Media Type: News / Op - Ed
Author(s): Andrew Beattie
Responses to the corona virus are widely perceived as trade-offs between health and wealth. Political and business leaders generally assert that, no matter what, the economy must come first, but should population health be sacrificed so that the economy does not suffer? To explore this dilemma, it is instructive to compare the covid impacts and public responses to the pandemic in Florida and Australia, since the two areas harbour about the same number of people, or from the virus’ point of view, the same number of hosts:
POPULATION COVID DEATHS CASES TESTS
FLORIDA 22m 14,142 696,171 5,269,101
AUSTRALIA 25m 882 27,063 7,589,332
FIG 1 Population size, corona virus cases, deaths and tests for Florida and Australia
Cities with over one million 5 0
Cities 100K – one million 11 26
Cities 10K – 100K 78 303
Percent over 65 16 21
Total land area (km2) 7,692,000 170,304
FIG 2 Sizes of towns and cities in Florida and Australia and the percent of adults over 65 for each.
While the populations of Florida and Australia are roughly similar (Fig 1) their total land areas differ dramatically (Fig 2) so it is important to first examine the geographic distribution of population as it could be argued that Australians are widely scattered across their continent and thus less likely to be subject to contagion. However, 89% of Australians live in five large cities and their urban surroundings. The actual numbers are (in km 2) Sydney: 12,368, Brisbane: 15,826, Melbourne: 9992, Adelaide: 3258, and Perth: 6418. Thus the total land area where most Australians live is of 47, 862 km2, which is less than one third of the total area of Florida. Thus, most Australians, despite the tourist advertisements, live in relatively small areas at high densities and in and close proximity. In contrast, the population of Florida is widely dispersed throughout most of the state, and there are no cities of over 1 million (Fig 2). These data together suggest that infection rates and deaths would be expected to be higher in Australia than in Florida, but they are not: the Australian death rate is 6% of the Florida death rate.
The relative success controlling the virus in Australia may be attributed to focusing on two essential elements of corona virus biology: first, that it requires a human host and second, that its only way of replicating is to be transmitted to another host. The appropriate public health response to the first element is to test as many potential hosts as possible to provide data on the location of infected human hosts. This generally also requires tracking and tracing those who have come into contact with active hosts and then, in turn testing those. Having thus established the locations of the virus, the active hosts, the appropriate public health response to the second element is to prohibit transmission to others, i.e. quarantine.
Both Florida and Australia initiated regulations intended to control the virus during March 2020. However, the rate of testing for the virus in Australia greatly exceeded that in Florida (Fig 1). Thus, Australia had a head-start in understanding exactly where the virus was by identifying the number and location of its active hosts. Australia then imposed severe quarantine regulations.
Viral transmission was controlled at two scales: national and community.
National: Australian national borders were quickly closed, preventing the entry of the virus from overseas. Further, each state closed its borders, preventing transmission within the country. There appear to have been no effective or critically policed border closures around Florida.
An associated regulation in Australia determined that those travellers permitted into the country or across state borders were obliged to enter quarantine for 14 days, initially at public expense but later at the individual’s expense. Ironically, in New South Wales and Victoria, it was a single breach of quarantine regulations in each state that resulted in most cases and deaths. This inadvertent ‘experiment’ alone suggests the importance of quarantining travellers to reduce virus transmission.
Except for Sydney, all airports were closed, although a small number of passengers could travel on compassionate grounds, and freight flights continued. Incoming passengers, restricted to a national cap of 4000 per week, were obliged to quarantine for 14 days. As most quarantine hotels were either 4 or 5- star, and expenses were paid by the government, at least for the first three months, few travellers complained! In fact, those interviewed upon their release said they agreed with the procedures.
Community: In any given local area, especially high-density ones, a significant proportion of the potential hosts were tested. Large numbers of testing stations were established to facilitate the procedure for as many people as conveniently as possible. Those testing covid-positive were quarantined for the incubation period of the virus. Where quarantine was not possible, positive individuals had to self-isolate for this same period in their homes, and their adherence to this instruction was policed. These regulations led to isolated protests on the reduction of freedom but they were poorly attended and the majority of Australians, probably around 95%, agreed with government regulations and were even more cautious than the government when it appeared time to relax them. Regulations were supervised by police and, for short periods, members of the military. Some of those breaking regulations received very hefty fines. One party was broken up by police and every participant fined A$ 1000.
Following initial successes at reducing cases and deaths nation-wide, there was an outbreak in the city of Melbourne. As indicated above, this resulted from mal administration of a major quarantine hotel. The response was both rapid and severe as the city was locked down for 6 weeks, with a 9.00pm curfew. The outbreak was slowly contained, and Melbourne is currently moving through a phased release from lockdown.
The economic costs of these strategies for Australia have been grave: it is estimated that the budget deficit will be approximately A$ 250 billion, probably rising still further with time, and unemployment will rise to approximately 8%. The government has provided a safety net for employees in the hardest hit business sectors, such as hospitality, tourism, and airlines, replacing the wages or salaries with government supplements. This has so far succeeded in keeping much of the workforce together and vulnerable businesses afloat. Nobody knows how this will play out in the coming year but there are significant signs of economic recovery.
The economic figures for Florida are harder to discern although it is clear that in some parts of the state unemployment and bankruptcies have been among the highest in the US. Further, although there have been lockdowns and quarantines, these measures have varied in space and time so that some local economies have managed to thrive, at least for a time. Two figures may reflect the gravity of the situation: on 19 May, the State of Florida requested $740 million from FEMA to cover covid costs. The Miami Herald reported that revenues were down by $878 million in just one month.
As of 5th October, there were 1,415 new cases in the previous 24 hours in Florida compared to 25 for Australia. Knowing the infectiousness of the virus, neither jurisdiction can afford to be complacent.
It has become clear that preparing for, and fighting disease, will be an important factor in economic planning. The real world is biological — and economics will have to learn to deal with it.