Covid 19 coronavirus: Matthew Hooton - Long-term impact on health must trump today's fears

COMMENT:

Prime Minister Jacinda Ardern is clearly signalling an end to the current form of lockdown as soon as Wednesday night.

Her announcement yesterday of the details of level 3, combined with the plunge in mystery cases to just 4 per cent, has raised public expectations she will find difficult to resist.

If the current lockdown is extended, it will be relatively briefly — perhaps only until Tuesday, April 28. While the new criteria for level 3 are more liberal than expected, the Prime Minister will also want to get to level 2 or even 1 as soon as possible.

The Prime Minister's stance will distress some of the harder line epidemiologists prominent in the media, but she is right to take a more holistic view than they can through their narrower lens.

Luckily, the adviser she has come to rely on most, Director-General of Health Dr Ashley Bloomfield, is not a narrow epidemiologist but a broader public health expert.

Ardern and Bloomfield both know that no responsible government or health official could possibly consider risking unemployment reaching 26 per cent, which is Treasury's new worst-case scenario.

Even Treasury's almost implausibly optimistic scenario — us eliminating Covid-19, leaving level 4 on Wednesday, sitting at level 3 through May, dropping back to levels 2 and 1 from June, and never experiencing another outbreak — leads to unemployment of 13.5 per cent by the middle of the year.

Prime Minister Jacinda Ardern. Photo / Getty Images

For context, during the Great Depression, New Zealand unemployment officially peaked at 15 per cent, although it was probably higher. Following the economic reforms of the 1980s and early 1990s, unemployment peaked at 11.2 per cent in September 1991. In the UK, it reached 11.9 per cent in 1984 at the height of Thatcherism and the miners' strike.

Covid-19 has already locked us in to experience the worst unemployment in living memory in just a few months.

Aged just 13 when the economy began growing strongly again in 1993, Ardern has personally only experienced something close to full employment with relatively brief blips after the Asian economic crisis and the global financial crisis. She could, therefore, be forgiven if she does not intuitively grasp the depth of misery unemployment above 10 per cent brings.

The good news from yesterday is that she is clearly listening not just to epidemiologists, but also to public health experts like Bloomfield who have consistently emphasised to their political masters the stark implications for morbidity and mortality from mass unemployment events.

According to the literature, in the first year of mass unemployment, mortality from circulatory diseases can be expected to double and from suicide to triple. But, even 20 years later, annual admissions to hospital for alcohol-related disease can be expected to be 22 per cent higher than they would have been otherwise.

Across the board, the long-term effects of mass unemployment are reported to include: worsening chronic ill-health; increased excess mortality including from circulatory disease; poorer mental health, including more self-harm and suicide; greater alcohol-related deaths; increased health-harming behaviours generally; and bigger demands for primary and secondary care.

This can all be debated, and New Zealanders will probably never agree whether the social costs associated with the speed and severity of the 1980s and 1990s economic reforms justified the benefits of a more open and competitive economy.

Nevertheless, we can surely all agree that unemployment in the mid-teens, let alone the mid-20s, must be avoided at almost any cost, even if that eventually requires Ardern to abandon her goal of elimination in favour of her original aim of "flattening the curve".

Some may think there is an easier way out of this dilemma by pointing to Finance Minister Grant Robertson announcing billions of dollars for bailouts and stimulus spending, just as Michael Cullen and Bill English mitigated the effects of the global financial crisis in 2008 and 2009.

But the comparison fails. Whereas 2008 was an immediate financial crisis that caused an economic crisis and consequent long-term health effects, this is an immediate health crisis which is causing an economic and probably financial crisis, which will, in turn, further damage long-term public health.

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Robertson himself appears to understand that unless the Government quickly allows economic activity to resume, ongoing stimulus spending will have nowhere to go except evaporate into inflation.

The remaining real debt will then need to be paid off by Gen-X, Millennials and Gen-Covid for the entirety of their working lives, even as many of them suffer the chronic diseases and premature deaths that are already certain to be worse than whatever public health effects we have suffered since 1991.

On Wednesday, Bloomfield — despite being a global expert on the prevention and control of exactly the non-communicable diseases that will soar with big increases in unemployment — admitted the Ministry of Health had not yet provided ministers with estimates of projected long-term public health effects.

That oversight is presumably being fixed today and over the weekend, or else Ardern and her Cabinet will go into their life-and-death meeting on Monday with information only on the costs of Covid-19 and none on the consequences of its response options.

Looking at the Swedish data after its extreme experiment that has killed more than 1200 people, those costs fall unfairly. While the number of cases is distributed relatively evenly through age brackets, nearly 90 per cent of deaths are of people over 70 and over 60 per cent among people over 80. Less than 1 per cent of deaths are among people under 40. No one under 20 has died and just three people in their 20s.

In Canada, half of all deaths have been people in aged-care facilities.

All lives are precious and everyone should have an equal opportunity to experience its joys. It is for that very reason that the Prime Minister and her colleagues must recognise that the interests of a healthy 20-something have to be given at least the same weight — and probably more — than those of an Alzheimer's patient in their 80s.

It is morally reprehensible for anyone to consider only the risk of Covid-19 to the latter and not the risk of chronic illness and early death to the former.

The Prime Minister now seems to have clearly in mind the interests of both the hundreds of mainly elderly people who are overwhelmingly most at risk of dying of Covid-19 and the thousands of New Zealanders who will take their own lives or die early of other non-communicable diseases if she allows unemployment to materially exceed its 1991 peak.

Where to get help?

If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.

If you need to talk to someone, the following free helplines operate 24/7:

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There are lots of places to get support. For others, click here.

- Matthew Hooton is an Auckland-based PR consultant and lobbyist. He has a range of clients working on issues associated with Covid-19. These views are his own.