Balancing health, harm

Finally, we are debating the national response to Covid-19 and that means facing some uncomfortable facts. In New Zealand, we have imperfect ways of detecting Covid-19. We test only people who are symptomatic or have been in close contact with a confirmed case – not enough to know what the entire population looks like.

We don’t have a test that shows whether you have already contracted and recovered from the virus. And, our current best available test misses many people who are infected. We probably have a lot of asymptomatic carriers of the virus, but don’t know who, where or how many.

Logically, there is very little chance of elimination. We can suppress Covid-19 and the lockdown is certainly doing that, but it comes at a cost.

There are limited resources in public health. We are always trying to achieve the best health outcomes with the least harms, at the lowest cost. This is the tradeoff.

Tradeoffs involving health, mortality and money are uncomfortable to discuss, but it’s the reality of public health. I’ve faced this my entire career, advocating for more in the meagre pot of preventative medicine.

One person gets renal dialysis for kidney failure from diabetes at $100,000 a year yet there is no money for a diet and exercise programme with a 50/50 success rate at $500 a year.

Now, we are being asked how to defeat an endemic virus and what we are prepared to pay in terms of dollars, loss of life and other health outcomes. We are being asked to put life-saving surgeries and other treatments on hold. We are