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The forthcoming decision as to when we should move to COVID Level 3 is high risk, with expectations high, but not enough information for confident decision making

The forthcoming decision as to when we should move to COVID Level 3 is high risk, with expectations high, but not enough information for confident decision making

The decision the New Zealand Government makes on Monday 20 April is likely to be the defining decision as to how history assesses the Ardern Government. There appear to be two options on the table. Do we go to LEVEL 3 on 23 April or do we stay in LEVEL 4 for another two weeks?

For each option there are two potential outcomes: success or failure.

There are also two criteria by which history will measure success or failure.  First, did the decision lead to eradication of COVID-19 within New Zealand? Second, did the decision lead to the minimisation of economic damage?

If history shows that the Government got it right, then Prime Minister Ardern will identified by many as the greatest New Zealand leader of all time. But if history says she got it wrong, then the current gloss will fade.

On a world scale, New Zealand is in an enviable position. China, Australia, South Korea and Taiwan are the only other nations with prospects of eradicating the virus in the short-term. My bet right now is that Taiwan is going to get there first. More of that later.

Japan and Singapore looked promising for a while, but both are now experiencing COVID-19 breakouts.

LEVEL 4 has been working well despite the mis-steps

In the five weeks since Prime Minister Ardern announced on 14 March that we were going ‘hard and early’ I have been generally optimistic that eradication was feasible. However, I have also been nervous as to whether we would get there. One day after the Prime Minister’s ‘hard and early’ announcement, in what was my fourth COVID-19 article and writing from high in the Canadian Rockies, I expressed the reservation that only time would tell if Jacinda had gone early enough.

Some two weeks earlier my wife and I had decided as a matter of community responsibility that we were going to self-isolate on our return from Canada, regardless of the official rules, and despite minimal cases of COVID-19 in Canada at that time. I was therefore appalled to see Air New Zealand putting on special wide-body jets from Australia on the evening of 15 March so people could beat the self-isolation requirements, and with the government extending the deadline so those flights could pour into New Zealand in the early hours of 16 March.

As I saw the glee with which my fellow Kiwi citizens exalted at their success in beating the self-isolation deadline, I could only say to myself, ‘these people do not understand what is happening’.

Since then there have also been some mis-steps around the management of self-isolation for those who arrived thereafter.

To put that into perspective, Taiwan has had (as of 18 April) 345 returnees who brought COVID-19 into the country, but they only passed that on, directly or indirectly to 50 additional people. In contrast, New Zealand had by that date 550 people who brought COVID-19 into the country but they passed it on, directly or indirectly to more than 850 people.

The difference reflects the fact that the Taiwan Government knew what they were doing whereas New Zealand had to start from scratch with almost no systems in place. This was despite knowing for months that COVID-19 was coming.

New Zealand has also had multiple problems with the supply and use of PPE, despite ongoing affirmations from Ministry of Health that supply was not an issue. Once again, the systems were not in place and health workers, particularly care-workers in rest-homes were inadequately trained in its use.

A consequence of this is that as at 18 April we have more than 60 health workers who are presumed to have been infected in the workplace.  This includes a large number of rest-home carers. This gets me more than a little angry.

Despite all of those issues, and another big one that I will soon come to, I have remained optimistic. Once LEVEL 4 was in place, I estimated that once the cases peaked some 10 to 14 days later, then we would see a decline of approximately 50 percent in new cases in each of the following weeks. Broadly speaking, that is what has been happening.

That estimate of halving the new cases each week did not come out of thin air. Under LEVEL 4, I thought we would get an R value, this being the number of people each infected person subsequently infects, of around 0.5 and an average transmission cycle of around one week.  I based the likely R value on what we were seeing happening in China.

Putting all of the politics and uncertainties aside, there was incontrovertible evidence coming from many independent sources that China was stamping hard and was smashing the epidemic. I estimated their R value was down to about 0.3 or maybe even lower.  I figured we might therefore be able to get to about 0.5 with our LEVEL 4.

Given the clear trend that we have now seen for some two weeks, I have been able to retain my optimism despite the mis-steps. Also, it has been exhilarating to see how almost everyone has worked hard to make it happen.  It reminded me somewhat of some events in my younger days when I was involved in mountain search and rescue, and how great things could be achieved when everyone worked together driven by need and team spirit.

Success at LEVEL 3 will be more challenging with less room for mis-steps

Right now, I am struggling to retain my optimism. I am scared that we are going to go into LEVEL 3 before we are ready. In particular I reflect on the fact that there are currently more than 550 active cases (confirmed and probable) capable of starting community transmission. I am also concerned that the decision to open day-care facilities and schools up to Year 10 as part of any move to LEVEL 3 has been made without sufficient consideration as to the risks.

Once again, I go back to my mountaineering days in various parts of the world, and the way we assessed risks. In my case, I got away with it, or else I could not be writing this now, but I also often reflect that there was an element of chance involved. And I know that for many in that mountaineering community, including many friends, their luck did run out.  Over the years I have become more conservative in my decision-making where life and limb are involved.

My current thinking is that any move to LEVEL 3 without another two weeks at LEVEL 4 puts everything at risk. It does seem like Russian roulette.

If we are to go to LEVEL 3 then my plea would be that it should be LEVEL 3+, with schools remaining shut for at least another two weeks.

In recent weeks I have been impressed by the ability of our Prime Minister to stay on top of the issues and also to communicate those issues to the rest of us. But this time, it seems she might be getting some poor advice from people who do not understand the realities of school situations. There also seem to be some messaging issues as to the specifics of the education proposals.

We need to think carefully about this. Young children are not particularly at risk themselves from the effects of COVID-19 but they have great capacity to be either pre-symptomatic or asymptomatic transmitters of COVID-19. Also, the idea that they can be in their own school bubble isolated from other bubbles, and with social distancing, is greatly flawed. School and home bubbles will overlap and that provides a big transmission pathway.

If we get it wrong, and there is a new outbreak of COVID-19, then there is likely to be no way back. With our current outbreak, we knew where it was coming from. In contrast, if there is a second wave then it will come at us from within the community and we will have no point of attack.

In that case, we will at best be in the same situation as Sweden, which has had delayed build-up of cases but is now on an exponential curve and has already experienced over 1400 deaths with nearly 400 of those deaths over the last three days. To put that in perspective, Sweden has about twice the population as New Zealand, so it would be like us having had about 700 deaths to date.

Right now, if there is any light at the end of the Swedish COVID-19 tunnel, it is not daylight. Rather, it is the headlight of an accelerating COVID-19 train.  All they can do is try and slow it down. As with everywhere in Europe, eradication would be a forlorn hope.

The question I ask right now, is why would we risk everything by going to LEVEL 3 too quickly?  Another two weeks would be tough for some, but it would give us a further chance to stamp real hard and also to get better systems in place for when we do emerge from LEVEL 4.

The testing program remains muddled

That brings me to another current frustration, and that relates to the surveillance program we are now undertaking. The level of testing that has been occurring in recent days in Queenstown and Christchurch, and now Waikato and Auckland, is only scratching the surface of what is needed to assess whether COVID-19 is circulating out there in the community. How can the Ministry of Health claim that this will provide guidance for the forthcoming decision of whether to move to LEVEL 3?

To illustrate this point, let’s assume that there might be 100 people in the community currently with infective COVID-19 that we do not know about.  That means that these people comprise one person out of 50,000 in the general population. Now let’s assume that we do 10,000 surveillance tests of that population. What is the chance that we will find at least one of those 100 people?

The answer is approximately one chance in five, or 18.1% to be more precise. The maths behind this is not particularly complex, based on sampling from a finite population, and a good year-13 student at scholarship level for maths or statistics could work that out in less than five minutes.

In reality, it seems that the Ministry of Health will only have at best about 1500 surveillance test results available on Monday. The probability of finding a positive COVID-19 sample with that number of tests, still assuming there are 100 positive infective cases in the population, now drops to just under three percent.  In other words, the value of these community-based tests in providing guidance as to whether we are ready to move to another level is zero.

Despite this, there is an important place for COVID-19 testing.  But the first place to start is with close contacts. It is also important to include antibody (serology) testing as well as swab (PCR) testing. As long as the community testing only uses swabs, then the numbers that can be tested are too low to find out the true story.

The question then becomes, given the messages coming from the Ministry of Health, as to whether Ministry of Health actually has anyone with mathematical skills on their technical panel. The answer may well be that they don’t.

As to why that might be the case, the technical expertise needed to guide a COVID-19 program draws on multiple disciplines. It needs an understanding of epidemiology, virology, immunology, statistics, and program management. These are all different knowledge sets. It may well be that there are gaps in the team.

Also, the specifics of COVID-19 surveillance are very different to the normal sentinel surveillance undertaken routinely by Ministry of Health, which Director General Ashley Bloomfield has been referring to in recent days.

The normal sentinel testing is to obtain guidance as to the approximate level of particular diseases in the community, such as common flu, and identify those diseases and specific infectious agents that are at high levels. That is very different to the situation with COVID-19 where we are trying to find out whether there are any needles still in the haystack, and we know that there only has to be one needle there for disaster down the track. It requires a whole new way of thinking.

Risk and payoff decisions when flying blind

To conclude, I want to come back to the issue of risk and payoff.

Regardless of the decisions that are made, there are no guarantees. Scientists like working with data but with COVID-19 there are big gaps in that data.

I recall one of my colleagues from University of Queensland a long time ago, who had below the name-plate on his door a sign saying “In God we trust. Everyone else must bring data”.

The problem right now is that we do have to make decisions despite insufficient data. Hence, no one is an expert and we are all learners. 

There is a range of decision frameworks taught in business schools that can assist the decision making. Nevertheless, there can be no avoidance of subjectivity in the assessment of risks and benefits from alternative options.

It is therefore true that so-called experts can inform components of the decision, but no-one can take away the burden of the ultimate decision-maker. It will come down to an informed but subjective judgement.

So, I say again, with COVID-19 there are no experts on which decision-makers can rely and hide behind. Our Prime Minister is the ultimate decision maker.

In that context, the way I read the disparate and at times conflicting sources of information, and how I then read the tea leaves, is that we should not risk the sacrifices of the last four weeks by shifting-down too early. Please, Prime Minister, don’t be unduly influenced by those who would risk all for short-term gain at this time.

At the very least, give us a LEVEL 3+ for a couple of weeks before any final decisions are made about returning children to school and day-care.  Also, please tighten up on all of those close contacts of existing active cases.  Every one of them must be in their personal equivalent of a tight LEVEL 4, staying only within the home.  

The short-term economic benefits from a premature LEVEL 3 will seem trivial if the consequence is an explosive COVID breakout, and we miss the goal of eradication.


*Keith Woodford was Professor of Farm Management and Agribusiness at Lincoln University for 15 years through to 2015. He is now Principal Consultant at AgriFood Systems Ltd. . He can be contacted at kbwoodford@gmail.com. Keith’s previous COVID-19 articles are available here.

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337 Comments

That is so exactly right! What the hell is going on then? We don’t live here in a WW2 style censorship. These are fundamental facts that affect all of us in determining the extent & status of the crisis we are sharing. Come on some damn journalist ask that question in the next briefing, it is actually more important than when your rescue package is arriving. KW can you at least suss out some figures of what falls into these categories?

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Foxglove,
I too have been very frustrated by the quality of the data that we are getting. I don't think they are hiding the data; they simply do not have it. And that tells me how poorly prepared we have been in NZ, with very weak information systems. Unfortunately, none of the journalists at the media conference are analytical, and so the MoH has been able to get away with not admitting to its inadequacies. I am hoping that with new cases now much lower, that MoH can analyse these in some detail. In my opinion, one of the reasons we need anther two weeks in LEVEL 4 is so that MoH can indeed get themselves better organised
KeithW

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Tks Keith, understood and disappointed equally. Hasten to add not with anything to do with Interest.com. Firstly that our journalists are of so low calibre for such high stakes. Secondly surely the MOH is tracking the status of contained clusters rest homes etc, and those still quarantined and therefore any new infection can be categorised accordingly. This excellent column of yours has been as valuable as it has been timely. And when we add in the flaws in information gathering by MOH and the highly suspect ability of NZ’s to trace it is obvious that there cannot yet be any relaxation from level 4. Personally I am appalled that some contributors here seem willing for CV19 to run its course more or less as a culling exercise, eskimo style culture for the good of the tribe, to take out the elderly and vulnerable who apparently are ready to pass anyway. Repugnant contradiction of humanity and the ethics on which our society is based.

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"one of the reasons we need another two weeks in LEVEL 4 is so that MoH can indeed get themselves better organised"

This is indeed a sad indictment of the pathetic level of MoH prepping in two areas that should have been clear on Feb 1st: PPE and tracing systems.

Perhaps that's because there are so many small, inherently low-scale, DHB's with suspect systems. I've seen one of these from the inside and it's not a pretty sight....

It would be worth doing an OIA request for Verrell's audit of the tracing system.....

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Yes, I agree with the above comment about rest homes because no more people are doing than usual every week in New Zealand. The same statistics apply in Europe, the UK and the USA. Deaths from lung disease are being put in the Covid-19 pile. There is no "excess mortality".

The MSM are selling a statistical chimera. Luckily most of them are going broke. For believing them Jacinda must go.

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Plenty of economists and public health experts questioning the govt's approach. Cue dissent from the echo chamber:

https://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=12…

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Yes, I am a dissenter.

I think it noteworthy, that all of the antibody/seroprevalence tests done in the world in the last two weeks prove that there are probably 50 times as many bug infections as cases reported. These are; a California test done by Stanford University, (John Ioannidis); a test in Robbia, Italy; and a test in Gangelt, Germany. (These tests are a lot more accurate than the PCR test now used as they show all who have been infected and not just those currently infected).

In other words, NZ has probably had about 70,000 infections - not 1,400. If deaths are 14, the infection fatality rate here is probably therefore only about 0.02%. This is five times lower than the flu. A low IFR was in fact predicted in February, 2020 by the above John Ioannidis, (from the "Diamond Princess" data), who estimated 0.1%.

The lock down was therefore not justified, as Covid19, is less dangerous than the flu. There was no scientific evidence, at the time of lockdown, to justify it and in fact the only reliable data indicated otherwise.

This was a MSM driven panic. Our current PM must go.

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It could all be a front for an economic reset though

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We can now state that people that still think that this is no worse than the flu are no longer a slow adaptive responder they are just plain stupid.

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Anyone that doesn't use any figures to argue with is not just stupid - they presumably have no brain or should lose theirs

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You are in a poaistion to be dissenter or whatever as timely action was taken. Should ask people in Italy, Spain and New York.

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Less people are dying this year in all of Europe than last year: there is no excess mortality anywhere. Check the data.

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Have to go find europe but weekly death rate in UK highest on record

https://www.google.com/amp/s/qz.com/1837493/how-many-people-are-dying-o…

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Italy appears much higher than normal deaths rates

https://www.google.com/amp/s/www.thejakartapost.com/amp/news/2020/04/01…

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Belgium sitting within their normal range (great graph).

EDIT zoom right in on graph and it shows only up to date till mid March and on a steep climb. Could well (likely?) be well above normal range by now.

https://epistat.wiv-isp.be/momo/

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Where are getting your stats from this is fairly unequivocal?

"Pooled mortality estimates from the EuroMOMO network continue to show a marked increase in excess all-cause mortality overall for the participating European countries, coinciding with the current COVID-19 global pandemic"

https://www.euromomo.eu/

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Average age of deaths in Italy 78. The majority had 1, 2 or 3 existing health problems. The majority who died, of that group had 3 existing conditions.

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'If' It is uncertain that these tests measure what they say they do - a strong possibility of a high number of false positives. If it is '50x' then how did 20% of Diamond Princess passengers manage to get infected? - with 2% dead so far. Pretty much destroys that theory.

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That report is by a Stanford University prfessor. All seroprevalence tests have had the SAME result. About 50 times more people have had this plague than are reported. Fact. Your argument has no logic.

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Good on ya. Too many people pressing the panic button. Never let a good crisis go to waste. The left always the loudest voices when it comes to sticking their noses into other peoples business.

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The Horrild article is the Ian Harrison (Tailrisk Economics) paper which Michael Reddell referenced a few days ago. Good to see the MSM catch up, although there is the usual pile-on by fellow academics who fear their Gubmint-funded lives upset.....

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WayMad, the assumption around contact tracing and isolation. What if the MoH assumption checker (5 weeks ago), looked at the then current system / workflow that could manage 50 cases a day (50 a day? needs be fact checked 50 open cases at a time does not mean complete a case in a day). And dismissed it as a contributing factor - not fit for purpose.

Meanwhile, Tailrisk are rather assuming some level of competence (competence not observed 5 weeks ago by the Otago team).

This would go some way to "right" the numbers (in a model sense), though we know, no one can predict the future.

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Managing Stores.
Procurement & Purchasing

https://i.stuff.co.nz/national/health/coronavirus/121113236/coronavirus…

Five million surgical masks are heading to frontline health staff, thanks to an importer and his rugby star mates.

Ash said he had previously imported health and safety gear in small quantities and decided to act on his supply chain after hearing media reports about a lack of PPE.

Ash said the Canterbury District Health Board (CDHB) had ordered 5 million surgical masks, which he believed may have been done on behalf of the Ministry of Health. The CDHB was not able to comment before deadline.

Another 1 million masks will be given to the New Zealand Defence Force, NZ Transport Agency and Maritime NZ.

The first shipment arrived in Christchurch on Saturday, touching down aboard a chartered Air New Zealand 787. Another planeload is arriving on Thursday.

A third lot is coming by boat and distribution of the masks would begin next week, Ash said.

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Perhaps the plods in the Stores Branch of the MoH had run out of Order Books, and then realised they couldn't acquire any more because they'd run out of the order books they needed to Order more with.....nothing would surprise me now.

I'd be fascinated to see Ms Verrell's report....OIA territory?

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It is very interesting that you can tell who have been financially successful on here by their comments!
All the property investors seem to want lockdown eased to level 3, and the anti property posters don’t.
The clear reason for this would appear to be that the property investors are people who want to improve their lot by getting out and about and have got goals!
The anti property investors tend to be jealous people who generally are reliant on other people for their lifestyle and therefore it doesn’t really affect them a lot by the lockdown and don’t like to take any risk in their lives!
I know some will come on and give it to me, their prerogative and Don’t care as just stating an observation!!

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What a Joke !

https://www.newshub.co.nz/home/new-zealand/2020/04/coronavirus-dire-con…

If malls are open in level 3, what is the point of having level 3 - lockdown. Is it not a joke to have open mall and level 3 lock-down.

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I think Ja-panic-a may have figured out that if the malls go broke NZ is stuffed. I think we need proper testing ie antibody testing, to get a handle on this. If 50,000 Kiwis have had it - as recent reports indicate - we clearly cannot trace and eradicate...

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Where has this 50k figure come from? In the UK they reckon that between 10-30% of the population have also already had from February, but not had any symptoms. But even if that was the case, WHO has said that there is no evidence that these people with some antibodies will be immune to new waves of it. But there doesn't seem to even be an accurate antibody test for it.

IMO there are only two solutions for a country, eradicate it and then run a domestic economy. Or stay in lockdown rotations for 18 months or more to slow down the spread, and hope that new waves won't infect people who have previously had it. But both still require a vaccine in 18 months, which is still an unknown.

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The 50,000 figure comes from the three random, antibody tests done in the world in Germany, Italy and the USA which indicated bug infection rates of 15%,20% and 4%.

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This figure comes from the only three random, large scale, antibody tests done in the world which indicated massive infection rates of 15%, 20% and 4% of the total population in Germany, Italy and the USA respectively. These were done in the last two weeks.

These studies all showed that there were at least 50 times as many infections as cases reported. NZ must have had therefore, I believe, at least 50,000 infections or 50 times the current case level of 1,400. This is 70,000 less any room for error.

I think the principal problem in this situation is statistical interpretation. In Europe, LESS people are actually dying every week than last year. There is no health crisis.

Part of the problem is that if you have severe cancer but died WITH Covid at 80 years old that is recorded, (wrongly from a pathologist's point of view) as a Covid19 death. The overall death rate, and life expectancy, has not risen anywhere.

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You should get Mike Hoskings, Phil OReilly, Judith Collins et el to read this.You cant negotiate with a virus - you only get one chance.

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In the book, The Road to Serfdom by Friedrich Hayek. The book describes how during times of crisis, such as a war, we surrender ourselves to central planners. They seem to have all the solutions, they tell us what to do, direct factories to produce certain things that are needed. While that may be useful during a crisis. After the crisis is over, the planners remain and keep regulating and restricting people’s rights.

Thats why come September we need a new Government

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Spot on, esp in relation to so called community testing and likelihood of getting a positive.
As a Social Science graduate, it has been clear to me for a while that statisticians in NZ government and on Health team in particular do NOT get risk and its profiling. They need Nassim Taleb on the job. Another 2 weeks at level 4 minimum, esp with kids as transmitters, (as any teacher could have told them!)

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Who knows? when we just clear up soon this lockdown? - about 6 months down the road suddenly, there'll be a surge of support to implement the CullenCGT - as the non supporter being handled in natural way.

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End this lock down nonsense. The Genie is out of the bottle and its not going back in. The rational for this assult on our freedoms was to "Flatten The Curve". Job done. The hospitals are under utilised.
Time to start living again.

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The key questions are:
a) What is the average age of those omitted to hospital because of Covid-19, into ICU and die respectively?
b) Of those, what other contributing pre existing conditions do they have?
c) What is the average life expectancy of those in the above categories, under non Covid-19 "normal" conditions?
d) What is the actual mortality rate from CoVid-19 (numbers I have read suggest it is 0.4-0.5% based on small populations globally but with large scale testing) versus the average mortality rate.
e) Is it realistic to irradicate the disease and it what expense?
From there we can have a more informed debate about the cost/benefits to society of various lock down or mitigation scenarios. I have seen nothing to suggest that these numbers have been crunched or assessed let alone debated. These difficult and brutal "what is good for society as a whole" questions are what politicians have to answer, but make it they must and with full transparency.

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I think the govt have fudged the numbers from the start, to manage panic levels mainly. I agree with idea of staying in level 4 a bit longer. However, the numbers do not justify the action taken. 2019 average deaths p/month 2855. 2019, road toll just under 30 deaths p/month. The govt screwed up with too tight a control on covid death #s, and now couldn't possibly justify any form of lockdown. This will cost the country dearly, especially if the actual numbers were much higher. The public have had enough, and there is no real statistical evidence to support the LD. Govt too carried away with glowing media reports. 11 deaths? Really? Govt spin doctors should have aimed for a more realistic number.

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