Sleeping with the enemy
The second lockdown has rattled nerves and shaken our faith in the war against Covid-19. Talk of alternative plans has grown. Rob Mitchell reports.
‘London for several days will be one vast, raving bedlam; the hospitals will be stormed, traffic will cease, the homeless will shriek for help, the city will be in pandemonium.’’
These were the predictions of one military planner as fears grew of aWorld War II German bombing campaign over London, which would become the Blitz.
But that planner was proved wrong, says academic Dr Susanna Every-Palmer. ‘‘The policy-makers had thought that if Germany bombed London, the effects on mental health would be profound,’’ says the Head of Department of Psychological Medicine at the University of Otago, Wellington.
‘‘While the Blitz itself was bad and buildings were destroyed and people were hurt and killed, they didn’t see a spike in mental distress that they had expected.’’
More than 40,000 people were killed and 2million houses destroyed but, while life and limb were broken, that mental line held.
‘‘There was a shared sense of purpose, sense of agency, feeling that you are on the right side, a common enemy . . . and people reported quite a strong sense of community.’’
The carnage, the casualties and the chaos can’t be compared, but Every-Palmer does see similarities in the Kiwi campaign against Covid-19. ‘‘To some degreewe had that through the first lockdown,’’ she says. ‘‘There was trust, at that stage, in the path the Government was taking; people were connecting digitally with their family and neighbours, people were trying to support one another and felt, at that stage, that they were winning the war.’’
But she also sees a growing challenge. ‘‘The effects on mental health will depend to some extent on the economic implications and also on the sense of social cohesion and trust that we are doing the right thing, and doing well.’’
Kirk Hope is asked if the many entrepreneurs and enterprises he represents can survive another lift in the alert levels, more lockdowns.
Seconds pass before he eventually replies. ‘‘No.’’
The chief executive of BusinessNZ is used to talking about the economy, policy positions and business confidence.
But his focus has increasingly been on a different side of economic health. ‘‘We run helplines for businesses,’’ he says, ‘‘and we are seeing people who are desperate, who have run out of support . . . they get agitated, abusive.
‘‘We saw plenty of calls during the national lockdown … the ones now are even more desperate.’’
If Hope’s frustration and angst are obvious in his voice, and his observations of others, EveryPalmer is seeing that distress in the numbers.
Her team studied the psychological impact of the first, national lockdown. ‘‘We found that most people are resilient, but 30 per cent of our 2010 [surveyed] New Zealanders reported moderate to severe psychological distress.’’
Younger people were more affected. ‘‘Rates of distress were three times more for people in their 20s than you would normally see
. . . older people seemed particularly resilient.
‘‘We speculated that could have been because older people have gone through difficult times before and have overcome adversity, so they would have a higher baseline level of resilience.’’
The numbers are not in yet on the impact of Auckland’s level 3 lockdown, and the rest of the country’s level 2, but she suspects it will have been harder on people.
‘‘We are designed by evolution to deal with short bursts of stress, rather than sustainedmicro stresses, and as the economic and social impacts start to bite deeper, that in itself is going to generate more stress and anxiety.
‘‘I see within the population, markers of stress at the moment: people are shorter-tempered, preoccupied, worried.’’
Jared Abbott sees it too. He’s a divisional secretary for First Union, which represents many of the people worst affected by not only the impacts on health of Covid-19 but also the failing health of the economy and jobs.
That includes 15,000 members in retail, many of whom are ‘‘juggling restructuring going on at several places like Mitre 10, The Warehouse’’.
‘‘A lot of people have seen hours cut back, a general decline in the amount of work . . . a lot of people going through redundancy, [it’s] pretty devastating.’’
For the workers and the people helping them.
As there was with Hope, there are echoes of fatigue and frustration in Abbott’s voice.
‘‘When it is happening at multiple businesses at once . . . it takes an emotional toll on people,’’ says Abbott. ‘‘As support people we share a bit of that burden.’’
Support mechanisms leaned on during the first lockdown were further undermined during the second period of restrictions, he says. ‘‘Most people have completely exhausted their sick leave, their annual leave, and often advance leave for the next year too, living week to week on bills.
‘‘[I was] helping awoman last week who hadn’t been paid for two weeks, immune compromised, ringing me every couple of hours in tears.’’
That impact of recession and economic turmoil on mental and physical health is well established in various studies; it has even been shown to shorten life expectancy.
A 2013 review of research by the National Library of Medicine in the US established a link between job insecurity and heart disease. The risk was greater for those in poorer socio-economic circumstances.
A 2009 study of the health impacts of the global financial crisis noted a 0.79 per cent rise in suicides for every 1 per cent increase in unemployment.
The consensus was that people
Dr Jay Bhattacharya in work were more likely to be healthy and live longer, while those out of work, or struggling, were more likely to harm themselves or others.
What makes it worse is that in New Zealand and elsewhere, those most affected by Covid-19 have been the poor and vulnerable with underlying medical issues. And they are also the people more likely to be impacted by the economic consequences of a campaign to eliminate it.
Nick Wilson concedes the link between people’s mental and physical health and that of the economy. And the public health academic at the University of Otago also admits the second lockdown has raised the risk of greater anxiety levels, distress, depression, self-harm and worse.
Elimination was still the right strategy, but yet another lockdown?
‘‘That would be bad for health,’’ he says. ‘‘The balance of the health harms from Covid, versus the health harms from the economic downturns . . . would start to get closer.’’
Especially for the most vulnerable. Especially with a vaccine many months or even years away. ‘‘Economic impacts of Covid, lockdowns, are likely to be greater for more vulnerable groups such as Ma¯ori and Pacific Islanders. Job security is lower.
‘‘If your skill level is lower, then you have fewer options.’’
Public support for elimination is holding. A number of polls suggest most Kiwis still see that approach as the right one, but more of them are talking about what the alternatives might look like. Especially as the costs mount: to jobs, livelihoods, people’s health, and even the country’s coffers.
In a recent online symposium organised by the New Zealand Covid Plan B group, a number of global health experts complimented the country on its campaign so far.
But they also made the point there were other options that would not destroy the economy while combating the pandemic.
Some even suggested that lockdowns and other restrictions could be worse for the country’s health than the reality of living with Covid.
Dr Jay Bhattacharya, a noted academic in the fields of medicine and economics at Stanford University in the US, told the symposium that lockdowns were ‘‘not amechanism for disease eradication, you are just delaying when the disease happens, so you pay the cost now or you pay the cost later’’.
He said the ‘‘economic costs themselves have consequences for the lives of people’’, including ‘‘real health harms from the economic harms in the lockdowns’’.
Bhattacharya said New Zealand had done well against Covid-19, but at great cost to its economy, and the workers and businesses that rely on it. ‘‘IMF has forecast a 7 per cent fall in GDP . . . repeated lockdowns mean New Zealand will do worse economically than the rest of the world.
‘‘Economic contraction could take a year off average lifespans.’’ It was a question of trade-offs, Bhattacharya told his audience, and he felt it made more sense to ‘‘protect the older population, who are more vulnerable, from dying and let the rest of the population face relatively minimal risks’’.
That was supported by other speakers, including public and preventive health experts Sunetra Gupta, professor of Theoretical Epidemiology at the University of Oxford; Byram Bridle, viral immunologist at the University of Guelph; and Dr David Katz, from New York.
Data scientist Ben Smith believes that better understanding and mitigating those risks will allow New Zealand to open travel bubbles with a number of other countries.
The pandemic had hit the tourism industry particularly hard, as well as its reliance on international students.
‘‘New Zealand can reopen its borders to many countries without a substantial increase in risk,’’ he told the symposium.
Some countries, including the Cook Islands, Fiji, Samoa and Taiwan, had no Covid-19 cases; others, like China, Malaysia and South Korea, had very few.
‘‘You can open borders to those countries at no risk, as long as you continue to monitor the data and respond,’’ he said. ‘‘Countries can move up and down the risk tiers.’’
That applied to international students as well. ‘‘There are around 69,000 international students from various low-prevalence countries, and you could use a 14-day quarantine.’’
That included China, which made up 27 per cent of the New Zealand intake, and Japan, which contributed 8 per cent.
Smith acknowledged there were high-risk countries, including the US, United Kingdom, and parts of Australia. ‘‘No interventions are available tomake them safe enough at the moment.’’
That will be of interest to Hope and many others concerned about the impact on the economy and jobs.
‘‘The prospect of moving through alert levels is creating quite a lot of anxiety for people,’’ he says. ‘‘There is a perspective out there that it is time to consider an alternative; for example, rather than locking down whole parts of the economy, you provide assistance and protection for people who are the most vulnerable to Covid.’’
Wilson concedes the country may need to look at those alternatives, especially if the elimination campaign stalls or fails, and more lockdowns are necessary.
‘‘Say that we fail with these outbreaks, at some point it would be rational to say this is too hard, we’re going to try and live with it, keep it suppressed, manage hospital capacity . . .’’
That would look a little like Sweden, ‘‘which has lockdown lite
. . . it keeps things ticking over, restaurants, bars, keep going, and there’s a bit of a tourism sector’’.
And 5864 deaths, from more than 87,800 cases, according to Johns Hopkins University.
Its neighbour Denmark adopted similar restrictions to those in New Zealand. It had recorded 635 deaths and more than 21,000 cases by late this week.
But Wilson and Every-Palmer believe these experts and others are not taking into account the fear of Covid, should rules be relaxed and lockdowns loosened. And the impact of that anxiety on the economy.
‘‘Those people who think that’s better than elimination at this time aren’t factoring in that big loss of consumer confidencewhen you have a circulating virus,’’ says Wilson. ‘‘International tourism is dead everywhere; maybe in some parts of Europe it is just alive. So even if we had completely open borders we just wouldn’t have this economic activity.
‘‘People have been surprised, and some US economists have also said, that the biggest impact is not lockdowns, it’s consumer fear of the virus.’’
Every-Palmer agrees. ‘‘Without doubt lockdowns have an effect on our mental health, but . . . I would strongly suspect that the mental health implications of having not gone into lockdown early and then having the virus rampant within the community, the psychological toll of that would have been higher than the psychological toll of a successful lockdown which then allowed people to return to a relatively normal life.’’
Even First Union’s Abbott, who represents people most at risk of the health and economic impacts of the virus, sees more value in sticking to the plan.
‘‘The reality is that if it was rampant, it would be more sites getting shut down, more workers getting sent home, more people being unable to work . . . the impact on our members would be severely worse if this idea of, let the virus run its course and focus on the economy, was to go ahead.
‘‘I don’t think the solution is just to pretend that there’s not a virus because the impact of that is a lot worse for working people.’’