I just received a video this morning featuring an Israeli Minister making an argument supporting “mitigation” as a strategy for combating Covid 19. He explained that since mortality rates are lower than 1% for the young, society just needs to isolate those above 70 years of age, and allow the infection to spread through the rest of the population so that after about 80% of the total population have recovered from being infected by Covid 19, one has herd immunity in the population and this will protect the older members from getting infected.

There are many misconceptions under-pinning this line of argument. The first is that the 1% mortality rate for Covid 19 infection only obtains when the infected patients receive optimum treatment. We now know from the experience of Wuhan and Italy that approximately 10 to 15% of the Covid infected patients develop respiratory difficulty and suffer a drop in their blood oxygen levels. Many of them can be managed with giving them oxygen. However 5% of all Covid patients deteriorate even with oxygen therapy, and they require intubation and ventilation in an ICU setting. Only when you can provide this level of care to all patients who need it, can you achieve mortality rates of about 1%.

But in both Wuhan and in Italy, the number of Covid cases requiring ICU care over-stripped the capacity of the Health Care system to provide ventilator support to all who need it. And you have to bear in mind that ventilator support is not for a day or two only. On the average, these 5% of the most ill patients need prolonged ventilation for 2, 3 or more weeks, tying up many ventilators in the process! That is why the mortality rate for Wuhan was about 3.4% and that for Italy seems to be around 5% and rising! So, blithely arguing that mortality is low for the young is a very dangerous misconception! Anyway, even the quoted 1% mortality rate is about 10 times higher than the mortality for Influenza.

Those still advocating the Mitigation strategy have now changed tack a bit and are now advocating “flattening the curve”. By this they mean that the country should practice social distancing so as to allow the infection to spread through the population, but at a rate that the health system can handle. Meanwhile the elderly should be shielded. This is another ill-conceived idea. Lets look at the math –

UK has a population of about 67 million. If you intended 80% of the population to get the infection naturally so that the population develops herd immunity, you are talking about allowing 53 million people to acquire the infection naturally with the caveat that the curve should be “flattened” so that it does not swamp the health care system’s capacity to give ICU care to those who need it. We know that with only 40,000 cases, Italy’s health services have been swamped many times over and that the situation there is quite grim. Assuming that the UK system is more robust and can provide optimum care to 50,000 new Covid patients a month, it would take the UK 89 years to develop the herd immunity! (53 million divided by 50,000; divided by 12). Makes much better sense to wait for the vaccine doesn’t it? Hopefully we should have one before the end of the year. That would confer us “herd” immunity much more painlessly than exposing 80% of our population to the natural infection!

Luckily Malaysia is following the other strategy of Covid 19 management – suppression of the outbreak by isolating all active cases and tracing and quarantining all contacts, thus breaking transmission. This is the strategy being followed in Wuhan, South Korea, Hong Kong and Singapore. And to me this seems to be the most sane and humane way of handling this epidemic. Wuhan has demonstrated that it can work – they managed to stop the epidemic there with only 70,000 cases out of a total population of 60 million (for Hubei province). The down-side to this approach is that is does not create herd immunity. In Hubei only 0.12% of the total population was infected, far short of the 80% required to give herd immunity. Imported cases can re-start the epidemic quite easily if vigilant surveillance and quick action in damping down any recrudescence is not implemented religiously.

This strategy of “Suppression” is quite different from the tactic of “flattening the curve”, and we should not confuse the two (as some people in Malaysia are doing). Suppression means we aim to bring the transmission of Covid 19 down to zero if we can. Flattening the curve means that the epidemic is permitted to spread through the population, but at a “controlled” rate. The latter approach is a dangerous route to follow. The UK and the USA seem to be particularly enamoured with the Mitigation strategy, and they are going to find that it is not easy to maintain a controlled spread of the Covid 19 epidemic through the population. It’s like talking about a controlled wild fire. It is sad that many thousand citizens in these two countries will pay the price for this deeply flawed policy.

It is always interesting to try and figure out the ideological basis of differing policies. Is it just a coincidence that the countries that subscribe most to neoliberal theory – the UK, the US and Israel – are the ones most taken up with the “Mitigation” strategy? You see, the “Suppression” strategy is not a final solution to the Covid 19 problem – you need to wait for the vaccine and that might take a year to materialize. In the meantime you have to keep disrupting production by quarantining contacts, encouraging workers with respiratory tract symptoms to stay at home on full pay, minimizing travel overseas and tourism, discouraging mass events such as concerts and sales etc. All these are measures that reduce economic activity and corporate profits. If somehow you could get herd immunity within 4 months by letting the epidemic rip through your population, yes, you would suffer horrendous casualities (deaths), but you emerge with a population that can go back to work without worrying about quarantining people and allowing sick leave etc. You would then have an economy that is more lean and efficient than the sissies who mollycoddled their population with the “mitigation” approach. You would be more “competitive”, and could expand your export market. With unemployment high in so many other countries, you could always import some labour if necessary – after all you no longer need to worry about “importing” Covid 19 as you have the herd immunity. Another bonus of the “let her rip” approach is that your dependency ratio would be less – you would have lower pension and social security expenses as, after all, the mortality rate is higher in the elderly.

Am I being overly cynical, or could this be the reason why certain political leaders are drawn to the “Mitigation” approach? I will let you decide.

Meanwhile, whether we like the present administration or not, we should all fully support the “Movement Restriction Order” and other follow-up steps that the government takes to bring down the spike in the infection rate. The health of our people as well as our own depends on it. We all need to work together and for each other to get over this difficult period.

Dr.Jeyakumar Devaraj
Chairperson PSM
22/3/20