Clear and Present [Continuous] Danger of the Coronavirus Pandemic
Do we clearly recognize the difference between an evolving pandemic and an earthquake scenario? I’m not sure. In a pandemic, the phase of acute danger will persist for months rather than hours or days. I’m concerned because holding onto to something for an extended period is quite a hurdle for our attention-deficit generation.
Even the life science savvy are amazed that a single strand of RNA (29,829 bases) inside a barely living microscopic speck has shut down the world and is terrorizing a catastrophe in public and economic health of every nation-state. This pathogenic speck has given us a simple equation to solve. To find X. This X is not about the virus, but it is instead determined by who we are and what we do as people for the next several months. We are the other side of this equation. We are a part of the solution. We can take courage from the fact that humanity has experienced “fast” (influenza), “slow” (HIV), “needle-based” (hepatitis C), “below the radar” (norovirus), and “ocean-limited” (Chikungunya) pandemics. But, do not assume that the best-protected citizens will belong to those nation-states who are well-resourced and have optimally organized societies. We see such societies are also quickly being overwhelmed by this COVID-19 pandemic. What most societies lack today in some measure is a strong sense of common purpose and shared responsibility. I wonder if our politically polarized climate has indoctrinated us to run away from a shared responsibility, to react to all breaking news with the same fixed sense of a media hype? To ask how many from the opposite political aisle buy this?
This situation is not about those sounding the warning bells seeking to manipulate us and, perhaps, enhance their own importance and access to power. This is no time to hit the snooze button to avoid responsibility and get back to vacationing in crowded locations, attending mega religious gatherings, or your favorite protest rally.
We understand our global village is connected by the internet sphere. It has accustomed us to chase the next “viral” TikTok video, an Insta update, a Netflix series, or a meme on social media. This time a serious biological meme composed of a single strand of RNA, replicating and forwarding itself from one person to another, has gone “viral.” It is trolling us to the point of our collapse. We are the “worried well” — as uninfected but anxious people are sometimes called — who are being reminded in an utterly unmerciful way that we share the same global village, principally an interconnected biological sphere. This is no time to show outright indifference and log-off from our natural reality. The scenery of the problem is microscopic, but the scale of the danger is mortally macroscopic. What disheartens me is that it was always evident. This threat was made explicit (albeit for an Influenza virus, it still applies to our Coronavirus situation) in a prescient document published in 2006, long before Bill Gates’ 2015 TED Talk.
Take a look at the series of screenshots I have posted with relevant points highlighted. You may notice that so many of these points are being missed by our current leadership. I personally feel no one can, or should, fully assuage our concern of this pandemic, as it can help us respond appropriately.
Leaders should know how to give a balanced message without the fear of raising a hornet’s nest. It is wrong for leaders to include the calculus of progress made against the virus without including the probability of failure.
Compare the following leadership responses to the Coronavirus situation a month ago.
Leader 1: https://www.youtube.com/watch?v=G5TZ6fTYrsE
Leader 2: https://www.youtube.com/watch?v=ZyZwtKJn-Ac&t=10s
You make the conclusion about who has followed a better template of response to this situation. Who has touched upon the tipping points mentioned in the document above?
The prescient document warns us that a dangerous situation is when mortality rates are in the 1–3% range, causing (ultimately) 70 million to 210 million deaths globally. Such an infection could potentially “get away” before we realize what is happening.
And, it is miserably getting away.
The least charming aspect of humanity has been the tendency to look for scapegoats to hide our shortcomings. In medieval times, Jews, secluded women, and any who appeared different were erroneously accused of spreading the plague. Nobody targeted the rats and the fleas! Today, let’s forget conspiracy theories and think about survival rather than casting blame. Leave judgments to the law, it will inevitably come out in retrospect.
A recent Nature Medicine paper (https://www.nature.com/articles/s41591-020-0820-9) presents analyses that clearly show COVID-19 is not a laboratory construct or a purposefully manipulated virus.
The anti-vaccine sentiment that is so strong in some communities will conceivably go out the window in the face of this rapidly spreading, severe pandemic, especially because even children are affected. In fact, I can fathom a situation where people will be angry because the limited supply of a future vaccine is being rationed, and many do not have access to them. I hope the mRNA vaccine trials succeed, and we have them in surplus. It is our international defense.
As with any form of defense, it takes political will and financial resources (both public and private) to serve the public health, fund research that leads to higher diagnostic acuity, novel drugs, and improved vaccines. Infectious diseases are no admirers of wealth, power, or personal merit. A pandemic infectious disease is one situation where we cannot afford to have ideological or religious exceptionalism to save us or blame others.
Another critical analysis is the Imperial College COVID-19 Report. It informs that limiting coronavirus infection will be possible only by severe and immediate restrictions on human-to-human contact for several months, maybe more than a year.
This report mentions several Non-Pharmaceutical interventions (NPIs), and all NPIs will have an impact if people respond to their introduction with at-most care. The report suggests that approximately one-third of transmission occurs in the household, one-third in schools and workplaces and the remaining third in the community.
The NPIs are:
- Social distancing of entire population: All households reduce contact outside household, school or workplace by 75%. (Suppression Strategy)
- Closure of schools and universities: Closure of all schools, 25% of universities remain open. (Suppression Strategy)
- Case isolation in the home: Symptomatic cases stay at home for 7 days, reducing non- household contacts by 75% for this period. (Mitigation Strategy)
- Voluntary home quarantine: Following identification of a symptomatic case all household members remain at home for 14 days. Contacts in the community reduce by 75%. (Mitigation Strategy)
- Social distancing of those over 70 years of age: Reduce other contacts by 75%. (Mitigation Strategy)
Mitigation strategy is employed to merely slow the spread (flatten the curve). It aims to reduce the health impact of the pandemic. In an unmitigated epidemic, this report predicts approximately 510,000 deaths in Great Britain and 2.2 million in the US. However, an “optimal” mitigation scenario (case isolation, home quarantine and social distancing of over 70s) would still result in an 8-fold higher peak demand on critical care beds in excess of the available beds in GB and the US.
Suppression strategy is employed to reduce case numbers to low levels or (as for SARS or Ebola) eliminate human-to-human transmission. Suppression model is based on China and South Korea’s implementation strategies. It carries enormous social and economic costs with significant impact on health and well-being in the short and longer-term. These strategies are assumed to be in place for 5 months or even longer. To avoid a rebound in transmission of infections, suppression will need to be maintained until large stocks of vaccine are available to immunize the population — which could be 18 months or more.
We glean from the report that, mitigation is unlikely to be a viable option without overwhelming healthcare systems, suppression is likely necessary for countries able to implement the intensive controls required.
Countries may employ adaptive triggering of suppression strategies. A simulation for Great Britain is shown below
COVID-19 represents a clear and ongoing danger. As individuals, we cannot afford to oscillate between panic or indifference. It is time we face the cold realism of procedures suggested to eradicate this contagion from our homes, workplaces, and communities. Humanity has the unruly habit of scripting ironies: it is now time to work together with a shared responsibility while being socially distant. This is the ‘X’ we are solving for.
