Covid, tourism and the value of a human life

When Queensland behind interstate barriers opened to intrastate tourism, we see that tourism operators were ‘ecstatic’ about easing restrictions if you scroll down this article:

    Tourism Tropical North Queensland chief executive, Mark Olsen, said… the region lost more than $200 million worth of bookings in March, with the impact to the end of April estimated at $500 million in lost visitor spending and thousands of jobs lost.

    “Over the last 24 hours, the phones have been ringing off the hook with travellers from the south-east corner confirming their accommodation and looking forward to their journeys, ” Mr Olsen said.

It raises the question as to how much scope there is in the intra-state tourist market, and secondly whether business is suffering too much through trying to wipe out the coronavirus.

Mediterranean Europe is opening with much higher comparative case loads to capture the summer tourist market. In Greece I’ve heard that 30% of the economy depends on tourism, in Italy 15%, I heard that Spain gets over 80 million visitors each year. This Qld Government site gives the key metrics:

    • More than 26 million domestic and international overnight visitors come to Queensland each year.
    • The industry directly and indirectly employs 217,000 Queenslanders – or 9.1% of all people employed in Queensland.
    • Tourism contributes $12.8 billion directly to the Queensland economy, accounting for 3.9% of Queensland’s gross state product (GSP). The industry indirectly contributes an additional $12.5 billion to the state’s economy, making the total contribution $25 billion, or 7.8% of total Queensland GSP.

So it’s significant. Of course to some businesses and localities it is everything, and there were real questions as to how much of the industry would survive if it missed the winter season. The Courier Mail’s Steven Wardill put together an article looking at how much various centres drew from the Queensland market in the past. This is what he found:

      Brisbane 56.4%

      Gold Coast 48.2

      Sunshine Coast 72.4

      Far-north Qld 67.7

      Wide Bay 87.3

      South West Q 79.9

      Townsville 82.1

      Mackay 87.3

      Fraser Coast 75.6

      Whitsunday 63.4

Overall it was more than I thought.

We have to consider now that people might not have as much money to spend on holidays. On the other hand tourism was a net import industry for Australia. That is to say, more Australians went overseas than foreigners coming here. So the unavailability of overseas holidays may help the local industry and compensate fto some extent for the lack of interstate and overseas tourists.

There is still a question as to how to best set the balance between suppressing the virus and strangling the economy. One with a strong opinion is economist Gigi Forster in an AFR article Correctly counting the cost shows Australia’s lockdown was a mistake.

I’ll start with some raw statistics, which she doesn’t, to give some idea what she’s on about. There are around 160,000 deaths in Australia each year. That’s roughly 440 per day. Not many of them make the news. However, most of the 102 deaths (so far) from Covid 19 did make the news. If you scroll down this site you’ll see that most of them were over 70:

More than half the total were made up of around 29 cruise ship passengers and crew, together with 26 nursing home residents.

Foster’s claim is firstly, that the actual modelling used overestimated the cases and deaths by orders of magnitude, and secondly that the true welfare costs of the lockdown were either ignored or calculated using full value-of-a-statistical-life (VSL) numbers, rather than age-adjusted VSL or quality-adjusted life years.

With reference to the second, she links to an article by Richard Holden and Bruce Preston, professors of economics at UNSW and Melbourne respectively, The costs of the shutdown are overestimated – they’re outweighed by its $1 trillion benefit. They assume that if we let the virus rip it would be stopped by herd immunity. With deaths at a 1% level this would have given us 225,000 deaths. They say the Australian government does actually use a ‘value of a human life’ at A$4.9 million (in the US it’s US$10 million.)

In their world government spending doesn’t cost anything, because you are simply moving money from one part of society to another.

So even though they see GDP taking a 10% hit ($180 billion), they come out with a cost of only $90 billion and benefits of $1 trillion.

Foster discounts oldies, because they, and society, are only shaving a few years off the end of their lives.

That is as may be. Oldies are typically devalued in our society. The real value of Foster’s article is that she reminds us of the direct and secondary negative effects of the lockdown other than loss of life. Here are some:

  • Many people suffer psychologically from the lockdown. Some have put this at 25% for serious effects. Deaths through suicide can result. Psychological effects can be long-lasting and affect life prospects.
  • Lower GDP now and going forward means lower levels of government services on education, healthcare, research and development, infrastructure, social services, and myriad other things that keep us happier, healthier and living longer.
  • Kids education will be disrupted. Career prospects will be changed, with effects lasting years.
  • Discoveries of cures for diseases other than COVID-19 will be delayed; IVF babies won’t be born; our progress on lifting up the tens of thousands of Australian children who live in poverty will be set back.

She says:

    The future we’ll now have is worse than the future we could have had without the policy responses we have seen.

    That comparison of what-we-will-have to what-we-could-have-had can be expressed in terms of quality-adjusted life years (QALYs) and wellbeing-adjusted life years (WELLBYs), and compared directly to estimates of the QALY and WELLBY costs of the COVID-19 deaths and suffering that our policies have averted.

    When you make this comparison, correctly, the evidence is clear that Australia’s lockdown has been a mistake. (Emphasis added)

The modelling which Foster claims got things wrong by orders of magnitude was done by Tony Blakely, Professor of Epidemiology at the University of Melbourne in Coronavirus modelling shows the government is getting the balance right – if our aim is to flatten the curve. The article was published on 22 March, after the initial decisions were made to restrict the size of gatherings on 13 March, but before schools and work places were closed. The first result was shocking:

500,000 cases per day is a big number. In fact in the real world the whole planet has recently broken through the 130K/day barrier, to everyone’s alarm.

At the time the epidemiology we had came out of China, and the horror of Italy was revealing just itself. On 21 March Italy had gone from fewer the 100 cases per day to over 6,500 per day in the course of about a month. This is what Australia’s graph looked like at the time:

Blakely was assuming a reproduction rate (RO) for the virus of 2.5, which he assumed could be brought down to 2.0 by the end of March. At the end of the article he worries that the model assumed that the cases were doubling every four days, whereas in real life cases were doubling every three days.

Blakely found that with the immediate implementation of “extreme social distancing” daily new cases could be lowered to 100,000 in Australia, or roughly where the whole world is now.

In real life, as it turned out, much more was done than social distancing in closing borders, contact identification, testing, isolating and closing borders. Everyone knew we could not clobber the virus the way China did, but no-one thought to look at Taiwan. There is no country in the world where nothing is done, even in Brazil, where the president may not care, but, like Australia, decisions on lockdown are made at lower levels of government.

Initially the talk was “flatten the curve”. While the virus could not be stopped it could be slowed down so that the health system could cope. However the aim was herd immunity. So we had curves like this:

The problem with this was that you end up with as many deaths as doing nothing. Futhermore, the number of hospital beds, the ICU’s, the ventilators and the specialist medical staff were nowhere near adequate, so graphs like this were appearing:

Because the area under the lower graph is smaller than the other, herd immunity would not be achieved. This means that we would have to create the capacity to suppress the virus and control it while still having a population vulnerable to infection.

So we gave suppression a red hot go, with a lockdown a bit less severe than New Zealand (we kept Bunnings and Officeworks open, and allowed exercise) and less severe than places like Italy. It worked, with effects within a week or so, as I showed in this graph:

Now look at this graph of daily new cases from the worldometer site:

Since 10 April we’ve had fewer than 100 cases per day. From 20 April we’ve mostly been under 20. Here’s the comparable graph for Germany, where restrictions were eased from about 6 May:

When they eased the lockdown the 7-day moving average was over 1,000 cases per day. They’ve been doing the kinds of things we are doing, and the average is now down to 343. Here’s the German country site.

Using Gigi Foster’s arguments, you could mount a case that we should have eased restrictions 6 to 8 weeks ago.

Meanwhile over the ‘ditch’ New Zealand drops Covid-19 restrictions after nation declared ‘virus-free’.

Right now we have SA, WA, Tasmania and the two territories effectively virus-free. Queensland says that we’ll always have to live with the virus, but is acting as though it also wants to be virus-free.

The federal health authorities are saying that we will have to live with outbreaks, and that we now have the ability to squash them as they appear, so we can. In recent times we have had the case of the Bundaberg fruit picker who dramatically brought the virus from Melbourne, causing 250 or so people to be tested, and at last count 44 have had to isolate.

As we open up to the world, which we must, this kind of thing is going to happen. As Gigi Foster says, the cost of staying locked down is considerable.

I would contend that it is unfair and unreasonable to ask a medical officer trained in the Hippocratic Oath and using the principles for public health ethics to make such decisions.

I like the idea of the German Ethics Council to advise government, where the members are strictly forbidden to have any connection with government. Neither epidemiologists nor economists should have the final say. That should rest with government.

I note that in Germany the decisions also rest at the second level of government, with the states and city-states.

29 thoughts on “Covid, tourism and the value of a human life”

  1. “Value of human life”, a very interesting and highly complex subject. well worth a thread of its own, independent of Covid complications, some day.

  2. The Covid 19 action taken by Australia will save a lot of lives that would be lost to normal flue. (between 1500 and 3000 Australians die of influenza in a normal year.) Flue cases in April 2020 were only 1.2% of normal!!!

    “Australia sees huge decrease in flu cases due to coronavirus measures Read more: https://www.newscientist.com/article/2242113-australia-sees-huge-decrease-in-flu-cases-due-to-coronavirus-measures/#ixzz6P28Thdhv
    A few key statements;
    “This year, Australia began with relatively high flu rates: it had 6962 laboratory-confirmed flu cases in January and 7161 in February. However, cases have since nosedived, with 5884 recorded in March and only 229 in April, compared with 18,705 in April 2019. This is despite more flu testing being conducted this year.
    Australia’s FluTracking surveillance system, which surveys about 70,000 people each week and records their flu-like symptoms, shows that, in the week ending 26 April, only 0.2 per cent of Australians had symptoms. This figure was 1.4 per cent at the same time last year.
    The sharp reduction in cases is probably due to Australia’s decision to shut its borders on 20 March and ban non-essential gatherings to try to stop the spread of covid-19, says Robert Booy at the University of Sydney. “We’re not importing any flu and anything that stops close contact with others is going to make it harder for the influenza virus to transmit,” he says.
    Additionally, very few children have been attending school since mid-March, when states and territories began encouraging remote learning where possible.
    This is probably another reason why flu cases are down, since schoolchildren are known to be major spreaders of the influenza virus in normal years, says Kirsty Short at the University of Queensland.
    Covid-19 lockdown measures also seem to have brought an early end to the flu season in Hong Kong, which normally extends to March or April, but this year tailed off in February.
    If strict measures to control covid-19 are kept in place, flu cases should continue to be suppressed, says Booy. “That could mean we see fewer deaths from respiratory infections overall this year,” he says.Covid-19 deaths in Australia have been relatively low at 92 so far, while between 1500 and 3000 Australians die of influenza in a normal year.
    But even if the restrictions are eased, we could still see a reduction in flu cases due to changes in people’s behaviour, says Short. “People are washing their hands more and instead of having the attitude that they can still go to work if they’re sick, they now know to stay home if they have respiratory symptoms,” she says.

  3. Brian: Social distancing made sense for Australia at the start of the crisis because Australia wasn’t properly prepared for the pandemic and social distancing was a strategy that could be implemented quickly without having to wait for adequate supplies of masks, hand-washes etc. to be found. Problem is that social distancing rules have been the major contributor to the job losses and economic damage associated with our efforts to control the pandemic to date.
    My bitch with the Australian governments is that they didn’t set up task forces to look for ways of controlling the virus without the need for damaging options like social distancing and state border closing. They didn’t have to look far. For example, Taiwan was better prepared and was ready to use a variety of strategies in parallel: “Taiwan’s success was based on a detailed preparations made in response to Taiwan’s experience with the SARS epidemic. This preparation allowed multiple strategies to be run in parallel or a particular strategy to be avoided where it was going to damaging to the economy. As result, Tim Colepatch could write for Inside story that: “Large gatherings are banned, but Taiwan has remained open for business: you can go to work, school or university, go shopping, go to a restaurant with your friends. But you will have to wear a face mask in public, obey social distancing rules, and constantly have your temperature checked and your hands sprayed.”
    We also seem to have missed the difference between the use of face coverings to keep infection out of the air and the use of face masks to protect individuals. The data I have seen says that even a simple cloth face covering is effective at preventing infraction escaping from an infected individual into the air but that a higher grade mask is needed to protect an individual from infected air.
    Time for governments to think a lot more widely than they have to date.

  4. “”Flue cases in April 2020 were only 1.2% of normal!!!“”

    What, flu cases are reduced due to the lockdown..?!??
    Wow, who could have predicted that on this very blog and got poo pooed by zoot for doing so ?

    Here’s another prediction, over 100 other health maladies will have lessor diagnoses.
    Some a very good thing, some very bad.

  5. There you go again Mr J.
    John was writing about flue deaths.

    It’s flue season in Victoria now: gas heaters and wood fired heaters going flat out. Frosty mornings, snow on the hills.

    Flue deaths usually occur when:
    Someone falls into a hot flue and asphyxia or severe burns ensue
    Someone is cleaning out a flue and falls off the roof
    Someone is installing a flue and falls
    Or a heavy flue falls on a vulnerable person

    /pedantry

    Glad to be able to help out.
    🙂

  6. Haven’t yet read all of this Brian, but any professional with the name Gigi is sure to have people oaying attention.

    Then give her a radio spot,…..

  7. Mr A, I judged JDs misspelling as low hanging fruit.
    I can fundamentally agree with most of the rest.

  8. So what are we going to do or not going to do to reduce potentially avoidable deaths and reductions in quality and/or length of life? I have no easy answer whether we are talking covid-19 deaths or non life threatening quality of life issues.
    Potentially avoidable deaths are deaths among people younger than 75 that are potentially avoidable within the present health care system. They include deaths from conditions that are potentially preventable through individualised care and/or treatable through existing primary or hospital care.
    In 2017, there were almost 27,000 potentially avoidable deaths: half (50%) of all deaths for people aged less than 75. Of these deaths, 64% were male and 36% were female.
    Potentially avoidable death rates fell by 46% between 1997 and 2017 (from 193 to 104 deaths per 100,000 population). Rates fell by 47% among males (from 253 to 134 deaths per 100,000 males) and by 46% among females (from 136 to 74 per 100,000 females). For more on death rates see: https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/summary

  9. Already existing measures are trying to reduce deaths attributable to

    Drink driving
    Smoking diseases
    Obesity
    Domestic murder
    Suicide
    Skin cancer
    Lack of seatbelt wearing by drivers
    Overtired truck drivers
    Unsafe workplaces
    Excessive work hours
    Industrial air pollution
    Unsafe swimming at beaches

    Probably missed a few….

    Quite a list. Where are your favourite foci, John?

    ☆☆☆☆☆

    Jumpy:
    Swing low, sweet low fruit picker
    Pickin’ on dem sweet low fruits!
    Swing low, you low down picker
    Pickin’ on dem sweet low fruits.

  10. John, in addition to South Korea and Japan have done well without locking down. I think Hong Kong also.

    I agree with you about face masks.

    On death statistics, I think they are fraught in many countries, because people dying without going to hospital may not be attributed to the virus.

    In terms of ‘doing well’, I tend to look at the ‘cases per million’ column at the Worldometer site.

    The countries that have done really well are Vietnam 3, Taiwan 19, Thailand 45, China 58.

    Those are last night’s figures, and I was looking at Asian countries and mainly OECD countries.

    Next best were Japan 136, Hong Kong 148, South Korea 232, Malaysia 258, Australia 285, Greece 293 and NZ 301.

    Countries over 1,000 include Finland, Austria and Norway.

    Countries 2 to 3,000 include Denmark, France, Germany, Canada, and The Netherlands.

    The Brits, Italy, and Switzerland were all over 3,000.

    Sweden was 4,637.

    Belgium was 5141, Ireland was 5,150.

    The US tonight was 6,246 charging ahead of Spain on 6,189.

    Ahead of them both was Singapore on 6,735.

    I think all the above have daily new cases in a downward trend, even the USA.

    I don’t trust the stats in places like Brazil, India and Indonesia.

    World-wide the virus is still advancing, according to the Johns Hopkins site.

  11. New Zealand is not the first to beat the virus according to the ABC.

    At least eight have got there ahead of NZ, including Montenegro, Eritrea, Timor-Leste, Fiji, Saint Kitts and Nevis, Holy See, Seychelles and Papua New Guinea.

    They are all small and most of them succeeded by keeping it out.

  12. Ambi, Gigi Foster grew up in the USA and has been doing The Economists on ABC RN with Peter Martin while Richard Aedy was off doing a special on climate change (Hot Mess).

    BilB, agree a ‘value of human life’ post would be interesting. Can’t see me fitting it in.

    Richard Dennis last year put it at $195,000 per person per year in Australia.

    He didn’t elaborate, except to say that there is one, and it’s used by the Commonwealth government quite commonly. I gather he was talking about the threshold for putting drugs on the Pharmaceutical Benefits Scheme, but he says it’s implied when we build roads, determine speed limits and stuff.

  13. I’m so ancient, I can remember (?) a fillum called “Gigi”.

    “I’ll have another warm cocoa, thanks Nurse.”

    {Starts reminiscing about going spaghetti-picking in the Kiewa Valley, hosted by a very nice Italian family from around Calabria way, ….. Of course n those days it was done by hand, none of this tractor business; oh no, their draught horse went on to win the Caulfield Guineas if I’m not mistaken…. It was all drays in those days, you youngsters wouldn’t have a clue; tiger snakes in the outside dunny….}

  14. Ambi, the fillum is Gigi 1958 a Lerner and Lowe musical, starring Leslie Caron, who could dance a bit.

    I remember it too but didn’t see it. No doubt Gigi Foster’s mum was a fan. A quick check reveals she got her BA from Yale in 1996, so still youngish.

    I’d never heard of Kiewa Valley, but if it’s the one near Mt Bogong, looks wild country.

    I went picking tobacco once up the Burdekin River, inland from Ayr. I worked for a German, but the place was full of Italians.

  15. Yes, the Kiewa Valley is near Mount Bogong, and noted for tobacco growing, orchards etc. The spaghetti-picking disappeared after the harvesting was mechanised.

    Notable in the area are the small Kiewa hydroelectric scheme, Falls Creek for skiing, and bushwalking on the High Plains, still dotted with cattlemens’ huts. The ski fields are relatively contained, and the snowfall isn’t very reliable.

    Skiing was of course imported from Europe.
    (c.f. surfboard riding and Hawai’i).

    Regularly on winter nights in central Gippsland we would be visited by large, juicy Bogong Moths, beating at the lighted windows. Apparently the locals used to congregate thereabouts to feast on the moths, every winter. Never tried one myself. Wimp.
    Gigi the fillum was a sensation but I being a little nipper was not yet permitted to view adult fillums. But that’s another (and even more boring) story.

  16. This popped out of the works:

    My earlier comment showed them up there with the best in terms of cases per million population – Vietnam 3, Taiwan 19, Thailand 45, China 58.

    The article stresses early action, clear government communication and a high compliance rate of 90% plus.

    I recall here Qld having a compliance rate on social distancing of 93%, which is one reason we did well.

    They also had 1,000 contract tracing teams.

    At the best of times, they give others a fair bit of personal space, and don’t shake hands of hug much.

    Therevada Buddhism is a common ‘religion’ if that is the right word for Buddhism. However, there is a common attitude of helping others, and thereby making merit for, whole society as well as themselves.

    Only 51% of the population is urban, compared with Japan 92% and Australia 86% (from Worldometer.

    The article mentions that Thais saw other people as well as themselves as potentially infected unless proven otherwise. This is the rational assessment of risk that underlies the wearing of masks.

    Anyway, more power to them.

  17. Interesting one on Thailand. Professional health system and public support important. I also think it is important to use things in parallel. What I read says that even cloth face covering is good at reducing the amount of virus escaping from a transmitter. (Lower grade masks not not so good at protecting. )
    We should have been using things in parallel and seen masks as a way of reducing the need for spacing, particularly given spacing is a job killer and its effectiveness can be affected by air flow protection, the extent to which air is recirculated frequency of had cleaning etc.

  18. Coronavirus surges in six American states – and it’s getting worse:

      New coronavirus infections have hit record highs in six US states, marking a rising tide of cases for a second consecutive week as most states moved forward with reopening their economies.

      Arizona, Florida, Oklahoma, Oregon and Texas all reported record increases in new cases on Tuesday after recording all-time highs last week.

      Nevada also reported its highest single-day tally of new cases on Tuesday, up from a previous high on May 23.

      The numbers of those being treated in hospital are also rising or are at record highs.

  19. Brian

    I hear rumours that some of those States “opened up again – quite early”.

    Could there be a correlation? I mean, are people carrying the virus infective?

    🙁

  20. China has a few bad Covid spot fires too right now.
    They must have had BLM riot in that travel destination.

  21. There I go forgetting the “s” on the end of some words.

    Don’t hate on me because I’m on THE spectrum.

  22. Hang on, Mr J.

    Are you pointing at street demonstrations as likely incubators of COVID or saying that the China outbreak dissuades you on that score??

    Jeepers Jumpy.
    Maybe there are lots of ways of catching the bl**dy WuFlu?

  23. I believe the Chinese are saying that the strain of virus they have in Beijing came from Europe, according to the DNA.

    Seems the virus modifies as it goes, so you can tell where it came from. I’d be inclined to believe the Chinese, but the issue is so politicised no-one trusts anyone else.

    • I hear rumours that some of those States “opened up again – quite early”.

      Could there be a correlation? I mean, are people carrying the virus infective?

    Ambi, I’m a simple person and sometimes a bit slow, so I’m not sure what you mean, but I think the answer is yes, they did, and yes, they are.

  24. I was attempting to lighten the mood by being facetious, Brian.

    Amongst all the conflicting reports and not-strictly-comparable figures from different Nations (and States?) one thing seems clear: if you open up and some folk ignore distancing and hand washing recommendations, then some folk and the people they encounter, will bl**dy well catch the bl**dy WuFlu.

    I believe the advice of our Commonwealth and State Chief Medical Officers.

    I don’t trust the “medical advice” issuing from the Twits of Pres Trump, though his uncle/cousin is/was very intelligent and also medically knowledgeable.

    (Some sarcastic person said, “a PhD is not hereditary”. I agree.)

  25. Yes, Brian.

    The virus modifies as it goes along.
    For that reason, if it started in China earlier than (say) November 2019, there may have been several modified strains circulating in the PRC before (perhaps) the most infective or dangerous strain, now helpfully labelled COVID-19 made its dastardly effects known in Hubei Province.

    (There are at least 200 epidemiological PhDs just in that topic. All good.)

Leave a Reply

Your email address will not be published. Required fields are marked *