There is never zero risk, so why do we treat COVID-19 so differently?

Prime Minister Scott Morrison arrives to receive his second Pfizer dose. Credit: Edwina Pickles

I was trying to write a column about relative risk on Tuesday afternoon, which I’ve been thinking a lot about, because you can’t help but think about relative risk if you’re constantly thinking about the pandemic.

In my line of work it feels like all we’ve been worried about for 14 months now.

And if, as I do, you have close family overseas with whom you are desperate to reunite, you think about it even more, while becoming extremely attuned to each development in the ever-shifting path back to normal.

Greg Hunt, the federal Health Minister, said perhaps the most dispiriting thing I have heard from a public official during the pandemic, but we will come back to that shortly.

You can find a very interesting COVID-19 risk calculator online put together by Oxford University thst allows you to put in a bunch of factors like age, weight, gender, associated health conditions and (because it is tailored to residents of the UK) your British postcode before it spits out a number demonstrating your chances of being hospitalised or dying of COVID-19.

Assuming I lived in pandemic-ravaged Britain, which has the tenth most COVID-19 deaths per capita in the world and is just emerging from one of its most prolonged and draconian lockdowns, my personal risk of hospitalisation would be 1 in 3704, while my risk of death would be 1 in 83,333.

When my wife and I went through routine screening testing ahead of the birth of our son, we got back risk numbers for serious genetic disorders that were orders of magnitude “riskier” than those results. Yet we proceeded with our pregnancy and welcomed a perfectly healthy baby into the world.

It is not how public health works, it is not how life works – there is never zero risk

OK, at 38, with a healthy body mass index and no underlying health conditions I am younger and healthier than many.

As an experiment, I put in a profile of a family member a generation older than me with a more complicated health profile to see how it would tilt my mental calculus. I would be devastated if this person was harmed by COVID-19.

This person in their 70s would see a 1 in 211 chance of hospitalisation and a 1 in 556 chance of death, according to the Oxford model.

Given we perceive the UK as one of the hardest hit nations in the world, they do not feel to me like extraordinarily, unacceptably high odds, but your mileage may vary.

Some more figures. In a “normal” year you would expect about 3 million people to die in the United States of America.

The US has recorded 562,000 COVID deaths, though total deaths in 2020 of all causes were about 3.1 million, according to preliminary estimates.

In 2019, 8.7 people per 1000 died in the United States. In 2020, according to those preliminary estimates, the figure was 9.7 per 1000.

I have a theory that what Australians are really most scared of when they look overseas is being locked down and masked up like so many places we see on TV.

Many Australians have British relatives, and what we get from the United States comes from the media capitals of New York and Washington DC, where lockdowns have been much more prevalent than in other parts of the country.

My family connections are in Florida, where life has been mostly normal since last April. Hospitals have not been overwhelmed, masks have not been mandated and other COVID-19 outcomes are not obviously worse than in the lockdown states.

Do you want to get COVID-19? Of course not, and evidence is still emerging about “long COVID” – symptoms that persist after a nominal “recovery” and it doesn’t sound like very much fun.

Should you get vaccinated? Absolutely: the evidence is strong that the vaccines – yes, AstraZeneca too – are very effective at preventing serious illness and death.

Is COVID-19 a death sentence? Almost certainly not, with the major caveat being that the elderly and those with multiple health conditions are at much, much greater risk (as they are of all causes of mortality), which is why the vaccine for these vulnerable groups should be such an urgent priority.

Professor Peter Collignon from the Australian National University is, I think, the most sensible and considered of the infectious diseases experts that we have heard from almost daily since the pandemic began.

In trying to put the risk of blood clots from the AstraZeneca vaccine in perspective, he said something this week that caught my attention.

“If you’re over the age of 70 and you get COVID you’ve got a 1 in 100 chance of dying and if you’re over 85 you’ve got a 1 in 5 or 1 in 10 chance of dying.”

I wondered what the chances are of dying of anything if you are over 70 and over 85, so I went burrowing into the ABS life tables data.

The chance of all-cause death at age 75 is 1 in 39 for men and 1 in 60 for women.

The chance of all-cause death at age 85 is 1 in 12 for men and 1 in 17 for women.

The figures show why it really is the elderly who should be most concerned about COVID and, for everyone else, the risk equation is far less tilted than the dominant media narratives would have us believe.

Two moments from our federal leaders have hit me like thunderbolts this past week.

The first was when Scott Morrison called a 7.15pm press conference to announce that AstraZeneca would no longer be preferred for under 50s because of extremely rare (1 in 250,000) but potentially serious blood clot risks.

I listened to it live on 6PR in the car and my heart sank, because it was obvious immediately how it would undermine confidence in the vaccination program and delay its rollout.

In the UK they shifted away from AstraZeneca for under 30s because they have ready supplies of alternatives for that very low risk portion of the population, but here, with so many eggs in the AstraZeneca basket, the consequences were obvious.

In any population there is vaccine hesitancy, and the government made it worse by highlighting risks that are close to negligible (you have about as much chance of winning a Division 2 Lotto prize as developing a blood clot from AstraZeneca).

There was much media and political focus on the West Australian woman in her 40s hospitalised in Darwin as a result of clotting linked to the jab, although not much of it was on this part: “The family has asked for privacy to be respected but the patient was making positive progress and recovering well.”

The other thunderbolt moment was Hunt.

“If the whole country were vaccinated, you couldn’t just open the borders,” he said. “We still have to look at a series of different factors: transmission, longevity (of vaccine protection) and the global impact – and those are factors which the world is learning about.”

Then it’s hard to see how we ever open the borders. The whole country will never be vaccinated, and the virus will never be eliminated globally.

It is not how public health works, it is not how life works – there is never zero risk.

None of this is an argument to “let it rip” but it has been starkly obvious how little work has been done to facilitate the return of the movement of people.

It is obvious that Howard Springs in the Northern Territory is the best practice model for quarantine — why haven’t we invested in 20 of them around the country in the name of a national recovery, persisting instead with too small, too risky hotel quarantine arrangements in the city centres?

It has been an increasingly disorienting experience to watch our national reaction to the pandemic and how we treat COVID-19 risk so differently to risk in literally every other area, not just of public health but of human endeavour.

The majority of Australians whose families and livelihoods exist within the bounds of a single state or territory are strongly supportive of the status quo.

For the minority whose families and livelihoods extend geographically further, the dread is real and growing with each passing week.

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