Let’s talk about death

While most kiwis spent Christmas eating, relaxing, and seeking out water and sun, I spent mine thinking about Covid. Not in a worried, frantic, kind of way – but rather in a way that considered whether our view of the pandemic has changed as our understanding of it has improved. Almost two years on from when Covid first appeared we now have an avalanche of data from all over the world from which we can draw conclusions, test theories and challenge or confirm beliefs and I was curious to know whether that information has been guiding our response here in New Zealand.

If your eyes glazed over at my use of the word ‘data’, bear with me. Data analysis is simply about using available information to test what we believe to be true and it’s something that we all do every day. When you drive faster to get to a destination sooner you’re calling on previous experience (information) from which you’ve learnt that there is a relationship between speed and time. When you use sunscreen to reduce the risk of sunburn you almost certainly do it based on previous experiences of burning, the time of day at which that is most likely to happen, and the amount of time you can safely spend in the sun before it starts to happen. It’s all just data and these examples are easy to understand because they’re based on things we’ve experienced ourselves.

When we’re looking at other peoples data it can seem a bit more confusing – but it shouldn’t because the principle is the same.

I use data a lot to test my own assumptions about the world. It’s an approach I’ve applied to many topics in the past, most notably property – and in the years since I started writing about the New Zealand property market I’ve tried to use the available data to help me to understand the behaviour of that market. I’ve found that letting the data ‘tell its own story’ without trying to impose my own worldview on it often leads to some startling conclusions and its fair to say that, as a direct result of this approach, some of my views today are quite different to those I held just a few short years ago. For instance, an honest review of the available data and information has helped me to understand that there is no housing shortage, that houses are more affordable, now, than they used to be, that higher house prices are a good thing, and that our home ownership rates aren’t dropping. 

As you can imagine, these data-led positions have put me offside with many people because they’re at odds with the popular narrative – but the data is the data and I simply call it as I see it. Nevertheless, it’s with some trepidation that I decided to apply the same philosophy to researching Covid numbers over the summer break – not because I mind having my own opinions challenged (I’m used to that) – but because experience has taught me that honest and objective research invariably kicks over someone’s sacred cow.

Obviously I’m not a health professional – but for this exercise I don’t need to be. As you’ll see as you read on, the numbers speak for themselves and can be understood by any layman who is prepared to be open to what the data reveals.

With that introduction aside, let’s commence with the premise from which I started writing this article: my belief that the primary focus of our response to Covid should be based on the extent to which it has the potential to kill people and that all other measures of it’s possible impact are either much less important or completely irrelevant. In other words – if the global mortality (death) rate from Covid is ‘significant’ (I’ll define that term later), we should be doing everything that we can to protect people from it and marshalling whatever resources are required to keep it under control. If, conversely, Covid isn’t killing people (or is only doing so in small numbers) then most of the things about which we’ve managed to whip ourselves up into an hysteria are largely irrelevant.

Either way, death, or the lack of it, should be the primary basis for our decisions going forward.

If you think that premise is fair, read on. If not, don’t waste your time.

If you’re still with me, let’s start by learning a bit more about death. Death is an uncomfortable topic for most of us – but it’s also a fact of life (or the end, thereof). On average, around 33,500 kiwis (equivalent to almost the entire city of Gisborne) die every year – a morbid reality which is masked by the countervailing number of live births (an average of around 58,700 each year), high levels of immigration (at least, up until Covid 19 struck), and social attitudes which dictate that death is not something we like to talk about too much.

But, uncomfortable or not, all of us will eventually pass on from this mortal coil. Young and old, male and female, rich and poor alike – we’ll all eventually stand before our Creator and be required to give an account of how we lived the life we were given. But it’s not so much the reality of our individual mortality, but rather the causes of it, that I want to bring to your attention today. While the list of things which could bring our time on earth to a close is theoretically endless – around 57% of all deaths in New Zealand are actually the result of just 12 causes – and while the precise number of kiwis who fall to these conditions changes from year to year, their overall ranking and approximate numbers have stayed remarkably consistent over a long period of time.

In 2021 the number of deaths attributable to these causes was as follows:

1	Coronary Heart Disease		5315
2	Stroke		2445
3	Alzheimer’s and Dementia		2262
4	Lung Disease		1718
5	Lung Cancers		1687
6	Colon Cancers		1370
7	Influenza and Pneumonia		905
8	Diabetes Mellitus		879
9	Prostate Cancer		694
10	Breast Cancer		681
11	Suicide		566
12	Skin Cancers		549
			19071

As you look down the list you’ll see that deaths from some of these causes are more ‘preventable’ than others – but there’s no doubt that the overall number of deaths from all of them could be reduced through the right mix of education, State intervention, healthier living, medication and investment in better medical services. The reasons that we choose not to do this are complex and relate to cost, ideology and (historically) a political determination to put the freedom of the individual above state intervention in matters of health. The last of these is always a balancing act and no Government will ever get it exactly right because there will always be lobby groups putting pressure on Governments to ‘do more’ to reduce the impact of their particular condition. (drives to increase investment in new Breast Cancer medication and Suicide prevention education come to mind as examples from recent years).

Overall, however, it’s clear that we accept that a certain number of people will die in any given year and that we have come to terms with this as part of an unspoken and unwritten social contract we live under as kiwis.

This isn’t to suggest that, at an individual level, lives aren’t impacted by the loss of a father, mother, son or daughter from one of these causes – but that, at a community level, we’ve found an equilibrium which balances mortality (the formal word for the death rate) against individual freedoms.

The reality of our understanding and acceptance of these numbers is best exemplified in our approach to the health system in that we actually use these numbers to guide our spending and support for these various causes of death using the average mortality rates as a benchmark of how they might be expected to impact on the system. Numbers of hospital and ICU beds, special units, hospice capacity, numbers of Medical Specialists and health professionals, health education spending and the availability of specialist medications are all examples of things which are partly determined by the predictability of these mortality rates. This may sound morbid, but without such numbers we would have no idea of how much we should spend in the health system from year to year, or where we should put particular focus.

Which brings me to Covid 19.

As I mentioned in my opening, it’s now almost two years since we first heard of the Coronavirus pandemic and an enormous amount has happened over that time. Like most Governments around the world, the Ardern Government took strong measures in response to the original threat and while they were slow to respond to the initial warning signs, their eventual decision to put the country into lockdown in late March 2020 was the right thing to do. In the absence of hard data, medical researchers and demographers were comparing Covid to the Spanish Influenza (which killed at least fifty million, globally) and suggesting that the mortality (death) rate could be as high as 7%. Had this estimate proven accurate global deaths could have been as high as 490 million and in New Zealand up to 350,000 could have died.

So significant was the threat, at the time, that District Health Boards had ordered refrigerated shipping containers to accommodate an influx of corpses and, for a while, the country was gripped by fear. Indeed, facing such carnage, Ardern’s Government had no choice but to take drastic action and while I don’t think former Prime Ministers English, Key or Clark would have responded any differently, Ardern deserves credit for the steps that she took at the time. Her actions made people feel ‘safe’ and she was rewarded for this at the 2020 election, as were most incumbent Governments which went into elections in that year, regardless of where they sat on the political spectrum (which suggests that concern about Covid overrode other political considerations in 2020).

But 22 months later, uncertainty around mortality is no longer a reasonable basis upon which to set policy. Almost two years on, we now have very good international data on the impact of Covid and its variant strains. We now know how it manifests itself, who is more likely to catch it, and most importantly, how many people will die from it as a subset of those who catch it. So let’s take a look at those numbers and see what they tell us.

Since the beginning of March in 2020 until now, around 5.5 million people, globally, were infected with Covid at the time of their death. It’s important to note that, in some of these cases Covid was not the cause of death and that the deceased died of a pre-existing terminal condition or some other cause but, for the purposes of this illustration, let’s assume that they were all Covid deaths.

5.5 million is a very significant number of people (it’s more than the population of New Zealand) – but needs to be put into context against the 490 million people that early estimates were predicting could die from the pandemic. It also needs to be contrasted against the number of people who have died, globally, from other conditions over the same period of time. Almost 6 million from influenza or pneumonia, almost 6.1 million from Lung disease, 11.5 million from strokes and 18.8 million from Coronary heart disease.

Yes, you read that right – over forty two million people have died from just four causes over the same period of time in which 5.5 million have died of Covid and all in greater numbers than Covid related deaths.

“Yes”, I hear you say, “But those Covid deaths would have been far greater if we had not taken the measures we did to constrain it’s spread”.

That’s a fair argument – but 22 months down the track, the numbers once again come to our aid to help us to bring some logic to bear and we now know much more about the spread and virulence of Covid than we did two years ago.

We know, for example, that globally over 200 million people contracted Covid 19, in one of its forms, in 2021. That number is important because, coupled with the number of people who died from Covid worldwide in 2021 (3.5 million) we can start to make some reliable assumptions about numbers going forward. In particular, we can have some certainty around the overall number of people who are likely to die as a percentage of those who catch Covid. Globally, that number is around 1.73% (or about one in every 58 infected people).

In very simple terms that means that, by controlling the rate of ‘contraction’ (the number of people who catch Covid) we can influence the number of deaths that occur as a result of the pandemic. If more people catch it more people will die – if fewer catch it, fewer will die. Essentially, that’s the basis upon which most of the more aggressive responses to Covid have been premised. The belief is that if we can reduce the number of people who catch Covid by doing things which limit contact – like lockdowns or social distancing – we can reduce the mortality rate (the number of people who will die from Covid as a percentage of those who catch it).

Simple right? Well yes – except that the average rate of Covid deaths in most western democracies is lower than the global average of 1.73 deaths per one hundred cases. In most cases, far lower. This can be seen clearly in the last column of the chart below:

	Total Population	% of Population fully vaccinated	Total contraction in 2021	Total deaths in 2021	Contraction as a % of population	Deaths as a % of population	Deaths as a % of contraction
Germany	84,000,000.00	71.1%	5,380,457	77,873	6.41%	0.09%	1.45%
United States	331,000,000.00	62.0%	34,618,122	475,716	10.46%	0.14%	1.37%
Canada	38,000,000.00	77.4%	1,559,613	14,674	4.10%	0.04%	0.94%
Spain	47,000,000.00	80.3%	4,312,203	38,450	9.17%	0.08%	0.89%
South Korea	50,000,000.00	82.2%	569,069	4,646	1.14%	0.01%	0.82%
United Kingdom	68,000,000.00	70.6%	10,212,249	74,186	15.02%	0.11%	0.73%
Sweden	11,000,000.00	71.3%	857,408	5,367	7.79%	0.05%	0.63%
Ireland	5,000,000.00	76.8%	674,577	3,664	13.49%	0.07%	0.54%
Israel	8,500,000.00	64.3%	947,550	4,887	11.15%	0.06%	0.52%
Norway	5,500,000.00	72.9%	341,411	869	6.21%	0.02%	0.25%
World	7,900,000,000.00	49.8%	202,426,671	3,498,073	2.56%	0.04%	1.73%
New Zealand	4,822,233.00	75.9%	12,203	26	0.25%	0.001%	0.21%

This information, which I have drawn together from a variety of official sources, also tells us some other interesting things. For example, it tells us that countries like the US and Sweden, which have both adopted a less rigid approach to Covid, also have death rates that are lower than the international average, as a percentage of those who have contracted Covid. This goes some way toward debunking the claim that these rates are only low because nations went into lockdown and prevented a wider spread. This may have been a factor, but clearly wasn’t the only reason for the lower mortality rate.

Of course, we should also note that the rate of contraction of the virus and the number of people who die from it, isn’t uniform in every country. Norway, for example, has a much lower rate of death as a percentage of contraction, than Sweden, even though both countries have similar contraction rates. In other words, the percentage of Swedes who have caught Covid is not significantly higher than the number of Norwegians who have have caught it – but considerably more Swedes have died from it (as a percentage of their respective populations).

So why does this all matter? It matters because, based on what we now know, we can now make some assumptions on how Covid might impact on our community if we returned to normality by abandoning some, or all, of the transmission reduction measures which have been implemented over the past couple of years. I’m not suggesting that we know precisely what the contraction rate might rise to but it’s reasonable to assume that it’s unlikely to exceed the numbers experienced in other nations to which we traditionally compare ourselves. So if we used these as a guide and assumed that contraction could increase to 8.5% of our population and deaths were .81% of this (the averages of the national stats above) the NZ death toll could be as high as 3,320 people in a year. Contrasted against the other major causes of death in New Zealand this would make Covid our 2nd largest cause of death in any year.

But would this mortality rate be considered ‘acceptable’ to kiwis?

This is an important question because our answer to it will determine how we should respond to Covid, going forward. If Covid doesn’t kill in numbers that are ‘significant’ (ie, in numbers greater than we would expect from deaths from other causes), then why are we applying a different standard to the way in which we respond to it? Why have we allowed ourselves to be gripped by fear and based our responses on irrelevant and non-lethal side issues in a way that we don’t do with other causes of death?

In truth, of course, there’s no right or wrong answer to the question. For some reading this, a death toll of over 3,000 would be far beyond their ‘threshold of acceptability’ – while others reading it will see that number of deaths as being within the range of fatalities from other causes and will believe that we should approach this in the same way. But for those people, how many deaths, per year, would be too many? 5,000? 7,500? 10,000? My point in posing that question isn’t to make you feel uncomfortable, but rather to highlight the nature of the political dimensions to this thing and the kinds of questions that the Government is grappling with.

However, we’re not finished with analysing the numbers yet. There are two additional measures which are not easy to locate consistently in any of the international data – but which could make an enormous difference to mortality, going forward:

• The first is an international measure of how many of those who died from Covid had been vaccinated versus those who had been unvaccinated. Surprisingly, this extremely important statistic is not uniformly captured in any of the international data that I was able to find – but it is available, individually, for some countries including Switzerland, Chile, the US, and Canada. In that data it clearly shows that those who are unvaccinated are far more likely to die from Covid at a rate 5 to 10 times higher than those who have received the vaccine. (for the record, this discovery was at odds with what I previously believed to be true – but the facts are the facts)
• The other missing statistic is a count of the number of people who have died, worldwide, from the latest Covid variant, Omicron. This strain is currently getting significant media attention, with NZ media breathlessly reporting on it’s imminent arrival as if Armageddon is at hand – so it would be useful to know how many people it has already killed, globally. As it turns out, the reason that there isn’t much data is because there have been almost no deaths – two or three, worldwide, as at the time of writing.

What this tells us is that the trend, going forward, (higher rates of vaccination and less lethal strains of Covid) may further reduce the global death toll to a point where it becomes difficult to justify ongoing controls over the lives of the average citizen, and in fact we may have already reached that point.

Based on what we now know we can already draw a number of important (and generally indisputable) conclusions about Covid:

1. While it was prudent to take extreme measures in the early stages of the pandemic (early 2020) we now know that the early estimates of global and national mortality (upon which most of the assumptions under which we’re still operating were based) were wrong. Completely wrong.
2. We now know that Covid 19 (in all of its variant forms) is not particularly lethal. Yes, 5.5 million is a large number of people, but compared to average global deaths Covid wasn’t even in the top four in 2021 and, worldwide, just 0.04% (1/25th of 1%) of the worlds people have died from the virus. Tellingly, the global number of Covid deaths in 2021 were lower than deaths from ‘normal’ flu.
3. As a percentage of the worlds population just 2.56% have actually caught Covid. To be fair, this is probably at least partly due to the extent to which some nations enacted measures to limit the opportunity for transmission (eg lockdowns and social distancing measures) however, there is no clear link between contraction rates and mortality on a country by country basis. Some countries, like the UK, have high contraction rates (over 15% of Brits had Covid in 2021) but relatively low deaths as a percentage of contraction – while other countries, like South Korea, have a much much lower contraction rate, but a higher percentage of deaths per case, than the Brits. Sadly, these numbers are obscured by a media obsession with headline numbers rather than deaths as a percentage of those who have caught Covid (which is a far more important measure).
4. The lack of international comparison data on the number of vaccinated versus unvaccinated people who died of covid in any given country in 2021 is frustrating – but there’s enough data out there to clearly show that being vaccinated makes a significant difference to mortality. Accordingly, deaths, going forward, are likely to be overwhelming amongst the unvaccinated.
5. Conversely, those who are vaccinated have little to fear from those who are not. While they might still catch Covid, they are almost certainly not going to die from it.

This last point raises some questions which are political rather than medical:

• Given that we’re getting to a point where (a) the numbers of kiwis who remain unvaccinated are that way by choice rather than neglect and (b) those who are vaccinated have almost no chance of dying from the virus, should we review the balance between the rights of the individual and the responsibility of the State to protect citizens? Vaccination obviously works for those who choose to ‘take the jab’ and they have nothing to fear from those who do not. In this respect, the situation is no different to getting the annual flu injection and should be viewed in that light. (Children are the ‘innocents’ in this debate because their choice over whether to be vaccinated or not is often in the hands of their parents – but mortality stats once again come to our aid and suggest that children are at much lower risk from Covid than adults)
• Given what we now know should we also consider abandoning most of the transmission reduction measures which have been taken over the past 22 months. Social distancing, mask wearing, the traffic light system, community lockdowns and even vaccine passes – these are all hangovers of a time when we believed that anyone was at risk. We now know that this is not the case and that only the unvaccinated are putting their own lives at risk.

The upshot of all of this is that there’s something to upset everyone in what I’ve written. Antivaxxers will note that I haven’t talked about the ‘dangers’ of the vaccine or the downstream health affects that it will supposedly have on those who have chosen to take it. Some may even claim that figures showing that deaths are higher among the unvaccinated have been planted as part of some sort of global conspiracy and will lament that I’ve ‘crossed over to the dark side’. Conversely, those who have been conditioned to be afraid will be horrified at my suggestion that perhaps we should return to normal life. They will either seek to find fault with my numbers or will resort to insisting that deaths should not be the metric by which our response is measured. Precisely why we should treat Covid any differently to other ailments will be ignored in their response because there’s no logical answer to that question.

So, if you’re from the Ministry of Health, Government or one of the major opposition parties and are still reading this, don’t take my word for it. Peer review my figures and, in particular, expand on my research around fatalities among the vaccinated and non-vaccinated in other countries. If my figures stack up, there are some obvious policy settings and actions which would make sense in light of this (new?) information:

1. Immediately undertake a multi-media campaign highlighting the difference in the international mortality rates between the vaccinated and the unvaccinated. This is, far and away, the most important metric in this whole debate – yet there is virtually no information about it being made available to the public.
2. Move to remove all mandatory transmission reduction measures within 3(?) months. This would mean the removal of mandatory measures and rules such as social distancing, limitations on public gatherings, sanitising, mask wearing, the use of vaccination passes and the repeal of legislation and orders which have created mandatory conditions for employment.
3. After this, require all businesses to suspend all measures which discriminate between customers and revert to the Bill of Rights as a basis for day to day activity.
4. Respect the right of individuals to voluntarily comply with the former rules if they choose to. This would include the wearing of masks, social distancing, Covid testing, and avoiding of public gatherings.
5. Direct the Ministry of Health to continue to coordinate a high profile vaccination campaign (in conjunction with the education campaign referred to above) and to continue to roll out vaccines and boosters, update vaccination passes (perhaps renamed ‘vaccination certificates’) and update information for anyone who wants to access any or all of these.
6. Immediately end any restrictions or preconditions on kiwis returning home.
7. Immediately suspend MIQ requirements for all others coming into the country but make entry into New Zealand, for these, contingent on proof of full vaccination (including boosters) within the past three months and rapid antigen testing at the border. No exceptions and no exemptions.
8. Progressively (but as quickly as possible) open our borders to the world to any nation which adopts the same criteria and the same approach to the pandemic.

This combination of measures would strike a balance between respecting the rights of those who choose to be afraid while allowing the rest of us to return to a high degree of normality. It would also allow those who choose not to be vaccinated to make an informed choice without fear of reprisals or exclusion from normal society.

Whether we’re mature enough, as a people, to accept the deaths which would inevitably follow these policies (an average of up to ten per day) is an open question. Despite the fact that these would be overwhelming amongst informed antivaxxers and that similar numbers are dying, everyday, from coronary heart disease and stroke, these latter deaths aren’t plastered across our media everyday in the way that Covid deaths would be and I’m not entirely sure that we would be able to hold our nerve.

In the end I suspect that we’ll simply stick with the current measures for a while yet. Labour seem to be committed to their approach for reasons which go beyond medical concerns, and National appear to have formalised their muddle-headed ‘Labour lite’ approach to policy which all but guarantees that there is no competition for fresh ideas and thinking. Nevertheless, I hope that my article goes some way toward adding valuable new information to the debate.

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