Matthew Hooton: Saving lives − at any cost?
Limiting death toll is Ardern’s main aim; it can’t be the only one
There is little doubt that the Prime Minister was right to lock down the country eight days ago. Faced with a rhinoceros racing towards you, there’s no time to think. The best strategy is to run for your life, climb a tree and wait to see what happens. If future historians quibble with Jacinda Ardern’s recent decisions, they’ll more likely debate whether her initial response was staunch enough, especially around border control.
But the lockdown will turn out to be the easy decision. More difficult is lifting it, especially if it is less effective than hoped. The Prime Minister says she will give a first indication of progress on Monday.
If Ardern indicates that the lockdown remains on track to be lifted in three weeks, we can look forward to something like normal life for most, except for the tourism and export-education sectors and those who rely on them. We’ll be safe behind a locked border awaiting a vaccine. Most of this column would happily remain mere speculation.
But if it looks like the lockdown needs to be extended another month or beyond, then extremely difficult ethical questions lie ahead — not just for the Prime Minister, but for all of us.
Among the most challenging are those of intergenerational fairness. The usual rough and tumble of politics and media — let alone Twitter and Facebook — is ill-equipped to seriously consider difficult choices. Instead, this may be a case where professional philosophers can help clarify all the important factors that should be considered by the country’s leadership. Offshore, ethicists are already writing about difficult immediate issues such as prioritising respirators and other health services for those with Covid19 compared with other health needs.
The Prime Minister’s original strategy, outlined on March 15, was to “flatten the curve”. Essentially, this accepts that a large number of people — perhaps most — will inevitably get Covid-19 but aims to spread the cases so health services can cope. This should also lower total mortality, including for those with other illnesses or injuries.
But make no mistake, flattening the curve involves casualties. Last month, the death rate from Covid-19 was thought to be around 2 per cent. Left unchecked, there were fears 89 per cent of New Zealanders would catch it and 80,000 would die, about 1.6 per cent of us. That is approximately the same proportion of New Zealanders killed in World War I and more than double our fatality rate in World War II.
If offshore experience with Covid19 is instructive, around 90 per cent of our fatalities would be people aged 60 or over, with the death rate rising starkly for people over 80. Even then, though, we would never know exactly how many died merely with — as opposed to of — Covid-19.
In comparison, the number of people under 60 who get seriously ill let alone die from Covid-19 is minuscule. Younger people are more at risk of dying from road accidents or suicide.
The cruder term for flattening the curve is seeking herd immunity in a managed way. The flow of cases is managed to stay within the health system’s capacity while immunity builds in the community and scientists work on a vaccine, expected to take at least a year.
Ardern’s objective has evolved since March 15. This week she said her Government “never ever considered [herd immunity] as a possibility, ever”. “I simply would not tolerate that,” she said, “and I don’t think any New Zealander would.”
Ardern’s strategy is now clearly elimination or at least suppression, where the goal is to keep the number of cases to an absolute minimum for as long as possible. The downside is needing to maintain controls until a vaccine becomes available. The Prime Minister confirmed on Wednesday that the lockdown will not be lifted until the virus was “back under control”.
Temporarily seeking suppression and then relaxing the lockdown risks huge economic damage followed by the same fatalities originally feared anyway. Arguably, it would be the worst possible strategy. Suppression must in practice mean elimination and the border remaining shut for at least a year.
Ardern is unquestionably motivated to do the ethical thing.
Protecting the elderly is undoubtedly an important virtue. But it is not the only ethical issue she must weigh up.
Since March 15, the most credible estimated death toll in an unmanaged environment has become clearer.
According to the data on which the Government is now basing its decisions, the very worst-case scenario is that 3,320,000 New Zealanders would experience symptoms, 146,000 would need hospital treatment, 36,600 would end up in intensive care; and 27,600 would die, about 0.5 per cent of us. As with previous New Zealand estimates, 89 per cent of deaths would be in the 60+ age-group. This means that even if pretty much the whole population caught Covid-19 by July, the death toll for people under 60 would be around 3000, less than one in 1000. Ma¯ori, Pacific and poorer people would, however, be overrepresented, the model suggests.
The Prime Minister’s announcement on Monday will tell us if the lockdown is on track towards elimination in three weeks. If not, it will need to be extended until elimination or at least substantial suppression occurs. If neither ever happens, the lockdown might need to last until a vaccination is found or else it may all have been for nothing.
This is where the ethics becomes almost impossibly complicated — not just for Ardern but even more so for the leaders of populous jurisdictions such as China, India, the EU, the US and Indonesia.
A lockdown of even several months — let alone a year — would cause unprecedented social and economic damage. Domestic violence rates have already spiked.
If we believe things like traditional schooling improves the life chances of young people, and that online schooling is inferior, then an extended lockdown must materially compromise a whole generation of our 5- to 17-year olds.
The social and economic costs of
If it looks like the lockdown needs to be extended another month or beyond, then extremely difficult ethical questions lie ahead — not just for the Prime Minister but for all of us.
our teenagers and 20-somethings then facing a longer-term downturn, where no one is hiring and launching a small business is implausible, also matter. So, too, the interests of those soon to be born whose earliest years will be blighted by economic stress.
The Prime Minister must properly balance these factors.
Even the measures taken to date in New Zealand and overseas risk a depression greater than in the 1930s. Treasury Secretary Caralee McLiesh estimates moving to level 4 caused output to immediately fall by up to 40 per cent, four times the technical definition of a depression.
Much output may bounce back strongly if the lockdown is lifted in three weeks but the ongoing need for border controls means the tourism and international education sectors are doomed for an extended period. The net fall in output will mean not even all the money New Zealanders usually spend on overseas holidays will be able to be spent domestically.
Unemployment will go “well into the double digits”, according to McLiesh. In recent times, New Zealand’s unemployment peaked at 11.2 per cent in 1991.
The first unbearable question is at what point, if ever, we decide that the immediate social and economic costs are too high to continue with a lockdown, if elimination or suppression fail. The second is who pays those costs, and when.
Finance Minister Grant Robertson was right to hurriedly launch his wage subsidy scheme, with the social goal of ensuring people can afford food on the table and the economic goal of somehow keeping businesses together. The $4.2 billion already paid out is barely material in the context of the times and could be paid back with even a decent one-year surplus later this decade, without future taxpayers even much noticing.
Similarly, increasing superannuitants’ winter energy payments and benefits by $25 a week can be justified as mitigating hardship in the short term.
But these amounts are nothing compared with the $50b line of credit Parliament has already extended Robertson and the perhaps hundreds of billions that will need to be pumped into the economy under a protracted lockdown to maintain a veneer of economic viability.
Beyond the shortest term, though, even the most massive economic stimulus will prove illusory because this is not a crisis caused by a financial shock but by the inability of workers to visit their offices and factories, salespeople to sell widgets and experiences, and logistics and frontline staff to deliver them to customers. Were it possible to maintain society with printed money instead of real economic activity, we’d live that way all the time.
As immediately following the Great Depression and WWII, stimulus spending soon evaporates largely into inflation. Ironically, governments may be happy with that since it would also help inflate away their debts. But, inevitably, inflation benefits those who own physical assets such as houses but devastates those trying to save, massively entrenching the intergenerational inequality Ardern was elected to address.
As always, the worst victims from the depression would be those from low-income backgrounds, with Ma¯ori and Pacific people being overrepresented. Child poverty would rise not just relatively but in material terms, with all its attendant health and education implications. Family violence and other crime, as well as youth suicide, would increase.
Ardern and all of us have no choice but to take these risks into account while grappling with the ethics of the decisions ahead. It may be repulsive to express it explicitly, but a protracted suppression strategy would materially and perhaps permanently damage the lives of the 2 million New Zealanders under the age of 30 to briefly maintain the life expectancy of some thousands of people in their 80s.
A free for all, where we passively accept the premature deaths of 0.5 per cent of our population — with deaths biased towards older, poorer, Ma¯ori and Pacific New Zealanders — is, as Ardern says, intolerable.
But it is an ethical cop-out for anyone to simply assert that eliminating risk to that 27,600 is a priority above any other, and that any cost the 2 million New Zealanders under 30 must pay over the months, years and decades ahead is worth it. The long-term interests of those 2 million young people in particular need to be much more explicitly considered.
As far as possible, all things considered, we should find a way for people born in 2000 to enjoy a bundle of opportunities that is as valuable to them as what those born in 1950 or 1975 have already enjoyed. A staged return of social and economic activity, supported by more imaginative physical distancing rules than simply “stay home”, must be developed whatever the Prime Minister reports about the lockdown on Monday. A system must also be found for the elderly themselves to pay their fair share of the costs of keeping them safe. If we’re “all in this together” when it comes to averting early deaths, then we had better all be in it together when it comes time to pay up.
No one enjoys confronting such trade-offs, but national leaders carry the burden of being ethically obliged to. Helpfully, New Zealand is home to some of the world’s most distinguished ethicists, including the global expert on intergenerational ethics, Professor Tim Mulgan, and a regular adviser to government departments on practical ethics, Professor Tim Dare, to name just two.
Ardern must listen first to the epidemiologists and public health officials but, as leader of the country elected on promises of fairness towards younger New Zealanders, she is obligated to take a much broader view and consciously and carefully weigh up the longer-term social and economic consequences of her decisions. Economists and professional ethicists must have a seat on her Zoom conference. If they are excluded, then even the actual long-term mortality of the current crisis risks being higher than the 27,600 worst-case scenario, not to mention compromised quality of life.
No one could envy Ardern her job, and those of us who shared the childhood dream of becoming Prime Minister can surely only be pleased we were unsuccessful.
With much smaller stakes though, I have had to run for my life and climb a tree to get away from a rhinoceros, when trekking in Bardiya National Park in Nepal a quarter-century ago. I quickly learned it isn’t possible to stay up a tree for long.
Much sooner than you feel safe, you have to judge that the rhinoceros is now far enough away, climb down from the tree and walk away through the long grass. That’s the terrifying thing we have to do as a society unless we are to leave an entire generation stuck up a tree for the most important years of their lives.
No one could envy Ardern her job, and those of us who shared the childhood dream of becoming Prime Minister can surely only be pleased we were unsuccessful.