavirus shutdown is worth everyone’s loss of quality of life

Do the benefits of the Covid-19 economic shutdown justify the costs? This is a fundamental question that governments need to address, and they should address it explicitly, regardless of how uncomfortable it may make people feel.

In his comment he said that “Much more rational analysis is needed on whether the years of poverty that will result for many people from this lockdown are worth the lives saved.”

Rational analysis like this?

An argument for lockdowns is that the alternative would be an overloaded hospital system. But this shouldn’t be a factor that overrides all others.

There is no doubt that a rigorous triage system could be put in place to keep the hospital system functioning for cases where larger numbers of QALYs are at stake. If society keeps running, then the government could spend the tax revenue it receives on expanding hospital capacity so that fewer hard decisions have to be made when, say, Covid-25 comes along.

Yes, sure, a rigorous triage system would solve the problem.  

And after a few thousand (mainly old) people had died we'd definitely spend more money on hospitals and facilities and nurses so we’d be ready next time.

No, of course we wouldn’t.  Both in the US and the UK (and elsewhere, no doubt) there have been exercises done to test readiness for a pandemic.  And governments have decided not to spend the money needed to be fully prepared.  Hospitals in the UK were running at close to full capacity when it is recommended that they should be operating at around 85% in order to be able to handle any emergencies.  That, of course, is because of lack of money.

Currently hospitals in most developed countries are just about coping, but many staff are exhausted from over-work, and tough decisions have to be made about who can be transferred to Intensive Care.  

This is with lockdowns in place.  What would it be like without them?

Lockdowns aren’t just needed to ensure that hospitals will be able to handle the outbreak.  There’s also the hope that better treatments can be identified and a vaccine can be found (and progress seems fairly encouraging on both fronts).

Paul Christensen seems to be getting carried away:

The current restrictions on economic activity are condemning many thousands of people who had basically comfortable lives to years or decades of poverty. There may be significant increases in suicide, divorce and domestic violence rates as people are cooped up to an unprecedented degree in small living spaces

Decades of poverty?  Restrictions apply to a relatively small part of the economy.  We are talking about Hong Kong here, aren’t we?

[To summarize what I wrote in my response by Paul's comment, I accept that some people will suffer significant hardship from the lockdown (UK) / restrictions (HK).  But the solution to that is not to accept more deaths it's for the government to make payments to people who lose their jobs.]

And Hong Kong apartments are definitely small, but we don’t have a lockdown and the only people who can’t go out are those who are in quarantine.  Those social problems are real, but they existed before COVID-19 and they will be there afterwards.  The impact of a few thousand people being in quarantine for 14 days is not really significant.

Certainly the restrictions everywhere will be eased in the coming weeks and months and maybe Hong Kong (and Singapore) offer a template for how it can be done:

‘Suppress and lift’: Hong Kong and Singapore say they have a coronavirus strategy that works 

Despite setbacks, Hong Kong’s and Singapore’s targeted strategies for fighting COVID-19 may yet succeed—and provide a model for other countries emerging from their first wave of cases.

In the last three weeks the number of COVD-19 cases in Hong Kong has increased from around 270 to 1,001.  That sounds a bit scary, but other countries have seen much larger increases over the same period (25x in US, 15x in UK).

The biggest factor by far has been the large number of people who returned from overseas, but there have also been “local” cases in Lan Kwai Fong and karaoke bars. 

The government has responded in typically haphazard manner.  Our great leader Carrie Lam Cheng Yuet-ngor wanted to ban the sale of alcohol because “people get intimate when they’re drunk.”  Hemlock explains that this was a typical over-reaction to a specific case of a “super spreader”.  It’s a Hong Kong thing, to be sure, but we still have to take off our shoes for airport security checks in some countries because of one failed terrorist incident nearly 20 years ago. 

Oh, and don’t be fooled by this headline (from news.gov.hk) CE explains alcohol sales ban – she doesn’t.

It took a few days for the government to figure out that they actually needed to close bars and pubs because, er, large number of people gathering in small spaces will spread COVID-19.  

They also ordered Karaokes, clubs, and mahjong parlours to close but it took longer to get round to beauty parlours.  Cinemas have also been ordered to close, even though they had already blocked alternate rows and were a long way from being full. 

More sensibly, restaurants have to keep tables 1.5 metres apart and no more than 4 people can sit together.  That’s obviously a rather arbitrary set of rules that works better in some places than others, and there have been suggestions that police have been rather over-zealous in applying this in “yellow” restaurants, but the basic idea is sound.

It seems inevitable that the restrictions will be eased based on the number of cases and then re-imposed (or possibly tightened) based on evidence of where it is spreading.

Visitors are also banned from Hong Kong and residents have to go to quarantine camps or “self-isolate” for 14 days after arrival.

Meanwhile, the rest of the world is slowly coming round to the idea that wearing masks might be a good idea.

• Asia may have been right about coronavirus and face masks
• The Spanish government plans to hand out facemasks at metro and train stations from Monday as some non-essential workers begin returning to their jobs.
• In Austria, masks are being given to people as they enter supermarkets
• The CDC is suggesting people wear home-made masks

Of course, masks are just part of the solution, but it’s hard to see how anywhere can properly emerge from lockdown without them.  “Social distancing” simply isn’t practical if you have large numbers of people in public places.

And, of course, there are other benefits: Hong Kong’s coronavirus response leads to sharp drop in flu cases

Three weeks ago Hong Kong had around 100 cases of the Coronavirus, and only a handful of new cases each day.  The trend looked much better than in many other countries (with typically around 33% daily increases)

Recently the daily increases have been more dramatic (15% on 18 March, 23% on 20 March), mainly because of people returning home from overseas.  But there have also been more locally transmitted cases, presumably because people had become a little complacent.  Most notably there have been photos circulating of large crowds in Lan Kwai Fong (mainly expats) with no masks in sight.   

There’s no doubt that people who stayed at home during the early days of the outbreak are going out more.  However, things are certainly not back to normal – the MTR are still running trains less frequently (and they are still less crowded than normal).  Many shops are opening later and closing earlier. 

Bars are still open, cinemas are mainly still open (but only alternate rows of seats are available for purchase, and there aren’t many customers).  One chain of gyms has closed temporarily, and the public sports facilities that had been re-opened a few weeks ago are closed again.  Libraries are also closing again.

So, life in Hong Kong is still much more normal than in many other large cities worldwide.  But not looking as good as it was 3 weeks ago.

Hong Kong streets and shopping centres are strangely quiet and traffic is light. 

Yes, we’ve been here before, but last time (just a couple of months ago) it was the protests whereas now it’s Novel coronavirus (2019-nCoV). 

Many local people are choosing to spend more time at home (with some employers telling staff not to come into the office), there are far fewer visitors from the Mainland, and Carrie Lam has said that Hong Kong’s Foreign Domestic Helpers should stay at home on their one day off every week.  That’s fair, right?  

There have been long queues in supermarkets, with some panic-buying of food and cleaning products.  As far as I can tell, although some food items are temporarily unavailable at times, there are no actual shortages (so far).

Surgical masks are a different matter.  They started disappearing off the shelves in early January and now there are long queues for any that become available, and some crazy prices in less reputable pharmacies.

Alcohol hand rub is also very hard to find (even Cathay Pacific seems to have run out). 

It’s a sensible precaution to wear a mask on public transport and in shopping centres (or anywhere that is crowded), but in the last couple of days I’ve even seen people wearing them outside in places where it would be almost impossible to be in close contact with anyone for more than a few seconds.

But we all remember SARS, and so it’s totally understandable that’s there’s an excess of caution.       

The New York Times has a timeline here: As New Coronavirus Spread, China’s Old Habits Delayed Fight