7 notes on COVID-19

I shared a Coronavirus PSA a few days back. A lot more data has been gathered since and I thought I’d share 7 things I’ve taken away from what I’ve read.

1. COVID-19 is a pandemic – do not compare it with the flu. The World Health Organization has declared COVID as a pandemic. A pandemic is a world wide spread of a new disease whose impact tends to be higher due to the lack of pre-existing immunity.

Here’s a simple chart comparing the death rates of both from a week ago. While new data is coming in every day, we are looking at an illness that is ~20x more likely to cause death.

2. It is growing exponentially. Every person who contracts with the virus passes it to more than 2 on average. This means it is spreading more rapidly than most folks can comprehend. The main question to ask is – how long is it taking for the number of cases in your area to double?

In most places, the answer is 3. Let’s imagine a country has 500 cases today. In 1 month, these 500 cases will become  1 million. And, within the next month, it would hit a billion people (assuming there are a billion to infect). (More on Our World in Data)

Tomas Pueyo shared an excellent post compiling data we have so far. Here’s a chart of what exponential growth looks like outside the 4 most affected countries.

3. The only reasonable strategy we have is to flatten the growth curve. As is the case with viral infections, we will all get it in time. 80% of us will only experience non critical symptoms. But, 20% will need medical care.

If this spread happens too quickly and before we have a cure (as is the case right now), the numbers will overwhelm any healthcare system – only worsening the situation in the absence of a vaccine/cure. So, it becomes critical to act early.

The earlier we take drastic action – effectively shutting down the country (workplaces, schools, etc.), the better the long term situation. The short term trade-offs are very real – specifically, a hit to the economy – but the long term effects make this the best strategy by a distance.

4. Japan, Hong Kong, and Singapore did just that. Learning from the SARS epidemic, all 3 countries acted really early and their growth curves look very different from the rest.

5. Countries that didn’t act quickly have had to take drastic measures to ramp up testing. South Korea has been at the forefront of this. The relative length of the bar on the left vs. the right is a leading indicator of the amount of trouble that lies ahead.

This is particularly important in the case of the Coronavirus because it takes a 5 days for symptoms to show. So, making tests easily available and, thus, enabling testing early and often is the best way to prevent further infection. Just as acting late makes it exponentially worse, acting early is exponentially better.

Thanks to a combination of rapid testing and widespread lock down, South Korea bent the epidemic curve – see the decline in new cases as of March 10.

6. The most dangerous places with COVID-19 on the planet today – particularly if you are over 50 years – are places which are neither acting early nor ramping up on testing. Sadly for those of us here, the United States squarely falls in that bucket. There are many good pieces of coverage that outline just how poorly the administration and the CDC have handled this situation.

Instead of focusing on that, I’d like to call attention to an incredible thread on Twitter from Trevor Bedford of the (excellent) Seattle Flu Study team on March 1. The 3 bullet version of this story is –

    • The Seattle Flu study team attempted to begin testing for the Coronavirus in the end of January. But, they were blocked by the CDC. As they grasped the seriousness of the situation given the events in Wuhan, they ran the tests anyway and informed the health officials. The response from the CDC, FDA, and the Federal Government was to cease and desist.
    • As a result of this, we are grossly under-testing in the United States and the flu study team estimates we are underestimating the actual number of cases by an order of magnitude. Tomas’ model suggests the real number of cases is at least 5x more.
    • When the CDC finally decided to act, it attempted to create its own test – however, these tests didn’t work.

As a result, we are left with these sorts of numbers as of 3 days ago.

And, the story emerging from clinics all around is identical – there aren’t enough test kits.

7. We can do our part. Trevor Bedford’s thread and revelations alone led to a chain of events that sparked a response across Washington and California – including companies working from home, canceled conferences/sports events, and so on.

We may soon look back at this thread and the Seattle Flu Study team’s bravery as a defining moment toward dealing with the Coronavirus in the US. Ben Thompson of Stratechery had an excellent article outlining why this thread matters in the broader context of technology and bureaucratic gatekeepers.

Over to what we can do – Flatten the curve is an excellent resource for the things we can do during this time – wash your hands, don’t touch your face, cancel travel, work remotely if you can, avoid large groups, and so on.

A final note: Reading and synthesizing this information reminded me of the final notes from the excellent HBO series – Chernobyl.

“To be a scientist is to be naive. We are so focused on our search for truth, we fail to consider how few actually want us to find it. But it is always there, whether we see it or not, whether we choose to or not. The truth doesn’t care about our needs or wants. It doesn’t care about our governments, our ideologies, our religions. It will lie in wait for all time. And this, at last, is the gift of Chernobyl. Where I once would fear the cost of truth, now I only ask: “What is the cost of lies?”

When I first heard these lines, I thought it was very applicable to the dialog on climate change. Sadly, it is just as applicable in the face of a pandemic.

In times like this, we come to realize the true cost of a lack of science/fact based and dynamic (i.e. open to learning from others/new data) leadership. Whether it is repeatedly comparing COVID-19 to the flu or attempting to downplay its risks, the effects of denial and delayed response have been, are, and will continue to be lethal.