Coronavirus: What is at Stake, and How to Deal with It?

« If you fail to prepare, you are preparing to fail » — In the wake of a likely global pandemic, never this say may have been as relevant as today.

(please note the date of this article, which was written at an early stage of the crisis)

Coronavirus SARS-CoV-2.
Credit NIAID RML/de Wit/Fischer
First, what do we know so far? The spread of the disease is rapid. It’s more a question of when than if the virus will hit where one lives. There are various estimates pointing to between 40% and 70% of the world population to be infected within a year. This is the opinion of Professor Marc Lipsitch from Harvard University, and it is shared by a range of other experts. The reason for such spread of the disease is that the virus is highly transmissible. Each person carrying the virus is estimated, in average, to transmit it to at least 2.6 other people. This leads to a very fast, exponential rise in the number of infected people.

It has also now been demonstrated that people transmit the virus even if they are asymptomatic, i.e. when they don’t even know they carry the virus and are contagious. I will assume in this succinct analysis that 50% of the population of a given country will be affected within a year. For an a hypothetical country of 1 million inhabitants, it means that 500,000 people would be infected within a year. This is huge and mostly unprecedented. But it’s what’s very unfortunately at stake, given what is known about the virus.

Second, in terms of mortality rate, current estimate is that in about 2% of reported cases, the disease is fatal. But it is likely that the number of reported cases is much lower than the number of people carrying the virus.  For example, many suffer only of mild symptoms and those cases are not necessarily reported. Therefore the 2% mortality rate may well be exaggerated. Let’s assume here a 1% mortality rate, which would mean one death out of 100 infected people.

With an hypothetical country of 1 million inhabitants, with 500,000 people infected within a year, this would mean 5,000 deaths the first year. This means 5 deaths for 1,000 inhabitants. Let’s put this in perspective. For example, in Belgium, the overall death rate was estimated in 2018 at 9.7 deaths for 1,000 inhabitants. The number of deaths from the coronavirus could amount to about 50% of the normal annual number of deaths observed in the country, which is considerable.

However, from what we know so far, the most vulnerable people affected by this virus appear to be seniors and those suffering from cardio vascular disease. So there is some overlap with the normal death rate. So in theory, the increase in mortality may therefore be somewhat lower.

But the increase in mortality may unfortunately be much higher, i.e. exceed 1 or 2%, and here is why.

Numerous Severe and Critical Cases to be Expected

According to the latest science available on the disease, « more than 80% of patients have mild disease and will recover. In about 14% of cases, the virus causes severe diseases including pneumonia and shortness of breath. And about 5% of patients have critical diseases including respiratory failure, septic shock and multi organ failure » « In 2% of reported cases, the virus is fatal. » (see article quoted by CNN below)

Screenshot – Dr John Campbell’s Podcast of Feb 19 2020
This means that in about 20% of the reported cases, one needs to get access to treatment in a hospital or another appropriate facility. Without such access, the risk of mortality is higher. Even if one brings down the 20% figure to 10%, to take into account the many non reported cases, it means that, for our hypothetical country of 1 million inhabitants, about 50,000 people will need to be treated, to be hospitalized during the first year of the pandemic.

If available health facilities don’t allow for such an increase in the number of hospitalized people, then mortality rates could increase substantially. Instead of a 1% mortality rate, it could be 2% or more. Instead of 5,000 extra deaths, it could be 10,000 extra deaths or more, in the case of 1 million inhabitants country.  For a typical industrialized country such as the USA, with a death rate of about 9 deaths per 1,000 in habitants, a bad case (not even a worse case) scenario could see the overall annual mortality rate double, from 9 deaths for 1,000 inhabitants to say 20 deaths for 1,000 inhabitants.

Note that such mortality rates are much much higher than for influenza. In France for example, for a population of about 70 million, the number of annual deaths caused by influenza is estimated at about 10,000, i.e. 143 deaths for 1 million inhabitants. This figure is to be compared to the 5,000 extra deaths associated with the coronavirus. In other words, the coronavirus could be 35 times more deadly, than the flu, and maybe even more, depending on access to quality care for those developing the disease.

The most important implication is that the actual death rate of this pandemic will be considerably influenced by the actions taken by governments. Rapid and drastic measures need to be taken to slow down the pandemic, and to take care of those developing the disease and requiring hospitalization.

Regarding a possible vaccine, the fast spread of the disease makes it unfortunately unlikely that a vaccine will be available soon enough to prevent such a scenario.  The World Health Organisation said this week it may be 18 months before a vaccine against the coronavirus is publicly available. The logistics of producing and administrating the vaccines to millions and millions of people, maybe to billions of people, also represent a colossal challenge.

There is work done to develop better treatments to fight the disease, but at this point, nothing seems yet to have been found effective. Like for a vaccine, this will most likely assume anyway that the treatment is available and can be administered, which will most likely require ERs, hospital beds or other suitable facilities, so the possible future availability of such better treatment does not change the nature of the policy measures to be taken.

As we are now facing a likely pandemic, what kind of measures need to be taken to slow down the spread of the virus? The virus is highly contagious and most people spreading it are asymptomatic and don’t know they carry it. Therefore, it’s our lifestyle, and especially our social lifestyle, that need to substantially change for a period of 1 or 2 years, to avoid getting the virus and to avoid transmitting if one is infected.

Hope for the Best – Prepare for the Worst

Governments, at all levels, have a huge task ahead. Like all of us, governments need to hope for the best, but need to prepare for the worst. Public messages need to promote preventative habits such as washing one’s hands. But measures need to go much beyond that. There is a strong case for drastic measures such as closing schools, universities, and getting students to have online classes instead. There is a strong case for promoting work from home when possible. At work places, drastic measures need to be taken to limit contagion.

Our social habits need to be revisited. Habits such as shaking hands or giving a simple hug or a kiss need to be suspended, and the public needs to be educated about that.  Habits such as going for a drink or to a restaurant with friends need to be revisited. Transmission by food, or simply by touching a table where an infected person was sitting previously, seems likely, from the information available so far.

Attendance of any events with crowds, such as sports events and concerts, need to be reconsidered. And yes, regarding the Tokyo Olympics, as the incidence of the disease grows, it would be a good idea to announce as soon as possible their postponement, so that they don’t contribute to spread the virus.

Even the relevance of having political gatherings should be revisited, with possible dramatic consequences on the US presidential campaign for example. Imagine if there were already contagious people at the recent rally of Bernie Sanders in Tacoma that gathered 17,000 people. It may be suitable for the campaigns to rapidly decide, collectively, on measures to address this exceptional situation. Hint of a solution: YouTube.

Public transportation, in the metro, buses, train, planes, will need to be avoided as much as possible. It’s worth noting that temperature testing is not efficient. It’s nearly impossible for transportation authorities and airlines to screen for the virus. And people travelling by air for example should not get a false sense of safety if such screening is operated at the airports.

If the disease develops especially in certain areas, in certain cities, there may be a need to impose travel restrictions and city level quarantines, which is done in Wuhan and 15 other cities in China.

People will need to stay home as much as possible and even limit the number of visits to local stores, like it’s done in many places in China already. Note that the Chinese authorities have started disinfecting bank notes, as they believe that the use of cash is a cause for the transmission of the disease. If confirmed, the use of electronic payments may need to become compulsory.

Lots of courage from the authorities will be needed, and it is a high risk that there will be a gross underestimation of the severity of the problem.

Yes, there is likely to be a decline in some sectors of the economy in the short term, and one of the key tasks for governments will be to avoid an overall collapse of the economy and ensure that the basic needs of families, including food availability, will be satisfied. 

All these actions may slow down the economy, and will likely lead to a recession. A scenario without such drastic actions to contain the spread of the disease would have even more harmful consequences to the economy in the medium and long run.

Regarding the treatment of sick people, new facilities will need to be rapidly built in most countries to admit patients. While the peak of the usual flu season in many countries will be over, current number of beds in ERs and hospitals in general are likely to be, in most cases, insufficient.

Most jurisdictions globally are ill-prepared to cope with a pandemic. For example, in Canada, year after year, many ER and hospital facilities are unable to cope with the seasonal flu, with people often staying for hours, sometimes days, in hospital corridors. The situation is known to be especially bad in a city like Montreal. If the current system cannot cope with the highly predictable seasonal flu, how could it cope with the coronavirus?

With the much higher number of affected people to be anticipated with the coronavirus, and the much higher transmission levels of the disease, compared to the usual flu, it can only be predicted that most existing facilities will be rapidly overburdened. These facilities, if overburdened, may become themselves hotbeds for spreading the disease, if insufficient preventative measures are taken. Lessons need to be learned in this respect from the recent experience of the Diamond Princess cruise ship in Japan, which seems to have rapidly become a hotbed for spreading the disease, although it was supposed to play a preventative quarantine role.

In addition, there are high risks of shortages of qualified health personnel (doctors, nurses, etc.) in many jurisdictions. And proper protection of health personnel is a huge challenge, as the China experience has already shown how vulnerable health personnel is with the outbreak there. RIP Dr Li Wenliang and the other medical personnel who already succumbed from the outbreak.

Shortages of equipment is also an immense concern, and ironically, such shortages are in part due to the high reliance on China for such equipment. What’s critical for national governments is to take action as soon as possible, and to plan for the worst case scenario, and do everything to avoid it to happen. What’s concerning of course is the kind of wait and see attitude, or sometimes totally dismissive attitude, currently adopted by too many. Hopefully, even the skeptic will rapidly take hold of the situation and take action.

Millions of Lives Can be Saved

>>  Brown University School of Public Health Dean Misinforms the World in NY Times Opinion
Source: https://www.worldometers.info/coronavirus/#countries
As of today, February 19, the disease is known to have already spread to 29 countries, in Asia, Europe, North America, Oceania, and Africa, in places as diverse as Australia, Iran, Egypt, Sweden and Russia. These are known cases. It is unknown where the many contagious, yet asymptomatic, and therefore unreported cases are located.

The actual list of countries where the virus is already present may exceed 29. Likewise, the number of cases within each of the affected countries is likely higher. Worldwide, the number of infected people is  likely much larger than the 75,317 presently reported. Even if the vast majority of reported cases presently is in China, the disease is spreading world-wide, and fast.

It’s hard to fully comprehend the consequences of having some 50% of the world population infected by the virus within a year, but it’s unfortunately a very plausible scenario we must now face.

There will be many many people dying from this pandemic. It’s a huge tragedy in the making.

Yet, the lives of millions of people worldwide can be saved from this pandemic if governments take immediate action and do all that can be done to slow down the spread of the disease and to build the capacity needed to deliver suitable care for those developing the disease.

About the Author Jean-Pierre Kiekens

I am an Oxford trained development economist – a topic I lectured for a few years at the University of Brussels. I also worked in development aid for various national and international agencies. This piece represents my current thoughts about the coronavirus and its implications. For sure, these thoughts will evolve with the availability of new information. The piece is aimed at helping people to connect the dots, to reflect about the significance of what is happening, and to take action.

For all of us, it’s critical to inform ourselves.

Here are some sources of information.

What will be the spread of the virus within a year?

« I think it is likely we will see a global pandemic. If a pandemic happens, 40% to 70% of people world-wide are likely to be infected in the coming year. »
Prof. Marc Lipsitch, Professor of Epidemiology, Harvard School of Public Health, Head, Harvard Ctr. Communicable Disease Dynamics, Feb. 14, 2020

https://www.mediaite.com/news/harvard-professor-sounds-alarm-on-likely-coronavirus-pandemic-40-to-70-of-world-could-be-infected-this-year/

About the coronavirus gathering steam, an interview of Harvard Epidemiology Professor Marc Lipsitch

https://news.harvard.edu/gazette/story/2020/02/harvard-expert-says-coronavirus-likely-just-gathering-steam/

Comparison: About the flu in France

« Chaque année, la grippe saisonnière touche 2 à 6 millions de personnes. Elle entraîne des dizaines de milliers de passages aux urgences et fait 10.000 morts en moyenne. »

https://www.futura-sciences.com/sante/actualites/grippe-epidemie-grippe-installe-france-metropolitaine-79406/

About the Evolution of the Disease

Coronavirus (COVID-19) Autopsy Report by Dr. Mike Hansen

https://www.youtube.com/watch?v=V-7SQGPkijs

About the spread of the virus through contaminated surfaces

https://edition.cnn.com/2020/02/17/health/novel-coronavirus-surfaces-study/

About Preventative Measures Taken in China

Wuhan, China, and at least 15 other cities have been quarantined as China attempts to halt the spread of the coronavirus. That’s about 50 million people on lockdown.

https://www.businessinsider.com/wuhan-coronavirus-officials-quarantine-entire-city-2020-1

Most Recent Findings by the Chinese Center for Disease Control and Prevention

“More than 80% of patients have mild disease and will recover. In about 14% of cases, the virus causes severe diseases including pneumonia and shortness of breath. And about 5% of patients have critical diseases including respiratory failure, septic shock and multiorgan failure,” he said. “In 2% of reported cases, the virus is fatal, and the risk of death increases the older you are.”

https://edition.cnn.com/2020/02/19/health/coronavirus-china-sars-mers-intl-hnk

About the Time Needed for a Vaccine

The World Health Organisation said this week it may be 18 months before a vaccine against the coronavirus is publicly available. Let’s explore why, even with global efforts, it might take this long.

https://www.sciencealert.com/who-says-a-coronavirus-vaccine-is-18-months-away

Doctors look to HIV and Ebola drugs for coronavirus cure

Doctors are likely to know within two to three weeks whether drugs being used to treat patients infected with the new coronavirus are working, according to the World Health Organization.
https://www.theguardian.com/science/2020/feb/20/doctors-hiv-ebola-drugs-coronavirus-cure-covid-19

US CDC Website on the virus

https://www.cdc.gov/coronavirus/2019-ncov/index.html

Expert Recommendations for US and Global Preparedness for COVID-19 – by The Center for Global Development 

https://www.cgdev.org/publication/expert-recommendations-us-and-global-preparedness-covid-19 

Dr John Campbell Youtube Podcast

Dr. John Campbell provides daily updates about the coronavirus.
https://www.youtube.com/user/Campbellteaching/videos
A must watch video is about how to protect oneself and one’s family
https://www.youtube.com/watch?v=IkdPFCStA38&t=1s
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