Report, Soapbox

Utilitarian strategists needed for recovery

The great escape for Australia in the COVID-19 battle may have been achieved. At time of writing there were good signs; but only if the next phase is not squandered by political and media discordance.

There is a danger that we are so mesmerised; obsessed; indeed hypnotised by the spikey COVID virus that we may not see the wider picture of cost versus benefit. Risk management both economically and medically is the key to continued success.

Despite the speed and urgency of government actions in March, there was a concerted effort to consult with medical advisory groups such as the Australian Society of Ophthalmologists (ASO) to calibrate clinical responses for minimal net health damage.

I was genuinely impressed with the responsiveness of the government to take guidance on a ‘trust basis’ without all the red tape. I think this will be one of the legacies of Health Minister Greg Hunt which won’t necessarily be reported; that he had good trusted relations and a deep understanding and familiarity with the medical profession and the broader industry which facilitated honest frank communication in the crisis.

From the earliest stages, I had written and spoken to my contacts in government about avoiding a COVID secondary health impact in which deferred medical care might create health impacts greater than COVID itself. These outcomes include delays in diagnostic investigations; delayed cancer treatments; resource diversions from critical care in cardiac intervention; cataract falls and fractures and the societal cost of drug abuse, depression, suicide and domestic violence due to prolonged social disruption.

After a suspension of elective surgery, we appear to be at a restart. Although these restrictions have now been lifted and we can return to performing eye procedures, we must be mindful that we are not out of the woods just yet, and another wavepeak in cases could lead to another shut down. Having shut down once, we have the experience to do it again. However, the first shutdown will have increased the waiting time for public hospital cataracts and compromised the care of glaucoma patients, diabetics and macular degeneration sufferers compared to optimal management. A second shutdown would certainly create a disproportionately larger decrement to best care.

The first stage of virus control has provided an excellent foundation. However, the first stage is only a foundation – a start for the next phase of national recovery. We must use reason and facts and must not devolve into a battle between zero virus zealots and recovery hawks. The media are no always responsible in this regard and have their own motivations and perverse incentives to entertain and create click traffic. We will need to learn to live with COVID for some time and be discerning analysts of everything we read.

Continued success in managing COVID now requires recognition that the exponential growth curve is the inverse curve of the exponential destruction of businesses and livelihoods. The longer we take to restore the economy, the harder it becomes to avoid permanent societal damage. Superimpose the possibility of a second wave and the calculus gets even more challenging.

It pains me to say that doctors are not the best people to decide on the recovery stage because they are naturally conservative and sometimes too close to the human suffering to be independent observers. Their 15 minutes of fame are over. Their skill is to treat the sick and expertly model the outcome projections. We still need cold hard utilitarian strategists who can overview the entire societal need and make difficult but calculated decisions. This role will fall to politicians and governments who will follow their sometimes-perverse incentives to a conclusion that we hope will optimise the outcome.

There are many more chapters to the COVID-19 story. We may look back on this time and regard it as a creation of over-hyped media. We may look back and be very grateful that urgent action was taken. We may look back at death rates and realise that the patients who died were already close to their end of life. The trouble is that we just don’t know yet and must continue to manage the risks appropriately. The 20/20 Retrospectoscope is a device not yet invented by Zeiss.

ABOUT THE AUTHOR

Name: Dr Peter Sumich
Qualifications: MBBS RANZCO
Workplace: Hunter Street Eye Specialists, Parramatta
Position: Cataract and Refractive
Surgeon; President, Australian Society of Ophthalmologists.
Location: Parramatta
Years in profession: 23