How do we go back to work?

The 1957 flu pandemic was caused by the H2N2 virus and resulted in 1.1 million deaths worldwide.  The pandemic lasted three years before sufficient immunity built up in the population.  The virus still persisted in the population for many years after the pandemic was officially over causing a further 3 million deaths before its was displaced by the N3N2 virus that caused its own pandemic in 1968. 

While the H2N2 virus has not been found in humans for many years, the virus is still found in animals and it could spark another pandemic if it crossed into humans as we have lost our immunity.

It is important to remind ourselves as we enter our fourth week of lockdown in South Africa that it is unlikely that this pandemic will be over soon (if history is anything to go by) and that we will need to contemplate lifting some of the restrictions of the lockdown.  

For the purpose of this analysis, let us break the population up into three groups:

• Those for whom COVID-19 poses a low health risk and who could return to work;
• Those for whom COVID-19 poses a major health risk and who should remain in lockdown and be protected from the virus; and
• Those falling between these two groups and should be free to make their own decision about whether to return to work (those who are more risk averse could stay in voluntary lockdown).

I have used the number of COVID-19 deaths as a proxy for health risk.  

The graph alongside compares the distribution of COVID-19 deaths recorded for South Africa with those recorded for New York City and the UK.

I could only find age data for 25 of the 34 deaths reported in South Africa. 

Even though the data sample is small, the distribution of COVID-19 deaths in South Africa does appear to be following international patterns.

The NMG model forecasts a 'worst-case' scenario for the COVID-19 deaths in South Africa at 180 900.  The South African census reports 446 500 deaths from all causes in 2017.  The graph below shows the ratio of forecast COVID-19 deaths to all-causes deaths in 2017 for the different age bands.

For the population below the age of 45, the COVID-19 deaths are less than 3% of the all-causes deaths.  Could one argue that COVID-19 poses a low health risk for this group (when compared against the other risks that this group faces)?

For the population age 65 and older, COVID-19 clearly poses a major health risk.

The population between 45 and 65 would perhaps fall in the middle group.

It is important to stress that this analysis is somewhat simplistic and should not be relied upon by those making these very difficult calls.  For starters, the health risk posed by COVID-19 will depend on a number of factors with age only being one of them.  Also, we are still waiting to understand the impact of COVID-19 on the poorer communities in South Africa, and lockdown should only be lifted once we have a better understanding of the risks posed for these communities.

We do, however, need to start talking about how we go back to work because the harm caused by stalling the economy will be material, especially for the poorer communities.

16 April 2020