Saskatchewan·Opinion

We don't know what victory looks like yet, but when this is over we must take stock of lessons learned

In a pandemic, decision-makers are faced with a tough balancing act in the face of major uncertainty: not doing enough versus doing too much. No one wants to risk and be held accountable for not doing enough.

We may grudgingly thank COVID-19 as the catalyst for reckonings long overdue

A person in Ottawa passes by an inspirational sign during the COVID-19 pandemic on Friday, April 3, 2020. (Adrian Wyld/The Canadian Press)

In a pandemic, decision-makers are faced with a tough balancing act in the face of major uncertainty: not doing enough versus doing too much. No one wants to risk and be held accountable for not doing enough.

Successful outcomes will be attributed to whatever actions are taken. Doing more than necessary often gets a free pass and its architects are showered in praise. It seems mean-spirited to niggle about costs in the afterglow of victory.

We don't know what victory looks like at this point.

Death toll

The coronavirus has killed 65,000 people (April 4, the date for all figures below). The numbers will rise, but by how much is unknown.

China was the first wave of the pandemic; Europe is the second. In Italy, Spain and France the daily death toll has approached 1,000. But the growth in the numbers infected appears to have flattened and in Italy, declined.

There is no sign that the crest has peaked in Africa, India, Indonesia, Brazil, and the United States. Leaders in the U.S. already concede that 200,000 may eventually die (about 8,500 to date). We have no idea about where it will end in other emerging hot spots.

'Alarming levels of spread'

It is not inconceivable that a million, and perhaps even five to 10 million people will die before this is over. The spread and the toll have spurred the shut-down of much of the world's travel, trade and commerce.

Dire predictions abound: an article in Foreign Affairs raises the prospect of "an almost unfathomable number of dead" in poor and crowded countries.

WHO Director-General Tedros Adhanom Ghebreyesus is "deeply concerned by the alarming levels of spread and severity" of the outbreak. Thesauri around the world are generating an endless string of synonyms for disaster.

The daily death toll is now over 6,000 worldwide.

Imagine the reaction if deaths rocketed to 160,000 in one day, and the number persisted day after day after day, with no end in sight.

Surely this would collapse the world order as we know it, people killing for cans of soup, rugged hillsides newly staked out by survivalists, civilization reduced to Lord of the Flies and Mad Max.

Nature, battered and bruised for centuries, overrun with nearly 8 billion humans, will have spun off the ropes like Muhammad Ali in Kinshasa in 1974, who smashed an over-confident George Foreman to the canvas in a heap of stunned exhaustion.

Healthcare workers wheel the bodies of deceased people from the Wyckoff Heights Medical Center during the outbreak of the coronavirus disease (COVID-19) in the Brooklyn borough of New York City, New York, U.S., April 2, 2020. (Brendan Mcdermid/Reuters)

Set aside these lurid scenarios. That 160,000 is not an alarmist figure pulled from a twisted fantasist's imagination.

It is the typical number of people who die on planet earth every day.

In Italy, where the COVID-19 pandemic had taken about 15,000 lives, 642,000 people died in 2019. In Canada nearly 300,000 die annually; in the U.S. just short of 3 million.

We do not panic at these numbers.

It is not death that scares us; it is novel causes of death, however few (SARS killed only 800 people in 2003), and the uncertainty about where the numbers will top out. Interestingly, COVID-19 isn't all that novel — it is a new member of the familiar coronavirus family, and like many viruses it is hardest on the aged. But there is yet no effective vaccine or drug, and the four per cent world-wide reported case fatality rate is about 40 times more deadly than the seasonal flu.

But the people who dutifully gather and report the data know the numbers are bogus and the death rates are inflated.

No one knows the true rate of infection in the population because no one has done population-level sample testing. Iceland has tested the most — seven per cent of the population — and roughly one per cent of asymptomatic people test positive.

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The health impact has been modest: from 1,417 confirmed cases, four deaths, 45 hospitalizations, 12 in ICUs. But Iceland is a small, isolated Nordic country and what's true there may not be true elsewhere.

Suppose the worst happens and ultimately a startling 25 million people die.

Typically one out of every 132 people in the world dies every year. With 25 million additional deaths the ratio would be one in 93. Most would be elderly with existing health issues. It would be an immense loss; lives matter, and it's a 40 per cent bump in the death rate.

But it's not an existential threat to the species.

The world will have to fumble its way through this pandemic, after which it must take stock of lessons learned if it is to do better next time.

If similar outbreaks become the new normal and the world must periodically come to a near-halt to contain them, there will have to be major adjustments to how the economy works and how wealth is distributed within and among nations.

Perhaps in the end we will grudgingly thank COVID-19 as the catalyst for reckonings long overdue.


This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.

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ABOUT THE AUTHOR

Steven Lewis

Health policy analyst

Steven Lewis is a health policy consultant formerly based in Saskatchewan. He now lives in Vancouver.

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