Should you worry about COVID-19?

We've looked through some of the noise to find out

Limited time on your hands? Here's this article in a nutshell:

  • The virus that causes COVID-19 has spread exponentially across the globe, much thanks to wilful inaction by world governments
  • Governments have failed to follow basic protocols for handling epidemics and pandemics
  • The popular press and social media have played an extremely potent and dangerous role in fuelling the chaos that now envelops society
  • Though testing has been lax, and even unreliable, it is not currently believed that SARS-CoV-2 is quick to mutate and neither is it believed that the virus is fully airborne
  • This means that the estimated rate of reproduction somewhere between 2 and 4 is probably accurate, though still sufficient to result in an exponential spread of the disease.
  • Personal protective equipment (PPE), like face-masks, respirators and gloves, is a subject of intense debate. If you can get PPE, avail yourself of it. If you can't, don't worry too much — healthcare professionals need PPE more than anyone else, and PPE should not be necessary if you're doing what you're supposed to be doing and staying at home.

Got time after all? Okay, let's begin.

There's a lot to cover, because we've endeavoured to gather as much information as possible regarding the pandemic as it has unfolded, and regarding SARS-CoV-2 and COVID-19. Were we to stick purely to what is known concretely about the disease and the current situation, this would be a very brief article due to fragmented or limited datasets, and an inherent lack of reliable conclusions that can be drawn from such datasets. We would pretty much be saying 'it's dangerous, stay indoors, wash/sanitise your hands' and not much else.

However, we also want to talk about how governments have acted (or failed to act) to contain the spread of the virus, and how governments have failed to act in accordance with even common sense when it comes to testing and restricting movement of people in response to outbreaks of COVID-19.

What is a pandemic?

A pandemic is a term used to refer to the phenomenon of a disease that has spread globally or across broad regions of the world ('pan'—'all', 'demos'—'people'). Compare with epidemic which refers to an intense spread of a disease but typically within a single region. The Ebola crisis in West Africa (2013-2016) is classified as an epidemic because it did not spread far beyond its epicentre.

Clarification of terms

One thing that we'd like to make clear is that there is a distinction between SARS-CoV-2 and COVID-19 — the former is 'the virus' which infects the human body and causes the latter, which is the disease that is incapacitating and killing people.

A virus gone viral

It's fair to say that the SARS-CoV-2 virus outbreak began as something which was largely ignored, like the Ebola epidemic in West Africa of 2014; H1N1 (swine flu) in 2009-2010; and H5N1 (avian flu), spiking in 2005-2006. Even SARS (2002-2003) came and went with little in the way of panic or alarm.

Each of these diseases received global media coverage, but I'm sure most will agree that they received less media focus compared to contemporary events such as the destruction of the World Trade Centre in 2001; the invasion of Iraq by US/UK coalition forces in 2003; the Indian ocean earthquake and tsunami in 2004; the financial crisis of 2007-2008; the Fukushima Daiichi nuclear disaster of 2011; and so on.

Each of these epidemic and pandemic events has had a non-trivial death toll, the 2009-2010 H1N1 pandemic in particular. The lethal potential of SARS, closely linked with coronaviruses, was the subject of considerable research in the last ten years. The potential threat was known to the virological academic community, and world governments had already gone through less acute threats than COVID-19, so why were our world governments so woefully unprepared for this pandemic?

Failing to prepare...

We have seen media coverage increase dramatically as the virus spread from Southeast Asia to the rest of the world, and again as soon as its spread was declared a pandemic by the World Health Organization (WHO).

There are two key factors to COVID-19 escalating from being something that most people rather ignorantly considered to be 'normal' for Southeast Asia to something that is literally the only topic of major news bulletins and even interrupts regular broadcasting schedules.

Firstly, and most obviously, response to COVID-19 has shut down countries. It seems to have an R0 (reproductive number, a quantification of how infectious a disease is) estimated to be somewhere between 2 and 3, which means that every infected person is likely to infect 2-3 other people. While the number is far from the highest seen in an infectious disease (measles has an R0 of 12-18) it's high enough that even one person bringing SARS-CoV-2 from one country to another would be sufficient to trigger an epidemic in the destination country.

COVID-19 is also fairly lethal. It's not quite as ferocious as pathogens depicted in Hollywood films, but if you look at the statistics, COVID-19's fatality rate is not trivial.

How dangerous is COVID-19?

So basically, there are two metrics when it comes to fatality rates of diseases like COVID-19: case-fatality rate (CFR) and infection-fatality rate (IFR), the difference being that CFR is the ratio between known cases and deaths while IFR aims to account for asymptomatic and unknown cases.

The CFR is the easiest to determine, while the IFR is the more useful metric, though in realistic terms the most interesting metric would probably be a hospitalisation rate i.e. the proportion of cases of infection that necessitate the use of specialist equipment and resources to keep the patient alive, thereby adding to the strain on a given health service. This metric is more useful in determining the impact of a disease that doesn't threaten to wipe out all life on the planet but could result in substantial numbers of deaths if the proper healthcare facilities are not in place.

It's currently more or less impossible to get a concrete figure for the true lethality of the disease given that, due to a lack of testing by most governments, we have very sketchy datasets with respect to numbers of total infected, considering that many people can apparently experience only mild symptoms, or even be asymptomatic all together. Many COVID-19 cases will have evaded, and will continue to evade, detection and inclusion in our datasets, and so any CFR will be inflated while any IFR estimate will be a best guess based on an R0 that may itself be inaccurate due to the same lack of testing.

Why do we have such an incomplete picture of SARS-CoV-2?

As we've indicated already, there has been a failure globally to conduct enough tests of cases or potential cases, and while this is due primarily to governments having failed to take the SARS-CoV-2 outbreaks seriously, it also comes down to some issues with the tests themselves.

Tests for infections can work in a number of different ways and are not graded by 'accuracy' which is a misleading and inappropriate term in epidemiology. Instead, they are measured on sensitivity and specificity, which can be thought of as the ability of a test to correctly identify a positive and to correctly identify a negative, respectively. If you've ever heard of a test result being a false positive, this might already be making sense to you. These are both actually expressed as probabilities, so no test is 100% certain (and thus the term 'accuracy' is inappropriate). Put simply, the tests we have for COVID-19 are unreliable, given that recovered patients can still test negative and subsequently positive again.

This could be down to the nature of the test — being a polymerase chain reaction (PCR) test that works like a DNA test, it can easily report negative if the tester takes a swap sample and misses the viral particles in one test and successfully hits viral particles in another. Conversely, the swab itself could end up contaminated, and since the PCR test will amplify whatever is on the swab, can report a false positive that way.

Despite the apparent mishaps with the tests themselves, it pretty much just points to a lack of training or possibly manufacturing errors, but retesting can be carried out. The fact that testing was simply not carried out enough is why we're currently in the dark.

What should governments have done?

They should have been far more prepared for a pandemic of any kind. As even Bill Gates warned years ago, and as many epidemiologists and other academics have been warning for even longer, the single most imminent threat to our species is that of pandemic disease. Asteroids impacts are rare, war is highly localised and the world's economies are far too intertwined to make war a probable occurrence in this day and age, and yet we have active programs looking for asteroids that could be on course for our planet in hundreds of years, and even more absurdly we have, as Mr. Gates observes in the linked video, nuclear deterrents and military forces in a state of constant readiness to prevent nuclear strikes and repel invasions, respectively.

Yet despite persistent academic intrigue and even ample expression of anxiety about the notion of a pandemic in fictional writing and creative media, it seems like every government around the world was asleep at the wheel when SARS-CoV-2 emerged.

Now, we're not the CDC here, we're not epidemiologists, but we had a crack at what a sensible approach to handling the emergence of a new infectious disease could look like:

  • immediately quarantine the infected individual(s)
  • quarantine anyone who was exposed to the person and monitor for infection
  • restrict all travel out of the vicinity of the outbreak including flights out of the country from any airport in traversable distance of the outbreak
  • test everyone who recently entered the vicinity and especially anyyone leaving that vicinity
  • trace the original infected person's movements (credit card payments, flight information, CCTV footage — anything
  • trace and test anyone with movement patterns that match the original infected if their paths crossed
  • trace the origin of infection

The moment that the outbreak looked like something that could spread exponentially (R0 ≥ 2) seal borders and ground travel leaving the country. Temporary inconvenience to a relatively small number of people would have been a miniscule price to pay compared to the economic collapse that is in progress in the world right now.

No government tested enough. The infection spread across the globe in a matter of weeks. Flights were grounded too late. Borders are still open at the time of writing. Neighbouring countries like Japan are still not in lock down. Lock down procedures in other countries came weeks too late.

What should governments do now?

While they've all messed up pretty severely in failing to take this virus seriously in its early, localised stages, governments can still turn this around if they take drastic action now. By strictly enforcing rules on isolating citizens and confining them to their homes, providing financial assistance/relief and mobilising the military to aid in the delivery of rations and PPE to civilians and healthcare professionals, respectively.

By financial aid, we do not necessarily mean in the form of loans to boost liquidity in an environment where people cannot go shopping, cannot get shopping delivered to them, and will not be purchasing luxuries like holidays or granite kitchen floors, but perhaps in the form of overlooking rent and in the form of subsidies to cushion the blow of wages to companies in frozen industries)

Set up treatment and triage centres in the now empty sports arenas and stadiums in major cities to cope with the impending waves of infected. The government need to start testing very aggressively to patch up the shitty datasets we currently have at our disposal.

What should you do?

First and foremost, do not go outside unless you have to. By 'have to' we don't mean for daily exercise, you can exercise indoors. We don't mean 'for food' if you already have food.

If you have no food, or if you're planning to buy for two weeks or more, go and get your food and supplies and do it right. Maintain a distance of two metres or more between yourself and other people including staff and people you've come out shopping with.

Plan your shopping in advance to both minimise your time in the shop and outside in general, and so that you aren't picking stuff up and putting it down again out of indecision. You want to minimise your contact with products for the benefit of others and yourself, to minimise contamination if you've hypothetically carried coronavirus particles and to minimise your chances of picking up contaminants when touching things.

When you come home, remove your footwear and put them outside, in your garage or at the very least in the hallway near the door, away from anything you wear or interact with while in your home. Sanitise your door handles and contact surfaces.

If you've been wearing PPE, remove it (taking care not to touch the parts that will likely have come into contact with contaminants) and either dispose of it or, if reusable, sterilise it following the standard procedures.

Remove any exterior clothing like coats, jackets or jumpers and hang in a well ventilated place, away from your homewear. Think of coming home as a process for which you'd want an airlock and decontamination chamber from a science fiction film. Wash/sanitise your hands and any exposed skin following the standard guidelines, 20 seconds with soap, thorough lathering and coverage, warm water.

Your phone is a surface on which the virus can survive and will have at the very least been in contact with your hands, possibly your face, so sanitise it as well. This goes for anything else you can think of that you took out with you.

If you display symptoms, stay at home. Under no circumstances should you leave your home. Isolate yourself from other family members. If you share a household, and your household's fellow residents have the slighest chance of exposure, you must all isolate. If your household's residents definitively had no exposure to you, arrange for alternative accommodation for those who would otherwise share your household.

Get yourself and everyone who may have come into contact with you to get themselves tested for COVID-19. This isn't just people you live with, this is people you've been in close proximity to for any length of time, people who touched the same bag of potato chips as you did in the supermarket, people who walked the same street.

If you test positive, you must isolate for a minimum of seven days. Treatment is limited to palliative care; consult your physician or call your country's official medical advice number and request advice. If, for some reason, you are entirely unable to get medical advice, stick to acetaminophen (aka paracetamol) — while there is no conclusive evidence for or against the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, there is ongoing investigation into whether NSAIDs are actually contraindicated in the case of COVID-19. Until this investigation yields conclusive and verifiable results one way or the other, it would seem sensible to avoid these medications.

One thing is for certain (to the point where even Google warns you) — antibiotics do not work against viruses. Antibiotics work in a number of different ways — the most rudimentary antibiotics, like penicillin, work by destabilising the cell walls of bacterial cells, leaving them unable to survive within the environment of the human body. Others work in a variety of different ways, from interfering with bacterial DNA replication to depriving them of vitamins and disrupting the bacterial cell membrane.

Viruses work by attaching themselves to human cells and using them to replicate. Antibiotics are already fairly targeted in their mechanisms to eliminate bacterial infection, and these mechanisms do not extend to targeting viruses or hijacked human cells, nor can they interfere with viral replication.

Antibiotics are, therefore, a waste of time, a waste of money, a waste of medical resources that could be better used for someone who happens to have a bacterial infection — and, to top it off, taking them will unnecessarily expose you to the numerous side-effects that antibiotics can have.

Now, antiviral medications do exist, but they tend to be just as targeted as antibiotics and, for your own safety, until they have been clinically proven to be effective against COVID-19, you should not try to obtain or take these medications.

What about pets?

If you're a pet owner, the first question that has likely popped into your mind is: 'are my pets at risk from infection?' — so far, the answer seems to be no. However, that doesn't mean they should be disregarded. A pet is a contact surface and an infection vector.

If you have a cat with free rein to go outside and from there into other people's gardens and homes, that cat may return contaminated — for the purposes of covering all your bases, it may be prudent to confine your cat to the home for the present time.

If you have a dog, you may wish to consider confining it to the home as well for much the same reason, though being a large animal it is unlikely to roam far from the garden. Nevertheless, when walking your dog, your canine friend might pick up contaminants by greeting strangers, other dogs, or simply from a contaminated surface he/she felt compelled to investigate. Dogs are more complicated since they require more exercise and are less self-sufficient than cats when it comes to amusement, but we would recommend becoming creative rather than needlessly exposing your household to additional risk.

Most other pets are either housebound (reptiles, birds, arachnids, etc) or are perhaps forbidden from entering the home at all (farmyard animals) but if your pet is an exception, just use common sense — if the animal is at all likely to have the opportunity to interact with contaminants in the outside world and has the opportunity to introduce contaminants to your home, take steps to prevent this from occurring.

What about the economy?

At the moment, despite unsurprising dips in the markets, there is optimism. Most market-watchers are making favourable comparisons between the current climate and that of 2008, highlighting that the implosion of the toxic and obfuscated loan casino that Wall Street had been up to that point resulted in catastrophic damage to investment banking and the issuing of debt, which had a domino effect throughout the economy, whilst hitting the taxpayer twice because it was the taxpayers around the world who had to bail out the banks and lenders.

In this case, while the global economy is at a standstill, and companies are laying off staff and are at the precipice of insolvency, in most cases these are companies who were in debt already and were thus already at risk. That's not to say that those jobs don't matter, of course they do — but the governments have an obligation to look after their citizens, and so there will not generally be a crash of the entire financial system.

Where many companies and entire industry sectors could not have been prepared for a pandemic of this magnitude or government measures to combat it and will suffer the consequences, there is also a huge number of new opportunities for start-ups in medicine and technology to better facilitate the tasks of treating COVID-19, accommodating the sick, testing the exposed, and getting work done from home.

In the immediate term, we can expect to see the standard flight to gold that most investors and serious savers do when catastrophe is inbound, and we can expect to see less spending for two reasons: firstly, people are generally more cautious with their money when there is a threat of disaster on their doorstep, especially if their job security is questionable; secondly, there's not really much to buy right now — trips abroad and vacations are pretty much not happening, sporting events are cancelled or postponed, social gatherings are prohibited, social venues are shut. So we can expect to see a decrease in spending activity in general, though people will still spend aggressively on groceries and home necessities.

In the mid-term, the more insidious character will be deflation. Regardless of whether companies have the liquidity to pay and retain their staff or whether they've laid them off and left them at the mercy of the government's welfare strategy, people will be conscious of the uncertainty surrounding their future income, and whatever money they do have will become something they won't want to part with lightly.

From an ordinary citizen's perspective, deflation, or the dropping of prices for goods and services, can seem like a good thing, but it's extremely unhealthy for the economy as a whole. An economy is an organism, and where in 2008 it suffered something of an aneurysm, deflation and its consequences can be seen as a creeping paralysis from the peripheral nerves inwards.

We already remarked that even now people will be saving their money and being cautious. With less cash flying around, the economy is already suffering and liquidity has been lost. At the moment, however, stores with perishable inventories don't have to worry too much, the demand for groceries is extremely high given that there are regulations on travelling outside, strong recommendations to shop for multiple weeks in advance, and in general there is an air of panic suggesting to consumers that their units of currency are less valuable than having physical goods in the pantry.

If this changes, i.e. once people have the goods they need, and once demand no longer exceeds supply, retailers will find themselves with an abundance of stock that they need to convert into cash before it becomes unsellable (e.g. food expiring). When this occurs, retailers will be obliged to reduce prices on products to encourage the consumers to purchase them (deflation).

The problem is that one price reduction does not boost demand permanently. A price reduction results in a transient boost in demand, and a follow-up boost in demand requires yet another price reduction. Consumers, already in a frame of mind to save, will not act immediately on the suggestion of urgency of price reductions, and will wait to see how low the prices can go.

So, should we be worried?

Yes, but don't flee to your fallout shelter just yet. We've tried to avoid commenting on our actual prognosis for society throughout this article — not because we fear the worst, but because there's simply too little data available to make a sensible forecast. It's irresponsible of news outlets and journalists to be saying that we will be back to normal in two weeks or indeed that we'll be forced to live underground for five years.

What we have instead tried to do is present the information we've observed and tried to present it in a fairly plain and consumable way so you can draw your own conclusions, along with some advice that is being given out universally by governmental and medical institutions.

What seems to be the prevailing opinion is that the next two weeks will see infections peak as the incubation period for the virus is reached in the people who disregarded government lock down guidelines, and that after that, we should see new infections flatten out and start to decline, but if lock down protocols are relaxed too soon, all the good they will have done will be very quickly undone and infections will skyrocket once more.

If governments play it safe, as they should do considering they're gambling with people's lives, we could expect to see ourselves being locked down and required to protract our isolation for at least three more months, perhaps even to the end of the year.

Which, if it works, is great. No one will be sad to see a definitive end to this virus. We do have to hope that the economy recovers, and that there will still be jobs to which people can return, but the preservation of life is far, far more important than preserving the economic status quo.

0 Comments:

Post a Comment

Say whatever you want.