How can we allay fear in our community?

I graduated from the University of Queensland with a degree in medicine (MB BS) in 1977 and then gained my fellowship of the Royal Australasian College of Physicians (FRACP) in 1985. After that, I worked in clinical practice in Queensland as a Consultant Thoracic Physician until 2018, when I reduced my practice to concentrate on Medicolegal work. I have had extensive experience in managing various kinds of acute viral respiratory infections. Thanks to my teachers in Brisbane and Newcastle, I have been well-trained in statistics and evidence-based medicine.

I have become very concerned about the level of fear which has developed in our Australian society today. Why has this happened? It is partly because the public has been subjected to a litany of facts and figures regarding Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19). These "statistics" are generated by our newspapers, television stations and internet providers every day. Ordinary people who have had no training in statistics, national demographics, death rates, public health and management of common respiratory viral infections have been barraged by daily tallies of "cases", which, in the absence of any serious symptoms or need for hospitalization, should better be described only as "positive tests". In early 2020, Governments around the world stated that their intent was to "flatten the curve" and prevent health services from being overrun. This proposal evolved into an unattainable ambition to completely eradicate Corona Virus in some isolated countries like Australia and New Zealand in late 2020.

It is not surprising that people have become terrified of dying of COVID-19 after being subject to the media's unremitting, daily presentation of the data. If you would like to read a brilliant, simple, and positive analysis of important outcomes associated with Corona Virus infections (COVID-19) in Australia, I can strongly recommend an article by Luke Massey, "Just the facts: Coronavirus in Australia by the numbers" (The Spectator, 9 September 2021). Luke Massey has interpreted data published by the Australian Government Department of Health on their "Coronavirus (COVID-19) case numbers and statistics" website. Massey makes the point that the recent average life expectancy of people living in Australia is 82.8 years. Up to October 2020, the average age of death from COVID in Australia was 85 years and the median age of death from COVID was 86 years. Up to 7 September 2021, the overall case-fatality rate (CFR) in Australia was 1.6%, which means that the likelihood of surviving COVID in Australia was 98.4%. In people under the age of 50 years, there were 16 COVID deaths out of 47,897 cases, giving a CFR of 0.0334%, which means that the likelihood of surviving COVID in this age group was 99.7%! The ICU admission rate for all ages during this time was 0.8%, meaning that the likelihood of not being admitted to ICU with COVID was 99.2%. The public needs to be made more aware of these relatively positive outcomes.

Context matters. For example, the daily hospital and ICU usage has not been reported in the context of the total number of beds available for use. Luke Massey notes that the current number of COVID cases in hospitals in Australia accounts for only 1.33% of hospital bed capacity and only 9.25% of ICU baseline capacity. Although it can generally be assumed that people admitted to ICU are seriously ill, it is not clear how many patients in ICU were being treated with High-flow Supplemental Oxygen and Continuous Positive Airways Pressure (CPAP), as opposed to people who were heavily sedated for mechanical ventilation via an endotracheal tube. Similarly, death rates "from COVID" could include anyone who died within thirty days of contracting a Corona Virus infection. However, it is difficult to accurately differentiate between those who died "from COVID", as opposed to those who died "with COVID". In other words, someone may have contracted this common cold virus and then died of natural causes such as myocardial infarction or trauma caused by a road accident, as opposed to someone who died of overwhelming systemic disease and pneumonia due to COVID.

Just as significantly, deaths have been presented as daily tallies, rather than in the context of excess deaths compared to the last five years. In Ramesh Thakur's well-researched article, "Lockdowns: an alibi for government to shun scrutiny of neglect of public health preparedness" (The Spectator, 3September 2021), he notes that there were 3,475 excess deaths from all causes in Australia between January and May 2021, compared to the five-year average for 2015 to 2019. By comparison, just 97 people died from COVID in Australia up to the end of August 2021. Therefore, most of these excess deaths cannot be attributed directly to COVID. The highest increases in death rates occurred in the categories of Dementia (17.1% increase), Diabetes (9.2% increase) and Cancer (6% increase). It could be validly argued that these increased death rates arose from the disruption of routine health services which have occurred because of government restrictions such as lockdowns, border closures and mandatory isolation of health care workers who have had any contact with people with Corona Virus infections.

There has not been enough public discussion, either by governments, health advisors, epidemiologists, or media, of the differences in important morbidity and mortality outcomes due to Corona Virus infections compared with previous epidemics of influenza. Luke Massey reports that there were over 300,000 cases of influenza in Australia in 2019 with about 4,000 hospitalizations and over 800 deaths. The CFR in Queensland during this epidemic which affected all age groups was 0.38%. This figure is much higher than the CFR for Australians under the age of fifty years with COVID in 2021 which was only 0.0034%. As with so many previous epidemics of acute respiratory viral infection, this bout of influenza in 2019 was sensibly managed by caring for sick patients at home or in hospital if required and advising common-sense public health measures such as avoidance of crowded situations. The epidemic was successfully managed without lockdowns, border closures, travel restrictions or mask mandates in Australia in 2019.

The media, in all its forms, has a responsibility to be objective in its reportage by presenting both positive and negative news about Corona Virus infections. Instead of feeding into people's fear of death by focusing exclusively on daily "case numbers", the media ought to provide context to those numbers by reporting how many people are seriously ill and require hospitalization and ICU care. Similarly, tell us how many hospital beds are available for use at any one time. Don't just report daily death numbers, but instead, report deaths in the context of Excess Deaths compared to the last five years. Report national death rates standardized for age and population size and compare these rates to those of other countries. Tell us how the important morbidity and mortality outcomes from Corona Virus infection compare with those of previous epidemics of influenza.

Our state and federal governments have become obsessed with a common cold, RNA virus, which can lead to pneumonia and premature death in frail, elderly people. Governments have highlighted the risk of dying from COVID-19 to the point that younger, healthy Australians have become needlessly afraid that they also will die from this virus, even though their actual risk of dying from Corona virus is very small. Asserting the now tired mantra, "keeping all of us safe", all governments have restricted our freedom to travel, locked down various major cities, mandated the use of masks in various situations, and imposed quarantine for travellers and anyone who has encountered someone who has recently had a positive test for Corona virus. Paul Alexander's scholarly article, "COVID-19 Mandates Will Not Work for the Delta Variant" (American Institute for Economic Research (AIER) website, 28 August 2021) cites several scientific studies to argue that: 1. lockdowns cause more harm than good (88 references); 2. school closures have no sound justification and are likely to adversely affect our younger generation (56 references); 3. masks are ineffective (41 references, including the brilliant work of Henning Bungaard and colleagues, "Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers", in Annals of Internal Medicine, 18 November 2020); and 4. masks may cause harm (32 references).

Given the wealth of research which runs counter to current Covid-19 health protocols in Australia, governments need to be held accountable by revealing the scientific evidence base for their restrictive practices such as border closures, mask mandates, physical distancing, home quarantine and enforced, self-funded hotel quarantine. In particular, the Queensland Government should reveal the evidence supporting the benefit to individual patients and to the wider community of their policy of enforced hospitalization for any person who has a positive test for Corona Virus in Queensland (Queensland is the only state which enforces this protocol). If the weight of scientific evidence does not validate any form of restrictive practice, then that restrictive practice should be abandoned.

Good health is not just the absence of sickness or injury, but also embraces mental, emotional, and social well-being. Our community has become increasingly afraid of an illness which predominantly causes premature death in frail, elderly people. Governments and media should do everything in their power to allay people's needless fears by presenting the facts – both positive as well as negative –on important outcomes as simply as possible. An important precept in medicine is the invocation to "do no harm". Governments should not be advocating restrictive practices which have no convincing scientific rationale, and which are probably doing more harm than good. In removing unjustifiable restrictive practices, governments will allow us to accept some small level of risk and get on with our lives. Let us help our neighbours, and "Be Not Afraid!".